Dealgodwin6986
86 (95% CI 0.81-0.90), specificity of 0.89 (95% CI 0.85-0.92), and an AUC of 0.94 (95% CI 0.91-0.96). Moreover, before 20 weeks of gestation, the combined sensitivity was 0.86 (95% CI 0.75-0.92), and the specificity was 0.90 (95% CI 0.83-0.95), which indicated that some of the circulating miRNAs had changed significantly before the clinical symptoms appeared in PE patients. Circulating miRNAs have high diagnostic and predictive accuracy and may be used as non-invasive biomarkers for the diagnosis and prediction of PE. However, a large sample prospective study is still needed.
Investigate the axial plane deformity in the scoliotic segment and its relationship to the deformity in the frontal and sagittal planes.
Two hundred subjects with AIS (Cobb ≥ 20°) underwent low dose biplanar X-rays with 3D reconstruction of the spine and pelvis. All structural curves were considered and were distributed as follows 142 thoracic (T), 70 thoracolumbar (TL), and 47 lumbar curves (L). Common 3D spino-pelvic and scoliosis parameters were collected such as frontal Cobb; torsion index (TI); hypokyphosis/lordosis index (HI). Parameters were compared between each type of curvature and correlations were investigated between the 3 planes.
Frontal Cobb was higher in all T (45 ± 19°) and TL (41 ± 15°) curves compared to L curves (35 ± 14°, p = 0.004). TI was higher in T curves when compared to TL and L curves (TI 15 ± 8°, 9 ± 6°, 7 ± 5°, p < 0.001). Detapac HI was similar between curve types. T curves showed significant correlations between the 3 planes Cobb vs. TI (r = 0.76), Cobb vs. HI (r = -0.54) and HI vs. TI (r = -0.42). The axial plane deformity was related to the frontal deformity and the type of curvature (adjusted-R
= 0.6).
Beside showing the most severe deformity frontally and axially compared to TL and L curves, the T curves showed strong correlations between the 3 planes of the deformity. Moreover, this study showed that the axial plane deformity cannot be fully determined by the frontal and sagittal deformities, which highlights the importance of 3D assessment in the setting of AIS.
Beside showing the most severe deformity frontally and axially compared to TL and L curves, the T curves showed strong correlations between the 3 planes of the deformity. Moreover, this study showed that the axial plane deformity cannot be fully determined by the frontal and sagittal deformities, which highlights the importance of 3D assessment in the setting of AIS.Biologics are indicated for the treatment of a wide range of conditions and have transformed care in several therapeutic areas; however, they are expensive for both health care systems and patients. The use of biosimilars, which are approved by the US Food and Drug Administration as being "highly similar" to the originator biologic, has the potential to change the health care landscape in the biologic space through considerable cost savings for both payors and patients. With the introduction of biosimilars, organizations are increasingly evaluating how to switch patients from originator biologics to biosimilars. While published studies have evaluated the outcomes of patients switched from originator biologics to biosimilars, there are few publications describing the process health care systems have used to adopt and switch patients to biosimilars. Since 2016, Kaiser Permanente Colorado (KPCO) has undertaken several biosimilar switches starting with the first biosimilar introduced to the market, filgrastim, and has been able to successfully switch 91.8% of patients receiving infliximab, 99.8% receiving rituximab, and 100% receiving filgrastim, trastuzumab, and bevacizumab originator biologics to their respective biosimilars. In an effort to support other health care systems and provide a framework for implementing biosimilar switches, the purpose of this paper is to describe the biosimilar switch model and share learnings from the KPCO experience.Bromvalerylurea is included in over-the-counter analgesics and is known to cause chronic bromism. Patients can also present acute intoxication because of suicide attempts. The treatment consists of drug cessation and intravenous drip with furosemide. Few reports have described the efficacy of blood purification therapy in a critical case. We report a 21-year-old Japanese woman who was admitted to our hospital in an unconscious state after she had taken 388 tablets of NARON ACE. She was intubated and high flow continuous hemodiafiltration was initiated because her blood pressure remained low, despite continuous intravenous drip infusion. To remove unknown drugs, direct hemoperfusion was performed twice. NARON ACE contains bromvalerylurea, ibuprofen, ethenzamide, and anhydrous caffeine; only the amount of bromvalerylurea was thought to exceed a lethal dose. The plasma concentrations of bromvalerylurea on the first, second, third, and fourth days were 118.9, 45.1, 30.2, and 12.6 μg/mL, respectively. Her level of consciousness improved on the third day and she was extubated. She became stable and was transferred to the psychiatric department to continue medication on day 14. Her clinical course improved, and she was discharged on day 89. In a potentially fatal case, direct hemoperfusion combined with intravenous drip should be considered.An 81-year-old Japanese woman was diagnosed with Bence Jones protein κ-type multiple myeloma with acute kidney injury and severe anemia, complicated by congestive heart failure with triple vessel coronary artery disease. Her serum κ-free light-chain (FLC) level was 49,400 mg/L and κ/λ ratio was extremely high at 2373. Her kidney function deteriorated rapidly and required hemodialysis before initiating chemotherapy. A combination therapy of daratumumab (16 mg/kg), lenalidomide, and dexamethasone was initiated as a first-line treatment; the infusion rate of daratumumab was adjusted to reduce the heart load. The level of κ-FLC was rapidly reduced by 75% in only one week and by 99% after three weeks. Furthermore, she was dialysis-independent after the fourth dose of daratumumab. We report the first case of untreated patient with myeloma who had been successfully treated with daratumumab, lenalidomide, and dexamethasone therapy even in dialysis requiring state. Daratumumab may benefit patients with acute kidney injury caused by multiple myeloma, owing to the immediate need of FLC level reduction. Daratumumab and lenalidomide combination therapy could be a valuable treatment option for patients requiring dialysis when bortezomib may be hesitate to use due to severe heart disease.Glucocorticoids are used as a first-line treatment for severe alcoholic hepatitis, and albumin reduces both the number of hospitalizations and mortality in patients with decompensated cirrhosis. However, for acute-on-chronic liver failure (ACLF), there is no definitive evidence that glucocorticoid therapy is beneficial. In this case report, we describe a male patient who developed into ACLF based on alcoholic cirrhosis, whose symptoms and clinical indicators continued to deteriorate after initial symptomatic treatment. The patient's condition gradually improved after low-dose glucocorticoid therapy, and long-term albumin supplementation resulted in a satisfactory outcome.
To assess the associations between TSH and free thyroxine (FT4) levels and decline in functional status in euthyroid older patients at risk of frailty.
Longitudinal prospective study.
Participants from the geriatric outpatient clinic of a university hospital, who fulfilled the criteria for frailty or were at risk of frailty, were recruited. Only those euthyroid, defined by age-specific reference range of TSH, were included. Serum was collected during enrollment and at the third and sixth years of follow-up to assess the mean value of all follow-up levels of serum TSH and FT4. Functional status assessing activities of daily living (ADL) and instrumental ADL were evaluated using the Katz Index and the Health Assessment Questionnaire, respectively. Functional decline was defined by a positive variation in any of the applied scales in the absence of disagreement between the scales or if the patient was institutionalized.
Of the 273 participants (72.5% females) enrolled (mean age 80years old), 48 died and 102 presented functional decline at the end of follow-up (mean 3.6 ± 1.7years). Each 0.1ng/dL increase in baseline and mean follow-up serum FT4 levels increased the risk of functional decline by 14.1% and 7.7%, respectively. The risk of functional decline was 9 times greater with baseline FT4 levels in the fourth and fifth quintiles (p = 0.049) and 50% lower with baseline FT4 levels in the first quintile (p = 0.046). No association between TSH and the outcome was found.
Higher and lower FT4 levels were, respectively, a risk and a protective factor for the decline in functional status in a cohort of euthyroid older adults at risk of frailty.
Higher and lower FT4 levels were, respectively, a risk and a protective factor for the decline in functional status in a cohort of euthyroid older adults at risk of frailty.
Balance is a key component of movement for daily activities, especially in older adults. Previous studies examining aquatic therapy as an effective way for improving balance have yielded inconsistent findings. The current systematic review and meta-analysis investigated the effectiveness of aquatic therapy on balance among older adults.
Sources include Cochrane Central Register of Controlled Trials, Medline, ISI Web of Science, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Randomized controlled or cross-over trials published by Feb 2020 were included following pre-determined search and selection criteria. link2 Data extraction was performed by two researchers independently using a pre-determined data extraction form. Methodological quality was assessed by two reviewers using the PEDro scale which was used to rate trials according to criteria such as concealed allocation, blinding, and intention-to-treat analysis. Furthermore, meta-analysis was conducted where possible. This review was registered at PROSPERO CRD42018118382.
Fifteen trials with 385 healthy participants aged 50 or over were included. Results showed that aquatic therapy had a significant effect on dynamic balance (SMD, - 1.13; 95% CI, [- 1.45 to (- 0.82)]; I
= 77%). link3 The analysis indicated that aquatic therapy improved balance ability compared to controls.
Aquatic therapy has a positive impact on dynamic balance in older adults. However, further high-quality and appropriately powered studies are required to confirm this assertion.
Aquatic therapy has a positive impact on dynamic balance in older adults. However, further high-quality and appropriately powered studies are required to confirm this assertion.
Plasma harvested from convalescent COVID-19 patients (CCP) has been applied as first-line therapy in the early phase of the SARS-CoV2 pandemic through clinical studies using various protocols.
We present data from a cohort of 267 hospitalized severe COVID-19 patients who received CCP. No transfusion-related complications were reported, indicating the overall safety of CCP therapy.
Patients who eventually died from COVID-19 received CCP significantly later (3.95 versus 5.22days after hospital admission) and had higher interleukin 6 (IL-6) levels (28.9pg/ml versus 102.5pg/ml) than those who survived. In addition, CCP transfusion caused a significant reduction in the overall inflammatory status of the patients regardless of the severity of disease or outcome, as evidenced by decreasing C-reactive protein, IL6 and ferritin levels.
We conclude that CCP transfusion is a safe and effective supplementary treatment modality for hospitalized COVID-19 patients characterized by better expected outcome if applied as early as possible.
