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Clinical medicine

Paolo Fusar-Poli, Grazia Rutigliano, Daniel Stahl, André Schmidt, Valentina Ramella-Cravaro, Shetty Hitesh, Philip McGuire
Importance: Pretest risk estimation is routinely used in clinical medicine to inform further diagnostic testing in individuals with suspected diseases. To our knowledge, the overall characteristics and specific determinants of pretest risk of psychosis onset in individuals undergoing clinical high risk (CHR) assessment are unknown. Objectives: To investigate the characteristics and determinants of pretest risk of psychosis onset in individuals undergoing CHR assessment and to develop and externally validate a pretest risk stratification model...
October 26, 2016: JAMA Psychiatry
Han Na Kwon, Hyunjung Lim
Serum vitamin D status has been associated with prediabetes and metabolic syndrome. Evidence for the increased risk of metabolic disorders in individuals with prediabetes and a low vitamin D status is limited and uncertain. Furthermore, it has not been confirmed whether this possible relationship occurs in the Korean population. The aim of this study was to assess serum vitamin D status and to examine the relationship between serum vitamin D levels and metabolic risk factors in Korean adults with prediabetes...
2016: PloS One
James P MacDonald, Pierre A dʼHemecourt, Lyle J Micheli
OBJECTIVE: Young athletes not uncommonly complain of back pain. Many patient-reported outcome measures are used to evaluate back pain, but none have been designed specifically to assess young, athletic patients. The Micheli Functional Scale (MFS) was developed to measure impairment due to back pain in this population. This study examined the reliability, validity, and responsiveness of the MFS used in routine clinical assessments. DESIGN: Retrospective Cohort Study...
November 2016: Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine
Jing Luo, An-Lu Wang, Hao Xu, Da-Zhuo Shi, Ke-Ji Chen
Stenosis of the coronary artery has been considered as an essential component of ischemic heart disease (IHD). Consequently, revascularization [e.g., percutaneous coronary intervention (PCI) and coronary artery bypass] has been the primary therapeutic approach to IHD. Such strategy has indeed revolutionized the management of IHD patients. However, not all patients with myocardial ischemia have visible coronary stenosis. Moreover, cardiovascular events occur in nearly 20% patients with stable coronary artery disease who have undergone PCI...
November 2016: Chinese Journal of Integrative Medicine
Rama I Mahran, Magda M Hagras, Duxin Sun, Dean E Brenner
Cancer is still a major cause of death all over the world. Its incidence and prevalence are increasing drastically. Cancer treatment imposes high socioeconomic burden with little impact especially on aggressive types of cancer. Reversing or delaying carcinogenesis "cancer chemoprevention" by purified or extracted natural products is a cost-effective alternative. Curcumin is widely available, inexpensive spice that has been used in ancient folk medicine for millennia, especially in India. Curcumin has the pharmacological properties that slow or reverse cellular proliferation and enhance apoptosis and differentiation associated with a diverse array of molecular effects...
October 25, 2016: AAPS Journal
Lauren A Maggio
INTRODUCTION: Evidence-based medicine (EBM) is an expectation of professional healthcare and a requisite component of medical school curricula. However, upon graduation medical students' EBM skills have been found lacking suggesting a need to examine EBM training. METHODS: This PhD report presents two studies on EBM education. The first study is a literature review that describes and attempts to assess educational interventions for teaching medical students EBM...
October 25, 2016: Perspectives on Medical Education
Matthias Jung, Dan Rujescu
No abstract text is available yet for this article.
October 25, 2016: European Archives of Psychiatry and Clinical Neuroscience
W Reith, S Roumia, P Dietrich
CLINICAL/METHODICAL ISSUE: Cerebellar syndromes result in distinct clinical symptoms, such as ataxia, dysarthria, dysmetria, intention tremor and eye movement disorders. STANDARD RADIOLOGICAL METHODS: In addition to the medical history and clinical examination, imaging is particularly important to differentiate other diseases, such as hydrocephalus and multi-infarct dementia from degenerative cerebellar diseases. Degenerative diseases with cerebellar involvement include Parkinson's disease, multiple system atrophy as well as other diseases including spinocerebellar ataxia...
October 25, 2016: Der Radiologe
Arno K Kumagai, Brittani Jackson, Saleem Razack
Learning the societal roles and responsibilities of the physician may involve difficult, contentious conversations about topics such as race, gender, sexual orientation, and class, as well as violence, inequities, sexual assault, and child abuse. If not done well, these discussions may be deeply traumatizing to learners for whom these subjects "cut close to the bone." Equally traumatizing is exposure to injustice and mistreatment, as well as to the sights, sounds, and smells of suffering and pain in the clinical years...
October 25, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Asmaa N Mohammad, Khairy H Morsy, Moustafa A Ali
BACKGROUND/AIMS: To find the most accurate, suitable, and applicable scoring system for the prediction of outcome in cirrhotic patients with bleeding varices. MATERIALS AND METHODS: A prospective study was conducted comprising 120 cirrhotic patients with acute variceal bleeding who were admitted to Tropical Medicine and Gastroenterology Department in Sohag University Hospital, over a 1-year period (1/2015 to 1/2016). The clinical, laboratory, and endoscopic parameters were studied...
September 2016: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Esmé G Trevelyan, Warren A Turner, Lynn Summerfield-Mann, Nicola Robinson
BACKGROUND: Post amputation, the complication of phantom limb pain (PLP) is prevalent and difficult to manage. This study aimed to determine whether it was feasible and acceptable to undertake a definitive multicentred randomised controlled trial assessing the effectiveness of acupuncture for treating lower limb amputees with PLP. METHODS: A mixed-methods embedded design, including a randomised controlled trial and semistructured interviews, was undertaken. A total of 15 participants with PLP were randomly assigned to receive either eight pragmatic Traditional Chinese Medicine acupuncture treatments and usual care or usual care alone over 4 weeks...
October 25, 2016: Trials
Rowayda M Amin, Mohamed Gowieda, Ahmed Bedda, Ahmed Kamel, Alaa Radwan
PURPOSE: To analyze the patterns and causes of intraocular inflammation in patients attending uveitis referral clinics in Egypt. METHODS: The study included 454 patients with uveitis examined both at the Department of Ophthalmology, Alexandria Faculty of Medicine, and tertiary uveitis referral clinics in Cairo and the International Eye Clinic in Upper Egypt, between August 2013 and March 2016. All patients had a comprehensive ocular examination and systemic work-up...
October 26, 2016: Ocular Immunology and Inflammation
Austin M Faught, Michael Trager, Fang-Fang Yin, John Kirkpatrick, Justus Adamson
PURPOSE: The recent development of multifocal stereotactic radiosurgery (SRS) using a single isocenter volumetric modulated arc theory (VMAT) technique warrants a re-examination of the quality assurance (QA) tolerances for routine mechanical QA recommended by the American Association of Physicists in Medicine Task Group Report Number 142. Multifocal SRS can result in targets with small volumes being at a large off-axis distance from the treatment isocenter. Consequently, angular errors in the collimator, patient support assembly (PSA), or gantry could have an increased impact on target coverage...
October 2016: Medical Physics
Bradley M Dickson, Parker W de Waal, Zachary H Ramjan, H Eric Xu, Scott B Rothbart
In this communication we introduce an efficient implementation of adaptive biasing that greatly improves the speed of free energy computation in molecular dynamics simulations. We investigated the use of accelerated simulations to inform on compound design using a recently reported and clinically relevant inhibitor of the chromatin regulator BRD4 (bromodomain-containing protein 4). Benchmarking on our local compute cluster, our implementation achieves up to 2.5 times more force calls per day than plumed2. Results of five 1 μs-long simulations are presented, which reveal a conformational switch in the BRD4 inhibitor between a binding competent and incompetent state...
October 21, 2016: Journal of Chemical Physics
Matthew J Delano, Peter A Ward
Sepsis occurs when an infection exceeds local tissue containment and induces a series of dysregulated physiologic responses that result in organ dysfunction. A subset of patients with sepsis progress to septic shock, defined by profound circulatory, cellular, and metabolic abnormalities, and associated with a greater mortality. Historically, sepsis-induced organ dysfunction and lethality were attributed to the complex interplay between the initial inflammatory and later anti-inflammatory responses. With advances in intensive care medicine and goal-directed interventions, early 30-day sepsis mortality has diminished, only to steadily escalate long after "recovery" from acute events...
November 2016: Immunological Reviews
Anh Nguyen Duc, Marcel Wolbers
Composite endpoints are widely used as primary endpoints of randomized controlled trials across clinical disciplines. A common critique of the conventional analysis of composite endpoints is that all disease events are weighted equally, whereas their clinical relevance may differ substantially. We address this by introducing a framework for the weighted analysis of composite endpoints and interpretable test statistics, which are applicable to both binary and time-to-event data. To cope with the difficulty of selecting an exact set of weights, we propose a method for constructing simultaneous confidence intervals and tests that asymptotically preserve the family-wise type I error in the strong sense across families of weights satisfying flexible inequality or order constraints based on the theory of χ¯2-distributions...
October 26, 2016: Statistics in Medicine
Yu-Ming Shen, Lien D Le, Rory Wilson, Ulrich Mansmann
BACKGROUND: Biomarkers providing evidence for patient-treatment interaction are key in the development and practice of personalized medicine. Knowledge that a patient with a specific feature - as demonstrated through a biomarker - would have an advantage under a given treatment vs. a competing treatment can aid immensely in medical decision-making. Statistical strategies to establish evidence of continuous biomarkers are complex and their formal results are thus not easy to communicate...
October 26, 2016: Methods of Information in Medicine
Paul McKenna, Brent Thoma, Ken Milne, Chris Bond
As part of the Canadian Journal of Emergency Medicine's (CJEM) developing social media strategy, 1 we are collaborating with the Skeptics' Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine (EM) literature using evidence-based medicine principles. In the "Hot Off the Press" series, we select original research manuscripts published in CJEM to be featured on the SGEM website/podcast 2 and discussed by the study authors and the online EM community. A similar collaboration is underway between the SGEM and Academic Emergency Medicine...
October 26, 2016: CJEM
Rita Turnaturi, Giuseppina Aricò, Giuseppe Ronsisvalle, Lorella Pasquinucci, Carmela Parenti
Polypharmacology, or the associations between two or more drugs producing biological effects on two or more different sites of action could represent a possible therapeutic approach for the clinical management of acute and chronic pain. The multitude and complexity of neuronal mechanisms that contribute to pain transmission provide several possible targets for pharmacological intervention. Thus, multitarget ligands possessing opioid-opioid or non-opioid-opioid mechanisms of action are potential drug candidates for pain relief...
October 24, 2016: Current Medicinal Chemistry
Ioline D Henter, Rafael T de Sousa, Philip W Gold, Andre R Brunoni, Carlos A Zarate, Rodrigo Machado-Vieira
Real-world effectiveness trials suggest that antidepressant efficacy is limited in many patients with mood disorders, underscoring the urgent need for novel therapeutics to treat these disorders. Areas Covered: Here, we review the clinical evidence supporting the use of novel modulators for the treatment of mood disorders, including specific glutamate modulators such as: 1) high-trapping glutamatergic modulators; 2) subunit (NR2B)-specific N-methyl-D-aspartate (NMDA) receptor antagonists; 3) NMDA receptor glycine-site partial agonists; and 4) metabotropic glutamate receptor (mGluR) modulators...
October 26, 2016: Expert Review of Clinical Pharmacology
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