Ropivacaine in Combination for Intrathecal Analgesia Impact Factor

The two articles in this month’s press of The Journal of Arthritis, one by Ekinci et al. titled ‘A New Treatment Option in Osteoarthritis: Prolotherapy Injections’ and the other by Senatorov et al. titled ‘Clinical Outcome of Hylan G-F 20 Injections in Shoulder and HipOsteoarthritis: A Retrospective Review’ raise several important points surrounding the topic of intra-articular injections Firstly that there is a paucity of high quality literature in the field that often leads to inconclusive or misrepresented conclusions on drug efficacy in established treatments.The articles also highlight the heterogeneity in injection procedure, site, concentration, preparation and outcome measurements. 

This editorial will, therefore, provide a concise review on some of the current injection therapies and suggest possible improvements to methodological structure to inspire readers strive for high quality data. Further, through an example of a possible novel therapy, Actovegin, this editorial will hopefully challenge readers’ way of thinking to consider the reapplication of established drugs; posing the question can you teach an old drug new tricks?

Cochrane review of 27 randomised control trials examining the effect of cortical steroid injections in Osteoarthritis reported an improved response to pain and function with cortical steroid treated patients when compared to placebo in smaller trials of low methodological quality and power with selected subgroups of patients. On the other hand larger trials with more rigorous selection criteria demonstrated limited effect of cortical steroid at 6 weeks, questioning its efficacy.Interestingly the Cochrane Musculoskeletal Group 2015 would consider cortical steroid to still be experimental in treating knee OA, they highlight two key issues for injection therapy.

The need of well-constructed, blinded, sham intervention/placebo controlled with adequately randomised and powered trials in established therapies .Obviously in a clinical setting this is not always possible, yet for upcoming therapies there is a need to strive for this gold standard of research.

The effect in meta-analyses caused by the wide variety of preparations and dosage . Should preparations such as Betamethasone, Dexamethasone, Prednisolone and Triamcinolone be evaluated under the same cortical steroid review? Certainly their efficacy should be assessed and considered individually and a dose response relationship calculated if any at all. Furthermore, most clinicians would mix a cortical steroid with different types of anaesthetic agents prior to injection; therefore their pharmacodynamics and pharmacokinetic property cannot be predicted.

Towards Wholeness and Integrity of Distributed Dynamic Systems

In an addition to the variety of topics listed in the Aims and Scope of the Journal of Computer Science and Systems Biology, we want to offer here some more areas within its general orientation which could encourage extended research and paper submissions. These especially relate to efficient organization of large distributed dynamic systems of diverse natures which may require innovative, even revolutionary, solutions reflecting the growing world dynamics in the 21st century.

We are witnessing a dramatic change in the character of national and international activity, especially in crisis and conflict areas, with the use of asymmetric, unconventional, and hybrid solutions. They may simultaneously involve economy, ecology, international relations, ethnicity, culture, law, religion, etc., defense and military too, occupying both physical and virtual environments. These solutions may need to be holistic, multidimensional, and highly integral in order to succeed.

The aim of this message is not to present new research or implementation results in aparticular field but rather introduce and popularize some important directions which could extend the benefits of symbiosis between ideas of computer science and biology under the general banner of wholeness and integrity of large distributed systems, including new technologies for their effective management and control.

Current Management Philosophy: Interoperability

Interoperability  is a quality of a system with understood and clear interfaces to work with other systems without restrictions. There may be different kinds of interoperability. Syntactic interoperability means that two or more systems are just capable to communicate with each other. Semantic interoperability supposes that beyond the ability to exchange information, different systems are capable of interpreting the exchanged information. Cross-domain interoperability occurs is when different kinds of entities (which may be multiple social, organizational, political, legal, etc.) can work together for a common purpose.

Interoperability is the key principle at present for joint operations in both civil and military areas. For example, NATO has been based on interoperability since 1949 when it was founded. Interoperability allows organizations of different nationalities and armed services to conduct joint peacekeeping operations. Interoperability is also dominant in any international relief missions acting after natural or manmade disasters