New DEA rules expand options for controlled substance disposal.

Prescription drug abuse and overdose are rapidly growing problems in the United States. The United States federal Disposal of Controlled Substances Rule became effective 9 October 2014, implementing the Secure and Responsible Drug Disposal Act of 2010 (Disposal Act). These regulations target escalating prescription drug misuse by reducing accumulation of unused controlled substances that may be abused, diverted or accidentally ingested. Clinical areas that can now participate in collecting unused controlled substances include retail pharmacies, hospitals or clinics with an onsite pharmacy, and narcotic treatment programs. Collection methods include placing a controlled substance collection receptacle or instituting a mail-back program. Because prompt onsite destruction of collected items is required of mail-back programs, collection receptacles are more likely to be used in clinical areas. Retail pharmacies and hospitals or clinics with an onsite pharmacy may also place and maintain collection receptacles at long-term care facilities. The Act and Rule are intended to increase controlled substance disposal methods and expand local involvement in collection of unused controlled substances. Potential barriers to participating in controlled substance collection include acquisition of suitable collection receptacles and liners, lack of available space meeting the necessary criteria, lack of employee time for verification and inventory requirements, and program costs.

Capsaicin 8% topical patch (Qutenza)--a review of the evidence.

Qutenza is a high-potency capsaicin (8%) topical patch, labeled for treating pain associated with postherpetic neuralgia (PHN). Qutenza decreases pain sensation by reducing transient receptor potential vanilloid 1 (TRPV1) expression and decreasing the density of epidermal nerve fibers in the application area. Systemic absorption from Qutenza is low. Qutenza has not been directly compared to any other medications for the treating PHN. Two pivotal clinical trials compared Qutenza to a control patch (0.04% capsaicin) in PHN. The primary endpoint of both trials was the reduction in numeric pain rating scale (NPRS) score. Qutenza reduced pain from baseline to weeks 2 to 8 (29.6% and 32% reductions) compared to control (19.9% and 24.4% reductions; P ≤ .01). The improvement in NPRS scores persisted, with score reductions greater with Qutenza (29.9% and 32.3% reductions) compared to control (20.4% and 25% reductions; P ≤ .03) for the period 2 to 12 weeks. Safety and efficacy of capsaicin 8% has been demonstrated in open-label trials for up to 48 weeks. The most common adverse drug reactions occurring with capsaicin 8% are application site erythema (63%) and application site pain (42%). Some patients experienced transient increases in blood pressure during Qutenza application. Qutenza must be administered by a physician or under the close supervision of a physician. Prior to application, pretreat the affected area with a topical anesthetic to reduce application site pain. Some patients may require systemic analgesics during and after treatment for treatment-associated pain. Applications of Qutenza can be repeated no sooner than once every 3 months, as needed.

Nonsteroidal anti-inflammatory drugs and colchicine to prevent gout flare during early urate-lowering therapy: perspectives on alternative therapies and costs.

Published evidence in the literature, regulatory status, and relative costs of colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) for prophylaxis of gouty flares during early urate-lowering therapy are reviewed.

Avenanthramide, a polyphenol from oats, inhibits vascular smooth muscle cell proliferation and enhances nitric oxide production.

The proliferation of vascular smooth muscle cells (SMC) and impaired nitric oxide (NO) production are both crucial pathophysiological processes in the initiation and development of atherosclerosis. Epidemiological data have indicated that diets rich in whole grain foods are associated with a reduced risk of developing atherosclerosis. Avenanthramides are polyphenols found exclusively in oats (Avena sativa L.). The present study was conducted to examine the effect of synthetically prepared avenanthramide-2c on the proliferation of SMC and NO production by SMC and human aortic endothelial cells (HAEC). Avenanthramide-2c significantly inhibited serum-induced SMC proliferation. At a concentration of 120 microM, avenanthramide-2c inhibited more than 50% of SMC proliferation, as measured by [3H] thymidine incorporation, and increased the doubling time of rat SMC line (A10) from 28 to 48 h. Treatment of human SMC with 40, 80, and 120 microM avenanthramide-2c inhibited cell number increase by 41, 62, and 73%, respectively. In addition, avenanthramide-2c treatment significantly and dose-dependently increased NO production in both SMC and HAEC. At a concentration of 120 microM, avenanthramide-2c increased NO production by three-fold in SMC, and by nine-fold in HAEC. These increases were in parallel with the up-regulation of mRNA expression for endothelial NO synthase (eNOS) in both vascular SMC and HAEC. These results suggest that the avenanthramides of oats may contribute to the prevention of atherosclerosis through inhibition of SMC proliferation and increasing NO production.

Aging, exercise, and phytochemicals: promises and pitfalls.

Phytochemicals are emerging comprehensive and versatile sources of antioxidants to be consumed to enhance the body's defenses against harmful reactive oxygen species generated endogenously or exogenously. Tocols, favonoids, and phenolic acids compose the majority of this class of antioxidants, although more complex compounds may also be involved, such as ginsenosides. In vitro and in vivo studies have demonstrated convincingly that dietary supplementation of phytochemicals has beneficial effects against certain types of pathogenesis, disease, cancer, and aging. There is evidence that these effects are related to the ability of phytochemicals to promote the antioxidant defense system and reduce oxidative stress and damage in the cell. However, due to their structural and chemical diversity and complexity, many of the benefits as well as potential adverse effects remain to be examined.

An MR transceive phased array designed for spinal cord imaging at 3 Tesla: preliminary investigations of spinal cord imaging at 3 T.

A 3 Tesla transceive phased array has been developed that demonstrates the feasibility of spinal cord imaging at high fields. The phased array includes transmit/receive switches, a power distribution network, and 4 coil elements arranged for specific anatomies. Images demonstrating anatomy of the spinal cord and posterior spine were presented. Simulations were performed to predict B(1) field and SAR, with SAR values found to be within Food and Drug Administration limits for the pulse sequences that were used.

In vivo prostate magnetic resonance imaging and magnetic resonance spectroscopy at 3 Tesla using a transceive pelvic phased array coil: preliminary results.

Magnetic resonance (MR) systems operating at 3 Telsa (T) and above have demonstrated considerable potential in human studies, offering improved signal-to-noise ratio and spectral resolution. However, because of radiofrequency limitations and concerns, and the lack of large volume body coils, most studies have been limited to the head. In this study we describe the design and construction of a transceive pelvic phased array coil with which MR images and spectra of the human prostate at 3 T have been obtained. Comparison with 1.5 T instruments with different hardware configurations is difficult; however, in a preliminary comparison the signal-to-noise ratio is improved in phantoms and humans when compared with a 1.5 T receive-only pelvic phased array coil, and high quality spectral resolution is demonstrated through the delineation of the citrate quadruplet in localized 1H prostate spectra. Higher fields offer the potential for MR prostate studies without the use of an endorectal coil.

The detection of psychiatric illness and psychological handicaps in a British pain clinic population.

Ninety-seven successive patients attending the Newcastle Pain Relief Clinic completed a battery of psychiatric, psychological and pain questionnaires, and an extensive personal information form. All patients were seen by a physician who evaluated the extent of the pain arising from physical, psychiatric and psychological causes, and by a psychiatrist, who administered a structured interview schedule. Thirty-two percent of the patients had sufficient symptoms to be classified as psychiatric cases on the Present State Examination (PSE), a further 22% had minor neurotic symptoms and features of illness behaviour, 35% were categorized as organic, and 11% were unclassified. The Leeds General Depression Scale for Depression and Anxiety and the Beck Depression Inventory were the most effective of the psychiatric questionnaires used in separating the psychiatric patients from the remainder, and can be recommended as screening instruments for psychiatric illness in this population. Factors associated with a psychiatric diagnosis included female sex, larger number of present medications, greater reduction in activities compared to the period before the pain developed and increasing subjective pain from the onset of this.