Management of Chlorine Gas-Related Injuries From the Graniteville, South Carolina, Train Derailment

2014 ◽  
Vol 8 (5) ◽  
pp. 411-416 ◽  
Author(s):  
Emily Mackie ◽  
Erik Svendsen ◽  
Stephen Grant ◽  
Jill E. Michels ◽  
William H. Richardson
Keyword(s):  
South Carolina ◽  
Large Scale ◽  
Treatment Options ◽  
Current Treatment ◽  
Automotive Electronics ◽  
Metal Production ◽  
Train Derailment ◽  
Randomized Controlled ◽  
Persistent Inflammation ◽  
Chlorine Gas

AbstractA widely produced chemical, chlorine is used in various industries including automotive, electronics, disinfectants, metal production, and many others. Chlorine is usually produced and transported as a pressurized liquid; however, as a gas it is a significant pulmonary irritant. Thousands of people are exposed to chlorine gas every year, and while large-scale exposures are uncommon, they are not rare. Symptoms are usually related to the concentration and length of exposure, and although treatment is largely supportive, certain specific therapies have yet to be validated with randomized controlled trials. The majority of those exposed completely recover with supportive care; however, studies have shown the potential for persistent inflammation and chronic hyperreactivity. This case report describes an incident that occurred in Graniteville, South Carolina, when a train derailment exposed hundreds of people to chlorine gas. This report reviews the events of January 6, 2005, and the current treatment options for chlorine gas exposure.(Disaster Med Public Health Preparedness. 2014;0:1-6)

scholarly journals The Arteriovenous Loop: Engineering of Axially Vascularized Tissue

2018 ◽  
Vol 59 (3-4) ◽  
pp. 286-299 ◽  
Author(s):  
Annika Weigand ◽  
Raymund E. Horch ◽  
Anja M. Boos ◽  
Justus P. Beier ◽  
Andreas Arkudas
Keyword(s):  
Tissue Engineering ◽  
Large Scale ◽  
Treatment Options ◽  
Current Treatment ◽  
Loop Model ◽  
Engineering Approach ◽  
In Vivo Tissue Engineering ◽  
Tissue Engineering Approach ◽  
Tissue Defects

Background: Most of the current treatment options for large-scale tissue defects represent a serious burden for the patients, are often not satisfying, and can be associated with significant side effects. Although major achievements have already been made in the field of tissue engineering, the clinical translation in case of extensive tissue defects is only in its early stages. The main challenge and reason for the failure of most tissue engineering approaches is the missing vascularization within large-scale transplants. Summary: The arteriovenous (AV) loop model is an in vivo tissue engineering strategy for generating axially vascularized tissues using the own body as a bioreactor. A superficial artery and vein are anastomosed to create an AV loop. This AV loop is placed into an implantation chamber for prevascularization of the chamber inside, e.g., a scaffold, cells, and growth factors. Subsequently, the generated tissue can be transplanted with its vascular axis into the defect site and anastomosed to the local vasculature. Since the blood supply of the growing tissue is based on the AV loop, it will be immediately perfused with blood in the recipient site leading to optimal healing conditions even in the case of poorly vascularized defects. Using this tissue engineering approach, a multitude of different axially vascularized tissues could be generated, such as bone, skeletal or heart muscle, or lymphatic tissues. Upscaling from the small animal AV loop model into a preclinical large animal model could pave the way for the first successful attempt in clinical application. Key Messages: The AV loop model is a powerful tool for the generation of different axially vascularized replacement tissues. Due to minimal donor site morbidity and the possibility to generate patient-specific tissues variable in type and size, this in vivo tissue engineering approach can be considered as a promising alternative therapy to current treatment options of large-scale defects.

scholarly journals Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer.

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1355 ◽  
Author(s):  
Cattrini ◽  
Castro ◽  
Lozano ◽  
Zanardi ◽  
Rubagotti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Small Sample Size ◽  
Treatment Options ◽  
Current Treatment ◽  
Abiraterone Acetate ◽  
Small Sample ◽  
Phase 3 ◽  
Tumor Patient ◽  
Randomized Controlled ◽  
Hormone Sensitive

The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-naïve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient’s risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers.

scholarly journals Modified Chaihu Shugan Powder for Functional Dyspepsia: Meta-Analysis for Randomized Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Nan Yang ◽  
Xuehua Jiang ◽  
Xuelan Qiu ◽  
Zhiqiang Hu ◽  
Ling Wang ◽  
...  
Keyword(s):  
Functional Dyspepsia ◽  
Large Scale ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Treatment Options ◽  
Serious Adverse Events ◽  
Prokinetic Drugs ◽  
Randomized Controlled ◽  
Chinese Herbal ◽  
Unpublished Studies

Context. Modified Chaihu Shugan powder (MCSP) is a popular traditional Chinese herbal formula for functional dyspepsia, which is revised from Chaihu Shugan San and recorded in a medical classic works of China. However, its role and effect in treating functional dyspepsia have not been well established.Objective. To assess the effect and safety of modified Chaihu Shugan powder for functional dyspepsia.Methods. We searched the published and unpublished studies up to August 2012. Only RCTs of modified Chaihu Shugan powder with or without prokinetic drugs versus prokinetic drugs in the patients diagnosed with functional dyspepsia were included.Results. Twenty-two clinical trials involving 1998 participants were included. There were evidences that modified Chaihu Shugan powder (RR = 1.20, 95%, CI 1.14 to 1.27) and modified Chaihu Shugan powder plus prokinetic drugs (RR = 1.18, 95%, CI 1.11 to 1.25) were significantly better treatment options than prokinetic drugs alone in improving symptoms. No serious adverse events were described in the included trials.Conclusions. This meta-analysis showed that modified Chaihu Shugan powder alone or in combination with prokinetic drugs might be more effective than prokinetic drugs alone. However, with poor methodological quality, all the included trials were at high risk of bias. Further large-scale high-quality trials are required for assessment.

scholarly journals Biologicals in Atopic Dermatitis

2021 ◽  
Author(s):  
Suvarna Samudrala
Keyword(s):  
Atopic Dermatitis ◽  
Large Scale ◽  
Treatment Options ◽  
Current Treatment ◽  
Phase 2 ◽  
Near Future ◽  
Larger Sample ◽  
Long Term Adverse Effects

Atopic dermatitis (AD) is a debilitating condition, and its management in both children and adults can be challenging for clinicians and patients alike. The current treatment options approved by the Food and Drug Administration (FDA) have variable efficacies, and long-term adverse effects, which further complicate the plan of management. There has been considerable progress towards the use of targeted medicines like biologicals and small molecular agents for atopic dermatitis. Various molecules targeting the TH2 pathway, JAK/STAT pathway, cAMP, IL-22, Il-12/IL-23 and IgE, have been developed, and are being studied extensively in both adults and pediatric patients of atopic dermatitis. Currently, only Dupilumab is approved by the FDA for the treatment of moderate to severe refractory atopic dermatitis. The other biological agents are currently in phase 2 or phase 3 trials. There is a paucity of multicentric, large-scale studies on the above drugs, along with a lack of comparative studies with the existing modalities of treatment. Therefore, more studies with a larger sample size and longer follow up periods are needed to determine their efficacy and long-term safety profiles. Overall, these agents are likely to be a part of the therapeutic armamentarium for atopic dermatitis in the near future.

Pediatric Gliomas: Current Concepts on Diagnosis, Biology, and Clinical Management

2017 ◽  
Vol 35 (21) ◽  
pp. 2370-2377 ◽  
Author(s):  
Dominik Sturm ◽  
Stefan M. Pfister ◽  
David T.W. Jones
Keyword(s):  
Large Scale ◽  
Treatment Options ◽  
Tumor Biology ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Cns Tumors ◽  
Low Grade ◽  
Who Grade ◽  
Short Period ◽  
Life Threatening

Gliomas are the most common CNS tumors in children and adolescents, and they show an extremely broad range of clinical behavior. The majority of pediatric gliomas present as benign, slow-growing lesions classified as grade I or II by the WHO classification of CNS tumors. These pediatric low-grade gliomas (LGGs) are fundamentally different from IDH-mutant LGGs occurring in adults, because they rarely undergo malignant transformation and show excellent overall survival under current treatment strategies. However, a significant fraction of gliomas develop over a short period of time and progress rapidly and are therefore classified as WHO grade III or IV high-grade gliomas (HGGs). Despite all therapeutic efforts, they remain largely incurable, with the most aggressive forms being lethal within months. Thus, the intentions of neurosurgeons, pediatric oncologists, and radiotherapists to improve care for pediatric patients with glioma range from increasing quality of life and preventing long-term sequelae in what is often a chronic, but rarely life-threatening disease (LGG), to uncovering effective treatment options to prolong patient survival in an almost universally fatal setting (HGG). The last decade has seen unprecedented progress in understanding the molecular biology underlying pediatric gliomas, fueling hopes to achieve both goals. Large-scale collaborative studies around the globe have cataloged genomic and epigenomic alterations in gliomas across ages, grades, and histologies. These studies have revealed biologic subgroups characterized by distinct molecular, pathologic, and clinical features, with clear relevance for patient management. In this review, we summarize hallmark discoveries that have expanded our knowledge in pediatric LGGs and HGGs, explain their role in tumor biology, and convey our current concepts on how these findings may be translated into novel therapeutic approaches.

scholarly journals Lennox-Gastaut Syndrome: An Update on Treatment

2012 ◽  
Vol 39 (6) ◽  
pp. 702-711 ◽  
Author(s):  
Lionel Carmant ◽  
Sharon Whiting
Keyword(s):  
Seizure Frequency ◽  
Seizure Control ◽  
Wide Spectrum ◽  
Controlled Trial ◽  
Treatment Options ◽  
Safety Data ◽  
Current Treatment ◽  
Epileptic Encephalopathy ◽  
Adjunctive Treatment ◽  
Randomized Controlled

Lennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy. Few current treatment options are effective in improving seizure control. This paper reviews the available treatments of LGS and discusses a new option in Canada, rufinamide. It is a wide spectrum anticonvulsant, approved in a number of countries for the treatment of LGS. In a randomized controlled trial in the LGS population, adjunctive rufinamide therapy has been shown to offer significantly greater reduction in total seizure frequency and tonic-atonic seizure frequency in comparison to placebo. Efficacy has been assessed over three years and appears to be sustained. Most adverse events were cognitive (e.g. somnolence) or gastrointestinal in nature and in many cases transient or mild. Based on the efficacy and safety data on rufinamide obtained to date, this medication will provide additional benefits to patients with LGS in Canada and is an important consideration for our patients in the adjunctive treatment setting.

scholarly journals Lichen Planus and Its Management: An Update and Observation

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Lichen Planus ◽  
Large Scale ◽  
Treatment Options ◽  
Current Treatment ◽  
Evidence Based ◽  
Aggressive Treatment ◽  
Ongoing Trial ◽  
Or Management ◽  
Cutaneous Disease ◽  
Different Types

Lichen planus (LP) is an inflammatory muco-cutaneous disease characterised by shiny, flat-topped papules and plaques. It affects around 1% of the population. The disease is usually self-limiting and benign in nature. However, some varieties of LP may cause considerable discomfort and recalcitrant in nature. So, treatment depends on appreciating the type, severity and nature of the disease. There are a good numbers of options for treating different types of LP. Few types of LP are difficult to treat and needs aggressive treatment to prevent complications like hair or nail loss. Author examined and summarized the published literature involving the treatment or management of LP. It is found that the large scale, evidence based trials are only few in number. At present, it is quite difficult to standardisation of treatment. This review outlines the ongoing trial and current treatment options. It is needed to assimilation and summarization of the recent findings to treat the critical cases in a more effective way

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

Relationship between total plasma homocysteine and the risk of aneurysms – a meta-analysis

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Hanji Zhang ◽  
Dexin Yin ◽  
Yue Zhao ◽  
Yezhou Li ◽  
Dejiang Yao ◽  
...  
Keyword(s):  
Large Scale ◽  
Meta Analysis ◽  
Single Species ◽  
Total Plasma ◽  
Control Groups ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
The Difference ◽  
The Relationship ◽  
Healthy Participants

Summary: Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.

Sign in / Sign up

Export Citation Format

Share Document