Articles: treatment.
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Randomized Controlled Trial
Effects of Sub-Anesthetic Oro-Mucosal Dexmedetomidine on Sleep in Humans: A Randomized, Controlled Pharmacokinetics-Pharmacodynamics Study.
The locus coeruleus noradrenergic system may provide a potential new target for pharmacologic insomnia treatment, particularly in patients suffering from elevated distress. The selective α 2 -noradrenergic agonist dexmedetomidine attenuates locus coeruleus activity in subanesthetic doses, yet no adequate nonparental delivery systems of dexmedetomidine are currently available. To examine the feasibility of oromucosal dexmedetomidine administration, the authors developed two distinct-one sublingual and one buccal-oromucosal, fast-disintegrating dexmedetomidine formulas tailored for self-administration. Here, the authors established the formulas' pharmacokinetic and pharmacodynamic profiles. ⋯ The favorable pharmacokinetic and pharmacodynamic profile of oromucosal dexmedetomidine delivery warrants further dose-finding and clinical studies to establish the exact roles of α 2 receptor agonism in pharmacologic sleep enhancement and as a possible novel mechanism to alleviate stress-related insomnia.
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Multicenter Study
Reconstructive Endovascular Treatment of Compensative-Flow-Related Posterior Circulation Aneurysms With Anterior Circulation Artery Occlusion.
The aim of this study was to delineate the reconstructive endovascular treatment and periprocedural management of compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. ⋯ Our study indicates that reconstructive endovascular treatments are feasible and effective strategies for compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. However, these treatments are associated with a risk of periprocedural ischemic complications, which can be reduced by collateral arterial assessment, appropriate periprocedural anesthesia management, and antiplatelet treatment.
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Spinal chordomas are primary bone tumors where surgery remains the primary treatment. However, their low incidence, lack of evidence, and late disease presentation make them challenging to manage. Here, we report the postoperative outcomes of a large cohort of patients after surgical resection, investigate predictors for overall survival (OS) and local recurrence-free survival (LRFS) times, and trend functional outcomes over multiple time periods. ⋯ Surgeons must often weigh the pros and cons of en bloc resection and sacrificing important but affected native tissues. Our findings can provide a benchmark for counseling patients with spinal chordoma. Tumors ≥100 cm 3 appear to have a 5.89-times higher risk of recurrence, mobile spine chordomas have a 7.73 times higher risk, and neoadjuvant radiotherapy confers an 11.1 times lower risk for local recurrence. Patients age ≥65 years at surgery have a 16.70 times higher risk of mortality than those <65 years.
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Rhinitis affects a significant portion of the world population and increases the cost of health care by billions of dollars in treatment costs and missed days of work. Allergic rhinitis is the most common cause. ⋯ Initial treatment includes using topical agents like intranasal corticosteroids and inhaled antihistamines as the first-line therapies for both allergic rhinitis and chronic rhinitis. Therapy can evolve in a stepwise manner depending on the primary symptom complaint prior to referral for advanced therapies such as allergen immunotherapy.
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Case Reports
Superselective Angiography of Vasa Vasorum Within Partially Thrombosed Vertebral Aneurysm: A Case Report.
Partially thrombosed vertebral artery aneurysms (PTVAs) are rare, most of which are not easy to treat. Furthermore, endovascular treatment of PTVAs may not have favorable outcomes. The relationship between PTVAs and well-developed vasa vasorum (VV), including the mechanism of aneurysm growth, has been reported, but there are no reports of imaging findings by digital subtraction angiography (DSA). In this case, we successfully performed superselective angiography of well-developed VV and evaluated its imaging characteristics. We present the first DSA report of a well-developed VV of PTVA. ⋯ We successfully identified a VV within PTVA. Superselective VV angiography showed staining of the thrombosed component and venous return draining into the suboccipital cavernous sinus. In this case, the embolization of the VV proved to be an effective endovascular treatment of PTVA, but the safety of this method is a challenge. Further case studies are required to validate this method, and we hope it will evolve into a new treatment of PTVA.