Multifactorial approach and superior treatment efficacy in renal patients with the aid of nurse practitioners. Design of The MASTERPLAN Study [ISRCTN73187232]

BACKGROUND: Patients with chronic kidney disease (CKD) are at a greatly increased risk of developing cardiovascular disease. Recently developed guidelines address multiple risk factors and life-style interventions. However, in current practice few patients reach their targets. A multifactorial approach with the aid of nurse practitioners was effective in achieving treatment goals and reducing vascular events in patients with diabetes mellitus and in patients with heart failure. We propose that this also holds for the CKD population. DESIGN: MASTERPLAN is a multicenter randomized controlled clinical trial designed to evaluate whether a multifactorial approach with the aid of nurse-practicioners reduces cardiovascular risk in patients with CKD. Approximately 800 patients with a creatinine clearance (estimated by Cockcroft-Gault) between 20 to 70 ml/min, will be included. To all patients the same set of guidelines will be applied and specific cardioprotective medication will be prescribed. In the intervention group the nurse practitioner will provide lifestyle advice and actively address treatment goals. Follow-up will be five years. Primary endpoint is the composite of myocardial infarction, stroke and cardiovascular mortality. Secondary endpoints are cardiovascular morbidity, overall mortality, decline of renal function, change in markers of vascular damage and change in quality of life. Enrollment has started in April 2004 and the study is on track with 700 patients included on October 15th, 2005. This article describes the design of the MASTERPLAN study

Формування та розвиток загальної теорії стійкості (середина XVIII ст. — 30-і рр. ХХ ст.)

У статті розглянуто історію вивчення стійкості (середина XVIII — початок XX ст., світовий контекст). Досліджено внесок А. Пуанкаре та О.М. Ляпунова в розвиток загальної теорії стійкості. Показано розвиток їх ідей у працях російських та українських учених.В статье рассмотрена история изучения устойчивости (середина XVIII — начало XX в., мировой контекст). Исследован вклад французского ученого А. Пуанкаре и русского ученого А.М. Ляпунова в развитие общей теории устойчивости. Показано дальнейшее развитие их идей в трудах русских и украинских ученых.The history of basic research in stability is given. Contributions from H.Poincaré, a French mathematician, mechanic and physicist, and O. Lapunov, a soviet mathematician and mechanic (working in the Kharkiv university) to development of the general theory of stability are shown. In 1892—1902, O. Lyapunov constructed an original robust mathematical apparatus to study stability of motion. Development of ideas and methods of H.Poincar of H.Poincar³e and O. Lapunov in works of later Ukrainian and Russian scientists is shown

Recurrent candidiasis and early-onset gastric cancer in a patient with a genetically defined partial MYD88

Gastric cancer is caused by both genetic and environmental factors. A woman who suffered from recurrent candidiasis throughout her life developed diffuse-type gastric cancer at the age of 23 years. Using whole-exome sequencing we identified a germline homozygous missense variant in MYD88. Immunological assays on peripheral blood mononuclear cells revealed an impaired immune response upon stimulation with Candida albicans, characterized by a defective production of the cytokine interleukin-17. Our data suggest that a genetic defect in MYD88 results in an impaired immune response and may increase gastric cancer risk