scholarly journals Backing into the future: pharmacological approaches to the management of resistant depression

2017 ◽  
Vol 47 (15) ◽  
pp. 2569-2577 ◽  
Author(s):  
P. J. Cowen
Keyword(s):  
General Medicine ◽  
Current Evidence ◽  
Antidepressant Effect ◽  
Dopamine Receptor Agonist ◽  
Depressed Patients ◽  
Pathophysiological Role ◽  
Resistant Depression ◽  
Pre Treatment ◽  
Continuous Use

Pragmatic studies indicate that a substantial number of depressed patients do not remit with current first-line antidepressant treatments and after two failed treatment steps the chance of remission with subsequent therapies is around 15%. This paper focuses on current evidence for pharmacological treatments in resistant depression as well as possible future developments. For patients who have failed to respond to two antidepressant trials, augmentation with atypical antipsychotic drugs, specifically quetiapine and aripiprazole, has the best evidence for efficacy, though older treatments such as lithium and triiodothyronine still have utility. The striking antidepressant effect of ketamine in resistant depression has stimulated research into glutamatergic compounds; however, capturing the efficacy of ketamine with drugs suitable for continuous use has proved challenging. Growing knowledge of the pathophysiological role of inflammation in depression offers great opportunities for future treatment in terms of repurposing anti-inflammatory agents from general medicine and pre-treatment stratification of those depressed patients in whom such interventions are likely to be beneficial. Finally an older drug, the dopamine receptor agonist pramipexole, if used carefully may well improve the prospects of depressed patients who are refractory to current approaches.

scholarly journals Arginine Derivatives in Cerebrovascular Diseases: Mechanisms and Clinical Implications

2020 ◽  
Vol 21 (5) ◽  
pp. 1798 ◽  
Author(s):  
Gerrit M. Grosse ◽  
Edzard Schwedhelm ◽  
Hans Worthmann ◽  
Chi-un Choe
Keyword(s):  
Ischemic Stroke ◽  
Vascular Function ◽  
Cerebrovascular Diseases ◽  
Current Evidence ◽  
Clinical Implications ◽  
Pathophysiological Role ◽  
Health And Disease ◽  
Oxide Synthase ◽  
Derivatives Of

The amino acid L-arginine serves as substrate for the nitric oxide synthase which is crucial in vascular function and disease. Derivatives of arginine, such as asymmetric (ADMA) and symmetric dimethylarginine (SDMA), are regarded as markers of endothelial dysfunction and have been implicated in vascular disorders. While there is a variety of studies consolidating ADMA as biomarker of cerebrovascular risk, morbidity and mortality, SDMA is currently emerging as an interesting metabolite with distinct characteristics in ischemic stroke. In contrast to dimethylarginines, homoarginine is inversely associated with adverse events and mortality in cerebrovascular diseases and might constitute a modifiable protective risk factor. This review aims to provide an overview of the current evidence for the pathophysiological role of arginine derivatives in cerebrovascular ischemic diseases. We discuss the complex mechanisms of arginine metabolism in health and disease and its potential clinical implications in diverse aspects of ischemic stroke.

Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

2013 ◽  
Vol 18 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Robert J. Barth
Keyword(s):  
Health Outcomes ◽  
Pain Perception ◽  
Driving Forces ◽  
Psychological Treatment ◽  
Dominant Role ◽  
Meta Analysis ◽  
General Medicine ◽  
Pain Syndrome ◽  
Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

Using serum biomarkers for identifying unstable carotid plaque: update of current evidence

2020 ◽  
Vol 26 ◽  
Author(s):  
Areti Sofogianni ◽  
Konstantinos Tziomalos ◽  
Triantafyllia Koletsa ◽  
Apostolos G. Pitoulias ◽  
Lemonia Skoura ◽  
...  
Keyword(s):  
High Risk ◽  
Great Proportion ◽  
Current Literature ◽  
Early Identification ◽  
Carotid Plaque ◽  
Potential Role ◽  
Carotid Atherosclerosis ◽  
Serum Biomarkers ◽  
Current Evidence

: Carotid atherosclerosis is responsible for a great proportion of ischemic strokes. Early identification of unstable or vulnerable carotid plaques and therefore of patients at high risk for stroke is of significant medical and socioeconomical value. We reviewed the current literature and discuss the potential role of the most important serum biomarkers in identifying patients with carotid atherosclerosis who are at high risk for atheroembolic stroke.

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

The application of virtual reality in health professions� digital education: a narrative review (Preprint)

2018 ◽  
Author(s):  
Lorraine Tudor Car ◽  
Bhone Myint Kyaw ◽  
Josip Car
Keyword(s):  
Virtual Reality ◽  
Professional Education ◽  
Health Professions ◽  
Health Professions Education ◽  
Narrative Review ◽  
Current Evidence ◽  
Future Research ◽  
Educational Content ◽  
Potential Applications

BACKGROUND Digital technology called Virtual Reality (VR) is increasingly employed in health professions’ education. Yet, based on the current evidence, its use is narrowed around a few most applications and disciplines. There is a lack of an overview that would capture the diversity of different VR applications in health professions’ education and inform its use and research. OBJECTIVE This narrative review aims to explore different potential applications of VR in health professions’ education. METHODS The narrative synthesis approach to literature review was used to analyse the existing evidence. RESULTS We outline the role of VR features such as immersion, interactivity and feedback and explain the role of VR devices. Based on the type and scope of educational content VR can represent space, individuals, objects, structures or their combination. Application of VR in medical education encompasses environmental, organ and micro level. Environmental VR focuses on training in relation to health professionals’ environment and human interactions. Organ VR educational content targets primarily human body anatomy; and micro VR microscopic structures at the level of cells, molecules and atoms. We examine how different VR features and health professional education areas match these three VR types. CONCLUSIONS We conclude by highlighting the gaps in the literature and providing suggestions for future research.

Institutions and the Embedded Entrepreneur

2019 ◽  
pp. 115-134
Author(s):  
Maryann Feldman ◽  
Paige Clayton
Keyword(s):  
Current Evidence ◽  
Future Research ◽  
Institutional Logic ◽  
The Relationship ◽  
Regional Resources

This chapter examines the relationship between entrepreneurs and the communities in which they are embedded. It argues that the actions of entrepreneurs and their firms are contextually situated in specific geographies that make their actions endogenous in the development of place and define a place-specific institutional logic. This argument is at odds with the view that industry clustering is due to the role of incumbent firms. This chapter reconciles these views by adopting a temporal view, allowing both incumbents and geography to co-occur and influence clustering. It then considers the current evidence of entrepreneurs’ effects on regional resources and capacity, and concludes with suggestions for future research.

scholarly journals Membrane condenser as emerging technology for water recovery and gas pre-treatment: current status and perspectives

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Adele Brunetti ◽  
Francesca Macedonio ◽  
Giuseppe Barbieri ◽  
Enrico Drioli
Keyword(s):  
Current Status ◽  
Innovative Technology ◽  
Water Recovery ◽  
Treatment Unit ◽  
Treatment Stage ◽  
Treatment Technologies ◽  
Pre Treatment ◽  
And Control

Abstract The recent roadmap of SPIRE initiative includes the development of “new separation, extraction and pre-treatment technologies” as one of the “key actions” for boosting sustainability, enhancing the availability and quality of existing resources. Membrane condenser is an innovative technology that was recently investigated for the recovery of water vapor for waste gaseous streams, such as flue gas, biogas, cooling tower plumes, etc. Recently, it has been also proposed as pre-treatment unit for the reduction and control of contaminants in waste gaseous streams (SOx and NOx, VOCs, H2S, NH3, siloxanes, halides, particulates, organic pollutants). This perspective article reports recent progresses in the applications of the membrane condenser in the treatment of various gaseous streams for water recovery and contaminant control. After an overview of the operating principle, the membranes used, and the main results achieved, the work also proposes the role of this technology as pre-treatment stage to other separation technologies. The potentialities of the technology are also discussed aspiring to pave the way towards the development of an innovative technology where membrane condenser can cover a key role in redesigning the whole upgrading process.

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