The Mount Sinai journal of medicine, New York
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Significant advances over the past 20 years in our understanding of the phenomenology and pathophysiology of obsessive-compulsive disorder, made in part from structural and functional neuroimaging and genetics research, can guide treatments that target brain regions, circuits, and neurotransmitter systems specific to obsessive-compulsive disorder, the disruption of which may alleviate obsessive-compulsive disorder symptoms. We discuss here our current understanding of the underlying neurobiology and heritability of obsessive-compulsive disorder and integrate that understanding with a review of the current pharmacological, neurosurgical, and brain stimulation treatments of refractory obsessive-compulsive disorder. Expanding on these studies, we hope that new pharmacological and psychological treatment strategies and research-driven targets for lesioning, stimulation, or other types of focal neuromodulation can be identified that could lead to future research directions. Cross-species translational research and neuroimaging of the physiological and anatomical pathways implicated in the pathophysiology and treatment response in obsessive-compulsive disorder will advance our understanding of the neural basis of obsessive-compulsive disorder and lead to more targeted and effective treatment options.
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New insights into the complex immunopathogenesis of multiple sclerosis have led to a proliferation of promising new therapeutic strategies. While the current armamentarium of immunomodulatory medications has demonstrated beneficial effects on the disease, more effective and tolerable therapies are needed. ⋯ Biomarker profiles may help elucidate disease subtypes as well as therapeutic response in an effort to individualize treatment choice. This review will highlight recent promising therapeutic strategies under investigation in the field of MS.
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Spirometry is the most commonly used pulmonary function test to screen individuals for suspected lung disease. It is also used for screening workers with exposures to agents associated with pulmonary diseases. Although the American Thoracic Society (ATS) provides guidelines for spirometers and spirometry techniques, many factors are not standardized, so that results from individual pulmonary function laboratories vary substantially. These differences can create substantial difficulties in using data pooled from multiple sites to understand health consequences of disasters that involve exposures to pulmonary toxins. This article describes the approach used to minimize these differences for a consortium of institutions who are providing medical monitoring examinations to World Trade Center (WTC) responders. The protocol improved upon the minimal ATS guidelines. ⋯ The program allowed standardization of the performance and interpretation of spirometry results across multiple institutions. This facilitated reliable and rapid diagnosis of lung disease in the large number of WTC responders screened. We recommend this approach for postdisaster pulmonary evaluations in other settings.
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Respiratory consequences from occupational and environmental disasters are the result of inhalation exposures to chemicals, particulate matter (dusts and fibers) and/or the incomplete products of combustion that are often liberated during disasters such as fires, building collapses, explosions and volcanoes. Unfortunately, experience has shown that environmental controls and effective respiratory protection are often unavailable during the first days to week after a large-scale disaster. ⋯ Respiratory health consequences after aerosolized exposures to high-concentrations of particulates and chemicals can be grouped into 4 major categories: 1) upper respiratory disease (chronic rhinosinusitis and reactive upper airways dysfunction syndrome), 2) lower respiratory diseases (reactive [lower] airways dysfunction syndrome, irritant-induced asthma, and chronic obstructive airways diseases), 3) parenchymal or interstitial lung diseases (sarcoidosis, pulmonary fibrosis, and bronchiolitis obliterans, and 4) cancers of the lung and pleura. This review describes several respiratory consequences of occupational and environmental disasters and uses the World Trade Center disaster to illustrate in detail the consequences of chronic upper and lower respiratory inflammation.