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Mildred Z Solomon
Two papers in this issue address the limits of surrogates' authority when making life-and-death decisions for dying family members or friends. Using palliative sedation as an example, Jeffrey Berger offers a conceptual argument for bounding surrogate authority. Since freedom from pain is an essential interest, when imminently dying, cognitively incapacitated patients are in duress and their symptoms are not manageable in any other way, clinicians should be free to offer palliative sedation without surrogate consent, although assent should be sought and every effort made to work with surrogates as harmoniously as possible...
January 2017: Hastings Center Report
Mariana Pinto Sirimarco, Helena Maciel Guerra, Eduardo Guimarães Lisboa, Joice Monalisa Vernini, Bianca Nicolosi Cassetari, Roberto Antonio de Araujo Costa, Marilza Vieira Cunha Rudge, Iracema de Mattos Paranhos Calderon
BACKGROUND: In August 2011, the Specialized Center for Diabetes and Pregnancy of the Botucatu Medical School/Unesp adopted a new diagnostic protocol for gestational diabetes mellitus, recommended by the American Diabetes Association and the International Association of the Diabetes and Pregnancy Study Group. The glycemic profile was evaluated using the 75-g oral glucose tolerance test (OGTT) used to diagnose mild gestational hyperglycemia, recognized and treated in our department as gestational diabetes mellitus...
2017: Diabetology & Metabolic Syndrome
R Makufa, M Bvochora-Nsingo, T Karumekayi, R J Schneider, J A Efstathiou, S Dryden-Peterson, A Odom, A Shulman, Y Pipman, D P Gierga
PURPOSE: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques...
June 2016: Medical Physics
El H Bentefour, H Lu
PURPOSE: We conducted a retrospective study of the useful clinical proton beam energy based on the beam range data of patients treated over the last 10 years at Massachusetts General Hospital Proton Therapy Center. METHODS: Treatment field information were collected for all patients treated over the last 10 years (2005-2015) in the two gantry treatment rooms at MGH. The beam ranges for these fields were retrieved and categorized per treatment site. The 10 prostate patients that required the highest beam range (lateral fields) were selected...
June 2016: Medical Physics
Tynan H Friend, Samantha J Jennings, Wilton C Levine
In April 2016, Massachusetts General Hospital (MGH) went live with the Epic electronic health records (EHR) system, replacing a variety of EHRs that previously existed in different departments throughout the hospital. At the time of implementation, the Vocera® Badge Communication System, a wireless hands-free communication device distributed to perioperative team members, had increased perioperative communication flow and efficiency. As a quality improvement effort to better understand communication patterns during an EHR go-live, we monitored our Vocera call volume and user volume before, during and after our go-live...
February 2017: Journal of Medical Systems
Brian B Ghoshhajra, Richard A P Takx, Pedro V Staziaki, Harshna Vadvala, Phillip Kim, Tomas G Neilan, Nandini M Meyersohn, Daniel Bittner, Sumbal A Janjua, Thomas Mayrhofer, Jeffrey L Greenwald, Quyhn A Truong, Suhny Abbara, David F M Brown, James L Januzzi, Sanjeev Francis, John T Nagurney, Udo Hoffmann
OBJECTIVES: To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience. METHODS: Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure...
November 24, 2016: European Radiology
Zhaohui Wang, Nalu Navarro-Alvarez, Jigesh A Shah, Huiping Zhang, Qi Huang, Qian Zheng, Joren C Madsen, David H Sachs, Christene A Huang, Zhirui Wang
Regulatory T cells (Tregs) are known to play an important role in immunoregulation and have been shown to facilitate induction of transplantation tolerance. Chemokine (C-C motif) receptor 4 (CCR4) is expressed on the surface of effector Tregs involved in controlling alloimmune and autoimmune responses. Recently we have developed a novel diphtheria-toxin based anti-human CCR4 immunotoxin for depleting CCR4(+) cells in vivo. In this study, we have demonstrated that the anti-human CCR4 immunotoxin bound to porcine lymphocytes including CD4(+)FoxP3(+) Tregs...
December 2016: Veterinary Immunology and Immunopathology
Tynan H Friend, Samantha J Jennings, Martin S Copenhaver, Wilton C Levine
In the hospital, fast and efficient communication among clinicians and other employees is paramount to ensure optimal patient care, workflow efficiency, patient safety and patient comfort. The implementation of the wireless Vocera® Badge, a hands-free wearable device distributed to perioperative team members, has increased communication efficiency across the perioperative environment at Massachusetts General Hospital (MGH). This quality improvement project, based upon identical pre- and post-implementation surveys, used qualitative and quantitative analysis to determine if and how the Vocera system affected the timeliness of information flow, ease of communication, and operating room noise levels throughout the perioperative environment...
January 2017: Journal of Medical Systems
Catherine A Bigelow, Neil S Horowitz, Annekathryn Goodman, Whitfield B Growdon, Marcela Del Carmen, Anjali J Kaimal
BACKGROUND: Cervical cancer is the third most common gynecologic malignancy in the United States. Approximately 1-3% of cervical cancers will be diagnosed in pregnant and peripartum women; optimal management in the setting of pregnancy is not always clear. OBJECTIVE: We sought to describe the management of patients with cervical cancer diagnosed in pregnancy and compare their outcomes to nonpregnant women with similar baseline characteristics. STUDY DESIGN: We conducted a retrospective chart review of all patients diagnosed with cervical cancer in pregnancy and matched them 1:2 with contemporaneous nonpregnant women of the same age diagnosed with cervical cancer of the same stage...
October 31, 2016: American Journal of Obstetrics and Gynecology
Maurizio Fava, Takao Okame, Yuki Matsushima, Pamela Perry, Emmanuelle Weiller, Ross A Baker
BACKGROUND: Approximately 50% of patients with major depressive disorder (MDD) do not respond adequately to their antidepressant treatment (ADT), underscoring the need for more effective treatment options. The objective of this study was to investigate the effect of adjunctive brexpiprazole on depressive symptoms in patients with MDD who were not responding to adjunctive or combination therapy of their current ADTs with several different classes of agents (NCT02012218). METHODS: In this 6-week, open-label, phase 3b study, patients with MDD who had an inadequate response to ≥1 adjunctive or combination therapy, in addition to history of ≥1 failure to monotherapy ADT, were switched to adjunctive brexpiprazole...
October 26, 2016: International Journal of Neuropsychopharmacology
Rajesh M Dhoble, Pratap Reddy Maddigapu, Sadhana S Rayalu, A G Bhole, Ashwinkumar S Dhoble, Shubham R Dhoble
Magnetic binary oxide particles (MBOP) were prepared by template method using chitosan in the laboratory for the removal of As(III) from water. The prepared MBOP has super paramagnetic property which is sufficient for magnetic separation. Column study was performed at two different flow rates of 2.0ml/min and 5.0ml/min and comparison was made with regenerated MBOP, commercial activated carbon and commercial activated alumina. It is observed that fresh MBOP has higher breakthrough time and capacity than regenerated MBOP by a factor of 1...
October 3, 2016: Journal of Hazardous Materials
Nathan R Tucker, Saagar Mahida, Jiangchuan Ye, Elizabeth J Abraham, Julie A Mina, Victoria A Parsons, Michael A McLellan, Marisa A Shea, Alan Hanley, Emelia J Benjamin, David J Milan, Honghuang Lin, Patrick T Ellinor
BACKGROUND: The genetic basis of atrial fibrillation (AF) and congenital heart disease remains incompletely understood. OBJECTIVE: We sought to determine the causative mutation in a family with AF, atrial septal defects, and ventricular septal defects. METHODS: We evaluated a pedigree with 16 family members, 1 with an atrial septal defect, 1 with a ventricular septal defect, and 3 with AF; we performed whole exome sequencing in 3 affected family members...
October 15, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
L Germine, E B Robinson, J W Smoller, M E Calkins, T M Moore, H Hakonarson, M J Daly, P H Lee, A J Holmes, R L Buckner, R C Gur, R E Gur
Breakthroughs in genomics have begun to unravel the genetic architecture of schizophrenia risk, providing methods for quantifying schizophrenia polygenic risk based on common genetic variants. Our objective in the current study was to understand the relationship between schizophrenia genetic risk variants and neurocognitive development in healthy individuals. We first used combined genomic and neurocognitive data from the Philadelphia Neurodevelopmental Cohort (4303 participants ages 8-21 years) to screen 26 neurocognitive phenotypes for their association with schizophrenia polygenic risk...
October 18, 2016: Translational Psychiatry
Kelun Wang, Dennis Boye Larsen, Tanja Kim Jensen, Tiejun Liu, Zhuxuan Liu, Lars Arendt-Nielsen
BACKGROUND/AIM: To potentially enhance the effects of conventional acupuncture, a novel acu-vibrator (prototype) has been developed to perform vibro-acupuncture (VA). The aim of this psychophysical study was to investigate the subjective sensations of VA compared with conventional manual acupuncture (MA) and non-penetrating sham acupuncture (SA). METHODS: 30 young healthy volunteers (21 men and 9 women) received VA, MA, and SA at LI4 and LI10 in a randomised, single-blind, placebo-controlled, cross-over manner...
October 2016: Acupuncture in Medicine: Journal of the British Medical Acupuncture Society
Peter Matzneller, Zoe Österreicher, Birgit Reiter, Edith Lackner, Thomas Stimpfl, Markus Zeitlinger
BACKGROUND: Telavancin is a novel lipoglycoprotein antibiotic with MRSA activity. To date, tissue pharmacokinetics (PK) and plasma protein binding of the drug are insufficiently described. OBJECTIVES: To investigate tissue PK and plasma protein binding of telavancin in healthy volunteers. METHODS: Eight male healthy subjects received a single dose of 10 mg/kg of body weight of telavancin as an intravenous infusion over 1 h. At defined timepoints before and up to 24 h after treatment, total telavancin concentrations were measured in plasma...
November 2016: Journal of Antimicrobial Chemotherapy
Bożena Bądzyńska, Andrzej W Lipkowski, Krzysztof H Olszyński, Janusz Sadowski
Opioids interact with sympathetic and renin-angiotensin systems in control of mean arterial pressure (MAP). Our earlier finding that biphalin, a synthetic enkephalin analogue, decreased MAP in anaesthetized spontaneously hypertensive rats (SHR) prompted us to further explore this action, to get new insights into pathogenesis of various forms of hypertension. Biphalin effects were studied in SHR, uninephrectomized rats on a high-salt diet (HS/UNX), and rats with angiotensin-induced hypertension (Ang-iH). Besides MAP, renal and iliac blood flows (RBF, IBF) and vascular resistances were measured...
June 8, 2016: Canadian Journal of Physiology and Pharmacology
Neusa Aparecida de Sousa Basso, Glilciane Morceli, Roberto Costa, Adriano Dias, Marilza Vieira Cunha Rudge, Iracema Mattos Paranhos Calderon
BACKGROUND: The present study validates a symphysis-fundal height chart (SFH-chart) for pregnant women with type 2 diabetes mellitus (DM2), gestational diabetes mellitus (GDM) and mild gestational hyperglycemia (MGH) attending at the Diabetes and Pregnancy Reference Service of the Botucatu Medical School, UNESP, Brazil. METHODS: A cross-sectional study was carried out to evaluate the performance of the specific FHC in predicting small (SGA) and large (LGA) for gestational age newborns (NB)...
August 3, 2016: Reproductive Health
E G de Souza, C C P Hara, D L G Fagundes, A A de Queiroz, G Morceli, I M P Calderon, E L França, A C Honorio-França
This study investigated the expression of the neonatal Fc receptor (FcRn) in maternal blood, cord blood and placental cells and determined IgG levels in maternal blood and cord blood from diabetic mothers. Peripheral blood, cord blood and placenta samples were collected from 26 mothers with normoglycaemia (non-diabetic, ND group) and 52 with hyperglycaemia (26 with mild gestational hyperglycaemia, MGH group, and 26 with type 2 diabetes mellitus, DM-2 group). Cells expressing CD19(+) and FcRn were identified by flow cytometry...
October 2016: Scandinavian Journal of Immunology
Hong Li, Lu Liu, Lei Xie, Dongmei Gan, Xiaoqing Jiang
CONTEXT: Losartan and berberine (BBR) are often simultaneously used for the treatment of senile diabetic nephropathy in clinics. However, the potential herb-drug interaction between losartan and BBR is unknown. OBJECTIVE: This study investigates the influence of BBR on the pharmacokinetics of losartan and EXP3174, and investigates the effects of BBR on the metabolic stability of losartan. MATERIALS AND METHODS: The pharmacokinetic profiles losartan and EXP3174 of orally administered losartan (10 mg/kg) with and without pretreatment with BBR (20 mg/kg) within 24 h were determined in Sprague-Dawley rats...
December 2016: Pharmaceutical Biology
Cristiane de Castro Pernet Hara, Eduardo Luzía França, Danny Laura Gomes Fagundes, Adriele Ataides de Queiroz, Marilza Vieira Cunha Rudge, Adenilda Cristina Honorio-França, Iracema de Mattos Paranhos Calderon
The present study characterized natural killer cells and cytokines in diabetic mothers, their placenta, and fetus. In the maternal blood from the hyperglycemic groups, the CD16(+)CD56(-) NK cells increased, whereas that of CD16(+)CD56(+) decreased in gestational diabetes mellitus [GDM] group. Cord blood from type 2 diabetes [DM-2] showed a higher proportion of CD16(+)CD56(-) and CD16(-)CD56(+). The placental extravillous layer of GDM and DM-2 showed an increase of CD16(+)CD56(-) cells and, irrespective of region, the proportion of CD16(-)CD56(+) cells was higher in mild gestational hyperglycemia [MGH] and GDM and lower in DM-2...
2016: Journal of Immunology Research
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