Novel approaches to pulmonary fibrosis.
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating condition with a poor prognosis and few treatment options. However, recent research into this condition has led to considerable insights into the pathophysiology of the disease, resulting in the identification of potential biomarkers to aid diagnosis and stratification of patients and the development of novel therapies. In this review we will discuss the recent developments in this field and review how this knowledge has been translated into clinical trials and a paradigm shift in our approach to patients with IPF.
PMID: 25468919 [PubMe...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Jenkins G, Goodwin A Tags: Clin Med Source Type: research
Rheumatoid arthritis: from palliation to remission in two decades.
Abstract
The last 20 years have seen a transformation in the landscape of rheumatoid arthritis, which has changed from being a life limiting condition to a chronic but often remitting illness. The importance of early disease control, the better use of existing therapies, and the development of new therapies have all been key to this success. The future of therapy now lies in the identification of stratifying biomarkers, to allow more rational delivery of treatment. The ultimate goal remains the reintroduction of immune tolerance to potentially achieve a 'cure.'
PMID: 25468920 [PubMed - in process...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Brown PM, Isaacs JD Tags: Clin Med Source Type: research
The emerging mysteries of IgG4-related disease.
Abstract
IgG4-related disease (IgG4-RD) is increasingly recognised in Western societies as a multi-system, inflammatory, fibrosing disease of unknown aetiology that typically, though not exclusively, presents in older men. The clinical manifestations are diverse and almost any organ may be affected. The cardinal histological features are a lymphoplasmacytic infiltrate, storiform fibrosis, obliterative phlebitis and an abundance of IgG4+ plasma cells in affected organs. Serum IgG4 levels are elevated in approximately 70% of patients and are a useful biomarker when present. IgG4-RD is frequently misdiagnosed...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Smit W, Barnes E Tags: Clin Med Source Type: research
Protons and more: state of the art in radiotherapy.
Abstract
The purpose of modern radiotherapy is to deliver a precise high dose of radiation which will result in reproductive death of the cells. Radiation should transverse within the tumour volume whilst minimising damage to surrounding normal tissue. Overall 40% of cancers which are cured will have received radiotherapy. Current state of the art treatment will incorporate cross-sectional imaging and multiple high energy X-ray beams in processes called intensity modulated radiotherapy and image guided radiotherapy. Brachytherapy enables very high radiation doses to be delivered by the direct passage of a ...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Hoskin PJ, Bhattacharya IS Tags: Clin Med Source Type: research
Update in the myeloproliferative neoplasms.
Abstract
The differential diagnosis of haematological abnormalities, such as leucocytosis, erythocytosis, thrombocytosis or indeed anaemia, is wide and disarming. Here we report on significant updates in the differential diagnosis of erythrocyosis and thrombocytosis presenting a simplified schema for the clinician. We then move to discuss significant advances in this field which have followed a series of key molecular findings, most specifically those affecting the JAK/STAT pathway.
PMID: 25468923 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Harrison CN, McMullin MF Tags: Clin Med Source Type: research
Thyroid and iodine nutritional status: a UK perspective.
Abstract
Iodine is an essential component of the thyroid hormones, which play a crucial role in brain and neurological development. At least one-third of the world's population is estimated to be iodine deficient predominantly in developing countries. Recently concern had also been expressed about the iodine status in industrialised countries such as the UK. A recent survey of the UK iodine status found that that more than two-thirds of schoolgirls aged 14-15 years were iodine deficient due to the reduced milk intake. Maternal iodine deficiency in pregnancy is correlated with cognitive outcomes such as in...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Vanderpump M Tags: Clin Med Source Type: research
Insights into cancer biology through next-generation sequencing.
Abstract
Cancer is the ultimate disorder of the genome, characterised not by just one or two mutations, but by hundreds to thousands of acquired mutations that have been accrued through the development of a tumour. Thanks to the recent increase in the speed of sequencing offered by modern sequencing technologies, we are no longer restricted to exploring tiny fragments of protein-coding portions of the human genome. We can now read all the genetic material in human cells. Here, the framework of a next-generation sequencing experiment is explained, giving insight into the advances and difficulties posed by p...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Nik-Zainal S Tags: Clin Med Source Type: research
Targeting care in Barrett's oesophagus.
Abstract
Barretts oesophagus represents the most significant risk factor for the development of oesophageal adenocarcinoma (OAC), although the majority of patients will not develop cancer. However, early detection of OAC and its precursors significantly improves outcome and underlines the importance of endoscopic surveillance programmes. Clearly there is a discrepancy between the small number of people who need to undergo surveillance because they are at significant progression risk, and the large number that do. Research is therefore now concentrated on risk stratification. Currently such stratification i...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Zeki S, Fitzgerald RC Tags: Clin Med Source Type: research
Optimising long-term graft survival: establishing the benefit of targeting B lymphocytes.
Abstract
Kidney transplants do not last for the natural lifespan of most recipients. Of the reasons why transplants fail, damage by the immune system is the commonest cause. Understanding how the immune system recognises transplanted organs has increased significantly in recent years, but there is little insight into how organs are damaged, and no still no way of suppressing immune-mediated damage without exposing patients to the detrimental effects of long-term immunosuppression. In this article, we review the role of antibodies and B cells in immune-mediated damage of kidney transplants, and discuss the ...
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Shiu KY, Dorling A Tags: Clin Med Source Type: research
Protecting the kidney from complement: atypical haemolytic uraemic syndrome.
Abstract
Atypical haemolytic uraemic syndrome is a thrombotic microangiopathy with a predominant renal phenotype. Research developments in the last 15 years have led to the elucidation of the role of complement over activation in the pathogenesis of the disease. This was to lead to the successful introduction of targeted pharmacological therapy, in the form of the complement inhibitor, eculizumab.
PMID: 25468928 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Brocklebank V, Kavanagh D Tags: Clin Med Source Type: research
Picture the future: emerging imaging modalities.
This article reviews the advances made in emerging imaging modalities as well as their potential applications in targeted therapy.
PMID: 25468929 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2014 Category: Journals (General) Authors: Lee JS, Gleeson FV Tags: Clin Med Source Type: research
Checking lists, ticking boxes.
PMID: 25301902 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 1, 2014 Category: Journals (General) Authors: Hodgson H Tags: Clin Med Source Type: research
In praise of clinical examinations.
PMID: 25301903 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - October 1, 2014 Category: Journals (General) Authors: Elder AT Tags: Clin Med Source Type: research
Safety in numbers: lack of evidence to indicate the number of physicians needed to provide safe acute medical care.
Abstract
Patient safety in hospital is dependent on a multitude of factors. Recent reports into the failings of healthcare organisations in the UK have highlighted low staffing levels as a significant factor. There is research into the impact of nurse-to-patient ratios on patient safety, but our literature search found little published data that would allow healthcare providers to define a minimum number of physician staff and skills mix that would assure safety in the largest hospital specialty: unscheduled (acute) medicine. Future work should focus on the evaluation of existing data on hospital mortality...
Source: Clinical Medicine - October 1, 2014 Category: Journals (General) Authors: Sabin J, Subbe CP, Vaughan L, Dowdle R Tags: Clin Med Source Type: research
Application of the WHO surgical safety checklist outside the operating theatre: medicine can learn from surgery.
Abstract
Safety checklists in medicine are designed to identify a potential error before it results in harm to a patient. The World Health Organization (WHO) safety checklist was widely implemented in surgical practice in the UK after significant reductions in death, and peri-operative complications were achieved in eight countries worldwide in the 'Safe Surgery Saves Lives' campaign of 2008. Nevertheless, use of the checklist for invasive medical procedures is not yet routine. Such procedures are becoming ever more complex, necessitating multidisciplinary team management and involving higher-risk patients...
Source: Clinical Medicine - October 1, 2014 Category: Journals (General) Authors: Braham DL, Richardson AL, Malik IS Tags: Clin Med Source Type: research
