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Clinical protocols

Rui Feng, Liyang Wang, Zhonguang Li, Rong Yang, Yu Liang, Yuting Sun, Qiuxia Yu, George Ghartey-Kwansah, Yanping Sun, Yajun Wu, Wei Zhang, Xin Zhou, Mengmeng Xu, Joseph Bryant, Guifang Yan, William Isaacs, Jianjie Ma, Xuehong Xu
Cardiovascular disease (CVD) is a major global cause of mortality, which has prompted numerous studies seeking to reduce the risk of heart failure and sudden cardiac death. While regular physical activity is known to improve CVD associated morbidity and mortality, the optimal duration, frequency, and intensity of exercise remains unclear. To address this uncertainty, various animal models have been used to study the cardioprotective effects of exercise and related molecular mechanism such as the mice training models significantly decrease size of myocardial infarct by affecting Kir6...
December 2, 2018: Life Sciences
James G Dolan, Peter J Veazie
PURPOSE: In the process of developing an evidence-based decision dashboard to support treatment decisions for patients with newly diagnosed prostate cancer, we found that the clinical evidence base is insufficient to provide high-quality comparative outcome data. We therefore sought to determine if clinically acceptable outcome estimates could be created using a modified version of the Sheffield Elicitation Framework (SHELF), a formal method for eliciting judgments regarding probability distributions of expected decision outcomes...
December 5, 2018: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Michael T Spooner, John E Alex, Joy A Greer, Donald R Delorey, Rebecca A Kiser, Carl Petersen, Travis Polk, Kim Gunzelman
Introduction: A standardized training curriculum designed for general medical officers (GMO) titled Simulation Training for Operational Medicine Providers (STOMP) was recently developed to educate and improve GMOs' procedural skills through directed feedback prior to assuming duties in an operational environment. This study aimed to determine the impact this novel curriculum had on GMOs'confidence levels in 21 core privileges covering eight different subspecialties while stationed at Naval Medical Center Portsmouth (NMCP)...
December 4, 2018: Military Medicine
Larissa Tais Soligo, Ediléia Lodi, Ana Paula Farina, Matheus Albino Souza, Cristina de Mattos Pimenta Vidal, Doglas Cecchin
The aim of this study was to compare the efficacy of grape seed extract (GSE), calcium hypochlorite [Ca(ClO)2], and sodium hypochlorite (NaOCl) irrigant solutions with rotary or reciprocating instrumentation for disinfection of root canals inoculated with Enterococcus faecalis. The mesiobuccal root canals of mandibular molars were prepared and inoculated with Enterococcus faecalis for 21 days. The roots were then randomly divided into the following eight experimental groups (n=11) according to the instrumentation technique and disinfection protocol: ProTaper Next or Reciproc R25 with sodium chloride (control group), 6% NaOCl, 6% Ca(ClO)2, or 50% GSE used for irrigation during instrumentation...
September 2018: Brazilian Dental Journal
Juliana Alvares Duarte Bonini Campos, Wanderson Roberto da Silva, Maria Claudia Bernardes Spexoto, Sergio Vicente Serrano, João Marôco
OBJECTIVE: To estimate the dietary intake of cancer patients and its relation with clinical and demographic characteristics, and to assess the contribution of dietary intake, appetite/symptoms and clinical and demographic characteristics to their quality of life. METHODS: The consumption of energy and macronutrients of patients was estimated. The relation between dietary intake and clinical and demographic characteristics was evaluated by analysis of variance. The intake of energy and macronutrient of the patients was compared to the nutritional recommendations using 95% confidence interval...
November 29, 2018: Einstein
Diego Rodrigues Pessoa, Davidson Ribeiro Costa, Bruno de Moraes Prianti, David Ribeiro Costa, Carolina Alves Delpasso, Emília Ângela Lo Schiavo Arisawa, Renata Amadei Nicolau
This case report aims to evaluate the treatment of Temporomandibular Disorder (TMD) of muscular origin by associating facial massage (FM), dry needling (DN), and low-level laser therapy (LLLT). The pre- and post-treatment evaluations consisted of clinical examinations based on the Research Diagnostic Criteria (RDC) for TMD, pain intensity quantification by means of the Visual Analog Scale (VAS), mandibular movement measurement, and electromyographic (EMG) analysis of the masseter and temporal muscles. Post-therapy assessment indicated a decrease in pain sites of 58%, in pain intensity mean (1...
November 29, 2018: CoDAS
Pedro Bichaff, Karina T Setani, Emiliana H G Motta, Artur F Delgado, Werther B Carvalho, Michele Luglio
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly...
October 2018: Revista da Associação Médica Brasileira
E Achilleos, C Rahiotis, K Kavvadia, G Vougiouklakis
The aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C)...
December 5, 2018: Operative Dentistry
Corrado Cesare Campisi, Melissa Ryan, Giuseppe Villa, Pietro Di Summa, Mario Cherubino, Francesco Boccardo, Corradino Campisi
PURPOSE: The current study aimed to determine the utility of including the study of deep subfascial lymphatic vessels in a 2-compartment lymphoscintigraphy for the diagnosis of lymphedema in patients with limb swelling. Lymphoscintigraphy is a valuable imaging tool for the timely diagnosis of peripheral lymphedema. However, there is a lack of standardization in its application, especially regarding which type of lymphatic vessels to examine (superficial, deep, or both). METHODS: Two hundred fifty-eight patients with lymphedema underwent segmental lymphoscintigraphy...
December 3, 2018: Clinical Nuclear Medicine
Diana Greene-Chandos, Michel Torbey
PURPOSE OF REVIEW: Weakness is a common reason patients are seen in neurologic consultation. This article reviews the differential diagnosis of neuromuscular disorders in the intensive care unit (ICU), discusses the intensive care needs and evaluation of respiratory failure in patients with neuromuscular disorders, and provides a practical guide for management. RECENT FINDINGS: Although primary neuromuscular disorders used to be the most common cause for weakness from peripheral nervous system disease in the ICU, a shift toward ICU-acquired weakness is observed in today's clinical practice...
December 2018: Continuum: Lifelong Learning in Neurology
Alejandro A Rabinstein
PURPOSE OF REVIEW: This article discusses the diagnostic and therapeutic approach to patients who are comatose and reviews the current knowledge on prognosis from various causes of coma. This article also provides an overview of the principles for determination of brain death as well as advice on how to avoid common pitfalls. RECENT FINDINGS: Technologic advances have refined our understanding of the physiology of consciousness and the spectrum of disorders of consciousness; they also promise to improve our prognostic accuracy...
December 2018: Continuum: Lifelong Learning in Neurology
Matthew A Koenig
PURPOSE OF REVIEW: This article reviews the management of cerebral edema, elevated intracranial pressure (ICP), and cerebral herniation syndromes in neurocritical care. RECENT FINDINGS: While corticosteroids may be effective in reducing vasogenic edema around brain tumors, they are contraindicated in traumatic cerebral edema. Mannitol and hypertonic saline use should be tailored to patient characteristics including intravascular volume status. In patients with traumatic brain injury who are comatose, elevated ICP should be managed with an algorithmic, multitiered treatment protocol to maintain an ICP of 22 mm Hg or less...
December 2018: Continuum: Lifelong Learning in Neurology
W Serra, A Fantin, C Longo, G Rabia, F De Rosa, C Plenteda, F Re, E Crisafulli, A Chetta
Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects. There is evidence supporting that adverse effects are dose-dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols. In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course...
December 4, 2018: Cardiovascular & Hematological Disorders Drug Targets
Laurelie R Wall, Sanjeewa Kularatna, Elizabeth C Ward, Bena Cartmill, Anne J Hill, Elizabeth Isenring, Joshua Byrnes, Sandro V Porceddu
Research advocates for the use of intensive, prophylactic swallowing therapy to help reduce the severity of dysphagia in patients receiving (chemo)radiotherapy ([C]RT) for head/neck cancer (HNC). Unfortunately, the intensity of this therapy, coupled with growing patient numbers and limited clinical resources, provides challenges to many international cancer facilities. Telepractice has been proposed as a potential method to provide patients with greater support in home-practice, whilst minimising burden to the health service...
December 4, 2018: Dysphagia
Ihab Eldessouki, Ola Gaber, Tariq Namad, Jiang Wang, John C Morris, Nagla Abdel Karim
Large cell neuroendocrine cancer (LCNEC) of the lung exhibits morphological and immunohistochemical characteristics of both neuroendocrine and large cell carcinomas. No defined optimal therapy has been described for this subset of patients and the question of whether these patients should be treated with non-small cell lung cancer (NSCLC) treatment protocols, according to the National Comprehensive Cancer Network (NCCN) guidelines, or with small cell lung cancer (SCLC) due to histological and clinical similarities is still uncertain...
2018: Journal of Oncology
Paul Lohan, Nick Murphy, Oliver Treacy, Kevin Lynch, Maurice Morcos, Bingling Chen, Aideen E Ryan, Matthew D Griffin, Thomas Ritter
High-risk cornea transplant recipients represent a patient population with significant un-met medical need for more effective therapies to prevent immunological graft rejection due to heightened anti-donor immune response. In this study, a rat model of pre-existing anti-donor immunity was developed in which corneal allografts were rejected earlier than in non-pre-sensitized recipients. In this model, third-party (non-donor, non-recipient strain) allogeneic mesenchymal stromal cells (allo-MSC) were administered intravenously 7 and 1 days prior to transplantation...
2018: Frontiers in Immunology
Noémi Kovács, Krisztián Szigeti, Nikolett Hegedűs, Ildikó Horváth, Dániel S Veres, Michael Bachmann, Ralf Bergmann, Domokos Máthé
Radiotherapy is one of the most frequently applied treatments in oncology. Tissue-absorbed ionizing radiation damages not only targeted cells but the surrounding cells too. The consequent long-term induced oxidative stress, irreversible tissue damage, or second malignancies draw attention to the urgent need of a follow-up medical method by which personalized treatment could be attained and the actually dose-limiting organ could be monitored in the clinical practice. We worked out a special hemisphere irradiation technique for mice which mimics the radiation exposure during radiotherapy...
2018: Contrast Media & Molecular Imaging
Glenn E Palomaki, Edward M Kloza
PURPOSE: We systematically reviewed the published literature on test failure rates for the sequencing of cell-free DNA (cfDNA) in maternal plasma to identify Down syndrome. METHODS: We searched peer-reviewed English publications with diagnostic results on all pregnancies that provided test failure rates. Data on the odds of failure in Down syndrome and euploid pregnancies and the impact of repeat testing were extracted. Random-effects modeling was then used to identify moderators that could explain variability...
November 2018: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Christian Michel, Andreas Burchert, Andreas Hochhaus, Susanne Saussele, Andreas Neubauer, Michael Lauseker, Stefan W Krause, Hans-Jochem Kolb, Dieter Kurt Hossfeld, Christoph Nerl, Gabriela M Baerlocher, Dominik Heim, Tim H Brümmendorf, Alice Fabarius, Claudia Haferlach, Brigitte Schlegelberger, Leopold Balleisen, Maria-Elisabeth Goebeler, Mathias Hänel, Anthony Ho, Jolanta Dengler, Christiane Falge, Robert Möhle, Stephan Kremers, Michael Kneba, Frank Stegelmann, Claus-Henning Köhne, Hans-Walter Lindemann, Cornelius F Waller, Karsten Spiekermann, Wolfgang E Berdel, Lothar Müller, Matthias Edinger, Jiri Mayer, Dietrich W Beelen, Martin Bentz, Hartmut Link, Bernd Hertenstein, Roland Fuchs, Martin Wernli, Frank Schlegel, Rudolf Schlag, Maike de Wit, Lorenz Trümper, Holger Hebart, Markus Hahn, Jörg Thomalla, Christof Scheid, Philippe Schafhausen, Walter Verbeek, Michael J Eckart, Winfried Gassmann, Michael Schenk, Peter Brossart, Thomas Wündisch, Thomas Geer, Stephan Bildat, Erhardt Schäfer, Joerg Hasford, Rüdiger Hehlmann, Markus Pfirrmann
Standard first-line therapy of chronic myeloid leukemia is treatment with imatinib. In the randomized German Chronic Myeloid Leukemia-Study IV, more potent BCR-ABL inhibition with 800mg (high-dose) imatinib accelerated achievement of a deep molecular remission. However, whether and when a de-escalation of the dose intensity under high-dose imatinib can be safely performed without increasing the risk of losing deep molecular response is unknown. To gain insights into this clinically relevant question, we analyzed the outcome of imatinib dose reductions from 800mg to 400mg daily in the Chronic Myeloid Leukemia-Study IV...
December 4, 2018: Haematologica
Edward Meinert, Michelle Van Velthoven, David Brindley, Abrar Alturkistani, Kimberley Foley, Sian Rees, Glenn Wells, Nick de Pennington
BACKGROUND: Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery...
December 4, 2018: JMIR Research Protocols
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