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81.
Ronchi CL Varca V Giavoli C Epaminonda P Beck-Peccoz P Spada A Arosio M 《The Journal of clinical endocrinology and metabolism》2005,90(3):1377-1382
Criteria to define remission of acromegaly have changed over years. Since 2000, criteria for cure are normal IGF-I levels and a nadir GH after oral glucose tolerance test (OGTT) of less than 1 microg/liter, although recent studies have suggested to lower this cutoff value. This study reevaluated long-term disease activity of acromegalic patients, who were previously considered in remission, using these criteria. The study included 70 of 146 patients operated on between 1984 and 1996 who were considered cured based on normal IGF-I levels, GH values less than 2.5 microg/liter, and/or disappearance of abnormal GH response to TRH/GnRH. Among these 70 patients, 16 were lost to follow-up, three died, and 11 (one of whom had disease recurrence) only gave a phone interview. Forty patients participated in the study and were reevaluated for IGF-I levels and post-OGTT GH nadir after 14.3 +/- 4.2 (mean +/- sd) yr from surgery. In all patients, normal IGF-I levels and a post-OGTT GH nadir of less than 1 microg/liter were found. In particular, 19 patients had a GH nadir of less than 0.19 microg/liter, i.e. the upper limit (mean + 2 sd) found in 30 controls, whereas 21 patients had a nadir between 0.19 and 0.77 microg/liter. No significant differences in hormonal parameters and comorbidities between the two subgroups were observed. These data showed that lowering the post-OGTT GH cutoff value within the normal range does not seem to better discriminate patients with different disease activity or long-term recurrence risk. 相似文献
82.
Fitzpatrick A Dowling M 《Nursing standard (Royal College of Nursing (Great Britain) : 1987)》2007,22(14-16):35-39
Parenting a child with a learning disability is a unique and often demanding experience. The learning disability nurse can play a key role in supporting parents and families by communicating effectively, providing information and working in partnership. 相似文献
83.
84.
Giavoli C Libé R Corbetta S Ferrante E Lania A Arosio M Spada A Beck-Peccoz P 《The Journal of clinical endocrinology and metabolism》2004,89(11):5397-5401
The aim of the study was to evaluate the hypothalamus-pituitary-adrenal (HPA) axis in patients (nine males, three females; mean age +/- sem 51 +/- 2 yr) with adult-onset GH deficiency (GHD) due to surgically treated pituitary tumors with preserved HPA function and without evidence of tumor recurrence before and during recombinant human (rh) GH replacement therapy (duration 31 +/- 6 months). HPA function was assessed by urinary free cortisol and morning serum cortisol levels as well as cortisol responses to 1 mug ACTH test (n = 7 patients) or insulin tolerance test (n = 5 patients) before and during rhGH therapy, the cut-off for the diagnosis of hypoadrenalism being a cortisol peak less than 18 microg/dl (<500 nmol/liter) after stimulatory tests. Serum cortisol and urinary free cortisol levels were significantly lower on therapy than before [7.6 +/- 0.8 vs. 11.5 +/- 0.9 microg/dl (208 +/- 22 vs. 317 +/- 24 nmol/liter), P < 0.01, and 19.6 +/- 2.5 vs. 32.2 +/- 3.2 microg per 24 h (54 +/- 7 vs. 89 +/- 9 nmol per 24 h), P < 0.05, respectively], whereas no change in cortisol-binding globulin levels was observed. Cortisol peak after either ACTH test or insulin tolerance test was lower on rhGH therapy than before [15.9 +/- 1.5 vs. 20.2 +/- 1.1 microg/dl (437 +/- 43 vs. 557 +/- 31), P = 0.01, and 13.1 +/- 2.6 vs. 20.4 +/- 1.4 microg/dl (362 +/- 71 vs. 564 +/- 37 nmol/liter), P = 0.03, respectively]. Accordingly, central hypoadrenalism was detected in nine of 11 patients. In conclusion, low GH and IGF-I levels, likely enhancing the conversion of cortisone to cortisol, may mask a condition of central hypoadrenalism. Therefore, the reassessment of HPA function in GHD patients during rhGH therapy is mandatory. 相似文献
85.
Joshi Gagan DiSalvo Maura Faraone Stephen V. Wozniak Janet Fried Ronna Galdo Maribel Belser Abigail Hoskova Barbora Dallenbach Nina T. De Leon Melissa F. Biederman Joseph 《European child & adolescent psychiatry》2020,29(6):791-801
European Child & Adolescent Psychiatry - The objective of this study was to investigate the stability and predictive utility of autistic traits (ATs) in youth with... 相似文献
86.
Mandrioli Jessica Zucchi Elisabetta Martinelli Ilaria Van der Most Laura Gianferrari Giulia Moglia Cristina Manera Umberto Solero Luca Vasta Rosario Canosa Antonio Grassano Maurizio Brunetti Maura Mazzini Letizia De Marchi Fabiola Simonini Cecilia Fini Nicola Tupler Rossella Vinceti Marco Chiò Adriano Calvo Andrea 《Journal of neurology》2023,270(2):877-890
Journal of Neurology - To unveil clinical features, comorbidities, disease progression and prognostic factors in a population-based cohort of ALS patients carrying C9ORF72 expansion... 相似文献
87.
Robert W. McConkey RANP RNP MSc BSc PG Dip PG Cert Therese Kelly RANP RNP MSc PG Dip PG Cert Rachael Dalton RANP RNT RNP MSc BSc PG Dip Geraldine Rooney cANP RNP BSc PG Dip PG Cert Michelle Healy cANP BSc PG Cert Louise Murphy PhD BSc PG Dip RPN RNT Maura Dowling PhD MSc RGN RNT 《International Journal of Urological Nursing》2023,17(1):78-83
Evidence based practice is essential to advanced practice nursing, enabling the delivery of quality care and improved patient outcomes. As the name suggests, it requires healthcare decisions to be based on the best available and current evidence. Advanced practice nurses need astute critical analysis skills to appraise the evolving literature, and require research skills to lead on scientific inquiry and develop the profession. Yet, advanced practice nurses may not recognize themselves as research leaders. Participation in a journal club can promote evidence-based practice, improve clinician's critical thinking skills, and expose members to different research methodologies, however, nurses continue to face barriers to participation in these clubs. Establishing a clinical-academic partnership appears to be both mutually beneficial for clinicians and academics and is a significant enabler in the sustainability and functioning of the club through sharing expertise and experience. A supportive workplace culture is favourable to research utilization and knowledge translation. This paper outlines the role, practicalities, challenges, and benefits of setting up a hybrid urology journal and research club for advanced practice nurses in a clinical-academic partnership. 相似文献
88.
Ernesto Paoletti Luca De Nicola Francis B. Gabbai Paolo Chiodini Maura Ravera Laura Pieracci Sonia Marre Paolo Cassottana Sergio Lucà Simone Vettoretti Silvio Borrelli Giuseppe Conte Roberto Minutolo 《Clinical journal of the American Society of Nephrology》2016,11(2):271-279
Background and objectives
Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive.Design, setting, participants, & measurements
We enrolled 445 patients with hypertension and CKD stages 2–5 in two academic nephrology clinics in 1999–2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m2 [women] and >131 g/m2 [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death).Results
Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m2. LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04–15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk.Conclusions
In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry. 相似文献89.
90.
Federico M Luminari S Gobbi PG Sacchi S Di Renzo N Lombardo M Merli F Baldini L Stelitano C Partesotti G Polimeno G Montanini A Mammi C Brugiatelli M 《European journal of haematology》2006,76(3):217-229
OBJECTIVES: To compare two different schedules of two different anthracycline-containing regimens, where length of treatment is modulated according to the international prognostic index (IPI) in patients with aggressive non-Hodgkin's Lymphoma (NHL). METHODS: In 1993 the Gruppo Italiano per lo Studio dei Linfomi (GISL) started a randomized 2 x 2 factorial phase III clinical trial for patients with newly diagnosed aggressive NHL comparing ProME(Epidoxorubicin)CE-CytaBOM (PE-C) to ProMI(Idarubicin)CE-CytaBOM (PI-C) and a fixed to a flexible treatment schedule where anthracycline dose was to be modulated according to observed hematological toxicity. Patients with low or low-intermediate IPI (IPI 0-2) and those with intermediate-high or high IPI (IPI 3-5) should receive six or eight courses, respectively. Involved-field radiotherapy was allowed for patients with initial bulky disease or with residual masses. RESULTS: Three hundred and fifty-six patients were registered into the study and randomized. Patients were well balanced among the four study arms in terms of clinical characteristics and prognostic factors. Three hundred and forty-five patients were available for evaluation of study endpoints. At the end of induction therapy complete remission rate was 61%, 5-year failure-free survival (FFS) rate was 40% and 5-year overall survival (OS) rate was 59%; no differences were observed according to treatment arms. Patients in the flexible arm received higher dose intensity of anthracycline (P < 0.001) with no apparent increase in toxicity. However, the flexible schedule was not superior to the fixed one. Patients with IPI 3-5 showed lower response rates (45% vs. 67%: P < 0.0001) and lower 5-year FFS (29% vs. 45%: P < 0.0001) compared to those with IPI 0-2. CONCLUSIONS: six courses of fixed or flexible PE-C or PI-C can determine a promising success rate in patients with advanced aggressive NHL with IPI 0-2, whereas the same regimens are less effective in patients with IPI 3-5, even if two additional courses are delivered. For the latter group of patients innovative approaches are warranted. 相似文献