1.
Comparison Between Subtotal Parathyroidectomy and Total Parathyroidectomy with Autotransplantation for Secondary Hyperparathyroidism in Patients with Chronic Renal Failure: A Meta-Analysis.
Chen, J, Zhou, QY, Wang, JD
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2015;(9):643-51
Abstract
We conducted a meta-analysis of randomized and 2-arm prospective or retrospective studies that compared the efficacy of PTX and TPTX+AT in patients with medically uncontrollable secondary HPT due to chronic renal failure. Citations were identified in the Medline, Cochrane, EMBASE, and Google Scholar databases through April 2014. The primary outcome of interest was HPT recurrence rate, while secondary outcomes included changes in serum calcium (Ca(++ )), parathyroid hormone (PTH), alkaline phosphatase (ALP), and phosphate (P) levels. Five studies were included in the present analysis. The NOS score of all the included studies was 7 or above, and heterogeneity among the studies was minimal for 3 of the 5 outcomes. The HPT recurrence rate was similar for patients who underwent SPTX vs. TPTX+AT [odds ratio (OR)=0.825; 95% confidence interval (CI)=0.368 to 1.846; p=0.639]. The changes in serum Ca(++ ), PTH, ALP, and P were also similar between the 2 treatment groups (Ca(++ ): Std diff in means=- 0.166; 95% CI=- 0.703 to 0.371; p=0.545; PTH: pooled diff in means=561.17; 95% CI=-174.30 to 1296.6; p=0.135; ALP: pooled diff in means=0.58; 95% CI=- 70.07 to 71.24; p=0.987; P: pooled Std diff in means=0.26; 95% CI=- 0.091 to 0.630; p=0.143). Our findings indicate that SPTX and TPTX+AT are equally successful in preventing recurrent HPT and improving secondary HPT. We therefore, conclude that the choice of procedure can be left to the surgeons.
2.
Predictive value of outcome scores in patients suffering from cardiogenic shock complicating AMI: APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II.
Kellner, P, Prondzinsky, R, Pallmann, L, Siegmann, S, Unverzagt, S, Lemm, H, Dietz, S, Soukup, J, Werdan, K, Buerke, M
Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2013;(8):666-74
Abstract
BACKGROUND Scoring systems in critical care patients are essential for prediction of outcome and for evaluation of therapy. In this study we determined the value of the APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scoring systems in the prediction of mortality in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). MATERIAL AND METHODS In this prospective, observational study, patients who were admitted to the ICU with CS complicating AMI were consecutively included. Data for the APACHE II, APACHE III, Elebute-Stoner, SOFA, and SAPS II scores were recorded on admission and during the following 96 h. Receiver operating characteristic curve analyses and the area under the curve (AUC) were used to estimate the predictive ability (mortality) of the scoring systems on admission and the maximum value. RESULTS Mortality among the 41 patients included in this study was 44 %. On admission, the mean APACHE II (p = 0.035), APACHE III (p = 0.003), SAPS II (p = 0.001), and SOFA (p = 0.042) scores were significantly higher in nonsurvivors than in survivors. At maximum score, APACHE II (p = 0.009), APACHE III (p < 0.001), and SAPS II (p < 0.001) appeared to have higher significance. On admission, the discrimination for APACHE III was 0.786, for SAPS II 0.790, and for APACHE II 0.691. The maximum-score AUC for APACHE II was 0.726, for APACHE III 0.827, and for SAPS II 0.832. Elebute-Stoner and SOFA did not yield valuable results at maximum score or, in the case of Elebute-Stoner, on admission. CONCLUSION These results suggest that at the time of diagnosis and at maximum value, the SAPS II, APACHE III, and APACHE II scores may be useful in predicting a high probability of survival of patients with CS complicating AMI.
3.
Non-pharmacological care for patients with generalized osteoarthritis: design of a randomized clinical trial.
Hoogeboom, TJ, Stukstette, MJ, de Bie, RA, Cornelissen, J, den Broeder, AA, van den Ende, CH
BMC musculoskeletal disorders. 2010;:142
Abstract
BACKGROUND Non-pharmacological treatment (NPT) is a useful treatment option in the management of hip or knee osteoarthritis. To our knowledge however, no studies have investigated the effect of NPT in patients with generalized osteoarthritis (GOA). The primary aim of this study is to compare the effectiveness of two currently existing health care programs with different intensity and mode of delivery on daily functioning in patients with GOA. The secondary objective is to compare the cost-effectiveness of both interventions. METHODS/DESIGN In this randomized, single blind, clinical trial with active controls, we aim to include 170 patients with GOA. The experimental intervention consist of six self-management group sessions provided by a multi-disciplinary team (occupational therapist, physiotherapist, dietician and specialized nurse). The active control group consists of two group sessions and four sessions by telephone, provided by a specialized nurse and physiotherapist. Both therapies last six weeks. Main study outcome is daily functioning during the first year after the treatment, assessed on the Health Assessment Questionnaire. Secondary outcomes are health related quality of life, specific complaints, fatigue, and costs. Illness cognitions, global perceived effect and self-efficacy, will also be assessed for a responder analysis. Outcome assessments are performed directly after the intervention, after 26 weeks and after 52 weeks. DISCUSSION This article describes the design of a randomized, single blind, clinical trial with a one year follow up to compare the costs and effectiveness of two non-pharmacological interventions with different modes of delivery for patients with GOA. TRIAL REGISTRATION Dutch Trial Register NTR2137.
4.
Prostaglandin E2 and treatment outcome in pulp therapy of primary molars with carious exposures.
Waterhouse, PJ, Nunn, JH, Whitworth, JM
International journal of paediatric dentistry. 2002;(2):116-23
Abstract
OBJECTIVES Prostaglandin E2 (PGE2) has been suggested as an indicator of irreversible pulpitis in permanent teeth [1]. There is scant information on the role of chemical mediators in primary molar pulp inflammation. The aim of this preliminary study was to investigate the levels of PGE2 in blood harvested from root pulp stumps following coronal pulp amputation in vital primary molar teeth with carious exposures. METHODS Seventy-nine cariously exposed primary molars underwent treatment by one of two vital pulp therapy techniques. Blood was harvested from 38 teeth and volume and concentration of PGE2 ([PGE2]) determined [2]. Treatment outcome was assessed from both clinical and radiographic evidence. RESULTS PGE2 was detected in all samples, with a wide concentration range (1-2641 ng/mL). The distribution was skewed, requiring log transformation. The difference in the mean (log) [PGE2] for radiological success (3.12, SD 1.60 and failure (4.62, SD 1.80) was significant, t = 2.05, P = 0.047. The difference in the mean (log) [PGE2] for clinical success (3.24, SD 1.65) and failure (5.44, SD 1.43 was near-significant, t = 1.84, P = 0.074. CONCLUSION [PGE2] correlated positively with radiological outcome following vital pulp therapy.