JAMA : the journal of the American Medical Association
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Comparative Study
Survival following primary androgen deprivation therapy among men with localized prostate cancer.
Despite a lack of data, increasing numbers of patients are receiving primary androgen deprivation therapy (PADT) as an alternative to surgery, radiation, or conservative management for the treatment of localized prostate cancer. ⋯ Primary androgen deprivation therapy is not associated with improved survival among the majority of elderly men with localized prostate cancer when compared with conservative management.
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Fetuin-A is a hepatic secretory protein that binds the insulin receptor and inhibits insulin action in vitro. In prior cross-sectional studies in humans, higher fetuin-A levels were associated with insulin resistance. However, the longitudinal association of fetuin-A with incident type 2 diabetes mellitus is unknown. ⋯ Among well-functioning older persons, serum fetuin-A is associated with incident diabetes, independent of other markers of insulin resistance.
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Although an invasive strategy is frequently used in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), data from some trials suggest that this strategy may not benefit women. ⋯ In NSTE ACS, an invasive strategy has a comparable benefit in men and high-risk women for reducing the composite end point of death, MI, or rehospitalization with ACS. In contrast, our data provide evidence supporting the new guideline recommendation for a conservative strategy in low-risk women.
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Multicenter Study
Epidemiology and treatment of painful procedures in neonates in intensive care units.
Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain. ⋯ During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.