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Goal-directed therapy

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https://www.readbyqxmd.com/read/29785843/insulin-therapy-weight-gain-and-prognosis
#1
REVIEW
Israel Hodish
Insulin therapy is mainly used by patients with type 2 diabetes who have failed other therapeutic modalities and have become insulin deficient. This group of patients represents about a quarter of all patients with type 2 diabetes. Almost all patients with type 2 diabetes who start insulin therapy or intensify it gain weight, which may potentially diminish the prognostic advantage of improved glycaemia. To date, all available guidelines emphasize both the attainment of A1c goals and weight control, without directing clinician which element is of a higher priority...
May 21, 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/29784123/endovascular-interventions-for-venous-disease
#2
REVIEW
Paul O'Connor, Robert Lookstein
Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, occur in up to 900,000 people per year in the United States. Current first-line therapy consists of systemic anticoagulation with a goal to prevent additional thrombus formation. Treatment with anticoagulation alone provides less than satisfactory results with some studies showing propagation of thrombus in almost 40% of cases. Current first-line therapy does not include active removal of thrombus and does little to alleviate acute symptoms and the damaging inflammatory response that may result in postthrombotic syndrome...
June 2018: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29781322/the-impact-of-chronic-kidney-disease-on-medication-choice-and-pharmacologic-management-in-patients-with-heart-failure
#3
Syed Raza Shah, David E Winchester
In the past few years, medical community, including doctors, have become increasingly aware of the fact that chronic kidney disease (CK) and heart failure (HF) have common risk factors which impacts one another in terms of choice of therapy. Areas covered: Management of these two diseases has been a challenge for physicians. The treatment goals for HF patients in CK are very important. They serve as the end-point in using a specific treatment for management and treatment of CK patients hence, decreasing mortality rates...
May 21, 2018: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/29779129/practical-impact-of-a-decision-support-for-goal-directed-fluid-therapy-on-protocol-adherence-a-clinical-implementation-study-in-patients-undergoing-major-abdominal-surgery
#4
Alexandre Joosten, Reda Hafiane, Marco Pustetto, Luc Van Obbergh, Thierry Quackels, Alexis Buggenhout, Jean-Louis Vincent, Brigitte Ickx, Joseph Rinehart
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%...
May 19, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29777616/regenerative-endodontics-a-review
#5
REVIEW
S G Kim, M Malek, A Sigurdsson, L M Lin, B Kahler
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. There is increasing literature on this field since the initial reports of Iwaya et al. (2001) and Banchs & Trope (2004). Endogenous stem cells from an induced periapical bleeding and scaffolds using blood clot, platelet rich plasma or platelet rich fibrin have been utilized in regenerative endodontics. This approach has been described as a 'paradigm shift" and considered the first treatment option for immature teeth with pulp necrosis...
May 19, 2018: International Endodontic Journal
https://www.readbyqxmd.com/read/29774303/myotonia-permanens-with-nav1-4-g1306e-displays-varied-phenotypes-during-course-of-life
#6
Frank Lehmann-Horn, Adele D'Amico, Enrico Bertini, Mauro Lomonaco, Luciano Merlini, Kevin R Nelson, Heike Philippi, Gabriele Siciliano, Frank Spaans, Karin Jurkat-Rott
Introduction: Myotonia permanens due to Nav1.4-G1306E is a rare sodium channelopathy with potentially life-threatening respiratory complications. Our goal was to study phenotypic variability throughout life. Methods: Clinical neurophysiology and genetic analysis were performed. Using existing functional expression data we determined the sodium window by integration. Results: In 10 unrelated patients who were believed to have epilepsy, respiratory disease or Schwartz-Jampel syndrome, we made the same prima facie diagnosis and detected the same heterologous Nav1...
September 2017: Acta Myologica: Myopathies and Cardiomyopathies: Official Journal of the Mediterranean Society of Myology
https://www.readbyqxmd.com/read/29772593/-coagulation-monitoring-and-bleeding-management-in-cardiac-surgery
#7
Berthold Bein, Robert Schiewe
The transfusion of allogeneic blood products is associated with increased morbidity and mortality. An impaired hemostasis is frequently found in patients undergoing cardiac surgery and may in turn cause bleeding and transfusions. A goal directed coagulation management addressing the often complex coagulation disorders needs sophisticated diagnostics. This may improve both patients' outcome and costs. Recent data suggest that coagulation management based on a rational algorithm is more effective than traditional therapy based on conventional laboratory variables such as PT and INR...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29772591/-monitoring-and-modern-hemodynamic-concepts-in-cardiac-anesthesia
#8
Matthias Heringlake, Christian Schmidt, Sebastian Brandt
Patients undergoing cardiac surgery are growing older, present with more comorbidities, and are frequently scheduled for more complex and prolonged surgical procedures. Routine application of neurological as well as extended hemodynamic monitoring combined with goal-directed perioperative hemodynamic optimization, targeting optimization of systemic and cerebral oxygen balance, show promise to reduce postoperative complications and to improve mortality in this high risk population. Expert recommendations suggest to avoid synthetic colloids for fluid optimization...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29772185/therapies-for-mobility-disability-in-persons-with-multiple-sclerosis
#9
Jessica F Baird, Brian M Sandroff, Robert W Motl
Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function...
May 17, 2018: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/29771381/preoperative-vs-postoperative-radiosurgery-for-resected-brain-metastases-a-review
#10
Roshan S Prabhu, Kirtesh R Patel, Robert H Press, Scott G Soltys, Paul D Brown, Minesh P Mehta, Anthony L Asher, Stuart H Burri
Patients who undergo surgical resection of brain metastases are at significant risk of cavity local recurrence without additional radiation therapy. Postoperative stereotactic radiosurgery (SRS) is a method of focal treatment to the cavity to maximize local control while minimizing the risk of neurocognitive detriment associated with whole brain radiation therapy. Recently published randomized trials have demonstrated the benefit of postoperative SRS in terms of cavity tumor control and preserving neurocognition...
May 16, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29770895/implementation-of-goal-directed-therapy-needs-a-boost-and-it-is-called-assisted-fluid-management
#11
EDITORIAL
Paul A van Beest
No abstract text is available yet for this article.
May 16, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29767462/soluble-fiber-use-in-pediatric-short-bowel-syndrome-a-survey-on-prevailing-practices
#12
Meredith Linley Harvie, Margaret Alyssa Tucker Norris, Wednesday Marie A Sevilla
BACKGROUND: In pediatric short bowel syndrome (SBS), adding fiber to enteral feedings is 1 treatment method to manage increased stool output. However, there are no standardized recommendations on the use of fiber in this setting, including type, dosage, titration strategies, etc. OBJECTIVE: The aim of this study is to determine current prevailing practices on the use of fiber in the treatment of chronic high stool output in the pediatric SBS population. METHODS: An anonymous electronic survey with 13 questions was sent through health professional electronic mailing lists...
May 16, 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29761293/stable-but-progressive-nature-of-heart-failure-considerations-for-primary-care-physicians
#13
REVIEW
Inder Anand
Primary care physicians play a significant role in managing heart failure (HF), with the goals of reducing mortality, avoiding hospitalization, and improving patients' quality of life. Most HF-related hospitalizations and deaths occur in patients with New York Heart Association functional class II or III, many of whom are perceived to have stable disease, which often progresses without clinical symptoms due to underlying deleterious effects of neurohormonal imbalance and endothelial dysfunction. Management includes lifestyle changes and stepped pharmacological therapy directed at the four stages of HF, with aggressive uptitration of therapies, including beta-blockers and inhibitors of the renin-angiotensin-aldosterone system...
May 14, 2018: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/29760790/anticancer-properties-of-fenofibrate-a-repurposing-use
#14
REVIEW
Xin Lian, Gang Wang, Honglan Zhou, Zongyu Zheng, Yaowen Fu, Lu Cai
Cancer is a leading cause of death throughout the world, and cancer therapy remains a big medical challenge in terms of both its therapeutic efficacy and safety. Therefore, to find out a safe anticancer drug has been long goal for oncologist and medical scientists. Among clinically used medicines with no or little toxicity, fenofibrate is a drug of the fibrate class that plays an important role in lowering the levels of serum cholesterol and triglycerides while elevating the levels of high-density lipoproteins...
2018: Journal of Cancer
https://www.readbyqxmd.com/read/29760724/adult-neural-stem-cells-basic-research-and-production-strategies-for-neurorestorative-therapy
#15
REVIEW
E M Samoilova, V A Kalsin, N M Kushnir, D A Chistyakov, A V Troitskiy, V P Baklaushev
Over many decades, constructing genetically and phenotypically stable lines of neural stem cells (NSC) for clinical purposes with the aim of restoring irreversibly lost functions of nervous tissue has been one of the major goals for multiple research groups. The unique ability of stem cells to maintain their own pluripotent state even in the adult body has made them into the choice object of study. With the development of the technology for induced pluripotent stem cells (iPSCs) and direct transdifferentiation of somatic cells into the desired cell type, the initial research approaches based on the use of allogeneic NSCs from embryonic or fetal nervous tissue are gradually becoming a thing of the past...
2018: Stem Cells International
https://www.readbyqxmd.com/read/29759030/development-of-human-derived-cell-culture-lines-for-recurrent-respiratory-papillomatosis
#16
James Attra, Li-En Hsieh, Linda Luo, Jun Qin Mo, Matthew Brigger, Yu-Tsueng Liu, Seth Pransky
Recurrent respiratory papillomatosis (RRP) is mainly caused by human papillomavirus (HPV) 6 and 11. While various adjuvant therapies have been reported, no effective therapy has been documented to universally "cure" this disease. In the era of precision medicine, it would be valuable to identify effective intervention based on drug sensitivity testing and/or molecular analysis. It is essential to be able to successfully carry out in vitro culture and expand tumor cells directly from patients to accomplish this goal...
May 1, 2018: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/29758221/inhibition-of-striatal-cholinergic-interneuron-activity-by-the-kv7-opener-retigabine-and-the-nonsteroidal-anti-inflammatory-drug-diclofenac
#17
Rodrigo Manuel Paz, Cecilia Tubert, Agostina Stahl, Analía López Díaz, Roberto Etchenique, Mario Gustavo Murer, Lorena Rela
Striatal cholinergic interneurons provide modulation to striatal circuits involved in voluntary motor control and goal-directed behaviors through their autonomous tonic discharge and their firing "pause" responses to novel and rewarding environmental events. Striatal cholinergic interneuron hyperactivity was linked to the motor deficits associated with Parkinson's disease and the adverse effects of chronic antiparkinsonian therapy like l-DOPA-induced dyskinesia. Here we addressed whether Kv7 channels, which provide negative feedback to excitation in other neuron types, are involved in the control of striatal cholinergic interneuron tonic activity and response to excitatory inputs...
May 11, 2018: Neuropharmacology
https://www.readbyqxmd.com/read/29757934/comparison-of-synthetic-media-designed-for-expansion-of-adipose-derived-mesenchymal-stromal-cells
#18
Michelle Lensch, Angela Muise, Lisa White, Michael Badowski, David Harris
Mesenchymal stromal cells (MSCs) are multipotent cells that can differentiate into various cell types, such as osteoblasts, myocytes, and adipocytes. This characteristic makes the cells a useful tool in developing new therapies for a number of common maladies and diseases. The utilization of animal-derived growth serum, such as fetal bovine serum (FBS), for the expansion of MSCs has traditionally been used for cell culture. However, in clinical applications, animal-derived products present limitations and safety concerns for the recipient, as exposure to animal (xeno-) antigens and infectious agents is possible...
May 14, 2018: Biomedicines
https://www.readbyqxmd.com/read/29756693/multi-parametric-functional-hemodynamic-optimization-improves-postsurgical-outcome-after-intermediate-risk-open-gastrointestinal-surgery-a-randomized-controlled-trial
#19
Pavel Szturz, Pavel Folwarczny, Roman Kula, Jan Neiser, Pavel Ševčík, Jan Benes
BACKGROUND: Perioperative goal directed therapy (pGDT) using flow monitoring has been associated with improved outcomes. However, its protocols are often based on stroke volume only: as a target for fluid loading, inotropic support and vasopresors (via mathematical coupling of systemic vascular resistance). In this trial, we have tested the multi- parametric pGDT protocol based on esophageal Doppler variables (corrected flow time, peak velocity) in intermediate-to-high risk patients undergoing gastrointestinal surgery...
May 11, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29754857/comparison-of-normal-saline-versus-lactated-ringer-s-solution-for-fluid-resuscitation-in-patients-with-mild-acute-pancreatitis-a-randomized-controlled-trial
#20
Sararak Choosakul, Kamin Harinwan, Sakkarin Chirapongsathorn, Krit Opuchar, Theeranun Sanpajit, Wanich Piyanirun, Chaipichit Puttapitakpong
BACKGROUND/OBJECTIVES: Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. However, there are few studies which focus on types of fluid therapy. METHODS: We performed a randomized controlled trial in patients with acute pancreatitis. The patients were randomized into two groups. Each group received Normal Saline solution (NSS) or Lactated Ringer's solution (LRS) through a goal-directed fluid resuscitation protocol. Systemic inflammatory response syndrome (SIRS) at 24 and 48 h, mortality, presence of local complications and inflammatory markers were measured...
May 7, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
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