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Epiduroscopy in treatment of degenerative chronic low back pain: A prospective analysis and follow-up at 60 months 硬膜外镜治疗退行性慢性腰痛:前瞻性分析和随访60个月
Pub Date : 2010-08-19 DOI: 10.3109/10601333.2010.485317
A. Di Donato, C. Fontana, D. Alemanno, A. Di Giacomo
The aim of this prospective study was to evaluate the efficacy of endoscopic epidurolysis in the treatment of degenerative chronic low back pain. Three-hundred and fifty patients with Visual analog scale (VAS) and Oswestry Low Back Pain Disability Index (ODI) from 0–60% (0–20%, group A; 20–40%, group B; 40–60%, group C) were enrolled and treated prospectively with endoscopic epidurolysis by means of a Myelotec endoscope and by the intermittent instillation of saline solution added with hyaluronidase. Targeted application of ozone and ciprofloxacin close to the abnormal areas was also performed. Short- and long-term efficacy was prospectively evaluated. A VAS score < 5 and ODI < 40% were considered as a positive outcome. The treatment significantly reduces the VAS in all three groups of patients, starting from the first week and throughout the entire follow-up period (p < 0.001), also the Disability Index (ODI) showed a statistically significant decrease of the score (p < 0.001), that was particularly evident at 3 months and maintained up to long-term follow-up intervals. In conclusion, epiduroscopy by mechanical adhesiolysis and administration on targeted areas of ciprofloxacina and ozone seems to be, in this prospective study, an effective technique to provide sensible and persisting pain relief and act of improving ODI in chronic low back pain.
这项前瞻性研究的目的是评估内镜下硬膜松解术治疗退行性慢性腰痛的疗效。350例患者采用视觉模拟量表(VAS)和Oswestry腰痛残疾指数(ODI)评分,评分范围0-60% (0-20%,A组;B组20-40%;40-60% (C组)的患者入组,通过Myelotec内窥镜和添加透明质酸酶的生理盐水间歇滴注进行内镜下硬膜松解治疗。在异常区附近定向应用臭氧和环丙沙星。对短期和长期疗效进行前瞻性评价。VAS评分< 5和ODI < 40%被认为是阳性结果。治疗显著降低了三组患者的VAS评分,从第一周开始到整个随访期间(p < 0.001),残疾指数(ODI)评分也有统计学意义的降低(p < 0.001),在3个月时尤其明显,并维持到长期随访间隔。总之,在本前瞻性研究中,硬膜外镜通过机械粘连松解和靶向环丙沙星和臭氧给药似乎是一种有效的技术,可以有效地持续缓解慢性腰痛患者的疼痛,并改善ODI。
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引用次数: 13
New era of transparent compression to control bleeding from traumatic wounds: Removing the blindfold 透明压迫控制创伤出血的新时代:去除眼罩
Pub Date : 2010-08-19 DOI: 10.3109/10601333.2010.491077
S. Naimer
While many issues regarding emergency care of polytrauma are still under debate, it is agreed that immediate control of acute external traumatic hemorrhage is the most critical instance where intervention by the rescue team plays a decisive role in determining the fate of the wounded. The aim of this report is to describe the evolution of a novel procedure for treating the bleeding wound that offers clear and obvious advantages. The method uses an elastic, adhesive dressing (ELAD) that eventually resulted in a single unit, utilizing a transparent material. This product is also termed Rapid Wrap™ (currently developed by Rapid Healing Technologies). The elastic adhesive dressing application is performed by placing the contact pad over the area of injured tissue and rapidly wrapping the roll component over the wound with growing tension. This paper follows the development of a new life saving device and demonstrates rewarding research for the treatment of profusely bleeding injuries.
虽然关于多发创伤的急救护理的许多问题仍在争论中,但人们一致认为,立即控制急性外伤性出血是最关键的情况,在这种情况下,救援队的干预对决定伤员的命运起着决定性作用。本报告的目的是描述一种治疗出血伤口的新方法的发展,这种方法具有明确和明显的优势。该方法使用弹性胶粘敷料(ELAD),最终使用透明材料制成单个单元。该产品也被称为Rapid Wrap™(目前由Rapid Healing Technologies开发)。弹性胶粘剂敷料的应用是通过将接触垫放置在受伤组织的区域上,并以不断增长的张力迅速将滚动组件包裹在伤口上来完成的。本文跟踪了一种新的救生装置的发展,并展示了治疗大量出血损伤的有益研究。
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引用次数: 0
Development and validation of rapid and sensitive HPLC method for the quantitative determination of doxorubicin in human plasma 人血浆中阿霉素快速灵敏HPLC定量测定方法的建立与验证
Pub Date : 2010-08-19 DOI: 10.3109/10601333.2010.486404
V. Sripuram, Harish K. Kaushik, S. Bedada, Narasimha Y. Reddy, K. Vangara, S. Praneeth Kumar, G. Indirapriyadarshini, K. Devarakonda
An isocratic reversed-phase high-performance liquid chromatographic method with ultraviolet detection at 254 nm has been developed for the determination of doxorubicin in human plasma. Plasma samples were extracted by a selective one-step liquid–liquid extraction using dichloromethane. Doxorubicin and the internal standard epirubicin were separated using a column packed with C18 material, using a mobile phase consisting of water:acetonitrile (75:25v/v). The calibration graph for doxorubicin was linear in the range 0.2–10 μg/mL, with a correlation coefficient, R2 = 0.9986. Lower limit of quantitation was 0.2 μg/mL, using 1 mL plasma samples. The extraction recovery ranged from 98.5–101.1%, and the recovery rate was consistent for drug and internal standard examined at each level. The interday and intraday precision values ranged between 0.5–2%. Validation data showed that the assay for doxorubicin is sensitive, selective, accurate, and reproducible. The assay has been used in population pharmacokinetics study.
建立了254 nm紫外检测等容反相高效液相色谱法测定人血浆中阿霉素的含量。采用二氯甲烷选择性一步液-液萃取法提取血浆样品。用C18填料柱分离阿霉素和内标表阿霉素,流动相为水:乙腈(75:25v/v)。阿霉素在0.2 ~ 10 μg/mL范围内线性关系良好,相关系数R2 = 0.9986。定量下限为0.2 μg/mL,采用1ml血浆样品。提取回收率为98.5 ~ 101.1%,各层次所检药物和内标的提取率一致。日内和日间的精度值在0.5-2%之间。验证数据表明,该方法灵敏度高,选择性好,准确度高,重复性好。该方法已用于群体药代动力学研究。
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引用次数: 7
A message from the Publisher 来自发布者的消息
Pub Date : 2010-06-01 DOI: 10.3109/10601331003680812
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引用次数: 0
Addressing issues affecting clinical trials in Brazil 解决影响巴西临床试验的问题
Pub Date : 2010-05-18 DOI: 10.3109/10601333.2010.480974
K. P. Virk
There are several factors that play a key role in the growth of clinical research specific to Brazil. These include a large, diverse, rapidly growing population much of which is treatment-naïve, shortened approval times, improved GCP compliance, and an emergence of diseases predominant in developed countries. Successful patient enrolment and retention rates, and proximity to Western biopharmaceutical companies are additional factors. Due to the fact that the Brazilian population exhibits great racial and ethnic diversity, as well as differences in economic and educational backgrounds, there are significant hurdles that foreign sponsors must consider. These include linguistic and cultural barriers, as well as other socio-economic factors such as poverty and illiteracy. Successful outsourcing of clinical trials to Brazil therefore involves an understanding of these factors, and how they affect clinical research.
有几个因素在巴西临床研究的增长中起着关键作用。这些因素包括庞大、多样化、快速增长的人口(其中大部分为treatment-naïve)、审批时间缩短、GCP依从性改善以及发达国家主要疾病的出现。成功的患者注册率和保留率,以及与西方生物制药公司的接近性是其他因素。由于巴西人口表现出巨大的种族和民族多样性,以及经济和教育背景的差异,外国赞助商必须考虑重大障碍。这些障碍包括语言和文化障碍,以及贫困和文盲等其他社会经济因素。因此,成功地将临床试验外包给巴西需要了解这些因素,以及它们如何影响临床研究。
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引用次数: 7
Bioanalytical approaches, bioavailability assessment, and bioequivalence study for waiver drugs: In vivo and in vitro perspective 豁免药物的生物分析方法、生物利用度评估和生物等效性研究:体内和体外视角
Pub Date : 2010-05-18 DOI: 10.3109/10601331003698517
M. Faiyazuddin, Sarfaraz Ahmad, G. Mustafa, F. Ahmad, F. Shakeel
Evidence of differences in bioavailability from different oral formulations of the same therapeutic agents had become obvious by the early 1960s. The consequent 40 years have produced the body of scientific belief, debate, and policy on the subject of bioequivalence. The motivating force behind many of these events has been the continued interest of the food and drug administration (FDA) to improve the manner in which these studies are conducted, the quality of the data generated from such studies, and the methods by which they are evaluated. Bioanalytical data used to support regulatory submission needs to be accurate and reproducible. In order to have confidence in the reliability of the data, it is important that the analytical method used to generate it is well characterized and fully validated. However, bioavailability assessment (BA) and bioequivalence (BE) studies are necessary in filing of the data towards the drug approval. This review article describes the methods for assessing bioavailability and bioequivalence; and bioanalytical approaches of pharmaceuticals in vivo and in vitro and also a waiver of BA/BE studies based on the biopharmaceutical classification (BCS) system.
同一治疗剂的不同口服制剂的生物利用度差异的证据在20世纪60年代初已经变得明显。在随后的40年里,关于生物等效性的科学信仰、辩论和政策产生了大量的成果。许多此类事件背后的推动力一直是食品和药物管理局(FDA)对改进这些研究的进行方式、研究数据的质量以及评估方法的持续兴趣。用于支持监管提交的生物分析数据需要准确和可重复。为了对数据的可靠性有信心,重要的是用于生成数据的分析方法要有很好的特征和充分的验证。然而,生物利用度评估(BA)和生物等效性(BE)研究是向药物批准提交数据的必要条件。本文综述了生物利用度和生物等效性的评价方法;以及体内和体外药物的生物分析方法,以及基于生物制药分类(BCS)系统的BA/BE研究的豁免。
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引用次数: 3
A simple and sensitive liquid chromatography–mass spectrometry routine method for determination of clarithromycin in human plasma: Application to a clinical pharmacokinetic study 一种简单灵敏的液相色谱-质谱法测定人血浆中克拉霉素的常规方法:在临床药代动力学研究中的应用
Pub Date : 2010-05-18 DOI: 10.3109/10601331003796634
Shiva N. V. Prasad Bathula, Seshagiri Rao JVLN
A simple and sensitive liquid chromatography-mass spectrometry (LC-MS) method was developed for the routine determination of Clarithromycin in human plasma, with Alprazolam as the internal standard. The separation was carried out on an Phenomenex (C18 100 × 4.6 mm, i.d 5 µm) column, with Acetonitrile and 10 mM Ammonium acetate Buffer solution (95:5) as the mobile phase under isocratic conditions at a flow rate of 0.2 mL/min. Detection of the analytes was achieved using positive ion electrospray tandem mass spectrometry in selected reaction monitoring (SRM) mode. The standard curves were linear (r2 > 0.99) over the concentration range of 300–5000 ng/mL. The intra- and inter-day precision (RSD) values were below 15%. The method is validated for the estimation of Clarithromycin in human plasma over a concentration range of 300–5000 ng/mL. Expected recoveries were observed. Limit of detection of the methods is 3.0 ng/ mL and limit of quantitation is 10.0 ng/mL that shows that the developed method has adequate sensitivity. The method was successfully applied to the pharmacokinetic study of Clarithromycin tablets in healthy male volunteers after oral administration.
以阿普唑仑为内标,建立了一种简便、灵敏的液相色谱-质谱联用法测定人血浆中克拉霉素的常规方法。色谱柱为Phenomenex (C18 100 × 4.6 mm, i.d 5µm),流动相为乙腈和10 mm醋酸铵缓冲液(95:5),流速为0.2 mL/min,等压条件下进行分离。在选择性反应监测(SRM)模式下,采用正离子电喷雾串联质谱法对分析物进行检测。在300 ~ 5000 ng/mL范围内,标准曲线呈线性(r2 > 0.99)。日内、日间精度(RSD)均在15%以下。该方法可在300 - 5000ng /mL的浓度范围内估计人血浆中克拉霉素的含量。观察到预期的复苏。方法的检出限为3.0 ng/mL,定量限为10.0 ng/mL,表明该方法具有足够的灵敏度。该方法成功应用于健康男性口服克拉霉素片的药代动力学研究。
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引用次数: 0
Blinding assessment in clinical trials: A review of statistical methods and a proposal of blinding assessment protocol 临床试验中的盲性评估:统计方法综述及盲性评估方案的建议
Pub Date : 2010-05-18 DOI: 10.3109/10601331003777444
H. Bang, Stephen P Flaherty, Jafar Kolahi, J. Park
There is strong consensus in the clinical trial community that blinding is an important issue in randomized controlled trials. At present grossly incomplete reporting of procedures and the use of any assessment for blinding still prevails. The term ‘double-blind’ has almost become a convention without any checks or balances. Also there is a lack of consensus on quantitative procedures for evaluating the success of blinding in the literature. This article reviews statistical methods of blinding assessment along with software options, and discusses some of the most pressing issues surrounding the acquisition, interpretation, and reporting of blinding data. Finally, it proposes a sample blinding assessment protocol to address some of these issues.
临床试验界一致认为,盲法是随机对照试验中的一个重要问题。目前,仍然普遍存在严重不完整的程序报告和使用任何评估来进行盲法。“双盲”一词几乎已经成为一种没有任何制衡的惯例。此外,在文献中对评估盲法成功的定量程序缺乏共识。本文回顾了盲法评估的统计方法以及软件选项,并讨论了一些围绕盲法数据的获取、解释和报告的最紧迫的问题。最后,提出了一个样本盲法评估方案来解决其中的一些问题。
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引用次数: 85
Development and application of a validated stability-indicating Ultra-Performance Liquid Chromatography (UPLC) method for the determination of dantrolene and its related impurities 稳定性指示超高效液相色谱(UPLC)测定丹trolene及其相关杂质的方法的建立与应用
Pub Date : 2010-02-26 DOI: 10.3109/10601331003623309
M. Tawakkul, P. Faustino, V. Sayeed, M. Khan, Saeed R. Khan
A rapid, sensitive, and specific ultra-performance liquid chromatographic (UPLC) method was developed for the simultaneous determination of dantrolene and its potential degradation impurities. Chromatographic separation was achieved on a Waters Acquity UPLC system using a Waters BEH C18 (2.1 × 100 mm, 1.7 µM) analytical column and Waters BEH C18 (2.1 × 5 mm, 1.7 µM) guard column. The compounds were eluted with a linear acetonitrile gradient (25–75%) over 3 min with a buffer composition of sodium acetate for method development, quantitation, and forced degradation studies. The flow rate was maintained at 0.5 mL/min. Column temperature was maintained at 35°C. Injection volume was 4 µL, and analysis was detected by a photodiode array detector at 375 nm. The method was validated according to USP Category I requirements for dantrolene. Forced degradation of dantrolene was conducted under the conditions of hydrolysis, oxidation, photolysis, and stability-indicating UPLC method was developed and validated. Two degradation products (related compound B and C) were formed in 0.1 N NaOH and 0.1 N HCl, respectively. The dantrolene was stable to oxidative decomposition. The degradation behavior under UV light was similar to 0.1 N HCl conditions. The method was used successfully for the quality assessment of dantrolene and its three impurities.
建立了一种快速、灵敏、特异的超高效液相色谱(UPLC)同时测定丹trolene及其潜在降解杂质的方法。色谱分离在Waters Acquity UPLC系统上实现,使用Waters BEH C18 (2.1 × 100 mm, 1.7µM)分析柱和Waters BEH C18 (2.1 × 5 mm, 1.7µM)保护柱。用乙腈线性梯度(25-75%)在3分钟内用醋酸钠缓冲成分洗脱化合物,用于方法开发、定量和强制降解研究。流速维持在0.5 mL/min。柱温保持在35℃。进样量为4µL,在375 nm处用光电二极管阵列检测器检测。该方法按照美国药典(USP)第I类对丹曲林的要求进行了验证。在水解、氧化、光解条件下对丹trolene进行了强制降解,建立了稳定性指示UPLC方法并进行了验证。在0.1 N NaOH和0.1 N HCl中分别形成两种降解产物(相关化合物B和C)。丹trolene对氧化分解稳定。紫外光下的降解行为与0.1 N HCl条件相似。该方法可用于丹曲林及其三种杂质的质量评价。
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引用次数: 7
Stability and self-nanoemulsification efficiency of ramipril nanoemulsion containing labrasol and plurol oleique 拉米普利纳米乳的稳定性及自乳化效率
Pub Date : 2010-02-26 DOI: 10.3109/10601330903571691
S. Shafiq, F. Shakeel
The aim of the present investigations was to evaluate the capacity of a combination of Labrasol and Plurol oleique as surfactant and cosurfactant on self-nanoemulsification efficiency of ramipril nanoemulsion. Sefsol-218, Labrasol, Plurol oleique, and standard buffer solution (pH 5.0) were selected as oil phase, surfactant, cosurfactant, and aqueous phase, respectively. Nanoemulsion formulations of ramipril were developed by a spontaneous emulsification method. Pseudoternary phase diagrams were constructed to identify nanoemulsion zones of ramipril. Selected formulations were evaluated in terms of thermodynamic stability tests using centrifugation, heating–cooling cycles, and freeze–thaw stress test. Some formulations were found stable and other formulations were unstable upon thermodynamic stability tests. Thermodynamically stable formulations were taken for self-nanoemulsification efficiency test. All the selected formulations passed self-nanoemulsification test in grade E only but not in grades A and B. Because none of the formulations passed the self-nanoemulsification efficiency test in grades A and B, it was concluded that a combination of Labrasol and Plurol is not suitable as surfactant and cosurfactant, respectively, for oral or self-nanoemulsifying drug delivery system of ramipril.
本研究的目的是评价Labrasol和Plurol oleique联合作为表面活性剂和助表面活性剂对雷米普利纳米乳自乳化效果的影响。选择Sefsol-218、Labrasol、Plurol oleique和标准缓冲液(pH 5.0)分别作为油相、表面活性剂、助表面活性剂和水相。采用自发乳化法制备雷米普利纳米乳。建立了伪三元相图,以确定雷米普利的纳米乳区。通过离心、加热-冷却循环和冻融应力测试来评估所选配方的热力学稳定性。通过热力学稳定性试验,发现一些配方是稳定的,而另一些配方是不稳定的。采用热力学稳定的配方进行自纳米乳化效率测试。所选制剂均通过了E级自纳米乳化试验,A级和B级均未通过自纳米乳化试验。由于A级和B级均未通过自纳米乳化试验,因此,Labrasol和Plurol分别作为表面活性剂和助表面活性剂不适合用于雷米普利口服或自纳米乳化给药系统。
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引用次数: 29
期刊
Clinical Research and Regulatory Affairs
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