Anemia treatment in chronic kidney disease accompanied by diabetes mellitus or congestive heart failure

Anemia is common in chronic kidney disease (CKD). The CHOIR study found increased risk of a composite cardiovascular outcome when anemia was treated with epoetin-alfa to a target hemoglobin level of 13.5 as compared with 11.3 g/dl. Whether this increase applies to all patient subgroups equally is unclear. We discuss an analysis by Szczech and colleagues of the effects of the higher hemoglobin target in CKD patients with diabetes mellitus or congestive heart failure

On the two-dataset problem

This paper considers the two-dataset problem, where data are collected from two potentially different populations sharing common aspects. This problem arises when data are collected by two different types of researchers or from two different sources. We may reach invalid conclusions without using knowledge about the data collection process. To address this problem, this paper develops statistical models focusing on the difference in measurement and proposes two prediction errors that help to evaluate the underlying data collection process. As a consequence, it is possible to discuss the heterogeneity/similarity of data in terms of prediction. Two real datasets are selected to illustrate our method

Economic variable selection

Regression plays a key role in many research areas and its variable selection is a classic and major problem. This study emphasizes cost of predictors to be purchased for future use, when we select a subset of them. Its economic aspect is naturally formalized by the decision-theoretic approach. In addition, two Bayesian approaches are proposed to address uncertainty about model parameters and models: the restricted and extended approaches, which lead us to rethink about model averaging. From objective, rule-based, or robust Bayes point of view, the former is preferred. Proposed method is applied to three popular datasets for illustration

Assessing Patient Experience and Orientation in the Emergency Department with Virtual Windows

Patients have benefitted from increasingly sophisticated diagnostic and therapeutic innovations over the years. However, the design of the physical hospital environment has garnered less attention. This may negatively impact a patient’s experience and health. In areas of the hospital, such as the emergency department (ED), patients may spend hours, or even days, in a windowless environment. Studies have highlighted the importance of natural light and imagery, as they are essential in providing important stimuli to regulate circadian rhythm and orientation, and to mitigate the onset of certain medical conditions. In hospital locations where standard windows may be infeasible, the use of a virtual window may simulate the benefits of an actual window. In this pilot study, we assessed patient experience and orientation with virtual windows in the ED. We demonstrated that virtual windows are an acceptable technology that may improve patient experience and orientation

Chronic electrical stimulation of the left ventrointermediate (Vim) thalamic nucleus for the treatment of pharmacotherapy-resistant Parkinson\u27s disease: A differential impact on access to semantic and episodic memory?

Thalamotomy for medically refractory Parkinson\u27s disease (PD) is considered to be efficacious and relatively safe. Because a minority of patients experience decrements in language and memory (often mild and transient) after thalamotomy, chronic thalamic deep brain stimulation (DBS) might be a safer treatment given its reversibility and the modifiability of stimulation parameters. Two preliminary studies support the relative cognitive safety of unilateral DBS of the ventral intermediate (Vim) thalamic nucleus, but it is unclear whether possibly subtle changes in language and memory represent effects of \u27microthalamotomy\u27 or of stimulation per se. This report provides preliminary data concerning effects of left thalamic stimulation on information processing speed, semantic memory (verbal fluency and visual confrontation naming), and verbal episodic memory in a patient with PD. In addition to being evaluated before and 3 and 6 months after surgery, the patient was tested 18 months after surgery either on or off medications and with the stimulator turned either on or off (order counterbalanced across medication conditions). Test performance differences between the stimulation conditions were attenuated \u27off\u27 as compared to \u27on\u27 medication. Vim stimulation consistently, albeit subtly, improved semantic verbal fluency but interfered with immediate recall of word lists. Parallels to findings from acute, intraoperative thalamic stimulation studies are explored. The hypothesis is offered that is offered that left Vim stimulation might facilitate access to semantic memory, but interfere with episodic memory processes

Prostaglandin D2 synthase: Apoptotic factor in alzheimer plasma, inducer of reactive oxygen species, inflammatory cytokines and dialysis dementia

Background: Apoptosis, reactive oxygen species (ROS) and inflammatory cytokines have all been implicated in the development of Alzheimer’s disease (AD). Objectives: The present study identifies the apoptotic factor that was responsible for the fourfold increase in apoptotic rates that we previously noted when pig proximal tubule, LLC-PK1, cells were exposed to AD plasma as compared to plasma from normal controls and multi-infarct dementia. Patients and Methods: The apoptotic factor was isolated from AD urine and identified as lipocalin-type prostaglandin D2 synthase (L-PGDS). L-PGDS was found to be the major apoptotic factor in AD plasma as determined by inhibition of apoptosis approximating control levels by the cyclo-oxygenase (COX) 2 inhibitor, NS398, and the antibody to L-PGDS. Blood levels of L-PGDS, however, were not elevated in AD. We now demonstrate a receptor-mediated uptake of L-PGDS in PC12 neuronal cells that was time, dose and temperature-dependent and was saturable by competition with cold L-PGDS and albumin. Further proof of this endocytosis was provided by an electron microscopic study of gold labeled L-PGDS and immunofluorescence with Alexa-labeled L-PGDS. Results: The recombinant L-PGDS and wild type (WT) L-PGDS increased ROS but only the WTL-PGDS increased IL6 and TNFα, suggesting that differences in glycosylation of L-PGDS in AD was responsible for this discrepancy. Conclusions: These data collectively suggest that L-PGDS might play an important role in the development of dementia in patients on dialysis and of AD