Prognostic Significance of ACE and PAI-1 Genes Polymorphisms with Diabetic Retinopathy and Diabetic Non-Retinopathy in Type 2 Diabetes.

Background: ACE a renin-angiotensin system that regulates blood pressure, balance of fluids and salts in body and PAI-1 is a serine protease inhibitor, which inhibits tissue plasminogen activator andurokinase.They are thought to play an important role in pathophysiology of kidney disease in diabetes. Aim: In our present study, we studied the association of altered ACE-gene and PAI-1 gene with diabetic retinopathy (DR) and NDR in 592 samples consisted of (cohort I; 196 DR patients, cohort II; 200 diabetic nonretinopathy (DNR) and cohort III, 196 respective controls. Methods: For genotyping of ACE-gene and PAI-1 gene, genomic DNA was isolated and purified which was then amplified by PCR, and thePCR products analyzedwere by Agarose gel electrophoresis. Results: In first part, the ACE genotype and allele frequency distribution was studied. For ACE gene polymorphism, the genotype and allele frequency distribution were analyzed in DR subjects and respective controls. The results indicated that there is no statistically significant difference between DR males and females compared to respective controls. The results were significantly high between genotype frequencies of DR and DNR in males. The recessive model was found to be significantly associated with the DR male subjects (OR=0.45 [95% CI=0.20-0.99], p<0.05), whereas in females these are non-significant as compared to respective controls individuals. In second part of study, the disease status analysis of ACE gene on basis of DR stages (NPDR and PDR) was observed. The χ2 analysis indicated that results are significantly different between NPDR and respective controls (χ2=8.75, p=0.01) .And in third part of present study, disease status analysis for PAI-1 gene on the basis of DR stages (NPDR and PDR) was studied, which indicated statistically nonsignificance. The χ2 analysis values for DNR and NPDR and for DNR and PDR was (χ2=0.48, p>0.05)(χ2 =2.00, p>0.05) respectively, Conclusion: Our present study suggests that changes in genetic polymorphisms of ACE-gene and PAI-1 gene in DR, DNR and T2D Patients are risk factors, which may serve as useful prognostic markers.

Awareness and Ethical Attitudes Toward 'Do-Not-Resuscitate (DNR)' for Cancer Patients

PURPOSE: This descriptive study was conducted to investigate awareness and attitudes toward 'Do-Not-Resuscitate (DNR)'. METHODS: Study data were collected from July 24 to September 30, 2011 using structured questionnaires. Study subjects were 209 patients suffering from cancer at "C" Univ. hospital located in Seoul and Cancer Patient Coalition in Seoul. The purpose of the study was explained directly to them. All the data of 209 questionnaires were collected and analyzed without dropping out. RESULTS: In terms of awareness toward DNR, 61.5% said DNR is "necessary" because "their recoveries are impossible" (51.7%) and "they want dignified deaths" (41.1%). When it comes to ethical attitudes toward DNR according to demographic characteristics, there were significant differences both between genders (p<.032) on "Medical staff should tell hopeless patients their conditions openly" and between level of education and monthly income (p<.013) on "DNR decision should be made according to the guideline, if needed". CONCLUSION: The result of this study suggests that decisions on DNR should be made not by only families and doctors but by patients themselves as well. For this, sufficient explanations and education programs for DNR need to be developed and DNR decision including both patient's and family's demand should be standardized.

Orden de no reanimar, consideraciones sobre este problema / Don not resuscitate order: some considerations about this problem

El artículo define aspectos y significados clínicos y éticos sobre Paro Cardiorrespiratorio (PCR), Maniobras de Reanimación Cardiopulmonar y Orden de No resucitación Cardiopulmonar (No-RCP). Enfatiza la diferencia entre el cese de la función cardiorrespiratoria por muerte natural (p.ej. por enfermedad crónica irreversible), distinguiéndolo de el PCR súbito, reversible. Se examinan estas situaciones a la luz de los “Fines de la Medicina” (Hastings Center, 1996).Se analizan los principales problemas, comenzando por las dificultades según los diferentes escenarios (servicio de urgencia, pabellón de maternidad, sala de hospitalizados, unidad de intensivo, pabellones quirúrgicos); se analiza la incertidumbre sobre el pronóstico de cada pacientes y sobre quién(es) deben tomar las decisiones sobre el fin de la vida. Idealmente debe ser el paciente autónomo quien tome la decisión, pero en otros casos se requieren alternativas, una de ellas es la Orden Unilateral. Otros problemas son la Validez de las órdenes de no-RCP en los diferentes tiempos evolutivos, el problema de la Futilidad y la Validez de las “Directivas Anticipadas”, en este grupo resalta el enfoque POLST (Physician’s Order for Life Sustaining Treatment) como más comprehensivo; como complemento ha surgido también el concepto AND (Allow Natural Death), que podría estar destinado a remplazar la orden de no-RCP (DNR).

This article examines the ethical and clinical significance of Cardiopulmonary Arrest, Cardiopulmonary Resuscitation maneuvers and Do Not Resuscitate Order (DNR). It emphasizes Cardiopulmonary Arrest, Cardiopulmonary Resuscitation maneuvers and Do Not Resuscitate Order (DNR). It emphasizes the difference between the cessation of cardiorespiratory function by natural death (e.g. by chronic irreversible disease) as different from the sudden, reversible cardiopulmonary arrest. It considers these situations under the light of the “Goals of Medicine” (Hastings Center, 1996). We look through the main problems, in first place the specific difficulties according to different scenarios (emergency room, maternity ward, hospital room, intensive care unit, surgical blocks); second we analyzes the uncertainty about patients prognosis and third the controversial issue about who should take charge the end of life decisions. The autonomous patient should ideally be who takes the decisions. Other cases need alternatives ways, one of them is the “Unilateral Order”. Other problems are the validity of the DNR orders in different clinical times, the problem of futility and the value of Advance Directives; in this last point POLST (Physician’s Order for Life Sustaining Treatment) approach appears as more comprehensive; at last, the new concept AND (allow natural death) could be destined to replace the DNR order.

Ordem de não reanimar o doente terminal: dilemas éticos dos enfermeiros / Order not to resuscitate the terminally ill: nurses's ethical dilemmas

O artigo discute a Ordem de Não Reanimar (ONR), temática que tem suscitado várias questões éticas no exercício da prestação dos cuidados de saúde. Baseado em pesquisa empreendida em dois hospitais com especialidade oncológica no Norte e no Sul de Portugal, o estudo teve como finalidade conhecer os principais dilemas éticos invocados pelos profissionais de enfermagem pelo fato de não existir uniformização quanto a esta decisão naquele país. A partir de amostra constituída por 231 enfermeiros que atuam em serviços afins enfatizou-se o posicionamento a respeito da tomada de decisão de ONR no doente terminal, bem como asquestões relativas a quem tem conhecimento sobre a mesma, assim como suas formas de registro e reavaliação. Além de caracterizar esse processo, este estudo pretendeu evidenciar qual o pensamento e atitude dos enfermeiros portugueses perante o doente com ONR.

Recognition of Advance Directives by Advanced Cancer Patients and Medical Doctors in Hospice Care Ward / 한국호스피스완화의료학회지

PURPOSE: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. METHODS: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. RESULTS: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. CONCLUSION: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.

Concept Analysis of DNR(Do-Not-Resuscitate) / 간호학회지

PURPOSE: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. METHOD: This study used the process of Walker & Avant's concept analysis. RESULT: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. CONCLUSION: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.

The APACHE III Score and Multiple Organ Failure(MOF) Score in Patients who were Recipients of Decision-Making Do-Not- Resuscitate / 성인간호학회지

PURPOSE: The purpose of this study was to identify characteristics of patients who were recipients of decision-making DNR, to describe the situations of DNR, and to analyze the APACHE III and MOF scores. METHOD: Data collection was conducted through reviews of medical records of 51 patients and through interviews with families of patients who were decision-makers for DNR at C university K Hospital located in Seoul from April to September 2002. RESULTS: The men's APACHE III and MOF scores were higher than the women's and the non cancer patients were higher than cancer patients. Some 80.4% of DNR orders was by communication, while 11.8% of consents were written. Each of APACHE III and MOF scores of patients in the intensive care unit was higher than the patients in general ward at both points of admission and decision-making of DNR. APACHE III and MOF scores positively correlated statistically with each other. CONCLUSIONS: The findings of this study suggest that APACHE III and MOF scores be useful for decision-making of DNR as a tool measuring severity.

Preparation of anti-gastric cancer monoclonal antibody with daunorubicin methotrexate conjugate and its cytotoxiciy to gastric cancer cells / 中国免疫学杂志

It is first time to use dextren T-40 oxidative method to conjugate anti-gastric cancer mono-colonal antibody(McAb)with anti-tumor medicines of daunorubicin(DNR)and methotrexate(MTX)together.Cytotoxicity of conjugates was measured by MTT method and ~3H-TdR incor-poration method respectively.Both sensitivity is similar.The results have showed that this conju-gate exhibited selective cytotoxicity on human gastric cancer cells in vitro.