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Magnolia Cardona-Morrell, Amanda Chapman, Robin M Turner, Ebony Lewis, Blanca Gallego-Luxan, Michael Parr, Ken Hillman
AIM: To investigate associations between clinical parameters - beyond the evident physiological deterioration and limitations of medical treatment - with in-hospital death for patients receiving Rapid Response System (RRS) attendances. METHODS: Retrospective case-control analysis of clinical parameters for 328 patients aged 60 years and above at their last RRS call during admission to a single teaching hospital in the 2012-2013 calendar years. Generalised estimating equation modelling was used to compare the deceased with a randomly selected sample of those who had RRS calls and survived admission (controls), matched by age group, sex, and hospital ward...
October 18, 2016: Resuscitation
Silje Hovden, Marie Louise Jespersen, Peter H Nissen, Per Løgstrup Poulsen, Lars Rolighed, Søren A Ladefoged, Lars Rejnmark
Familial hypocalciuric hypercalcemia type 3 should be considered as differential diagnosis in patients with suspected primary hyperparathyroidism and/or suspected multiple neoplasia syndrome, as correct diagnosis will spare the patients for going through multiple futile parathyroidectomies and for the worry of being diagnosed with a cancer susceptibility syndrome.
October 2016: Clinical Case Reports
Amber Mills, Anne Walker, Michele Levinson, Alison M Hutchinson, Gemma Stephenson, Anthea Gellie, George Heriot, Harvey Newnham, Megan Robertson
OBJECTIVE: To determine the prevalence of resuscitation orders and Advance Care Plans, and the relationship with Medical Emergency Team (MET) calls. METHOD: A point prevalence review of patient records at five Victorian hospital services. RESULTS: One thousand nine hundred and thirty-four patient records were reviewed, and 230 resuscitation orders and 15 Advance Care Plans found. Significantly, more resuscitation orders were found at public hospitals...
October 19, 2016: Australasian Journal on Ageing
Koko Asakura, Toshimitsu Hamasaki, Scott R Evans
We discuss group-sequential designs in superiority clinical trials with multiple co-primary endpoints, that is, when trials are designed to evaluate if the test intervention is superior to the control on all primary endpoints. We consider several decision-making frameworks for evaluating efficacy or futility, based on boundaries using group-sequential methodology. We incorporate the correlations among the endpoints into the calculations for futility boundaries and sample sizes as a function of other design parameters, including mean differences, the number of analyses, and efficacy boundaries...
October 19, 2016: Biometrical Journal. Biometrische Zeitschrift
Nathan S Hart, Melinda Fitzgerald
Red-near-infrared light has been used for a range of therapeutic purposes. However, clinical trials of near-infrared laser light for treatment of stroke were abandoned after failing interim futility analyses. Lack of efficacy has been attributed to sub-optimal treatment parameters and low penetrance of light to affected brain regions. Here, we assess penetrance of wavelengths from 450-880 nm in human post-mortem samples, and demonstrate that human skin, skull bone and brain transmits therapeutically relevant quantities of light from external sources at wavelengths above 600nm...
September 2016: Discovery Medicine
Bayo Aluko-Olokun, Ademola Abayomi Olaitan
The literature on keloids is replete with authors expressing frustration with treatment results. Triamcinolone is effective in shrinking keloids and preventing their recurrence following excision, if delivered successfully. Strategies for effective delivery of drug are presented: recommended needle size, use of metal syringe, slow injection to avoid skin rupture, and delayed withdrawal of needle after injection. The futility of expecting pedunculated keloids to be completely flattened by steroid injection alone is mentioned...
October 14, 2016: Journal of Craniofacial Surgery
Sverre Kjeldsen
Results of outcome trials form the basis for treatment guidelines in hypertension. Further outcome trials are needed wherever there are gaps in knowledge. Thus, rationale for setting up and performing and outcome trial with investment of large resources is based on a strong hypothesis.Second, an outcome trial must be done with sufficient statistical power. Power is calculated from the risk level of the people to be investigated and the event rate, the expected benefit of the agent to be investigated and the number of treatment years (number of participants involved and years in the study)...
September 2016: Journal of Hypertension
Elsa Perrody, Laurence Abrami, Michal Feldman, Beatrice Kunz, Sylvie Urbé, Gisou van der Goot
Many membrane proteins fold inefficiently and require the help of enzymes and chaperones. Here we reveal a novel folding assistance system that operates on membrane proteins from the cytosolic side of the endoplasmic reticulum (ER). We show that folding of the Wnt signaling coreceptor LRP6 is promoted by ubiquitination of a specific lysine, retaining it in the ER while avoiding degradation. Subsequent ER exit requires removal of ubiquitin from this lysine by the deubiquitinating enzyme USP19. This ubiquitination-deubiquitination is conceptually reminiscent of the glucosylation-deglucosylation occurring in the ER lumen during the calnexin/calreticulin folding cycle...
October 18, 2016: ELife
Han Gong, Wei Chu, So Hiu Lam, Angela Yu-Chen Lin
This study shows the degradation of ibuprofen in aqueous solution using oxone process mediated by Fe(2+) with UV irradiation (FOU). Fe(2+)/Oxone (FO), Fe(2+)/UV (FU), Oxone/UV (OU) processes were investigated separately to elucidate the role of different conditions in the processes. The effects of UV wavelength, the dosage of Fe(2+), the dosage of oxone, initial target compound concentration, solution pH and anions on the degradation efficiency were studied. In general the FOU is best performed among the processes...
October 14, 2016: Chemosphere
Solvey Schüle, Jean-Benoît Rossel, Diana Frey, Luc Biedermann, Michael Scharl, Jonas Zeitz, Natália Freitas-Queiroz, Valérie Pittet, Stephan R Vavricka, Gerhard Rogler, Benjamin Misselwitz
BACKGROUND: Low bone mineral density (BMD) remains a frequent problem in patients with inflammatory bowel diseases (IBD). There is no general agreement regarding osteoporosis screening in IBD patients. METHODS: Cases of low BMD and disease characteristics were retrieved from 3172 patients of the Swiss IBD cohort study. Multivariate logistic regression analysis was conducted for predictive modeling. In a subgroup of 877 patients, 253 dual-energy X-ray absorptiometry (DXA) scans were available for validation...
October 2016: United European Gastroenterology Journal
Song Feng, Meritxell Sáez, Carsten Wiuf, Elisenda Feliu, Orkun S Soyer
Bistability, and more generally multistability, is a key system dynamics feature enabling decision-making and memory in cells. Deciphering the molecular determinants of multistability is thus crucial for a better understanding of cellular pathways and their (re)engineering in synthetic biology. Here, we show that a key motif found predominantly in eukaryotic signalling systems, namely a futile signalling cycle, can display bistability when featuring a two-state kinase. We provide necessary and sufficient mathematical conditions on the kinetic parameters of this motif that guarantee the existence of multiple steady states...
October 2016: Journal of the Royal Society, Interface
Magdalena Lang, Roi Treister, Anne Louise Oaklander
Small-fiber polyneuropathy (SFPN) causes non-specific symptoms including chronic pain, cardiovascular, gastrointestinal, and sweating complaints. Diagnosis is made from history and exam in patients with known risk factors such as diabetes, but objective test confirmation is recommended for patients without known risks. If tests confirm SFPN, and it is "initially idiopathic" (iiSFPN), screening for occult causes is indicated. This study's aim was to evaluate the 21 widely available, recommended blood tests to identify the most cost-effective ones and to learn about occult causes of iiSFPN...
October 11, 2016: Journal of Neurology
Fuat H Saner, Carmen Kirchner
BACKGROUND: Patients with end-stage liver disease (ESLD) are assumed to be at high risk of bleeding when undergoing any kind of invasive intervention (any kind of operation, including transplantation or minimally invasive interventions). Both bleeding and thrombosis are associated with a poor outcome. METHODS: A selective literature research was conducted with the following key words: 'cirrhosis', 'coagulation', 'bleeding', 'INR' (international normalized ratio), 'aPTT' (activated partial thromboplastin time), and 'thrombocytopenia'...
August 2016: Visc Med
Roger Mulder, Giles Newton-Howes, Jeremy W Coid
Significant efforts have been made to identify risk factors associated with suicide. However, the evidence suggests that risk categorisation may be of limited value, or worse, potentially harmful, confusing clinical thinking. We argue instead for a shift in focus towards real engagement with the individual patient, their specific problems and circumstances.
October 2016: British Journal of Psychiatry: the Journal of Mental Science
Susan B Williams, Michael D Dahnke
Extracorporeal membrane oxygenation (ECMO) is temporary life-support technology that provides time to rest the cardiac and respiratory system of critically ill people with acute, reversible medical conditions. Health care providers face emotional and challenging situations, where death may result, when withdrawing ECMO. A deepening of understanding of the ethical issues involved can aid clinicians in handling such difficult situations, leading to a possible mitigation of the moral problems. Toward this end, the ethical issues raised in the consideration of ECMO withdrawal are analyzed with respect to the ethical principles and concepts of autonomy, nonmaleficence/beneficence, medical futility, moral distress, and justice...
October 2016: Critical Care Nurse
K Lehmann, D Eshmuminov, P Bauerfeind, C Gubler, P Veit-Haibach, A Weber, H Abdul-Rahman, M Fischer, C Reiner, P M Schneider
INTRODUCTION: The accuracy of preoperative lymph-node staging in patients with adenocarcinoma of the esophagogastric junction (AEG) or gastric cancer (GC) is low. The aim of this study was to assess the accuracy of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT) for lymph-node staging in patients with AEG or GC, with or without neoadjuvant treatment. PATIENTS AND METHODS: 221 consecutive patients with GC (n = 88) or AEG (n = 133) were evaluated...
September 7, 2016: European Journal of Surgical Oncology
Andrew Rankin, Samuel J Klempner, Rachel Erlich, James X Sun, Axel Grothey, Marwan Fakih, Thomas J George, Jeeyun Lee, Jeffrey S Ross, Philip J Stephens, Vincent A Miller, Siraj M Ali, Alexa B Schrock
INTRODUCTION: A KRAS mutation represented the first genomic biomarker to predict lack of benefit from anti-epidermal growth factor receptor (EGFR) antibody therapy in advanced colorectal cancer (CRC). Expanded RAS testing has further refined the treatment approach, but understanding of genomic alterations underlying primary and acquired resistance is limited and further study is needed. MATERIALS AND METHODS: We prospectively analyzed 4,422 clinical samples from patients with advanced CRC, using hybrid-capture based comprehensive genomic profiling (CGP) at the request of the individual treating physicians...
September 28, 2016: Oncologist
Lenora Smith, Elaine J Amella, Lynne Nemeth
The purpose of this study was to explore perceptions of home healthcare nurses related to suffering, artificial nutrition and hydration in people with late-stage dementia, and if these perceptions influence care to people with dementia and their families. Part of a mixed-methods study, the qualitative portion examined perceptions of home healthcare nurses in a rural area in the southern United States. Seventeen home healthcare nurses participated in this study. Semistructured focus group interview questions were used...
October 2016: Home Healthcare Now
Belinda A Di Bartolo, MyNgan Duong, Stephen J Nicholls
PURPOSE OF REVIEW: Inhibition of cholesteryl ester transfer protein (CETP) has received considerable interest by virtue of its favorable effects on atherogenic and protective lipid parameters. The impact of CETP inhibitors in large clinical outcome trials will be reviewed. RECENT FINDINGS: Population and genetic studies demonstrate that low CETP activity associates with lower rates of cardiovascular events. Inhibiting CETP activity in animal models has a favorable impact on experimental atherosclerosis...
September 26, 2016: Current Opinion in Lipidology
James Voelker, Paul H Berg, Matthew Sheetz, Kevin Duffin, Tong Shen, Brian Moser, Tom Greene, Samuel S Blumenthal, Ivan Rychlik, Yoram Yagil, Philippe Zaoui, Julia B Lewis
TGF-β has been implicated as a major pathogenic factor in diabetic nephropathy. This randomized, double-blind, phase 2 study assessed whether modulating TGF-β1 activity with a TGF-β1-specific, humanized, neutralizing monoclonal antibody (TGF-β1 mAb) is safe and more effective than placebo in slowing renal function loss in patients with diabetic nephropathy on chronic stable renin-angiotensin system inhibitor treatment. We randomized 416 patients aged ≥25 years with type 1 or type 2 diabetes, a serum creatinine (SCr) level of 1...
September 19, 2016: Journal of the American Society of Nephrology: JASN
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