Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Progression”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,639 records · Page 91Linked to original sources
PubMed2003

Progression of cerebral white matter lesions: 6-year results of the Austrian Stroke Prevention Study.

More than half of all elderly people have some degree of cerebral white matter lesions. However, the rate of progression of these lesions is uncertain. We aimed to assess the progression of lesions in community-dwelling volunteers aged 50-75 years without neuropsychiatric disease. We used MRI to grade and measure the total volume of white matter lesions in 296 volunteers at baseline, 3 years, and 6 years. 58 participants with no lesions and 123 with punctate abnormalities at baseline had a low tendency for lesion progression, whereas 14 participants with early confluent and nine with confluent lesions underwent median increases of 2.7 cm(3) (IQR 0.5-5.9) and 9.3 cm(3) (7.1-21.0), respectively, in lesion volume at 6 years. Lesion grade at baseline was the only significant predictor of lesion progression (p<0.0001). Punctate white matter lesions are not progressive and are thus benign, whereas early confluent and confluent white matter abnormalities are progressive, and thus malignant.

Aged↗
PubMed2004

Adjuvant autologous renal tumour cell vaccine and risk of tumour progression in patients with renal-cell carcinoma after radical nephrectomy: phase III, randomised controlled trial.

BACKGROUND: Organ-confined renal-cell carcinoma is associated with tumour progression in up to 50% of patients after radical nephrectomy. At present, no effective adjuvant treatment is established. We aimed to investigate the effect of an autologous renal tumour cell vaccine on risk of tumour progression in patients with stage pT2-3b pN0-3 M0 renal-cell carcinoma. METHODS: Between January, 1997, and September, 1998, 558 patients with a renal tumour scheduled for radical nephrectomy were enrolled at 55 institutions in Germany. Before surgery, all patients were centrally randomised to receive autologous renal tumour cell vaccine (six intradermal applications at 4-week intervals postoperatively; vaccine group) or no adjuvant treatment (control group). The primary endpoint of the trial was to reduce the risk of tumour progression, defined as progression or death. All patients were assessed after standardised diagnostic investigations at 6-month intervals for a minimum of 4.5 years. FINDINGS: By preoperative and postoperative inclusion criteria, 379 patients were assessable for the intention-to-treat analysis. At 5-year and 70-month follow-up, the hazard ratios for tumour progression were 1.58 (95% CI 1.05-2.37) and 1.59 (1.07-2.36), respectively, in favour of the vaccine group (p=0.0204, log-rank test). 5-year and 70-month progression-free survival rates were 77.4% and 72%, respectively, in the vaccine group and 67.8% and 59.3%, respectively, in the control group. The vaccine was well tolerated, with only 12 adverse events associated with the treatment. INTERPRETATION: Adjuvant treatment with autologous renal tumour cell vaccine in patients with renal-cell carcinoma after radical nephrectomy seems to be beneficial and can be considered in patients undergoing radical nephrectomy due to organ-confined renal-cell carcinoma of more than 2.5 cm in diameter.

Cancer Vaccines↗
PubMed1994

J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis.

The J-shaped relation between diastolic blood pressure and mortality from coronary heart disease continues to provoke controversy. We examined the association between diastolic blood pressure and progression of aortic atherosclerosis in a population-based cohort of 855 women, aged 45-64 years at baseline. The women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to reflect intimal atherosclerosis. After 9 years of follow-up, slight progression of atherosclerosis was noted in 19% of women and substantial progression in 16%. The age-adjusted relative risk of substantial atherosclerotic progression in women with a decrease in diastolic pressure of 10 mm Hg or more was 2.5 (95% CI 1.3-5.6), compared with the reference group of women who had a smaller decrease or no change. The excess risk in this group was confined to women whose increase in pulse pressure was above the median (3.9 [1.5-9.9] vs 1.1 [0.3-4.2] in women with an increase in pulse pressure below the median). The relative risks for women with rises in diastolic pressure of 1-9 mm Hg and 10 mm Hg or more were 2.2 (1.1-4.3) and 3.5 (1.6-8.0), respectively. These findings suggest that a decline in diastolic blood pressure indicates vessel wall stiffening associated with atherosclerotic progression. They support the hypothesis that in low-risk subjects progression of atherosclerosis may be accompanied by a decrease in diastolic blood pressure rather than the opposing idea that low diastolic blood pressure precipitates the occurrence of atherosclerotic events.

Age Factors↗
PubMed1997

Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood.

BACKGROUND: Some studies have suggested that a low-protein diet slows the deterioration of renal function in patients with chronic renal failure (CRF). The effects of a low-protein diet on renal function and growth, have not been assessed in a large, prospective randomised trial in children with CRF. METHODS: A 2-year prospective, stratified, and randomised multicentre study recruited 191 patients aged 2-18 years. After a run-in period of at least 6 months, patients were stratified into either a progressive or non-progressive category based on the change in creatinine clearance in this period. The patients were also stratified into three renal-disease categories and then randomly assigned to a control or diet group. In the diet group, the protein intake was the lowest, safe WHO recommendation--i.e., 0.8-1.1 g/kg daily adjusted for age. All patients were advised to have a calorie intake of at least 70% of the WHO recommendations. Glomerular filtration rate (GFR) was measured every 2 months by creatinine clearance; dietary compliance was checked by urinary urea-nitrogen excretion and dietary diaries (weighing method). 112 patients completed an optional third year of the study. FINDINGS: The low-protein diet did not affect growth. However, there was no effect of diet on the mean decline in creatinine clearance over 2 years (diet vs control: progressive group -9.7 [SD 8.0] vs -10.7 [11.8] mL/min per 1.73 m2; non-progressive group -2.5 [7.5] vs -4.3 [10.0] mL/min per 1.73 m2). Patients classified as having progressive disease were older and had a lower creatinine clearance and a higher blood pressure at randomisation, and had a greater decrease in creatinine clearance than non-progressive patients. On multivariate regression analysis proteinuria (partial R2 = 0.259) and systolic blood pressure (partial R2 = 0.087) were independent predictors of the change in GFR. Similar results were found after the study was extended for a third year. INTERPRETATION: A low-protein diet for 3 years did not affect the decrease in renal function in children with CRF. Proteinuria and blood pressure explain a large part of the variability of, and may be causally related to the decline in the GFR.

Adolescent↗
PubMed1984

Diabetic retinopathy. Assessment of severity and progression.

This study describes a classification of overall retinopathy severity based on the presence and severity of lesions graded in the Airlie House classification of diabetic retinopathy, and demonstrates its use in assessing progression of retinopathy over a 6-year period in a group of insulin-taking patients. One hundred and ninety-one insulin-taking patients with diabetes of at least 5 years' duration were identified from their doctors' records in 1970-1971. Patients were seen again in 1972-1973 and 1976-1977. Stereoscopic color fundus photographs of 7 fields in each eye were taken at each visit. All photos were graded using a modification of the Airlie House classification, which specified 6 levels of retinopathy for a given eye; when both eyes are considered an 11-step grading scheme results. Of all patients seen at the 2-year visit whose retinopathy was at risk of progressing, 41.2% showed progression of one level or more on the scale, 19.2% progression of two or more levels. At the 6-year examination comparable rates were 75.0% and 58.4%. Of patients whose retinopathy was level 4 in each eye (nonproliferative retinopathy of "moderate" severity) at the baseline visit, 13/21 (72%) had progressed to proliferative retinopathy in at least one eye at the 6-year examination. The classification scheme proposed appears useful for characterizing overall retinopathy severity of patients on the basis of gradings of fundus photographs. The data presented may be of help in planning trials of treatment aimed at slowing the development or progression of retinopathy.

Adolescent↗
PubMed1994

Prognostic factors for the progression of keratoconus.

PURPOSE: The progression of keratoconus to a stage where penetrating keratoplasty (PK) is required for visual rehabilitation has considerable implications for affected patients. To assist with counselling, the authors have attempted to identify which factors measurable early in the course of the disease may indicate the likelihood of subsequent surgery. METHODS: The authors reviewed the records of all patients who attended a single center over a 7-year period for contact lens management of their keratoconus. The influence of clinical variables on the time taken for the worst eye to progress to PK was evaluated by actuarial methods and multivariate analysis. RESULTS: Included in the study were 2723 patients with a mean follow-up for unoperated eyes from the first visit of 4.5 years (range, 3 months to 28 years). Data were available for multivariate analysis in 2363 patients. At the end of the study period, 757 eyes (21.6% of all patients) had been grafted. The number of eyes progressing to PK was independently related to both the maximum and minimum keratometry, a corneal cylinder of more than 1.9 mm, the Snellen acuity, the racial group (P < 0.0001), and the age at presentation (P = 0.0006). Sex, laterality, systemic atopic disease, maternal or paternal age at birth, joint hypermobility, and a family history of keratoconus were not statistically related to outcome. Progression to PK in one eye increased the risk of progression in the contralateral eye (P < 0.0001) and a linear model of disease progression is proposed. CONCLUSIONS: Several clinical variables can be measured in patients at the presentation of keratoconus that influence the probability of a subsequent PK.

Adolescent↗
PubMed1994

Ocular factors in the incidence and progression of diabetic retinopathy.

PURPOSE: To investigate the association of intraocular pressure (IOP), ocular perfusion pressure, and myopia with the incidence and progression of diabetic retinopathy. METHODS: The design is a cohort study of a population-based sample (n = 1210) of persons with younger-onset diabetes (diagnosis was made before 30 years of age, and subjects were taking insulin) and a random sample (n = 1780) of persons with older-onset diabetes (diagnosis made after 30 years of age). Baseline and 4-year follow-up examinations were completed by 891 younger-onset and 987 older-onset persons. Retinopathy was graded from stereoscopic fundus photographs. Endpoints were incidence of retinopathy, progression of retinopathy, and progression to proliferative diabetic retinopathy (PDR). Ocular perfusion pressure was calculated from IOP and blood pressure. Myopia was a refractive error of -2 diopters or less. RESULTS: In univariate analyses, ocular perfusion pressure was associated with incidence of retinopathy (P < 0.005), progression of retinopathy (P = 0.07), and progression to PDR (P < 0.001) in the younger-onset group but not in older-onset subjects taking or not taking insulin. Intraocular pressure and myopia were not associated with any endpoint in any group. Using logistic regression to control for covariates, ocular perfusion pressure was significantly associated only with incidence of retinopathy in younger-onset persons. The odds ratio for a 10-mmHg increase in ocular perfusion pressure was 2.13 (95% confidence interval, 1.30-3.50). Also, myopia was protective for progression to PDR in younger-onset persons with an odds ratio of 0.40 (95% confidence interval, 0.18-0.86). CONCLUSIONS: These results suggest that pressure phenomena may be related to the development of retinopathy in younger-onset persons. This would have implications for treatments affecting both IOP and blood pressure.

Adult↗
PubMed1998

Opiates as potential cofactors in progression of HIV-1 infections to AIDS.

Because of the widely documented association of AIDS with opiate abuse, there is considerable interest in knowing whether opiates alter progression of HIV-1 infections to AIDS. The main reason for this interest is that opiates and opiate-abuse have been shown to have broad influence on immune processes as well as in vitro expressions of HIV-1. This article reviews literature defining the connection between opiate use and AIDS. Basic understanding of the effects of opiates on immune process and HIV-1 infection, especially as derived from study of a monkey model of AIDS, are discussed as well as epidemiological data regarding the connection between chronic injected drug abuse and AIDS, in the context of current knowledge about the HIV-1 infectious process and AIDS pathogenesis. Theoretically, there is ample reason to suspect that opiates are involved in progression of HIV-1 infections to AIDS. To date, however, epidemiological approaches have been unable to link decline in CD4 T-cell counts, as a marker of AIDS progression, with opiate use--although other indices of AIDS progression have yet to be thoroughly evaluated in this regard. Also, the impact of opiate use and abuse on opportunistic infections occurring prior to or concurrent with HIV-1 infection has not been closely scrutinized. Interestingly, despite considerable evidence delineating the potential of opiates to exacerbate HIV-1 infections, there is suggestive evidence from both clinical observations and basic studies that homeostatically balancing conditions of chronic, consistent opiate exposure have the potential to protect the host from progression of HIV-1 infections--a situation that may well differ from when opiate-naive subjects first experience exposure to opiates and when opiate dependency is not maintained in a consistent fashion. Taken together, therefore, information from basic studies, including most particularly studies with monkeys, and epidemiological studies, indicates that effects of opiates on progression to AIDS may be conditionally variable. There are many aspects of the drug abuse culture that have potentially offsetting consequences in terms of their potential to up- or down-regulate both HIV-1 expression and host protective responses thereto that could be relevant in this regard. In conclusion, many ambiguities are yet to be considered, and basic and epidemiological studies to be pursued before the opiate-AIDS connection is fully understood.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Predictive value of progression of muscularis mucosae and percentage G3 cells in vesical TIG3 tumours].

INTRODUCTION AND OBJECTIVE: Vesical tumor T1G3 constitutes the border between the superficial tumor and the infiltrante tumor. Some of these tumors do not respond to BCG and progress, with cystectomy that present poor results, patients who would benefit from a precocious and aggressive treatment if we could identify them in an preinvasive stage. New predictive factors try to select to these tumors, being little the works that consider anatomo-pathological meticulous study (substanding of the T1 in T1a and T1b and percentage of present G3 cells in the tumor). Our objective is to analyze the value of these anatomo-pathological considerations like predictive factors of progression. MATERIAL AND METHODS: Retrospective study of a series of 91 patient affection of vesical tumor T1G3 with initial treatment by means of RTU and BCG. We analyzed 12 variables. The new predictive factors: the level of invasion respect to muscularis mucosae and the percentage of G3 cells. By means of logistic regression analisys we establish the independent pronostic factors for tumoral progression. RESULTS: A total of 31 patients presented infiltration of detrusor, passing away 17 of tumoral cause, after an average time of pursuit of 57.8 +/- 28.2 months. In 8 cases (9%) the substanding could not be determined. The rate of progression for T1a tumors was of 20% (8/40) and for T1b 53% (23/43). Presented independent predictive value of progression the multiplicity (odds: 7.26), the size (odds: 2.14), the presence of Cis (odds: 1.42) and the subestanding (odds: 6.81). CONCLUSION: The substanding is a predictive factor of progression clinically useful in vesical tumors T1G3, reason why we considered habitual clinical introduction.

Aged↗
PubMed1986

Progression of coronary atherosclerotic disease assessed by cinevideodensitometry: relation to clinical risk factors.

Progression of coronary artery stenosis was measured using a quantitative, computer-assisted cinevideodensitometric method in 144 arterial segments in 44 subjects undergoing coronary arteriography on two separate occasions at least 6 months apart. Projected coronary arteriograms were digitized into 512 X 512 pixel mode and percent stenosis was calculated by comparing background-corrected videodensitometric values over stenotic and normal segments. Subjects underwent repeat coronary arteriography because of worsening symptoms of angina or heart failure; subjects with renal failure, coronary artery bypass grafts or cardiac transplant were excluded. Clinical variables determined at the time of the first arteriogram included age, sex, serum cholesterol, systolic blood pressure and presence or absence of cigarette smoking, diabetes mellitus and left ventricular hypertrophy. The mean interval between arteriograms was 29.3 months. Overall progression of coronary stenosis was observed in 40 of the 44 subjects; the mean progression at 24 months was 39% (90% confidence interval, 33 to 45%) and at 36 months was 48% (40 to 56%). The degree of overall progression was related to the length of time between arteriograms (F = 5.81, p less than 0.05) and to serum cholesterol level (F = 4.37, p less than 0.05). These data indicate that using an accurate, quantitative method, it is possible to measure progression of coronary artery atherosclerosis within 2 to 3 years of the initial arteriogram. Serum cholesterol appears to be an important determinant of disease progression.

Angiography↗
PubMed1995

Transgenic expression of human acetylcholinesterase induces progressive cognitive deterioration in mice.

BACKGROUND: Cognitive deterioration is a characteristic symptom of Alzheimer's disease. This deterioration is notably associated with structural changes and subsequent cell death which occur, primarily, in acetylcholine-producing neurons, progressively damaging cholinergic neurotransmission. We have reported previously that excess acetylcholinesterase (AChE) alters structural features of neuromuscular junctions in transgenic Xenopus tadpoles. However, the potential of cholinergic imbalance to induce progressive decline of memory and learning in mammals has not been explored. RESULTS: To approach the molecular mechanisms underlying the progressive memory deficiencies associated with impaired cholinergic neurotransmission, we created transgenic mice that express human AChE in brain neurons. With enzyme levels up to two-fold higher than in control mice, transgenic mice displayed an age-independent resistance to the hypothermic effects of the AChE inhibitor, paraoxon. In addition to this improved scavenging capacity for anti-AChEs, however, these transgenic mice also resisted muscarinic, nicotinic and serotonergic agonists, indicating that secondary pharmacological changes had occurred. The transgenic mice also developed progressive learning and memory impairments, although their locomotor activities and open-field behaviour remained similar to those of matched control mice. By six months of age, transgenic mice lost their ability to respond to training in a spatial learning water maze test, whereas they performed normally in this test at the age of four weeks. This animal model is therefore suitable for investigating the transcriptional changes associated with cognitive deterioration and for testing drugs that may attenuate progressive damage. CONCLUSION: We conclude that upsetting cholinergic balance may by itself cause progressive memory decline in mammals, suggesting that congenital and/or acquired changes in this vulnerable balance may contribute to the physiopathology of Alzheimer's disease.

Acetylcholinesterase↗
PubMed2001

Cellular rejection and rate of progression of transplant vasculopathy: a 3-year serial intravascular ultrasound study.

Intravascular ultrasound (IVUS) is established as the optimal method for early detection of transplant vasculopathy. The association between cellular rejection and development of transplant vasculopathy remains controversial. This study attempts to determine the rate of progression of transplant vasculopathy lesions and its relationship with cellular rejection in a long-term (> 1 year) IVUS serial follow-up.A study cohort of 47 patients undergoing heart transplantation from 1993 to 1995 was evaluated. Intravascular ultrasound was performed at baseline (within 8 weeks) and annually for a period of 3 years to determine maximum intimal thickness and maximum plaque area in each coronary segment. Significant allograft vasculopathy was defined as a site with intimal thickness > 0.5 mm not present at baseline. Biopsy results were scored by assigning a numerical weight to each ISHLT grade during the first year. Donor lesions ranged from 0.86 to 1.1 mm, showing no evidence of progression at serial follow-up. De novo lesions were identified in 30 patients. These lesions appeared yearly but progressed slowly. The average biopsy score in the entire cohort was 1.1 +/- 0.8. Average biopsy score was > 1.0 in 35 patients with significant linear correlation between the rate of intimal progression and biopsy score (r = 0.42, p = 0.01). Multivariate analysis demonstrated that only the biopsy score correlated with the rate of progression. Lesions of donor atherosclerosis do not change significantly after transplantation. However, de novo lesions continue to develop every year. In patients with evidence of rejection, the rate of progression of transplant vasculopathy correlates with the severity of rejection.

Adult↗
PubMed2003

Five-year risk of progression of primary angle closure to primary angle closure glaucoma: a population-based study.

OBJECTIVE: To report the 5-year progression to primary angle closure glaucoma (PACG) in a population-based cohort of primary angle closure (PAC) subjects. METHODS: A total of 37 patients diagnosed as PAC during a population-based study in 1995 were invited for re-examination in 2000. Patients underwent a complete ophthalmic examination including ocular biometry. Progression to PACG was based on optic disc damage and field defects on automated perimetry. RESULTS: In all, 28 of 32 PAC subjects who could be contacted presented for examination. Eight (28.5%; 95% CI 12-45%) had progressed to PACG; two of seven with appositional and six of 21 with synechial closure. All were advised laser peripheral iridotomy (LPI) in 1995; one of the nine who underwent LPI progressed compared to seven of 19 who refused LPI. Four of those originally diagnosed with appositional closure developed peripheral anterior synechiae. One eye of a person previously diagnosed with appositional PAC was reclassified as a primary angle closure suspect (PACS). There was no significant difference in biometric parameters between those who progressed and those who did not. None developed acute PACG or blindness due to glaucoma. CONCLUSION: In this population-based study of primary angle closure, the 5-year incidence of PACG was eight patients (28.5%; 95% CI 12-45%). We were unable to identify any features that predicted progression.

Biometry↗
PubMed1983

Inhibition of cell-cycle progression by acute treatment with various degrees of hypoxia: modifications induced by low concentrations of misonidazole present during hypoxia.

The effect on cell-cycle progression in various phases of the cell cycle caused by an acute exposure to hypoxia in absence and presence of misonidazole (MISO) was investigated. Exponentially growing and synchronized cells of the human line NHIK 3025 were exposed to different degrees of hypoxia for a short period (1.5 or 3 h). The cell-cycle progression was studied both during and after hypoxia by flow-cytometric recording of DNA-histograms from treated and untreated cells. The rate of cell-cycle progression was reduced during hypoxia only if the O2-concentration was below 1000 ppm. The inhibition was phase specific with a strong effect in S (reduced DNA-synthesis), and a specific cell-cycle inhibition in late G1, probably at the G1/S-border. For cells inhibited (or arrested for extreme hypoxia) at the G1/S-border, the cell-cycle progression changed back to normal shortly after aerobic conditions were re-established. For cells rendered hypoxic and inhibited during S, hypoxia exerted a lasting effect expressed by a low cell-cycle progression rate even after aerobic conditions were re-established. This effect was strongly dependent on both the degree and the duration of the hypoxic treatment. The presence of a low concentration of MISO (0.05 mM) during hypoxia did not affect the cell-cycle progression during hypoxia at any O2-concentration. For cells rendered hypoxic during S, however, MISO (0.05 mM) counteracted the lasting effect of hypoxia for all concentrations of O2 where this lasting effect was observed.

Cell Cycle↗
PubMed1988

Differences in mortality rate between abrupt and progressive carotid ligation in the gerbil: role of endogenous angiotensin II.

Studies have shown that in comparison to rapid occlusion of a vessel, gradual occlusion produces less severe tissue ischemia due to a more effective development of collateral circulation. As other studies have shown that collateral circulation can be enhanced by stimulation of the endogenous renin-angiotensin II system, it was hypothesized that this system is involved in the mechanism of protection against ischemia that obtains during gradual vascular occlusion. To test this hypothesis, mortality rates were evaluated in gerbils subjected to gradual vascular occlusion by means of progressive carotid ligation while simultaneously infused with inhibitors of the renin-angiotensin II cascade--enalaprilat or saralasin. Groups of animals with either abrupt or progressive carotid ligation infused with saline served as controls. Results showed that (1) in saline-infused animals, there was a significant decrease in the mortality rate of progressive-ligated animals when compared to abrupt-ligated animals, and (2) administration of either enalaprilat or saralasin to progressive-ligated animals resulted in mortality rates that were indistinguishable from those of saline-infused abrupt-ligated animals. These results suggest that the endogenous renin-angiotensin system is indeed involved in an adaptive mechanism that occurs during progressive ligation of the carotid artery, and more specifically, that the relatively benign effect of progressive carotid ligation may be due to the action of angiotensin II to stimulate the development of collateral circulation and reduce the severity of focal brain ischemia.

Angiotensin II↗
PubMed1988

Creatinine measurements often yielded false estimates of progression in chronic renal failure.

In 9 of 22 observation periods (lasting an average of 15 months) in 17 patients with moderate to severe chronic renal failure (GFR 4 to 23 ml/min), rates of progression as estimated from the linear regression on time of 24-hour creatinine clearance (b1) differed significantly from rates of progression as estimated from the regression on time of urinary clearance of 99mTc-DTPA (b2), during all or part of the period of observation. b1 exceeded b2 in four cases and was less than b2 in the other five. Thus there were gradual changes in the fractional tubular secretion of creatinine in individual patients, in both directions. Owing to these changes, measurements of creatinine clearance gave erroneous impressions of the rate or existence of progression during all or a portion of the period of observation in nearly half of these patients. In the 22 studies as a group, using the entire periods of observation, b1 indicated significantly more rapid progression (by 0.18 +/- 0.06 ml/min/month, P less than 0.01) than did b2, and had a significantly greater variance. Measurements of progression based on the rate of change of reciprocal plasma creatinine (multiplied by an average rate of urinary creatinine excretion in each study) were equally misleading, even though less variable. We conclude that sequential creatinine measurements are often misleading as measures of progression and should, when feasible, be replaced by urinary clearance of isotopes in following patients with chronic renal failure.

Creatinine↗
PubMed1993

A crossover comparison of progression of chronic renal failure: ketoacids versus amino acids.

Rates of progression of chronic renal failure were compared in patients receiving alternately an amino acid supplement (AA) and a ketoacid supplement (KA) to a very low protein (0.3 g/kg), low phosphorus (7 to 9 mg/kg) diet. The first supplement was randomly chosen. Bias due to carryover effects was minimized by delaying the regression analysis until one month after starting or changing supplements. In order to minimize possible bias caused by initiating the two supplements at differing levels of severity, a multiple crossover design was used (ABA, BAB, ABAB, or BABA) with at least four GFR's in each treatment period (except for three GFR's in one instance). Sixteen patients completed the protocol; five dropped out. Average starting GFR's were nearly identical for the two supplements (15.4 and 15.9 ml/min). For each patient, mean progression on KA was compared with mean progression on AA. Thirteen out of 16 patients progressed more slowly on KA than AA. On the average, progression on KA was significantly slower (95% confidence limits = -0.36 to 0.09 ml/min/month) than on AA (-0.91 to -0.41 ml/min/month; P = 0.024). There was no significant difference in estimated protein intake, phosphate excretion, or mean arterial pressure between KA and AA periods. Serum triglyceride concentration was significantly lower on KA (P = 0.0026). 17-hydroxycorticosteroid excretion was also lower (P = 0.031). We conclude that KA slow progression, relative to AA, independently of protein or phosphorus intake, in patients on this regimen.

Adult↗
PubMed2003

Differences in the progress of discharged and undischarged patients in a medium secure unit: a pilot study.

This study compared 15 patients ('undischarged' group) who were showing little sign of progress in a medium secure unit (MSU) after 2 years with 15 who had been discharged from the same unit 1-2 years following admission. The two groups were compared across a number of broadly defined behavioural indices during their first 6 months and first 12 months following admission. The measures used were indices of progress to wards of lower security (highest ward status and transfers to wards of higher security) and progress in terms of leave (highest leave status and reductions in leave status). In addition, the two groups were compared on number of recorded incidents attributable to them. Discharged patients were significantly older at the time of their admission than the undischarged patients (median ages 33 and 26 years, respectively). They made more progress in their first year in terms of ward security and leave status and were responsible for fewer recorded incidents. These results were also obtained at 6 months following admission with the exception that the difference for highest ward status was not statistically significant. The findings of this small-scale study suggest that within the first 6 months of admission, it may be possible to distinguish patients who will probably make good progress in a MSU from those whose progress is likely to be very slow. Implications of the study are discussed.

Adult↗