Borcharmstrong1367

Lower gestational age and birth weight were associated with higher rates of readmissions after NICU discharge. CONCLUSION  Duration off and invasiveness of respiratory support prior to discharge did not predict risk of 90-day readmission nor did discharge during months with traditionally higher prevalence of respiratory viruses. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.OBJECTIVE  This study aimed to analyze whether hospital safety-net burden status is associated with increased risk for severe maternal morbidity (SMM) and postpartum readmissions. STUDY DESIGN  The 2010 to 2014 Nationwide Readmissions Database was utilized for this retrospective cohort study. Hospitals were categorized as high-burden hospitals (25% of hospitals with the highest safety-net burden), medium-burden hospitals (50% of hospitals with intermediate safety-net burden), and low-burden hospitals (25% of hospitals with the lowest safety-net burden) based on the proportions of Medicaid or uninsured patients. Risk for (1) SMM, (2) 60-day postpartum readmissions, and (3) SMM during postpartum readmissions was analyzed. Unadjusted and adjusted log-linear regression models were performed, respectively, for these outcomes with unadjusted risk ratio (RR) and adjusted RR (aRR) as measures of effect. Adjusted models included demographic, hospital, and clinical factors. RESULTS  High-burden safety-net status was asue, New York, NY 10001, USA.in English, German Bei der Therapie des metastasierten Prostatakarzinoms wurden in letzter Zeit deutliche Fortschritte erzielt. Zusätzlich zur Androgendeprivation stehen verschiedene Optionen zur Verfügung, wie gegen den Androgenrezeptor gerichtete Therapien und die Taxan-basierte Chemotherapie. Nach wie vor wird diskutiert, ob oligometastasierte Patienten primär nur systemisch behandelt werden sollten, ober ob sie von einer zusätzlichen Lokaltherapie des Primärtumors profitieren. Bis Mitte 2018 gab es keine evidenzbasierte Empfehlung, bei neu diagnostiziertem Prostatakarzinom mit Fernmetastasen eine lokale Bestrahlung der Prostata durchzuführen. Diese konnte als Einzelfallentscheidung aufgrund der Daten retrospektiver Serien indiziert werden. Dementsprechend gab es hierzu keine Empfehlungen in den Leitlinien. Durch die 2018 /19 publizierten Daten der STAMPEDE- und der HORRAD-Studie ist die Indikation zu einer lokalen Bestrahlung des Primärtumors beim oligometastasierten Prostatakarzinom mit weniger als 4 Knochenmetastasen nun klar belegt. Die folgende Übersicht fasst die Daten der beiden Studien zusammen, bewertet diese und gibt eine Empfehlung für den Einsatz der lokalen Strahlentherapie der Prostata in der oligometastasierten Situation.in English, German Die Huntington-Erkrankung (HD) ist eine autosomal-dominante neurodegenerative Erkrankung, die vornehmlich zwischen dem 30. und 50. Lebensjahr auftritt. Verursacht wird sie durch eine Genmutation auf dem Chromosom 4, welche zu einer Tripletexpansion (CAG) führt. Weniger als 10% der Betroffenen erkranken vor dem 20. Lebensjahr. Die beim Erwachsenen typischen choreatiformen Bewegungsmuster tauchen beim Jugendlichen erst im späteren Verlauf auf, können aber auch ganz fehlen. Etwa ein Drittel der Jugendlichen entwickelt eine Epilepsie.Wir präsentieren sechs Fälle kindlicher/juveniler HD und beschreiben vergleichend zur adulten HD Erstsymptome, genetische Befunde und weitere Besonderheiten.Die klinische Präsentation und auch der Erkrankungsverlauf der jugendlichen HD-Patienten unterscheiden sich mitunter deutlich von der adulten Form. Es imponieren initial vor allem Teilleistungsstörungen bei den Kindern sowie psychiatrische Symptome wie Depression und Aufmerksamkeitsstörungen bei den Jugendlichen.Aufgrund der niedrigen Prävalenz juveniler HD sowie der variablen klinischen Symptomatik ist eine Diagnosestellung im Kindes- und Jugendalter schwierig und gelingt oftmals erst mit einer zeitlichen Latenz. Die frühe Diagnosestellung kann allerdings wichtig sein, insbesondere, um soziale und schulische Probleme zu entschärfen.BACKGROUND  Statins are guidelines recommended in patients with peripheral artery disease (PAD) for the prevention of cardiovascular (CV) events. Comprehensive meta-data on the impact of statins on major adverse limb events (MALE) in PAD patients are lacking. We examined the association of statin use with MALE in patients with PAD. METHODS  We performed a systematic review (registered at PROSPERO number CRD42019137111) and metanalysis of studies retrieved from PubMed (via MEDLINE) and Cochrane (CENTRAL) databases addressing the impact of statin on MALE including amputation and graft occlusion/revascularization. Secondary endpoints were all-cause death, composite CV endpoints, CV death, and stroke. RESULTS  We included 51 studies with 138,060 PAD patients, of whom 48,459 (35.1%) were treated with statins. The analysis included 2 randomized controlled trials, 20 prospective, and 29 retrospective studies. Overall, 11,396 MALE events, 21,624 deaths, 4,852 composite CV endpoints, 4,609 CV deaths, and 860 strokes were used for the analysis. Statins reduced MALE incidence by 30% (pooled hazard ratio [HR] 0.702; 95% confidence interval [CI] 0.605-0.815) and amputations by 35% (HR 0.654; 95% CI 0.522-0.819), all-cause mortality by 39% (pooled HR 0.608, 95% CI 0.543-0.680), CV death by 41% (HR 0.594; 95% CI 0.455-0.777), composite CV endpoints by 34% (pooled HR 0.662; 95% CI 0.591-0.741) and ischemic stroke by 28% (pooled HR 0.718; 95% CI 0.620-0.831). CONCLUSION  Statins reduce the incidence of MALE, all-cause, and CV mortality in patients with PAD. In PAD, a high proportion of MALE events and deaths could be prevented by implementing a statin prescription in this patient population. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Cilostazol-based dual antiplatelet therapy (DAPT) is widely used in patients with aspirin intolerance after coronary drug-eluting stent (DES) implantation in China. However, this empirical strategy is not recommended or even mentioned in Chinese or international guidelines due to a lack of evidence from large-scale studies. We aimed to explore the efficacy and safety of cilostazol-based DAPT in this special population. METHODS  In this cohort study, patients were grouped according to the DAPT strategy that they received after coronary DES implantation. The primary efficacy endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs). Angiographic follow-up and major bleeding events were also recorded. RESULTS  A total of 918 patients receiving cilostazol-based DAPT due to aspirin intolerance were enrolled, matched with 918 patients receiving aspirin-based DAPT. After 15-month prospective follow-up, the cilostazol group had lower risk of MACCE (5.1% vs. 7.6%, propensity score adjusted hazard ratio = 0.671 [95% confidence interval 0.462-0.974], p = 0.036) compared with the aspirin group. Lower rate of coronary lesion progression was also found through follow-up angiography in the cilostazol group (17.4% vs. 23.6%, p = 0.022), especially in nontarget lesions (12.1% vs. 17.6%, p = 0.019). The two groups had the same risk of major bleeding events (0.8% vs. 0.4%, p = 0.364). CONCLUSION  In the current study, cilostazol is a good substitute for aspirin in patients who have aspirin intolerance but need DAPT after coronary DES implantation in China. However, large-scale randomized controlled trials were still required to further confirm its efficacy and safety. Phleomycin D1 mouse Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Venous thromboembolism (VTE) is a major cause of death in cancer patients. Although patients with cancer have numerous risk factors for VTE, the relative contribution of cancer treatments is unclear. OBJECTIVE  The objective of this study is to evaluate the association between cancer therapies and the risk of VTE. METHODS  From UK Clinical Practice Research Datalink, data on patients with first cancer diagnosis between 2008 and 2016 were extracted along with information on hospitalization, treatments, and cause of death. Primary outcome was active cancer-associated VTE. To establish the independent effects of risk factors, adjusted subhazard ratios (adj-SHR) were calculated using Fine and Gray regression analysis accounting for death as competing risk. RESULTS  Among 67,801 patients with a first cancer diagnosis, active cancer-associated VTE occurred in 1,473 (2.2%). During a median observation time of 1.2 years, chemotherapy, surgery, hormonal therapy, radiation therapy, and immunotherapy were given to 71.1, 37.2, 17.2, 17.5, and 1.4% of patients with VTE, respectively. The active cancers associated with the highest risk of VTE-as assessed by incidence rates-included pancreatic cancer, brain cancer, and metastatic cancer. Chemotherapy was associated with an increased risk of VTE (adj-SHR 3.17, 95% confidence interval [CI] 2.76-3.65) while immunotherapy with a not significant reduced risk (adj-SHR 0.67, 95% CI 0.30-1.52). There was no association between VTE and radiation therapy (adj-SHR 0.91, 95% CI 0.65-1.27) and hormonal therapies. CONCLUSION  VTE risk varies with cancer type. Chemotherapy was associated with an increased VTE risk, whereas with radiation and immunotherapy therapy, an association was not confirmed. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Low molecular weight heparins (LMWH) are often used as a first-line therapy for the prevention of thrombosis in cancer patients. Preclinical evidence from animal models suggests that LMWH may have antimetastatic properties. Clinical evidence of this effect is inconclusive. The objective of this systematic review is to evaluate the effect of LMWH on overall survival in patients with solid tumor malignancies. METHODS  MEDLINE, Embase, and The Cochrane Central Register of Controlled trials were searched from inception to November 26, 2018. We included randomized controlled trials that compared LMWH to placebo, a no-treatment arm, or a short-term prophylactic course of LMWH in adult patients with solid tumors. The primary outcome was overall survival. Secondary outcomes included progression-free survival, the occurrence of venous thromboembolism, and major bleeding events. The risk of bias was assessed in duplicate using the Cochrane Risk-of-Bias tool. RESULTS  Forty-five articles were included in the review. Overall, no difference in overall survival was observed between groups (risk ratio 1.00; 95% confidence interval 0.98-1.02; I2 = 36.5%). In our a priori defined subgroup analyses, the effect was not shown to vary by the type of LMWH, duration of LMWH use, length of study follow-up, comparator used in the study, or the setting in which the LMWH was administered. The majority of studies had an unclear risk of bias for at least one methodological criterion. CONCLUSION  Although LMWH is thought to possess antimetastatic properties and thus have the potential to improve survival in cancer patients, existing data do not support this hypothesis. Georg Thieme Verlag KG Stuttgart · New York.Prognostic factors for venous thromboembolism (VTE) recurrence following provoked VTE are largely unknown. Using the Clot Formation and Lysis (CloFAL) assay, single institutional research has shown overall improvement in acute hypercoagulability during the first 3 months postpediatric VTE, yet a rise in plasma coagulability in a subgroup of patients. We sought to define the incidence of rise in coagulability during the first 3 months post-provoked VTE, to investigate its relationship with elevated D-dimer, and to test the hypothesis that a marked rise in coagulability is independently prognostic of VTE recurrence. CloFAL and D-dimer assays were performed on plasma at 4 to 6 weeks and 3 months post-VTE in the Johns Hopkins pediatric VTE cohort and National Institutes of Health-sponsored Kids-DOTT trial. Associations of VTE recurrence with D-dimer and CloFAL assay measures were evaluated via logistic regression. Eighty-seven patients were included. Median follow-up was 1 year. Complete veno-occlusion was determined in 12% at 6 weeks.