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[PMID]: 29287105 [Au] Autor: Labens R; Daniel C; Hall S; Xia XR; Schwarz T [Ad] Endereço: School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia. [Ti] Título: Effect of intra-articular administration of superparamagnetic iron oxide nanoparticles (SPIONs) for MRI assessment of the cartilage barrier in a large animal model. [So] Source: PLoS One;12(12):e0190216, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Early diagnosis of cartilage disease at a time when changes are limited to depletion of extracellular matrix components represents an important diagnostic target to reduce patient morbidity. This report is to present proof of concept for nanoparticle dependent cartilage barrier imaging in a large animal model including the use of clinical magnetic resonance imaging (MRI). Conditioned (following matrix depletion) and unconditioned porcine metacarpophalangeal cartilage was evaluated on the basis of fluorophore conjugated 30 nm and 80 nm spherical gold nanoparticle permeation and multiphoton laser scanning and bright field microscopy after autometallographic particle enhancement. Consequently, conditioned and unconditioned joints underwent MRI pre- and post-injection with 12 nm superparamagnetic iron oxide nanoparticles (SPIONs) to evaluate particle permeation in the context of matrix depletion and use of a clinical 1.5 Tesla MRI scanner. To gauge the potential pro-inflammatory effect of intra-articular nanoparticle delivery co-cultures of equine synovium and cartilage tissue were exposed to an escalating dose of SPIONs and IL-6, IL-10, IFN-γ and PGE2 were assessed in culture media. The chemotactic potential of growth media samples was subsequently assessed in transwell migration assays on isolated equine neutrophils. Results demonstrate an increase in MRI signal following conditioning of porcine joints which suggests that nanoparticle dependent compositional cartilage imaging is feasible. Tissue culture and neutrophil migration assays highlight a dose dependent inflammatory response following SPION exposure which at the imaging dose investigated was not different from controls. The preliminary safety and imaging data support the continued investigation of nanoparticle dependent compositional cartilage imaging. To our knowledge, this is the first report in using SPIONs as intra-articular MRI contrast agent for studying cartilage barrier function, which could potentially lead to a new diagnostic technique for early detection of cartilage disease. [Mh] Termos MeSH primário: Cartilagem Articular/diagnóstico por imagem Articulações Imagem por Ressonância Magnética/métodos Nanopartículas de Magnetita/administração & dosagem Modelos Animais [Mh] Termos MeSH secundário: Animais Biomarcadores/metabolismo Cartilagem Articular/metabolismo Quimiotaxia de Leucócito Técnicas de Cocultura Vias de Administração de Medicamentos Feminino Corantes Fluorescentes Cavalos Masculino Microscopia Confocal Neutrófilos/citologia Suínos [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Biomarkers); 0 (Fluorescent Dyes); 0 (Magnetite Nanoparticles) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180207 [Lr] Data última revisão: 180207 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171230 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0190216

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[PMID]: 29298155 [Au] Autor: Johnson JR; Russo TA [Ad] Endereço: From Minneapolis Veterans Affairs (VA) Health Care System and the University of Minnesota, Minneapolis (J.R.J.); and the University of Buffalo, State University of New York, and VA Western New York Health Care System, Buffalo (T.A.R.). [Ti] Título: Acute Pyelonephritis in Adults. [So] Source: N Engl J Med;378(1):48-59, 2018 01 04. [Is] ISSN: 1533-4406 [Cp] País de publicação: United States [La] Idioma: eng [Mh] Termos MeSH primário: Antibacterianos/uso terapêutico Hidratação Pielonefrite/diagnóstico Pielonefrite/terapia [Mh] Termos MeSH secundário: Doença Aguda Adulto Terapia Combinada Drenagem Vias de Administração de Medicamentos Esquema de Medicação Feminino Seres Humanos Guias de Prática Clínica como Assunto Pielonefrite/complicações Fatores de Risco Índice de Gravidade de Doença [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW [Nm] Nome de substância: 0 (Anti-Bacterial Agents) [Em] Mês de entrada: 1801 [Cu] Atualização por classe: 180118 [Lr] Data última revisão: 180118 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 180104 [St] Status: MEDLINE

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[PMID]: 29096811 [Au] Autor: Divakaran S; Loscalzo J [Ad] Endereço: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. [Ti] Título: The Role of Nitroglycerin and Other Nitrogen Oxides in Cardiovascular Therapeutics. [So] Source: J Am Coll Cardiol;70(19):2393-2410, 2017 Nov 07. [Is] ISSN: 1558-3597 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: The use of nitroglycerin in the treatment of angina pectoris began not long after its original synthesis in 1847. Since then, the discovery of nitric oxide as a biological effector and better understanding of its roles in vasodilation, cell permeability, platelet function, inflammation, and other vascular processes have advanced our knowledge of the hemodynamic (mostly mediated through vasodilation of capacitance and conductance arteries) and nonhemodynamic effects of organic nitrate therapy, via both nitric oxide-dependent and -independent mechanisms. Nitrates are rapidly absorbed from mucous membranes, the gastrointestinal tract, and the skin; thus, nitroglycerin is available in a number of preparations for delivery via several routes: oral tablets, sublingual tablets, buccal tablets, sublingual spray, transdermal ointment, and transdermal patch, as well as intravenous formulations. Organic nitrates are commonly used in the treatment of cardiovascular disease, but clinical data limit their use mostly to the treatment of angina. They are also used in the treatment of subsets of patients with heart failure and pulmonary hypertension. One major limitation of the use of nitrates is the development of tolerance. Although several agents have been studied for use in the prevention of nitrate tolerance, none are currently recommended owing to a paucity of supportive clinical data. Only 1 method of preventing nitrate tolerance remains widely accepted: the use of a dosing strategy that provides an interval of no or low nitrate exposure during each 24-h period. Nitric oxide's important role in several cardiovascular disease mechanisms continues to drive research toward finding novel ways to affect both endogenous and exogenous sources of this key molecular mediator. [Mh] Termos MeSH primário: Fármacos Cardiovasculares/administração & dosagem Doenças Cardiovasculares/tratamento farmacológico Óxidos de Nitrogênio/administração & dosagem Nitroglicerina/administração & dosagem [Mh] Termos MeSH secundário: Animais Fármacos Cardiovasculares/metabolismo Doenças Cardiovasculares/metabolismo Doenças Cardiovasculares/patologia Vias de Administração de Medicamentos Seres Humanos Óxidos de Nitrogênio/metabolismo Nitroglicerina/metabolismo [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Cardiovascular Agents); 0 (Nitrogen Oxides); G59M7S0WS3 (Nitroglycerin) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171117 [Lr] Data última revisão: 171117 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171104 [St] Status: MEDLINE

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[PMID]: 28973553 [Au] Autor: Savas M; Muka T; Wester VL; van den Akker ELT; Visser JA; Braunstahl GJ; Slagter SN; Wolffenbuttel BHR; Franco OH; van Rossum EFC [Ad] Endereço: Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, Netherlands. [Ti] Título: Associations Between Systemic and Local Corticosteroid Use With Metabolic Syndrome and Body Mass Index. [So] Source: J Clin Endocrinol Metab;102(10):3765-3774, 2017 Oct 01. [Is] ISSN: 1945-7197 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Context: Use of systemic corticosteroids (CSs) may induce adverse cardiometabolic alterations, potentially leading to obesity and metabolic syndrome (MetS). Although evidence is accumulating that local CSs have considerable systemic effects, their effects on cardiometabolic factors in the general population remain unclear. Objective: To investigate the association between overall CS use and specific CS types with MetS, body mass index (BMI), and other cardiometabolic traits. Design: Cross-sectional cohort study. Setting: General population from the northern Netherlands. Participants: A total of 140,879 adult participants in the population-based Lifelines Cohort Study. Main Outcome Measures: BMI, waist circumference, systolic and diastolic blood pressure, fasting metabolic serum parameters, and a comprehensive set of potential confounding factors. Results: In women, overall, systemic, and local CS use was associated with higher odds of having MetS. Among local female users, only nasal (odds ratio [OR], 1.20 [95% confidence interval (CI), 1.06 to 1.36]) and inhaled CSs [OR, 1.35 (95% CI, 1.24 to 1.49)] users were more likely to have MetS. In men, no association was found between overall and specific CS use and presence of MetS. Use of local-only CSs in women, specifically inhaled CSs in both sexes, was associated with higher BMI. Conclusions: Use of local CSs, particularly inhaled types, as well as systemic CSs, was associated with higher likelihood of having MetS, higher BMI, and other adverse cardiometabolic traits, especially among women. Because the inhaled agents are the main group of prescribed CSs, this might be a substantial risk to public health in case of a yet-to-be-proven causal relationship. [Mh] Termos MeSH primário: Índice de Massa Corporal Glucocorticoides/administração & dosagem Glucocorticoides/efeitos adversos Síndrome Metabólica/epidemiologia Obesidade/epidemiologia [Mh] Termos MeSH secundário: Adulto Estudos de Coortes Estudos Transversais Vias de Administração de Medicamentos Feminino Seres Humanos Masculino Síndrome Metabólica/etiologia Meia-Idade Países Baixos/epidemiologia Obesidade/etiologia Fatores de Risco Circunferência da Cintura/efeitos dos fármacos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Glucocorticoids) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171116 [Lr] Data última revisão: 171116 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171004 [St] Status: MEDLINE [do] DOI: 10.1210/jc.2017-01133

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[PMID]: 28865230 [Au] Autor: Burmanczuk A; Grabowski T; Bladek T; Kowalski C; Debiak P [Ad] Endereço: . [Ti] Título: Withdrawal of cefoperazone with milk after intramammary administration in dairy cows - prospective and retrospective analysis. [So] Source: Pol J Vet Sci;20(2):261-268, 2017 Mar 01. [Is] ISSN: 1505-1773 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: The aim of the study was to carry out retrospective and prospective comparative analyses of the pharmacokinetics of CEF after single intramammary (IMM) administration in cows. The prospective study (study A) was conducted on 9 dairy cows of the Polish Black-White race with clinical mastitis during the lactation period. Milk samples were collected at 2, 4, 6, 8, 10, 24, 36, 48, 72 and 84 h after single IMM administration of 250 mg of CEF to one quarter. Drug concentrations in milk samples were determined by HPLC-MS/MS technique and the results of the pharmacokinetic analysis were compared to those obtained in previous studies based on the microbiological (study B) and HPLC-UV methods (study C and D). Pharmacokinetic parameters were calculated based on adapted two-compartment model of drug distribution. One of the findings of the comparison of the analysed investigations is that the CEF kinetics determined with the microbiological method is consistent with the results obtained by the authors of this paper. Both studies yielded similar results of the key pharmacokinetic parameters related to the level of the drug distribution to tissues and elimination half-life. In the pharmacodynamic analysis, the observations in all four studies were entirely consistent and have shown lower values of T>MIC90 in healthy animals and significantly higher values in infected dairy cows. The comparison of studies A, B, C, and D revealed that the time of complete CEF wash-out of 90.90% varied and amounted to 5.7, 8.0, 2.2, and 2.2 days after administration of the drug, respectively. It was confirmed that not only the type of the analytical method but also correct sampling have a significant impact on determination of the correct value of the drug half-life after IMM administration. The comparative analysis of studies in which the milk yield was high and low allows a conclusion that this parameter in the case of CEF has no significant effect on T>MIC90. [Mh] Termos MeSH primário: Antibacterianos/farmacocinética Cefoperazona/farmacocinética Mastite Bovina/tratamento farmacológico Leite/química [Mh] Termos MeSH secundário: Animais Antibacterianos/administração & dosagem Antibacterianos/uso terapêutico Área Sob a Curva Bovinos Cefoperazona/administração & dosagem Cefoperazona/uso terapêutico Vias de Administração de Medicamentos Resíduos de Drogas Feminino Meia-Vida Estudos Retrospectivos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anti-Bacterial Agents); 7U75I1278D (Cefoperazone) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171106 [Lr] Data última revisão: 171106 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170903 [St] Status: MEDLINE

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[PMID]: 28837693 [Au] Autor: Weissmueller NT; Marsay L; Schiffter HA; Carlisle RC; Rollier CS; Prud'homme RK; Pollard AJ [Ad] Endereço: Department of Paediatrics, Oxford Vaccine Group, University of Oxford and the NIHR Oxford Biomedical Research Institute, Oxford, Oxfordshire, United Kingdom. [Ti] Título: Alternative vaccine administration by powder injection: Needle-free dermal delivery of the glycoconjugate meningococcal group Y vaccine. [So] Source: PLoS One;12(8):e0183427, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Powder-injectors use gas propulsion to deposit lyophilised drug or vaccine particles in the epidermal and sub epidermal layers of the skin. We prepared dry-powder (Tg = 45.2 ± 0.5°C) microparticles (58.1 µm) of a MenY-CRM197 glyconjugate vaccine (0.5% wt.) for intradermal needle-free powder injection (NFPI). SFD used ultrasound atomisation of the liquid vaccine-containing excipient feed, followed by lyophilisation above the glass transition temperature (Tg' = - 29.9 ± 0.3°C). This resulted in robust particles (density~ 0.53 ±0.09 g/cm3) with a narrow volume size distribution (mean diameter 58.1 µm, and span = 1.2), and an impact parameter (ρvr ~ 11.5 kg/m·s) sufficient to breach the Stratum corneum (sc). The trehalose, manitol, dextran (10 kDa), dextran (150 kDa) formulation, or TMDD (3:3:3:1), protected the MenY-CRM197 glyconjugate during SFD with minimal loss, no detectable chemical degradation or physical aggregation. In a capsular group Y Neisseria meningitidis serum bactericidal assay (SBA) with human serum complement, the needle free vaccine, which contained no alum adjuvant, induced functional protective antibody responses in vivo of similar magnitude to the conventional vaccine injected by hypodermic needle and syringe and containing alum adjuvant. These results demonstrate that needle-free vaccination is both technically and immunologically valid, and could be considered for vaccines in development. [Mh] Termos MeSH primário: Glicoconjugados/administração & dosagem Vacinas Meningocócicas/administração & dosagem Neisseria meningitidis Sorogrupo Y/imunologia Pós [Mh] Termos MeSH secundário: Administração Cutânea Animais Anticorpos Antibacterianos/sangue Vias de Administração de Medicamentos Ensaio de Imunoadsorção Enzimática Seres Humanos Vacinas Meningocócicas/imunologia Camundongos Microscopia Eletrônica de Varredura Tamanho da Partícula [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Antibodies, Bacterial); 0 (Glycoconjugates); 0 (Meningococcal Vaccines); 0 (Powders) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171023 [Lr] Data última revisão: 171023 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170825 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0183427

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[PMID]: 28796080 [Au] Autor: Mizoshita T; Katano T; Tanida S; Hirano A; Miyaki T; Ozeki K; Suzuki Y; Sugimura N; Kataoka H; Joh T [Ad] Endereço: aDepartment of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences bDepartment of Gastroenterology, Nagoya City West Medical Center cDepartment of Gastroenterology, Toyokawa City Hospital dDepartment of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital eDepartment of Gastroenterology, Nagoya Memorial Hospital, Nagoya, Japan. [Ti] Título: Prospective comparison of preference and efficacy of adalimumab and infliximab for treating ulcerative colitis naive to antitumor necrosis factor therapy. [So] Source: Medicine (Baltimore);96(32):e7800, 2017 Aug. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: There have been few reports on 2 tumor necrosis factor alpha inhibitors, infliximab and adalimumab, with respect to patient preference and efficacy in ulcerative colitis (UC).We used questionnaires to evaluate the preference and reasons for drug choice between infliximab and adalimumab in UC patients naive to antitumor necrosis factor alpha therapy. We also analyzed the efficacy of infliximab and adalimumab prospectively and endoscopically before treatment and at 14 and 54 weeks.Of the 25 UC patients, infliximab and adalimumab were chosen by 10 (40%) and 15 (60%), respectively. Patients who favored infliximab considered "fear of syringes" (7/10, 70%) as the most important influencing factor, whereas patients who favored adalimumab considered "ease of administration" (10/15, 66.7%) and "time required for therapy" (10/15, 66.7%) as the most important factors. There were no statistical differences in remission induction and maintenance between the infliximab and adalimumab groups with regard to response, remission, mucosal healing, steroid-free, and steroid-free remission rates at weeks 14 and 54.The efficacy of adalimumab in remission induction and maintenance was equivalent to that of infliximab in UC patients naive to antitumor necrosis factor alpha therapy in this prospective study, but more patients preferred adalimumab. [Mh] Termos MeSH primário: Adalimumab/uso terapêutico Colite Ulcerativa/tratamento farmacológico Fármacos Gastrointestinais/uso terapêutico Infliximab/uso terapêutico Preferência do Paciente/psicologia [Mh] Termos MeSH secundário: Adalimumab/administração & dosagem Adalimumab/efeitos adversos Adulto Idoso Idoso de 80 Anos ou mais Vias de Administração de Medicamentos Feminino Fármacos Gastrointestinais/administração & dosagem Fármacos Gastrointestinais/efeitos adversos Seres Humanos Infliximab/administração & dosagem Infliximab/efeitos adversos Masculino Meia-Idade Estudos Prospectivos Seringas Fatores de Tempo [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Nm] Nome de substância: 0 (Gastrointestinal Agents); B72HH48FLU (Infliximab); FYS6T7F842 (Adalimumab) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170827 [Lr] Data última revisão: 170827 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170811 [St] Status: MEDLINE [do] DOI: 10.1097/MD.0000000000007800

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[PMID]: 28701106 [Au] Autor: Bou-Fakhredin R; Halawi R; Roumi J; Taher A [Ad] Endereço: a Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon. [Ti] Título: Insights into the diagnosis and management of iron deficiency in inflammatory bowel disease. [So] Source: Expert Rev Hematol;10(9):801-808, 2017 Sep. [Is] ISSN: 1747-4094 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: INTRODUCTION: Iron deficiency is a frequent comorbidity of chronic diseases such as inflammatory bowel disease that can severely impact the health and quality of life of affected individuals. It can exist as a silent condition and manifest in non-specific symptoms even in the absence of anemia. Even though iron deficiency anemia is the most common complication and extra-intestinal manifestation of inflammatory bowel disease, the majority of inflammatory bowel disease patients who are diagnosed with iron deficiency anemia are not treated. Areas covered: In this review, we discuss iron deficiency and iron deficiency anemia in patients with inflammatory bowel disease, and review diagnostic and therapeutic options. Expert commentary: We invite international gastroenterological societies and associations to refine the practice guidelines and include iron deficiency as a potential morbidity associated with IBD in analogy to arthritis, uveitis or any other extra intestinal manifestations. There should a more unanimous agreement among different societies on the specific diagnostic cutoff values for C-reactive protein levels, serum ferritin, and transferrin saturation in order to differentiate iron deficiency anemia from anemia of chronic disease. [Mh] Termos MeSH primário: Anemia Ferropriva/diagnóstico Anemia Ferropriva/etiologia Doenças Inflamatórias Intestinais/complicações Doenças Inflamatórias Intestinais/metabolismo [Mh] Termos MeSH secundário: Algoritmos Anemia/diagnóstico Anemia/etiologia Anemia/terapia Anemia Ferropriva/terapia Gerenciamento Clínico Vias de Administração de Medicamentos Seres Humanos Ferro/administração & dosagem Ferro/efeitos adversos Ferro/uso terapêutico Guias de Prática Clínica como Assunto Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: E1UOL152H7 (Iron) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171009 [Lr] Data última revisão: 171009 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170714 [St] Status: MEDLINE [do] DOI: 10.1080/17474086.2017.1355233

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[PMID]: 28628617 [Au] Autor: Eggerbauer E; Pfaff F; Finke S; Höper D; Beer M; Mettenleiter TC; Nolden T; Teifke JP; Müller T; Freuling CM [Ad] Endereço: Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Greifswald-Insel Riems, Germany. [Ti] Título: Comparative analysis of European bat lyssavirus 1 pathogenicity in the mouse model. [So] Source: PLoS Negl Trop Dis;11(6):e0005668, 2017 Jun. [Is] ISSN: 1935-2735 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: European bat lyssavirus 1 is responsible for most bat rabies cases in Europe. Although EBLV-1 isolates display a high degree of sequence identity, different sublineages exist. In individual isolates various insertions and deletions have been identified, with unknown impact on viral replication and pathogenicity. In order to assess whether different genetic features of EBLV-1 isolates correlate with phenotypic changes, different EBLV-1 variants were compared for pathogenicity in the mouse model. Groups of three mice were infected intracranially (i.c.) with 102 TCID50/ml and groups of six mice were infected intramuscularly (i.m.) with 105 TCID50/ml and 102 TCID50/ml as well as intranasally (i.n.) with 102 TCID50/ml. Significant differences in survival following i.m. inoculation with low doses as well as i.n. inoculation were observed. Also, striking variations in incubation periods following i.c. inoculation and i.m. inoculation with high doses were seen. Hereby, the clinical picture differed between general symptoms, spasms and aggressiveness depending on the inoculation route. Immunohistochemistry of mouse brains showed that the virus distribution in the brain depended on the inoculation route. In conclusion, different EBLV-1 isolates differ in pathogenicity indicating variation which is not reflected in studies of single isolates. [Mh] Termos MeSH primário: Modelos Animais de Doenças Lyssavirus/patogenicidade Raiva/patologia Raiva/virologia [Mh] Termos MeSH secundário: Animais Encéfalo/patologia Quirópteros/virologia Vias de Administração de Medicamentos Imuno-Histoquímica Lyssavirus/isolamento & purificação Camundongos Análise de Sobrevida [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170720 [Lr] Data última revisão: 170720 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170620 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pntd.0005668

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[PMID]: 28620949 [Au] Autor: Sánchez Fernández I; Gaínza-Lein M; Loddenkemper T [Ad] Endereço: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A. [Ti] Título: Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis. [So] Source: Epilepsia;58(8):1349-1359, 2017 Aug. [Is] ISSN: 1528-1167 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To quantify the cost-effectiveness of rescue medications for pediatric status epilepticus: rectal diazepam, nasal midazolam, buccal midazolam, intramuscular midazolam, and nasal lorazepam. METHODS: Decision analysis model populated with effectiveness data from the literature and cost data from publicly available market prices. The primary outcome was cost per seizure stopped ($/SS). One-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters. RESULTS: The most cost-effective rescue medication was buccal midazolam (incremental cost-effectiveness ratio ([ICER]: $13.16/SS) followed by nasal midazolam (ICER: $38.19/SS). Nasal lorazepam (ICER: -$3.8/SS), intramuscular midazolam (ICER: -$64/SS), and rectal diazepam (ICER: -$2,246.21/SS) are never more cost-effective than the other options at any willingness to pay. One-way sensitivity analysis showed the following: (1) at its current effectiveness, rectal diazepam would become the most cost-effective option only if its cost was $6 or less, and (2) at its current cost, rectal diazepam would become the most cost-effective option only if effectiveness was higher than 0.89 (and only with very high willingness to pay of $2,859/SS to $31,447/SS). Second-order Monte Carlo simulations showed the following: (1) nasal midazolam and intramuscular midazolam were the more effective options; (2) the more cost-effective option was buccal midazolam for a willingness to pay from $14/SS to $41/SS and nasal midazolam for a willingness to pay above $41/SS; (3) cost-effectiveness overlapped for buccal midazolam, nasal lorazepam, intramuscular midazolam, and nasal midazolam; and (4) rectal diazepam was not cost-effective at any willingness to pay, and this conclusion remained extremely robust to wide variations of the input parameters. SIGNIFICANCE: For pediatric status epilepticus, buccal midazolam and nasal midazolam are the most cost-effective nonintravenous rescue medications in the United States. Rectal diazepam is not a cost-effective alternative, and this conclusion remains extremely robust to wide variations of the input parameters. [Mh] Termos MeSH primário: Anticonvulsivantes/administração & dosagem Anticonvulsivantes/economia Análise Custo-Benefício Estado Epiléptico/tratamento farmacológico [Mh] Termos MeSH secundário: Análise de Variância Vias de Administração de Medicamentos Feminino Seres Humanos Masculino Modelos Teóricos Método de Monte Carlo Pediatria/economia Pediatria/métodos Sensibilidade e Especificidade Estado Epiléptico/economia [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anticonvulsants) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170817 [Lr] Data última revisão: 170817 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170617 [St] Status: MEDLINE [do] DOI: 10.1111/epi.13812

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1			PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2
2	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2
3	and or and not		PalavrasDescritor de assuntoDescritor de assunto primárioLimitesAutorPalavras do títuloPalavras do resumoIdiomaPaís de publicaçãoNome de substânciaNome de pessoa como assuntoRevistaAssunto de RevistaISSNTipo de publicaçãoIdentificador únicoMês de entradaAno de publicaçãoTexto completoAtualização por classeCategoria DeCSCategoria DeCS explodidaCategoria CID-10SubSetsPais de AfiliaçãoAfiliaçãoAfiliação 2

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