Iontophoresis: Modeling, Methodology, and Evaluation

Iontophoresis is a noninvasive and painless means of delivering various drugs into the body. Many drugs, in particular peptides, proteins, and hormones are given parenterally either through intravenous, subcutaneous, or intramuscular injections. Transdermal delivery using iontophoresis circumvents hepatic clearance and breakdown by the gastric juices thus allowing local high concentrations of active compounds. Local delivery of these compounds is much safer than parenteral routes since lower concentrations are necessary to reach the target sites. The present analysis focuses on previously overlooked areas including skin impedance, iontophoretic waveforms, skin modeling, optimization of delivery parameters, and their effects on iontophoretic delivery. Particular emphases are placed on modeling, methodology, and evaluations of the efficacy of iontophoresis.     

Evaluation,Diagnosis, and Classification of Pulmonary Hypertension

Pulmonary hypertension (PH) is a rare heterogenous disease characterized by elevated blood pressure in the lungs. Patients with PH require careful evaluation and management at an expert center. Understanding of the mechanisms underlying the development of PH has increased over the past two decades, and several treatment options for pulmonary arterial hypertension have emerged. Despite this progress, PH continues to carry high morbidity and mortality. The 6th World Symposium on Pulmonary Hypertension that occurred in late 2018 modified the clinical classification of PH into five groups. In this review, we focus on the evaluation and diagnosis of PH and discuss the updated clinical classification.     

Design,Synthesis, and Biological Evaluation of New Azulene-Containing Chalcones

Azulene-containing chalcones have been synthesized via Claisen–Schmidt condensation reaction. Their chemical structure has been established by spectroscopic methods where the ¹H-NMR spectra suggested that the title chalcones were geometrically pure and configured trans (J = 15 Hz). The influence of functional groups from azulene-containing chalcones on the biological activity of the 2-propen-1-one unit was investigated for the first time. This study presents optical and fluorescent investigations, QSAR studies, and biological activity of 10 novel compounds. These chalcones were evaluated for their antimicrobial activity against Gram-positive and Gram-negative bacteria. The results revealed that most of the synthesized compounds showed inhibition against Gram-negative microorganisms, independent of the substitution of azulene scaffold. Instead, all azulene-containing chalcones exhibited good antifungal activity against Candida parapsilosis, with MIC values ranging between 0.156 and 0.312 mg/mL. The most active compound was chalcone containing azulene moieties on both sides of the 2-propene-1-one bond, exhibiting good activity against both bacteria-type strains and good antifungal activity. This antifungal activity combined with low toxicity makes azulene-containing chalcones a new class of bioorganic compounds.     

Evaluation of platelet function, a method comparison

Platelet function can be studied using many different methods why it is of interest to understand how data from different assays relate to each other. In the present study we compare two methods suitable for screening purposes with two established although laborious methods, impedance aggregometry and platelet-rich plasma (PRP) aggregation. The alternative assays tested were: (i) exposure of active alphaIIbbeta3, in diluted whole blood and (ii) whole blood aggregation assessed by residual platelet counting. The fibrinogen receptor activation assay was found to have the lower variability, higher sensitivity to ADP, and higher signal to noise ratio compared with residual platelet counting. The sensitivity and response profile of the fibrinogen receptor activation assay and residual platelet counting were more similar to PRP aggregation than to impedance aggregometry, whereas impedance aggregometry displayed lower sensitivity to ADP. The two alternative assays correlated well with PRP aggregation as well as with each other. The fibrinogen receptor activation assay displayed the highest potency for AR-C69931MX, possibly due to a lower protein content compared with residual platelet counting. The two studied assays compare well with the more established assays, and are thus both good alternatives for platelet function testing and evaluation of new potential platelet antagonists.     

Evaluation of National Tsutsugamushi Disease Surveillance--Japan, 2000

In Japan, Tsutsugamushi disease, which is caused by Orientia tsutsugamushi, is re-emerging with newly recognized strains and is now endemic in all prefectures except Hokkaido and Okinawa. We analyzed recent surveillance data to describe the epidemiology of Tsutsugamushi disease and to evaluate the newly implemented national surveillance system according to the CDC guidelines for evaluating surveillance systems. In 2000, 756 cases of Tsutsugamushi disease were reported from 37 of 47 prefectures; two of these cases were fatal. The median age of case-patients was 64 years (range: 2 - 94 years); 414 (54.8%) were male. In northern Japan, most cases were diagnosed in the months of May through July and in the months of October through December, and in southern Japan, cases were diagnosed almost year-round with a peak from October through December and in January. Reporting and transfer of surveillance information from the prefecture to the national level was effective and timely, but the completeness and quality of case reporting could still be improved. The current system for Tsutsugamushi disease surveillance is useful for describing epidemiologic patterns by time, prefecture, and demographic characteristics. However, collection of additional information on suspected place of transmission, activity performed at the place of transmission, or the case-patient's profession would likely make the system more valuable for outbreak detection and for better defining populations at risk.     

顽固性高血压的评估和治疗

顽固性高血压在临床实践中越来越多见但研究资料有限,其诊断需要良好的血压监测技术.顽固性高血压常有多种病因且并存其他多种心血管危险因素如肥胖、糖尿病、慢性肾损害和阻塞性睡眠呼吸暂停.推荐顽固性高血压患者应接受有效的多药联合治疗方案.     

Evaluation of patients with small, subcentimeter nodules

The prevalence of subcentimeter pulmonary nodules is on the rise due to widespread use of multidetector row computed tomography. These lesions have created a new set of challenges for patients and their physicians. Such nodules are poorly characterized by imaging tests and are difficult to biopsy. Fortunately, the available data suggest that the vast majority of such nodules are benign in etiology. However, this increases the challenge to provide a cost-effective evaluation that minimizes unnecessary radiation exposure and complications from invasive biopsies while promptly identifying malignancy when it is present. In this review, we summarize the current available literature regarding subcentimeter nodules, as well as the current recommendations regarding their investigation.     

Prevalence,Formation, Maintenance,and Evaluation of Interdisciplinary Student Aging Interest Groups

The authors describe the prevalence, formation, maintenance, and evaluation of student aging interest groups. They conducted a cross-sectional electronic survey of the 46 academic medical centers funded by the Donald W. Reynolds Foundation. To evaluate their group of approximately 50 students, the authors conducted an electronic pretest and posttest of attitudes toward interdisciplinary education and knowledge about aging. Twenty-nine of 32 responding institutions funded by the Reynolds Foundation conducted a group; only medical students participated in one half of these groups. Panel presentations were the most prevalent group activity. Evaluation of their group revealed that an interprofessional service learning experience had the greatest impact on student perceptions of the educational preparation and competency of other disciplines. At posttest, medical students in their group had significantly less positive perceptions of actual cooperation between disciplines than did physical therapy or pharmacy students. Aging interest groups conducted by institutions funded by the Reynolds Foundation did not have a high level of interdisciplinary participation. Intermittent exposure to other disciplines during a small number of group activities may be insufficient to overcome “disciplinary split” and achieve interprofessional team orientation without changes in the structure of medical education.     

Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding

BACKGROUND: The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated. OBJECTIVE: To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB. DESIGN: A single-center prospective study. PATIENTS: During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding. RESULTS: CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%). LIMITATIONS: This study had a limited number of patients. CONCLUSIONS: CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management.     

Evaluation of a novel, rapid-acting, sterilizing solution at room temperature

Test data are presented for a novel chemical germicide formulation capable of sterilizing reusable medical devices in 30 minutes at 20 degrees C in an open tray. The tests conducted with this rapid-acting sterilizing solution (RSS) included sporicidal, mycobactericidal, and virucidal studies performed in accordance with Association of Official Analytical Chemist International or Environmental Protection Agency published guidelines, by using RSS stressed for as long as 7 days. Sporicidal assays were performed at 20 degrees C with a 30-minute exposure time by using both Clostridium sporogenes and Bacillus subtilis spores dried on porcelain penicylinders or suture loops (n = 60 carriers per treatment). For comparison, identical carriers were exposed to a commercial glutaraldehyde-based sterilizing solution stressed to a maximum-use time of 14 days and exposed per manufacturer's requirements (10 hours at 25 degrees C). The RSS sterilized 100% of the carriers of both spore types. The glutaraldehyde solution demonstrated 100% sterilization of C sporogenes -treated carriers but had difficulty sterilizing B subtilis spore-laden carriers (ie, no sterilization of suture loops and only 57% sterilization of porcelain penicylinders). Similarly, Mycobacteria bovis and selected fungal and viral agents were exposed to stressed solution for 5 minutes or less at 20 degrees C. In each case, the resulting log decrease in viable microorganisms significantly supported a claim for rapid high-level disinfection. Based on these data, RSS demonstrates high-level disinfection in 5 minutes and sterilization in 30 minutes at 20 degrees C.     

Epidemiology,Evaluation, and Treatment of Urinary Incontinence in Octogenarian Women

Urinary incontinence (UI) is an extremely common clinical condition in elderly women. Although both the incidence and prevalence tend to increase with advancing age, UI should not be considered a normal or inevitable part of the aging process. UI tends to have negative-associated outcomes for both patients and caregivers in terms of quality of life, social isolation, and burden of care. This paper reviews the recent peer-reviewed literature on epidemiology, diagnostic evaluation, and clinical treatment options for UI in older adult women.