Open Reading Frame brings together a selection of recent publication highlights from elsewhere in  the open access ecosystem. This week we take a look at the past few weeks in medicine.


Reducing mortality risk in hip fracture patients
In middle-aged and elderly people, those with hip fractures are at increased risk of mortality compared with the general population. To reduce this risk, it is important to understand the factors affecting mortality in these patients. A study carried out in Norway found that older age, comorbidities and osteoporosis are associated with hip fracture mortality, suggesting that treating osteoporosis with bisphosphonates could be an effective strategy to reduce deaths in this patient group.
Diamantopoulos et al. PLoS One


Retigabine: a new treatment for focal seizures?
Focal seizures, also known as partial seizures, are common in patients with epilepsy and affect only part of the brain. Retigabine (RTG) was approved as an adjunctive therapy for focal seizures in 2011 in the US and Europe, and is the first anti-epileptic drug that works by targeting potassium channels in the brain. Now, a systematic review and meta-analysis has synthesized the evidence on RTG efficacy, showing that the drug is effective for treating focal seizures, and has fewer drug interactions than other anti-epileptic treatments as a result of its unique mechanism of action. However, RTG does have some adverse effects, including urinary retention and skin pigment changes, and the authors conclude that its place in epilepsy therapy is yet to be determined.
Michele Splinter. Journal of Central Nervous System Disease


Walking test predicts survival in cardiovascular disease patients
In patients with cardiovascular and pulmonary illnesses, disease severity is often assessed by measuring  oxygen consumption during maximal exercise. However, it is not possible to carry out these tests in all patients, and walking tests have been developed as an alternative way to measure functional capability. New research shows that walking speed maintained during a 1km treadmill test can predict survival in patients with cardiovascular disease, and patients can also be subdivided into risk categories based on walking speed. These results suggest that the treadmill walking test is a useful tool for risk stratification in people who cannot complete maximal exercise tests, such as those undergoing cardiac rehabilitation programs.
Chiaranda et al. BMJ Open


New therapeutic options for advanced hepatocellular carcinoma
Hepatocellular carcinoma (HCC) is the most common type of liver cancer, and often occurs as a complication of liver disease. HCC can be cured if caught early, but many patients present at a later stage with poor prognosis, as such there is an urgent need for the development of effective treatments for late stage HCC. Blood vessel formation is a major problem in HCC, and anti-angiogenic agents are a promising therapeutic option to treat patients with advanced disease. In a review article, Martin-Walter Welker and Joerg Trojan  discuss the anti-angiogenic drugs in clinical development for HCC, including tyrosine kinase inhibitors and antibody therapies, and explore their safety and efficacy in comparison with treatments currently used in the clinic.
Welker and Trojan. Cancer Management and Research


When should antiretroviral therapy be initiated in HIV-infected children?
It is estimated that approximately 3.3 million children are living with HIV worldwide, and over 90 percent live in Sub-Saharan Africa. New research has been carried out in HIV-infected children in Uganda and Zimbabwe to assess the effects of early treatment with antiretroviral therapy on immune system function later in life. The researchers found that children under ten can achieve good immune system function – measured by CD4 cell counts – in adulthood, provided World Health Organisation guidelines for treatment are followed. However, in children older than ten, it is unlikely that immune constitution will be achieved if current CD4 thresholds for treatment initiation are followed. These results suggest that antiretroviral therapy should be considered for children older than 10 with a high CD4 count, even though they are at low risk for disease progression, in order to preserve long-term immunity to infection.
Picat et al. PLoS Medicine


A new prognostic marker in ovarian cancer?
The continued identification of prognostic cancer biomarkers is important to predict patient outcome and develop new therapies. New research has shown that low expression of the protein mixed lineage kinase domain-like protein (MLKL) is associated with decreased survival in ovarian cancer patients. This suggests that, following further validation, MLKL could be used in the clinic as a prognostic marker for ovarian cancer.
He et al. OncoTargets and Therapy


School-based CPR training could save lives
Cardiopulmonary resuscitation (CPR) is a life-saving procedure, and CPR training in schools has been introduced in many countries in order to improve public understanding of the process. Now, a trial has been carried out in Malaysia to assess the effectiveness of a CPR training program in secondary schools. The researchers found that although CPR knowledge and attitudes were judged to be acceptable at the beginning of the study, brief CPR training significantly improved children’s knowledge. These results emphasize the importance of CPR training, and suggest that school-based training programs have great potential to improve public knowledge of the procedure and save lives.
Rahman et al. International Journal of Emergency Medicine


Preventing cardiovascular disease: the importance of left ventricular remodeling
In patients with hypertension, an abnormal increase in left ventricular (LV) mass is an important predictor of cardiovascular disease risk, and LV structure also provides useful information on patient prognosis. Now, a study using echocardiography measurements in Nigerian patients has revealed four different patterns of LV hypertrophy. The authors found that those with concentric hypertrophy – where the LV walls are thickened but no overall enlargement occurs – have higher blood pressure, and that concentric remodeling is the most common pattern of LV alterations in hypertensive patients. These results emphasize the importance of LV remodeling in cardiovascular disease development, and the authors conclude that hypertension should be treated promptly in order to prevent increases in LV mass.
Adebadyo et al. Clinical Medicine Insights: Cardiology


Written by Claire Barnard, Senior Editor for BMC Medicine.


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