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Expedition medicine

Michael S Diamond, Julie E Ledgerwood, Theodore C Pierson
Zika virus (ZIKV) emerged at a global level when it spread to the Americas and began causing congenital malformations and microcephaly in 2015. A rapid response by academia, government, public health infrastructure, and industry has enabled the expedited development and testing of a suite of vaccine platforms aiming to control and eliminate ZIKV-induced disease. Analysis of key immunization and pathogenesis studies in multiple animal models, including during pregnancy, has begun to define immune correlates of protection...
November 2, 2018: Annual Review of Medicine
V Sekhar, E Wong, H A Elhassan, N Singh
BACKGROUND: Mules and other equine species have been used in warfare for thousands of years to transport goods and supplies. Mules are known for 'braying', which is disadvantageous in warfare operations. This article explores the fascinating development of surgical techniques to stop military mules from braying, with particular emphasis on the key role played by the otolaryngologist Arthur James Moffett in devoicing the mules of the second Chindit expedition of World War II. METHOD: The PubMed database (1900-2017) and Google search engine were used to identify articles related to devoicing mules in the medical and veterinary literature, along with information and images on the Chindit expedition...
October 29, 2018: Journal of Laryngology and Otology
A Marcell Szasz, Johan Malm, Melinda Rezeli, Yutaka Sugihara, Lazaro H Betancourt, Daniel Rivas, Balázs Gyorffy, György Marko-Varga
There is an increasing global interest to support research areas that can assist in understanding disease and improving patient care. The National Cancer Institute (NIH) has identified precision medicine-based approaches as key research strategies to expedite advances in cancer research. The Cancer Moonshot program ( ) is the largest cancer program of all time, and has been launched to accelerate cancer research that aims to increase the availability of therapies to more patients and, ultimately, to eradicate cancer...
October 24, 2018: Cell Biology and Toxicology
Yuan Jiang, Long Yan, Longkuo Xia, Xiaoyin Lu, Wenliang Zhu, Dewen Ding, Mingxia Du, Da Zhang, Hongmei Wang, Baoyang Hu
Human pluripotent stem cells hold great promise for improving regenerative medicine. However, a risk for tumor formation and difficulties in generating large amounts of subtype derivatives remain the major obstacles for clinical applications of stem cells. Here, we discovered that zinc finger E-box-binding homeobox 1 (ZEB1) is highly expressed upon differentiation of human embryonic stem cells (hESCs) into neuronal precursors. CRISPR/Cas9-mediated ZEB1 depletion did not impede neural fate commitment, but  prevented hESCs-derived neural precursors from differentiating into neurons, indicating that ZEB1 is required for neuronal differentiation...
October 18, 2018: Journal of Biological Chemistry
Su-Han Chang, Chiao-Hsuan Hsieh, Yi-Ming Weng, Ming-Shun Hsieh, Zhong Ning Leonard Goh, Hsien-Yi Chen, Tung Chang, Chip-Jin Ng, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chen-June Seak
Background: Renal abscess is a relatively uncommon yet debilitating and potentially fatal disease. There is no clearly defined, objective risk stratification tool available for emergency physicians' and surgeons' use in the emergency department (ED) to quickly determine the appropriate management strategy for these patients, despite early intervention having a beneficial impact on survival outcomes. Objective: This case control study evaluates the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting risk of mortality in ED adult patients with renal abscess...
2018: BioMed Research International
Michael L Gross
Military medical research requires informed consent from test subjects, which is difficult to obtain for deployed (in-theatre) or prehospital studies where patients are incapacitated and legal representatives are not available. Although US and UK regulations make provisions for exceptions to informed consent, these are rarely used, thereby hindering trauma research and prospective experimental studies of new devices, surgeries or drugs. In their place, a survey of research articles published in the Journal of the Royal Army Medical Corps and Military Medicine between 2004 and 2018 shows how researchers turned to clinical surveys and retrospective, case or animal studies instead...
October 15, 2018: Journal of the Royal Army Medical Corps
Vicki Hunt, Dave Anderson, Richard Lowrie, Colette Montgomery Sardar, Susan Ballantyne, Graeme Bryson, John Kyle, Peter Hanlon
UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician...
October 10, 2018: NPJ Primary Care Respiratory Medicine
Hafiz M N Iqbal
In recent years, the Antimicrobial Resistance (AMR) or Multidrug Resistance (MDR) and viral infections have become serious health issues, globally. Finally, after decades of negligence, the AMR/MDR and viral infection issues have now captured a worldwide attention of the global leaders, public health community, legalization authorities, academia, research-based organizations, and medicinal sector of the modern world, alike. Aiming to resolve these issues, various methodological approaches have been exploited, in the past several years...
2018: Open Virology Journal
Fengyun Vicky Han, Karen Weiss
The Asia Pacific (AP) region is diverse and dynamic. It comprises over 40 economies, with about 24 markets that are relatively more active in terms of promulgating and implementing regulations that impact the biopharmaceutical industry and advance drug development. Although many country- and territory-specific regulations, often driven by the local economy and market dynamics, exist, the overall trend in the AP region is toward international harmonization and global convergence. More markets are now participating in the International Council on Harmonization (ICH), and there is growing interest in identifying and incorporating best practices from competent regulatory agencies...
September 24, 2018: Therapeutic Innovation & Regulatory Science
Lauren R Frank, Patrick F P Roynard
The increase in client willingness to pursue surgical procedures, the heightened perceived value of veterinary patients, and the desire to provide comprehensive medical care have driven the recent demand of using an integrative treatment approach in veterinary rehabilitation. Physical therapy following neurologic injury has been the standard of care in human medicine for decades, whereas similar rehabilitation techniques have only recently been adapted and utilized in veterinary medicine. Spinal cord injury is the most common neurologic disease currently addressed by veterinary rehabilitation specialists and will be the primary focus of this review; however, research in other neurologic conditions will also be discussed...
June 2018: Topics in Companion Animal Medicine
Alison Matthews
Airway management in the wilderness runs the gamut from basic airway support to endotracheal intubation. Fortunately, direct laryngoscopy is a seldom called upon skill in expedition medicine. However, the medical skills required during a mission or expedition are never truly known in advance. Improvisation during evolving medical events is a mainstay of expedition medicine education and practice. It is unlikely, given constraints of weight and size of expedition medical kits, that a conventional laryngoscope would find its way into a standard "go bag...
September 2018: Wilderness & Environmental Medicine
Gisela Wilcox
Once based mainly in paediatrics, inborn errors of metabolism (IEM), or inherited metabolic disorders (IMD) represent a growing adult medicine specialty. Individually rare these conditions have currently, a collective estimated prevalence of >1:800. Diagnosis has improved through expanded newborn screening programs, identification of potentially affected family members and greater awareness of symptomatic presentations in adolescence and in adulthood. Better survival and reduced mortality from previously lethal and debilitating conditions means greater numbers transition to adulthood...
March 2018: Reviews in Endocrine & Metabolic Disorders
Camila M Crnkovic, Aleksej Krunic, Daniel S May, Tyler A Wilson, Diana Kao, Joanna E Burdette, James R Fuchs, Nicholas H Oberlies, Jimmy Orjala
Cyanobacteria are a source of chemically diverse metabolites with potential medicinal and biotechnological applications. Rapid identification of compounds is central to expedite the natural product discovery process. Mass spectrometry has been shown to be an important tool for dereplication of complex natural product samples. In addition, chromatographic separation and complementary spectroscopic analysis (e.g., UV) can enhance the confidence of the dereplication process. Here, we applied a droplet-liquid microjunction-surface sampling probe (droplet probe) coupled with UPLC-PDA-HRMS-MS/MS to identify two new natural products in situ from the freshwater strain Calothrix sp...
September 28, 2018: Journal of Natural Products
Joel Lexchin
OBJECTIVES: This study examines the use of expedited approval pathways by Health Canada over the period 1995 to 2016 inclusive and the relationship between the use of these pathways and the therapeutic gain offered by new products. DESIGN: Cross-sectional study. DATA SOURCES: Therapeutic Products Directorate, Biologics and Genetic Therapies Directorate, Notice of Compliance database, Notice of Compliance with conditions web site, Patented Medicine Prices Review Board, La revue Prescrire, WHO Anatomical Therapeutic Chemical classification system...
August 30, 2018: BMJ Open
Subotheni Thavaneswaran, Lucille Sebastian, Mandy Ballinger, Megan Best, Dominique Hess, Chee K Lee, Katrin M Sjoquist, Wendy E Hague, Phyllis N Butow, R John Simes, David Thomas
BACKGROUND: Precision medicine aims to link molecular targets in tumours with corresponding therapies, particularly for patients with rare cancers. Innovative approaches are needed to translate molecular opportunities into clinical care. The Cancer Molecular Screening and Therapeutics (MoST) program employs a molecular screening platform to identify molecular changes of therapeutic relevance (actionable changes) and a master protocol for multiple, parallel signal-seeking clinical substudies, focused on therapies for patients with rare and neglected cancers...
August 27, 2018: Medical Journal of Australia
Thomas G W Edwardson, Takahiro Mori, Donald Hilvert
Oligonucleotide therapeutics have transformative potential in modern medicine but are poor drug candidates in themselves unless fitted with compensatory carrier systems. We describe a simple approach to transform a designed porous protein cage into a nucleic acid delivery vehicle. By introducing arginine mutations to the lumenal surface, a positively supercharged capsule is created, which can encapsidate oligonucleotides in vitro with high binding affinity. We demonstrate that the siRNA-loaded cage is taken up by mammalian cells and releases its cargo to induce RNAi and knockdown gene expression...
August 22, 2018: Journal of the American Chemical Society
Andreas Leischker, Fritz Ge Holst
For many acute diseases and injuries, treatment does not differ between industrialised environment and wilderness setting. However, for some emergencies, treatment needs to be adapted if advanced medical care facilities cannot be reached within 4 hours.In these situations, dislocated joints and fractures should be reduced quickly. Contaminated wounds should be cleaned carefully, with drinking water being sufficient when no sterile solution is available. A patient with a contaminated wound should receive a systemic antibiotic coverage within one hour...
August 2018: Deutsche Medizinische Wochenschrift
Elena Fountzilas, Apostolia M Tsimberidou
In recent years, the therapeutic management of selected patients with cancer has shifted toward the 'precision medicine' approach based on patient's mechanisms of tumorigenesis, and their baseline characteristics and comorbidities. Complete tumor and cell-free DNA profiling using next-generation sequencing, proteomic and RNA analysis, and immune mechanisms should to be taken into consideration and accurate bioinformatic analysis is essential to optimize patient's treatment. Areas covered: The challenges and opportunities of conducting clinical trials in precision oncology are summarized...
August 2018: Expert Review of Clinical Pharmacology
Michael S Bagwell, Kevin E Wilk, Ricardo E Colberg, Jeffrey R Dugas
Background: Medial collateral ligament (MCL) injuries are one of the most commonly treated knee pathologies in sports medicine. The MCL serves as the primary restraint to valgus force. The large majority of these injuries do not require surgical intervention. Case Subject Description: A 30-year-old professional wrestling athlete presented to the clinic with acute complaints of right medial knee pain resulting from a traumatic valgus force. Physical exam revealed Grade 3 MCL injury...
June 2018: International Journal of Sports Physical Therapy
Noushin Nabavi, Jingchao Wei, Dong Lin, Colin C Collins, Peter W Gout, Yuzhuo Wang
Malignant mesothelioma (MM) is a rare disease often associated with environmental exposure to asbestos and other erionite fibers. MM has a long latency period prior to manifestation and a poor prognosis. The survival post-diagnosis is often less than a year. Although use of asbestos has been banned in the United States and many European countries, asbestos is still being used and extracted in many developing countries. Occupational exposure to asbestos, mining, and migration are reasons that we expect to continue to see growing incidence of mesothelioma in the coming decades...
2018: Frontiers in Genetics
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