A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis.

Regenerative medicine, specifically bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), has become a novel adjunct that orthopedic surgeons have started to use with surgical rotator cuff repairs (RCR). Thus, we are conducting this systematic review to determine if either RCRs with BMAC alone or with BMAC and PRP result in superior functional outcomes. We conducted a comprehensive search using five databases including PubMed, Web of Science, Embase, Scopus, and Cochrane. After duplicates were removed, 1205 studies were screened by title and abstract using Rayyan, resulting in three included studies (one BMAC with PRP and two BMAC only). Only studies that reported functional outcomes using the American Shoulder and Elbow Surgeons Shoulder Score and the University of California Los Angeles Shoulder Score were included. Changes in assessment scores from baseline to follow-up evaluation were quantified using the effect size and used in the meta-analysis for each group. Interpretation of treatment efficacy was represented using Cohen's d. The effect size of BMAC with PRP (Cohen's d = 2.19) was not significantly different (p = 0.76) from that of BMAC alone (Cohen's d = 2.35). Between-group differences in functional outcomes were Cohen's d = 0.16, which was not significant. Given the lack of superiority and the small sample size, more research is required before a conclusion can be drawn as to the benefits of combining PRP with BMAC for RCR. If functional outcomes are the same, using BMAC alone as an adjunct may be optimal to reduce resources used and cost. Future studies should be conducted with a larger pool as our primary limitation is that only three studies were included.

Footprints and Ootheca of Lycorma delicatula Influence Host-Searching and -Acceptance of the Egg-Parasitoid Anastatus orientalis.

The spotted lanternfly, Lycorma delicatula White (1845) (Hemiptera: Fulgoridae), is an invasive insect that was first reported in North America in Berks County, Pennsylvania, in 2014. It is a polyphagous phloem feeder that attacks over 70 plant species, threatening the agricultural, lumber, and ornamental industries of North America. Infestations of the pest have been reported in several U.S. counties, and a lack of endemic predators and parasitoids feeding on L. delicatula suggests a release from natural enemies in the invaded range. An egg-parasitoid Anastatus orientalis (Hymenoptera: Eupelmidae) was reported attacking L. delicatula at high rates in its native range and may play a key role in reducing its populations there. To better understand the foraging behavior of A. orientalis, a series of behavioral experiments were conducted to determine successful parasitism and behavioral responses to traces left by adult L. delicatula and to the oothecae which cover their eggs. Our results suggest that wasps detected chemical traces left by L. delicatula adults while walking on surfaces and exhibited a strong arrestment response. Moreover, wasps preferred to oviposit in egg masses with intact oothecae. The implications of these findings are herein discussed with regard to the exploitation of host kairomones by foraging wasps, as well as to its ability to overcome host structural defenses.

Ion traps in modern mass spectrometry.

This review is devoted to trapping mass spectrometry wherein ions are confined by electromagnetic fields for prolonged periods of time within limited volume, with mass measurement taking place within the same volume. Three major types of trapping mass spectrometers are discussed, specifically radiofrequency ion trap, Fourier transform ion cyclotron resonance and Orbitrap. While these three branches are intricately interwoven with each other over their recent history, they also differ greatly in their fundamentals, roots and historical origin. This diversity is reflected also in the difference of viewpoints from which each of these directions is addressed in this review. Following the theme of the issue, we focus on developments mainly associated with the country of Germany but, at the same time, we use this review as an illustration of the rapidly increasing globalization of science and expanding multi-national collaborations.

Acute coronary syndrome - a frequent clinical manifestation of bare metal in-stent restenosis.

BACKGROUND: In-stent restenosis (ISR) complicates 20-30% of percutaneous coronary interventions (PCI) with bare metal stent (BMS) implantation. Although the widespread use of drug eluting stents (DES) across Europe caused a considerable reduction of BMS implantations, their number is still lower than the number of BMS implantations in several countries. AIM: The clinical presentation of ISR has not been well characterissed. Thus, we attempted to analyze this condition and assess the treatment of ISR in everyday clinical practice. METHODS: We searched our database for all cases of bare metal ISR between 1999 and 2007. Follow-up angiography after PCI was not a routine procedure but a clinically driven examination. Clinical presentations of ISR were divided into: stable angina, and acute coronary syndromes (ACS), i.e. unstable angina (UA) and myocardial infarction (MI) (further subdivided into NSTEMI and STEMI). Analysis included variables associated with different clinical manifestations, methods of ISR treatment and in-hospital complications of ISR. RESULTS: In-stent restenosis was identified in 432 (3%) of 15,910 patients who underwent PCI. The mean age was 61.6 + or - 15.6 (27-86) years, and 295 (68.3%) patients were men. Risk factor distribution was typical for a Caucasian population. Recurrent clinical episode occurred at a mean of 7 (1-108) months after PCI. Exertional angina was present in 245 (56.7%) patients, UA in 128 (29.6%) patients and MI in 59 (13.7%) patients, including STEMI in 28 (6.5%) and NSTEMI in 31 (7.2%) patients. Overall, ACS was diagnosed in 187 patients or 43.3% of all cases of ISR. Multivariate analysis showed a positive correlation between previous MI and younger age and ACS as the clinical manifestation of ISR, and a negative correlation between more severe restenosis and ACS manifestation. The incidence of clinical complications (MI or death) was higher in patients with ACS as the clinical manifestation of ISR (6.9% vs 1.6%). CONCLUSIONS: In-stent restenosis after BMS implantation is a serious clinical problem. More than 40% of patients with ISR present with ACS, including 13.7% patients with MI, more frequently among younger patients and patients with previous MI. Most patients with ISR are treated with repeated PCI with high success rate (97.7%), although the risk of clinical complications is considerably higher in patients presenting with ACS.

Isobolographic analysis of interactions between remacemide and conventional antiepileptic drugs in the mouse model of maximal electroshock.

Using the mouse maximal electroshock-induced seizure model, indicative of tonic-clonic seizures in humans, the present study was aimed at characterizing the interaction between remacemide and valproate, carbamazepine, phenytoin, and phenobarbital. Isobolographic analysis indicated additive interactions between remacemide and valproate, carbamazepine, and phenytoin (for all fixed ratios of tested drugs: 1:3, 1:1, and 3:1). Additivity was also observed between remacemide and phenobarbital applied in proportions of 1:1 and 3:1. In contrast, the combination of remacemide and phenobarbital at the fixed-ratio of 1:3 resulted in antagonism. Neither motor performance nor long-term memory was impaired by remacemide or by carbamazepine, phenobarbital, phenytoin, and valproate whether or not these drugs were administered singly or in combination. In combination with remacemide, brain concentrations of carbamazepine, phenobarbital, and phenytoin were increased by 71, 21, and 16%, respectively. Although brain valproate concentrations were unaffected by remacemide co-administration, brain concentrations of remacemide and its active metabolite, desglycinyl-remacemide, were increased by 68 and 162%, respectively. In contrast, phenobarbital co-administration was associated with decreases in brain remacemide (27%) and desglycinyl-remacemide (9%) concentrations, whereas only remacemide concentrations (increased by 131%) were affected by carbamazepine co-administration. In conclusion, significant and desirable pharmacodynamic interactions were observed between remacemide and valproate, carbamazepine, phenytoin, and phenobarbital. However, the concurrent pharmacokinetic interactions associated with remacemide complicate these observations and do not make remacemide a good candidate for adjunctive treatment of epilepsy.

Role of nuclear factor kappaB in the central nervous system.

The aim of this review was to assemble current literature data on nuclear factor kappa B (NF-kappaB). Many authors believe that NF-kappaB, a transcription factor, has essential influence on the regulation of numerous genes in the organism. In this review, we have focused on the role of NF-kappaB and its target genes in the central nervous system functioning. Unfortunately, the contribution of NF-kappaB to neuroprotection or to neurodegeneration is not clear, yet. Therefore, its exact role in these processes and potential applications in pharmacology are still to be determined.

Is there any future for felbamate treatment?

Felbamate (2-phenyl-1,3-propanediol dicarbamate), a representative of novel antiepileptic drugs (AESs), proved to have broad-spectrum anticonvulsive activity. Particularly beneficial efficacy was found against partial seizures and Lennox-Gastaut syndrome. Therefore, felbamate started to be indicated not only as an adjunctive antiepileptic drug but also in monotherapy. Unfortunately, it was also evidenced that the drug may induce aplastic anemia or hepatic failure. The former complication was frequently described in patients with previously diagnosed hematopoetic disturbances. Thirty-four cases of well-documented bone marrow suppression, occurred fatal in thirteen cases. Subsequently, felbamate's usage was essentially restricted and at present felbamate is not a first-line AED. However, excluding anemia-prone individuals, new possibilities may open for felbamate position in add-on therapy of drug-resistant epilepsy. Experimental studies provide a good theoretical basis for this kind of treatment.

Remacemide--a novel potential antiepileptic drug.

Epilepsy belongs to common diseases of the brain. It affects approximately 1% of the population. The aim of epilepsy therapy is to keep the patient free of seizures without interfering with normal brain function. Unfortunately, about 30% of all epilepsies remain without control. In this situation patients require polytherapy which is usually a combination of antiepileptic drugs (AEDs) acting via different mechanisms of action. Many potential AEDs have been developed but the proportion of patients failing to respond to drug treatment has not been fundamentally changed. The aim of this review was to assemble current literature data on remacemide, a novel AED, which is suggested for the treatment of epilepsy. Remacemide hydrochloride is a low-affinity NMDA receptor blocker as well as Na(+) fast-channel blocker. The drug exerts anticonvulsant activity both in various animal seizure models and in clinical studies. In addition to its antiseizure properties, the drug seems to provide neuroprotection. Remacemide holds promise to serve as neuroprotectant not only in seizures but perhaps in other neurodegenerative conditions in humans as well.

Perspectives of losigamone in epilepsy treatment.

Patients with drug resistant epilepsy represent about 40% of the whole population of epileptic patients. These patients require more than one antiepileptic drug. In animal models of epilepsy, it is possible to determine which combinations produce supra-additive anticonvulsive effects with minimal or even no adverse reactions. The experimental data can be helpful for predicting effective drug combinations in patients with refractory epilepsy. Losigamone is a new antiepileptic drug with an unknown mechanism of action. The drug belongs to the group of beta-methoxy-butenolides, and exists as a racemic mixture of two enantiomers (AO-242 and AO-294). The drug is eliminated by oxidation. Cytochrome CYP2A6 appears to be the main isoenzyme responsible for the metabolism of losigamone. In vitro, losigamone exerts anticonvulsant activity in the picrotoxin model in CA1 and CA3 hippocampal areas, the low Ca(2+) model in CA1 area and the low Mg(2+) model in the entorhinal cortex and hippocampus. In vivo, the drug exhibits significant efficacy against maximal electroshock-induced seizures in rodents and pentetrazole-induced clonic convulsions in mice. Potency of losigamone varies with the respective seizure test, animal species used in experiments and route of drug administration. Toxicity studies do not indicate any teratogenic risk of the drug, at least in animals. In clinical trial, losigamone proved to have satisfactory effectiveness and good tolerance in the treatment of partial and secondary generalized seizures. The enantiomer AO-242 seems to be more potent than AO-294 or racemate.

Zonisamide: a new antiepileptic drug.

Although the significant progress in pharmacotherapy of epilepsy during last decade was achieved, about one third of patients are resistant to the current treatment. When the monotherapy is not efficient, the polytherapy should be applied. Zonisamide (ZNS) is a new antiepileptic drug (AED) efficient in treating refractory epilepsy. Its efficacy in different types of seizures was confirmed in various animal studies as well as in clinical conditions. ZNS inhibits voltage-dependent Na(+) channels and Ca(2+) channels of T-type. The drug influences also monoamine neurotransmission and exhibits free radical scavenging properties. ZNS has a linear and favorable pharmacokinetics with excellent oral bioavailability. Furthermore, ZNS treatment, compared to other anticonvulsants, is relatively safe and well tolerated. Since ZNS is often used in polytherapy, its interactions with other AEDs seem to be of particular importance. However, the experimental data are rather inconsistent and further studies are necessary to elucidate exact effects of coadministration of ZNS with other AEDs. Recently, the clinical and experimental studies have suggested some new indications for ZNS administration, as mania, neuropathic pain, Parkinson's disease or migraine prophylaxis. Nowadays, it is also well established that ZNS exerts neuroprotective properties.

Neuroprotective effects of antiepileptic drugs.

Experimental and clinical data indicate that epilepsy and seizures lead to neuronal cell loss and irreversible brain damage. This neurodegeneration results not only in the central nervous system dysfunction but may also be responsible for the decreased efficacy of some antiepileptic drugs (AEDs). The aim of this review was to assemble current literature data on neuroprotective properties of AEDs. The list of hypothetical neuroprotectants is long and consists of substances which act via different mechanisms. We focus on AEDs since this heterogeneous group of pharmaceuticals, as far as mechanisms of their action and mechanisms of neuronal death are concerned, should provide protection in addition to antiseizure effect itself. Most studies on neuroprotection are based on animal experimental models of neuronal degeneration. Electrically and pharmacologically evoked seizures as well as different models of ischemia are frequently used. Although our knowledge about properties of AEDs is still not complete and discrepancies occasionally occur, the group seems to be promising in terms of neuroprotection. Some of the drugs, though, turn out to be neutral or even have adverse effects on the central nervous system, especially on immature brain tissue (barbiturates and benzodiazepines). Unfortunatelly, we cannot fully extrapolate animal data to humans, therefore further well designed clinical trials are necessary to determine neuroprotective properties of AEDs in humans. However, there is a hope that AEDs will have a potential to serve as neuroprotectants not only in seizures, but perhaps, in other neurodegenerative conditions in humans as well. The novel AEDs (especially lamotrigine, tiagabine, and topiramate) seem particularly promising.