Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor

Background　Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. Case presentation　A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. Conclusions　Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives

Evaluating the Need for and Effect of Percutaneous Transluminal Angioplasty on Arteriovenous Fistulas by Using Total Recirculation Rate per Dialysis Session (“Clearance Gap”)

The functioning of an arteriovenous fistula (AVF) used for vascular access during hemodialysis has been assessed mainly by dilution methods. Although these techniques indicate the immediate recirculation rate, the results obtained may not correlate with Kt/V. In contrast, the clearance gap (CL-Gap) method provides the total recirculation rate per dialysis session and correlates well with Kt/V. We assessed the correlation between Kt/V and CL-Gap as well as the change in radial artery (RA) blood flow speed in the fistula before percutaneous transluminal angioplasty (PTA) in 45 patients undergoing continuous hemodialysis. The dialysis dose during the determination of CL-Gap was 1.2 to 1.4 Kt/V. Patients with a 10% elevation or more than a 10% relative increase in CL-Gap underwent PTA (n＝45), and the values obtained for Kt/V and CL-Gap before PTA were compared with those obtained immediately afterward. The mean RA blood flow speed improved significantly (from 52.9 to 97.5cm/sec) after PTA, as did Kt/V (1.07 to 1.30) and CL-Gap (14.1% to －0.2%). A significant correlation between these differences was apparent (r＝－0.436 and p＝0.003). These findings suggest that calculating CL-Gap may be useful for determining when PTA is required and for assessing the effectiveness of PTA, toward obtaining better dialysis

Role of the RNA-Binding Protein Nrd1 in Stress Granule Formation and Its Implication in the Stress Response in Fission Yeast

We have previously identified the RNA recognition motif (RRM)-type RNA-binding protein Nrd1 as an important regulator of the posttranscriptional expression of myosin in fission yeast. Pmk1 MAPK-dependent phosphorylation negatively regulates the RNA-binding activity of Nrd1. Here, we report the role of Nrd1 in stress-induced RNA granules. Nrd1 can localize to poly(A)-binding protein (Pabp)-positive RNA granules in response to various stress stimuli, including heat shock, arsenite treatment, and oxidative stress. Interestingly, compared with the unphosphorylatable Nrd1, Nrd1DD (phosphorylation-mimic version of Nrd1) translocates more quickly from the cytoplasm to the stress granules in response to various stimuli; this suggests that the phosphorylation of Nrd1 by MAPK enhances its localization to stress-induced cytoplasmic granules. Nrd1 binds to Cpc2 (fission yeast RACK) in a phosphorylation-dependent manner and deletion of Cpc2 affects the formation of Nrd1-positive granules upon arsenite treatment. Moreover, the depletion of Nrd1 leads to a delay in Pabp-positive RNA granule formation, and overexpression of Nrd1 results in an increased size and number of Pabp-positive granules. Interestingly, Nrd1 deletion induced resistance to sustained stresses and enhanced sensitivity to transient stresses. In conclusion, our results indicate that Nrd1 plays a role in stress-induced granule formation, which affects stress resistance in fission yeast

Adequação das técnicas de validação dos modelos de probabilidade de default em carteiras simuladas

O acordo de Basiléia II permite que instituições financeiras utilizem modelos internos para mensuração do capital mínimo exigido. No entanto, a utilização de modelos internos exige, dentre outras aprovações, a validação destes por uma área independente. Com isso, o desenvolvimento de técnicas para validação de modelos de riscos tem ganhado importância nos últimos anos tanto no âmbito acadêmico quanto no mercado financeiro. Este estudo tem como finalidade avaliar algumas das principais técnicas utilizadas na validação dos modelos de probabilidade de default (PD), através da aplicação destas técnicas em modelos desenvolvidos a partir de carteiras simuladas. Foram avaliadas desde técnicas mais tradicionais como KS, AR e área sob a curva ROC, até técnicas mais recentes como CIER, Information Value e a medida M. A vantagem em se utilizar carteiras simuladas é que elas permitem o estudo de um grande número de situações distintas, o que seria inviável através da utilização de carteiras reais. A partir deste estudo será possível entender as limitações das metodologias de validação dos modelos de PD e identificar quais técnicas são mais sensíveis a cada um dos casos analisados.The Basel II accord allows financial institutions to use internal models for measuring capital requirements. However, the use of internal models requires, among other approvals, a validation by an independent area. Thus, the development of techniques for validating risk models has gained much importance in the academic and in the financial markets. This study aims to evaluate some of the main techniques used for validate probability of default models, through the application of these techniques in PD models developed from simulated portfolios. Were evaluated traditional techniques such as KS, AR and area under ROC curve and newer techniques such as CIER, Information Value and measure M. The advantage of using simulated portfolios is that they allow the study of a large number of different situations, which would be impossible by using real portfolios. This study will provide an understanding of the limitations present in validation methodologies of PD models and an assessment of which techniques are more sensitive for each case analyzed

Adequação das Técnicas de Validação dos Modelos de Probabilidade de Default em Carteiras Simuladas

O acordo de Basiléia II exige que as instituições financeiras realizem a validação dos modelos desenvolvidos internamente, antes de utilizá-las para mensuração de risco, gestão e alocação de capital. Com isso o desenvolvimento de técnicas para validação de modelos de riscos tem ganhado importância nos últimos anos tanto no âmbito acadêmico quanto no mercado financeiro. Este estudo tem como finalidade avaliar algumas das principais técnicas utilizadas para mensuração da capacidade discriminante dos modelos de probabilidade de default, ou seja, avaliar as técnicas que mensuram se os modelos discriminam de forma eficiente, bons e maus pagadores. Foram avaliadas desde técnicas mais tradicionais como Kolmogorov-Smirnov, Accuracy Ratio e área sobre a curva ROC, até técnicas mais recentes como Conditional Information Entropy Ratio e Information Value. Para realização da avaliação foram utilizadas carteiras simuladas com distribuição normal de bons e maus pagadores e carteiras simuladas com distribuição normal de bons pagadores e bimodal para maus pagadores. A vantagem em se utilizar este tipo de carteira é que elas permitem simular um grande número de situações distintas, o que seria muito complexo utilizando carteiras reais. A partir deste estudo será possível entender as limitações das metodologias de validação dos modelos de probabilidade de default que foram analisadas e identificar as melhores técnicas a serem utilizadas para os diferentes tipos de carteira

Cytophagic Histiocytic Panniculitis in Systemic Lupus Erythematosus

This paper presents a case of cytophagic histiocytic panniculitis in a Japanese woman, who had systemic lupus erythematosus complicated with Hashimoto's thyroiditis and lupus nephritis from the age of 12. The patient had painful multiple purplish subcutaneous nodules on the face, trunk and extremities, high fever and liver dysfunction without coagulopathy. The histological features of the skin nodules were extensive histiocyte and/or macrophage infiltration often with leuko- and/or erythrophagocytosis in the subcutaneous fat tissue

High Cervical Intradural Lipoma : Case Report

A rare high cervical intradural subpial lipoma unassociated with spinal dysraphism manifested by a slowly progressive myelopathy simulating Brown-Sequard syndrome in a 37-year-old male. The diagnosis was based on neuroradiological imaging. Intraoperative recording of somatosensory evoked potentials showed recovery of the prolonged N_ latency, indicating adequate decompression was achieved

チイキカン ショトク ノ フビョウドウ カイヒ ト ホジョキン ノ ブンパイ

論文タイプ||論