Use Of Recordings Research Articles

Formulation Strategies to Overcome Amphotericin B Induced Toxicity.

Fungal infection poses a major global threat to public health because of its wide prevalence, severe mortality rate, challenges involved in diagnosis and treatment, and the emergence of drug-resistant fungal strains. Millions of people are getting affected by fungal infection, and around 3.8 million people face death per year due to fungal infection, as per the latest report. The polyene antibiotic AmB has an extensive record of use as a therapeutic moiety against systemic fungal infection and leishmaniasis since 1960. AmB has broad-spectrum fungistatic and fungicidal activity. AmB exerts its therapeutic activity at the cellular level by binding to fungal sterol and forming hydrophilic pores, releasing essential cellular components and ions into the extracellular fluid, leading to cell death. Despite using AmB as an antifungal and antileishmanial at a broad scale, its clinical use is limited due to drug-induced nephrotoxicity resulting from binding the aggregated form of the drug to mammalian sterol. To mitigate AmB-induced toxicity and to get better anti-fungal therapeutic outcomes, researchers have developed nanoformulations, self-assembled formulations, prodrugs, cholesterol- and albumin-based AmB formulations, AmB-mAb combination therapy, and AmB cochleates. These formulations have helped to reduce toxicity to a certain extent by controlling the aggregation state of AmB, providing sustained drug release, and altering the physicochemical and pharmacokinetic parameters of AmB. Although the preclinical outcome of AmB formulations is quite satisfactory, its parallel result at the clinical level is insignificant. However, the safety and efficacy of AmB therapy can be improved at the clinical stage by continuous investigation and collaboration among researchers, clinicians, and pharmaceutical companies.

Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter study: 1-year outcomes.

Previous randomized controlled trials have reported a significantly higher occlusion rate of large and giant aneurysms when utilizing the Tubridge flow diverter (FD). In the present trial, the safety and efficacy of the Tubridge FD in treating unruptured internal carotid artery (ICA) or vertebral artery (VA) aneurysms were assessed in a real-world setting. The Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter (IMPACT) study is a prospective, multicenter, single-arm clinical trial assessing the efficacy of the Tubridge FD in the management of unruptured aneurysms located in the ICA or VA. The primary endpoint was the complete occlusion (Raymond-Roy class 1) rate at the 1-year follow-up. The secondary endpoints included the technical success rate, the successful occlusion rate of the aneurysm, which is the degree of aneurysm embolization scored as Raymond-Roy class 1 or 2, major (> 50%) in-stent stenosis, and incidence of disabling stroke or neurological death associated with the target aneurysms. This study included 14 interventional neuroradiology centers, with 200 patients and 240 aneurysms. According to angiographic core laboratory assessment, 205 (85.4%) aneurysms were located in the ICA, 34 (14.2%) in the VA, and 1 (0.4%) in the middle cerebral artery. Additionally, 189 (78.8%) aneurysms were small (< 10 mm). At the 12-month follow-up, the total occlusion rate was 79.0% (166/210, 95% CI 72.91%-84.34%). Additionally, the occurrence of disabling stroke or neurological death related to the specified aneurysms was 1% (2/200). The 1-year results from the IMPACT trial affirm the safety record of use of the Tubridge FD in the treatment of intracranial aneurysms in real-world scenarios. These results reveal low morbidity and mortality rates of 3.5% and 1.5%, respectively. Furthermore, they provide evidence of the effectiveness of the Tubridge FD, as demonstrated by the complete occlusion achieved in 166 of 210 (79%) cases.

Targeting the core program of metastasis with a novel drug combination.

We previously reported that metastases are generally characterized by a core program of gene expression that activates tissue remodeling/vascularization, alters ion homeostasis, induces the oxidative metabolism, and silences extracellular matrix interactions. This core program distinguishes metastases from their originating primary tumors as well as from their destination host tissues. Therefore, the gene products involved are potential targets for anti-metastasis drug treatment. Because the silencing of extracellular matrix interactions predisposes to anoiks in the absence of active survival mechanisms, we tested inhibitors against the other three components. Individually, the low-specificity VEGFR blocker pazopanib (in vivo combined with marimastat), the antioxidant dimethyl sulfoxide (or the substitute atovaquone, which is approved for internal administration), and the ionic modulators bumetanide and tetrathiomolybdate inhibited soft agar colony formation by breast and pancreatic cancer cell lines. The individual candidate agents have a record of use in humans (with limited efficacy when administered individually) and are available for repurposing. In combination, the effects of these drugs were additive or synergistic. In two mouse models of cancer (utilizing 4T1 cells or B16-F10 cells), the combination treatment with these medications, applied immediately (to prevent metastasis formation) or after a delay (to suppress established metastases), dramatically reduced the occurrence of disseminated foci. The combination of tissue remodeling inhibitors, suppressors of the oxidative metabolism, and ion homeostasis modulators has very strong promise for the treatment of metastases by multiple cancers.

The effect of diabetes mellitus on perioperative outcomes after colorectal resection: a national cohort study

BackgroundDiabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes after colorectal resection using a national cohort. MethodsAdults with a recorded colorectal resection in England between 2010 and 2020 were identified from Hospital Episode Statistics data linked to the Clinical Practice Research Database. The primary outcome was 90-day mortality. Secondary outcomes included hospital length of stay (LOS) and readmission within 90 days. ResultsOf the 106 139 (52 875, 49.8% male) patients included, diabetes mellitus was prevalent in 10 931 (10.3%), 2145 (19.6%) of whom had a record of use of insulin. Unadjusted 90-day mortality risk was 5.7%, with an increased adjusted hazard ratio (aHR) for people with diabetes mellitus (aHR 1.28, 95% confidence interval [CI] 1.19–1.37, P<0.001). This risk was higher in both people with diabetes using insulin (aHR 1.51, 95% CI 1.31–1.74, P<0.001) and not using insulin (aHR 1.22, 95% CI 1.13–1.33, P<0.001), compared with those without diabetes. Ninety-day readmission occurred in 20 542 (19.4%) patients and this was more likely in those with diabetes mellitus (aHR 1.23, 95% CI 1.18–1.29, P<0.001). Median (inter-quartile range) LOS was 8 (5–15) days and was higher in people with diabetes mellitus (adjusted time ratio 1.10, 95% CI 1.08–1.11, P<0.001). ConclusionsPeople with diabetes mellitus undergoing colorectal resection are at a higher risk of 90-day mortality, prolonged LOS, and 90-day readmission, with use of insulin associated with additional risk.

Cardiovascular Risk Assessment in Pregnancy: Findings From a Large Urban Academic Medical Center [ID 2683572

INTRODUCTION: The goal of this study is to describe patients who screened positive and had true cardiovascular disease (CVD) identified using a risk assessment tool in pregnancy or postpartum. METHODS: This is a prospective validation study of the CVD screening algorithm proposed by the California Maternal Quality Care Collaborative (CMQCC). The CVD risk assessment tool was embedded in the electronic medical record for use by all prenatal care providers with a goal of at least one CVD risk assessment during pregnancy and/or postpartum period. Patients identified with increased risk of CVD received an echocardiogram, electrocardiogram, and cardiology consultation. We describe the assessment tool responses, timing of assessment, cardiac findings, and subsequent interventions. This study was approved by the IRB at Albert Einstein College of Medicine. RESULTS: A total of 1,877 patients were screened as of September 1, 2023, with 148 screening positive for at risk of CVD. Thirty-two patients were found to be true positives including 2 (6.25%) with systolic and/or diastolic dysfunction, 10 (31.3%) with ventricular dilation or hypertrophy, and 23 (71.9%) with a valvular abnormality. CONCLUSION: All 32 true-positive cases were seen by a multidisciplinary cardio-obstetrics team at least once. Ten patients had multiple visits with the cardio-obstetrics team. Three patients were deemed to be of higher risk for decompensation during labor by modified World Health Organization classification and required detailed plans for intrapartum and postpartum management. Seven patients were started on cardiovascular medications. The cardiovascular risk assessment tool proved valuable for identifying and providing individualized care for cardio-obstetric patients.

Preliminary Phytochemical Analysis, &lt;i&gt;In-vitro&lt;/i&gt; Evaluation of Antibacterial and Anticancer Activity of &lt;i&gt;Cleome aspera&lt;/i&gt; Aerial Part Extracts

Various species of the Cleome genus belong to the circle of relatives Cleomaceae family, and order Brassicales, constitute flowering flora with a long record of use in conventional remedies, and have been related to the prevention of many illnesses. Cleome aspera has not been thoroughly investigated in the medicinal area; however, it may offer a therapeutic choice in favour of the management of various disorders. In this recent study, the aerial parts of C. aspera were extracted with petroleum ether, ethyl acetate, and ethanol sequentially in ascending polarity order. Ethanol extract exhibited a rich phytochemical profile and antibacterial and anti-cancer action among the solvent extracts. The phytochemical analysis of three extracts exhibited the existence of many secondary metabolites like flavonoids, alkaloids tannins, polyphenols, steroids, glycosides, and terpenoids. The antibacterial activity against two Gram (+) bacteria, Staphylococcus aureus (ATCC 6538), and Bacillus subtilis (ATCC 6633), as well as two Gram (-) bacteria, Pseudomonas aeruginosa (ATCC 9027) and Escherichia coli (ATCC 8739) was assessed at three concentrations (50, 100, 200 μg/ml) of each extract. The broth dilution method tested the extract’s minimum inhibitory concentration against four bacterial strains. Using the MTT (3-(4,5-Dimethylthiazol-2-Yl)-2,5-Diphenyltetrazolium Bromide) assay, the three extracts (petroleum ether, ethyl acetate, and ethanol) of C. aspera were evaluated for in-vitro cytotoxic activity. The extracts were detected to have substantial antibacterial activity against Gram-positive as well as Gram-negative bacteria in a dose-dependent manner. The ethanol extract of C. aspera showed notable anticancer efficacy after comparing it with petroleum ether, and ethyl acetate extracts. This study proved that the plant C. aspera has potential as a source of plant-based drugs and has therapeutic qualities like antibacterial and anticancer activities. It may provide a healing choice for the control of several diseases. A further extensive study on the isolation of active ingredients, purification, characterization, and elucidation of viable mechanisms can be executed.

Abstract IA013: Integrating natural product samples back into drug screening programs

Abstract Natural products have a proven track record in use as anti-cancer agents. As of 2020 natural products (NPs), NP pharmacophores, and NP mimics represent a significant percentage of small molecule-based anti-cancer drugs. However, accessing the potential of NPs in high-throughput screening (HTS) campaigns has been challenging due to the complexity of the crude NP extracts, the time necessary for follow-up isolation efforts, and indefinite capabilities for resupply. This has resulted in NP-based libraries being significantly underrepresented in most recent large-scale HTS programs. The US National Cancer Institute’s Natural Product Extract Repository is one of the world’s largest, most diverse collections of natural products containing &amp;gt;200,000 unique extracts derived from plant, marine and microbial organisms. To address the challenges in screening NPs and encourage increased assay of NP chemical diversity, the NCI created a Program for Natural Product Discovery (NPNPD) which has developed an automated, high-throughput robotics platform that has created 500,000 pre-fractionated NP samples and released them to the public for screening. In addition, automated secondary purification and structure elucidation systems were created that significantly decrease costs and timelines. This presentation will discuss the reasons for, challenges to, and mechanisms by which the NCI is working to increase the pace and efficiency of NP-based drug discovery. Citation Format: Barry R. O'Keefe. Integrating natural product samples back into drug screening programs [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr IA013.

Water consumption assessment and classification in industrial buildings - The case study of Continental Advanced Antenna, Vila Real, Portugal

Water abstraction for the industrial, domestic, and agricultural sectors increased from 0.67 trillion m3/year in the 1900s to 3.79 trillion m3/year in 2000, and it is expected to increase by 55 % in 2050 when the majority of the world's population will live in urban areas. Concerning the industrial sector, despite the efforts to a more sustainable use, water is still an essential and irreplaceable resource, and this situation tends to increase due to modern industrial installations that require large-scale and complex water distribution systems. Usually, industries consume a large volume of water, however due to more and severer regulations, it is necessary to propose strategies for the aid of water conservation.This article presents a methodology to analyse, classify and optimize water consumption in industrial installations, using a real case study located in Vila Real, Portugal. The daily water consumption per worker, the daily record of use of each type of device and the hourly usage pattern were analysed and a classification was achieved according to the ANQIP (National Association for Quality in Building Installations) calculator. The case study revealed a great opportunity of improvement in what concerns to water efficient use. Some measures to improve the efficiency of water use in the building were pointed out, such as the use of rainwater harvesting systems, the use of aerators and replacements of taps and faucets when possible.The methodology is expeditious and user-friendly, and easy to replicate in similar cases, however it reveals some difficulties (especially in the data collection process that is made by inquiry, once it is always dependent on the respondent sensibility and willingness).

Lower mortality with andexanet alfa vs 4-factor prothrombin complex concentrate for factor Xa inhibitor-related major bleeding in a U.S. hospital-based observational study

BackgroundWell-designed studies with sufficient sample size comparing andexanet alfa vs 4-factor prothrombin complex concentrate (4F-PCC) in routine clinical practice to evaluate clinical outcomes are limited. ObjectivesTo compare in-hospital mortality in patients hospitalized with rivaroxaban- or apixaban-related major bleeding who were treated with andexanet alfa or 4F-PCC. MethodsAn observational cohort study (ClinicalTrials.gov identifier: NCT05548777) was conducted using electronic health records between May 2018 and September 2022 from 354 U.S. hospitals. Inclusion criteria were age ≥18 years, inpatient admission with diagnosis code D68.32 (bleeding due to extrinsic anticoagulation), a record of use of the factor Xa inhibitors rivaroxaban or apixaban, andexanet alfa or 4F-PCC treatment during index hospitalization, and a documented discharge disposition. Multivariable logistic regression on in-hospital mortality with andexanet alfa vs 4F-PCC was performed. The robustness of the results was assessed via a supportive propensity score-weighted logistic regression. ResultsThe analysis included 4395 patients (andexanet alfa, n = 2122; 4F-PCC, n = 2273). There were 1328 patients with intracranial hemorrhage (ICH), 2567 with gastrointestinal (GI) bleeds, and 500 with critical compartment or other bleed types. In the multivariable analysis, odds of in-hospital mortality were 50% lower for andexanet alfa vs 4F-PCC (odds ratio [OR], 0.50; 95% CI, 0.39-0.65; P < .01) and were consistent for both ICH (OR, 0.55; [0.39-0.76]; P < .01) and GI bleeds (OR, 0.49 [0.29-0.81]; P = .01). Similar results were obtained from the supporting propensity score-weighted logistic regression analyses. ConclusionIn this large observational study, treatment with andexanet alfa in patients hospitalized with rivaroxaban- or apixaban-related major bleeds was associated with 50% lower odds of in-hospital mortality than 4F-PCC. The magnitude of the risk reduction was similar in ICH and GI bleeds.

A Wearable Fiber-Free Optical Sensor for Continuous Monitoring of Cerebral Blood Flow in Freely Behaving Mice.

Wearable technologies for functional brain monitoring in freely behaving subjects can advance our understanding of cognitive processing and adaptive behavior. Existing technologies are lacking in this capability or need procedures that are invasive and/or otherwise impede brain assessments during social behavioral conditions, exercise, and sleep. In response a complete system was developed to combine relative cerebral blood flow (rCBF) measurement, O2 and CO2 supplies, and behavior recording for use on conscious, freely behaving mice. An innovative diffuse speckle contrast flowmetry (DSCF) device and associated hardware were miniaturized and optimized for rCBF measurements in small subject applications. The use of this wearable, fiber-free, near-infrared DSCF head-stage/probe allowed no craniotomy, minimally invasive probe implantation, and minimal restraint of the awake animal. Significant correlations were found between measurements with the new DSCF design and an optical standard. The system successfully detected rCBF responses to CO2-induced hypercapnia in both anesthetized and freely behaving mice. Collecting rCBF and activity information together during natural behaviors provides realistic physiological results and opens the path to exploring their correlations with pathophysiological conditions.

European regulations on the use of antibiotics in veterinary medicine

Antimicrobial resistance endangers the successful combat of bacterial infections in humans and animals. The common use of antibiotic classes including those of high clinical value in human as well as veterinary medicine is a critical factor contributing to or suspected to promote the emergence of antibiotic resistance. New legal provisions laid down in veterinary drug legislations and related guidelines and advice are in force in the European Union to safeguard the effectiveness, accessibility and availability of antibiotics.Categorisation of antibiotics in classes of importance for treatment of infections of humans by the WHO was one of the first steps. This task is also undertaken for antibiotics for treatment of animals by the EMA's Antimicrobial Advice Ad Hoc Expert Group. The new veterinary Regulation (EU) 2019/6 has extended restrictions for use of some antibiotics in animals to a full ban of certain antibiotics. While some (but not all) antibiotic compounds not being authorized in veterinary medicine may still be used in companion animals more strict provisions were already applicable for treatment of food producing animal species. Distinct regulations are in place for the treatment of animals kept in large numbers in flocks. Initial regulations focussed on the protection of consumers from residues of veterinary drugs in food commodities, new regulations address prudent (not routinely) and responsible selection, prescription and use of antibiotics, and have improved the practicality for cascade use outside the terms of marketing authorisation. Mandatory recording of use of veterinary medicinal products for food safety reasons is extended to rules for veterinarians and owners or holders of animals to regularly report the use of antibiotics for the purpose of official surveillance of consumption. National sales data of antibiotic veterinary medicinal products have been collected on a voluntary basis until 2022 by ESVAC, which has created awareness of major differences between EU member states. A significant decline in sales was reported for third and fourth generation cephalosporines, polymyxins (colistin), and (fluoro)quinolones since the initiation in 2011.

Barriers and Opportunities for the Use of Digital Tools in Medicines Optimization Across the Interfaces of Care: Stakeholder Interviews in the United Kingdom

People with long-term conditions frequently transition between care settings that require information about a patient's medicines to be transferred or translated between systems. This process is currently error prone and associated with unintentional changes to medications and miscommunication, which can lead to serious patient consequences. One study estimated that approximately 250,000 serious medication errors occur in England when a patient transitions from hospital to home. Digital tools can equip health care professionals with the right information at the right time and place to support practice. This study aimed to answer the following questions: what systems are being used to transfer information across interfaces of care within a region of England? and what are the challenges and potential opportunities for more effective cross-sector working to support medicines optimization? A team of researchers at Newcastle University conducted a qualitative study by performing in-depth semistructured interviews with 23 key stakeholders in medicines optimization and IT between January and March 2022. The interviews lasted for approximately 1 hour. The interviews and field notes were transcribed and analyzed using the framework approach. The themes were discussed, refined, and applied systematically to the data set. Member checking was also performed. This study revealed themes and subthemes pertaining to 3 key areas: transfer of care issues, challenges of digital tools, and future hopes and opportunities. We identified a major complexity in terms of the number of different medicine management systems used throughout the region. There were also important challenges owing to incomplete patient records. We also highlighted the barriers related to using multiple systems and their subsequent impact on user workflow, a lack of interoperability between systems, gaps in the availability of digital data, and poor IT and change management. Finally, participants described their hopes and opportunities for the future provision of medicines optimization services, and there was a clear need for a patient-centered consolidated integrated health record for use by all health and care professionals across different sectors, bridging those working in primary, secondary, and social care. The effectiveness and utility of shared records depend on the data within; therefore, health care and digital leaders must support and strongly encourage the adoption of established and approved digital information standards. Specific priorities regarding understanding of the vision for pharmacy services and supporting this with appropriate funding arrangements and strategic planning of the workforce were also described. In addition, the following were identified as key enablers to harness the benefits of digital tools to support future medicines optimization: development of minimal system requirements; enhanced IT system management to reduce unnecessary repetition; and importantly, meaningful and continued collaboration with clinical and IT stakeholders to optimize systems and share good practices across care sectors.

On the use ofsì?(‘yes?’) as invariant follow-up in Italian

AbstractFollow-ups are elliptical interrogative forms typically constituting an utterance in their own right. They are used to signal attention to the interlocutor, to encourage them to continue or as a reply to a call. This paper investigates the invariant follow-upsì?(‘yes?’) in Italian and it argues that it represents a case of pragmatic language change. To this end, it investigates the diachronic distribution, collocation and contexts of usage ofsì?in a variety of language sources in relation to plausible, equivalent expressions (i.e.,dimmianddica[‘tell me’]). The analysis will show that since its earliest record of use in films in 1960, the frequency of occurrence of this form has dramatically increased to the point that, today, it is the preferred device. The study will also provide solid evidence of positive correlations between the use ofyes?in English language audio-visual products and the use ofsì?in scripted and real-use Italian, strongly suggesting that the marker would in fact be a case of pragmatic borrowing from English.

사람 간암세포주 HepG2에서 수벌번데기 ( Apis mellifera L.) 추출물의 증식억제효과

In recent years, edible insects have caught the attention of researchers, because of their potential as an alternative source of food and nutraceuticals. Based on the record of use for edible and medicinal purpose, drone pupa was approved as a new food ingredient in 2021. To investigate the possibility of antiproliferative effect for malignancy, we observed the viability of HepG2 cells by treating the extract. When the extract was treated in HepG2 cells at 10 mg/mL and 5 mg/mL for 24 hours, the cell viability was 49.33 and 66.98%, respectively. Detection nucleosomes in cytoplasmic fractions showed that drone pupa extract induced apoptosis in HepG2. Western blotting was used to evaluate apoptosis-related protein expression such as Bcl-2, Bcl-xL, Bax, caspase 3. Our result suggest that drone pupa extract have apoptosis-induced activity in HepG2 cancer cell.

Past, Present and Future of Bacillus Calmette-Guérin Vaccine Use in China.

The BCG vaccine is prepared from a weakened strain of Mycobacterium bovis (M. bovis), a bacterium closely related to Mycobacterium tuberculosis (MTB), which causes tuberculosis (TB). The vaccine was developed over 13 years, from 1908 to 1921, in the French Institut Pasteur by Léon Charles Albert Calmette and Jean-Marie Camille Guérin, who named the product Bacillus Calmette–Guérin (BCG). BCG, the only licensed vaccine currently available to prevent TB, is given to infants at high risk of TB shortly after birth to protect infants and young children from pulmonary, meningeal, and disseminated TB. The BCG vaccine, one of the safest and most widely used live attenuated vaccines in the world, recently celebrated its 100th anniversary (from 1921 to 2021); its record of use in preventing TB in China is also approaching 100 years. In 2022, a new century of BCG vaccine immunization will begin. In this article, we briefly review the history of BCG vaccine use in China, describe its current status, and offer a preliminary outlook on the future of the vaccine, to provide BCG researchers with a clearer understanding of its use in China.

Analysis of sedation and general anesthesia in patients with special needs in dentistry using the Korean healthcare big data.

BackgroundPeople with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry.MethodsThe study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution.ResultsThe number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M: F = 64.36% : 35.64%).ConclusionThe application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.

Analysis of changes and trends in the use of sedatives in dental sedation using data from the National Health Insurance in Korea.

BackgroundAlthough dental sedation helps control anxiety and pain, side effects and serious complications related to sedation are gradually increasing. Due to the introduction of new drugs and sedation methods, insurance rates, legal regulations, drugs, and methods used for dental sedation are inevitably changed. In the Republic of Korea, National Health Insurance is applied to all citizens, and this study investigated changes in the use of sedatives using this big data.MethodsThis study used customized health information data provided by the Healthcare Insurance Review & Assessment Service of Korea. Among patients with a record of use of at least one of eight types of sedatives for dental sedation between January 2007 and September 2019 were selected; the data of their overall insurance claims for dental treatment were then analyzed.ResultsThe number of patients who received dental sedation was 786,003, and the number of dental sedation cases was 1,649,688. Inhalational sedation using nitrous oxide (N2O) accounted for 86.8% of all sedatives that could be claimed for drugs and treatment. In particular, it was confirmed that the number of requests for sedation using N2O sharply increased each year. Midazolam showed an increasing trend, and in the case of chloral hydrate, it gradually decreased.ConclusionAccording to our analysis, the use of N2O and midazolam gradually increased, while the use of chloral hydrate gradually decreased.

Evaluation of Anti-Ulcer activity of Tephrosia purpurea Linn Pers Leaf Extract in Wistar Rats

India is known for its traditional medicinal system – Ayurveda, Siddha and Unani. There are several references in our ancient literature about the miraculous curing properties of the plant-based drugs. “Rig Veda and Atharva veda” seems to be the earliest record of use of plant in the medicine. A stomach ulcer involves an erosion in a person’s gastrointestinal tract. ‘Peptic’ is derived from Greek word “Peptikos” who’s meaning is related to digestion. Peptic ulcer occurs in the part of the gastrointestinal track which is exposed to gastric acid and pepsin (i.e) the stomach and duodenum. The extract of Tephrosia purpurea flowers against viruses and is very good antibacterial against Gram +ve and Gram -ve strain. The Plant extract was prepared and the phytochemical analysis was performed. The extract was administered with animals. The drug were administered orally once daily for 2 days and 45 min prior to pyloric ligation. The animals are sacrificed after four hours of pylorus ligation. The result indicates that, Flavonoids and Tannins have shown to be present in the TPAL treated groups. Since flavanoids antagonize aggressive factor which play a decisive role in the pathogenesis of gastric lesion and also enhance defence factor to protect the gastric mucosa from injury. Flavanoids diminish histamine secretion from mast cell by inhibition of histidine decarboxylase and stimulate PG biosynthesis. So the antiulcer activity of TPAL may be attributed to its flavonoid content. The study concluded that TPAL has an anti ulcer activity which may be due to protection and the strengthening of the mucosal defensive factor like mucus, bicarbonate, prostaglandin.

Tacrolimus Induced Organ Failure: Reversal by Activation of the Cytochrome P450-3a System

Tacrolimus is the cornerstone component of all immunosuppressive regimens. Despite its long record of use, very little is known about its acute toxicity syndrome. We describe five patients with acute organ failure, involving both native and transplanted organs, which was reversed by inducing the cytochrome P450-3A system. In all patients, the causative drug was stopped and phenytoin was given intravenously to accelerate tacrolimus metabolism. Within 24 h, tacrolimus trough levels fell daily at a significant level (p &lt; 0.05) and all failed organs recovered their normal function within 48–72 h. Therefore, phenytoin metabolic induction appears to be a safe therapeutic option for patients with acute tacrolimus toxicity.

Pilot Testing of Simulation in the Evaluation of a Novel, Rapidly Deployable Electronic Health Record for use in Disaster Intensive Care.

The SARS-CoV-2 pandemic has highlighted the need for rapid creation and management of ICU field hospitals with effective remote monitoring which is dependent on the rapid deployment and integration of an Electronic Health Record (EHR). We describe the use of simulation to evaluate a rapidly scalable hub-and-spoke model for EHR deployment and monitoring using asynchronous training. We adapted existing commercial EHR products to serve as the point of entry from a simulated hospital and a separate system for tele-ICU support and monitoring of the interfaced data. To train our users we created a modular video-based curriculum to facilitate asynchronous training. Effectiveness of the curriculum was assessed through completion of common ICU documentation tasks in a high-fidelity simulation. Additional endpoints include assessment of EHR navigation, user satisfaction (Net Promoter), system usability (System Usability Scale-SUS), and cognitive load (NASA-TLX). A total of 5 participants achieved a 100% task completion on all domains except ventilator data (91%). Systems demonstrated high degrees of satisfaction (Net Promoter = 65.2), acceptable usability (SUS = 66.5), and acceptable cognitive load (NASA-TLX = 41.5); with higher levels of cognitive load correlating with the number of screens employed. Clinical usability of a comprehensive and rapidly deployable EHR was acceptable in an intensive care simulation which was preceded by < 1 hour of video education about the EHR. This model should be considered in plans for integrated clinical response with remote and accessory facilities.