Zobrazení zdroje stránky Bossenmackenzie6681

COVID-19 can cause acute respiratory distress syndrome (ARDS) that is rapidly progressive, severe, and refractory to conventional therapies. Extracorporeal membrane oxygenation (ECMO) can be used as a supportive therapy to improve outcomes but evidence-based guidelines have not been defined.<br /><br /> Initial mortality rates associated with ECMO for ARDS in COVID-19 were high, leading some to believe that there was no role for ECMO in this viral illness. With more experience, outcomes have improved. The ideal candidate, timing of cannulation, and best post-cannulation management strategy, however, has not yet been defined.<br /><br /> We conducted a retrospective review from April 1 to July 31 2020 of the first 25 patients with COVID-19 associated ARDS placed on V-V ECMO at our institution. We analyzed the differences between survivors to hospital discharge and those who died. Modified Poisson regression was used to model adjusted risk factors for mortality.<br /><br /> 44% of patients (11/25) survived to hospital discharge. Survivorsudies are needed to define best practices for V-V ECMO use in COVID-19.<br /><br /> Examine the impact of COVID-19 pandemic on the outcomes in patients with CLTI or DFI.<br /><br /> Patients with CLTI and/or DFI are at risk of amputations if not treated in a timely manner.<br /><br /> We compared the outcomes in patients with CLTI or DFI during 2 periods; Period 1[P1] (15/03/2019-31/05/2019) and period 2[P2] (15/03/ 2020-31/05/2020- corresponding to COVID-19 pandemic).<br /><br /> One hundred thirty-nine patients were treated in P1 [mean age 70 years (±11), MaleFemale = 10237] whereas 95 patients were treated in P2 [mean age 67 (±12), MaleFemale = 6431]. The 2 cohorts were matched regarding Rutherford category (P = 0.25) and GLASS classification (P = 0.38). Notably, the time from onset of symptom to clinical presentation was significantly longer [31 (1-105) days vs 27 (0-78) days, (P = 0.017)], whereas the time from presentation to first intervention was significantly shorter [3 (0-61) days vs 5 (0-65) days, (P = 0.013)] in P2 compared to P1. There was a significantly higher white cell count (P = 0.014) and CRP (P = 0.004) on admission in P2. Having treatment for CLTI or DFI in P2 was an independent predictor of worse primary patency rate and freedom from major adverse limb events. At 90 days, amputation-free survival and limb salvage were noticeably worse in P2 compared to P1 (amputation-free survival was 80% and 87% whereas limb salvage was 64% and 72% in P2 and P1, respectively).<br /><br /> Patients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and freedom from major adverse limb events and therefore close and long follow-up is advisable.<br /><br />Patients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and freedom from major adverse limb events and therefore close and long follow-up is advisable.<br /><br /> To compare the efficacy and safety of algenpantucel-L [HyperAcute-Pancreas algenpantucel-L (HAPa); IND# 12311] immunotherapy combined with standard of care (SOC) chemotherapy and chemoradiation to SOC chemotherapy and chemoradiation therapy alone in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (PDAC).<br /><br /> To date, immunotherapy has not been shown to benefit patients with borderline resectable or locally advanced unresectable PDAC. HAPa is a cancer vaccine consisting of allogeneic pancreatic cancer cells engineered to express the murine α(1,3)GT gene.<br /><br /> A multicenter, phase 3, open label, randomized (11) trial of patients with borderline resectable or locally advanced unresectable PDAC. Patients received neoadjuvant SOC chemotherapy (FOLFIRINOX or gemcitabine/nab-paclitaxel) followed by chemoradiation (standard group) or the same standard neoadjuvant regimen combined with HAPa immunotherapy (experimental group). The primary outcome was overall survival.<br /><br /> Between May 2013 and December 2015, 303 patients were randomized from 32 sites. Median (interquartile range) overall survival was 14.9 (12.2-17.8) months in the standard group (N = 158) and 14.3 (12.6-16.3) months in the experimental group (N = 145) [hazard ratio (HR) 1.02, 95% confidence intervals 0.66-1.58; P = 0.98]. Median progression-free survival was 13.4 months in the standard group and 12.4 months in the experimental group (HR 1.33, 95% confidence intervals 0.72-1.78; P = 0.59). Grade 3 or higher adverse events occurred in 105 of 140 patients (75%) in the standard group and in 115 of 142 patients (81%) in the experimental group (P &gt; 0.05).<br /><br /> Algenpantucel-L immunotherapy did not improve survival in patients with borderline resectable or locally advanced unresectable PDAC receiving SOC neoadjuvant chemotherapy and chemoradiation.<br /><br /> ClinicalTrials.gov Identifier NCT01836432.<br /><br />ClinicalTrials.gov Identifier NCT01836432.<br /><br /> To identify rates of positive circumferential resection margin (CRM) for colon cancer surgery in the U.S.<br /><br /> CRM is one of the most important determinants of local control in colorectal cancers. The extent to which CRM involvement exists after colon cancer surgery is unknown.<br /><br /> Colon cancer cases with resection 2010-2015 were identified from the National Cancer Data Base. Adjusting for patient and tumor characteristics, comparisons were made between cases with CRM &gt;1 mm (negative margin) and those with margin involved with tumor or ≤1 mm (positive margin, CRM+). Hospital-level analysis was performed, examining observed-to-expected CRM+ rates.<br /><br /> In total, 170,022 cases were identified 150,291 CRM- and 19,731 CRM+ (11.6%). Pathologic T-category was the greatest predictor of CRM+, with higher rates in pT4(25.8%), pT4A(24.7%), and pT4B(31.5%) versus pT1(4.5%), pT2(6.3%) and pT3 (10.9%, P &lt; 0.001). Within pT4 patients, predictors of CRM+ included signet-ring histology (38.1% vs. 26.7% non-mucinous, and 26.9% mucinous adenocarcinoma, P &lt; 0.001), removing &lt; 12 lymph nodes (36.5% vs. 26.1% ≥12, P &lt; 0.001), community facilities (32.7%) vs. academic/research (23.6%, P &lt; 0.001), year (30.1% 2010 vs. 22.6% 2015, P &lt; 0.001), and hospital volume (24.5% highest quartile vs. 32.7% lowest, P &lt; 0.001). Across 1,288 hospitals, observed-to-expected ratios for CRM+ ranged from 0 to 7.899; 429 facilities had higher than expected rates.<br /><br /> Overall rate of CRM+ in U.S. colon cancer cases is high. Variation exists across hospitals, with higher than expected rates in many facilities. [https://www.selleckchem.com/products/SL327.html selleck kinase inhibitor] Although biology is a major influencing factor, CRM+ rates represent an area for multidisciplinary improvement in quality of colon cancer care.<br /><br />Overall rate of CRM+ in U.S. colon cancer cases is high. Variation exists across hospitals, with higher than expected rates in many facilities. Although biology is a major influencing factor, CRM+ rates represent an area for multidisciplinary improvement in quality of colon cancer care.