Gilbertmartinussen8841

PURPOSE OF REVIEW Genetic, socioeconomic and clinical features vary considerably among individuals with type 2 diabetes (T2D) influencing disease development, progression and response to therapy. Although a patient-centred approach to pharmacologic therapy of T2D is widely recommended, patients are often treated similarly, irrespective of the differences that may affect therapeutic response. Addressing the heterogeneity of T2D is a major task of diabetes research to lower the high rate of treatment failure as well as to reduce the risk of long-term complications. RECENT FINDINGS A pathophysiology-based clustering system seems the most promising to help in the stratification of diabetes in terms of complication risk and response to treatment. This urges for clinical studies looking at novel biomarkers related to the different metabolic pathways of T2D and able to inform about the therapeutic cluster of each patient. Here, we review the main settings of diabetes heterogeneity, to what extent it has been already addressed and the current gaps in knowledge towards a personalized therapeutic approach that considers the distinctive features of each patient.Vibrio parahaemolyticus (V. parahaemolyticus) caused huge diseases and economic losses in shrimp aquaculture. Understanding the infection mechanism might help develop new strategies for controlling pathogen outbreak. Redistribution of trace element homeostasis, accompanied by impairment of antioxidant status and immune response, was observed during various infections. Accordingly, we hypothesized that V. parahaemolyticus infection might influence trace element homeostasis, impair antioxidant function, and induce inflammation response in shrimp. In the present study, the aim of this study was to investigate the influence of V. parahaemolyticus infection on trace element homeostasis, antioxidant status, and inflammation response in Litopenaeus vannamei (L. vannamei). The results showed that compared with the control group, V. parahaemolyticus infection significantly increased (P  less then  0.05) intestinal V. parahaemolyticus number, serum copper (Cu) concentration at 24, 48, and 72 h and significantly increaster understanding of the L. vannamei and V. parahaemolyticus interactions and may deliver the basis for further research in preventing the bacterial diseases.BACKGROUND Evidence supporting corticosteroids adjunctive treatment (CAT) for Pneumocystis jirovecii pneumonia (PCP) in non-HIV patients is highly controversial. We aimed to systematically review the literature and perform a meta-analysis of available data relating to the effect of CAT on mortality of PCP in non-HIV patients. METHODS We searched Pubmed, Medline, Embase, and Cochrane database from 1989 through 2019. Data on clinical outcomes from non-HIV PCP were extracted with a standardized instrument. Heterogeneity was assessed with the I2 index. Pooled odds ratios and 95% confidence interval were calculated using a fixed effects model. We analyzed the impact of CAT on mortality of non-HIV PCP in the whole PCP population, those who had hypoxemia (PaO2  less then  70 mmHg) and who had respiratory failure (PaO2  less then  60 mmHg). RESULTS In total, 259 articles were identified, and 2518 cases from 16 retrospective observational studies were included. In all non-HIV PCP cases included, there was an association between CAT and increased mortality (odds ratio, 1.37; 95% confidence interval 1.07-1.75; P = 0.01). CAT showed a probable benefit of decreasing mortality in hypoxemic non-HIV PCP patients (odds ratio, 0.69; 95% confidence interval 0.47-1.01; P = 0.05). Furthermore, in a subgroup analysis, CAT showed a significantly lower mortality in non-HIV PCP patients with respiratory failure compared to no CAT (odds ratio, 0.63; 95% confidence interval 0.41-0.95; P = 0.03). CONCLUSIONS Our meta-analysis suggests that among non-HIV PCP patients with respiratory failure, CAT use may be associated with better clinical outcomes, and it may be associated with increased mortality in unselected non-HIV PCP population. Clinical trials are needed to compare CAT vs no-CAT in non-HIV PCP patients with respiratory failure. Furthermore, CAT use should be withheld in non-HIV PCP patients without hypoxemia.BACKGROUND Cardiac rehabilitation (CR) has favourable effects on cardiovascular mortality and morbidity. Therefore, it might reasonable to expect that incomplete CR participation will result in suboptimal patient outcomes. METHODS We studied the 914 post-acute coronary syndrome patients who participated in the OPTImal CArdiac REhabilitation (OPTICARE) trial. They all started a 'standard' CR programme, with physical exercises (group sessions) twice a week for 12 weeks. Incomplete CR was defined as participation in less then 75% of the scheduled exercise sessions. Patients were followed-up for 2.7 years, and the incidence of cardiac events was recorded. Major adverse cardiac events (MACE) included all-cause mortality, non-fatal myocardial infarction and coronary revascularisation. RESULTS A total of 142 (16%) patients had incomplete CR. They had a higher incidence of MACE than their counterparts who completed CR (11.3% versus 3.8%, adjusted hazard ratio [aHR] 2.86 and 95% confidence interval [CI] 1.47-5.26). Furthermore, the incidence of any cardiac event, including MACE and coronary revascularisation, was higher (20.4% versus 11.0%, aHR 1.54; 95% CI 0.98-2.44). Patients with incomplete CR were more often persistent smokers than those who completed CR (31.7% versus 11.5%), but clinical characteristics were similar otherwise. CONCLUSION Post-ACS patients who did not complete a 'standard' 12-week CR programme had a higher incidence of adverse cardiac events during long-term follow-up than those who completed the programme. Since CR is proven beneficial, further research is needed to understand the reasons why patients terminate prematurely.OBJECTIVES Aortic valve endocarditis is occasionally complicated by periannular spreading of the infection and abscess formation, leading to a more aggressive course of the disease and life-threatening complications. This retrospective observational study investigated the long-term outcomes of patients with this complication, which was surgically managed with annular reconstruction and aortic valve replacement. METHODS Between 1998 and 2018, 69 patients were identified with aortic valve endocarditis complicated by periannular abscess formation. All patients were treated with debridement of the infected tissue, gentamicin filling of abscess cavities, annulus reconstruction with bovine pericardium, and valve replacement. Long-term follow-up was performed to detect the rate of recurrence of endocarditis, aortic valve reoperation and survival. RESULTS Mean age was 58 ± 15 years, 81% of patients were male, and the infected valve was native in 51% of all patients. The overall mortality was 36%, with a 30-day mortality of 13% and 120-day mortality of 16%. Five- and 10-year survival was 69.4 ± 12.0% and 55.7 ± 14.3%, respectively. Ten-year freedom from recurrent endocarditis was 83.5 ± 13.3%. CONCLUSION Endocarditis with annular abscess remains associated with high morbidity and mortality and aggressive treatment of the infected tissue and abscess cavities is crucial. Compared with earlier literature, long-term outcome of annular reconstruction in this series is comparable to that of aortic root replacement.In castration-resistant prostate cancer (CRPC) patients, observational studies have reported that statins may boost the antitumor activity of abiraterone (AA) and data suggest an improvement in efficacy; conclusions with vitamin D are less clear but an eventual benefit has been pointed. We conducted a post hoc analysis of individual patient data of CRPC patients treated with prednisone and/or AA with or without statins/vitamin D on randomized clinical trials. In the COU-AA-301 trial, use of AA with statin and vitamin D reduced the risk of death by 38% (p = 0.0007) while AA alone was associated with a decrease of 10% (p = 0.025), compared to prednisone alone. Meanwhile, in the COU-AA-302 trial, use of AA plus statin plus vitamin D was associated with a reduced risk of death of 26% (p = 0.0054). In this data analysis from two prospective randomized clinical trials, statin and vitamin D use was associated with superior overall survival in metastatic CRPC patients treated with AA and prednisone. To our knowledge, this is the first report suggesting the impact of statin plus vitamin D in this population. New strategies using big data may help to clarify these questions easily and in a most cost-effective approach.INTRODUCTION This retrospective cohort study evaluated the impact of endometriosis on the risks of work loss events and salary/growth over a 5-year period. METHODS Women aged 18-49 years with ≥ 1 endometriosis diagnosis were identified in a claims database and matched 11 to women without endometriosis (controls). The index date was the first endometriosis diagnosis date (endometriosis cohort) or a random date during the period of continuous eligibility (controls). Baseline characteristics were compared between cohorts descriptively. Average annual salaries were compared over the 5 years post-index using generalized estimating equations accounting for matching. Time-to-event analyses assessed risk of short-term disability, long-term disability, leave of absence, early retirement, and any event of leaving the workforce (Kaplan-Meier curves with log-rank tests). RESULTS A total of 6851 matched pairs (mean age at index date 38.7 years) were included in the salary growth analysis, with a subset of 1981 pairs in th work loss events, compared with matched controls.BACKGROUND Photographic documentation of the nose is the standard procedure for many surgeons who perform rhinoplasty across the world. One of the most challenging views in the photograph documentation is the frontal view that requires special photographic skills and may create a bias. Our dynamic video recording process allows us to improve the quality of patient evaluation, making the assessment more convenient and enabling the documentation of high-level rhinoplasty database. OBJECTIVES Our main goal was to present our selected video recording process that ensures standardized, high-quality documentation of the data from rhinoplasty patients. As per our knowledge, this tool has not been published before. METHODS We have invented a rotational platform-based chair that allows us to make a dynamic evaluation of the patients under standardized photograph settings (patient's position, camera, and lighting features) through a video recording. RESULTS We demonstrated that the quality of our rotational video recording process is similar to that of standardized photographs. However, this additional dynamic evaluation helps to avoid Photoshop® corrections which may result in bias. CONCLUSIONS This high-quality patient evaluation represents advancement in the photograph-documentation process in the modern era of rhinoplasty. TAK-715 concentration This new dynamic video recording process prevents image misinterpretation, helps improve the quality of patient evaluations, makes the process more convenient, and enables the documentation of high-quality data for rhinoplasty patients. Moreover, this new recording process is an excellent tool for educational purposes and presentations. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.