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Weiss Dueholm posted an update 9 days ago
PURPOSE Psychological stress and ensuing modulation of the immune and nervous systems can have a significant impact on itch. Stress can exacerbate itch and vice versa, resulting in a vicious cycle that can greatly impair a patient’s quality of life. This review summarizes the association between stress and itch, elucidates the mechanism by which these two phenomena influence one another, and explores treatment modalities that aim to reduce stress-induced itch. METHODS A complete search of the PubMed and Google Scholar databases was completed and literature pertinent to this review was compiled. FINDINGS Both acute and chronic stress can significantly affect itch in healthy individuals and in those diagnosed with itchy skin diseases as well as systemic diseases, thus resulting in a vicious cycle in which stress exacerbates itch and vice versa. Calcium folinate mouse The mechanisms by which stress induces or aggravates itch include both central and peripheral activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. Activation of these systems, in turn, affects the mast cells, keratinocytes, and nerves that secrete neuropeptides, such as substance P, nerve growth factor, acetylcholine, histamine, and itchy cytokines. A dysfunctional parasympathetic response is thought to be involved in the chronic stress/itch response. Brain structures associated with emotion, such as the limbic system and periaqueductal gray, which work on the descending facilitation of itch, play a significant role in stress-induced itch. IMPLICATIONS As specific brain structures are associated with stress, drug treatments targeting these areas (ie, γ-aminobutyric acid-ergic drugs, serotonin and norepinephrine reuptake inhibitors) may help to modulate itch. Stress can also be combatted using nonpharmacologic treatments such as cognitive-behavioral therapies and stress-relieving holistic approaches (eg, yoga, acupuncture). PURPOSE The complex combination of medicines associated with age-related physiological alterations leads older adults to experience drug-related problems (DRPs). The goal of this study was to review the frequency and type of DRPs and DRP risk factors in home-dwelling older adults. METHODS A MEDLINE PubMed and EMBASE scientific databases search was performed. Articles published from January 2000 through December 2018 reporting DRPs in home-dwelling older adults were included. FINDINGS From 668 articles screened, 13 met the inclusion criteria and were included in this study. Overall, the studies included 8935 home-dwelling patients. The mean number of DRPs per patient observed was 4.16 (1.37-10). The main causes of DRPs were “drug selection” (51.41%), “dose selection” (11.62%), and “patient related” (10.70%) problems. The drug classes more frequently associated with DRPs were “cardiovascular system,” “alimentary tract and metabolism,” and “nervous system,” and they represented 32.1%, 29.4%, and 16.5% of all drug selection problems, respectively. Respiratory system medicines accounted for 6.65% of all DRPs, of which “patient related” problems accounted for 97.28%. IMPLICATIONS Despite the heterogeneity of methodology of the included studies and the heterogeneity of tools used to identify DRPs, this analysis clearly shows the high prevalence of DRPs in home-dwelling older adults and highlights the need for interventions to improve medicine use in this population. This work also provides useful information for the development of strategies to improve medication use in home-dwelling older adults. PURPOSE The search for new agents to treat multidrug-resistant gram-negative bacterial infections has been ongoing. Specifically, carbapenem-resistant Enterobacteriaceae (CRE) infections often exhibit multiple resistance mechanisms, including alterations in drug structure, bacterial efflux pumps, and drug permeability. Vaborbactam, a cyclic boronic acid pharmacophore, has the highest potency in vitro with meropenem as an inhibitor of class A carbapenemases, including Klebsiella pneumoniae carbapenemase (KPC). This combination product was approved by the US Food and Drug Administration for complicated urinary tract infections (cUTIs) in August 2017, and recent Phase III trial data have expanded the literature available. This article aimed to describe the literature regarding spectrum of activity, dosing and administration, including pharmacokinetic and pharmacodynamics properties, safety profile, and efficacy end points. METHODS The terms meropenem, vaborbactam, RPX7009, and meropenem-vaborbactam were used to for overall treatment of cUTIs and acute pyelonephritis and clinical cure (64.3% vs 33.3%; P = 0.04) when compared with best available therapy for CRE infections in various sites of infection. Adverse events have been described as mild to moderate, with few events requiring discontinuation of the drug therapy. IMPLICATIONS Currently, meropenem-vaborbactam is approved for treatment of cUTIs and acute pyelonephritis; however, off-label use, in particular for CRE infections, appears beneficial. Clinical trials to date have found an improvement in clinical cure and potentially an improved tolerability compared with standard therapies. Most of the evidence for meropenem-vaborbactam activity and the role in therapy focuses on KPC-producing organisms; however, because in vitro activity has been found with some non-KPC-producing CRE, its role may be further described from upcoming in vivo cases and postmarketing research. (Clin Ther. 2020; XXXXX-XXX) © 2020 Elsevier HS Journals, Inc. INTRODUCTION The biomechanical properties of small vessels and microvascular anastomoses have not been studied completely yet. However, in case of vascular injury and various microsurgical reconstructive procedures a safe anastomosis is essential. Quick and reliable tests are needed to test various anastomoses in research and in teaching courses as well for quality control and proper feedback. We aimed to compare selected biomechanical properties of the simple interrupted, the continuous suture and the modified Lauritzen’s sleeve-technique. MATERIALS AND METHODS Sixty femoral arteries from chicken thigh biopreparates and 12 abdominal aortas from rats were used in this study. In case of the pressure resistance test the groups were the simple interrupted, the continuous suture and the modified Lauritzen’s sleeve-technique. The tensile-strength, elongation and elasticity measurement groups were the simple interrupted and continuous sutures with 8 and 12 stitches. Furthermore the suture materials in various conditions (simple thread, knotted threads, stitch with intact and damaged threads) were also compared.