Prostacyclin (prostaglandin I) is commonly considered the most effective treatment for PAH. Epoprostenol (synthetic prostacyclin, marketed as Flolan®) is given via continuous infusion that requires a semi-permanent central venous catheter. This delivery system can cause sepsis and thrombosis. Flolan® is unstable, and therefore has to be kept on ice during administration. Since it has a half-life of 3 to 5 minutes, the infusion has to be continuous (24/7), and interruption can be fatal. Other prostanoids have therefore been developed. Treprostinil (Remodulin®) can be given intravenously or subcutaneously, but the subcutaneous form can be very painful. Iloprost (Ilomedin®) is also used in Europe intravenously and has a longer half life. Iloprost (marketed as Ventavis®) is the only inhaled form of prostacyclin approved for use in the US and Europe. This form of administration has the advantage of selective deposition in the lungs with less systemic side effects.
The dual (ET and ET) endothelin receptor antagonist bosentan (marketed as Tracleer®) was approved in 2001. Two selective endothelin receptor antagonists (ET only) are in the final stages of approval: sitaxsentan and ambrisentan. Sildenafil, a selective inhibitor of cGMP specific phosphodiesterase type 5 (PDE5), was approved for the treatment of PAH in 2005. It is marketed for PAH as Revatio®. Tadalafil (currently marketed as Cialis® for erectile dysfunction) is currently is Phase III trials. Vasoactive intestinal peptide by inhalation should enter clinical trials for PAH in 2007. PRX-08066 is a serotonin antagonist currently being developed for hypoxic pulmonary hypertension.
Atrial septostomy is a surgical procedure that creates a communication between the right and left atria. It relieves pressure on the right side of the heart, but at the cost of lower oxygen levels in blood (hypoxia). It is best performed in experienced centers. Lung transplantation cures pulmonary arterial hypertension, but leaves the patient with the complications of transplantation, and a survival of about 5 years.
Pulmonary thromboendarterectomy (PTE) is a surgical procedure that is used for chronic thromboembolic pulmonary hypertension. It is the surgical removal of an organized thrombus (clot) along with the lining of the pulmonary artery; it is a large and very difficult procedure that is currently performed in a few select centers. Case series show remarkable success in most patients.
Treatment for hypoxic and miscellaneous varieties of pulmonary hypertension have not been established. However, studies of several agents are currently enrolling patients. Many physicians will treat these diseases with the same medications as for PAH, until better options become available.
The NIH IPAH registry from the 1980s showed an "untreated" median survival of 2–3 years from time of diagnosis, with the cause of death usually being right ventricular failure (cor pulmonale). Although this figure is widely quoted, it is probably irrelevant today. Outcomes have changed dramatically over the last two decades. This may be because of newer drug therapy, better overall care, and earlier diagnosis (lead time bias). A recent outcome study of those patients who had started treatment with bosentan (Tracleer®) showed that 86% patients were alive at 3 years. With multiple agents now available, combination therapy is increasingly used. Impact of these agents on survival is not known, since many of them have been developed only recently. It would not be unreasonable to expect median survival to extend past 10 years in the near future.
Eastern Standard Time
There are three different time zones called Eastern Standard Time Zone:
Decameron
The Decameron is a collection of 100 short stories. It was written by the Italian writer Giovanni Boccaccio around 1350. In the book, ten friends, seven young women and three young men, leave the city of Florence because of the plague and stay in a large house in the countryside. Each day, they entertain each other by taking turns to tell stories. The stories are of different types. Some are romantic, some are erotic, some are comedies and some are tragedies.
Other writers have used the stories for ideas. Many paintings have been done which illustrate the stories. The picture to the right shows a scene from the story of "The Pot of Basil" in which Isabella buries the head of her murdered lover Ferdinand inside a potplant.
Lung transplant
A lung transplant is a type of surgery. People who can not breathe without additional oxygen may need a lung transplant. In this surgery, the patient's ill lung or lungs are removed. A healthy lung or lungs are put into the patient. The healthy lungs may come from a dead or from a living person. When the person who gives, or donates, the healthy lung is still alive, only one lung is removed. Sometimes a healthy person can give just part of a lung to a sick person. A healthy person can normally give a lung or part of a lung without becoming sick.
Commodity
Commodity is a term with distinct meanings in both business and in Marxian political economy. For the former, it is a product, that is traded solely on the basis of price. For Marxian political economy it means wares offered for exchange.
In the world of business, a commodity is a product, good or service that is traded based solely on its price, rather than quality and features. Examples include: electricity (most users of electric power are only concerned with energy consumption; only a minority of users are concerned with the quality and technical details of voltage and frequency deviations), wheat, bulk chemicals such as sulfuric acid, metals, and even orange juice.
In the original and simplified sense, "commodities" were things of value, of uniform quality, that were produced in large quantities by many different producers; the items from each different producer are considered as of the same value.
Wheat is an example of a soft commodity. Wheat from many different farms comes together. Generally, it is all traded at the same price; wheat from farm A has not another price than wheat from farm B. Some uniform standard of quality is assumed. (There may be various standards leading to different pools: one say for genetically modified wheat, and one for unmodified wheat.)
Markets for trading commodities can be very efficient, particularly if the division into pools matches demand segments. These markets will quickly respond to changes in supply and demand to find a price.
In classical political economy and especially Karl Marx's critique of political economy, a commodity is simply any good or service offered as a product for sale on the market. Some items are also seen as being treated "as if" they were commodities, e.g. human labour or labor power, works of art and natural resources, even though they may not be produced specifically for the market, or be non-reproducible goods.
Marx's analysis of the commodity is intended to help solve the problem of what establishes the economic value of goods, using the labor theory of value. This problem was extensively debated by Adam Smith, David Ricardo and Karl Rodbertus-Jagetzow among others. Value and price are not equivalent terms in economics, and theorising the specific relationship of value to market price has been a challenge for both liberal and Marxist economists.