#molecular iodine therapy

[altecisbit]

Thesis - elemental sulphur - (oxidised) - molecular hydrogen or Co2 - carbon source - S2 L I (o8) - electron donor - (1A) - H - 7A-(1) - 8A2 - HE -  1A = H - single bonding - H2 - 7A - 8A - (HE) - H2 - carbon dioxide source as the electron donor - 1A - 7A - Co2 as carbon source and H2s as the electron donor.

Purple sulphur bacteria - thiorhodaceae - non sulphur bacteria - athiorhodaceae  (resembles anaerobic photolithotropics) - hydrogen sulphide-elemental sulphur - (oxidised) molecular hydrogen - phoaos - synthetic reaction non sulphur organic electron donor- electron donors acetate via tricarboxyal acid pairs of acetate molucules are combined reduced and polymerised in general however  to carbohydrate.

Carbon dioxide and the regenerated Co2 acceptor appears to be controlled by the energy charge of the cell in such away that fixates as reduction occurs only when the cell wall is endowed with energy is2 - helium - L- is2 - 2s contains one orbital - ml = 0 - atom no4 - beryllium - effects on humans after long exsposure even at even at low levels often fatal.

Analogy of lithium hydroxide the H2 single bond in the H2 molocule and the non exsistence of He2- the diatomic molacule w2 - o2 - f2 as the molocule Li2 - B2 and e2 are less common gas phase  in contrast the molocules Be2 and Ne either highly unstable or non exsistent of the valance bond is n2 - o2 - f2 and the atomic orbitals-elements and the combining two 2s orbitals one from each atom gives two molecular orbitals.- the exchange electron theory.

#Cancer C 14-tracer-photosynthisis Co2/6- (g) + H2o/6 - (1) + C6 + H12 + o2/6 - (s) + o2/6 - cobalt - 66 - malignent goiter - sodium idione - thyroid cancer - 131 or 128 - (idione argon krypton) - sulphur/helium + argon = krypton - arsnic/pottasium = krypton mn cesium + mg12 + C6 + S16 + N7 + H1 + Na11 + chlorine + calcium + mg3 + C3 + S2 + N4 + H3 + Na3 + arsnic magnanenese cesium pottasium sulphur - krypton = argon - helium = aluminium + mecury.

#Alchemy (RCM) formula Mg3 + C3 + S2 + N4 + H3 + Na3 the trace element pottassium idione arsnic chlorine reacte with sulphur - helium- + argon - calcium - rubidium = extraction of krypton gases  &  weight term deposits pure  essence of idione - deposits of mecury add pure mecury exclude distilled Idione from extraction - find rubidium - calcuim -  I + Kr + Ar - Mg12 + C6 + S16 + N7 + H1 + Mn cesium  krypton  argon  sulphur  Mn  and cesium  chlorine  arsnic  iodine  potassium  hydrogen + mg3 +  C3 + S2 + N4 + H3 + Na3 + hydrogen - Gold - mg12 + C6 + S16 + N7 + H1 + Na11 - hydrogen - helium -  arsnic iodine potassium chlorine calcium sulphur argon.

Mn + cesium argon sulphur helium chlorine  calcium have the same bases and the extraction of traces by adding of mecury and base iodine - krypton + argon + left with cadium find - magananese - cadium - cesium = a radioactive battery - equivelent fuel source - rubidium.   

Ammonia transfer- lipioc acid - Lip(sh)2-Lip - s2  - lipioc acid hydrogen and acyel carrier phosphenlpyrate - 2 - aceytal -  CoA +  1/2 + H2o = iso - citric - lyase and tpp - orthophoshate - N.A.D.P.H = 2 molcules of glutamate - trade name - Biotin - methione aspartic inhibitor - glucose-phosphenlpyrate - 2 - acetyal -  coa + 1/2 + h2o - catalyst - iso - citric - lyase - malate - syntheisis- tissue test - adpose and millennium.

Clinical trail of lithium hydroxide - body mass index vs measured in take of H2o between the times of 6am - 9am -12pm - 3pm - = dosage - 6pm - 9pm - sleep - 6am - dosage - body mass index/fluid per hr x3 = 6 test times = 18 cycles = 6 x 18 = 108 ÷ 3 = 36 intakes of fluid one every hour for 1 test time of 3 hours measure output every cycle - subtract output every cycle and add remiander of measure of intake per cycle x6 cycles is the average of intake asborbed by body in a given 24 hr period x6 ÷ 3 to find final dosage per one 1 hour cycle -tempurature modification therapy and medication.

R.T.M-copyright-patent pending-A.M.P.C-Soldier of New England. 

Pubiished by Alex Clayton October 10 2014. - notes 1992.-updated October 13 2014.?

Iodine (argon krypton) mg3 +C3+S2+n4+h3++na3 

calcium chlorine 

Mg12+c6+s16+n7+h1+na11

Mn cesium

arsnic +pottassium (krypton) sulphur helium +argon

arsnic magnanese cesium pottassium sulphur krypton argon helium

Answer- aluminium mecury

(Iodine) argon krypton

formula mg3+C3+S2+n4+h3+na3

Trace element - arsenic iodine pottasium

extraction pure rubidium

formula

chlorine mg 1p2+c6+s16+n7+h1+na11

Mn and cesium (80) 

argon reacted with sulphur helium (rubidium extraction of krypton

Formula- gold -mn + cesium 

argon sulphur helium

Chlorine - calcium

same bases extraction of bases adding of mercury -base iodine 

krypton +argon

Answer -left with cadium and rubidium

Bowen gold - mg-h-mn-kr-cd-cs

Gold - mg12 + C6 + S16 + N7 + H1 + Na11 - hydrogen - helium - arsnic iodine potassium chlorine calcium sulphur argon.-s6-h-kr - gold

Semitype oxd

I kr Argon

Krypton Vapour

Sulphur h20

Cd - mg Ces - mg

13 82 80 -atomic numbers extraction

Extraction and add

Mn -C2-h-mg3-s3-cs

Potassium

Mg3-c3-s2-n4-h3-na3

Exclude pure iodine to find rubidium

The other formula they are talking about is a duplication of one of the other formulas written  so you have the formula a different way

Neutron Star - mecury -s6 - h - rubidium - mecury - kr85 gold -kr85 ,-cesium - or s6-h -rubidium -kr85 gold kr85 -cesium. 13:55P.M 6/8/2019.

Mecury (80) / s6-h-kr (36) a sister element to rubidium (37) s6-h-kr = rubidium extracted from mecury (80) (79)- gold sister pairs of atoms for the basis of element once extracted from eachother s6 (16) (15) phosphorus  chlorine (17) allowing us to correctly order the periodic table 7:54A.M 6/11/2019.

How the formula for gold DESTSTABILIZED THE GLOBAL SECURITY (ECONOMY)

Fort Knox -U.S79 YEN79-destabilising the basis for currency -1992/93 or 2012/13 Australian Government steals the formula for gold -or sold on by unscruplious phyciatrist in a foriegn deal D.F.A.T in a confirmed report by NY.P.D S.O.D 17:59P.M 22/3/2019 lord jesus christ prediction world economic stock crash unless we can find a substitute R.R.C.C the Vatican H.R.H E:R I SHOULD BE THE RICHEST MAN IN THE WORLD THE "MEEK SHALL INHERIT THE EARTH" report retracted based on a false statement made to me (source undisclosed) hailbury 1 we know why now my sister and niece were murdered

https://m.facebook.com/story.php?story_fbid=2384654365194021&id=100009484426712

https://m.facebook.com/story.php?story_fbid=2512273519098771&id=100009484426712 hon doctorate in medical science and astrophysics general alex m.m clayton (retired) 14:12P.M 6/11/2019.

https://m.facebook.com/story.php?story_fbid=2384654365194021&id=100009484426712 parallel worlds and a greater universe 8:22A.M 17/6/2019.

https://m.facebook.com/story.php?story_fbid=2425243574468433&id=100009484426712 hon doctorate.

3:56A.M 6/11/2019 @ABCNews the formula mecury /gold -s6-h-kr rubidium was developed in 1992/93:without (revised) correctly ordering the elements in the begining of our universe the big bang. -as stolen in 2012/2013 and SMMHR has my n.d.i.s cleaner stolen the hard copy the cleaner confessed 2019. -

https://m.facebook.com/story.php?story_fbid=2512273519098771&id=100009484426712 hon doctorate in medical science and astrophysics general alex m.m clayton (retired) 14:12P.M 6/11/2019.

[helthcareheven]

Glowing Precision: Redefining Healthcare with Advanced Imaging Reagents

Introduction

Medical imaging reagents play an integral role in diagnostic imaging procedures by enhancing contrast in images and rendering physiological processes more visible. These reagents are designed to selectively accumulate in targeted tissues or organs and illuminate areas of medical interest when exposed to various imaging modalities such as MRI, CT, ultrasound, nuclear medicine, and optical imaging. By improving image contrast and diagnostic precision, medical imaging reagents transform patient care pathways and outcomes.

Types

MRI Contrast Agents

MRI contrast agents, commonly referred to as MR contrast or MRI dyes, are designed to alter the relaxation properties of surrounding water protons and increase the signal intensity of targeted tissues on MRI scans. The most widely used MRI contrast agents are gadolinium-based, consisting of the gadolinium metal ion chelated to a ligand molecule. They shorten T1 relaxation times and appear bright on T1-weighted MRI sequences. Examples include gadobutrol, gadoterate meglumine, and gadoteridol.

CT Contrast Agents

Intravenous iodinated contrast media is routinely used in CT imaging to enhance visibility of blood vessels and internal organs. Iodine has a high atomic number that strongly absorbs X-rays, producing bright areas on CT that demarcate the administered contrast from surrounding soft tissues. Common iodinated CT contrast agents include iohexol, iopamidol, iomeprol, and iodixanol. Some newcomers like gadoxetate disodium can be taken up by hepatocytes and serve as both CT and MRI contrast agents.

Radiopharmaceuticals

Nuclear medicine imaging relies on radiopharmaceuticals – compounds containing radioactive tracers that emit gamma rays or positrons. When injected or inhaled, they accumulate in specific organs or tissues based on physiological properties. Detection of tracer distribution yields functional and molecular information about biological processes. Example radiotracers include technetium-99m for bone scans, fluorine-18 FDG for PET, and xenon-133 gas for ventilation imaging in the lungs.

Ultrasound Contrast Agents

Microbubble-based ultrasound contrast agents are capable of greatly enhancing ultrasonic backscatter when intravenously injected. Made up of inert gases enclosed by restrictive elastic membranes, they oscillate and expand/contract when exposed to ultrasonic waves, appearing as bright echoes on ultrasound monitors. Leading agents are sulphur hexafluoride microbubbles (SonoVue) and perflutren lipid microspheres (Definity).

Optical Imaging Agents

A variety of fluorescent, bioluminescent, and spectrally-encoded probes have utility in optical imaging modalities. Near-infrared fluorescent dyes like indocyanine green enable visualization of blood flow and perfusion. Bioluminescent proteins like luciferase and fluorescent proteins like green fluorescent protein (GFP) act as genetic reporters and cell/molecular tracers. Advanced agents include activatable probes that change signal properties upon enzyme cleavage or binding specific cellular targets.

Application of Medical Imaging Reagents

Every year, tens of millions of MRI, CT, ultrasound, nuclear medicine, and related imaging tests are performed globally guided by medical imaging reagents. Their targeted accumulation improves detection of disease and expands clinical applications. Some key uses of imaging reagents include:

- Diagnosis of cancers, infections, and cardiovascular/neurological conditions by exploiting differences in vascularity, tissue permeability, metabolic activity.

- Guidance of biopsies to suspicious lesions identified on enhanced scans for definitive diagnosis.

- Assessment of treatment response to therapies like chemotherapy, radiation therapy, ablation via changes in enhancement patterns before and after intervention.

- Angiography to analyze blood supply to organs and detect abnormalities in vasculature like stenosis, aneurysms or arteriovenous malformations.

- Evaluation of organ perfusion, function and blood flow to assess conditions impacting the liver, kidneys, heart and brain.

- Cell/molecular imaging research exploring disease pathogenesis at the cellular/genetic level using targeted probes and animal models.

Impact on Patient Care and Outcomes

Medical imaging reagents have completely transformed modern medical diagnostics over the past few decades. Some of their major impacts include:

- Dramatically improved detection rates for cancers and other abnormalities by making lesions more distinct on scans. This aids earlier diagnosis when treatment is most effective.

- Enhanced precision and specificity of scans. Imaging reagents home directly to targets of interest rather than depending on non-specific changes in anatomy.

- Guidance of minimally invasive image-guided procedures like biopsies, ablations and surgeries with greater accuracy due to improved visualization.

- Ability to serially monitor treatment response in oncology, reducing unnecessary treatments and costs when response is poor. Earlier switching to alternative strategies.

- Safer alternative to invasive diagnostic tests as scans don’t require tissue sampling. Less risk of complications.

- Widespread use of CT, MRI, ultrasound avoids use of x-ray-based modalities in children and pregnant individuals for radiation safety.

In summary, medical imaging reagents play a pivotal role in modern medical practice by supporting non-invasive diagnosis, guidance, and management. They continue to evolve, ushering new diagnostic and therapeutic capabilities.

[omkarpatel]

Beyond Imaging: The Therapeutic Potential of Radiopharmaceuticals in Cancer Treatment

Radiopharmaceuticals: Enabling Diagnosis and Treatment through Nuclear Medicine Nuclear medicine is a medical specialty that utilizes tiny amounts of radioactive material, known as radiopharmaceuticals, to diagnose and treat diseases. These radioactive compounds, when administered to the patient, allow physicians to non-invasively visualize organs, bones, or tissues within the body. Radiopharmaceuticals play a critical role in enabling the promising field of nuclear medicine to deliver accurate diagnostic information and targeted therapies to patients. What are Radiopharmaceuticals? Radiopharmaceuticals are radioactive compounds consisting of a radioisotope bound to or incorporated into a molecular structure known as a ligand or carrier. The radioisotope, usually in the form of a radionuclide such as technetium-99m, emits radiation as its unstable nucleus decays. The ligand delivers the radioisotope to specific organs, tissues, or cellular targets within the body. The two main types of radiopharmaceuticals are diagnostic and therapeutic. Diagnostic Radiopharmaceuticals in Nuclear Medicine Imaging Nuclear medicine imaging plays a vital role in disease diagnosis through the use of radioactive tracer molecules. The most widely used diagnostic radiopharmaceutical is technetium-99m (Tc-99m), which emits gamma rays that can be tracked by a gamma camera. Tc-99m has near-ideal radiation properties and is easily produced by many nuclear pharmacies onsite at hospitals using generators. It is incorporated into ligands that target specific organs and tissues. Some common examples include Tc-99m sestamibi, which localizes to heart muscle cells and is utilized in cardiac imaging, and Tc-99m sulfur colloid, which localizes to liver and spleen allowing imaging of these abdomional organs.

Therapeutic Radiopharmaceuticals for Cancer Treatment Radioactive atoms have also found applications in directly treating certain types of cancer. Radionuclide therapy harnesses the cell-killing effects of radiation exposure. Common radiopharmaceutical therapies include iodine-131 to treat thyroid cancer and certain types of non-Hodgkin's lymphoma, and radium-223 for bone metastases from castration-resistant prostate cancer. Ensuring Safety in Radiopharmaceutical Production and Delivery Strict guidelines must be followed to guarantee the safe production, quality control, transportation, clinical use, and disposal of radioactive drugs. All radiopharmaceutical production facilities and nuclear pharmacies are regulated by bodies like the International Atomic Energy Agency and the United States Nuclear Regulatory Commission. Healthcare workers who handle radiopharmaceuticals are specifically trained and monitored using personal dosimetry badges to ensure radiation exposure levels remain very low. The future of Radiopharmaceuticals Looking ahead, new radioisotopes and radiolabeling techniques continue expanding the toolbox of nuclear medicine. Targeted alpha therapies hold promise in oncology, and radiopharmaceuticals image and treat neurodegenerative diseases. Cellular and molecular radiotracers could enable earlier disease detection. Combination therapy using radiolabeled drugs with immunotherapy or chemotherapy may offer enhanced treatment responses. Advances in manufacturing technology are improving radiopharmaceutical production capabilities and availability worldwide. In conclusion, radiopharmaceuticals are instrumental diagnostic and therapeutic tools that underpin the rapidly advancing field of nuclear medicine. Strict safety guidelines ensure their reliable clinical use. Continued innovation promises to further expand radiopharmaceutical applications to benefit many more patients worldwide in the future

[pranay-234]

Thyroid Cancer Market: Analysis and Outlook During 2023-2032

Introduction

Thyroid cancer is a condition that affects the thyroid gland, a small butterfly-shaped organ located in the front of the neck. Over the years, the Thyroid Cancer Market has evolved significantly, with advancements in diagnosis, treatment, and improved prognosis. This article provides a comprehensive overview of the market dynamics surrounding thyroid cancer, shedding light on the latest insights into diagnosis, treatment options, and prognosis.

𝐑𝐞𝐪𝐮𝐞𝐬𝐭 𝐒𝐚𝐦𝐩𝐥𝐞 𝐂𝐨𝐩𝐲 𝐎𝐟 𝐑𝐞𝐩𝐨𝐫𝐭 : https://www.alliedmarketresearch.com/request-toc-and-sample/10679

COVID-19 Scenario Analysis: The Emergence of Diagnostic Solutions

In the early phases of the COVID-19 pandemic, the global healthcare community faced a significant challenge – the lack of specific diagnostic tests to accurately detect the disease in patients. The absence of reliable diagnostic tools meant that alternative tests were initially employed, but they proved to be less effective.

This dearth of specific COVID-19 diagnostic tests created a unique and promising opportunity for diagnostic manufacturers to step up to the plate. Recognizing the pressing need for accurate testing, many leading players in the field, as well as innovative startups from various countries, seized this opportunity to introduce their COVID-19 diagnostic kits. This marked a pivotal moment in the global response to the pandemic.

These proactive diagnostic manufacturers gained a competitive edge, capitalizing on the surging demand for COVID-19 diagnostic tests. Their swift response and effective solutions not only aided in fulfilling the diagnostic needs of healthcare systems worldwide but also played a crucial role in maintaining their revenues during a time of unprecedented crisis.

In this dynamic environment, the collaboration between industry leaders and emerging players demonstrated the power of innovation and adaptability in the face of a global health crisis. Their contributions in the early stages of the pandemic significantly improved the diagnostic capabilities essential for controlling the spread of COVID-19, underlining the importance of preparedness, swift response, and innovation in healthcare. 

Diagnosis Trends

Diagnosing thyroid cancer has witnessed notable improvements, largely due to advancements in medical imaging, molecular testing, and a better understanding of the disease. Some key diagnosis trends include:

Ultrasound and Fine Needle Aspiration (FNA): High-resolution ultrasound imaging combined with FNA has become the gold standard for thyroid nodule evaluation. This non-invasive and highly accurate method helps identify suspicious nodules.

Molecular Testing: Molecular testing of thyroid nodules has gained prominence. It helps distinguish between benign and malignant nodules, providing more targeted and personalized treatment options.

Telemedicine: Telemedicine has played a crucial role, especially during the COVID-19 pandemic, by enabling remote consultations and reducing the need for in-person visits for diagnosis and monitoring.

𝐏𝐫𝐞-𝐛𝐨𝐨𝐤 𝐭𝐡𝐢𝐬 𝐑𝐞𝐩𝐨𝐫𝐭 𝐍𝐨𝐰 : https://www.alliedmarketresearch.com/thyroid-cancer-market/purchase-options

Treatment Strategies

The landscape of thyroid cancer treatment has evolved significantly, offering more tailored approaches to care. Some key treatment strategies include:

Surgery: Surgical options, including thyroidectomy, have become more precise and less invasive. Techniques like robotic-assisted surgery and minimally invasive procedures lead to quicker recovery times and fewer complications.

Radioactive Iodine Therapy: Radioactive iodine therapy remains a crucial treatment for certain types of thyroid cancer. Advances in dosing and delivery have improved the efficacy of this treatment while minimizing side effects.

Targeted Therapies: Targeted therapies, such as tyrosine kinase inhibitors, have been introduced for advanced or recurrent thyroid cancer. They are designed to block specific cancer-related molecules, providing a more precise treatment approach.

Immunotherapy: Immunotherapy is a promising frontier in thyroid cancer treatment. Checkpoint inhibitors are being studied for their potential to enhance the immune system's ability to combat thyroid cancer cells.

Prognosis and Quality of Life

Prognosis for thyroid cancer has improved significantly over the years. Early diagnosis and effective treatment options have led to higher survival rates. Factors influencing prognosis include the cancer's stage, type, and response to treatment.

Additionally, there is a growing emphasis on improving the quality of life for thyroid cancer survivors. This includes managing long-term side effects of treatments, addressing emotional well-being, and providing support to patients as they navigate life after diagnosis.

𝐈𝐧𝐭𝐞𝐫𝐞𝐬𝐭𝐞𝐝 𝐭𝐨 𝐏𝐫𝐨𝐜𝐮𝐫𝐞 𝐭𝐡𝐞 𝐑𝐞𝐬𝐞𝐚𝐫𝐜𝐡 𝐑𝐞𝐩𝐨𝐫𝐭? 𝐈𝐧𝐪𝐮𝐢𝐫𝐞 𝐁𝐞𝐟𝐨𝐫𝐞 𝐁𝐮𝐲𝐢𝐧𝐠 : https://www.alliedmarketresearch.com/purchase-enquiry/10679

Challenges and Future Prospects

While significant progress has been made in the thyroid cancer market, several challenges persist. These include:

Rising Incidence: The increasing incidence of thyroid cancer presents a challenge in terms of early detection and access to timely treatment.

Overdiagnosis and Overtreatment: The fine line between identifying clinically significant thyroid cancer and overdiagnosis is a challenge. Avoiding unnecessary treatments while providing timely intervention is a complex balance.

Drug Resistance: Resistance to targeted therapies and the need for more effective treatments for advanced and aggressive forms of thyroid cancer remain areas of active research.

In conclusion, the dynamics of the Thyroid Cancer Market are shaped by constant advancements in diagnosis, evolving treatment strategies, and improved prognosis. While challenges persist, ongoing research and innovation offer hope for better outcomes and an improved quality of life for those affected by this condition.

About Us

Allied Market Research (AMR) is a full-service market research and business-consulting wing of Allied Analytics LLP based in Wilmington, Delaware. Allied Market Research provides global enterprises as well as medium and small businesses with unmatched quality of "Market Research Reports" and "Business Intelligence Solutions." AMR has a targeted view to provide business insights and consulting to assist its clients to make strategic business decisions and achieve sustainable growth in their respective market domain.

Pawan Kumar, the CEO of Allied Market Research, is leading the organization toward providing high-quality data and insights. We are in professional corporate relations with various companies and this helps us in digging out market data that helps us generate accurate research data tables and confirms utmost accuracy in our market forecasting. Each and every data presented in the reports published by us is extracted through primary interviews with top officials from leading companies of domain concerned. Our secondary data procurement methodology includes deep online and offline research and discussion with knowledgeable professionals and analysts in the industry.

[radiologyassociatesimaging]

Advancements in Nuclear Medicine Radiology: A Review

Nuclear Medicine Radiology is a specialized medical field that involves the use of radioactive substances to diagnose and treat various diseases. It's a branch of medical imaging that focuses on capturing images of the body's internal structures and functions at a molecular and cellular level. This field combines aspects of radiology, physics, chemistry, and medicine to provide valuable information to physicians for diagnosis and treatment planning.

Here are some key aspects of Nuclear Medicine Radiology:

Radiopharmaceuticals: These are radioactive substances that are injected into the body or taken orally. These substances emit gamma rays, which can be detected by specialized imaging equipment. Different radiopharmaceuticals are used for different purposes, and they are chosen based on the specific condition being investigated.

Imaging Techniques: The two primary imaging techniques used in nuclear medicine are Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET). These techniques provide functional information about the body's organs and tissues, helping doctors to understand their physiological processes.

SPECT: SPECT involves injecting a radiopharmaceutical into the patient's bloodstream. The emitted gamma rays are detected by a gamma camera, which rotates around the patient's body, creating a three-dimensional image of the distribution of the radiopharmaceutical.

PET: PET uses radiopharmaceuticals that emit positrons, which are positively charged particles. When a positron collides with an electron in the body, they annihilate each other and produce gamma rays. These gamma rays are detected by the PET scanner, which creates detailed images of metabolic processes in the body.

Applications:

Diagnosis: Nuclear medicine can be used to diagnose a wide range of conditions, including cancer, heart disease, neurological disorders, and bone disorders. For example, PET scans are often used to detect cancer metastases and assess the extent of disease.

Therapy: In addition to diagnosis, nuclear medicine can be used for therapeutic purposes. Radioactive substances can be targeted to specific tissues to treat conditions such as thyroid disorders (using radioactive iodine) and bone pain associated with metastatic cancer.

Safety: Nuclear medicine procedures involve the use of small amounts of radioactive material. These amounts are carefully selected to minimize the patient's exposure to radiation while still obtaining useful information. The benefits of the diagnostic or therapeutic information obtained from these procedures generally outweigh the risks associated with the low levels of radiation exposure.

Interdisciplinary Collaboration: Nuclear Medicine Radiology involves close collaboration between radiologists, nuclear medicine physicians, technologists, physicists, and other healthcare professionals. This interdisciplinary approach ensures accurate imaging and proper patient care.

[medcarediagnostics]

Radionucleotide Therapy  In Mumbai – Medcare Daignostic

Exploring the Advancements of Radionuclide Therapy in Mumbai

Introduction

In recent years, the field of medical science has witnessed remarkable advancements, with innovative approaches to treating various diseases. One such groundbreaking development is Radionuclide Therapy, a targeted treatment method that utilizes radioactive substances to target and destroy cancerous cells while minimizing damage to healthy tissues. Mumbai, India's bustling metropolis, has emerged as a hub for cutting-edge medical treatments, including Radionuclide Therapy. In this blog, we will delve into the world of Radionuclide Therapy, its applications, benefits, and how Mumbai is at the forefront of providing this revolutionary treatment. Radionucleotide Therapy Specialist in Mumbai and be part of a transformative journey towards a healthier and brighter future.

Understanding Radionuclide Therapy

Radionuclide Therapy, also known as targeted molecular therapy or molecular radiotherapy, involves the use of radioactive substances, known as radionuclides, to treat various medical conditions, primarily cancer. These radioactive substances emit radiation that damages the DNA within cancer cells, leading to their destruction. What sets Radionuclide Therapy apart is its precision; it specifically targets cancer cells while sparing healthy tissues, reducing the side effects commonly associated with traditional treatments like chemotherapy and radiation therapy.

Applications of Radionuclide Therapy

Cancer Treatment: Radionuclide Therapy is commonly used to treat certain types of cancer, such as thyroid cancer, neuroendocrine tumors, and bone metastases. The therapy can effectively target cancer cells that have spread to bones, offering relief from pain and improving the patient's quality of life.

Pain Management: In cases where cancer has metastasized to the bones, Radionuclide Therapy can provide significant pain relief by targeting the cancerous cells causing discomfort. This can greatly enhance the patient's overall well-being.

Hyperthyroidism Treatment: Radionuclide Therapy is employed to treat hyperthyroidism by administering a radioactive iodine isotope. This isotope selectively accumulates in the thyroid gland, helping to regulate its activity and treat the condition.

Peptide Receptor Radionuclide Therapy (PRRT): PRRT is an innovative approach used for treating neuroendocrine tumors. It involves attaching a radioactive substance to a peptide that binds to specific receptors on cancer cells, delivering radiation directly to the tumor.

Mumbai's Role in Advancing Radionuclide Therapy

Mumbai, a city renowned for its medical expertise and state-of-the-art facilities, has been a pioneer in the field of Radionuclide Therapy in India. The city boasts several leading healthcare institutions that offer advanced treatment options for cancer patients, including Radionuclide Therapy.

Cutting-edge Facilities: Mumbai is home to world-class medical facilities equipped with the latest technology for diagnosis, treatment, and research in the field of nuclear medicine and Radionuclide Therapy.

Expert Medical Professionals: The city attracts top-notch medical professionals, including nuclear medicine physicians, radiation oncologists, and radiologists, who are well-versed in the intricacies of Radionuclide Therapy.

Research and Innovation: Mumbai's healthcare institutions actively engage in research and innovation related to Radionuclide Therapy. Clinical trials and studies are conducted to continually enhance the effectiveness of this treatment approach.

Benefits of Radionuclide Therapy

Precise Targeting: Radionuclide Therapy's precision targeting ensures that cancer cells are destroyed while healthy tissues remain unharmed, minimizing side effects.

Reduced Pain and Discomfort: For patients with bone metastases or certain types of cancer, Radionuclide Therapy can alleviate pain and discomfort, significantly improving their quality of life.

Minimized Invasive Procedures: In some cases, Radionuclide Therapy can be administered through oral or intravenous methods, reducing the need for invasive surgeries.

Conclusion

Radionuclide Therapy has revolutionized the landscape of cancer treatment, offering a more targeted and effective approach while reducing the adverse effects commonly associated with conventional treatments. Mumbai's prominent role in advancing this field highlights the city's dedication to providing cutting-edge medical care to its residents and patients from around the world. With its state-of-the-art facilities, expert medical professionals Pathology Lab Near Me, Mumbai and commitment to research, Mumbai is poised to continue making significant contributions to the field of Radionuclide Therapy, providing hope and healing to countless individuals battling cancer and other medical conditions.

[priyanshisingh]

Radiopharmaceutical Theranostics Market Size, Industry Share, Growth Demand, Supply Chain, Trends Future Outlook, Forecast 2030

The latest market report published by Credence Research, Inc. “Global Radiopharmaceutical Theranostics Market: Growth, Future Prospects, and Competitive Analysis, 2016 – 2028. Steady growth in recent years is expected to grow at a CAGR of 11.90% between 2022 and 2030. The market was valued at USD 1.6 billion in 2022 and is expected to reach USD 3.52 billion in 2030.

Radiopharmaceutical theranostics market dynamics play a crucial role in the advancement of personalized medicine and targeted therapy. The term "theranostics" combines diagnostics and therapy, highlighting the dual functionality of radiopharmaceuticals in both identifying disease biomarkers and delivering therapeutic interventions. This rapidly evolving field is driven by several key factors that shape its dynamic landscape. Technological advancements in imaging techniques, such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), have significantly improved diagnostic accuracy and aided treatment decision-making processes. Additionally, the increasing prevalence of chronic diseases, including cancer and cardiovascular disorders, has surged the demand for precise molecular imaging tools capable of guiding effective treatment strategies.

Global Disease Burden Amplifying Market Growth

The mounting global burden of chronic diseases, particularly cancer and neurodegenerative disorders, plays a pivotal role in propelling the radiopharmaceutical theranostics market. Advances in theranostics have shown significant promise in addressing these health challenges, making them a focal point in the healthcare sector's battle against chronic diseases.

Technological Innovations as Market Catalysts

Innovation is at the heart of the radiopharmaceutical theranostics market's surge. Groundbreaking developments in medical imaging technologies, such as PET and SPECT, and novel radioisotope therapies are stimulating market growth. The fusion of these technologies has birthed an era of targeted, efficient, and minimally invasive treatment options.

Market Segmentation:

By Application: Cancer Remains the Leading Segment

Cancer theranostics remains the predominant market segment, driven by the ever-increasing global cancer incidence. The advent of radiopharmaceuticals like Lutathera and Azedra has transformed the oncology landscape, offering groundbreaking solutions for neuroendocrine tumors and pheochromocytoma.

By End-user: Hospitals and Diagnostic Centers Lead the Way

Hospitals and diagnostic centers represent the leading end-user segment. These institutions are at the forefront of adopting radiopharmaceutical theranostics due to their comprehensive treatment capabilities and access to advanced medical imaging modalities.

Browse 210 pages report Radiopharmaceutical Theranostics Market By Radioisotope (Technetium-99, Gallium-68, Iodine-131, Radium-223, Fluorine-18) By Application (Oncology, Cardiology, Others) - Growth, Future Prospects & Competitive Analysis, 2016 – 2030)- https://www.credenceresearch.com/report/radiopharmaceutical-theranostics-market

Regional Market Dynamics:

North America: The Dominant Player

North America retains its stronghold on the radiopharmaceutical theranostics market. This is attributable to the region's robust healthcare infrastructure, advanced research facilities, and high adoption rate of innovative medical technologies.

Europe and Asia-Pacific: Regions on the Rise

Europe and Asia-Pacific regions are also notable market players. Europe's progress is driven by its sophisticated healthcare systems and a strong focus on research and development. Asia-Pacific, meanwhile, benefits from a booming healthcare sector and an increasing prevalence of chronic diseases.

Key Market Players:

Dominant players in the global radiopharmaceutical theranostics market include Novartis AG, Advanced Accelerator Applications, and Progenics Pharmaceuticals. Their innovative strides in radioisotope production, medical imaging, and theranostic applications shape the industry's landscape and future trajectory.

The Road Ahead: Future Perspectives in Radiopharmaceutical Theranostics

As we look to the future, the radiopharmaceutical theranostics market is set to witness continued growth. Aided by technological advancements, increased healthcare spending, and an unyielding commitment to improving patient outcomes, the theranostic revolution will continue to flourish, transforming the way we diagnose and treat diseases.

Why to Buy This Report-

The report provides a qualitative as well as quantitative analysis of the global Radiopharmaceutical Theranostics Market by segments, current trends, drivers, restraints, opportunities, challenges, and market dynamics with the historical period from 2016-2020, the base year- 2021, and the projection period 2022-2028.

The report includes information on the competitive landscape, such as how the market's top competitors operate at the global, regional, and country levels.

Major nations in each region with their import/export statistics

The global Radiopharmaceutical Theranostics Market report also includes the analysis of the market at a global, regional, and country-level along with key market trends, major players analysis, market growth strategies, and key application areas.

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[karimsarhane]

Advances in Thyroid Cancer Diagnosis and Treatment

Karim Sarhane, MD

Thyroid cancer affects endocrine glands that regulate crucial bodily processes via hormone production. Tumor growth in the neck region, which characterizes thyroid cancer, can result in discomfort, difficulty swallowing, and inflamed lymph nodes. Previously, radiation was the go-to treatment option. However, recent advancements have enabled the medical community to understand the disease better, leading to more advanced diagnoses and treatments. Overdiagnosis, which refers to detecting small, slow-growing nodules or tumors that may not be cancerous, is а significant issue when diagnosing thyroid cancer. Studies from the National Cancer Institute (NCI) reveal that in one-third of instances where а questionable nodule (tumor) is removed from the thyroid, it is not cancerous. Researchers backed by the NCI have devised novel genomic tests to identify if these dubious nodules are cancerous, reducing unwarranted surgeries and enabling the selection of the most suitable treatment alternatives. Optical diagnostic imaging (OI) is a new technology that utilizes light to observe cellular, tissue, or organ structure and function, assisting in diagnosis. Compared to traditional imaging methods like x-ray, OI provides molecular specificity, flexibility, and safety, potentially mitigating issues of overdiagnosis and enhancing diagnostic efficacy. Additionally, it supports precise and non-invasive treatments for thyroid cancer. Fluorescence imaging (FI) is another promising modality for cancer diagnosis. It involves intravenous injection of a fluorescent dye before the operation. Upon exposure to а specific light wavelength, the dye emits fluorescence that helps highlight the parathyroid glands and other cancerous tissues. This technique offers several advantages over conventional imaging methods, including reduced invasiveness, cost-effectiveness, and superior spatial and temporal resolution. FI has demonstrated clinical potential in various applications, such as image-guided surgery. Doctors typically recommend radioactive iodine therapy (RIT) to treat differentiated thyroid cancers, such as papillary cancer originating from follicular cells in thyroid glands. RIT involves the patient taking a pill or liquid containing high doses of radioactive iodine, which collects in the thyroid gland and targets cancerous cells. Before treatment, doctors may conduct tests to determine if the cancer will likely respond to RIT. Targeted therapy is another thyroid cancer treatment involving drugs that specifically attack certain targets on cancer cells. Kinase inhibitors and anti-angiogenesis drugs are examples of drugs used in targeted therapy. Kinase inhibitors help treat thyroid cancer cells with mutations in specific genes, while anti-angiogenesis drugs disrupt the formation of new blood vessels supplying tumors with nutrients and enabling them to grow. An alternative treatment for thyroid cancer is ethanol ablation, whereby a doctor injects alcohol into the targeted nodule to shrink or kill tumor cells by changing the structure of their proteins. The procedure involves inserting a thin needle, guided by ultrasound, into the nodule to inject alcohol. It is one of the safest therapeutic profiles and has successfully been used to treat toxic and benign cystic nodules. Alcohol ablation is a good alternative for patients unwilling or unable to undergo surgery. RNA therapy is another innovative approach to treating thyroid cancer. It involves using small interfering RNA (siRNA) to target and silence genes associated with cancer cells. Anaplastic thyroid cancer (ATC), a difficult-to-treat form of thyroid cancer, can now be targeted with novel nanotechnology that allows for the precise delivery of RNA therapy to ATC cells. Animal testing has demonstrated RNA therapy's effectiveness in halting tumor growth and preventing cancer from spreading to other body parts.

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[teachingrounds]

Nuclear therapies rely on agents that can be both diagnostic and therapeutic, which led to the term "theranostics;" in the words of Dr. Frank Baum, this is the ability to "treat what we see and see what we treat." 

Radioactive iodine (RAI) is the prototypical (and oldest) agent that is both diagnostic and therapeutic. RAI therapy was introduced by Saul Hertz in 1941 and has since been a mainstay of nuclear medicine. Nearly all oral iodide is concentrated in the thyroid gland and the beta particles (high energy electrons) emitted by I-131 decay ablate thyroid tissue. RAI therapy can be used to treat Grave's disease, toxic multinodular goiter, hyperfunctioning nodules (aka toxic adenomas), and thyroid cancer (after thyroidectomy, including metastatic thyroid cancer). 

Image depicts the normal biodistribution of orally administered [I-131]-NaI. Image source and more information can be found at http://endocrinediseases.org/thyroid/cancer_rai.shtml

#TeachingRounds #FOAMed #FOAMRad #Nuclear #Medicine #NuclearMedicine #Therapy #NuclearTherapy #Radiology #Endocrinology #Oncology #Theranostics #Molecular #Imaging #MolecularImaging

[drforambhuta]

There are different types of cancers that can be treated using radiation therapy. The different types of radiation therapies include:

1.External beam radiation therapy can be used to treat several types of cancer.

2. Brachytherapy is most commonly used to treat the cancers of the head and neck, breast, cervix, prostate, eye cancer.

3. Radioactive iodine, or I-131, is most commonly used to treat certain types of thyroid cancers.

4. Also known as Molecular Radiotherapy, systemic radiation therapy, also known as targeted radionuclide therapy, is used for treating some patients having advanced prostate cancer or gastroenteropancreatic , neuroendocrine tumor (GEP-NET).

There are many good hospitals in Bangalore where radiation therapy is done with great success.

[healthcare-market]

Radiopharmaceutical Theranostics Market to Witness Widespread Expansion by 2031

Radiopharmaceutical Theranostics Market: Introduction

According to the report, the global radiopharmaceutical theranostics market was valued at US$ 0.84 Bn in 2020 and is projected to expand at a CAGR of 11% from 2021 to 2031. Nuclear medicine imaging is primarily based on the principle of using radioactive isotopes attached to specific molecules (i.e., radiopharmaceutical agents or radiotracers) to examine key biologic processes, including disease pathophysiology. Radiopharmaceuticals are agents used for both diagnostic and therapeutic purposes. Organizations across the world classify these differently. According to the WHO, these are categorized into ready-for-use radioactive goods, radionuclide generators, non-radioactive components (“kits”) for the production of labelled compounds containing a radioactive component, and precursors used for radiolabelling other substances prior to administration.

The radiopharmaceutical market is projected to be driven by factors such as increase in therapeutic applications, public awareness, usage of hybrid imaging, technological advancements, efficient diagnosis & treatments, emergence of new radioisotopes, and replacement of traditional equipment.

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Rise in Prevalence of Cancer to Drive Global Market

The significance of customized medicine has been growing rapidly, owing to a more urgent need to avoid unnecessary and expensive treatments. In radiopharmaceuticals, the theranostics approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets could help predict if a patient would benefit from a particular treatment. According to the International Agency for Research on Cancer, the global cancer burden surged to 19.3 million cases and 10 million cancer deaths in 2020. By 2040, the number of new cancer cases per year is anticipated to reach 29.5 million, with 16.4 million cancer-related deaths.

Radiopharmaceutical theranostics is becoming an increasingly essential component of cancer treatment. Radioiodine is the classic radiotheranostic agent for clinical treatment of thyroid tumors. Radiolabeled metaiodobenzylguanidine is another prominent radiotheranostic drug, which has been used for diagnostic imaging and therapy of neuroblastoma, paraganglioma, and pheochromocytoma patients.

Significant and promising advancements have been made in radiotheranostics for neuroendocrine tumors, prostate cancer, and other conditions. Few instance of radiopharmaceutical theranostics pair are 177Lu/68Ga, 111In, 223Ra/99Tc, 18NaF, 131I/123I, 124I, etc.

Radiopharmaceutical theranostics is gaining traction and will most likely be able to expand its scope to include new cancer biomarkers and indications in future. Hence, rise in the prevalence of cancer is projected to propel the demand for radiopharmaceutical theranostics over the next few years.

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Lutetium (Lu) 177 to Dominate Global Market

In terms of radioisotope, the global radiopharmaceutical theranostics market has been classified into technetium-99, gallium-68, iodine-131, iodine-123, fluorine-18, yttrium-90, lutetium (Lu) 177, copper (Cu) 67, copper (Cu) 64, and others. The lutetium (Lu) 177 segment dominated the global radiopharmaceutical theranostics market in 2020 and the trend is anticipated to continue during the forecast period. The favorable nuclear characteristics as well as easy availability of high activity levels of high specific activity 177Lu are the major factors for the widespread interest in the clinical use of this radionuclide.

Oncology to Offer Lucrative Opportunities

Based on application, the global radiopharmaceutical theranostics market has been categorized into oncology, cardiology, and others. The oncology segment dominated the global radiopharmaceutical theranostics market in 2020. Most of the radioisotopes are used in oncology for diagnosis or radiation therapy. 68 Ga DOTATE and 177 Lu DOTATOC is the commonly used theranostics pair in diagnosis and treatment of neuroendocrine tumors.

High Number of Cyclotrons Facilities to Drive Global Market

In terms of source, the global radiopharmaceutical theranostics market has been bifurcated into nuclear reactors and cyclotrons. The cyclotrons segment dominated the market in 2020. The segment is expected to expand at the highest CAGR from 2021 to 2031. The segment is likely to witness rapid growth, owing to a large number of existing cyclotron facilities across the world.

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Targeted Therapeutic (Rx) to be Promising Segment

Based on approach, the global radiopharmaceutical theranostics market has been classified into targeted therapeutic (Rx) and companion diagnostic (DX). The targeted therapeutic (Rx) segment dominated the market in 2020. The segment is projected to expand at the highest CAGR from 2021 to 2031. Increasing evidence supports the efficacy and safety of targeted therapeutics, as well as an increase in overall survival.

Hospitals to be Major End Users

In terms of end user, the global radiopharmaceutical theranostics market has been divided into academic & research institutes, hospitals, and others. The hospitals segment dominated the market in 2020. The segment is anticipated to expand at the highest CAGR from 2021 to 2031. Rise in number of hospital facilities and favorable outcomes of treatment in hospitals due to the availability of a range of treatment options lead to high preference to hospitals.

North America to Lead Radiopharmaceutical Theranostics Market

The global radiopharmaceutical theranostics market has been segmented into five major regions: North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America dominated the global market in 2020, followed by Europe. North America accounted for a major share of the global radiopharmaceutical theranostics market in 2020. The high prevalence of neuroendocrine tumors (NETs) drives the radiopharmaceutical theranostics market in North America. Over 12,000 people in the U.S. are diagnosed with neuroendocrine tumors each year. The sensitivity and specificity of Ga-68 and Lu-177 as a theranostics pair have been evaluated in a number of clinical trials. This factor is expected to fuel the growth of the market in the region.

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Competition Landscape

The global radiopharmaceutical theranostics market is fragmented due to the presence of a large number of leading players. Key players operating in the global market include Nihon Medi-Physics, ITM Isotopen Technologien München AG, Advanced Accelerator Applications, Telix Pharmaceuticals, GE Healthcare, Theragnostics Ltd, NuView Life Sciences, Jubilant Pharma Limited, Lantheus Holdings, Inc., Curium Pharma, Bayer AG, and Clarity Pharmaceuticals. New product development through robust R&D activities and mergers & acquisitions are the key strategies adopted by these players to expand business in the global radiopharmaceutical theranostics market.

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[dreddymd]

Saving Sepsis Patients Lives

Are doctors ready to save half a million people a year who die from Sepsis? We now have a game-changer for a condition that occurs in more than 1.5 million people a year in America, with a 28 percent to 50 percent fatality rate, according to the National Institutes of Health. Sepsis rates are even higher in third-world countries. Sepsis, a systematic inflammatory response to infection, is one of the most serious diseases in an ICU. Although comprehensive therapy has been developed for it, sepsis is still associated with high morbidity and mortality.

Science Daily reports, “With infectious diseases, it is often not the pathogen itself, but rather an excessive inflammatory immune response (sepsis) that contributes to the patient’s death, for instance as a result of organ damage. On intensive care units, sepsis is the second-most common cause of death worldwide. In patients with a severely compromised immune system specially, life-threatening candida fungal infections represent a high risk of sepsis.”

Dr. Paul Marik made headlines across the globe with a sepsis treatment he believes is saving lives, however he says he must “lie low” about the controversial treatment. Dr. Marik said the response by patients’ physicians has been about half and half, with some willing to try, and “the other half saying it’s complete and utter nonsense.” He is administering a common sense basic medicine approach that puts out cysteine storms with IV infusions of vitamin C, hydrocortisone and thiamine.

Vitamin C, Cancer and Oxidative Stress

A research team at the University of California, Berkeley found evidence that vitamin C does significantly reduce levels of oxidative stress, which is associated with a variety of chronic diseases, for people exposed to environmental tobacco smoke. Vitamin C also seems to ameliorate imidacloprid-induced oxidative damage by decreasing LPO (lipid peroxidation levels) and altering antioxidant defense systems in the liver.

Vitamin C is an important independent antioxidant with a key role in protecting cells from oxidative challenge and cell death from oxidative stress. When used in combination with other antioxidants like hydrogen, glutathione, magnesium, bicarbonate and iodine one can feel confident that such a protocol will address the most serious threats of sepsis as well as other life-threatening diseases.

IV vitamin C is a wonderful treatment when people are on the edge between life and death for it has the power to bring people back from the brink. Each of the medicinals mentioned above are heavy weight medicines useful in the direst medical circumstances when used correctly. Take vitamin D as an example, probably 200,000 units 50,000 at a time should be used for four days for sepsis patients. Vitamin D does some heavy lifting when administered intravenously to dialysis patients.

Hydrogen Outperforms Vitamin C

Sepsis, a multiple organ dysfunction syndrome, is the leading cause of death in critically ill patients. Hydrogen gas inhalation significantly improved the survival rate and organ damage of septic mice with moderate or severe cecal ligation and puncture, by reducing levels of early and late pro-inflammatory cytokines in serum and tissues.[1]

Hydrogen’s protective effect on sepsis has been proved by biopsy, levels of inflammatory factors/anti-inflammatory factors, oxidative stress reductions, behavioral experiment, and other related indicators of organ function. Molecular hydrogen therapy is able to significantly reduce the release of inflammatory factors and oxidative stress injury thereby reducing damage of various organ functions that are so common with sepsis.[2]

Hydrogen has protected organisms against polymicrobial sepsis injury, acute peritonitis injury both by reducing oxidative stress and via decreasing mass pro-inflammatory responses. It is also known that most viral induced tissue damage and discomfort are mainly caused by an inflammatory cytokine storm and oxidative stress rather than by the virus itself. Same goes for fungus infections that bring on sepsis.

Studies have shown that suppressing the cytokine storm and reducing oxidative stress can significantly alleviate the symptoms of influenza and other severe viral infections diseases. Medical scientists thus hypothesize that hydrogen-rich solution therapy to be a safe, reliable, and effective treatment for Multiple Organ Dysfunction Syndrome (MODS) induced by influenza and other viral infectious diseases.

Hydrogen is Safer

The main point here is not to stop administering C into these patients. Vitamin C has other healing life saving effects, as sufferers from Scurvy know. These properties are sorely needed in ICU patients. However, with hydrogen there is a greatly reduced need for high dosages of C not only because of the continuous nature of hydrogen inhalation, but also because hydrogen helps recycle Vitamin C. This is important because medical scientists say, “Hydrogen is a safer gentler antioxidant that Vitamin C or E.” High levels of antioxidant vitamins C and E may have significant detrimental effects on the most sensitive cells (placental function), as reflected by decreased cell viability and secretion of hCG; and placental immunity, as reflected by increased production of TNF-a. Meanwhile hydrogen showed no such effects on cell proliferation and TNF-α expression, but it could affect the level of hCG, indicating hydrogen as a potential candidate of antioxidant in the management of preeclampsia (PE) should be further studied.[3]

Cell viability was significantly suppressed by 500 μmol/L vitamins C and E (P < 0.05), but not by 500 μmol/L molecular hydrogen (P > 0.05). The expression of TNF-α was increased by 100 μmol/L vitamin C and 50 μmol/L vitamins E, separately or combined (P < 0.05), but not by molecular hydrogen (0-500 μmol/L), as validated by real-time RT-PCR. But the secretion of hCG was both inhibited by 50-500 μmol/L molecular hydrogen and high levels of vitamin C and E, separately or combined.

Convincing Evidence

When we focus on Dr. Marik’s work it is impossible not to see the merits of his work and how many lives it can save. His hospital experimented with his protocol and saw a stunning mortality drop, but doctors are still skeptical because his hospitals study involved a small number of subjects, and because the study compared something at one point in time to a control group further back in time. However, medical institutions are taking this seriously enough to launch more than several studies, all of which will be too late to help the next million who will die of sepsis.

Published online in December 2016 in Chest, an American College of Chest Physicians medical journal. The study showed that in 47 patients with sepsis treated in Norfolk General’s ICU in 2016, four died, an 8 percent mortality rate. Of those four, none died of sepsis but rather the conditions that led to sepsis in the first place. The previous year, 19 of the hospital’s 47 septic patients died, a 40 percent rate. Dr. Marik has treated 700 patients with the protocol, and while some have died, it’s usually been because of the underlying disease, such as cancer, that led them to a septic state.

Is it too hard to listen to this doctor who is not only sharing his belief but the success of his treatments? Bending to the ignorance of modern medicine he says, “People who know about the treatment either are excited, or they think it’s snake oil medicine. It’s absolutely clear we need randomized controlled trials to validate this. It’s absolutely essential.”

He knows though this is not true, anyone who will pay the slightest attention will see it needs to be put into wide use now. Why wait to change if one is already failing miserably with what one is presently doing. From this moment onward, we can stare directly at the possibility of saving a million lives a year around the world with a safe and effective protocol for sepsis.

Saving Millions of Lives

We all know that the present day medical and governmental institutions will not see things in a way that will bring relief to these millions of patients and their families.

With sepsis it’s a matter of death for more than 500 thousand Americans a year. Most of these patients can be saved with hydrogen, oxygen, Vitamin C, D, CO2, administered with hydrocortisone and thiamine. Survival rates would be pushed higher with injectable selenium, IVs of sodium bicarbonate and injections of magnesium chloride. Many substances can be administered orally or as a gas for inhalation therapy.

Selenium is a strong antioxidant anti-inflammatory that can also be used. Protection against reperfusion injury, myocardial infarction, ischemic stroke, vascular surgery, are all alleviated with selenium injections as would cytokine storms provoked from out of control infections.

Inflammation is the activation of the immune system in response to infection, irritation, or injury. Characterized by an influx of white blood cells, redness, heat, swelling, pain, and dysfunction of the organs involved, inflammation has different names when it appears in different parts of the body. Our new protocol for sepsis works directly, not only on the life threatening oxidative stress but reduces and even removes that massive inflammation that is directly leads to organ failure.

The above essay is a chapter from my Hydrogen Medicine eBook.

References (3)

Protective effects of hydrogen gas on murine polymicrobial sepsis via reducing oxidative stress and HMGB1 release. Xie K, Yu Y, Pei Y, Hou L, Chen S, Xiong L, Wang G. Shock. 2010 Jul; 34(1):90-7.

Oxidative Medicine and Cellular Longevity. Volume 2016 (2016), Molecular Hydrogen Therapy Ameliorates Organ Damage Induced by Sepsis

Arch Gynecol Obstet. 2015 Aug;292(2):337-42. doi: 10.1007/s00404-015-3647-8. Epub 2015 Feb 14. Effects of vitamin C, vitamin E, and molecular hydrogen on the placental function in trophoblast cells.

Dr. Mark Sircus AC., OMD, DM (P)

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[juniperpublishers-toxicology]

Transdermal Methimazole for Feline Hyperthyroidism

Introduction

Over the past 20 years, the prevalence of feline hyperthyroidism has increased astoundingly [1-3]. It has become the most common endocrine disorder in cats, and the risk worsens with each year of increasing age, being most common in middle to older-aged felines [1]. The disease is primarily characterized by an excessive production and release of the thyroid hormones thyroxine (T4) and triiodothyronine (T3) most commonly due to a functional, benign adenomatous hyperplasia of the thyroid gland. At present, there is not a feline specific thyroid stimulating hormone (TSH) assay test available, therefore unlike human hyperthyroid diagnosis, veterinarians do not commonly depend on a low TSH value for primary hyperthyroid diagnosis. Hyperthyroidism diagnosis in cats is generally based on a high free T4 level and the presence of clinical signs and symptoms. Some of the clinical complications of hyperthyroidism that may be present include emotional lability, hyperactivity, palpitations, tachycardia, and a plethora of other manifestations of the disease (Table 1). Although the exact etiology is unknown, many nutritional and environmental causes are suspected, including canned cat food products containing iodine, soybean, phthalates, polyphenols, and polychlorinated biphenyls [2,4,5].

Regardless of the etiologic origin, medical management of prolonged thyroid hormone elevation is very important. Untreated hyperthyroidism can have many consequences on the cat. Many cats initially present with a change in personality or behavior, often being more easily agitated and mean, as well as with unexplained weight loss, changes in eating habits, accelerated heart rates, and a goiter. Hyperthyroidism, if left untreated, can also have life threatening adverse effects, such as causing hypertension, cardiac tachyarrhythmia, atrial fibrillation, and even death [6,7]. These result from elevated thyroid hormone levels and cause up-regulation of various gene expressions involved in the body’s metabolism, thermogenesis for heat regulation, nerve function, and muscle and bone function [7]. They also function to increase activation of the sympathetic nervous system, which elevates the heart rate, the heart’s force of contraction, and increases cardiac output overall [8,9]. Clearly, both the symptoms of the disease, as well as the enhancement of these biochemical pathways, can pose serious health risks to the feline patient. The longer a cat goes without treatment, the worse their complications become [6,10,11].

Like the management of hyperthyroidism in humans, there are several different treatment options available for cats. The top three recommended therapies include surgical thyroidectomy, radioiodine therapy, and medication treatment. Thyroidectomy and radioiodine treatment can be permanent solutions to the disease. However, limitations such as expense and permanent hypothyroidism prevent these from being practical options for most feline patients [7,11] (Table 2). Medication therapy is often the most practical and accessible way to manage hyperthyroid cats. Methimazole (Tapazole, Felimazole) is the most common and favored agent in the United States [12]. Other alternatives include carbimazole (a prodrug of methimazole marketed only in the UK), iodine-containing agents, iodine dietary restricted food, and homeopathic regimens [6,12-14]. Dietary iodine restriction is another option, however, there is limited supporting data to determine a true benefit.

Although several treatment options are available for hyperthyroid cats, each therapy option has considerable drawbacks to both the client and the feline patient. Oral methimazole has historically been the most accessible and affordable choice. However, gastrointestinal side effects and an unfavorable twice-a-day oral administration schedule often limit its ultimate therapeutic outcomes in the cat. Both negative attributes are avoided with use of the transdermal methimazole gel compound. Due to the limited amount of data available on transdermal methimazole, this review aims to evaluate whether the pluronic lecithin organogel (PLO) compound of methimazole is effective in treating hyperthyroid cats. In addition, it also serves to provide insight on the recommendations for its use.

Methods

A PubMed search was conducted to identify articles in which the safety or efficacy of transdermal methimazole for treatment of feline hyperthyroidism was assessed. Key MeSH search terms included feline hyperthyroidism with a subheading for treatment. In addition, feline hyperthyroidism plus one of the following search terms were searched: treatment, drug-related side effects and adverse drug reactions. A free-text search was also conducted to identify articles not included in the MeSH term search. Metaanalyses, randomized controlled clinical trials, and case reports were included in the review if the primary focus of the article related to the use of oral or transdermal methimazole for feline hyperthyroidism. Studies were excluded if published in languages other than English. In addition, studies highlighting mechanisms of action, studies of pharmacodynamics or pharmacokinetic effects were excluded.

Results

Clinical data on the topic of feline hyperthyroidism treatment is limited. A PubMed search revealed 14 articles with transdermal methimazole and feline hyperthyroidism as a subheading. Of the articles used in this review, there were six that directly assessed the use and efficacy of transdermal methimazole in the treatment of feline hyperthyroidism. Of those six, five were small clinical studies and one was a case report/series.

Evaluation of oral methimazole

Oral methimazole has remained the mainstay of feline hyperthyroidism treatment since the early 1980’s. It reversibly suppresses thyroid hormone levels by inhibiting thyroid peroxidase. It does not inactivate circulating T4 and T3, resulting in a 2 to 4-week delay before serum T4 concentrations begin to normalize [8]. While it accumulates in the thyroid gland, it does not block the release of preformed hormone, nor does it help reduce goiters [8,15]. Oral methimazole has variable bioavailability ranging from 27 to 100% so its efficacy varies from patient to patient [6]. The recommended dose for maximum efficacy is 2.5mg administered twice daily.

In a randomized, unblinded, clinical trial by Trepanier et al. [11], forty methimazole naive cats with newly diagnosed hyperthyroidism were studied to compare the efficacy of one daily dosing of oral methimazole to twice daily dosing. Owners completed a questionnaire of their cat’s baseline behavior status and reported any changes that occurred during the study. The overall efficacy of once daily methimazole was found to be less effective than twice daily dosing. Serum T4 concentrations were considerably higher in cats receiving once daily dosing, and only 54% (13/24) were found to be euthyroid at two weeks, compared to 87% (13/15) euthyroid in the twice daily group [16]. Both treatment groups showed considerable clinical improvement of many complications caused by hyperthyroidism. However, among the initial 40 cats studied, one cat in the once daily dosing group was removed prior to the 2-week point due to considerable gastrointestinal (GI) upset. Of the remaining 38 feline patients, 17 (44%) developed some type of adverse event throughout the four-week duration. Throughout the remainder of the study, 23% (9 cats) reported similar GI upset. Among the 24 cats treated once daily, 42% (10/24) required discontinuation of therapy, in order to resolve oral methimazole induced adverse events. Facial excoriation was reported in six patients, five reported from the once daily dosed group alone. Five of the six total facial excoriation cases reported were from the once daily dosed group. Manifestations of blood dyscrasias and hepatopathy were not significantly reported in either group [16].

Not only were adverse events such as GI upset and facial excoriations, found to be less prevalent in cats dosed twice a day, but also these cats were also more likely to obtain the goal euthyroid state. Cats also show rebound increases in serum T4 concentrations and a return to hyperthyroid state within 24 to 48 hours of methimazole discontinuation [3,16,17]. This likely correlates with the need for twice daily dosing in cats, and further research should be performed to help determine methimazole’s true intrathyroidal residence time in cats. Oral methimazole is not a cure for feline hyperthyroidism, and treatment must be continued indefinitely. With the intolerable GI upset from the oral tablets and the difficulty many owners face administering the medication twice daily to uncooperative cats, the alternative transdermal route of administration poses significant benefits [16].

Transdermal methimazole formulation

Despite the limited clinical studies on transdermal methimazole, some clinicians have achieved a good therapeutic benefit to using this dosage form in cats. Pluronic lecithin organogel is a microemulsion-based gel containing lecithin, isopropyl palmitate, and pluronic acid to effectively deliver both hydrophilic and lipophilic drugs topically across the stratum corneum and may aid in the administration of methimazole [18- 22]. PLO is composed of both an oil phase (lecithin phase) and an aqueous phase (pluronic phase). It includes isopropyl palmitate acts as a solvent and permeation enhancer while lecithin also serves as a permeation enhancer by increasing the fluidity of the stratum corneum, and slightly disorganizing the skin structure to permit substance permeation [23-25]. PLO reversibly turns into a thick gel at body temperature, leading to an increase in dehydration of the aqueous solution, forming a shell-like structure of aggregated micelles [7,24-28]. Methimazole is an ideal drug for transdermal delivery due to its low molecular weight, high lipid solubility, water solubility, low daily dose, and is non-irritating and non-sensitizing to the skin [20,24].

Efficacy of the PLO methimazole

In a small retrospective study examining dispensing records for 16 hyperthyroid cats undergoing transdermal methimazole treatment, the transdermal formulation was effective at reducing serum T4 concentrations in 15 of the 16 cats studied. One cat showed an increase in serum T4 level, but there is no mention or clarification of appropriate application or other possible contributing factors. The only adverse event reported was a single case of increased blood urea nitrogen level, thought to be the unmasking of prior renal disease. This study also demonstrates variability in dosing and administration frequency of the topical, ranging between 5 mg once a day to a twice daily dose of 7.5mg every morning and 5 mg every night. This wide variation between each feline patient, limits our ability to recommend a standard dose or administration frequency, but does indicate the need for patient-specific doses and frequencies in order to effectively reach the euthyroid goal [29].

 In a randomized clinical trial conducted by Sartor et al, 47 newly diagnosed hyperthyroid cats were used to investigate whether PLO formulated transdermal methimazole was safe and efficacious in controlling feline hyperthyroidism. At two weeks of treatment, more cats in the oral methimazole group had serum T4 concentrations within the reference range (14 of 16 [88%], p=0.035). By week four, there was no difference between the oral and transdermal methimazole. The PLO transdermal methimazole group took longer to reduce serum T4 concentrations to the acceptable reference range, however, it was as effective as oral administration in producing euthyroidism by the fourth week of treatment [30]. Fewer GI adverse events were reported with the transdermal formulation (1/27 vs 4/17 in the oral group). The reduction of GI upset deems consideration as it is often the cause of discontinuation of oral methimazole [30,31].

Lecuyer et al evaluated the efficacy of transdermal methimazole in 13 newly diagnosed hyperthyroid cats. The feline patients received 5mg methimazole concentrated in PLO, applied to the inner ear twice daily. In addition to reaching the euthyroid state, all 10 cats that completed the study also showed improved clinical signs related to hyperthyroidism consistent with other previously reported studies [16,32-33]. No GI adverse events were reported, and investigators concluded that PLO transdermal methimazole is a safe and effective alternative to oral methimazole [6].

Duration of t4 suppression

A study by Boretti et al. [33] evaluated the duration of serum T4 suppression among newly diagnosed hyperthyroid cats treated with once daily transdermal methimazole versus twice daily dosing. Twenty cats were treated with the PLO-based methimazole formulation dosed either 2.5mg every 12 hours (10 cats, group 1) or 5mg every 24 hours (10 cats, group 2). Serum T4 concentrations were measured one and three weeks after initiation of therapy, immediately before and every two hours after gel application for up to 10 hours. Cats were limited to a maximum of five blood samplings in one day [33]. A sustained suppression of T4 concentration for at least 24 hours was seen following gel application and there was no significant difference in change in serum T4 concentration immediately before or any time after gel administration in either group. As also discussed in Lecuyer’s study [6], further research is needed concerning the duration of intra thyroid methimazole accumulation [6,33,34]. Among the twice daily dosing group, reductions were required in three cats, and a dose increase was required in one patient. Of the once daily dosing group, two cats required a decrease in dose, and one cat required an increased dose, after three weeks of treatment as a result of sustained hyperthyroid levels [33]. Investigators concluded that once daily application of the PLO methimazole compound can effectively reduce serum T4 concentrations in most hyperthyroid cats. Once a day dosing is most convenient for the owner, and thus promotes better compliance [33]. The compounding of this preparation allows for changes in dose or frequency and allows for the individualization of therapy.  

PLO vs. novel lipophilic base

In a 12-week prospective study by Hill et al, a novel lipophilic formulation of methimazole was investigated. The study included 45 cats newly diagnosed with untreated, naturally occurring hyperthyroidism [12]. The study used a novel lipophilic formulation prepared with methimazole, “carrier compounds” (propylene glycol, polyethylene glycol 4000, dimethyl formamide, and cyclodextrin), and several penetration enhancers, chosen from fatty acids, terpenes, pyrrolidones, a short chain alcohol, glycol ethers, acetins, and triglycerides. The formulation was determined to be stable for 12 months after preparation, by the International Cooperation on Harmonization of Technical Requirements for Registration of Veterinary Products. Cats were treated with a starting dose of either oral carbimazole (5mg twice a day) or the novel transdermal methimazole formulation (10mg, or 0.1mL applied to the inner ear once a day). Both the once daily novel transdermal methimazole and twice daily oral carbimazole were effective in the treatment of feline hyperthyroidism in cats with compliant owners. All owners were satisfied with the improved clinical symptoms.

 The novel lipophilic transdermal formulation had several advantages over the oral carbimazole, as the transdermal medication was tolerated better, and caused no gastrointestinal side effects in the cats. Owners reported that administering tablets to their cats was a challenge, and 35% admitted to missing doses or cats spitting out the medication [12]. Unlike the rare occurrences of pruritus reported with the PLO formulation of methimazole, no adverse events of pruritus or erythema of the inner ear were reported [6,12]. The study suggests that since methimazole is a lipophilic drug, a lipophilic vehicle might more suitable than the PLO base.

Although this study clearly highlights the effectiveness of once a day use of this novel lipophilic formulation, it would have been more appropriate to study it in comparison with the PLO methimazole formulated topical. The novel lipophilic formulation appears to be less irritating to the skin among cats than the PLO. However, this has not been shown clinically significant in any study, and thus does not provide enough evidence to recommend one transdermal formulation over the other [6,12,33]. Further evaluation and study are needed to compare the costs, efficacy, stability, accessibility, and adverse event rates between the PLO and novel lipophilic formulations of methimazole.

Discussion

Transdermal drug delivery is an appealing route of administration for veterinary medicine, especially for clients with uncooperative pets. PLO used for methimazole is recognized as a viable transdermal delivery tool because of its enhanced drug transport capabilities. It can effectively deliver both hydrophilic and lipophilic drugs. Transdermal methimazole circumvents the liver’s first pass metabolism, potentially allowing a lower drug dose for an equal effect while also avoiding the intolerable GI upset often caused by oral drugs leading to discontinuation. Following chronic daily application of PLO formulated methimazole to the inner ear of cats with hyperthyroidism, successful resolution of clinical signs and lower T4 levels have been noted [6,18,30,31,33].

Although ultimately effective, delayed onset of action was noted and transdermal methimazole takes longer to achieve therapeutic serum T4 concentrations compared to oral methimazole activity. Oral administration may be more suitable in cats with very severe hyperthyroidism, requiring rapid reduction of thyroid hormone levels. Repeated dosing with the PLO formulation can lead to exfoliation of the inner ear, mild inflammation, and may cause a depot of drug in the skin [30,35]. As the PLO works to compromise the skin barrier over time, more drug is absorbed. Therefore, maximum effectiveness is not seen immediately, but most feline patients will reach a euthyroid level by week 4 of treatment. Transdermal methimazole can be deemed noninferior to the widely approved oral formulation.

Oral methimazole has only been proven effective if dosed twice a day in cats [16]. Once daily dosing of transdermal methimazole was successful, however, the need for twice daily dosing was recognized early in treatment. Once daily dosing presents an obvious advantage as it is most convenient for the owner and aids in promoting good compliance. Near perfect compliance is imperative when treating hyperthyroidism, because serum T4 concentrations can return to their hyperthyroid level within 48 hours after the last dose. Another unique advantage of the transdermal formulation is that it can be compounded into any dosage concentration needed.

In the past, transdermal methimazole was recommended only for short-term use in cases of oral methimazole induced GI upset or an uncooperative cat. Oral methimazole was indirectly favored due to the cost, variable stability, and unknown pharmacokinetic information of the transdermal form. However, more recent studies have suggested extended effectiveness with long-term use of the transdermal methimazole. Also, upon diagnosis of hyperthyroidism, most cats are near the end of the life and shortterm treatment is usually enough in resolving the hyperthyroid illness until the cat expires due to other unrelated diseases. Although the transdermal formulation is more expensive, it is still a more reasonable cost compared to the expense of thyroidectomy and radioactive therapy. Cat owners reported missing oral doses or cats spitting tablets, thus the transdermal gel may be worth the extra cost in order to manage the disease. Clients at large reported satisfaction with the compounded medicine, with only a few reports of precipitation of the gel [6].

Conclusion

Transdermal use of PLO compounded methimazole is an effective therapy for lowering serum T4 concentrations in cats. It is safe, posing fewer adverse effects than the oral formulation. It can be effectively used to treat feline hyperthyroidism through individualized dosing and frequency of administration. Owners should rotate ears each application and remove any residue with a damp cotton ball prior to the next application. Cats tolerate it very well, and it is favored by owners for its convenience and resolved GI upset events. Frequent monitoring of the cat’s liver function tests, BUN, creatinine, CBC, platelet count, and serum T4 concentration is recommended. Very little data exists regarding its pharmacokinetic properties and formulation stability, and the significance of the information available is limited by the small sample sizes studied.

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LupinePublishers|Recent Breakthroughs in Textile Materials for Wound Care

Abstract

The article surveys some significant trends in the textile wound dressing during recent years. An ideal wound Dressing need to be redefined based on the nature of wound and wound classifications. Since generations, wound have been defined as selfhealing process, but chronic wounds and other wound requires handling and care from different parameters like moist conditions, biocompatibility, microbial infection to mention a few. Bioactive dressings based on different materials sodium alginate, chitosan, hydrocolloid, iodine have been explored. The future of fiber technology for medical applications depends largely on the future needs of our civilization. The use of new fibers for healthcare textiles application has increased rapidly over the past quarter of a century. With the recent advances in tissue engineering, drug delivery, and gene delivery‐ alginate, chitin/chitosan and their derivatives present a novel and useful class of biomaterials. Hence small changes in their molecular structure can bring large changes in their interactions with components of biological tissues or drugs. These polymers are excellent candidates for applications in the biomedical field because of their versatility, biocompatibility, bio absorbability and significant absence of cytotoxicity. Modern wound dressings combine medical textiles with active compounds that stimulate wound healing while protecting against infection. Electrospun wound dressings have been extensively studied and the electrospinning technique recognized as an efficient approach for the production of nanoscale fibrous mats.

Keywords: Electrospun polymeric dressings; Wound healing; Bioactive; Polysaccharides

Introduction

Human body has strong immune system with capabilities of self-healing. The protective layer of the skin protects the body against the external environment. The important layers of skin are Epidermis (outermost layer), Dermis (middle layer) and subcutaneous fat (deepest layer). The Epidermis consists of dead cells of keratin, which makes this layer water proof whereas dermis consist of living cells, blood vessels and nerves running through it, which provides structure and support. The subcutaneous fat layer is responsible for insulation and shock absorbency [1]. In normal skin, there exists an equilibrium between epidermis and dermis [2]. Wound dressing design and fabrication are important segments of the textile medical and pharmaceutical wound care market worldwide. In the past, traditional dressings were used to simply manage the wound, to keep it dry and prevent bacterial entrance. Nowadays, the fabrication of wound dressings aims to create an optimal environment that accelerates wound healing, while promoting oxygen exchange and intensively preventing microbial colonization [3]. The use of natural fibers in medical applications spans to ancient times. These fibers afford a bioactive matrix for design of more biocompatible and intelligent materials owing to their remarkable molecular structure. Oligosaccharides and polysaccharides are biopolymers commonly found in living organisms, and are known to reveal the physiological functions by forming a specific conformation. There has been an intensified effort in recent years in identifying the biological functions of polysaccharides as related to potential biomedical applications.

Wound Dressings of Third Generation

Wound is defined as any cut or break in the layer of skin. The normal process of wound healing starts operating once the protective barrier is broken. Majority of wounds heal without any complication. because cells on the surface of the skin are constantly replaced by regeneration from below with the top layers sloughing off. However, in case of chronic non- healing wounds, there is more tissue loss and the natural process of healing is disturbed, thus special care is required for rapid and hygienic healing [4]. This thus poses the biggest challenge for wound care product researchers and developers. The purpose or aim of choosing a wound dressing is to protect the wound from infection, ease pain, promote healing and to avoid maceration. Usually, the selection of wound dressing depends on the type of the wound. Traditionally, different materials like neem paste, honey paste, turmeric, animal fats, etc. were used as wound dressing materials. But these traditional or homemade wound healing methods could not control the infection which hampers the healing process. Continuous efforts are in progress to develop wound dressings which can improve the healing process. Nowadays, different materials are in use for rapid and cosmetically acceptable healing. Thus materials are being developed with special emphasis on solving complexities of the healing process, speedy healing and prevention of scarring i.e., keloid formation or contractures.

Wound management and wound care has gained importance in recent years. Global market is flooded with different varieties of wound dressings. Some of the polymeric materials used in wound dressings are based on hydrogel materials, sodium alginate, hydrocolloid, collagen to mention a few. Different wound dressings are selected based on the type of wounds. The major problem of exudate management is a matter of concern. Advances have been made to achieve wound management with better absorption systems using super absorbent polymers and developing layer dressing (composite dressings). The various advances made in wound dressings have been reviewed with special focus on layered dressings with superabsorbent polymers.

Chitosan Dressings

Chitosan is a valuable natural polymer derived from chitin. Chitosan is known in the wound management field for its anti-viral, anti-fungal, non-toxic, non-allergic, biocompatible, biodegradable properties and helps in faster wound healing but it exhibits excellent anti-bacterial activity [5,6]. Chitosan dressings show scar prevention which is the most important criteria in today’s world of wound dressing technology [5]. Chitosan wound dressing has excellent oxygen permeability, controlled water loss and wateruptake capability. There are number of references on chitosan in wound treatment [6-11]. Wound dressing and wound management is an active area of research developing biocompatible dressings with more focus on bioactive materials incorporating growth factors. Speciality absorbents are the need for treatment of chronic wounds, highly exudating wounds, and in total cosmetically acceptable healing.

Electrospun Polymeric Dressings for Improved Wound Healing

Electro spinning has become one of the most popular processes to produce medical textiles in the form of wound dressings. This is a simple and effective method to produce nanoscale fibrous mats with controlled pore size and structure, from both natural and synthetic origin polymers. This technique has gain much attention because of its versatility, reproducibility, volume-to-surface ratio and submicron range [12-14] [2-4]. Recently, functionalizing these electrospun wound dressings with active compounds that accelerate wound healing and tissue regeneration has become the major goal [15]. The rising of antibiotic-resistant infection agents has increased the need for such therapies. While antibiotics act selectively against bacteria, dressings functionalized with antimicrobial peptides (AMPs) act at multiple sites within microbial cells, reducing the likelihood of bacteria to develop resistance [16]. The combination of collagen type I (Col I), one of the most important extracellular. matrix (ECM) proteins to wound healing, with these AMP-polymer mat systems has yet to be investigated. Col I has been highlighted as uniquely suited for wound dressing therapies because of its involvement in all phases of wound-healing [17]. Thus the combination of Col I with the AMPs would represent a new step further in the optimization/development of new generation wound dressings.

Due to the continue rising of antimicrobial resistant pathogens, the need for engineered alternated treatments for acute to chronic wound care has increased. As a first strategy to overcome this issue, AMPs have been loaded onto existing textile medical dressings to improve their healing and antimicrobial capacities [18]. We highlighted the most well known AMPs and the most appropriate methods to functionalize the surface of electro spun mats with such molecules. This is still a very new formulation and further research should be conducted. Indeed, long-term therapeutics using AMPs. functionalized dressings should be carefully evaluated to prevent the risk of compromising our innate immune defense and, therefore, the ability to control commensal microbiome and microbial infections. Functionalizing surfaces with AMPs should be managed by standardized tests that not only evaluate the action of the AMPs but as well its stability, releasing abilities and tunable performance. The level of control in peptide loading and release timescales that are required in applications that could benefit from such antimicrobial profile has thus far not been demonstrated. Because they are still being developed and tested, these systems, AMPs-polymeric mat, should be cautiously defined so that the best combination between selected polymer, mechanism of action, AMPs and immobilization process is achieved. Although Col I has been extensively used in wound healing and its potential already demonstrated, the combination with AMPs-polymeric mats systems has yet to be explored. In a near future, we intend to examine the synergistic performance of these molecules in the treatment of chronic wounds, namely diabetic ulcers. It is expected that these new systems aside from acting against the pathogens will also accelerate the wound healing process by establishing a symbiotic action.

Role of Polysaccharide Fibres In Wound Management

Polysaccharides appear in many different forms in plants. They might be neutral polymers or they might be poly anionic consisting of only one type of monosaccharide, or they might have two or more, up to six different monosaccharide types. They can be linear or branched and they might be substituted with different types of organic groups, such as methyl and acetyl groups. Other types of polysaccharides isolated from plants used in the traditional medicine were identified as having their biologically active sites in the complementary system, the case of arabinans and arabinogalactans [19]. In moist healing concept, alginate fiber becomes one of the most important fibers in the wound dressing [20]. The incorporation of biological agents into the fiber used for nonwoven wound dressings provide a means for directly introducing such agents to the wound without a separate application and with no additional discomfort to the patient. Many authors discussed the wound healing ability of the alginate fiber with different modification [21,22]. The Second part discusses the chitin and chitosan polysaccharides and their applications in various medical fields. The specialty of chitin and chitosan fiber is, its high biocompatibility, non toxic and ability to improve wound healing and therefore it is evaluated in a number of medical applications10 such as drug delivery wound dressing, etc [23-26].

Alginate in Wound Dressings

Physical and chemical properties of alginate dressing depend on the relative content of calcium and sodium ions and the relative concentration and arrangements of the mannuronic and guluronic monomers. Dressing rich in guluronic acid react readily with sodium ions and form stronger gels. On the other hand, mannuronic acid rich dressings form fewer gels. Alginate fibers have a unique ion exchange property [27]. On contact with wound exudates, the calcium ions in the fiber exchange with the sodium ions in the body fluid and as a result, part of the fiber becomes sodium alginate. Since sodium alginate is water soluble, this ion‐exchange leads to the swelling of the fiber and the insitu formation of gel on the wound surface. This Now a days there are various types of alginate fibers and dressings available, utilizing the diversified properties of the different types of alginate extracted from different sources of seaweeds and the availability of many types of salts of alginate, such as zinc and silver alginate, which are used for zinc‐deficient people and for antimicrobial properties respectively [28]. Due to their unique properties and the fact that the dressings can be used in the dry form or hydrated form, alginate dressings can be used for a wide range of wounds, providing a cost‐effective treatment that involves a minimum number of dressing changes.

Chitin and Chitosan in Wound Dressings

Especially using the two polymers in medical applications has attracted interest because of having a lot of advantages as being natural renewable resources, being the most abundant polymeric material in the earth, biocompatibility, biodegradability, easy availability, nontoxicity, the ability to chelate heavy metals, Interestingly, some antibacterial and antifimgal activities have been described with chitosan and modified chitosan derivatives. Due to the antimicrobial property both Chitin and chitosan has long been known as being able to accelerate the wound‐healing process. It has been shown that by applying chitin dressings, the wound healing process can be accelerated by up to 75% [29]. Textile materials are very important in all aspects of medicine, surgery and healthcare and extend of applications to which the materials used because of the versatility of textile materials. Advances in fiber sciences have resulted with a new breed of wound dressing, which contributing healing process in an effective way [30]. The role of polysaccharide fibres in wound management has been highlighted. Also the different properties and requirements of various polysaccharide fibers to the healing of different wounds have been discussed. In particular special properties of Alginate, chitin and chitosan were summarized with the various experimental results of different researchers.

Conclusion

Traditional methods have been continuously worked upon to deliver better products. Starting from simple gauze dressings in 1900’s to bioactive dressings till today have been worked upon. Bioactive dressings based on different materials sodium alginate, chitosan, hydrocolloid, iodine has been covered in this review. Based on wounds different classifications of type of wounds, correlation of wounds with wound dressing have also been focussed upon. This has led to development of interactive dressings which are further developed as per wound requirement viz. semipermeable and hydrogel dressings. Efforts are in process to develop super absorbing and bioactive material for critical wound care. The conventional primary and secondary dressings have been replaced by composite dressings composed by 4 to 5 layers with super absorbing materials incorporated in one of the layers which accumulates exudates from the wounds and also provides protection from leakage and thus avoiding cross infections which at times become a major concern. This article focuses on changing trends in the area of wound dressings through three decades. Wound healing rate depends mainly on proper dressing materials. Over the last few years there has been a rapidly expanding interest in polysaccharides from both a fundamental viewpoint and also from an applications viewpoint. With different varieties of polysaccharides in modern wound dressings, this article discusses the effective utilization of polysaccharide fibers like alginate, chitin and chitosan for the medical application, specifically for wound management. Further it explains the current research status and also summarizes the different findings of researchers. The unique diverse function and architecture of antimicrobial peptides (AMPs) has attracted considerable attention as a tool for the design of new anti-infective drugs. Functionalizing electrospun wound dressings with these AMPs is nowadays being researched. These new systems have been explored by highlighting the most important characteristics of electropsun wound dressings, revealing the importance of AMPs to wound healing, and the methods available to functionalize the electrospun mats with these molecules. The combined therapeutic potential of collagen type I and these AMP functionalized dressings will be highlighted as well; the significance of these new strategies for the future of wound healing will be clarified.

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Pediatric Versus Adult Papillary Thyroid Carcinoma: Different Diseases Requiring Different Surgical Approaches-Juniper publishers

Introduction

Differentiated thyroid carcinoma is rare in young age and represents 0.5% to 3.0% of childhood carcinomas: the incidence increases with age, and peak incidence is observed between 15 and 19 years of age [1]. Even at large referral centers, only few pediatric thyroid cancers are treated every year; it may take ≥30 years for a major center to collect a series of 100 children and adolescents with thyroid cancer [2]. Papillary thyroid cancer (PTC), the most common type of differentiated thyroid cancer, spreads predominantly via the lymphatics to the local draining lymph nodes: cervical lymph node involvement in 60% to 80% of cases and lung metastases at diagnosis in 20% of cases [3]. Since pediatric thyroid cancer is such a rare disease, treatment recommendations have been based on expert opinion and retrospective data collected from different practices over decades [4-6]. Given the paucity of evidence-based pediatric data, guidelines for adult thyroid cancer occasionally have been generalized to children, treating them “just like little adults.” Such extrapolations may not be warranted, in particular when it comes to postoperative morbidity after thyroidectomy [7].

Traditionally, in most institutions, the therapy for pediatric and adolescence PTC has been the same as for adults, aimed to the eradication of all clinical and subclinical neoplastic foci both at thyroid and lymph-node level. The reasons for such an approach were  

To have a better progression-free survival and overall survival,   

To detect subclinical metastases by radioactive iodine (RAI) scintigraphic scan and treat them by RAI ablation,   

To make the value of serum thyroglobulin level a very sensitive marker of post-treatment relapse, and   

To avoid possible dedifferentiation of occult neoplastic microfoci over time [8]. PTC in children and adolescents is treated in similar fashion as that in adults, primarily because of rarity of disease in pediatric population and lack of availability of pediatric PTC treatment guidelines [9].

As well as in adults, the treatment of PTC is based on the combination of three therapeutic modalities: surgery, hormone replacement with levothyroxine, and radioiodine treatment. Surgery ranges from lobectomy to total thyroidectomy accompanied by different cervical lymphadenectomies. Latest guidelines recommend total thyroidectomy, mainly for tumors larger than 1 cm associated with cervical dissection of central or lateral compartment block if lymph node metastases are seen in preoperative imaging or during the surgery [10,11]. The main surgical complications include persist enthypo parathyroidism and laryngeal nerve damage that may cause a wide spectrum of clinical consequences: from hoarseness to total vocal cord paralysis, with need for definitive tracheotomy [12]. Thus, most societies recommend radioiodine ablation in the vast majority of patients under 45 years old but none of them make specific recommendations for children and adolescents [10,13].

In contrast to adults, pediatric PTC has some distinctive differences such as   

Larger primary tumor at the time of diagnosis,   

High prevalence of neck lymph nodes and distant metastases (DM) at the time of diagnosis,  

The high risk of recurrences [13], and   

Multifocality [14,15]. Nevertheless, advanced pediatric cancers are more likely to respond to therapy and have a better prognosis compared to their adult counterparts [16].

The unusual association between the aggressive presentation of pediatric PTC and its favorable prognosis is behind the controversy regarding its most appropriate initial management, particularly when it comes to choose between total thyroidectomy and thyroid lobectomy. Despite its seemingly aggressive biologic behavior, pediatric PTC is considered a favorable prognosis cancer.

An important difference between thyroid carcinoma in pediatric and adult age is related to the high prevalence of expression of sodium-iodide transporter (NIS) in metastatic focus found in children [17]. In the absence of stimulation of thyroid-stimulating hormone (TSH), the expression of NIS is undetectable in 65% of papillary tumors in patients under 20 years of age [18]. In contrast, the expression of NIS is absent or negligible in 90% of differentiated carcinomas in adults [19]. The greater expression of NIS in the pediatric population results in greater responsiveness to radioiodine treatment and better prognosis. In young patients, the recurrence risk increases in patients that do not express the protein NIS when compared to those that express it. Thus, the degree of NIS expression correlates with radioiodine avidity by metastases and lower clinical recurrence rates [20]. The management of patients with PTC consisted basically of primary surgery followed by evaluation for RAI treatment. Criteria for RAI ablation in patients with PTC was tumor size >1cm, lymph node metastasis (LNM), presence of extra thyroid extension, macroscopic postoperative residual disease in the neck, and/or DM [21,22].

Another important difference between PTC in pediatric and adult age was represented by a very high sensitivity shown by pediatric PTC to hormonal manipulation consisting of L-thyroxine administration at TSH-suppressive doses that can inhibit normal and neoplastic proliferation, thus preventing cancer progression and relapse. These findings, together with the significant morbidity of radical surgery and RAI therapy, led to the proposal by several groups for a conservative approach for pediatric PTC, not aimed at the eradication of all clinical and subclinical neoplastic foci by surgery plus RAI therapy, but rather the removal of only the grossly detectable disease, followed by TSH-suppressive hormone therapy to control subclinical disease, and reserving more aggressive approaches to selected cases. All these results highlight the extremely high sensitivity to hormonal manipulation that can control subclinical disease and prevent the occurrence of clinical relapse. This sensitivity to hormonal manipulation seems to represent an important biological difference with respect to adult PTC.

All these observations are in keeping with the proposal made by Cady et al. [23] on clinical grounds and supported by genetic findings that thyroid carcinomas in children and adults are different diseases and not merely different stages in a single disease, with specific prognosis and therapy needs [23,24]. Thus, the category of microcarcinoma (including tumors with less than 1cm), commonly used in adults, should be avoided in children, since a 1cm tumor constitutes a very important finding in this age group. Regarding the molecular biology of these tumors, apparently RET-PTC rearrangements occur in childhood more frequently than in adults, especially in the radiation-related tumors [25].

The prognosis remains excellent with a low rate of mortality even in advanced stages [26], but local recurrence is more frequent than in adults, leading to reoperation [27]. Predictive factors of recurrence remain incompletely known, although some factors have been suggested from retrospective studies [15,28,29]. They include young age (<16 years), lymph node involvement or DM at diagnosis, and histopathologic characteristics (mainly the diffuse sclerosing papillary variant, which is frequent in children) [30]. Among them, nodal status is considered one of the most statistically significant predictors for an adverse prognosis in young patients [31-33].

The American Thyroid Association (ATA) guidelines for pediatric PTC doesn’t recommend prophylactic lymph node dissection (LND) in children clinically negative for LNM due to the higher rates of complications as recurrent laryngeal nerve injury and hypocalcemia, which ranges from 1-4% even in experienced hands [34-38]. Moreover for ATA, in patients with pre-operative evidence of central and/or lateral neck metastasis, a therapeutic LND should be performed. For this kind of patients, LND is associated with a decreased risk of persistent/ recurrent locoregional disease as well as the potential to increase the efficacy of RAI ablation for distant metastases [39,40]. According with ATA, Borson-Chazot et al. [41] suggest a lymph node dissection with the addition of RAI ablation, in presence of palpable cervical lymph nodes at diagnosis because it is associated with more invasive forms of malignancy and is a predictive factor of recurrence.

Tumors with diffuse sclerosing variant are more common in younger patients between 15 and 30 years of age according to Koo et al. [30]. In their study pediatric patients with diffuse sclerosing variant had a higher incidence of bilateral thyroid involvement, extrathyroidal extension, lymph node involvement and recurrence. Also for Lloyd et al. [42], the diffuse sclerosing variant tumors are characterized by diffuse involvement of the thyroid (both lobes are typically involved), lymph node and lung metastasis, but the tumors do not usually lead to the demise of the patient.

Recently, indications for an optimal surgical management have been proposed [15,43]: patients with tumor smaller than 2cm, limited to one lobe, no lymph node involvement and absence of distant metastasis can be treated with conservative surgery. In absence of these parameters, radical surgery should be performed.