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Chronic Rhinosinusitis
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Treatment of CRS is primarily medical. Saline nasal irrigation is safe and effective and may be well tolerated by some children. The evidence base for most pharmacological interventions in children is weak, but INCSs are usually recommended, certainly before contemplating any surgical treatment. EPOS guidelines recommend that surgery should only be considered following ‘appropriate medical treatment’ (AMT), and despite the poor evidence base to support the use of antibiotics, most ORL specialists will recommend a course of antibiotics before considering surgery.
Carriers for Nucleic Acid Delivery to the Brain
Published in Carla Vitorino, Andreia Jorge, Alberto Pais, Nanoparticles for Brain Drug Delivery, 2021
Free nucleic acids cannot use any of the above-mentioned CMT, RMT or AMT pathways, which is why they must be formulated with suitable carriers for brain delivery. Viral vectors such as adenoviruses or adeno-associated viruses found wide application for clinical gene delivery. However, nonviral nucleic acid delivery systems have lower safety concerns, are easier to manufacture and allow for delivery of all types of nucleic acid cargoes, such as chemically modified mRNA or small interfering RNA (siRNA), which induce gene silencing by RNA interference (RNAi) [7]. The first siRNA drug, Patisiran, a liposomal liver-targeted formulation of siRNA for the treatment of hereditary ATTR amyloidosis, has obtained market approval by the US Food and Drug Administration (FDA) in August 2018 [8].
Melatonin for Prevention and Treatment of Complications Associated with Chemotherapy and Radiotherapy: Implications for Cancer Stem Cell Differentiation
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
Germaine Escames, Ana Guerra-Librero, Dario Acuña-Castroviejo, Javier Florido, Laura Martinez-Ruiz, Cesar Rodríguez-Santana, Beatriz I Fernandez-Gil, Iryna Russanova
Melatonin (N-acetyl-5-methoxytryptamine; aMT), a derivative of serotonin (5-hydroxytryptamine), was initially isolated from bovine pineal tissue [36]. For a number of years after its discovery by Lerner in 1958, melatonin, which regulates circadian and circannual rhythms, was considered to be produced exclusively in the pineal gland [37]. Following the identification of melatonin synthesis in the pineal gland, melatonin-related enzymes were found to be present in the retina and cerebellum [38,39] and were subsequently identified in many other peripheral tissues and organs [37]. Melatonin is also found in a very wide and diverse range of biological systems, ranging from single cells to highly complex human organisms [40]. Chronobiologists have traditionally regarded melatonin as a hormone that only regulates circadian day-night rhythms and seasonal biorhythms [41]. However, melatonin also performs functions that enable organisms to be protected against environmental changes. In addition, depending, for the most part, on its cellular redox state and inflammatory status, melatonin genomically regulates the expression of genes such as glutathione peroxidase (GPx), glutathione reductase (GRd), superoxide dismutase (SOD), inducible nitric oxide synthase (iNOS), and cytokines [42]. It is also a chemotoxicity-reducing agent, a putative anti-aging substance, and an anticancer agent, as well as an essential regulator of mitochondrial function.
Effect of adapted motorized ride-on toy use on developmental skills, quality of life, and driving competency in nonambulatory children age 9–60 months
Published in Assistive Technology, 2023
Kara Arps, Nancy Darr, Jamie Katz
It would be beneficial to repeat this study with a larger sample size as a clinical trial with a control group or within subject ABA design to more accurately differentiate benefits of AMT use on development and to validate the PMSC. It may be important to consider a longer intervention period and to use the PMSC to track the average number of weeks and total number of sessions to obtain maximal driving ability for a more accurate depiction of ideal AMT dosage. This increase in study duration would need to be balanced with the time burden required for families to participate in the research study. In future studies, it may be valuable to introduce the option for independent steering earlier in the intervention period to provide ample time for participants to practice navigating their environments. Further, it would be advantageous to provide more structured training for parents, so they could focus on eliciting specific AMT skills at home through appropriate motivation and play techniques.
Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps
Published in Expert Review of Clinical Immunology, 2022
Juan Carlos Ceballos Cantu, Isam Alobid, Joaquim Mullol
Currently, treatment of CRSwNP usually consists of three levels: 1) appropriate medical treatment (AMT), 2) surgical treatment when the response to medical treatment is not optimal, re is not an optimal response to medical treatment, and more recently, 3) biologic therapies. The management of these patients remains a challenge. However, in recent years, there has been significant progress with the emergence of anti-T2 biologics to add to the treatment of severe uncontrolled asthma. Until very recently, biologic therapies were indicated for patients with severe asthma but not for those with CRSwNP. The emergence of dupilumab (anti IL-4 Rα), omalizumab (anti-IgE), and mepolizumab (anti-IL-5), and their acceptance by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) has significantly changed the treatment options for type 2 CRS (mostly CRSwNP). Other monoclonal antibodies such as benralizumab (anti-IL-5 Rα) and tezepelumab (anti-TSLP) are expected to be added to this list.
Recent innovations in non-invasive brain stimulation (NIBS) for the treatment of unipolar and bipolar depression: a narrative review
Published in International Review of Psychiatry, 2022
Eleonora Piccoli, Matteo Cerioli, Michele Castiglioni, Luca Larini, Carolina Scarpa, Bernardo Dell’Osso
In the last 5 years, many studies focussed on a new rTMS protocol known as TBS. TBS involves magnetic pulses applied in bursts of three at high-frequency (50 Hz) with an interburst interval of 200 ms (resulting in a 5 Hz frequency, which is in the range of theta frequency). Conventional rTMS procedures last between 20 and 45 min, as compared to TBS paradigms that require 1–3 min of stimulation, resulting in a time-saving advantage. TBS also requires lower intensity (typically 80% of the active motor threshold (aMT)) to produce longer-lasting effects compared to other rTMS protocols, resulting in a sustained clinical efficacy. Two commonly used TBS protocols are: continuous (cTBS) and intermittent (iTBS), which have opposite effects. In cTBS, either 300 pulses (20 s) or 600 pulses (40 s) of TBS are delivered without any interruption. This protocol reduces cortical excitability by approximately 20 min for 300 cTBS pulses, and up to 1 hr for 600 cTBS pulses. In iTBS, 2 s of TBS trains (30 pulses) are repeated every 10 s for 190 s, with a total number of 600 pulses. iTBS produces facilitatory effects on motor cortex excitability that outlast the stimulation time for at least 15 min (Chung et al., 2015).