伊朗传统医学治疗牙周疾病

目的:牙周疾病非常普遍,尽管有各种特定的治疗方法,但我们始终面临治疗方法有限的问题。考虑到世界组织十分关注传统医学在医疗服务中的发展和应用,我们在一直考察研究伊朗传统医学中药物对牙周疾病的治疗作用。方法:此项研究是一个对有关方面书籍的综合论述,伊朗传统医学内容是经过对重量级作者如Avicenna和Alzahrawy所著的有价值的书籍修订,收集了各医学院校馆藏图书和医药公司的有关信息编辑而成,因为在伊朗传统医学中牙周疾病分成不同目类,对有关药物的研究也被分成8个大组63个题目。(1)缓解牙龈肿胀药物(2)治疗牙龈恶化药物(3)治疗口疮腐烂药物(4)治疗牙龈肥大药物(5)利于伤口康复药物(6)利于牙龈加固的药物(7)阻止牙龈出血的药物(8)防止牙齿松动药物。结果结论:伊朗传统医学在准确的观察和实践的基础上来描述和治疗牙周疾病的。在制药学、有效治疗方面、科学研究手段等领域,伊朗传统医学在以下几个方面可作为现代制药研究的重要资源:(1)纯天然资源(2)容易获得(3)相对比较安全。     

Once-Daily Triple Therapy in Patients with COPD: Patient-Reported Symptoms and Quality of Life

Introduction

Directly recorded patient experience of symptoms and health-related quality of life (HRQoL) can complement lung function and exacerbation rate data in chronic obstructive pulmonary disease (COPD) clinical studies. The FULFIL study recorded daily symptoms and activity limitation together with additional patient-reported outcomes of dyspnea and HRQoL, as part of the prespecified analyses. FULFIL co-primary endpoint data have been previously reported.

Methods

FULFIL was a phase III, 24-week, randomized, double-blind, double-dummy, multicenter study comparing once-daily single inhaler triple therapy [fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI)] 100 µg/62.5 µg/25 µg with twice-daily inhaled corticosteroid/long-acting β₂-agonist therapy [budesonide/formoterol (BUD/FOR)] 400 µg/12 µg in patients with symptomatic COPD at risk of exacerbations. A subset participated for 52 weeks. Patient-reported assessments were: Evaluating Respiratory Symptoms in COPD? (E-RS: COPD), St George’s Respiratory Questionnaire (SGRQ) for COPD, COPD Assessment Test (CAT), baseline and transitional dyspnea indices (TDI) and daily and global anchor questions for activity limitation.

Results

FF/UMEC/VI showed greater reductions from baseline in 4-weekly mean E-RS: COPD total and all subscale scores compared with BUD/FOR; differences were statistically significant (P < 0.05) at each time period. FF/UMEC/VI also demonstrated greater improvements from baseline at weeks 4 and 24 in SGRQ domain scores and TDI focal score compared with BUD/FOR. At weeks 4 and 24, improvements greater than the minimal clinically important difference from baseline were observed in CAT score with FF/UMEC/VI, but not BUD/FOR; differences were statistically significant (P ≤ 0.003).

Conclusion

These findings demonstrate sustained daily symptom and HRQoL benefits of FF/UMEC/VI versus BUD/FOR. The inclusion of the CAT may provide data that are readily generalizable to everyday clinical practice.

Trial registration

ClinicalTrials.gov number: NCT02345161.

Funding

GSK.

     

Randomized clinical trials of osteoarthritis: a review

Aim: The objective of this study was to review published randomized clinical trials (RCTs) of osteoarthritis (OA) in three time periods to determine the characteristics of RCTs and the types of outcome measures used and whether any changes have occurred. Methods: We identified RCTs assessing clinical efficacy of treatments for osteoarthritis published in English in 1987/1988, 1997/1998 and 2001/2002, using MEDLINE. RCTs were then assessed for baseline disease characteristics, treatment type and outcome measures utilized. We classified outcome measures into 10 broad subgroups. Results: The number of RCTs increased with each time period (31 in 1987/1988; 36 in 1997/1998; 91 in 2001/2002). The majority of RCTs were of knee, hip or both (94% in 1987/1988, 69% in 1997/1998, 71% in 2001/2002). The median duration of RCTs for all three time periods was ≤ 3 months. In 1987/1988, nonsteroidal anit‐inflammatory drugs (NSAIDs) accounted for 65% of RCTs. In 1997/1998, NSAID/COX‐2 trials accounted for 41.7%, with glucosamine (14%) and hyaluronan (11%). In 2001/2002, 28% of RCTs were related to NSAID/COX‐2 inhibitors and 25% to complementary therapies. The median number of participants was unchanged over the three time periods. The median number of outcome measures used at all three time periods was four (range 1–8). The most commonly used outcome measures were: (i) symptoms (pain, stiffness); (ii) function; (iii) global assessment (patient, physician); and (iv) composite scores (such as Western Ontario and McMaster [WOMAC] Osteoarthritis index) in order of use. There has been significant increase in use of function and composite score as outcome measures. Conclusion: There has been a recent increase in both the number and variety of therapeutic interventions for OA. This study shows that currently a wide variety of outcome measures are used. This reinforces the importance of using standardized responder criteria, such as the OMERACT‐OARSI set of responder criteria, which incorporate pain, function and patient's global assessment.     

Push‐out bond strength of two root‐end filling materials in root‐end cavities prepared by Er,Cr:YSGG laser or ultrasonic technique

This study compared the push‐out bond strength of mineral trioxide aggregate (MTA) and a new endodontic cement (NEC) as root‐end filling materials in root‐end cavities prepared by ultrasonic technique (US) or Er,Cr:YSGG laser (L). Eighty single‐rooted extracted human teeth were endodontically treated, apicectomised and randomly divided into four following groups (n = 20): US/MTA, US/NEC, L/MTA and L/NEC. In US/MTA and US/NEC groups, root‐end cavities were prepared with ultrasonic retrotip and filled with MTA and NEC, respectively. In L/MTA and L/NEC groups, root‐end cavities were prepared using Er,Cr:YSGG laser and filled with MTA and NEC, respectively. Each root was cut apically to create a 2 mm‐thick root slice for measurement of bond strength using a universal testing machine. Then, all slices were examined to determine the mode of bond failure. Data were analysed using two‐way anova . Root‐end filling materials showed significantly higher bond strength in root‐end cavities prepared using ultrasonic technique (US/MTA and US/NEC) (P < 0.001). The bond strengths of MTA and NEC did not differ significantly. The failure modes were mainly adhesive for MTA, but cohesive for NEC. In conclusion, bond strengths of MTA and NEC to root‐end cavities were comparable and higher in ultrasonically prepared cavities.     

HLA Antigens Shed from the Surface of Synthetic or Naturally Occurred Platelet-Derived Microparticles During Storage of Platelet Concentrate

The demand for standard platelet concentrates (PCs) has continued to increase in the recent years. Infusible platelet membranes (IPM) prepared from new or outdated human platelets have been developed as an alternative to standard PCs, with the additional advantage of long shelf life and increased viral safety. Reduction of HLA antigens on the IPM has been assigned as one of the probable advantages of this product. In re-examining this issue, we studied the existence of HLA class I on the surface of IPM microparticles. In comparison we also surveyed HLA expression on the surface of the naturally occurred platelet-derived microparticles (nPMPs) during 7 days storage. Intended for producing IPM, PCs obtained from Iranian blood transfusion organization were lysed; virally inactivated with wet heat in the presence of a heat stabilizer and then sonicated. IPMs were separated using centrifugation and liquid-stored in 4°C. The expression of HLA class I antigens was surveyed using flow cytometry technique. HLA molecules were present on the microparticles. Shedding of HLA antigens was demonstrated from the surface of the both liquid-stored IPM and nPMPs during storage. Storage of IPM in 4°C was accompanied with significant reduction of HLA molecules. It seemed that achievement of HLA-free IPM could be impossible unless chloroquine treated platelets were used to prepare these microvesicles.     

Effect of mu and kappa opioids on injury-induced microglial accumulation in leech CNS: involvement of the nitric oxide pathway

Damage to the leech or mammalian CNS increases nitric oxide (NO) production and causes accumulation of phagocytic microglial cells at the injury site. Opioids have been postulated to modulate various parameters of the immune response. Morphine and leech morphine-like substance are shown to release NO and suppress microglial activation. Regarding the known immuno-modulatory effects of selective mu and kappa ligands, we have assessed the effect of these agents on accumulation of microglia at the site of injury in leech CNS. Leech nerve cords were dissected, crushed with fine forceps and maintained in different concentrations of opiates in culture medium for 3 h and then fixed and double stained with Hoechst 33258 and monoclonal antibody to endothelial nitric oxide synthase (NOS). Morphine and naloxone (> or =10(-3) M) but not selective mu agonist, DAMGO [d-Ala2, N-Me-Phe-Gly5(ol)-enkephalin] and antagonist, CTAP [D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2] inhibited the microglial accumulation. The effect of morphine was abrogated by pre-treatment with naloxone and also non-selective NOS inhibitor, l-NAME [N(omega)-nitro-l-arginine-methyl-ester; 10(-3) M] implying an NO-dependent and mu-mediated mechanism. These results are similar to properties of recently found mu-3 receptor in leech, which is sensitive to alkaloids but not peptides. Both selective kappa agonist, U50,488 [3,4-dichloro-N-methyl-N-(2-(1-pyrrolidinyl)cyclohexyl)-benzeneacetamide; > or =10(-3) M], and antagonist, nor-binaltorphimine (nor-BNI; > or =10(-3) M), inhibited the accumulation. The effect of nor-BNI was reversed by l-NAME. Immunohistochemistry showed decreased endothelial NOS expression in naloxone and U50,488-treated cords. Since, NO production at the injury site is hypothesized to act as a stop signal for microglias, opioid agents may exert their effect via changing of NO gradient along the cord resulting in disruption of accumulation. These results suggest an immuno-modulatory role for mu and kappa opioid receptors on injury-induced microglial accumulation which may be mediated via NO.     

Development and validation of a sensitive HPLC method for the determination of lisinopril in human plasma after derivatization with 4-fluoro-7-nitro-2,1,3-benzoxadiazole

In this study, we developed a simple and sensitive HPLC method for the determination of lisinopril in human plasma. The sample clean-up was carried out by solid-phase extraction (SPE) using a cation-exchange (Strata-SCX^®) extraction cartridge. After a pre-column derivatization with 4-fluoro-7-nitro-2,1,3-benzoxadiazole, the reaction mixture was analyzed on an Agilent Zorbax SB^®-C₁₈ (150 mm×4.6 mm, 5 μm). The flow rate was set at 1.0 mL/min. Fluorescence detection was performed at an excitation wavelength of 470 nm and an emission wavelength of 530 nm. The mobile phase consisted of a mixture of methanol and 0.02 M sodium dihydrogen phosphate (pH = 3.0, 60:40, v/v). The average extraction recovery of lisinopril and fluvoxamine (internal standard) was >85%. The method exhibited a linear calibration curve over the concentration range of 1–1000 ng/mL with a correlation coefficient (r²) of ≥0.98 and a limit of quantification (LOQ) equal to 2 ng/mL. The within-run and between-run precisions were satisfactory with an RSD of 3.8%–13.7% (accuracy: from 95.0% to 96.4%) and 4.273%–14.3% (accuracy: from 94.4% to 98.5%), respectively.     

Influence of the final irrigation solution on the push-out bond strength of calcium silicate-based,epoxy resin-based and silicone-based endodontic sealers

Odontology - The aim was to evaluate the influence of different irrigation solutions on the push-out bond strength (POBS) of three different sealers (AH Plus, BioRoot RCS, GuttaFlow2). Root canals...