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https://www.readbyqxmd.com/read/28932574/lung-allocation
#1
REVIEW
Jens Gottlieb
Shortage of donor lungs in most western countries and broadening of indications for lung transplantation (LTx) has led increased waiting list mortality in the past. Usually donor lungs and recipients are matched by size as measured by total lung capacity and blood type in first order. In some countries regional allocation comes first, in other countries a national wait list exists and some nations are organized in supranational allocation systems. Organ distribution should respect the ethical principles of equity, justice, beneficence and utility...
August 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28927764/how-to-value-patient-values-cesarean-sections-for-the-periviable-fetus-and-home-births
#2
REVIEW
Howard Minkoff, Fouad Atallah
Respect for patient autonomy involves providing sufficient information to patients to allow them to make informed decisions, and then honoring their requests unless they are unethical or futile. At times, the factors that patients consider may not be purely biologic ones but rather will include "spiritual" factors (a sense of control in a home birth). When patients balance biologic risks against spiritual gain, physicians may not be comfortable giving deference to patients' choice. In order to explicate this issue we explore two clinical scenarios: home birth, and cesarean section for a periviable fetus; and we consider futility and limits on affirmative autonomy...
September 15, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28922791/targeting-hypoxia-to-improve-non-small-cell-lung-cancer-outcome
#3
Ahmed Salem, Marie-Claude Asselin, Bart Reymen, Alan Jackson, Philippe Lambin, Catharine M L West, James P B O'Connor, Corinne Faivre-Finn
Oxygen deprivation (hypoxia) in non-small cell lung cancer (NSCLC) is an important factor in treatment resistance and poor survival. Hypoxia is an attractive therapeutic target, particularly in the context of radiotherapy, which is delivered to more than half of NSCLC patients. However, NSCLC hypoxia-targeted therapy trials have not yet translated into patient benefit. Recently, early termination of promising evofosfamide and tarloxotinib bromide studies due to futility highlighted the need for a paradigm shift in our approach to avoid disappointments in future trials...
January 1, 2018: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/28918795/-acute-on-chronic-liver-failure
#4
Nikolaj Worm Ørntoft, Karen Louise Thomsen, Gitte Dam, Niels Kristian Aagaard, Henning Grønbæk
Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute decompensation of liver cirrhosis, organ failure and high short-term mortality (20-80% at one month). The main precipitants are infections and excessive alcohol intake, and the mechanistic features include a high level of systemic inflammation, macrophage activation and liver injury. The severity of ACLF is graded according to the number and extent of organ failures. Prognostic scores help predict mortality and support decisions on intensive treatment or futility...
September 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28918118/case-report-aquatic-therapy-and-end-stage-dementia
#5
Bruce E Becker, Stacy Lynch
A 54-year old female, retired due to progressive cognitive decline, was diagnosed with early-onset Alzheimer's dementia. Conventional medication therapy for dementia had proven futile. Initial evaluation revealed a non-verbal female seated in a wheelchair, dependent on 2-person assist for all transfers and activities of daily living (ADLs.) She had been either non-responsive or actively resistive for both ADLs and transfers in the 6 months prior to assessment. Following a total of 17 one hour therapy sessions over 19 weeks in a warm water therapy pool, she achieved ability to tread water for 15 minutes, transfers improved to moderate to-maximum assist from seated, ambulation improved to 1000' with minimum-to-moderate assist of 2 persons...
September 13, 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28917544/effects-on-the-incidence-of-cardiovascular-events-of-the-addition-of-pioglitazone-versus-sulfonylureas-in-patients-with-type-2-diabetes-inadequately-controlled-with-metformin-tosca-it-a-randomised-multicentre-trial
#6
Olga Vaccaro, Maria Masulli, Antonio Nicolucci, Enzo Bonora, Stefano Del Prato, Aldo P Maggioni, Angela A Rivellese, Sebastiano Squatrito, Carlo B Giorda, Giorgio Sesti, Paolo Mocarelli, Giuseppe Lucisano, Michele Sacco, Stefano Signorini, Fabrizio Cappellini, Gabriele Perriello, Anna Carla Babini, Annunziata Lapolla, Giovanna Gregori, Carla Giordano, Laura Corsi, Raffaella Buzzetti, Gennaro Clemente, Graziano Di Cianni, Rossella Iannarelli, Renzo Cordera, Olga La Macchia, Chiara Zamboni, Cristiana Scaranna, Massimo Boemi, Ciro Iovine, Davide Lauro, Sergio Leotta, Elisabetta Dall'Aglio, Emanuela Cannarsa, Laura Tonutti, Giuseppe Pugliese, Antonio C Bossi, Roberto Anichini, Francesco Dotta, Antonino Di Benedetto, Giuseppe Citro, Daniela Antenucci, Lucia Ricci, Francesco Giorgino, Costanza Santini, Agostino Gnasso, Salvatore De Cosmo, Donatella Zavaroni, Monica Vedovato, Agostino Consoli, Maria Calabrese, Paolo di Bartolo, Paolo Fornengo, Gabriele Riccardi
BACKGROUND: The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. METHODS: TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy...
September 12, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28916726/the-nqo1-bioactivatable-drug-%C3%AE-lapachone-alters-the-redox-state-of-nqo1-pancreatic-cancer-cells-causing-perturbation-in-central-carbon-metabolism
#7
Molly A Silvers, Stanislaw Deja, Naveen Singh, Robert A Egnatchik, Jessica Sudderth, Xiuquan Luo, Muhammad S Beg, Shawn C Burgess, Ralph J DeBerardinis, David A Boothman, Matthew E Merritt
Many cancer treatments, such as those for managing recalcitrant tumors like pancreatic ductal adenocarcinoma, cause off-target toxicities in normal, healthy tissue, highlighting the need for more tumor-selective chemotherapies. β-Lapachone is bioactivated by NAD(P)H:quinone oxidoreductase 1 (NQO1). This enzyme exhibits elevated expression in most solid cancers and therefore is a potential cancer-specific target. β-Lapachone's therapeutic efficacy partially stems from the drug's induction of a futile NQO1-mediated redox cycle that causes high levels of superoxide, then peroxide formation, which damages DNA and causes hyperactivation of poly (ADP-ribose) polymerase (PARP), resulting in extensive NAD+/ATP depletion...
September 15, 2017: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/28914279/blood-products-provided-to-patients-receiving-futile-critical-care
#8
Thanh H Neville, Alyssa Ziman, Neil S Wenger
The number of hospitalized patients receiving treatment perceived to be futile is not insignificant. Blood products are valuable resources that are donated to help others in need. We aimed to quantify the amount of blood transfused into patients who were receiving treatment that the critical care physician treating them perceived to be futile. During a 3-month period, critical care physicians in 5 adult intensive care units completed a daily questionnaire to identify patients perceived as receiving futile treatment...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28911327/negotiating-power-relations-gender-equality-and-collective-agency-are-village-health-committees-transformative-social-spaces-in-northern-india
#9
Kerry Scott, Asha S George, Steven A Harvey, Shinjini Mondal, Gupteswar Patel, Kabir Sheikh
BACKGROUND: Participatory health initiatives ideally support progressive social change and stronger collective agency for marginalized groups. However, this empowering potential is often limited by inequalities within communities and between communities and outside actors (i.e. government officials, policymakers). We examined how the participatory initiative of Village Health, Sanitation, and Nutrition Committees (VHSNCs) can enable and hinder the renegotiation of power in rural north India...
September 15, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28910418/the-effect-of-s-substitution-at-the-o6-guanine-site-on-the-structure-and-dynamics-of-a-dna-oligomer-containing-a-g-t-mismatch
#10
Elaine Ann Moore, Yao-Zhong Xu
The effect of S-substitution on the O6 guanine site of a 13-mer DNA duplex containing a G:T mismatch is studied using molecular dynamics. The structure, dynamic evolution and hydration of the S-substituted duplex are compared with those of a normal duplex, a duplex with S-substitution on guanine, but no mismatch and a duplex with just a G:T mismatch. The S-substituted mismatch leads to cell death rather than repair. One suggestion is that the G:T mismatch recognition protein recognises the S-substituted mismatch (GS:T) as G:T...
2017: PloS One
https://www.readbyqxmd.com/read/28906251/centriole-triplet-microtubules-are-required-for-stable-centriole-formation-and-inheritance-in-human-cells
#11
Jennifer T Wang, Dong Kong, Christian R Hoerner, Jadranka Loncarek, Tim Stearns
Centrioles are composed of long-lived microtubules arranged in nine triplets. However, the contribution of triplet microtubules to mammalian centriole formation and stability is unknown. Little is known of the mechanism of triplet microtubule formation, but experiments in unicellular eukaryotes indicate that delta-tubulin and epsilon-tubulin, two less-studied tubulin family members, are required. Here, we report that centrioles in delta-tubulin and epsilon-tubulin null mutant human cells lack triplet microtubules and fail to undergo centriole maturation...
September 14, 2017: ELife
https://www.readbyqxmd.com/read/28905989/assessment-of-futility-in-out-of-hospital-cardiac-arrest
#12
P Setälä, S Hoppu, I Virkkunen, A Yli-Hankala, A Kämäräinen
BACKGROUND: Our aim was to evaluate the impact of futile resuscitation attempts to the outcome calculations of attempted resuscitation in out-of-hospital cardiac arrest (OHCA). Defined as partial resuscitations, we focused on a subgroup of patients in whom cardiopulmonary resuscitation (CPR) was initiated, but further efforts were soon abandoned due to evidence of futility. METHODS: We conducted this study using the Utstein template during a 12-month study period...
September 14, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28904078/towards-a-systems-approach-to-human-cytochrome-p450-ensemble-interactions-between-cyp2d6-and-cyp2e1-and-their-functional-consequences
#13
Dmitri R Davydov, Nadezhda Y Davydova, John T Rodgers, Thomas H Rushmore, Jeffrey P Jones
Functional cross-talk among human drug-metabolizing cytochromes P450 through their association is a topic of emerging importance. Here we studied the interactions of human CYP2D6, a major metabolizer of psychoactive drugs, with one of the most prevalent human P450 enzymes, ethanol-inducible CYP2E1. Detection of P450-P450 interactions was accomplished through luminescence resonance energy transfer (LRET) between labeled proteins incorporated into human liver microsomes and the microsomes of insect cells containing NADPH-cytochrome P450 reductase...
September 13, 2017: Biochemical Journal
https://www.readbyqxmd.com/read/28898482/impact-of-renal-replacement-therapy-on-survival-in-patients-with-kdigo-stage-3-acute-kidney-injury-a-propensity-score-matched-analysis
#14
Hoi-Ping Shum, King-Chung Chan, Catherine Wing-Yan Tam, Wing-Wa Yan, Tak Mao Chan
PURPOSE: To investigate the impact of renal replacement therapy (RRT) on 90-day mortality in critically ill patients suffering from KDIGO stage 3 acute kidney injury (AKI) with or without life-threatening complications using propensity score matching analysis. MATERIAL AND METHODS: We conducted a retrospective analysis of critically ill adult patients with KDIGO Stage 3 AKI with or without RRT during ICU stay between 1/1/2011-31/12/2013. Cox regression analysis and propensity score matching methods were used to determine predictors for 90-day mortality...
September 12, 2017: Nephrology
https://www.readbyqxmd.com/read/28895204/liver-transplantation-in-critically-ill-patients-preoperative-predictive-factors-of-post-transplant-mortality-to-avoid-futility
#15
Baptiste Michard, Thierry Artzner, Benjamin Lebas, Camille Besch, Max Guillot, François Faitot, François Lefebvre, Philippe Bachellier, Vincent Castelain, Quentin Maestraggi, Francis Schneider
Liver transplant (LT) is often the only life-saving therapeutic option for patients with acute liver failure (ALF) (i.e. without prior liver disease) and for acute-on-chronic liver failure (ACLF). With the progressive introduction of the model for end-stage liver disease (MELD) score in liver transplantation allocation algorithms (since 2007 in France), a new paradigm has begun to emerge based on the idea of prioritizing transplant allocations to patients who are more acutely ill and with the highest MELD scores...
September 12, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28892278/reflection-on-stroke-deaths-and-end-of-life-stroke-care
#16
Syed Zujajuddin Quadri, Thang Huynh, Cecilia Cappelen-Smith, Nirupama Wijesuriya, Abul Mamun, Roy Beran, Alan Mcdougall, Dennis Cordato
BACKGROUND: The benefit of palliative care referral for severe stroke patients on end-of-life care pathways (EOLCP) is increasingly recognised. Palliative care provides assistance with symptom management and transition to end-of-life care. Advance care planning (ACP) may help accommodate patient/family expectations and guide management. METHOD: Retrospective study of all stroke deaths (2014-2015) at Liverpool Hospital, Sydney, Australia. Data examined included age, co-morbidities, living arrangements, pre-existing ACP, palliative care referral rates and 'survival time'...
September 11, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28890410/positron-emission-tomography-modalities-prevent-futile-radical-resection-of-pancreatic-cancer-a-meta-analysis
#17
REVIEW
L Wang, P Dong, W G Wang, B L Tian
BACKGROUND: Numerous distant metastases were not detected preoperatively. Positron emission tomography (PET) has been used for oncology diagnosis recently. However, it remains controversial whether PET modality is a more efficient way in detecting unresectable features for radical resection of pancreatic cancer (PC). This meta-analysis aims to validate the efficiency of PET modalities (including PET and PET/CT) in preoperative assessment of PC, and compare them with computed tomography (CT)...
September 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28885062/out-of-hospital-cardiac-arrest-always-coronary-angiography
#18
Andrea Rognoni, Chiara Cavallino, Marco Giovanni Mennuni, Lucia Barbieri, Roberta Rosso, Francesco Rametta, Federico Nardi, Alessandro Lupi, Angelo Sante Bongo
Out-of-hospital cardiac arrest (OHCA) remains one of the principle challenges in the setting of critical care medicine and emergency cardiology. Areas covered: Long-term survival rates even after successful resuscitation are variable but increasing in the recent years; due to the improvement of base and advanced cardiac life support techniques an increasing number of resuscitated patients are admitted to the hospital. Recent data suggested that patients surviving to hospital discharge after OHCA presented long-term outcome similar to patients with ST-elevation myocardial infarction...
September 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28881383/processes-of-code-status-transitions-in-hospitalized-patients-with-advanced-cancer
#19
Areej El-Jawahri, Kelsey Lau-Min, Ryan D Nipp, Joseph A Greer, Lara N Traeger, Samantha M Moran, Sara M D'Arpino, Ephraim P Hochberg, Vicki A Jackson, Barbara J Cashavelly, Holly S Martinson, David P Ryan, Jennifer S Temel
BACKGROUND: Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. METHODS: We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR...
September 7, 2017: Cancer
https://www.readbyqxmd.com/read/28878105/percutaneous-balloon-dilation-of-discrete-subaortic-stenosis-a-futile-exercise
#20
Nagaraja Moorthy, Rajiv Ananthakrishna, Dattatreya P V Rao, Satvic C Manjunath, Manjunath C Nanjappa
Discrete subaortic stenosis (DSS) is a progressive obstruction of left ventricular outflow tract (LVOT) resulting in the development of aortic regurgitation in its natural course. Hence, early intervention is recommended. Percutaneous balloon dilation of DSS has been reported and can substantially reduce LVOT pressure gradient. The response to balloon dilation of DSS is transient and may complicate with chordal or papillary muscle rupture. Hence, balloon dilation of DSS should be discouraged.
September 2017: Journal of Invasive Cardiology
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