A patient with Graves' disease was treated with radioactive iodine. For several years following treatment, the patient displayed clinical hypothyroidism and persistently low serum thyroxine (T4) and ...triiodothyronine (T3) levels despite large T4 replacement dosage (0.3-0.4 mg L-thyroxine daily). A defect in T4 absorption was considered unlikely since absorption of fat soluble materials (vitamins A and E) was essentially normal as reflected by their serum concentrations. Abnormalities in serum protein binding of T4 especially by immunoglobulins were suspected; however, thyroid hormone binding antibodies were absent. Thyroxine binding prealbumin (TBPA) levels were either frankly elevated or in the upper normal range and such variations were mirrored by retinol binding protein (RBP) concentrations. Thyroxine binding globulin (TBG) concentration was normal. A surprising finding was an elevated percent dialyzable thyroxine (.041%; normal range, .018-.034%) in spite of a normal concentration of TBG. Serum free fatty acid levels were also elevated. The marked increase in percent free T4 (FT4) fraction together with a low serum total T4 concentration resulted in normal or marginally elevated FT4 levels. An increase in T4 metabolic clearance as suggested by the elevated percent FT4 fraction was corroborated by steady state serum T4 values observed following changes in T4 dosage.
The relative concentrations of pCG14 RNA (a myelocyte-specific mRNA), pAM6 RNA (a monocyte-lineage specific marker), and c-myc RNA (present at higher concentrations in more primitive cells) were ...measured in the RNAs from peripheral blood leucocytes from leukaemic samples and normal individuals. The potential of differences in the relative abundances of these three RNAs in a series of 34 leukaemias was assessed as a means of distinguishing among the myeloid leukaemias. The chronic phase CGL samples were clustered with a high pCG14 RNA, a medium to low c-myc RNA abundance, and a variable pAM6 RNA level. The ANLL samples could be distinguished from the chronic phase CGL by virtue of different relative abundances of these RNAs: low pCG14, medium to high c-myc and a variable pAM6. The acute phase CGL samples showed a variety of relative RNA abundances with some samples sited within the ANLL region. Using samples obtained during the progression of CGL we have shown a shift in the relative abundances of these RNAs from the CGL region towards the ANLL region, and have suggested that the use of these parameters may allow the progression to acute phase to be monitored and, possibly, predicted.
A 20 x 50 ft, full scale bridge deck was constructed in the laboratory. The deck had both cast-in-place and precast panel sections, was detailed in accordance with Texas SDHPT provisions for Ontario ...type decks, and had about 60 percent of the reinforcement required by the current AASHTO Code. The bridge was loaded in a simply supported configuration (Phase I). It performed satisfactorily under current AASHTO design load levels. Under service and overload conditions, the behavior of the deck slab was essentially linear, and was not affected by fatigue loading.
There is increasing interest in the role of physical exercise as a therapeutic strategy for individuals with Alzheimer's disease (AD). We assessed the effect of 26 weeks (6 months) of a supervised ...aerobic exercise program on memory, executive function, functional ability and depression in early AD.
This study was a 26-week randomized controlled trial comparing the effects of 150 minutes per week of aerobic exercise vs. non-aerobic stretching and toning control intervention in individuals with early AD. A total of 76 well-characterized older adults with probable AD (mean age 72.9 7.7) were enrolled and 68 participants completed the study. Exercise was conducted with supervision and monitoring by trained exercise specialists. Neuropsychological tests and surveys were conducted at baseline,13, and 26 weeks to assess memory and executive function composite scores, functional ability (Disability Assessment for Dementia), and depressive symptoms (Cornell Scale for Depression in Dementia). Cardiorespiratory fitness testing and brain MRI was performed at baseline and 26 weeks. Aerobic exercise was associated with a modest gain in functional ability (Disability Assessment for Dementia) compared to individuals in the ST group (X2 = 8.2, p = 0.02). There was no clear effect of intervention on other primary outcome measures of Memory, Executive Function, or depressive symptoms. However, secondary analyses revealed that change in cardiorespiratory fitness was positively correlated with change in memory performance and bilateral hippocampal volume.
Aerobic exercise in early AD is associated with benefits in functional ability. Exercise-related gains in cardiorespiratory fitness were associated with improved memory performance and reduced hippocampal atrophy, suggesting cardiorespiratory fitness gains may be important in driving brain benefits.
ClinicalTrials.gov NCT01128361.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The use of noninvasive ventilation for patients with cardiogenic pulmonary edema and acute respiratory failure has been studied extensively. We identified 20 relevant ...RCTs.42-46,48-51,53-57,59,61,62,64-66 These trials examined the use of noninvasive posi tive-pressure ventilation plus usual therapy versus usual therapy alone,48,49,53 continuous positive airway pressure by mask plus usual therapy versus usual therapy alone,42-44,46,51,55,66 continuous positive airway pressure by mask plus usual therapy versus noninvasive positive-pressure ventilation plus usual therapy45,54,57,59,61,62 or all three of these treatments.50,56,64,65 Before publication of a recent large RCT,65 which accounted for 40% of all patients who have been studied in RCTs of continuous positive airway pressure for cardiogenic pulmonary edema and 70% of patients receiving noninvasive positive-pressure ventilation for this indication, five separate systematic reviews162-166 had consistently demonstrated a significant reduction in endotracheal intubation with both types of noninvasive ventilation. When this large trial was included in the metaanalysis, there was a trend toward reduction in endotracheal intubation with noninvasive positive- pressure ventilation (RR 0.55, 95% CI 0.29-1.03) and a significant reduction in endotracheal intubation with continuous positive airway pressure by mask (RR 0.42, 95% CI 0.28- 0.63) relative to oxygen alone. Notably, this recent large trial65 differed from most others, in that patients who met the criteria for treatment failure were allowed to cross over to one of the two forms of noninvasive ventilation rather than undergoing insertion of an endotracheal tube. Although the rate of endotracheal intubation did not differ between arms, a much higher proportion of patients in the oxygen arm crossed over to noninvasive ventilation (56/367 patients v. 5/346 from continuous positive airway pressure to noninvasive positive-pressure ventilation and 12/356 from noninvasive positive-pressure ventilation to continuous positive airway pressure). In addition, the proportion of patients who did not remain in their assigned treatment arm because of respiratory distress was significantly higher in the oxygen-only arm (8.4% v. 3.4% for noninvasive positive-pressure ventilation and 1.4% for continuous positive airway pressure; p < 0.001). Because of the potential for crossover in this trial to confound the outcomes of endo tracheal intubation and hospital mortality, we considered the outcome of "treatment failure" in developing our final guideline statement. Pooled treatment failure for all trials was sig nificantly lower for both noninvasive positivepressure ventilation (RR 0.36, 95% CI 0.25- 0.51) and continuous positive airway pressure (RR 0.23, 95% CI 0.17-0.32). Including all trials, there was a trend toward lower hospital mortality (for noninvasive positive-pressure ventilation, RR 0.84, 95% CI 0.63-1.13; for continuous positive airway pressure, RR 0.73, 95% CI 0.51-1.05). Two RCTs studied noninvasive positivepressure ventilation in patients with communityacquired pneumonia and acute hypoxemic res piratory failure but no prior history of COPD. In one trial, patients with COPD were included, and results for patients who did and did not have this condition were reported separately.38 In the subgroup of patients who did not have COPD (n = 33), the addition of noninvasive positivepressure ventilation did not reduce endotracheal intubation (6/16 v. 8/17 in control group) or hospital mortality (6/16 v. 4/17). In the other trial, which involved patients with acute hypoxemic respiratory failure but no underlying COPD, there was benefit (reduced endotracheal intubation and ICU mortality) for the subgroup of patients (n = 34) with severe communityacquired pneumonia.39 For these two small subgroups (67 patients in total) from two RCTs, the results were conflicting regarding the addition of noninvasive positive-pressure ventilation to usual therapy for patients with severe com munity-acquired pneumonia but no prior history of COPD (pooled results: RR 0.54, 95% CI 0.24-1.17 for endotracheal intubation and RR 0.70, 95% CI 0.13-3.63 for hospital mortality). We did not identify any RCTs on the use of continuous positive airway pressure for patients with severe community-acquired pneumonia and without COPD.
Pseudomonas aeruginosa exotoxin A was injected into rabbit corneas. Death of epithelial, endothelial, and stromal cells resulted, and necrosis of the cornea followed. Control eyes with exotoxin ...neutralized by specific antitoxin showed minimal damage. A dose-response pattern was evident. Antitoxin neutralization of pseudomonas exotoxin A in corneal ulcers may have possible therapeutic implications.
The adjustments made relate specifically to articles commissioned by The BMJ and apply to medical education articles that will, in future, be commissioned solely from authors without industry ...funding. 1 Reducing the influence of financial competing interests in clinical education and practice guidelines is essential to promoting best practices that put public interest ahead of personal gain.
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