tamsulosin (tamsulosin WOWTAB / Harnal D)

The silent signal is tadalafil counterbalancing tamsulosin induced ejaculatory dysfunction.

Zhang Tao T, Yu Maobin M

Anatomic Total Shoulder Arthroplasty Using Lesser Tuberosity Osteotomy: Technical Considerations.

Jaber Ayham A, Murphy Colin P CP, Uppstrom Tyler J TJ, Nocek Michael M et al.

Glenohumeral osteoarthritis (GHO) is a common cause of shoulder pain and dysfunction in middle-aged and older adults. Anatomic total shoulder arthroplasty (aTSA) is the preferred surgical treatment for patients with an intact rotator cuff. This video focuses on technical considerations in aTSA using a lesser tuberosity osteotomy (LTO). aTSA is indicated in patients with advanced GHO who experience persistent pain, mechanical symptoms, and functional limitations despite prolonged conservative treatment. The rotator cuff should be intact. The patient is positioned in the beach-chair position. A standard deltopectoral approach is used. The clavipectoral fascia is incised lateral to the biceps tendon. The anterior circumflex vessels are cauterized, and the superior pectoralis tendon is released for exposure. The biceps tendon is tenodesed after sheath release. An oscillating saw and curved osteotome are used to osteotomize the lesser tuberosity with a ~4 mm thick bone block. The lesser tuberosity and subscapularis are tagged. A "double hammock" inferior capsular release is performed to protect the axillary nerve. The humeral head is osteotomized. Glenoid exposure is achieved with retractors and labrum and biceps stump excision. Preoperative planning software is used to correct glenoid version and inclination. A glenoid component is cemented after concentric/eccentric reaming. The humerus is broached sequentially. A press-fit stem is implanted and secured with locking screws if needed. A trial head confirms soft tissue balance before final implantation. The lesser tuberosity is repaired with cerclage sutures. The rotator interval is closed in external rotation. Postoperative anteroposterior and axillary radiographs confirm proper implant positioning and soft tissue balance. Patients are placed in a sling for 3 weeks for comfort, with immediate full passive range of motion except limiting external rotation to 30° for the first 3 weeks to protect the osteotomy. Active and active-assisted range of motion begins at 4 weeks. Initial resistance strengthening begins at 5 weeks, with advanced resistance at 8 weeks. We present a reproducible technique using a deltopectoral approach, LTO, capsular releases, and meticulous implant positioning. This implant system accommodates native anatomy with variable offset, inclination, and version. Rigid fixation of the lesser tuberosity allows for reliable healing, which can be assessed on routine postoperative radiographs. Pain-free and improved function can be achieved in patients with an appropriate indication for the procedure. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Development of Extended-Release Oral Dosage Forms of Salbutamol Sulfate Using the Hot-Melt Extrusion Manufacturing Technique.

Ramadan Banan B, Al-Zoubi Nizar N, Migdadi Eman E, AlSuwais Alia Kh AK et al.

To fabricate and characterize extrudable polymeric matrices using a combination of ethyl cellulose (EC) and two different grades of hydroxypropyl cellulose (HPC) that can provide sustained drug release of the model drug salbutamol sulfate. Implementation of the Hot-Melt Extrusion (HME) technique in the fabrication of polymeric combinations that will provide ready-to-use matrices for sustained release dosage forms. Two formulation groups were developed; each with six formulations. The first group contained EC: HPC 370,000 ratios ranging from 55.52:13.8% to 6.9:62.46%, respectively. The second group contained EC: HPC 80,000 ranging from 59.4:10% to 9.4:60%, respectively. The release profiles were determined via in vitro studies to assess the ability of matrices to prolong salbutamol release. Solid-state characterization was also performed on the raw material and representative extrudates formulations using differential scanning calorimetry (DSC) and X-ray powder diffraction (XRPD) and polarized light microscopy (PLM). The first group formulations exhibited prolonged drug release profiles that accelerated progressively as the level of HPC 370,000 increased. In contrast, the second group formulations exhibited a noticeably faster release, demonstrating that HPC 80,000 can effectively accelerate drug release through enhanced matrix erosion and water penetration. DSC and XRPD revealed that the model drug remained in its stable crystalline state even after thermal processing via HME. PLM further confirmed drug crystallinity within the extrudates. EC-HPC matrices successfully demonstrated the feasibility of using HME to prepare sustained-release matrices for salbutamol sulfate with the ability to tune drug release by varying polymer grade and ratio.

Evolutionary rise of a synaptic mechanism for creating and diversifying key reinforcement signals.

Rodriguez-Sosa Natalia N, Rios Lupita L, Lin You-Hsin YH, Rybalchenko Volodymyr V et al.

Most neurons release either excitatory or inhibitory neurotransmitters. However, multiple inputs to the lateral habenula (LHb) co-transmit glutamate and GABA, transmitters with opposing effects on LHb output. Although the LHb has an established role in reinforcement learning, the adaptive significance of glutamate/GABA co-release remains unclear. Using experimentally informed simulations, we show that GABA co-release is sufficient to produce temporal difference (TD)-like transformations of input activity, computations commonly used for reinforcement learning and behavioral optimization. Heterogeneous GABA-to-glutamate ratios, like those found among LHb neurons ex vivo, produce diverse TD-like computations linked to higher-order decision-making. Single-cell RNA-sequencing analysis and machine-learning image analysis further indicate that glutamate/GABA co-release expanded across vertebrate evolution, from fish to mice, rats, and monkeys. Evolutionary expansion of glutamate/GABA co-release may have supported increasingly sophisticated learning and decision-making that contribute to intelligent behavior.