Interdisciplinary Treatment of Maladaptive Behaviors Associated with Postural Orthostatic Tachycardia Syndrome (POTS): A Case Report.

The prevalence of postural orthostatic tachycardia syndrome (POTS) in adolescents and young adults has been increasing during the past decade. Despite this increase, documentation regarding treatment of these patients is just beginning to emerge. In addition, despite a call for a multidisciplinary or interdisciplinary approach, no studies have examined the efficacy of such an approach to treatment. This paper describes a case study of a 19-year-old male with debilitating POTS seen at a tertiary clinic for evaluation and subsequent intensive interdisciplinary treatment. The treatment approach is described and outcomes are presented.

Divergent Mechanistic Avenues to an Aliphatic Polyesteracetal or Polyester from a Single Cyclic Esteracetal.

The cyclic esteracetal 2-methyl-1,3-dioxane-4-one (MDO) was polymerized in bulk using diethyl zinc as the catalyst and benzyl alcohol as the initiator to yield either the corresponding polyesteracetal (PMDO) or the aliphatic polyester poly(3-hydroxypropionic acid) (PHPA) at low and high catalyst concentrations, respectively. Spectral analysis gave evidence for distinct propagating species in the two catalyst concentration regimes. At low zinc concentrations ring opening by attack of the initiating species at the acetal functionality, yielding a zinc carboxylate, followed by propagation to yield pure PMDO was implicated. At high zinc concentrations we propose that ring opening via attack at the ester functionality produced a labile zinc hemiacetal, which rapidly and irreversibly expelled acetaldehyde to form a propagating zinc alkoxide and ultimately pure PHPA. Initial rate studies indicated that the rate of PHPA formation had a second-order dependence on zinc concentration; in contrast, the rate of PMDO formation was first order in zinc concentration. High molar mass PMDO exhibited only a glass transition temperature (Tg) ≈ -30 °C, whereas high molar mass PHPA had a Tg ≈ -30 °C and a melting temperature (Tm) ≈ 77 °C. When PHPA and PMDO were subjected to neutral or slightly acidic environments, PMDO exhibited expedited degradation as compared with PHPA.

Bioresorbable polymersomes for targeted delivery of cisplatin.

Nontoxic bioresorbable polymersomes have been developed that efficiently and site-selectively tether targeting peptides under mild conditions with no toxic catalysts. The binding and release properties of these polymersomes have been evaluated when targeting DLD-1 human colon cancer cells overexpressing the α(5)ß(1) integrin. The delivery efficacy to these cells is markedly improved over commonly used RGD targeting peptides by use of an α(5)ß(1)-specific targeting peptide, PR_b. Release profiles in buffered solution from pH 7.4 to 4.5 were evaluated and compared to release after binding to cells, and enzymatic degradation was identified as a major cause of rapid payload release in the cell. Intracellular trafficking and release were imaged via confocal microscopy in live cells and colocalization with organelles was evaluated quantitatively over time. Finally, the anticancer drug cisplatin was encapsulated in the PR_b functionalized polymersomes and the presence of PR_b greatly improved delivery efficacy, with increased cisplatin-induced losses to targeted DLD-1 colon cancer cell viability. When delivered to CACO-2 model human epithelial cells expressing low levels of α(5)ß(1) integrin, low toxicity was maintained, suggesting that targeting was specific to α(5)ß(1) overexpressing cells. These results demonstrate that PR_b-functionalized bioresorbable polymersomes may be an attractive route to minimizing the dose-limiting side effects associated with existing approaches to cisplatin chemotherapy.

Peptide- and aptamer-functionalized nanovectors for targeted delivery of therapeutics.

Targeted delivery of therapeutics is an area of vigorous research, and peptide- and aptamer-functionalized nanovectors are a promising class of targeted delivery vehicles. Both peptide- and aptamer-targeting ligands can be readily designed to bind a target selectively with high affinity, and more importantly are molecules accessible by chemical synthesis and relatively compact compared with antibodies and full proteins. The multitude of peptide ligands that have been used for targeted delivery are covered in this review, with discussion of binding selectivity and targeting performance for these peptide sequences where possible. Aptamers are RNA or DNA strands evolutionarily engineered to specifically bind a chosen target. Although use of aptamers in targeted delivery is a relatively new avenue of research, the current state of the field is covered and promises of future advances in this area are highlighted. Liposomes, the classic drug delivery vector, and polymeric nanovectors functionalized with peptide or aptamer binding ligands will be discussed in this review, with the exclusion of other drug delivery vehicles. Targeted delivery of therapeutics, from DNA to classic small molecule drugs to protein therapeutics, by these targeted nanovectors is reviewed with coverage of both in vitro and in vivo deliveries. This is an exciting and dynamic area of research and this review seeks to discuss its broad scope.

Electrolytic trichloroethene degradation using mixed metal oxide coated titanium mesh electrodes.

Electrochemical systems provide a low cost, versatile, and controllable platform to potentially treat contaminants in water, including chlorinated solvents. Relative to bare metal or noble metal amended materials, dimensionally stable electrode materials such as mixed metal oxide coated titanium (Ti/MMO) have advantages in terms of stability and cost, important factors for sustainable remediation solutions. Here, we report the use of Ti/MMO as an effective cathode substrate for treatment of trichloroethene (TCE). TCE degradation in a batch reactor was measured as the decrease of TCE concentration over time and the corresponding evolution of chloride; notably, this occurred without the formation of commonly encountered chlorinated intermediates. The reaction was initiated when Ti/MMO cathode potentials were less than -0.8 V vs. the standard hydrogen electrode, and the rate of TCE degradation increased linearly with progressively more negative potentials. The maximum pseudo-first-order heterogeneous rate constant was approximately 0.05 cm min(-1), which is comparable to more commonly used cathode materials such as nickel. In laboratory-scale flow-though column reactors designed to simulate permeable reactive barriers (PRBs), TCE concentrations were reduced by 80-90%. The extent of TCE flux reduction increased with the applied potential difference across the electrodes and was largely insensitive to the spacing distance between the electrodes. This is the first report of the electrochemical reduction of a chlorinated organic contaminant at a Ti/MMO cathode, and these results support the use of this material in PRBs as a possible approach to manage TCE plume migration.