Suchergebnisse

Rafael Ríos-Tamayo,1–4 Agustín Martín-García,5,6 Carolina Alarcón-Payer,5 Dolores Sánchez-Rodríguez,1,7 Ana María del Valle Díaz de la Guardia,5 Carlos Gustavo García Collado,5 Alberto Jiménez Morales,5 Manuel Jurado Chacón,1–4 José Cabeza Barrera4,5 1Monoclonal Gammopathies Unit, 2Department of Hematology, University Hospital Virgen de las Nieves, Granada, Spain; 3Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS, Granada, Spain; 4Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; 5Department of Pharmacy, 6Clinical Trials Unit, University Hospital Virgen de las Nieves, Granada, Spain; 7FIBAO, Granada, Spain Abstract: Multiple myeloma is a very heterogeneous disease with variable survival. Despite recent progress and the widespread use of new agents, patients with relapsed and refractory disease have a poor outcome. Immunomodulatory drugs play a key role in both the front-line and the relapsed/refractory setting. The combination of pomalidomide (POM) and dexamethasone is safe and effective in relapsed and refractory patients, even in those with high-risk cytogenetic features. Furthermore, it can be used in most patients without the need to adjust according to the degree of renal failure. In order to further improve the results, POM-based triplet therapies are currently used. This article highlights the most relevant issues of POM and POM-based combinations in the relapsed/refractory multiple myeloma setting, from a pharmacological and clinical point of view. Keywords: multiple myeloma, pomalidomide, triplet therapy, dexamethasone

Mohammad Rashid Shahidi Bonjar,1 Leyla Shahidi Bonjar2 1School of Dentistry, Kerman University of Medical Sciences, Kerman Iran; 2Department of Pharmacology, College of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran Abstract: This hypothesis proposes a new prospective approach to slow the aging process in older humans. The hypothesis could lead to developing new treatments for age-related illnesses and help humans to live longer. This hypothesis has no previous documentation in scientific media and has no protocol. Scientists have presented evidence that systemic aging is influenced by peculiar molecules in the blood. Researchers at Albert Einstein College of Medicine, New York, and Harvard University in Cambridge discovered elevated titer of aging-related molecules (ARMs) in blood, which trigger cascade of aging process in mice; they also indicated that the process can be reduced or even reversed. By inhibiting the production of ARMs, they could reduce age-related cognitive and physical declines. The present hypothesis offers a new approach to translate these findings into medical treatment: extracorporeal adjustment of ARMs would lead to slower rates of aging. A prospective "antiaging blood filtration column" (AABFC) is a nanotechnological device that would fulfill the central role in this approach. An AABFC would set a near-youth homeostatic titer of ARMs in the blood. In this regard, the AABFC immobilizes ARMs from the blood while blood passes through the column. The AABFC harbors antibodies against ARMs. ARM antibodies would be conjugated irreversibly to ARMs on contact surfaces of the reaction platforms inside the AABFC till near-youth homeostasis is attained. The treatment is performed with the aid of a blood-circulating pump. Similar to a renal dialysis machine, blood would circulate from the body to the AABFC and from there back to the body in a closed circuit until ARMs were sufficiently depleted from the blood. The optimal application criteria, such as human age for implementation, frequency of treatments, dosage, ideal homeostasis, and similar concerns, should be revealed by appropriate investigations. If AABFC technology undergoes practical evaluations and gains approval, it would hold future promises such as: 1) prolonged lifespans; 2) slowed age-related illnesses such as low bone mass, weak muscular systems, diabetes, arthritis, Alzheimer's disease, and impaired memory in the elderly; 3) reduced health expenses; 4) reduced cosmetic surgeries performed on the elderly; 5) healthier astronauts in extended outer space journeys; 6) reduced financial burden of advanced care for the elderly imposed upon both government and society; and 7) rejuvenating effects in healthy, non-aged individuals. Keywords: aging, NF-κB, blood filtration, lifespan, rejuvenation, nanotechnology

Professional development and recognition is an 'old' issue in music therapy but still a relevant, complex and crucial one. Burning questions regarding professionalisation are at the forefront of most music therapy associations' agendas across Europe and beyond, and feed back directly to the work of the EMTC. Considering the wider political, socio-economic, cultural and disciplinary aspects of professionalisation, different development pathways impact directly on music therapy practice, training, ethics, professional collaboration and employment conditions. Although a number of endeavours have been implemented regarding music therapy's professional development and recognition in different countries, documentation and sharing of such endeavours on international level has been limited and scattered. Drawing from the EMTC's work since the early '90s, as well as from colleagues' experiences (and struggles) of music therapy's professional pathways in different European countries, this special issue aims: * to provide an overview of the current 'state of affairs' in Europe by systematically documenting music therapy's paths of professional development across different countries by tracing not only its achievements, but also its failures and problems. * to offer opportunities to critique and reflect on the interrelationships between music therapy as a discipline (with all its requirements to clinical and/or academic training) and music therapy as a profession (with its regulations, governmental recognition, and registration, legitimisation/authorisation or licensing issues). Capturing the diversity of music therapy's professional development across different European countries, this special issue will contribute to the establishment of a shared platform of knowledge upon which further local or international initiatives can be developed. ; Professional development and recognition is an 'old' issue in music therapy but still a relevant, complex and crucial one. Burning questions regarding professionalisation are at the forefront of most music therapy associations' agendas across Europe and beyond, and feed back directly to the work of the EMTC. Considering the wider political, socio-economic, cultural and disciplinary aspects of professionalisation, different development pathways impact directly on music therapy practice, training, ethics, professional collaboration and employment conditions. Although a number of endeavours have been implemented regarding music therapy's professional development and recognition in different countries, documentation and sharing of such endeavours on international level has been limited and scattered. Drawing from the EMTC's work since the early '90s, as well as from colleagues' experiences (and struggles) of music therapy's professional pathways in different European countries, this special issue aims: * to provide an overview of the current 'state of affairs' in Europe by systematically documenting music therapy's paths of professional development across different countries by tracing not only its achievements, but also its failures and problems. * to offer opportunities to critique and reflect on the interrelationships between music therapy as a discipline (with all its requirements to clinical and/or academic training) and music therapy as a profession (with its regulations, governmental recognition, and registration, legitimisation/authorisation or licensing issues). Capturing the diversity of music therapy's professional development across different European countries, this special issue will contribute to the establishment of a shared platform of knowledge upon which further local or international initiatives can be developed. Apart from a report from each country, this special issue of Approaches includes the following 16 articles: The role of the EMTC for development and recognition of the music therapy profession Hanne Mette Ridder, Adrienne Lerner & Ferdinando Suvini (pp.13-22) The European Music Therapy Confederation: History and development Monika Nöcker-Ribaupierre (pp. 23-29) Maintaining the dialogue of influence: Developing music therapy theory in pace with practice and research Claire M. Ghetti (pp.30-37) The academic training of music therapists: Chances of normalisation and specialisation Thomas Wosch (pp.38-43) Paths of professional development in music therapy: Training, professional identity and practice Jane Edwards (pp.44-53) Music therapy as academic education: A five-year integrated MA programme as a lighthouse model? Brynjulf Stige (pp.54-61) Continuing professional development – Why, what and how? Angela Harrison (pp.62-66) Supervision during music therapy training: An interview with two Swedish supervisors Rut Wallius (pp.67-73) Supervisor training: An integration of professional supervision and the use of artistic media Inge Nygaard Pedersen (pp.74-85) The Bonny method of Guided Imagery and Music (GIM) in Europe Lars Ole Bonde (pp.86-90) Solo or tutti, together or alone – What form of professional/legal recognition is best for music therapy? Melanie Voigt (pp.91-97) The role of professional associations in the recognition process Ranka Radulovic (pp.98-109) Towards professionalisation of music therapy: A model of training and certification in Poland Krzysztof Stachyra (pp.110-117) Perspectives on the development of the music therapy profession in the UK Alison Barrington (pp.118-122) A process of two decades: Gaining professional recognition in Austria Elena Fitzthum (pp.123-126) Development of the music therapy profession in Latvia Mirdza Paipare (pp.127-130)

The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.

Xiaolan Lv,1,* Liming Wang,2,* XiaoRong Zou,3 Shigao Huang4 1Department of Laboratory Medicine, Liuzhou Maternity and Child Healthcare Hospital, Liu Zhou, Guang Xi, People's Republic of China; 2Shaanxi Jiuzhou Biomedical Science and Technology Group, Xi'an, Shaan Xi, People's Republic of China; 3Department of Hematology, 986 Hospital of Fourth Military Medical University, Xi'an, Shaan Xi, People's Republic of China; 4Faculty of Health Sciences, University of Macau, Macau, People's Republic of China*These authors contributed equally to this workCorrespondence: Shigao Huang Email huangshigao2010@aliyun.comAbstract: Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology with a high rate of disability. Traditional treatments for RA remain a challenging issue. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) have no therapeutic effects on joint destruction, and the prominent side effects include gastrointestinal symptoms. RA is characterized by recurrence and bone attrition. Therefore, regenerative medicine and the use of umbilical cord mesenchymal stem cell (UC-MSC) therapies have recently emerged as potential options. UC-MSCs are multifunctional stem cells that are present in neonatal umbilical cord tissue and can differentiate into many kinds of cells, which have broad clinical application prospects in the tissue engineering of bone, cartilage, muscle, tendon, ligament, nerve, liver, endothelium, and myocardium. Moreover, UC-MSCs have advantages, such as convenient collection of materials and no ethical disputes; thus, these cells have attracted increasing attention from researchers. However, there are few clinical studies regarding UC-MSC therapy for RA. In this paper, we will review traditional drugs for RA treatment and then focus on UC-MSC therapy for RA, including preclinical and clinical UC-MSC applications for RA patients in the context of regenerative medicine. Finally, we will summarize the challenges and perspectives of UC-MSCs as a potential therapeutic strategy for RA. This review will help to design and discover more potent and efficacious treatments for RA patients and aid in advancing this class of cell therapy.Keywords: cell-based therapies, rheumatoid arthritis, mesenchymal stem cells, umbilical cord, regenerative medicine

Kwaku Poku Asante, George Adjei, Yeetey Enuameh, Seth Owusu-Agyei Kintampo Health Research Centre, Kintampo, Brong Ahafo Region, Ghana Abstract: Though the burden of malaria has decreased in the last decade in some sub-Saharan African countries, it is still high in others, and there is no malaria vaccine in use. The development of malaria vaccines in combination with current control programs could be effective in reducing the malaria burden. In this paper, we review and discuss the progress made in the RTS,S malaria vaccine development and considerations for its postapproval process. We conclude that the development of malaria vaccines has been a long process confronted with challenges of funding, difficulty in identifying malaria antigens that correlate with protection, and development of adjuvant systems among others. The scientific approval of the vaccine by the European Medicines Agency in July 2015 and subsequent recommendations for pilot implementation studies by the World Health Organization made history as the first human parasite vaccine. It is also a major public health achievement as the vaccine has the potential to prevent thousands of malaria cases. However, there are implementation challenges such as cold chain systems, community acceptance, and monitoring of adverse events post-licensure that need to be carefully addressed. Keywords: malaria, vaccines, challenges, introduction, Africa, implementation considerations

Laura Mumoli,1 Caterina Palleria,2 Sara Gasparini,1 Rita Citraro,2 Angelo Labate,1 Edoardo Ferlazzo,1 Antonio Gambardella,1 Giovambattista De Sarro,2 Emilio Russo2 1Institute of Neurology, 2Institute of Pharmacology, University Magna Græcia, Catanzaro, Italy Abstract: Brivaracetam (BRV), a high-affinity synaptic vesicle protein 2A ligand, reported to be 10–30-fold more potent than levetiracetam (LEV), is highly effective in a wide range of experimental models of focal and generalized seizures. BRV and LEV similarly bind to synaptic vesicle protein 2A, while differentiating for other pharmacological effects; in fact, BRV does not inhibit high voltage Ca2+ channels and AMPA receptors as LEV. Furthermore, BRV apparently exhibits inhibitory activity on neuronal voltage-gated sodium channels playing a role as a partial antagonist. BRV is currently waiting for approval both in the United States and the European Union as adjunctive therapy for patients with partial seizures. In patients with photosensitive epilepsy, BRV showed a dose-dependent effect in suppressing or attenuating the photoparoxysmal response. In well-controlled trials conducted to date, adjunctive BRV demonstrated efficacy and good tolerability in patients with focal epilepsy. BRV has a linear pharmacokinetic profile. BRV is extensively metabolized and excreted by urine (only 8%–11% unchanged). The metabolites of BRV are inactive, and hydrolysis of the acetamide group is the mainly involved metabolic pathway; hepatic impairment probably requires dose adjustment. BRV does not seem to influence other antiepileptic drug plasma levels. Six clinical trials have so far been completed indicating that BRV is effective in controlling seizures when used at doses between 50 and 200 mg/d. The drug is generally well-tolerated with only mild-to-moderate side effects; this is confirmed by the low discontinuation rate observed in these clinical studies. The most common side effects are related to central nervous system and include fatigue, dizziness, and somnolence; these apparently disappear during treatment. In this review, we analyzed BRV, focusing on the current evidences from experimental animal models to clinical studies with particular interest on potential use in clinical practice. Finally, pharmacological properties of BRV are summarized with a description of its pharmacokinetics, safety, and potential/known drug–drug interactions. Keywords: brivaracetam, epilepsy, partial seizure, adjunctive therapy, antiepileptic drugsCorrigendum for this paper has been published.

In this. the first installment of a series on CranioSacral Therapy and energy medicine, I have attempted to describe in brief the many facets of the system and therapy as they presented themselves, almost simultaneously. The observations that led to the research into the craniosacral system are described. The clinical and educational ramificarions are also considered. In the second and third installments, these two latter aspects will be considered in more detail. Political aspects and events which resulted from the release of CranioSacral Therapy to the healthcare community at latge and to the public will be described and discussed.

In this, the second installment of a three part series on CranioSacral Therapy, I have discussed the status of CranioSacral Therapy as a treatment modality today. Also included in the discussion are some of the reasons for its current status, political and control issues that have arisen, its clinical applications, its progeny and integration with other therapeutic approaches, and explorations that are currently underway.

Raju Sunagar, Sudeep Kumar, Brian J Franz, Edmund J Gosselin Center for Immunology and Microbial Disease, Albany Medical College, Albany, NY, USA Abstract: Francisella tularensis (Ft) is a gram-negative intercellular pathogen and category A biothreat agent. However, despite 15 years of strong government investment and intense research focused on the development of a US Food and Drug Administration-approved vaccine against Ft, the primary goal remains elusive. This article reviews research efforts focused on developing an Ft vaccine, as well as a number of important factors, some only recently recognized as such, which can significantly impact the development and evaluation of Ft vaccine efficacy. Finally, an assessment is provided as to whether a US Food and Drug Administration-approved Ft vaccine is likely to be forthcoming and the potential means by which this might be achieved. Keywords: Sex bias, media impact, differential protection, cellular immunity, humoral immunity

Lan Li,1 Zhenrong Ge,1 Dengke Zhang,1 Jun Kuang,2 Xiang Ma,3 Shubin Jiang1 1Coronary Care Unit, The Traditional Chinese Medicine Hospital, Xinjiang Medical University, 2Department of Cardiology, General Hospital of Xinjiang Military Command, 3Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China Background: Although it has been shown to be superior to simple antithrombotic drug therapy, most patients are unable to receive timely percutaneous coronary intervention (PCI) and are treated with conventional triple antithrombotic therapy (aspirin, clopidogrel, low-molecular-weight heparin). Here, we evaluate the efficacy and safety of adding low-dose tirofiban to this regimen. Methods: A total of 1,783 patient records (unable to receive PCI) indicating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) were included. A total of 882 received conventional triple antithrombotic therapy; 901 received quadruple antithrombotic therapy. Efficacy was evaluated in terms of major adverse cardiovascular event (MACE) parameters. Safety was evaluated based on the occurrence of bleeding events. Data were collected over a 6-month period post treatment. Results: The rate of occurrence of MACE was significantly lower in the quadruple antithrombotic group (10.5% versus 14.1% at 6 months, P=0.02). The log-rank test showed improved survival in the quadruple antithrombotic group. Total bleeding events were higher in the quadruple antithrombotic group (9.7%) than in the triple antithrombotic group (7.1%) (P=0.04); however, this may be attributed to increased clinically insignificant minor bleeding events. Conclusion: Quadruple antithrombotic therapy demonstrated a superior alternative for the treatment of high-risk NSTE-ACS patients failing to receive PCI. Keywords: low-dose tirofiban, non-ST-segment elevation acute coronary syndrome, quadruple drug therapy

Abstract Introduction: The questions of local life comprise a scheme of meanings produced daily and are taken by socio-economic processes that produce vulnerabilities as threats to the cohesion of networks of participation. Projects in Local Development can facilitate participatory engagements that take into account the collaboration between civil society and public power to address these issues. Objective: Analyse the reach of the occupational therapy in the orientation of projects and actions in Local Development. Method: This is a qualitative documentary research in which documents produced from a university extension project between January 2011 and July 2015, in the municipality of Itapeva, state of São Paulo, and content analysis procedures were discussed. Results: A sociohistorical matrix was extracted that comprised four large dimensions of knowledge in occupational therapy: daily, human activities, mediation skills, and collective life projects, all operated by the teaching methodology in participatory local development. Conclusion: Occupational therapy can directly reach the structures and political functions for Local Development, through processes that take into account the construction of networks of actions that mobilize the participatory engagement of local agents. These processes are based on the foundations of occupational therapy, demonstrating contributions to new research and assistance insertions.

Advanced therapy medicinal products (ATMPs), including cell therapy products, form a new class of medicines in the European Union. Since the ATMPs are at the forefront of scientific innovation in medicine, specific regulatory framework has been developed for these medicines and implemented from 2009. The Committee for Advanced Therapies (CAT) has been established at the European Medicines Agency (EMA) for centralized classification, certification and evaluation procedures, and other ATMP-related tasks. Guidance documents, initiatives, and interaction platforms are available to make the new framework more accessible for small- and medium-sized enterprises, academia, hospitals, and foundations. Good understanding of the centralized and national components of the regulatory system is required to plan product development. It is in the best interests of the cell therapy developers to utilize the resources provided starting with the pre-clinical stage. Whilst there have been no mesenchymal stem cell (MSC)-based medicine authorizations in the EU, three MSC products have received marketing approval in other regions since 2011. The information provided on the regulatory requirements, procedures, and initiatives is aimed at facilitating MSC-based medicinal product development and authorization in the EU.