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Topical NSAIDs are currently recommended in several national and international guidelines for knee osteoarthritis, hand osteoarthritis and acute musculoskeletal pain. However, there is still widespread skepticism about the effectiveness of this treatment. This article discusses different reasons for this skepticism, a short summary of the pharmacokinetics and pharmacodynamics of topical NSAIDs and an overview of available evidence regarding efficacy and safety. Based on this evidence topical NSAIDs have a clear place in the treatment of knee and hand osteoarthritis and acute musculoskeletal pain. Due to less systemic side effects they should be recommended before an oral NSAID is considered. Topical NSAIDs might even be an option for patients with contra-indications for oral NSAIDs. There is a large variety of available topical NSAIDs. Of the available topical NSAIDs in the Netherlands, diclofenac gel seems the most sensible choice.The Dutch Medicines Act and the Medical Treatment Contracts Act (WGBO) form the legal framework for off-label prescribing. These acts are complemented with position statements and guidelines of professional organizations. However, this legal framework is not yet sufficiently embedded in daily practice. The explicit translation of the legal conditions into practical stepwise guidance can therefore provide important guidance when prescribing off-label. This article describes a step-by-step guide for responsible off-label prescribing. The step-by-step guide ensures that decisions about off-label use of drugs are made based on a deliberate and explicit consideration of the unmet medical need and alternative treatment strategies against the potential risks and benefits for the individual patient. In addition, the step-by-step guide ensures the correct provision of information to patients. In this way, the step-by-step guide enables the doctor to meet the regulatory requirements on the off-label prescription of drugs. In addition, we need better information provision on off-label use and professional consensus on information and consent obligation in order to be able to prescribe even more effectively off-label.Fasting ketoacidosis is especially an underdiagnosed problem in patients with neuro-muscular disease with severely depleted muscular mass. During periods of prolonged fasting, low levels of insulin and high levels of glucagon induce lipolysis in the peripheral fat tissue. This will result in elevated free fatty acids levels in de blood and increased ketogenesis in the liver. These ketones pass into the blood, leading to a ketoacidosis. Patients with low muscular mass are more susceptible to develop ketoacidosis due to lower energy reserves and reduced glycogen stores on the one hand, and a reduced uptake of ketones by their low muscular mass on the other hand. During periods of increased metabolism and in the absence of adequate caloric intake, this can easily lead to severe ketoacidosis. An adequate oral caloric intake is essential in the prevention and treatment of fasting ketoacidosis.Polypharmacy is increasing with age. With increasing numbers of medication, the risk of the use of potential inappropriate medication is also increasing. In this article we suggest using the WHO-6-step for rational prescribing. We also describe methods and instruments (amongst others the systemic tool to reduce inappropriate prescribing)physicians can use in assessing the appropriateness of the medication already used by their patients. Finally we describe how, based on recent Dutch guidelines, deprescribing can be done.

Recurrent respiratory papillomatosis (RRP, also known as laryngeal papillomatosis) is a debilitating chronic disease induced by a human papilloma virus (HPV). Wart-like lesions develop in the airways. Patients suffer from dysphonia, coughing and ultimately dyspnea. There is no curative treatment. Recurrent surgical intervention is necessary to keep the airways free of disease.

We describe a 25-year-old woman who developed RRP, despite having been vaccinated according to the national vaccination program. She underwent 11 surgeries in the past 5 years.

RRP is an invalidating disease, necessitating repeated surgical interventions. Despite worldwide use and availability of adequate preventive HPV vaccines against this disease, the Dutch government choose to use a vaccine which does not prevent against this chronic disease.

RRP is an invalidating disease, necessitating repeated surgical interventions. Despite worldwide use and availability of adequate preventive HPV vaccines against this disease, the Dutch government choose to use a vaccine which does not prevent against this chronic disease.A 19-year-old man presented on the Emergency Room on New Year's Eve with a 2 cm-wide black burn located on his lower arm. Earlier that evening he was hit by a piece of firework. Even though he immediately felt a sharp burning pain, he did not realize the severity of the injury. He presented with numbness in the digiti 4 and 5 and the Wartenberg sign, which are signs of an ulnar nerve injury. An exploration of the ulnar nerve was performed. Extensive burns and gunpowder were seen on the flexor carpi radialis and ulnaris muscle, the fascia and the epineurium of the ulnar nerve. However, the ulnar nerve was intact. A week later a babysitting procedure was performed because of absent intrinsic muscle activity, with an end-to-side anastomosis of the anterior interosseous nerve to the motor branch of the ulnar nerve. Hand physiotherapy was started after the operation.Today, bacterial cellulose has received a great deal of attention for its medical applications due to its unique structural properties such as high porosity, good fluid uptake, good strength, and biocompatibility. This study aimed to fabricate and study bacterial cellulose/graphitic carbon nitride/nettles/trachyspermum nanocomposite by immersion and PVA/BC/g-C3 N4 /nettles/trachyspermum nanofiber by electrospinning method as a wound dressing. The g-C3 N4 and g-C3 N4 solution were synthesized and then were characterized using Fourier transform infrared, X-ray diffraction, Zeta Potential, and scanning electronic microscope analyzes. Also, the antibacterial properties of the synthesized materials were proved by gram-positive and gram-negative bacteria using the minimum inhibitory concentration method. Orelabrutinib cell line Besides, the toxicity, migration, and cell proliferation results of the synthesized materials on NIH 3T3 fibroblasts were evaluated using MTT and scratch assays and showed that the BC/PVA/g-C3 N4 /nettles/trachyspermum composite not only had no toxic effect on cells but also contributed to cell survival, cell migration, and proliferation has done. To evaluate the mechanical properties, a tensile strength test was performed on PVA/BC/g-C3 N4 /nettles/trachyspermum nanofibers, and the results showed good strength of the nanocomposite. In addition, in vivo assay, the produced nanofibers were used to evaluate wound healing, and the results showed that these nanofibers were able to accelerate the wound healing process so that after 14 days, the wound healing percentage showed 95%. Therefore, this study shows that PVA/BC/g-C3 N4 /nettles/trachyspermum nanofibers effectively inhibit bacterial growth and accelerate wound healing.Chemical and biological limitations in bioactive compound design based on natural product (NP) structure can be overcome by the combination of NP-derived fragments in unprecedented arrangements to afford "pseudo-natural products" (pseudo-NPs). A new pseudo-NP design principle is described, i.e., the combination of NP-fragments by transformations that are not part of current biosynthesis pathways. A collection of indofulvin pseudo-NPs is obtained from 2-hydroxyethyl-indoles and ketones derived from the fragment-sized NP griseofulvin by means of an iso-oxa-Pictet-Spengler reaction. Cheminformatic analysis indicates that the indofulvins reside in an area of chemical space sparsely covered by NPs, drugs, and drug-like compounds and they may combine favorable properties of these compound classes. Biological evaluation of the compound collection in different cell-based assays and the unbiased high content cell painting assay reveal that the indofulvins define a new autophagy inhibitor chemotype that targets mitochondrial respiration.Identification of the novel HLA-C*15192 allele that differs from HLA-C*15020101 at one position in exon 2.

This study aimed to assess the effectiveness of a programme designed to promote global health competency among nursing students.

It used a randomized pre-post-test comparison group design to compare the effects of a global health competency programme among nursing students.

Data collection for the pre-test was carried out for 2 days (25-26 October 2018) and that of post-test was conducted for 2 days (23-24 December 2018). A total of 38 fourth-year nursing students participated in this study (14 in the international nursing group, 11 in the transcultural nursing group and 13 in the complementary and alternative medicine group). The participants were from the nursing department of a university in Cheongju.

There were no statistically significant differences between the groups in the pre-test homogeneity test. The international nursing group showed statistically significant improvements between the pre- and post-tests in global health competency, cultural competency, global health confidence and cultural nursing confidence.

There were no statistically significant differences between the groups in the pre-test homogeneity test. The international nursing group showed statistically significant improvements between the pre- and post-tests in global health competency, cultural competency, global health confidence and cultural nursing confidence.In the past two decades, micromotors have experienced rapid development, especially in environmental remediation, the biomedical field, and in cargo delivery. In this study micromotors have been synthesized from a variety of materials. Different functional layers and catalytic layers are formed through template electrodeposition (the bottom-up method). At the same time, the article analyzes the influence of hydrogen peroxide concentration, surfactant type and concentration on the speed of the micromotors. Cargo transportation through tubular micromotors has always been a problem that people are eager to solve. In this article, we electrodeposit a layer of Ni in the microtubes, which effectively guides the microtubular motors to complete the cargo transportation. The potential applications of micromotors are also being explored. We added the prepared micromotors to the methylene blue solution to effectively enhance the degradation.

To provide guidance to rheumatology providers on the use of coronavirus disease 2019 (COVID-19) vaccines for patients with rheumatic and musculoskeletal diseases (RMDs).

A task force was assembled that included 9 rheumatologists/immunologists, 2 infectious disease specialists, and 2 public health physicians. After agreeing on scoping questions, an evidence report was created that summarized the published literature and publicly available data regarding COVID-19 vaccine efficacy and safety, as well as literature for other vaccines in RMD patients. Task force members rated their agreement with draft consensus statements on a 9-point numerical scoring system, using a modified Delphi process and the RAND/University of California Los Angeles Appropriateness Method, with refinement and iteration over 2 sessions. Consensus was determined based on the distribution of ratings.

Despite a paucity of direct evidence, 74 draft guidance statements were developed by the task force and agreed upon with consensus to provide guidance for use of the COVID-19 vaccines in RMD patients and to offer recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination.