bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Controversies in the Treatment of Asthma
Authors: Kamada Alan K. 
Published: January 2017

OBJECTIVE: To introduce readers to the current controversial topics in the area of asthma therapy. Background is provided such that clinicians are aware of these issues and can make rational decisions. DATA SOURCES: Pertinent articles were individually identified and reviewed from each journal. STUDY SELECTION: Relevant studies, determined by topic and other specific criteria, e.g., testing methodology, were included. DATA SYNTHESIS: Further investigation is required in the areas discussed. Systemic effects, specifically growth suppression (in children), adrenal suppression, and osteoporosis, have been demonstrated with high-dose inhaled glucocorticoids; however, the clinical relevance of such intravenous glucocorticoid formulations via nebulizer have not been demonstrated. Likewise, data on the equivalence of the inhaled glucocorticoids, with regard to efficacy and potential systemic effects, and the differences between metered-dose inhalers and dry powder inhalers, with regard to aerosol characteristics and drug delivery, are unclear. Theophylline, when used with inhaled β-adrenergic agonists and systemic glucocorticoids for the treatment of acute asthma, as not been shown to provide clear benefit and may result in increased adverse effects. The use of regular (vs. “as needed” or prn) inhaled β-adrenergic agonists, although shown in two studies to be detrimental to the control of asthma and result in an increased risk of death or near death caused by asthma, has not been conclusively demonstrated to be harmful. CONCLUSIONS: Monitoring for adverse effects and the use of techniques to minimize systemic absorption (spacers and mouth rinsing) are recommended when high-dose inhaled glucocorticoid therapy is used. Intranasal and intravenous glucocorticoid products are not recommended for administration via nebulizer because of safety concerns. Until further data are available, inhaled glucocorticoids are thought to be equivalent on a μg-per-μg basis rather than an actuation-per-actuation basis. Theophylline is no longer recommended for treatment of acute exacerbations in nonhospitalized patients not already receiving the medication, and the link between deterioration of asthma control (and the risk for death) and regular inhaled beta-adrenergic agonists appears weak.
Multiple-Dose Pharmacokinetics of Pentoxifylline and its Metabolites during Renal Insufficiency
Authors: Paap Christopher M , Simpson Karon S , Horton Michael W , Schaefer Karen L , Lassman Howard B , Sack Marshall R 
Published: January 2017

OBJECTIVE: To characterize pentoxifylline (PTF) and metabolite disposition after multiple oral doses given two and three times a day to patients with renal dysfunction. DESIGN: An open-label, randomized, crossover, parallel group design. SETTING: Community-based clinical research center. PATIENT POPULATION: Subjects with renal function stratified based on 24-hour urinary creatinine clearance (Clcr): group I = Clcr >80 mL/min (n = 9); group II = Clcr 30-80 mL/min (n = 6); and group III = Clcr <30 mL/min (n = 10). METHODS: PTF 400 mg bid or tid was administered on days 1–7 and 400 mg bid or tid was given on days 14-20 with a 1-week washout. Timed blood samples were taken on days 1, 7, and 20. Blood samples were analyzed for PTF and its metabolites (M-I, M-IV, M-V) by gas-liquid chromatography. MAIN OUTCOME MEASURES: Maximum plasma concentration (Cmax), time to maximum concentration (tmax), average steady-state plasma concentration (Cssavg), and area under the plasma concentration-time curve at steady-state (AUCss) were determined by visual and model independent methods. ANOVA, paired t-test, and linear regression were used with significance level set at p < 0.05. RESULTS: The ratio of PTF AUCss (tid):AUCss (bid) and M-I AUCss (bid and tid) were not significantly different between the groups. Significant differences were found in M-IV and M-V Cmax, AUCss, Cssavg, and AUCss ratios (M-IV:PTF and M-V:PTF) between renal function groups (p < 0.05 for all). A change in dosage regimen from tid to bid resulted in significant changes in M-IV and M-V Cssavg for subjects with normal renal function and in those with moderate dysfunction, although not in subjects with severe renal dysfunction. CONCLUSIONS: Renal dysfunction did not cause significant accumulation of PTF or M-I after multiple bid and tid dosing; however, M-IV and M-V had significant accumulation in patients with renal impairment. Dosage reduction to 400 mg bid for patients with moderate renal impairment and 200-400 mg/d for severe renal impairment, as well as close clinical monitoring, seem prudent until the complex pharmacologic interactions of PTF and its metabolites can be further delineated.
Oleoresin Capsicum (CAP-STUN) Toxicity from Aerosol Exposure
Authors: Watson William A , Stremel Katrina R , Westdorp Ellen J 
Published: January 2017

OBJECTIVE: To describe the clinical toxicity caused by oleoresin capsicum (OC) spray during law-enforcement action. DESIGN: A medical record review. SETTING: Emergency department (ED), Truman Medical Center, Kansas City, MO. PATIENTS: Consecutive patients who presented to the ED after OC-spray exposure from law-enforcement action between June 1991 and June 1994. MAIN OUTCOME MEASURES: Patient presentation and symptoms at presentation, evaluation, and treatment during ED stay. RESULTS: Eighty-one ED patients, approximately 10% of all individuals sprayed by police officers, presented after exposure to OC. Ocular burning and redness were the most common presenting symptoms. None of the patients required hospitalization due to OC toxicity. Corneal abrasions and respiratory symptoms occurred in 7 and 6 patients, respectively. CONCLUSIONS: The need for ED evaluation and treatment was infrequent after exposure to OC. A transient burning sensation, erythema, and localized irritation were the most common findings. While no patients had adverse outcomes attributed to OC exposure, practitioners assessing exposure should consider the potential for pulmonary and ocular toxicity.
Neurologic Complications following Intranasal Administration of Heroin in an Adolescent
Authors: Zuckerman Gary B , Ruiz Donna C , Keller Irwin A , Brooks Jill 
Published: January 2017

OBJECTIVE: To describe an adolescent patient who developed a stroke following intranasal administration of heroin. CASE SUMMARY: A 17-year-old adolescent with no prior medical problems “snorted” an unknown quantity of heroin. The patient developed respiratory failure, shock, and seizures. When he regained consciousness, the patient had evidence of hypoxic-toxic encephalopathy on neuropsychologic examination. Magnetic resonance imaging revealed an infarct in the globus pallidus region of the brain. DISCUSSION: Serious neurologic complications following intranasal administration of heroin have been reported rarely in children. Correlations between findings on neuropsychologic examination and magnetic resonance imaging following drug overdoses have likewise been rarely described. We reviewed literature pertaining to the etiology, pharmacology, and pathophysiology of neurologic complications resulting from heroin intoxication. CONCLUSIONS: As the use of intranasal heroin is increasing in the pediatric population, healthcare professionals should be aware of the various potentially serious complications that may occur.
Inhaled Antibiotics in Cystic Fibrosis: A Review
Authors: Toso Cynthia , Williams Dennis M , Noone Peader G 
Published: January 2017

OBJECTIVE: To provide an overview of aerosol drug therapy, including physical considerations and aerosol drug delivery systems, and to review clinical experience with inhaled antibiotics in cystic fibrosis (CF) when used as adjunctive therapy to intravenous therapy for acute pulmonary exacerbations and chronic, suppressive therapy. DATA SOURCES: A MEDLINE search (1966-1995) of English-language literature describing the use of inhaled antibiotics for the management of CF. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in the review. Pertinent information as judged by the authors was selected for discussion. DATA SYNTHESIS: The use of inhaled antibiotics as adjunctive therapy to systemic therapy for acute exacerbations did not improve pulmonary function tests, increase hospital discharge rate, or permanently eradicate sputum Pseudomonas. Clinical trials of inhaled antibiotics as suppressive therapy yielded variable results. Individually, four trials documented a significant improvement in pulmonary function, three trials documented a slower decline in pulmonary function, and four trials reported a reduced frequency of hospitalizations. However, the trials were unable to collectively document a prolonged beneficial effect of inhaled antibiotics on pulmonary function, sputum bacterial density, and frequency of hospitalizations. CONCLUSIONS: Clinical trials conducted thus far suggest no role for inhaled antibiotics in the treatment of acute pulmonary exacerbations in patients with CF. Aerosolized antibiotics used as suppressive therapy may be useful in certain patients, but their use should be limited to select patients based on individual response to therapy. Additional long-term, well-controlled trials of inhaled antibiotics as suppressive therapy are needed before routine use can be recommended.
Methodologic Assessments of Quality of Life Measures in Clinical Trials
Authors: Kong Sheldon Xiaodong , Gandhi Sanjay K. 
Published: January 2017

OBJECTIVE: To provide a comprehensive overview and to evaluate the quality of published clinical trials assessing the effect of drug therapy on patients' quality of life. DATA SOURCE: Clinical trials that assessed the effect of drug therapy on patient quality of life published in English, peer-reviewed journals were identified through a MEDLINE search (1966–1995) and review of references from recent publications. DATA EXTRACTION: A data collection form was used to record information on trial demographics, quality-of-life assessment, study design, and statistical analyses. A quality score was computed for each article based on a checklist of items. RESULTS: Two hundred sixty-five articles were eligible for this study. Reliability data on the quality-of-life instruments were provided by 23.8% of the studies and validity data were provided by 21.5%. Quality of life was defined in about 14% of the trials, while 15% provided the rationale for selecting the specific instrument(s). The average overall quality score for the trials was 0.34, based on a scale of 0–1. The trials with quality-of-life scores as the primary end point had significantly higher quality scores than those designed primarily to measure clinical outcomes (p < 0.05). CONCLUSIONS: Although there was a gradual but significant improvement in the quality of published clinical trials over time, more attention should be paid to various aspects of quality-of-life assessment (e.g., defining construct, instrument selection).
Economic Evaluation of the Use of Nadroparin in the Treatment of Deep-Vein Thrombosis in Switzerland
Authors: Lloyd Adam C. , Aitken Judith A. , Hoffmeyer Ullrich K. , Kelso Emma J. , Wakerly Elizabeth C. , Barber Nicholas D. 
Published: January 2017

OBJECTIVE: To compare the cost implications, from the payer's perspective, of the use of nadroparin instead of unfractionated heparin in the initial treatment of deep-vein thrombosis. DESIGN: Cost-minimization study. SETTING: Switzerland. MATERIAL: Survey of clinical practice in six Swiss hospitals used to model three treatment regimens. MAIN OUTCOME MEASURES: Cost of treatment ($US) per patient. RESULTS: Treatment with nadroparin instead of unfractionated heparin would reduce costs by $153 per patient. Treatment with nadroparin instead of subcutaneous unfractionated heparin would reduce costs by $109 per patient. CONCLUSIONS: The cost of initial treatment of deep-vein thrombosis is considerably lower with nadroparin than with either of the alternative regimens. Nadroparin reduces costs through greater ease of administration and by reducing the amount of laboratory monitoring. Treatment with nadroparin might also allow patients to be discharged from the hospital more quickly than is possible with intravenous infusion of unfractionated heparin.
Stability of Amiodarone in an Oral Suspension Stored under Refrigeration and at Room Temperature
Authors: Nahata Milap C. 
Published: January 2017

OBJECTIVE: Amiodarone is currently available in a tablet dosage form, which cannot be used in young pediatric patients. The objective of our study was to determine the stability of amiodarone in an oral suspension stored at two temperatures. METHODS: Commercially available amiodarone tablets (200 mg each) were dissolved in purified water and a suspension prepared in methylcellulose 1 % and syrup to yield a concentration of 5 mg/mL. The dosage form was stored in 10 glass and 10 plastic prescription bottles. One-half of the bottles were stored at 4 °C and the others at 25 °C. Three samples were taken from each bottle at 0, 7, 14, 28, 42, 56. 70, and 91 days (n = 15). Amiodarone concentrations were measured by a validated and stability-indicating HPLC method; the pH was also determined in each sample. The drug was considered stable if its concentration exceeded 90% of the original concentration. RESULTS: The mean concentration of amiodarone was 90% or more at 4 °C for 91 days and at 25 °C for 42 days. The concentration was not affected by the type of storage container. Over 91 days, the pH did not change at 4 °C; it decreased slightly from 4.4 to 4.3 at 25 °C. CONCLUSIONS: Amiodarone was stable in an oral suspension for 3 months under refrigeration and for 6 weeks at room temperature.
Lovastatin-Induced Rhabdomyolysis Possibly Associated with Clarithromycin and Azithromycin
Authors: Grunden John W. , Fisher Kenneth A. 
Published: January 2017

OBJFXTTVE: To describe two cases of rhabdomyolysis in patients taking lovastatin that were precipitated by the use of the newer macrolide antibiotics clarithromycin and azithromycin. CASE SUMMARIES: In each case, the patients were treated over 5 years with lovastatin and developed rhabdomyolysis that coincided with the completion of a prescribed regimen of a newer macrolide antibiotic. Following intravenous hydration and administration of bicarbonate, the patients' condition resolved without permanent sequelae. DISCUSSION: Rhabdomyolysis is a clinical syndrome resulting from the destruction of skeletal muscle that may progress to renal failure. Several drugs have been associated with rhabdomyolysis, including lovastatin, a hydroxymethylglutaryl-coenzyme A reductase inhibitor. Erythromycin is a macrolide antibiotic that may increase the risk of lovastatin-induced rhabdomyolysis. To our knowledge, these cases are the first published reports of lovastatin-induced rhabdomyolysis associated with azithromycin and clarithromycin. CONCLUSIONS: The risk of drug-induced rhabdomyolysis due to the potential interaction between lovastatin and azithromycin or clarithromycin should be considered before the concomitant use of these agents.
Danaparoid in the Prevention of Thromboembolic Complications
Authors: Skoutakis Vasilios A. 
Published: January 2017

OBJECTIVE: To review the therapies used to prevent postoperative thromboembolic complications with a focus on the role of danaparoid, a new low-molecular-weight glycosaminoglycan. DATA SOURCES: A MEDLINE search was performed to identify pertinent English-language literature including studies, abstracts, and review articles. Key search terms included danaparoid, heparinoid, lomoparin, heparin, prophylaxis, thrombosis, embolism, thromboembolism, and thromboembolic and postoperative complications. The manufacturer of danaparoid was contacted for additional information related to this compound. STUDY SELECTION AND DATA EXTRACTION: All identified articles were reviewed for possible inclusion in this review. Comparisons primarily focused on data obtained from prospective, randomized, controlled, blind clinical trials. Another important consideration was the use of venography to determine the presence of deep venous thrombosis. DATA SYNTHESIS: Various therapies are available for the prevention of postoperative thromboembolic complications. Effective pharmacologic treatments currently available include adjusted-dose heparin, warfarin, aspirin, dextran, and low-molecular-weight heparins (LMWHs). Until recently, warfarin was considered the drug of choice for thromboprophylaxis in high-risk patients, including patients undergoing orthopedic surgical procedures. Because of their comparable efficacy and greater ease of use, LMWHs are gaining favor over warfarin in this patient population. In well-designed clinical trials involving patients undergoing elective total hip replacement or fractured hip surgery, danaparoid has demonstrated greater efficacy than other active treatments, including warfarin, dextran, aspirin, and heparin plus dihydroergotamine. While studies comparing danaparoid with LMWHs have not yet been published, danaparoid may be more useful in patients with heparin-associated thrombocytopenia. CONCLUSIONS: Danaparoid is an antithrombotic agent with characteristics that distinguish it from heparin and LMWHs. Based on the efficacy and safety data reviewed, danaparoid should be considered one of the drugs of choice for the prevention of thromboembolic complications in patients undergoing orthopedic hip procedures and the drug of choice for the management of any patient with heparin-induced thrombocytopenia who requires anticoagulant therapy.
The Environmental Politics of the International Waste Trade
Authors: Strohm Laura A. 
Published: January 2017

To date, the international trade in toxic wastes has caused more significant political damage than actual environmental degradation. It has elicited a new dialogue about the concept of an “environmental factor” in comparative trade advantage. The realities of the waste trading system suggest that the current regime of Prior Informed Consent (PIC) is failing in all ways. Sovereign environmental risk assessment is compromised by information gaps and liability confusion. Our prescriptions for an international waste trading policy reflect the presence of three familiar underlying tensions in international negotiations, which yield lessons for international environmental policymaking. “This firm's exports to Nigeria, Togo, Senegal, Lebanon, Syria, and Turkey had all been authorized by officials of those countries! The Italian government should seek reparations from foreign governments that refused to honor their commitments….” Comments of Renato Pent of Jelly Wax Company, an Italian waste exporter, upon being billed by the Italian government for the costs of politically required waste re-importations.1
L-carnitine contributes to enhancement of neurogenesis from mesenchymal stem cells through Wnt/β-catenin and PKA pathway
Authors: Fathi Ezzatollah , Farahzadi Raheleh , Charoudeh Hojjatollah Nozad 
Published: January 2017

The identification of factors capable of enhancing neurogenesis has great potential for cellular therapies in neurodegenerative diseases. Multiple studies have shown the neuroprotective effects of L-carnitine (LC). This study determined whether neuronal differentiation of rat adipose tissue-derived mesenchymal stem cells (ADSCs) can be activated by LC. In this study, protein kinase A (PKA) and Wnt/β-catenin pathways were detected to show if this activation was due to these pathways. The expression of LC-induced neurogenesis markers in ADSCs was characterized using real-time PCR. ELISA was conducted to assess the expression of cyclic adenosine monophosphate (cAMP) and PKA. The expression of β-catenin, reduced dickkopf1 (DKK1), low-density lipoprotein receptor-related protein 5 (LRP5), Wnt1, and Wnt3a genes as Wnt/β-catenin signaling members were used to detect the Wnt/β-catenin pathway. It was observed that LC could promote neurogenesis in ADSCs as well as expression of some neurogenic markers. Moreover, LC causes to increase the cAMP levels and PKA activity. Treatment of ADSCs with H-89 (dihydrochloride hydrate) as PKA inhibitor significantly inhibited the promotion of neurogenic markers, indicating that the PKA signaling pathway could be involved in neurogenesis induction. Analyses of real-time PCR data showed that the mRNA expressions of β-catenin, DKK1, LRP5c-myc, Wnt1, and Wnt3a were increased in the presence of LC. Therefore, the present study showed that LC promotes ADSCs neurogenesis and the LC-induced neurogenic markers could be due to both the PKA and Wnt/β-catenin signaling pathway. Impact statement Neural tissue has long been believed as incapable of regeneration and the identification of cell types and factors capable of neuronal differentiation has generated intense interest. Mesenchymal stem cells (MSCs) are considered as potential targets for stem cell-based therapy. L-carnitin (LC) as an antioxidant may have neuroprotective effects in oxidative damage and possibly in neurodegenerative disorders. We have tried to evaluate the effect of LC as an antioxidant on the neurogenic differentiation of ADSCs in order to further elucidate the simultaneous effects on the capability of the neural regeneration. In this study, PKA and Wnt/β-catenin signaling pathways were detected to see if LC could also activate these pathways. The results of this study showed that 200 µM LC promoted ADSCs neurogenic differentiation, and that it was correlated with the PKA and Wnt/β-catenin signaling pathways.
The Pink Elephant Paradox (or, Avoiding the Misattribution of Data)
Authors: Spiers Jude A. 
Published: January 2017

The pink elephant paradox refers to the threat to inductive thinking caused by the difficulty of inadvertently proving the existence of a concept or phenomena just because it overtly or insidiously exists in one's thoughts, leading to misattribution, or miscategorization of data, and thus subverting inductive processes. As Morse and Mitcham discussed in Part I, this is reduced through inductive strategies, including processes of saturation, replication, and verification. In this article, I present a story of how the phenomenon of interest in nurse-patient interaction evolved and emerged through a number of qualitative projects. At each stage, concepts were identified, explored, and developed in order to more elucidate the central phenomenon. I will show how, while at times I could identify and avoid the pink elephant, at other times there were one or a herd lurking in the shadows or rampaging through my work. I think that discussing both the successes and pit falls is one way to acknowledge and address the fact that, although we accept the evolution in ideas and thought processes in qualitative research, we still may not be comfortable in articulating the far more complex and insidious threats to inductive processes. Some schools of qualitative inquiry consider analysis of the literature a hindrance—in fact an invalidity—before commencing fieldwork. To the contrary, when a researcher is studying a concept rather than letting a concept emerge from a setting, it is essential to undertake a thorough theoretical and conceptual analysis of the literature (Morse, 2000; Morse et al, 1996). In my own program of research, the concept analysis was a study in, and of, itself, with the purpose of examining the maturity of concepts, and the explicit and implicit theoretical and research models. The literature constituted data that could be analyzed and formed the basis for a reconceptualization of the original concept by contrasting it with the theory derived from the fieldwork studies.