Dysgonic Fermenter-type 2: an emerging zoonosis. Report of two cases and review

We report Dysgonic Fermenter-type 2 septicaemia presenting in two previously healthy individuals, and review 52 cases of infection with Dysgonic Fermenter-type 2 reported in the English language literature. This zoonosis is usually acquired through contact with dogs and cats. Infection often presents with little warning to patient or physician and carries a high mortality. The immunosuppressed patient, those without a spleen, alcoholics and those with chronic disease appear to be most susceptible, although the healthy individual is also prone to infection. The infection is probably underdiagnosed due to difficulties in isolating Dysgonic Fermenter-type 2 by conventional blood culture techniques. Clinical and microbiological awareness is of prime importance in the early diagnosis of this potentially lethal infection.     

Tricuspid valve myxoma infected with dysgonic fermenter-2

We have described a patient with an infected myxoma attached to the tricuspid valve. Unlike those previously reported, our patient had a significant underlying disease, chronic lymphocytic leukemia, and presented the problem of multiple pulmonary infiltrates in an immunosuppressed host, with persistently negative blood cultures. The infecting bacterium, isolated only at operation, was a recently described fastidious gram-negative rod belonging to the CDC group dysgonic fermenter-2.     

Drug abuse in chronic headache: a clinico-epidemiologic study

Among the patients referred to the Headache Centre in Parma between 1979 and 1984, 95 (5%) were found to be drug abusers, having taken analgesics every day for at least a year. They had had chronic headache for at least 12 months: migraine with interparoxysmal headache in 83.1% and chronic tension headache in 16.9%. Almost all patients were combination-analgesics abusers, and only about a quarter of them were taking ergotamine. The largest single factor favouring the transformation of episodic headache into a chronic one was the drug abuse. The patients studied during 1984 were subjected to detoxification with 6 months' follow-up study. Our investigation suggests that all instant-relief drugs can sustain and possibly initiate a chronic headache.     

Solvent-free incorporation of CO2 into 2-oxazolidinones: a review

This review is an attempt to give an overview on the recent advances and developments in the synthesis of 2-oxazolidinone frameworks through carbon dioxide (CO₂) fixation reactions under solvent-free conditions. The cycloaddition of CO₂ to aziridine derivatives is discussed first. This is followed by carboxylative cyclization of N-propargylamines with CO₂ and three-component coupling of epoxides, amines, and CO₂. Finally, cycloaddition of CO₂ to propargylic alcohols and amines will be covered at the end of the review. The literature has been surveyed up until the end of 2018.

This review is an overview on the recent advances in the synthesis of 2-oxazolidinones through CO₂ fixation reactions under solvent-free conditions.     

Hypoglycemia in type 2 diabetes: a critical review

Hypoglycemia is the most important barrier to tight glycemic control. Although severe hypoglycemia is uncommon, milder events can occur so often that they represent a deterrent to intensifying treatment. High-risk patient behaviors are the most important cause for episodes for which a cause can be identified. Because symptoms are an unreliable way of establishing the diagnosis, SMBG should be considered for the patients at highest risk, particularly as they approach their glycemic targets. SMBG is superior to HbA1c in forecasting the hypoglycemia rate because it provides information about glucose variability--an independent risk factor. Patient education and medication changes are potential ways of reducing the hypoglycemia rate. However, it remains to be proven that patient education is beneficial in this regard.     

Low-temperature operating ZnO-based NO2 sensors: a review

Owing to its excellent physical and chemical properties, ZnO has been considered to be a promising material for development of NO₂ sensors with high sensitivity, and fast response and recovery. However, due to the low activity of ZnO at low temperature, most of the current work is focused on detecting NO₂ at high operating temperatures (200–500 °C), which will inevitably increase energy consumption and shorten the lifetime of sensors. In order to overcome these problems and improve the practicality of ZnO-based NO₂ sensors, it is necessary to systematically understand the effective strategies and mechanisms of low-temperature NO₂ detection of ZnO sensors. This paper reviews the latest research progress of low-temperature ZnO nanomaterial-based NO₂ gas sensors. Several efficient strategies to achieve low-temperature NO₂ detection (such as morphology modification, noble metal decoration, additive doping, heterostructure sensitization, two-dimensional material composites, and light activation) and corresponding sensing mechanisms (such as depletion layer theory, grain boundary barrier theory, spill-over effects) are also introduced. Finally, the challenges and future development directions of low-temperature ZnO-based NO₂ sensors are outlined.

A comprehensive review on designs and mechanisms of ZnO-based NO₂ gas sensors operated at low temperature.     

Differential lung ventilation: a review and 2 case reports

The respiratory parameters of some of the patients with acute respiratory failure deteriorates while using conventional ventilation. These patients suffer unilateral lung disease and the failure to respond favourably to therapy is due to increased intrapulmonary shunt. There is a reflex vasodilation in the injured lung. Functional residual capacity is reduced in the injured lung and the compliance decreases. Gas flow is then deviated to the other lung, thus increases alveolar collapse and decreases regional compliance in the injured lung. These events cause severe hypoxemia. We present here two cases with unilateral lung disease that failed to respond to conventional mechanical ventilation. Asynchronized differential lung ventilation was found to be the therapeutic answer to the problem. We discuss the pathophysiology of unilateral lung injury and the physiology of differential lung ventilation.     

Peginterferon alfa-2a: a review of approved and investigational uses

BACKGROUND: In October 2002, the US Food and Drug Administration approved peginterferon alfa-2a for the management of chronic hepatitis C virus (HCV) infection. The addition of polyethylene glycol (PEG) moiety to the interferon (IFN) molecule results in a product with altered pharmacokinetic properties. OBJECTIVE: The aim of this article is to review the pharmacology, medications interactions, adverse events (AEs), and approved or investigational uses of PEG-IFN alfa-2a for viral hepatitis and oncologic conditions. METHODS: Relevant articles were identified through searches of MEDLINE (1980-July 2003) and EMBASE (1980-July 2003). Search terms included, but were not limited to, peginterferon alfa-2a, pharmacokinetics, pharmacology, pharmacodynamics, and therapeutic use, as well as terms for specific disease states and AEs. Further publications were identified from citations of resulting papers. RESULTS: Pegylation of IFN alfa-2a results in major changes in the pharmacokinetics of the product. Absorption is prolonged and serum concentrations are sustained over the dosing regimen. PEG-IFN alfa-2a has been shown to be more effective with or without ribavirin (RBV), in the management of treatment-naive patients with chronic HCV infection, than unmodified IFN alfa-2a with or without RBV. Results in other disease states are still preliminary. AEs are similar, in incidence and severity, to those occurring with unmodified IFN. They include earlier hematologic symptoms and fewer influenza-like symptoms. Drug-drug interactions are the same as those occurring with the unmodified IFN product. CONCLUSIONS: The pharmacokinetic profile of IFN alfa-2a is improved by pegylation, which enables less frequent administration and results in improved efficacy with a similar side-effect profile. Combination of PEG-IFN alfa-2a with RBV is associated with a greater chance of achieving a sustained virologic response in treatment-naive patients with chronic HCV, compared with unmodified IFN alfa-2a/RBV combinations. Documentation of efficacy in other conditions awaits results of controlled clinical trials.     

帕金森叠加综合征2例报告及文献复习

目的:比较路易体痴呆及进行性核上性麻痹的临床特点,并与其他的帕金森叠加综合征相鉴别。方法:报告2例2003-10/2004-01宣武医院收治的帕金森病叠加综合征病例,进行相关的文献复习。结果:病例1表现为智能损害、反复出现的视幻觉、症状的波动性及帕金森病样的表现,临床诊断为路易体痴呆。病例2表现为体位不稳、垂直性的眼肌运动麻痹、中轴性的肌张力增高及智能减退等,临床诊断为进行性核上性麻痹。结论:对路易体痴呆和进行性核上性麻痹及时做出诊断,并与其他相关疾病做鉴别是非常重要的,可以为治疗的选择及护理提供有益的信息。     

Representative 2D-material-based nanocomposites and their emerging applications: a review

Composites (or complex materials) are formed from two or many constituent materials with novel physical or chemical characteristics when integrated. The individual components can be combined to create a unique composite material through mechanical transfer, physical stacking, exfoliation, derivative chemical mixtures, mixtures of solid solutions, or complex synthesis processes. The development of new composites based on emerging 2D nanomaterials has allowed for outstanding achievements with novel applications that were previously unknown. These new composite materials show massive potential in emerging applications due to their exceptional properties, such as being strong, light, cheap, and highly photodegradable, and their ability to be used for water splitting and energy storage compared to traditional materials. The blend of existing polymers and 2D materials with their nanocomposites has proven to be immediate solutions to energy and food scarcity in the world. Although much literature has been reported in the said context, we tried to provide an understanding about the relationship of their mechanisms and scope for future application in a comprehensive way. In this review, we briefly summarize the basic characteristics, novel physical and chemical behaviors, and new applications in the industry of the emerging 2D-material-based composites.

Composites (or complex materials) are formed from two or many constituent materials with novel physical or chemical characteristics when integrated.     

Clinical evidence of subcutaneous CO2 insufflations: a systematic review

OBJECTIVE: To evaluate the evidence of clinical effectiveness of subcutaneous CO2 insufflations (SCIs). STUDY LOCATION: The entire databases of MEDLINE, EMBASE Excerpta Medica (Field: Rehabilitation and Physical Medicine) and the Cochrane Library were screened for data up to August 1999. In addition, other potentially relevant journals were handsearched and references were checked. STUDY SELECTION: Uncontrolled observational trials (UCOTs) with sample sizes of at least n = 100, and controlled clinical trials (CCTs) and randomized controlled trials (RCTs) were included. Outcomes had to be patient-centered. English-, Czechoslovakian-, and German-language papers were considered. DATA ANALYSIS: For all study types, a criteria-based analysis was performed. For controlled trials only, quality was quantitatively assessed with the Jadad and Maastricht Scales. RESULTS: Thirteen studies (5 RCTs, 2 CCTs, and 6 UCOTs) were included. Mean scores on the Jadad and Maastricht Scales were 2 (Maximum 5) and 37 (Maximum 100), respectively. SCIs were found to be effective in addition to standard physical therapy in "peripheral arterial occlusive disease" (2 RCTs) and "stable angina pectoris" (1 RCT) and superior to sham needling for migraine headaches (1 RCT). There were no differences among SCIs and CO2 gas baths (1 RCT) or combined interventions, including SCIs (2 CCTs). All 6 UCOTs showed marked longitudinal effects. CONCLUSIONS: The low number and quality of the available studies precludes firm conclusions on the clinical effectiveness of SCIs.     

Osteoarthritis: a review

In 1994, the Centers for Disease Control and Prevention reported that by the year 2020, arthritis will have the largest increase in numbers of new patients of any disease in the United States. The term arthritis refers to many diseases, the most common of which is osteoarthritis (OA). OA affects at least 16 million Americans, most of whom are older than 60 years. The disease is usually defined using radiologic criteria. More than 80% of people older than 75 years are symptomatic of OA. Considering cost of diagnosis, therapy (nonpharmacologic, pharmacologic, and surgical), side effects of therapy, and lost productivity, it is one of the more expensive and debilitating diseases in the United States. Given the large numbers of patients and the expense of the disease, it is not surprising that the diagnosis and care of patients with OA have come under scrutiny. The following article will provide some background on the disease and discuss management approaches that view the patient as a whole.     

Teriparatide: a review

BACKGROUND: Traditionally, the management of osteoporosis in men and women has included the use of antiresorptive agents in combination with calcium and vitamin D supplementation. The mechanism of action of teriparatide is unique in that it possesses anabolic properties and therefore builds bone. Since the approval of teriparatide in the United States in 2002, a great deal of interest regarding its use in osteoporosis has developed. OBJECTIVES: This article reviews the information available on the new recombinant human parathyroid hormone teriparatide (hPTH [1-34]), including its clinical pharmacology, mechanism of action, pharmacokinetic properties, clinical efficacy, safety profile, potential drug interactions, contraindications and warnings, dosage and administration, and pharmacoeconomics. METHODS: The articles included in this review were identified through searches of PubMed and MEDLINE (1966-December 2003) and International Pharmaceutical Abstracts (1970-December 2003). Search terms included teriparatide, Forteo, recombinant human parathyroid hormone (1-34), and osteoporosis. The references of the identified articles were reviewed for additional publications. Specific product information was also obtained from the manufacturer of teriparatide. RESULTS: Teriparatide has been studied in postmenopausal women with osteoporosis, drug-induced osteoporosis (specifically, corticosteroid-induced osteoporosis), and men with osteoporosis. The data available from various clinical trials have shown an increase in both bone mineral density (BMD) and bone mineral content (BMC) with the use of teriparatide compared with placebo. One study found that women treated with the 20-microg dose and the 40-microg dose were 35% and 40%, respectively, less likely to have one or more new nonvertebral fractures compared with placebo (P = 0.02). Another study compared the use of daily teriparatide 40-microg injections versus oral daily alendronate. Results showed that the incidence of nonvertebral fractures was significantly lower in the teriparatide group than the alendronate group (P < 0.05). A study using 20- and 40-microg daily injections of teriparatide was performed in men with osteoporosis. There was a statistically significant increase in lumbar spine BMD of 5.9% in the 20-microg group and 9.0% in the 40-microg group (both, P < 0.001). In the femoral neck, a 1.5% increase in BMD occurred in the 20-microg group (P = 0.021) and a 0.9% increase in the 40-microg group (P < 0.001). A limited number of studies are available assessing the combination of antiresorptive medications and teriparatide; however, the available data suggest that the effects of teriperatide do not require prior stimulation of bone resorption. CONCLUSIONS: Teriparatide has been shown clinically to improve BMD and BMC in postmenopausal women and in men. Because of its anabolic capabilities, teriparatide can be used as an alternative to the traditional therapies that are currently available for the treatment of osteoporosis, with scheduled monitoring for adverse effects such as hypercalcemia and urinary calcium excretion. In 1 study, mild hypercalcemia was seen most often 4 to 6 hours after SC injection of teriparatide before returning to normal. Urinary calcium was observed to increase by 30 mg/d (0.75 mmol/d) with teriparatide.     

Splenosis: a review

Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. Splenosis is usually found incidentally and unless symptomatic, therapy is not indicated. However, since radiographically it can mimic malignancy, most patients have an extensive workup. The diagnostic method of choice is nuclear scintigraphy, specifically, a heat-damaged red blood cell scan. Splenosis usually occurs within the abdominal and pelvic cavities, but patients have been described with intrathoracic, subcutaneous, intrahepatic and intracranial lesions.     

Tetanus: a review

Tetanus is a preventable illness occurring worldwide with a high mortality, mostly affecting neonates in developing countries. Effects are toxin mediated and the diagnosis is clinical. Antibiotics, antitoxin, immunoglobulin and wound care are the mainstays of management.     

Hyperkalemia: a review

Potassium is the principal intracellular cation, and maintenance of the distribution of potassium between the intracellular and the extracellular compartments relies on several homeostatic mechanisms. When these mechanisms are perturbed, hypokalemia or hyperkalemia may occur. This review covers hyperkalemia, that is, a serum potassium concentration exceeding 5 mmol/L. The review includes a discussion of potassium homeostasis and the etiologies of hyperkalemia and focuses on the prompt recognition and treatment of hyperkalemia. This disorder should be of major concern to clinicians because of its propensity to cause fatal arrhythmias. Hyperkalemia is easily diagnosed, and rapid and effective treatments are readily available. Unfortunately, treatment of this life-threatening condition is often delayed or insufficiently attentive or aggressive.