Jeffrey L Saver, Mayank Goyal, Alain Bonafe, Hans-Christoph Diener, Elad I Levy, Vitor M Pereira, Gregory W Albers, Christophe Cognard, David J Cohen, Werner Hacke, Olav Jansen, Tudor G Jovin, Heinrich P Mattle, Raul G Nogueira, Adnan H Siddiqui, Dileep R Yavagal, Blaise W Baxter, Thomas G Devlin, Demetrius K Lopes, Vivek K Reddy, Richard du Mesnil de Rochemont, Oliver C Singer, Reza Jahan
BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group)...
June 11, 2015: New England Journal of Medicine
P J Devereaux, Homer Yang, Salim Yusuf, Gordon Guyatt, Kate Leslie, Juan Carlos Villar, Denis Xavier, Susan Chrolavicius, Launi Greenspan, Janice Pogue, Prem Pais, Lisheng Liu, Shouchun Xu, German Málaga, Alvaro Avezum, Matthew Chan, Victor M Montori, Mike Jacka, Peter Choi
BACKGROUND: Trials of beta blockers in patients undergoing non-cardiac surgery have reported conflicting results. This randomised controlled trial, done in 190 hospitals in 23 countries, was designed to investigate the effects of perioperative beta blockers. METHODS: We randomly assigned 8351 patients with, or at risk of, atherosclerotic disease who were undergoing non-cardiac surgery to receive extended-release metoprolol succinate (n=4174) or placebo (n=4177), by a computerised randomisation phone service...
May 31, 2008: Lancet
Angelika Reissig, Roberto Copetti, Gebhard Mathis, Christine Mempel, Andreas Schuler, Peter Zechner, Stefano Aliberti, Rotraud Neumann, Claus Kroegel, Heike Hoyer
BACKGROUND: The aim of this prospective, multicenter study was to define the accuracy of lung ultrasound (LUS) in the diagnosis of community-acquired pneumonia (CAP). METHODS: Three hundred sixty-two patients with suspected CAP were enrolled in 14 European centers. At baseline, history, clinical examination, laboratory testing, and LUS were performed as well as the reference test, which was a radiograph in two planes or a low-dose CT scan in case of inconclusive or negative radiographic but positive LUS findings...
October 2012: Chest
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. METHODS: We conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care...
April 2, 2015: New England Journal of Medicine
Georgios Tsakos, Richard G Watt, Patrick L Rouxel, Cesar de Oliveira, Panayotes Demakakos
OBJECTIVES: To examine the effect of total tooth loss (edentulousness) on decline in physical and cognitive functioning over 10 years in older adults in England. DESIGN: Secondary data analysis. SETTING: English Longitudinal Study of Ageing, a national prospective cohort study of community-dwelling people aged 50 and older. PARTICIPANTS: Individuals aged 60 and older (N = 3,166). MEASUREMENTS: Cognitive function (memory) was measured using a 10-word recall test...
January 2015: Journal of the American Geriatrics Society
Claire Colmant, Michèle Morin-Surroca, Florent Fuchs, Hervé Fernandez, Marie-Victoire Senat
Early prenatal diagnosis of fetal sex is necessary to optimize pregnancy management in families known to be at risk of some heritable disorders. The demonstration of cell-free fetal DNA (cffDNA) in the mother's blood has made it possible to identify Y chromosome sequences in maternal blood and to determine fetal sex noninvasively, during the first trimester. This procedure can significantly reduce the number of invasive procedures for women with fetuses at risk of sex-linked diseases and optimize the management of these pregnancies...
December 2013: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Françoise Van Bambeke
Lipoglycopeptide, ketolide, and quinolone antibiotics are currently in clinical development, with specific advantages over available molecules within their respective classes. The lipoglycopeptide oritavancin is bactericidal against MRSA, vancomycin-resistant enterococci, and multiresistant Streptococcus pneumoniae, and proved effective and safe for the treatment of acute bacterial skin and skin structure infection (ABSSSI) upon administration of a single 1200 mg dose (two completed phase III trials). The ketolide solithromycin (two phase III studies recruiting for community-acquired pneumonia) shows a profile of activity similar to that of telithromycin, but in vitro data suggest a lower risk of hepatotoxicity, visual disturbance, and aggravation of myasthenia gravis due to reduced affinity for nicotinic receptors...
November 2014: Annals of Medicine
Virginia A Moyer
DESCRIPTION: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for and treatment of hepatitis C virus (HCV) infection in asymptomatic adults. METHODS: The Agency for Healthcare Research and Quality commissioned 2 systematic reviews on screening for and treatment of HCV infection in asymptomatic adults, focusing on evidence gaps identified in the previous USPSTF recommendation and new studies published since 2004. The evidence on screening for HCV in pregnant women was also considered...
September 3, 2013: Annals of Internal Medicine
Laurent M Haegeli, Hugh Calkins
Catheter ablation of atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. There is considerable evidence available from several prospective randomized trials demonstrating that catheter ablation of AF is superior to antiarrhythmic drug therapy in controlling AF and that AF ablation improves quality of life substantially. This is especially true for patients with paroxysmal AF without other severe comorbidities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed...
September 21, 2014: European Heart Journal
Igor Gosev, Marzia Leacche
No abstract text is available yet for this article.
September 9, 2014: Circulation
Donna R Parker, Bing Lu, Megan Sands-Lincoln, Candyce H Kroenke, Cathy C Lee, Mary O'Sullivan, Hannah L Park, Nisha Parikh, Robert S Schenken, Charles B Eaton
PURPOSE: Metabolic, hormonal, and hemostatic changes associated with pregnancy loss (stillbirth and miscarriage) may contribute to the development of cardiovascular disease (CVD) in adulthood. This study evaluated prospectively the association between a history of pregnancy loss and CVD in a cohort of postmenopausal women. METHODS: Postmenopausal women (77,701) were evaluated from 1993-1998. Information on baseline reproductive history, sociodemographic, and CVD risk factors were collected...
July 2014: Annals of Family Medicine
P McGale, C Taylor, C Correa, D Cutter, F Duane, M Ewertz, R Gray, G Mannu, R Peto, T Whelan, Y Wang, Z Wang, S Darby
BACKGROUND: Postmastectomy radiotherapy was shown in previous meta-analyses to reduce the risks of both recurrence and breast cancer mortality in all women with node-positive disease considered together. However, the benefit in women with only one to three positive lymph nodes is uncertain. We aimed to assess the effect of radiotherapy in these women after mastectomy and axillary dissection. METHODS: We did a meta-analysis of individual data for 8135 women randomly assigned to treatment groups during 1964-86 in 22 trials of radiotherapy to the chest wall and regional lymph nodes after mastectomy and axillary surgery versus the same surgery but no radiotherapy...
June 21, 2014: Lancet
Salimah H Meghani, Youjeong Kang, Jesse Chittams, Erin McMenamin, Jun J Mao, Jeffrey Fudin
PURPOSE: Renal impairment is highly prevalent among patients with cancer, and many patients have undiagnosed chronic kidney disease (CKD) from underlying disease, treatment, or both. African American individuals have disproportionate risk factors (diabetes, hypertension) predisposing them to CKD. We investigated whether African American patients are more likely than white patients to receive morphine with 3- and 6-glucuronide metabolites, which are known to be neurotoxic and accumulate in CKD; whether insurance type mediates the relationship between race and the prescriber's opioid selection; and whether the chosen opioid has a resultant negative effect according to race...
September 1, 2014: Journal of Clinical Oncology
Timothy J Henrich, Emily Hanhauser, Francisco M Marty, Michael N Sirignano, Sheila Keating, Tzong-Hae Lee, Yvonne P Robles, Benjamin T Davis, Jonathan Z Li, Andrea Heisey, Alison L Hill, Michael P Busch, Philippe Armand, Robert J Soiffer, Marcus Altfeld, Daniel R Kuritzkes
BACKGROUND: It is unknown whether the reduction in HIV-1 reservoirs seen after allogeneic hematopoietic stem cell transplantation (HSCT) with susceptible donor cells is sufficient to achieve sustained HIV-1 remission. OBJECTIVE: To characterize HIV-1 reservoirs in blood and tissues and perform analytic antiretroviral treatment interruptions to determine the potential for allogeneic HSCT to lead to sustained, antiretroviral-free HIV-1 remission. DESIGN: Case report with characterization of HIV-1 reservoirs and immunity before and after antiretroviral interruption...
September 2, 2014: Annals of Internal Medicine
Kevin D Mullen, Arun J Sanyal, Nathan M Bass, Fred F Poordad, Muhammad Y Sheikh, R Todd Frederick, Enoch Bortey, William P Forbes
BACKGROUND & AIMS: Rifaximin is a gut-selective, oral antimicrobial agent shown to reduce the recurrence of overt hepatic encephalopathy (HE) and HE-related hospitalizations in a 6-month, randomized, controlled trial (RCT). We performed a phase 3, open-label maintenance study to assess the safety and rate of hospitalization with long-term rifaximin use. METHODS: We conducted a 24-month, open-label maintenance study of rifaximin (550 mg, twice daily) in patients with HE who participated in the previous RCT of rifaximin or new patients enrolled from March 2007 to December 2010...
August 2014: Clinical Gastroenterology and Hepatology
Gilles Montalescot, Leonardo Bolognese, Dariusz Dudek, Patrick Goldstein, Christian Hamm, Jean-Francois Tanguay, Jurrien M ten Berg, Debra L Miller, Timothy M Costigan, Jochen Goedicke, Johanne Silvain, Paolo Angioli, Jacek Legutko, Margit Niethammer, Zuzana Motovska, Joseph A Jakubowski, Guillaume Cayla, Luigi Oltrona Visconti, Eric Vicaut, Petr Widimsky
BACKGROUND: Although P2Y12 antagonists are effective in patients with non-ST-segment elevation (NSTE) acute coronary syndromes, the effect of the timing of administration--before or after coronary angiography--is not known. We evaluated the effect of administering the P2Y12 antagonist prasugrel at the time of diagnosis versus administering it after the coronary angiography if percutaneous coronary intervention (PCI) was indicated. METHODS: We enrolled 4033 patients with NSTE acute coronary syndromes and a positive troponin level who were scheduled to undergo coronary angiography within 2 to 48 hours after randomization...
September 12, 2013: New England Journal of Medicine
Kelly A Woodall, Isabel G Jacobson, Nancy F Crum-Cianflone
BACKGROUND: Motor vehicle crashes (MVCs) continue to account for a third of service member fatalities each year. Sociodemographic factors associated with MVCs among service members have been evaluated, but whether deployment-specific experiences during the recent operations are associated with a higher risk of MVCs is unclear. PURPOSE: Evaluate if military members with specific deployment experiences are at an increased risk of MVCs, while taking into account several potential confounders...
April 2014: American Journal of Preventive Medicine
Aneesha Nilakantan, Jarred Younger, Arthur Aron, Sean Mackey
OBJECTIVE: Individuals involved in the early stages of a passionate romantic relationship can be consumed by the experience and report emotional dependence and constant focus on their romantic partner. A few studies have shown that viewing pictures of a romantic partner can significantly reduce experimental pain. The strength of the effect, however, varies substantially between individuals. To study why some individuals experience significant pain reduction when looking at a picture of their partner, we examined partner preoccupation...
June 2014: Pain Medicine
Juan Ignacio Pérez-Calvo, Francisco José Ruiz-Ruiz, Francisco Javier Carrasco-Sánchez, José Luis Morales-Rull, Sergio Manzano-Fernández, Luis Galisteo-Almeda, Domingo Pascual-Figal
BACKGROUND: Cystatin C (CysC) is a good prognostic marker in heart failure. However, there is not much information of CysC combined with other biomarkers in acute heart failure (AHF). AIM: To assess prognostic value of CysC and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients hospitalized for AHF with no apparent deterioration of renal function. DESIGN: Prospective, multicenter, observational study. METHODS: CysC and NTpro-BNP were measured in patients consecutively admitted with a diagnosis of AHF...
October 2012: European Journal of Internal Medicine
Claudia I Henschke, Rowena Yip, David F Yankelevitz, James P Smith
BACKGROUND: Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-positive" findings may result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a positive result on the rates of positive results and cancer diagnoses is unknown. OBJECTIVE: To assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds...
February 19, 2013: Annals of Internal Medicine
2014-04-14 11:54:02
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