A Remarkable Example of Bubble Nucleation Suppression

Suppression of cavitation is a relatively common goal of fluid engineers and therefore examples of bubble nucleation suppression in other technological contexts are useful in suggesting ways in which such suppression might be achieved. In this paper we describe a remarkable example of bubble nucleation suppression achieved by a combination of the elimination of nucleation sites and the reduction of bubble growth time. The context is the invention of a device that allows the injection of aqueous solutions highly supersaturated with oxygen into the bloodstream without the formation of significant gaseous oxygen bubbles

Injection of Highly Supersaturated Oxygen Solutions without Nucleation

It is possible to inject highly supersaturated aqueous solutions of gas through a small capillary into an aqueous environment without the formation of significant gas bubbles. Such a technique has considerable potential therapeutic value in the treatment, for example, of heart attacks and strokes. The present paper is the second in a series (see Brereton et al. [1]) investigating the basic phenomenon behind this surprising effect. Recent experiments clearly demonstrate that the nucleation, when it does occur, results from heterogeneous nucleation on the interior surface of the distal end of the capillary. This paper describes the effects of the treatment of this interior surface on the nucleation processes and the results of high speed video observations of the phenomena. A heterogeneous nucleation model is presented which is in accord with the experimental observations

The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis.

Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects. This article reviews the efforts to develop alternative PD solutions that obviate some of these side effects, through the replacement of part of their glucose content with other osmolytes which are at least as efficient in removing fluids as glucose, but less impactful on patient metabolism. In particular, we will summarize clinical studies on the use of alternative osmotic ingredients that are commercially available (icodextrin and amino acids) and preclinical studies on alternative solutions under development (taurine, polyglycerol, carnitine and xylitol). In addition to the expected benefit of a glucose-sparing approach, we describe an 'osmo-metabolic' approach in formulating novel PD solutions, in which there is the possibility of exploiting the pharmaco-metabolic properties of some of the osmolytes to attenuate the systemic side effects due to glucose. This approach has the potential to ameliorate pre-existing co-morbidities, including insulin resistance and type-2 diabetes, which have a high prevalence in the dialysis population, including in PD patients

Health-Care Resource Utilization and Treatment Patterns in Men with Erectile Dysfunction and Benign Prostatic Hyperplasia-Associated Lower Urinary Tract Symptoms in the United States: A Retrospective Database Study

Irwin Goldstein,1 Tarek Hassan,2 Kelly Zou,3 Victoria Divino,4 Mitch DeKoven,4 Joseph Imperato,3 Vamshi Ruthwik Anupindi,4 Jim Li3 1Department of Sexual Medicine, Alvarado Hospital, San Diego, CA, USA; 2Department of Urology, Viatris Inc, Canonsburg, PA, USA; 3Global Medical Analytics and Real World Evidence, Viatris Inc, Canonsburg, PA, USA; 4Health Economics/Outcomes Research and Real-World Insights, IQVIA, Falls Church, VA, USACorrespondence: Tarek Hassan, Global Medical Lead, Department of Urology, Global Medical and Clinical, Viatris Inc, 1000 Mylan Blvd, Canonsburg, PA, 15317, USA, Tel +1 3474432850, Email [email protected]: To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US).Methods: This was a noninterventional, real-world evidence study of men (aged ≥ 45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]).Results: The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p< 0.0001) and outpatient surgical visits (63.0% vs 68.8%, p< 0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p< 0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses.Conclusion: Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.Plain Language Summary: Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) conditions are more common in adult men and increase with age. These conditions affect their sexual satisfaction, create mental stress, and impact their interactions with family and associates. This study examined the patterns of health-care resource utilization (HCRU) in 11,351 patients treated with tadalafil versus 48,722 not treated with any PDE5i and compared treatment adherence to and persistence with tadalafil in patients with ED and comorbid BPH-LUTS in the US. All-cause and disease-specific HCRU were lower in patients treated with tadalafil than patients not treated with any PDE5i. The persistence with and adherence to therapy was higher with once-daily dose of tadalafil (2.5 or 5 mg) compared with as-needed dose of tadalafil (10 or 20 mg). Therefore, a lower dose of tadalafil demonstrated benefit in the management of men with ED and BPH-LUTS.Keywords: medication adherence, persistence, phosphodiesterase-5 inhibitor, real-world evidence, tadalafi

Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable

In a groundbreaking meeting, leading global kidney disease organizations came together in the fall of 2020 as an International Home Dialysis Roundtable (IHDR) to address strategies to increase access to and uptake of home dialysis, both peritoneal dialysis and home hemodialysis. This challenge has become urgent in the wake of the coronavirus disease 2019 (COVID-19) pandemic, during which patients with advanced kidney disease, who are more susceptible to viral infections and severe complications, must be able to safely physically distance at home. To boost access to home dialysis on a global scale, IHDR members committed to collaborate, through the COVID-19 public health emergency and beyond, to promote uptake of home dialysis on a broad scale. Their commitments included increasing the reach and influence of key stakeholders with policy makers, building a cooperative of advocates and champions for home dialysis, working together to increase patient engagement and empowerment, and sharing intelligence about policy, education, and other programs so that such efforts can be operationalized globally. In the spirit of international cooperation, IHDR members agreed to document, amplify, and replicate established efforts shown to improve access to home dialysis and support new policies that facilitate access through procedures, innovation, and reimbursement

Antiageing Mechanisms of a Standardized Supercritical CO 2

The use of topical retinoids to treat skin disorders and ageing can induce local reactions, while oral retinoids are potent teratogens and produce several unwanted effects. This way, efforts to explore complementary care resources should be supported. Based on this, we evaluate the antiageing effects of a supercritical CO2 extract from Bidens pilosa L. (BPE-CO2A) containing a standardized multicomponent mixture of phytol, linolenic, palmitic, linoleic, and oleic acids. BPE-CO2A was assessed for its effects on human dermal fibroblasts (TGF-β1 and FGF levels using ELISA; collagen, elastin, and glycosaminoglycan by colorimetric assays, and mRNA expression of RXR, RAR, and EGFr by qRT-PCR) and human skin fragments (RAR, RXR, collagen, elastin, and glycosaminoglycan by immunohistochemical analysis). Levels of extracellular matrix elements, TGF-β1 and FGF, and EGFr gene expression were significantly increased by BPE-CO2A. The modulation of RXR and RAR was positively demonstrated after the treatment with BPE-CO2A or phytol, a component of BPE-CO2A. The effects produced by BPE-CO2A were similar to or better than those produced by retinol and retinoic acid. The ability to stimulate extracellular matrix elements, increase growth factors, and modulate retinoid and rexinoid receptors provides a basis for the development of preparation containing BPE-CO2A as an antiageing/skin-repair agent