Insufficient Patients Research Articles

ETIKA U TRANSPLANTACIJI SOLIDNIH ORGANA

Ethics in transplantation (TX) has been determined by history, philosophy, science, medicine, law, sociology and economics. Croatian national peculiarities are based on the excellent achievements in solid organ TX and outstanding legislation, which supports this success. Thus the prevalent ethical issues in TX at global level, such as organ shortage, donation, allocation and distributive justice, are simply not of major importance in Croatia. There is a model law on presumptive consent for organ donation after death in Croatia (so called “opt-out” law, while a person should declare only if willing to be “out” of the possible donors’ pool). Lack of knowledge of the opt-out law of organ donation after brain death, which is currently established in Croatia, lack of coordination of this law with Croatian Codex of Medical Ethics and Deontology in regard to family permission for organ donation after brain death arise as our particular ethical questions along with insufficient patients’ recruitment as candidates for TX. It is expected to have TX with organs of non-human origin in the future,like the one bred in a swine, which may raise new ethical concerns.

Clinical outcomes of African American patients with advanced or metastatic non-small cell lung cancer on Nivolumab in a single community-based cancer center.

African Americans (AA) have the highest incidence and mortality rates with lung cancer. They are diagnosed at an earlier age with more advanced disease. Programmed cell death protein-1 inhibitor, Nivolumab, was approved as a second-line agent after failure of platinum-based therapy for advanced or metastatic non-small cell lung cancer (NSCLC). The original studies leading to the approval of Nivolumab had insufficient AA patients, thus there is still inadequate knowledge on treatment outcomes among AA patients. Our primary study endpoints were to determine the median overall survival, 1-year overall survival rate, median progression-free survival, and 1-year progression-free survival rate of patients with advanced or metastatic non-small cell lung cancer on Nivolumab. Our secondary study endpoints were to determine the overall tumor response rate, median time to response, median duration of response, and incidence of treatment-related adverse events of grade 3 or 4. In this retrospective study, we reviewed the charts of 38 patients, 29 of which were AA, with advanced or metastatic NSCLC who received Nivolumab from March 1, 2015 until November 30, 2017 from a single community-based cancer center and compared our results with historical data. Adenocarcinoma was the most common histology (71%) among all patients. Seven (18%) continued to use Nivolumab while 21 (55%) discontinued the treatment mainly due to progression of the disease. The median overall survival was 21.4months (95% CI 13.5-27.4) and 17.6months (95% CI 11.5-27.6) for all the patients and AA, respectively. Both have statistically significant difference (P < 0.001) compared to the historical studies of Borghaei et al. and Brahmer et al. At 1 year, the overall survival rate was 73% (95% CI 50-86) and 66% (95% CI 40-82) for all patients and AA, respectively. The median progression-free survival was also statistically significant (P < 0.001) between all the patients 6.3months (95% CI 2.8-8), AA 6.0months (95% CI 2.3-8.0), and the said historical studies. The 1-year progression-free survival rate was 23% (95% CI 10-39) and 28% (95% CI 12-47) for all patients and AA, respectively. Overall tumor response rate which includes complete and partial responses was 21% (95% CI 10-37) and 24% (95% CI 10-43) for all patients and AA, respectively. The median time to response was 3 and 2.8months for all patients and AA, respectively. The median duration of response was 3.8 and 4.0months for all patients and AA, respectively. Treatment-related adverse events of grade 3 or 4 were reported in 8 and 10% in all patients and AA, respectively, similar to the rates previously shown. AA patients with advanced or metastatic NSCLC on Nivolumab had increased overall survival and progression-free survival with similar grade 3 or 4 treatment-related adverse events. Providing adequate access to immunotherapy is indispensable to maximize survival benefit for AA patients.

Contrast-enhanced ultrasonography of the pancreas shows impaired perfusion in pancreas insufficient cystic fibrosis patients

BackgroundPerfusion assessment of the pancreas is challenging and poorly evaluated. Pancreatic affection is a prevalent feature of cystic fibrosis (CF). Little is known about pancreatic perfusion in CF. We aimed to assess pancreatic perfusion by contrast-enhanced ultrasound (CEUS) analysed in the bolus-and-burst model and software.MethodsWe performed contrast enhanced ultrasound of the pancreas in 25 CF patients and 20 healthy controls. Perfusion data was analysed using a dedicated perfusion model providing the mean capillary transit-time (MTT), blood flow (BF) and blood-volume (BV). CF patients were divided according to exocrine function.ResultsThe pancreas insufficient CF patients had longer MTT (p ≤ 0.002), lower BF (p < 0.001) and lower BV (p < 0.05) compared to the healthy controls and sufficient CF patients. Interrater analysis showed substantial agreement for the analysis of mean transit time.ConclusionThe bolus-and-burst method used on pancreatic CEUS-examinations demonstrates reduced perfusion in CF patients with pancreas affection. The perfusion model and software requires further optimization and standardization to be clinical applicable for the assessment of pancreatic perfusion.

Magnetic resonance imaging based anthropometric study of knee joint in anterior cruciate ligament insufficient knees

Purpose: The objective of this study was to evaluate multiple morphological features on MR images in patients with ACL insufficient knees. Methods: Magnetic resonance imaging (MRI) of the knee of 40 anterior cruciate ligament insufficient patients and 20 anterior cruciate ligament intact patients who came to Katuri Medical College and Hospital, Guntur, between May 2017 and April 2018 were reviewed. Their intercondylar notch, femoral condyles dimensions and tibial slopes were measured using MRI. Results: The ACL insufficient knees and ACL intact knees were comparable in terms of intercondylar notch width. Lateral femoral condyle height and transepicondylar axis are more in ACL insufficient knees. Medial posterior tibial slope is more than Lateral posterior tibial slope in both ACL insufficient knees and ACL intact knees. Conclusion: The ACL insufficient patients have more Lateral femoral condyle width, intercondylar notch width, intercondylar notch height compared to ACL intact knees. ACL-ruptured patients had statistically significant smaller heights of femur’s lateral condyle. MTS is more than LTS in both ACL insufficiency patients and ACL intact patients.

MP31-15 SERUM VITAMIN D STATUS, VITAMIN D3 SUPPLEMENTATION AND URINE CALCIUM LEVELS AMONG 140 CALCIUM KIDNEY STONE PATIENTS

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy II1 Apr 2018MP31-15 SERUM VITAMIN D STATUS, VITAMIN D3 SUPPLEMENTATION AND URINE CALCIUM LEVELS AMONG 140 CALCIUM KIDNEY STONE PATIENTS Barry S. Farber, M.D. and Robert E. Kennedy, Jr., Ph. D. Barry S. Farber, M.D.Barry S. Farber, M.D. More articles by this author and Robert E. Kennedy, Jr., Ph. D.Robert E. Kennedy, Jr., Ph. D. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1044AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although there are current guidelines for the metabolic evaluation of patients with nephrolithiasis, there is no guideline for the management of coexisting vitamin D deficiency among these patients. The available research is not clear regarding the role of vitamin D in either causation of, or protection from, kidney stone formation. It is known that vitamin D has an essential role in calcium metabolism, and that vitamin D deficiency is common in the population. The purpose of this research is to help clarify the association, if any, between vitamin D status and urine calcium levels among patients with calcium kidney stones. METHODS This study detected and treated vitamin D insufficiency in calcium kidney stone patients with concurrent metabolic urine studies before and after vitamin D supplementation. Between 2015 and 2017, 140 patients were evaluated in a community based urology practice following management of an acute episode of nephrolithiasis. Only patients with calcium composition stones were included. Initial metabolic evaluation measured stone composition, serum chemistry, 24 hour urine chemistry and baseline serum 25-hydroxy vitamin D (25-OHD). Patients who were found to be "not sufficient" for 25-OHD (<30 ng/ml) were advised to take10,000 IU of over-the-counter vitamin D3 per day for two months, and then to return for retesting of 25-OHD and 24 hour urine calcium. RESULTS Almost three-quarters of the 140 patients initially were not sufficient in 25-OHD (N=101 or 72%). No statistically significant association (at the 0.05 level) was found between 25-OHD status and urine calcium level. Two-thirds of the 101 insufficient patients had a follow-up 25-OHD test after two months of advised vitamin D3 intake (N=65 or 64%). Of these, most became sufficient (N=58 or 89%), and none exceeded the sufficient range of 30-100 ng/ml. Two-fifths of the 101 patients had both follow-up tests: 25-OHD and 24 urine calcium (N=40 or 40%). There was no statistically significant change (at the 0.05 level) over time (from pre-D3 supplement to post supplement) in the initial lack of association between 25-OHD status and urine calcium levels. CONCLUSIONS Correction of vitamin D insufficiency with over-the counter vitamin D3 in calcium kidney stone patients was promptly effective, and did not significantly affect urine calcium level. In other words, the observed positive change in 25-OHD status did not significantly improve, or harmurine calcium levels. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e417 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Barry S. Farber, M.D. More articles by this author Robert E. Kennedy, Jr., Ph. D. More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Discussion on the Functional Mechanism of the Community Health Service Center in the Existing Medical Service System

The current situation of patients visiting hospitals is that, large hospitals are overcrowded with patients, but there are relatively insufficient patients in community hospitals. The root cause is that the role of existing basic medical and health institutions has not been properly and fully utilized. If this situation cannot be fundamentally changed, then it is impossible to say that the medical reform has embarked on the road to success. Therefore, if the overall medical development strategy can be implemented to provide more preferential support to the grass-roots hospital, in order to lead the general direction of social and medical development further, and facilitate the work of grass-roots hospitals; the work direction of community health service centers, in terms of business philosophy, examination, treatment, technical means, hospital management, and resource mobilization in all directions etc.., has been adjusted accordingly, so as to create internal conditions and driving factors for more patients to return to the grass-roots hospitals; the large hospitals should also provide more corresponding support and help to community health service centers in the focus of work, with the aim of promoting the development of grass-roots medical institutions objectively at the higher medical level, we believe that the number and categories of diseases of patients visiting basic medical and health institutions will change a lot in the near future, even fundamentally.

Bolus Weekly Vitamin D3 Supplementation Impacts Gut and Airway Microbiota in Adults With Cystic Fibrosis: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

Disruption of gut microbiota may exacerbate severity of cystic fibrosis (CF). Vitamin D deficiency is a common comorbidity in patients with CF that may influence composition of the gut microbiota. Compare microbiota of vitamin D-sufficient and -insufficient CF patients and assess impact of a weekly high-dose vitamin D3 bolus regimen on gut and airway microbiome in adults with CF and vitamin D insufficiency (25-hydroxyvitamin D < 30 ng/mL). Forty-one subjects with CF were classified into two groups: vitamin D insufficient (n = 23) and vitamin D sufficient (n = 18). Subjects with vitamin D insufficiency were randomized to receive 50,000 IU of oral vitamin D3 or placebo weekly for 12 weeks. Sputum and stool samples were obtained pre- and postintervention and 16S ribosomal RNA genes sequenced using Illumina MiSeq technology. Gut microbiota differed significantly based on vitamin D status with Gammaproteobacteria, which contain numerous, potentially pathogenic species enriched in the vitamin D-insufficient group. Principal coordinates analysis showed differential gut microbiota composition within the vitamin D-insufficient patients following 12 weeks treatment with placebo or vitamin D3 (permutation multivariate analysis of variance = 0.024), with Lactococcus significantly enriched in subjects treated with vitamin D3, whereas Veillonella and Erysipelotrichaceae were significantly enriched in patients treated with placebo. This exploratory study suggests that vitamin D insufficiency is associated with alterations in microbiota composition that may promote inflammation and that supplementation with vitamin D has the potential to impact microbiota composition. Additional studies to determine the impact of vitamin D on microbiota benefit clinical outcomes in CF are warranted.

Comparison of Adverse Events Between Selective Internal Radiation Therapy Versus Sorafenib in Locally Advanced Hepatocellular Carcinoma in Mongolia: A Subgroup Analysis of SIRveNIB Study

Objective: This study compared the adverse events associated with selective internal radiation therapy to sorafenib in the treatment of patients with locally advanced hepatocellular carcinoma (HCC). Methods: From March 2011 to June 2106, the National Cancer Center of Mongolia recruited 39 patients from Mongolia (19 received sorafenib and 20 received SIRT in Singapore) with advanced hepatocellular carcinoma who had not received surgical therapy into a multicenter study involving a total of 360 patients at 27 sites in 11 Asia-Pacific countries. The study was a phase III randomized-controlled clinical trial comparing sorafenib or SIRT. Results: Adverse events for patients receiving sorafenib were predominantly grade 1 or 2 in gastrointestinal, constitutional and dermatologic in nature. The most frequently reported drug-related adverse events in patients treated with sorafenib were hypertension, hand-foot skin reaction, diarrhea, alopecia, fatigue. Common procedure-related adverse events were usually mild (grade 1/2) and included nausea and vomiting (27.7% all grades) and abdominal pain (22.1% all grades), with very few grades 3 or greater adverse events. Conclusion: In our analysis of 39 patients, we were unable to detect a statistically significant difference in adverse effects between sorafenib and SIRT treatment groups, likely because there were insufficient number patients in our study.

Evaluation of Effectiveness of Use of Oral Vit D Supplements in Documented Vit D Insufficient or Deficient Patients- A Study in North Bihar

Evaluation of Effectiveness of Use of Oral Vit D Supplements in Documented Vit D Insufficient or Deficient Patients- A Study in North Bihar

Wound Investigation in Insulin Insufficient Patients Using Image Processing Technique

An injury is a scratch to our body. It is a common phrase that denotes to hurt occurred by a few accidents. Gash is damages which divide the pelt or stiff tissues. It is most treacherous and common complications of diabetes. The compromised protected approach habitually merges diabetes. Increased glucose levels measured down the resistant cells that unleash to brawl off infections. When bacteria stir in to settle on the foot, the ramparts out vain. Ulcers may normally upturn. If infection reaches the bone, elimination is needed. The body has possibility of fighting the infection. Doctors use a lot of tools to take care of infected wounds. In critical slash, handling is very thorny to find the status. In present days, diabetic patient and their care takers have the responsibility to take more care in daily gash care. For the analysis of wound in the insulin insufficient patients, the research concentrates the mean shift algorithm.

Abstract 2274: Extreme telomere length was associated with gastric adenocarcinoma risk: The Singapore Chinese Health Study

Abstract Background: Evidence regarding extreme telomere length and increased gastric cancer risk has been limited in retrospective case-control study setting which was potentially subjected to selection bias and reverse causality. We conducted a prospective analysis in an Eastern Asian population to examine the hypothesis that extreme telomere length is associated with increased risk of gastric adenocarcinoma. Methods: Among 63,257 participants of the Singapore Chinese Health Study, a population-based prospective cohort of Chinese men and women aged 45-74 years recruited between 1993 and 1998, 28,219 provided baseline blood samples. We used quantitative polymerase chain reaction (PCR) method to quantify relative telomere length determined by the ratio of telomere repeat copy number (T) to single-copy gene for albumin (S) (i.e., TSR) on all subjects. The present analysis included 24,846 subjects with valid TSR values after excluding samples with insufficient DNA (n = 1,908) and/or patients with prevalent cancer at baseline blood draw (n = 1,465). As of December 31, 2014, 191 study participants who were free of cancer developed gastric adenocarcinoma. The information on demographic and lifestyle characteristics was collected using structured questionnaires at baseline and two follow-up interviews. Cox proportional hazard regression method was used to estimate hazard ratio (HR) and the corresponding 95% confidence interval (CI) of developing gastric adenocarcinoma for different levels of decile TSR. Restricted cubic spline (RCS) analysis was applied to examine the nonlinear relationship between TSR level and gastric adenocarcinoma risk. Results: The RCS analysis revealed a U-shaped relationship between TSR and gastric adenocarcinoma risk (p-value for non-linear association=0.009). Compared with the 4th decile, HR (95% CI) for the lowest and highest deciles of TSR 2.27 (1.17-4.40) and 1.98 (0.95-4.13), respectively after adjusting for age, sex, education, interview year, dialect group and smoking status. Conclusions: This was the first prospective analysis of TSR and risk of developing gastric adenocarcinoma in a general population. The study demonstrates both extreme short and long telomere length to be associated with significantly increased risk of gastric adenocarcinoma. These results suggest a complex relationship between telomere length and gastric cancer risk. Citation Format: Zhensheng Wang, Woon-Puay Koh, Aizhen Jin, Renwei Wang, Jian-Min Yuan. Extreme telomere length was associated with gastric adenocarcinoma risk: The Singapore Chinese Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2274. doi:10.1158/1538-7445.AM2017-2274

Abstract 2267: A prospective assessment for telomere length in relation to risk of cancer in the Singapore Chinese Health Study

Abstract Background: Telomeres are crucial in the maintenance of chromosome integrity and genomic stability. A critically short telomere length can trigger cell to enter replicative senescence with a result of cell death; alternatively, cells continue to divide if death does not occur, which results in genomic instability and chromosomal abnormality. A series of epidemiological studies have examined the association between telomere length and the risk of cancers, but the findings remain conflicting. Methods: Among 63,257 participants of the Singapore Chinese Health Study, a population-based prospective cohort of Chinese men and women aged 45-74 years recruited from 1993 through 1998, 28,219 provided baseline blood samples. We used quantitative polymerase chain reaction (PCR) method to quantify relative telomere length determined by the ratio of telomere repeat copy number (T) to single-copy gene for albumin (S) (i.e., TSR) on all subjects. The present analysis included 24,847 subjects with valid TSR values after excluding samples with insufficient DNA (n = 1,908) and/or patients with prevalent cancer at baseline blood draw (n =1,464). As of December 31, 2015, 3,778 participants developed cancer, including 722 colorectal cancer, 599 lung cancer, and 412 breast cancer. Cox models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) of developing any cancer and these selected specific cancer types for different quintiles of TSR. Results: Women had a 5.7% higher TSR value than men (P&amp;lt;0.0001). Age, level of education, number of cigarettes/day, years of smoking, and pack-years of smoking were all inversely associated with TSR (P&amp;lt;0.0001). High TSR was associated, in a dose-dependent manner, with significantly increased risk of total cancer and breast, colorectal and lung cancer. Compared with the lowest quintile, the HRs (95% CIs) of total cancer for the 2nd, 3rd, and 4th, and 5th quintile of TSR were 1.03 (0.89, 1.20), 1.08 (0.93-1.26), 1.15 (0.98-1.34), and 1.36 (1.16-1.58), respectively, after adjustment for age, sex, education and smoking (Ptrend=0.001). The corresponding HRs (95% CIs) were 1.21 (0.72-2.03), 1.59 (0.97-2.60), 1.59 (1.04-2.75) and 1.62 (0.99-2.66) for breast cancer (Ptrend=0.023); 1.44 (1.03-2.00), 1.10 (0.76-1.59), 1.32 (0.92-1.90) and 1.88 (1.32-2.66) for colorectal cancer (Ptrend=0.004); and 1.41 (0.98-2.05), 1.37 (0.93-2.02), 1.31 (0.86-1.99) and 1.88 (1.26-2.81) for lung cancer (Ptrend=0.010). Conclusions: This prospective cohort study demonstrates that longer telomere length is associated with significantly increased risk of total and major cancers in a general population. These results suggest a complex role of telomere in the development of cancer. Citation Format: Jian-Min Yuan, Renwei Wang, Kenneth Beckman, Aizhen Jin, Woon-Puay Koh. A prospective assessment for telomere length in relation to risk of cancer in the Singapore Chinese Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2267. doi:10.1158/1538-7445.AM2017-2267

Empirically Reduced Dosages of Tinzaparin in Patients with Moderate-to-Severe Renal Insufficiency Lead to Inadequate Anti-Xa Levels

Background: Due to the higher molecular weight of tinzaparin, the low molecular weight heparin (LMWH) is less dependent on renal excretion than other LMWH preparations. However, several international guidelines recommend the same preemptive dosage reduction for all therapeutic dose LMWHs prescribed in renal insufficient patients, to ensure that there is no accumulation of anticoagulant activity and increased risk of bleeding. This study is aimed at assessing whether a preemptive dosage reduction of tinzaparin in all renal insufficient patients (comprising 25% reduction in patients with Modification of Diet in Renal Disease - estimated glomerular filtration rate (MDRD-eGFR) 30-60 mL/min/1.73 m² and 50% reduction in patients with MDRD-eGFR <30 mL/min/1.73 m²) leads to adequate anti-Xa levels. Methods: We selected the anti-Xa levels of in-hospital patients (≥18 years) with moderate-to-severe renal insufficiency (MDRD-eGFR <60 mL/min/1.73 m²), on therapeutic dosages of tinzaparin. Anti-Xa levels were measured using a chromogenic assay. Results: Preemptive dosage reduction resulted in a median anti-Xa activity of 0.50 IU/mL (interquartile range [IQR] 0.38-0.60). In 92.3% of patients the anti-Xa level was below the target anti-Xa level of >0.85 IU/mL for therapeutic indications. Unadjusted dosages led to a median anti-Xa activity of 0.74 IU/mL (IQR 0.56-0.92). The preemptive dosage reduction was significantly associated with anti-Xa activity below therapeutic range (p = 0.007). No difference in anti-Xa activity was observed between patients with moderate (0.71 IU/mL, IQR 0.61-0.95) versus severe (0.65 IU/mL, IQR 0.41-1.06) renal insufficiency in whom an unadjusted dose had been administered (p = 0.77). None of the anti-Xa levels were above the upper margin of the presumed therapeutic range of 2.0 IU/mL. Conclusion: In renal insufficient patients, the preemptive dosage reduction of tinzaparin leads to inadequate anti-Xa levels.

308 Vitamin D supplementation in pancreatic sufficient and insufficient cystic fibrosis patients

308 Vitamin D supplementation in pancreatic sufficient and insufficient cystic fibrosis patients

SP377THE EFFECT OF SHORT-TERM VITAMIN D SUPPLEMENTATION ON HYPERCALCAEMIC VITAMIN D INSUFFICIENT RENAL TRANSPLANT RECIPIENTS

INTRODUCTION AND AIMS: Vitamin D insufficiency is highly prevalent amongst renal transplant recipients and in observational studies is associated with adverse outcomes. Hypercalcaemia, usually due to persistent hyperparathyroidism, also commonly occurs in this population and often coexists with vitamin D insufficiency. However, concern that Vitamin D supplementation might exacerbate the pre-existing hypercalcemia often leads clinicians to avoid Vitamin D supplementation in such patients. This feasibility study aimed to quantify the effect on serum calcium of short-term low dose cholecalciferol supplementation in a group of hypercalcemic renal transplant recipients. METHODS: We conducted a two-week, single arm, open-label, trial of 1000iu cholecalciferol supplementation daily in 18 hypercalcaemic, vitamin D insufficient adult patients with a functioning renal allograft (eGFR >30 30 ml/min/1.73m2). At baseline and following 2 weeks of treatment serum creatinine, eGFR, calcium, phosphorous, iPTH, albumin, 25- and 1,25-dihydroxycholecalciferol, fibroblast growth factor-23 (FGF23) and urinary calcium and creatinine were measured. Subjects were counseled to maintain their usual diet. Variables are summarized using their mean (sd) or median (Intra-Quartile Range [IQR]). Change over follow-up are examined using Wilcoxin signed ranks tests with a 2-sided type 1 error rate of 0.05. RESULTS: The mean age was 53(13) years and mean duration of transplantation was 7.6(4.8) years; 13(72%) of subjects were male. Baseline eGFR was 56(12) ml/min/1.73m2. All subjects were vitamin D insufficient (mean baseline 25-hydroxycholecalciferol level was 40.1(14.3) nmol/L); all had a baseline serum albumin >42 mmol/L and the mean (sd) serum calcium was 2.63(0.15) mmol/L. Mean (sd) iPTH was 127(72). PTH correlated with ionized calcium r=0.69, p=0.03. With supplementation the median rise in 25- and 1,25-hydroxycholecalciferol were 9.0 nmol/L, p<0.05 and 21.9 mmol/L, p=0.05 respectively. Median (IQR) change in serum calcium from baseline to follow-up was -0.02 (-0.9 to 0.02); p=0.3. Ionized calcium (n=15) decreased from 1.31(0.08) at baseline to 1.29(0.07), p= 0.05. There was a trend for an increase in serum phosphate (within the normal range) from 0.83(0.11) mmol/L to 0.88(0.16), p=0.08, without any substantial change in FGF23 (median change: -1.9). The median (IQR) change in the urinary calcium:creatinine ratio was 0.002 (-23.5 to 22.73), p=0.88). The change in ionized calcium correlated with change in 25-OH Vitamin D (r=0.64, p=0.01) but not with change in other measures. CONCLUSIONS: In hypercalcemic vitamin D insufficient renal transplant recipients low-dose short-term oral cholecalciferol supplementation improves vitamin D levels without exacerbating hypercalcaemia or increasing the urinary calcium;creatinine ratio.

Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature

The development of autoimmunity and/or autoimmune diseases is multifactorial. Vitamin D is one of the factors that might play a role. We postulated that both the presence of adjuvants and insufficient levels of vitamin D may result in the development of autoimmunity in patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in relation to silicone implant incompatibility. We measured vitamin D levels in 135 patients with ASIA in relation to silicone implant incompatibility and related findings to the presence of autoantibodies that are commonly used to diagnose systemic autoimmune diseases. Furthermore, we systematically reviewed the literature regarding vitamin D deficiency as a risk factor for the development of autoantibodies. Vitamin D measurements were available for analysis in 131 of 135 patients with ASIA in relation to SIIS. Twenty-three patients (18%) tested positive for autoantibodies, from which 18 patients (78%) had either a vitamin D deficiency or insufficiency (median vitamin D level 60.5 mmol/L), whereas five patients (22%) had sufficient vitamin D levels. The risk to develop autoantibodies was significantly increased in vitamin D deficient and/or insufficient patients [RR 3.14; 95% CI, 1.24–7.95; p = 0.009]. Reviewed literature suggested an association between vitamin D levels and the presence and/or titer levels of autoantibodies in different autoimmune diseases. From our current study and from our review of the literature, we conclude that vitamin D deficiency is related to the presence of autoantibodies. Whether vitamin D supplementation results in a decrease of autoimmunity needs to be studied prospectively.

Parenteral vitamin D supplementation is superior to oral in vitamin D insufficient patients with type 2 diabetes mellitus

Background/objectivesOral vitamin D supplementation is better than parenteral in improving vitamin D deficiency in individuals with no systemic illness. Our aim was to compare the efficacy of oral and parenteral routes of vitamin D supplementation on circulating serum 25(OH) vitamin D level in patients with type 2 diabetes mellitus. MethodsTotal 85 cases of with type 2 diabetes mellitus were screened for vitamin D status of which 71 patients were vitamin D insufficient/deficient. They were randomized into two intent to treat groups with different vitamin D supplementation protocols (a) Oral-60000 IU per day for 5days (group I; n=40) and (b) injectable-300000 IU intramuscularly once (group II; n=31). Baseline and one month post supplementation 25(OH) vitamin D levels were measured in both the groups. ResultsBaseline clinical characteristics and 25(OH) vitamin D levels were comparable in both the groups. Post treatment 25(OH) vitamin D level in group I was 26.06±9.06ng/ml and in group II was 49.69±18.92ng/ml. After one month of vitamin D supplementation, increment in 25(OH) vitamin D level from baseline was significantly higher in group II than group I (p<0.001). Interpretation & conclusionsInjectable method of supplementation was better than oral route in improving serum 25 (OH) vitamin D status in patients with type 2 diabetes. The study suggested impaired absorption of vitamin D from the gastrointestinal tract in patients with type 2 diabetes mellitus and a need for parenteral route of vitamin D supplementation in deficient patients with type 2 diabetes mellitus.

Preoperative parameters and their prognostic value in amyotrophic lateral sclerosis patients undergoing implantation of a diaphragm pacing stimulation system.

Introduction:Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with devastating and fatal respiratory complications. Diaphragm pacing stimulation (DPS) is a treatment option in diaphragm insufficient ALS patients. Ventilatory insufficiency depending on diaphragmatic failure is treated by the present study aimed to investigate prognostic value of preoperative clinical and functional characteristics of ALS patients undergoing implantation of a DPS system and to determine appropriate indications for the DPS system.Methods:The study included 34 ALS patients implanted with DPS system. All patients underwent multidisciplinary and laboratory evaluations before the surgery. The laboratory examinations included pulmonary function tests and arterial blood gas analysis. Survival rates were recorded in a 2-year follow-up after the surgery.Results:Twenty-eight of 34 patients with ALS survived after a 2-year follow-up. These patients were younger than those who died and had the disease for a longer time; however, the differences were not significant. Both right and left hemidiaghragms were thicker in the survived patients (P < 0.0001 for each). Pulmonary function tests revealed no significant differences between the patients who survived. Arterial blood gas analysis demonstrated lower partial pressure of carbon dioxide in the survived patients (P = 0.025).Conclusions:DPS implantation was more efficacious in ALS patients with mild respiratory failure and thicker diaphragm. Predictors of long-term effectiveness of DPS system are needed to be addressed by large-scale studies.

Epidemiología de la hipertensión arterial

Hypertension (HT) is the first cause of death and disability worldwide. One in 3 adults in Spain is hypertensive (66% in those > 60 years). Despite improvement in hypertension management over time, only half of treated hypertensive patients are adequately controlled. This translates in 40,000 annual cardiovascular deaths attributable to H T. Among modifable determinants of lack of blood pressure (BP) control in Spain are: a) the white coat phenomenon (accounting for 20-50% of false lack of control) due to not using ambulatory BP monitoring (current use, 20%) or self-BP measurement (use, 60%) for confirming HT diagnosis; b) insufficient patients adherence to BP reducing lifestyles (e.g., only 40% of hypertensive patients have a sodium intake < 2.4 g/day, or follow a weight reduction advice), and c) use of drug monotherapy (≈50%), usually insufficient to achieve adequate control. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Not just a FREAK finding, but perhaps an important insight.

Key Points Chronic renal failure patients carry enhanced risk for coronary artery disease that may not be captured by simple FFR measurements Microvascular resistance appears elevated in renal insufficiency and is a potential confounder that could result in a FFR higher than otherwise measured in a patient with normal microvascular system The potential for microvascular resistance in the final interpretation of FFR values in chronic renal insufficient patients raises interesting questions for further outcomes based research