Advancements In pulmonary arterial hypertension treatment

Pulmonary arterial hypertension is a rare, chronic disease characterized by progressive remodeling of the pulmonary vasculature. Historically, prognosis has been very poor with relatively low 3-year survival rates. Common symptoms include fatigue and shortness of breath upon exercise, chest pain, and syncope. Patients exhibit increased pressure and resistance in pulmonary arteries due to fibrosis, vessel narrowing, and elevated levels of vasoconstrictive agents; diagnosis is confirmed by right heart catheterization. Reduced blood flow through the pulmonary vasculature not only reduces the amount of oxygenated blood available for the systemic circulation, but increases afterload on the right ventricle and, if left untreated, ultimately causes right ventricular heart failure. In the past, few medications were available to pulmonary arterial hypertension patients. However, recent advancements in our molecular understanding of the disease have led to the development of new therapeutic options that show promise of slowing, or in some cases reversing, disease progression. Currently available treatments have been shown to significantly improve 3-year survival rates and help promote a better quality of life for patients. While an exact molecular or genetic mechanism of disease progression is not yet known, several studies have noted the presence of dysfunctional endothelial cells and an imbalance in molecular modulators of the pulmonary vasculature. Specifically, patients exhibit chronically low levels of vasodilating agents such as prostacyclin and nitric oxide. In addition, there is a heightened vasoconstrictive effect due to elevated endothelin-1 and thromboxane A2. Drugs have been developed to target these signaling pathways and show considerable promise and efficacy for managing pulmonary hypertension in patients. Although these therapeutics have been shown to significantly improve survival rates and symptoms, many have complex and inconvenient administration protocols and a host of adverse side effects. Moreover, many require monitoring or frequent follow up visits due to their off-target effects. Recent innovative advancements in pulmonary arterial hypertension pharmaceuticals hope to deliver safe, efficacious treatment options to patients debilitated by this chronic disease

Success in Sectoral Export Promotion and Economic and Environmental Indicators : A Multisectoral Modelling Analysis

UK policymakers are seeking to use the levers of a more active industrial policy to develop economic opportunities, including through new and expanded trading opportunities. At the same time, the UK Government has committed to a net zero greenhouse gas emissions target by 2050. While increases in exports are expected to raise economic activity, it is unclear what impact this will have on UK energy use and emissions. With a main plank of the UK strategy the development of "Sector Deals", it is unknown whether this is also true for specific industrial sectors. We examine this empirically in a multisectoral Computable General Equilibrium model of the UK that captures the interdependence between economic activity, energy use and emissions. Our results suggest that while economic outcomes move in the desired direction there are mixed impacts on energy use, UK territorial industrial emissions, and the energy- and emissions-intensity of the UK economy. Notably, we identify instances where growing exports in specific sectors helps to meet the objectives of both the Clean Growth Strategy and Industrial Strategy

Analysis of electrical drive speed control limitations of a power take-off system for wave energy converters

The active control of wave energy converters with oil-hydraulic power take-off systems presents important demands on the electrical drives attached to their pumps, in particular on the required drive accelerations and rotational speeds. This work analyzes these demands on the drives and designs reliable control approaches for such drives by simulating a wave-to-wire model in a hardware in-the-loop simulation test rig. The model is based on a point absorber wave energy converter, being the wave, hydrodynamic and oil-hydraulic part simulated in a computer that sends and receives signals from the real embedded components, such as the drive generator, controller and back-to-back converter. Three different control strategies are developed and tested in this test rig and the results revealed that despite the drive limitations to acceleration levels, well above 1 × 104 rpm/s, these do not significantly affect the power take-off efficiency, because the required acceleration peaks rarely achieve these values. Moreover this drive is much more economical than an oil-hydraulic and equivalent one that is able to operate at those peaks of acceleration.This work was performed within the Strategic Research Plan of the Center for Marine Technology and Ocean Engineering, which is financed by Portuguese Foundation for Science and Technology (Fundacao para a Ciencia e Tecnologia-FCT) and the project "Generic hydraulic power take-off system for wave energy converters" funded by the Portuguese Foundation for Science and Technology (FCT) under contract PTDC/EMS-SIS-1145/2014. The testing has received support from MARINET, a European Community - Research Infrastructure Action under the FP7 "Capacities" Specific Programme, grant agreement nr. 262552. The research leading to these results is also part of the OceaNET project, which has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreement nr. 607656

Comparative Evaluation of Pain Scores during Periodontal Probing with or without Anesthetic Gels

Context. The initial periodontal examination which includes full-mouth periodontal probing is one of the discomforting procedures for a patient. Aim. To evaluate the efficacy of two local anesthetic gels in the reduction of pain during periodontal probing using Florida probe in CGP patients in comparison with manual probing. Materials and Methods. Ninety systemically healthy patients with moderate to severe CGP patients were recruited. In each patient, the quadrants were randomly assigned to manual probing with UNC-15 probe, probing with Florida probe, and Florida probing with lidocaine 10% gel and with benzocaine 20% gel. In the quadrants undergoing probing with anesthetic gels, the sites were isolated and the gel was injected using syringe and a blunt-end cannula. Pain was measured using 10 mm horizontal VAS. Statistical Analysis. The analysis was carried out using SPSS version 18. The comparison of mean VAS scores was done using repeated measures ANOVA with post hoc Bonferroni test. Results. Mean VAS for manual probing was significantly more than Florida probing. Further, the mean VAS score for Florida probing was higher than the two gels. Conclusion. It is suggested that the gels might be useful in reducing pain experienced during full-mouth periodontal probing in patients with CGP

Where have all the diseases gone during the COVID-19 pandemic?

This article focuses on a marked drop in volumes in the lockdown period during the COVID-19 pandemic across all modalities X-ray, sonography, CT scan and MRI scans and compares the volumes of data between a private and public hospital in Mumbai. This trend has been witnessed globally also. Even with easing of lockdown this has not reflected in an increase in numbers. Imaging volumes of a 1900-bed public hospital and a 220-bed private hospital in Mumbai were collated for all modalities, i.e., X-ray, sonography, CT and MRI for the months January, February 2020- Prelockdown, March 2020 Peri-lockdown, April, May 2020- Lockdown, June Unlock 1.0, July Unlock 2.0. The imaging volumes during lockdown, Unlock, were compared with prelockdown values. It was initially felt that this was due to a fear of visiting hospitals that are considered hotbeds of SARS-CoV-2. However, the same status has persisted over the 2 months of lockdown and the 2 months of unlocking. What is the cause of this huge drop in imaging volumes

Role of antimicrobial peptides in periodontal innate defense mechanism

The periodontal epithelium neighboring the tooth is precise to form a seal and attachment around the tooth. This exclusive function imparts unique challenges to the tissue and leads to certain vulnerabilities allied with periodontal disease, particularly in view of the continual exposure to the bacterial biofilm (dental plaque) that form that is formed on the tooth surface at the junction of the soft tissue. It is obvious that oral epithelial cells can counter unbroken microbial challenges from dental plaque by the production of antimicrobial peptides (AMPs), chemokines and cytokines that boost inflammation and immune response in periodontal tissues. AMPs are early responders of the innate immune system that search and destroy invading pathogens. The large variety of AMPs presumably allows for an effective response to the large variety of microorganisms that invade the mouth and airways. The present paper portrays the association between altered expression of AMPs and some types of periodontitis along with AMPs and their clinical significance in other oral diseases

The Role of Vitamin D as a Prognostic Marker in Papillary Thyroid Cancer

The role of vitamin D in modulating several cancer-related pathways has received an increasing amount of attention in the past several years. Previous literature has found an abundance of evidence of vitamin D exerting an anti-proliferative, anti-inflammatory, and pro-differentiation effect in various types of cancers including breast, colon, prostate, and pancreatic cancer. Although the link between vitamin D and thyroid cancer remains controversial, both biochemical evidence and clinical studies have attempted to establish a link between papillary thyroid carcinoma (PTC) and vitamin D status. Furthermore, the use of vitamin D as a prognostic marker has received increased attention, both in regards to clinical outcomes and cancer staging. In this review, we briefly discuss the metabolism and proposed mechanism of action of vitamin D in the context of PTC, and explore links between modulators in the vitamin D pathway and progression of PTC. We provide evidence from both clinical studies as well as molecular studies of metabolic targets, including vitamin D receptor and activating enzymes exerting an effect on PTC tissue, which indicate that vitamin D may play a significant prognostic role in PTC

Comparative evaluation of hemodynamic, vasoconstrictive, and SpO2variability during different stages of periodontal surgery performed using 0.5% ropivacaine or 2% lignocaine HCl (1:80,000 adrenaline) local anesthesia: A randomized, double-blind, split-mouth pilot study

Aim: The aim of this study is to compare anesthetic, hemodynamic, vasoconstrictive, and SpO2variability of 0.5% ropivacaine to the “gold standard” lignocaine (2%) with epinephrine (1:80,000) during periodontal surgery. Materials and Methods: A total of 20 systemically healthy controls meeting the inclusion criteria were selected from the Outpatient Department of Sri Sai College of Dental Surgery. Preoperatively, all participants were infiltrated with 0.5 ml of 0.5% ropivacaine intradermally as test solution to record any allergic reaction. Open flap debridement was performed using local anesthesia containing 2% lignocaine hydrochloride with 1:80,000 epinephrine or 0.5% ropivacaine. Recordings were made of the time of onset, duration of action, the intensity, and depth of anesthesia and various hemodynamic changes throughout the surgical procedure. In addition, blood loss volume and postoperative pain were also assessed. Results: Ropivacaine showed statistically longer duration of action (mean±SD =5.3±0.71 hrs) than lignocaine with epinephrine (mean=2.14±0.98 hrs). Blood loss during flap surgery was comparatively less when performed under ropivacaine. No statistical differences were observed in systolic BP, diastolic BP, SpO2 and heart rate during different stages of periodontal surgery between either of the local anesthetic agents Conclusion: Ropivacaine demonstrates comparable efficacy as lignocaine with added advantage of longer duration of action and superior postoperative pain control. No adverse events from this newer anesthetic were noted, and hence, it can be used safely as a viable local anesthetic for periodontal surgical procedures