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81.
Diagnostic Imaging Strategies for Occult Hip Fractures: A Decision and Cost–Effectiveness Analysis
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82.
Nuclear factor of activated T cells balances angiogenesis activation and inhibition 总被引:10,自引:0,他引:10
Zaichuk TA Shroff EH Emmanuel R Filleur S Nelius T Volpert OV 《The Journal of experimental medicine》2004,199(11):1513-1522
83.
Rukshana Shroff Craig Knott Lesley Rees 《Pediatric nephrology (Berlin, Germany)》2010,25(9):1607-1620
Vitamin D deficiency is common in healthy adults and children as well as in the chronic kidney disease (CKD) population. What
was once a disease of malnourished children in the developing world has re-emerged and reached pandemic proportions. In parallel
with this development, there is a growing awareness that vitamin D is not simply a ‘calcaemic hormone’ but plays an important
role in the prevention of cardiovascular disease, infectious and auto-immune conditions, renoprotection, glycaemic control
and prevention of some common cancers. Most tissues in the body have a vitamin D receptor and the enzymatic machinery to convert
‘nutritional’ 25-hydroxyvitamin D to the active form 1,25-dihydroxyvitamin D; it is estimated that 3% of the human genome
is regulated by the vitamin D endocrine system. Although there are few well-conducted studies on the benefits of vitamin D
therapy, an exuberant use of vitamin D is now seen in the general population and at all stages of CKD. There is emerging evidence
that vitamin D may in fact have a therapeutic window, and at least from the effects on the cardiovascular system, more is
not necessarily better. In this review, we discuss the role of nutritional vitamin D (ergocalciferol or cholecalciferol) supplementation
in CKD patients, interpreting the clinical studies in the light of the vitamin D metabolic pathway and its pluripotent effects.
While nutritional vitamin D compounds clearly have numerous beneficial effects, randomised controlled studies are required
to determine the effectiveness and optimal dose at different stages of CKD, its concurrent use with activated vitamin D compounds
and its safety profile. 相似文献
84.
Shazia Adalat Adrian S. Woolf Karen A. Johnstone Andrea Wirsing Lorna W. Harries David A. Long Raoul C. Hennekam Sarah E. Ledermann Lesley Rees William van't Hoff Stephen D. Marks Richard S. Trompeter Kjell Tullus Paul J. Winyard Janette Cansick Imran Mushtaq Harjeeta K. Dhillon Coralie Bingham Emma L. Edghill Rukshana Shroff Horia Stanescu Gerhart U. Ryffel Sian Ellard Detlef Bockenhauer 《Journal of the American Society of Nephrology : JASN》2009,20(5):1123-1131
85.
A Pareek SD Zawar SB Salagre NB Chandurkar ND Karnik 《European journal of medical research》2009,14(7):297-303
Objective
High blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.Methods
Total 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.Results
The study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na+, K+, Cl-)and fasting blood sugar, evident across the treatment groups.Conclusion
Chlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option. 相似文献86.
87.
Surgical treatment for acute symptomatic refractory status epilepticus: a case report 总被引:1,自引:0,他引:1
Mohamed IS Otsubo H Imai K Shroff M Sharma R Chuang SH Donner E Drake J Snead OC 《Journal of child neurology》2007,22(4):435-439
A previously healthy 10-year-old boy developed generalized convulsive status epilepticus following a mild febrile illness. Prolonged video-electroencephalographic monitoring revealed frequent right hemispheric electrographic seizures that were refractory to high-dose suppressive therapy. Ictal and interictal magnetoencephalography demonstrated dipole sources projecting from the right mesial temporal region. Diffusion-weighted imaging showed restricted diffusion involving the right hippocampus. Right anterior temporal lobectomy resulted in cessation of status epilepticus. At 1-year follow-up, he attends regular school and has infrequent nocturnal seizures on chronic antiepileptic drug therapy. Surgical treatment should be considered to stop status epilepticus in selected cases of acute symptomatic refractory status epilepticus with no preexisting epilepsy or magnetic resonance imaging abnormalities and may avoid the complications associated with prolonged high-dose suppressive therapy. 相似文献
88.
Predictive models of complex drug-drug interactions between multiple inhibitors and their metabolites have not been evaluated. The purpose of this study was to evaluate an interaction model for cytochrome P450 3A4 (CYP3A4) that incorporated the simultaneous reversible and irreversible inhibition by multiple inhibitors. Erythromycin (ERY) and diltiazem (DTZ), and their major metabolites, N-desmethylerythromycin (nd-ERY) and N-desmethyldiltiazem (nd-DTZ), were chosen to evaluate the model. k(inact) (rate constant for maximal inactivation), K(I) (inhibitor concentration at 50% maximal inactivation), and K(i) (reversible inhibition constant) were estimated for ERY, DTZ, nd-ERY, and nd-DTZ, respectively, using cDNA-expressed CYP3A4 and human liver microsomes under optimal experimental conditions. To evaluate the interaction model, combinations of inhibitors and metabolites were incubated at concentrations equal to K(I), (1/2)K(I), and 2K(I) of each inhibitor for specified durations in both enzyme systems. The models were further evaluated by the incubation of combinations of inhibitors with the substrate testosterone for 10 min. CYP3A4 inhibition in the presence of drug mixtures was predicted from the inhibition parameters determined for each drug or metabolite alone. The CYP3A4 activity in the presence of multiple inhibitors was well predicted by the model incorporating additive irreversible inhibition as modified by mutual competitive inhibition (percent mean error and percent mean absolute error ranged from -0.06 to 0.04 and from 0.03 to 0.09, respectively). In conclusion, the additive model predicted the combined effect of multiple inhibitors on CYP3A inhibition in vitro. However, simultaneous reversible and irreversible inhibition effects should be taken into account in a reaction mixture of substrate and multiple inhibitors of CYP3A4. 相似文献
89.
PURPOSE: To retrospectively determine and compare the sensitivity and specificity of unenhanced and contrast material-enhanced computed tomography (CT) (reference standard) in the diagnosis of brain abnormalities and to evaluate any change in diagnosis that resulted from the contrast-enhanced study. MATERIALS AND METHODS: This study was approved by the local research ethics board; the requirement for informed consent was waived. The authors reviewed the unenhanced and contrast-enhanced CT scans of the brain obtained in 353 children for indications other than trauma. There were 196 boys and 157 girls aged 0 months to 17.8 years. Scans were read independently by two pediatric neuroradiologists who were blinded to clinical information. The diagnosis for each scan was recorded according to the anatomic section (supratentorial, infratentorial, ventricles, and skull). The final diagnosis was classified as normal, abnormal, or equivocal. kappa Statistics, with 95% confidence intervals, were reported, and the sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: Interreader agreement for different anatomic regions varied between good (kappa coefficient, 0.63) and very good (kappa coefficient, 0.88) for unenhanced and contrast-enhanced scans. Sensitivity, specificity, positive predictive value, and negative predictive value for unenhanced scans were 97%, 89%, 87%, and 97%, respectively. The use of contrast material led to a change in the original normal or equivocal diagnosis to an abnormal diagnosis for only five (2.7%) of the 183 normal unenhanced scans. CONCLUSION: Unenhanced CT of developing brains has high sensitivity and specificity in the diagnosis of pathologic findings. The use of intravenous contrast material after unenhanced CT of the brain in children did not change the diagnosis frequently. 相似文献
90.