Nanoemulsions are biphasic dispersion of two immiscible liquids: either water in oil (W/O) or oil in water (O/W) droplets stabilized by an amphiphilic surfactant. These come across as ultrafine ...dispersions whose differential drug loading; viscoelastic as well as visual properties can cater to a wide range of functionalities including drug delivery. However there is still relatively narrow insight regarding development, manufacturing, fabrication and manipulation of nanoemulsions which primarily stems from the fact that conventional aspects of emulsion formation and stabilization only partially apply to nanoemulsions. This general deficiency sets up the premise for current review. We attempt to explore varying intricacies, excipients, manufacturing techniques and their underlying principles, production conditions, structural dynamics, prevalent destabilization mechanisms, and drug delivery applications of nanoemulsions to spike interest of those contemplating a foray in this field.
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A better understanding of the biology of chronic lymphocytic leukemia (CLL) has led to significant advances in therapeutic strategies for patients with CLL. Chemoimmunotherapy (CIT) has been the ...standard first-line therapy for CLL. Age and comorbidities can help decide which patients may benefit from a CIT approach. FCR (fludarabine, cyclophosphamide, and rituximab) is the current standard treatment option for younger patients with CLL. For older patients and for patients with renal dysfunction, bendamustine and rituximab may be a better option. For older patients with comorbidities who may not be able to tolerate intensive CIT, the combination treatment of chlorambucil and obinutuzumab or ofatumumab is an option. For patients with del(17p), ibrutinib is the treatment of choice. Several ongoing phase 3 clinical trials with novel therapies will further refine the frontline therapy of CLL.
IMPORTANCE: Acute traumatic spinal cord injury results in disability and use of health care resources, yet data on contemporary national trends of traumatic spinal cord injury incidence and etiology ...are limited. OBJECTIVE: To assess trends in acute traumatic spinal cord injury incidence, etiology, mortality, and associated surgical procedures in the United States from 1993 to 2012. DESIGN, SETTING, AND PARTICIPANTS: Analysis of survey data from the US Nationwide Inpatient Sample databases for 1993-2012, including a total of 63 109 patients with acute traumatic spinal cord injury. MAIN OUTCOMES AND MEASURES: Age- and sex-stratified incidence of acute traumatic spinal cord injury; trends in etiology and in-hospital mortality of acute traumatic spinal cord injury. RESULTS: In 1993, the estimated incidence of acute spinal cord injury was 53 cases (95% CI, 52-54 cases) per 1 million persons based on 2659 actual cases. In 2012, the estimated incidence was 54 cases (95% CI, 53-55 cases) per 1 million population based on 3393 cases (average annual percentage change, 0.2%; 95% CI, −0.5% to 0.9%). Incidence rates among the younger male population declined from 1993 to 2012: for age 16 to 24 years, from 144 cases/million (2405 cases) to 87 cases/million (1770 cases) (average annual percentage change, −2.5%; 95% CI, −3.3% to −1.8%); for age 25 to 44 years, from 96 cases/million (3959 cases) to 71 cases/million persons (2930 cases), (average annual percentage change, −1.2%; 95% CI, −2.1% to −0.3%). A high rate of increase was observed in men aged 65 to 74 years (from 84 cases/million in 1993 695 cases to 131 cases/million 1465 cases; average annual percentage change, 2.7%; 95% CI, 2.0%-3.5%). The percentage of spinal cord injury associated with falls increased significantly from 28% (95% CI, 26%-30%) in 1997-2000 to 66% (95% CI, 64%-68%) in 2010-2012 in those aged 65 years or older (P < .001). Although overall in-hospital mortality increased from 6.6% (95% CI, 6.1%-7.0%) in 1993-1996 to 7.5% (95% CI, 7.0%-8.0%) in 2010-2012 (P < .001), mortality decreased significantly from 24.2% (95% CI, 19.7%-28.7%) in 1993-1996 to 20.1% (95% CI, 17.0%-23.2%) in 2010-2012 (P = .003) among persons aged 85 years or older. CONCLUSIONS AND RELEVANCE: Between 1993 and 2012, the incidence rate of acute traumatic spinal cord injury remained relatively stable but, reflecting an increasing population, the total number of cases increased. The largest increase in incidence was observed in older patients, largely associated with an increase in falls, and in-hospital mortality remained high, especially among elderly persons.
OBJECTIVEPatient-reported outcome scales determine response to treatment. The minimal clinically important difference of these scales is a measure of responsivenessthe smallest change in a score ...associated with a clinically important change to the patient. This study sought to summarize the literature on minimal clinically important difference for the most commonly reported shoulder outcome scales.
DESIGNA literature search of PubMed and EMBASE databases identified 193 citations, 27 of which met the inclusion/exclusion criteria.
RESULTSFor rotator cuff tears, a minimal clinically important difference range of 9–26.9 was reported for American Shoulder and Elbow Surgeons, 8 or 10 for Constant, and 282.6–588.7 for the Western Ontario Rotator Cuff Index. For patients who underwent arthroplasty, a minimal clinically important difference range of 6.3–20.9 was reported for American Shoulder and Elbow Surgeons, 5.7–9.4 for Constant, and 14.1–20.6 for the Shoulder Pain and Disability Index. For proximal humeral fractures, a minimal clinically important difference range of 5.4–11.6 was reported for Constant and 8.1–13.0 for Disability of the Arm, Shoulder, and Hand.
CONCLUSIONSA wide range of minimal clinically important difference values was reported for each patient population and instrument. In the future, a uniform outcome instrument and minimal clinically important difference will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.
Patient-reported outcome scales determine response to treatment. The minimal clinically important difference of these scales is a measure of responsiveness: the smallest change in a score associated ...with a clinically important change to the patient. This study sought to summarize the literature on minimal clinically important difference for the most commonly reported shoulder outcome scales.
A literature search of PubMed and EMBASE databases identified 193 citations, 27 of which met the inclusion/exclusion criteria.
For rotator cuff tears, a minimal clinically important difference range of 9-26.9 was reported for American Shoulder and Elbow Surgeons, 8 or 10 for Constant, and 282.6-588.7 for the Western Ontario Rotator Cuff Index. For patients who underwent arthroplasty, a minimal clinically important difference range of 6.3-20.9 was reported for American Shoulder and Elbow Surgeons, 5.7-9.4 for Constant, and 14.1-20.6 for the Shoulder Pain and Disability Index. For proximal humeral fractures, a minimal clinically important difference range of 5.4-11.6 was reported for Constant and 8.1-13.0 for Disability of the Arm, Shoulder, and Hand.
A wide range of minimal clinically important difference values was reported for each patient population and instrument. In the future, a uniform outcome instrument and minimal clinically important difference will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.
Quantum random number generators promise perfectly unpredictable random numbers. A popular approach to quantum random number generation is homodyne measurements of the vacuum state, the ground state ...of the electro-magnetic field. Here we experimentally implement such a quantum random number generator, and derive a security proof that considers quantum side-information instead of classical side-information only. Based on the assumptions of Gaussianity and stationarity of noise processes, our security analysis furthermore includes correlations between consecutive measurement outcomes due to finite detection bandwidth, as well as analog-to-digital converter imperfections. We characterize our experimental realization by bounding measured parameters of the stochastic model determining the min-entropy of the system's measurement outcomes, and we demonstrate a real-time generation rate of 2.9 Gbit/s. Our generator follows a trusted, device-dependent, approach. By treating side-information quantum mechanically an important restriction on adversaries is removed, which usually was reserved to semi-device-independent and device-independent schemes.
Background We assessed the contribution of reverse shoulder arthroplasty to overall utilization of primary shoulder arthroplasty and present age- and sex-stratified national rates of shoulder ...arthroplasty. We also assessed contemporary complication rates, mortality rates, and indications for shoulder arthroplasty, as well as estimates and indications for revision arthroplasty. Methods We used the Nationwide Inpatient Samples for 2009 through 2011 to calculate estimates of shoulder arthroplasty and assessed trends using Joinpoint (National Cancer Institute, Bethesda, MD) regression. Results The cumulative estimated utilization of primary shoulder arthroplasty (anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty) increased significantly from 52,397 procedures (95% confidence interval CI, 47,093-57,701) in 2009 to 67,184 cases (95% CI, 60,638-73,731) in 2011. Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases. The highest rate of reverse shoulder arthroplasty was in the 75- to 84-year-old female subgroup (77 per 100,000 persons; 95% CI, 67-87). Revision cases comprised 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were because of mechanical complications/loosening whereas 18% were because of dislocation. Conclusions The utilization of primary shoulder arthroplasty significantly increased in just a 3-year time span, with a major contribution from reverse shoulder arthroplasty in 2011. Indications appear to have expanded because a large percentage of patients did not have rotator cuff pathology. The burden from revision arthroplasties was also substantial, and efforts to optimize outcomes and longevity of primary shoulder arthroplasty are needed.
We demonstrate the experimental feasibility of a Trojan-horse attack that remains nearly invisible to the single-photon detectors employed in practical quantum key distribution (QKD) systems, such as ...Clavis2 from ID Quantique. We perform a detailed numerical comparison of the attack performance against Scarani-Ac´ın-Ribordy-Gisin (SARG04) QKD protocol at 1924 nm versus that at 1536 nm. The attack strategy was proposed earlier but found to be unsuccessful at the latter wavelength, as reported in N. Jain et al., New J. Phys. 16, 123030 (2014). However at 1924 nm, we show experimentally that the noise response of the detectors to bright pulses is greatly reduced, and show by modeling that the same attack will succeed. The invisible nature of the attack poses a threat to the security of practical QKD if proper countermeasures are not adopted.
What’s New in Orthopaedic Rehabilitation Kasitinon, Donald; Williams, Reed; Gharib, Mahmood ...
Journal of bone and joint surgery. American volume,
11/2023, Letnik:
105, Številka:
22
Journal Article
Surgery for rotator cuff tears Karjalainen, Teemu V; Jain, Nitin B; Heikkinen, Juuso ...
Cochrane database of systematic reviews,
12/2019, Letnik:
2019, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Background
This review is one in a series of Cochrane Reviews of interventions for shoulder disorders.
Objectives
To synthesise the available evidence regarding the benefits and harms of rotator cuff ...repair with or without subacromial decompression in the treatment of rotator cuff tears of the shoulder.
Search methods
We searched the CENTRAL, MEDLINE, Embase, Clinicaltrials.gov and WHO ICRTP registry unrestricted by date or language until 8 January 2019.
Selection criteria
Randomised controlled trials (RCTs) including adults with full‐thickness rotator cuff tears and assessing the effect of rotator cuff repair compared to placebo, no treatment, or any other treatment were included. As there were no trials comparing surgery with placebo, the primary comparison was rotator cuff repair with or without subacromial decompression versus non‐operative treatment (exercises with or without glucocorticoid injection). Other comparisons were rotator cuff repair and acromioplasty versus rotator cuff repair alone, and rotator cuff repair and subacromial decompression versus subacromial decompression alone. Major outcomes were mean pain, shoulder function, quality of life, participant‐rated global assessment of treatment success, adverse events and serious adverse events. The primary endpoint for this review was one year.
Data collection and analysis
We used standard methodologic procedures expected by Cochrane.
Main results
We included nine trials with 1007 participants. Three trials compared rotator cuff repair with subacromial decompression followed by exercises with exercise alone. These trials included 339 participants with full‐thickness rotator cuff tears diagnosed with magnetic resonance imaging (MRI) or ultrasound examination. One of the three trials also provided up to three glucocorticoid injections in the exercise group. All surgery groups received tendon repair with subacromial decompression and the postoperative exercises were similar to the exercises provided for the non‐operative groups. Five trials (526 participants) compared repair with acromioplasty versus repair alone; and one trial (142 participants) compared repair with subacromial decompression versus subacromial decompression alone.
The mean age of trial participants ranged between 56 and 68 years, and females comprised 29% to 56% of the participants. Symptom duration varied from a mean of 10 months up to 28 months. Two trials excluded tears with traumatic onset of symptoms. One trial defined a minimum duration of symptoms of six months and required a trial of conservative therapy before inclusion. The trials included mainly repairable full‐thickness supraspinatus tears, six trials specifically excluded tears involving the subscapularis tendon.
All trials were at risk of bias for several criteria, most notably due to lack of participant and personnel blinding, but also for other reasons such as unclearly reported methods of random sequence generation or allocation concealment (six trials), incomplete outcome data (three trials), selective reporting (six trials), and other biases (six trials).
Our main comparison was rotator cuff repair with or without subacromial decompression versus non‐operative treatment. We identified three trials for this comparison, that compared rotator cuff repair with subacromial decompression followed by exercises with exercise alone with or without glucocorticoid injections, and results are reported here for the 12 month follow up.
At one year, moderate‐certainty evidence (downgraded for bias) from 3 trials with 258 participants indicates that surgery probably provides little or no improvement in pain; mean pain (range 0 to 10, higher scores indicate more pain) was 1.6 points with non‐operative treatment and 0.87 points better (0.43 better to 1.30 better) with surgery. Mean function (zero to 100, higher score indicating better outcome) was 72 points with non‐operative treatment and 6 points better (2.43 better to 9.54 better) with surgery (3 trials; 269 participants), low‐certainty evidence (downgraded for bias and imprecision). Participant‐rated global success rate was 48/55 after non‐operative treatment and 52/55 after surgery corresponding to risk ratio (RR) 1.08, 95% confidence interval (CI) 0.96 to 1.22; low‐certainty evidence (downgraded for bias and imprecision). Health‐related quality of life was 57.5 points (SF‐36 mental component score, 0 to 100, higher score indicating better quality of life) with non‐operative treatment and 1.3 points worse (4.5 worse to 1.9 better) with surgery (1 trial; 103 participants), low‐certainty evidence (downgraded for bias and imprecision).
We were unable to estimate the risk of adverse events and serious adverse events as only one event was reported across the trials (very low‐certainty evidence; downgraded once due to bias and twice due to very serious imprecision).
Authors' conclusions
At the moment, we are uncertain whether rotator cuff repair surgery provides clinically meaningful benefits to people with symptomatic tears; it may provide little or no clinically important benefits with respect to pain, function, overall quality of life or participant‐rated global assessment of treatment success when compared with non‐operative treatment. Surgery may not improve shoulder pain or function compared with exercises, with or without glucocorticoid injections.
The trials included have methodology concerns and none included a placebo control. They included participants with mostly small degenerative tears involving the supraspinatus tendon and the conclusions of this review may not be applicable to traumatic tears, large tears involving the subscapularis tendon or young people. Furthermore, the trials did not assess if surgery could prevent arthritic changes in long‐term follow‐up. Further well‐designed trials in this area that include a placebo‐surgery control group and long follow‐up are needed to further increase certainty about the effects of surgery for rotator cuff tears.
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