Steinthomassen0619
Finally, we discuss our own hospital experience with coagulation testing and the paucity of evidence of improved outcomes with viscoelastic testing.
Improving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.
Improving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.
A 31-year-old man who had a chronic popliteus avulsion fracture 18 years earlier treated with physical therapy presented with new onset left knee locking after exercising at the gym. Magnetic resonance imaging demonstrated a chronic popliteus avulsion fracture of the lateral femoral condyle. Surgical excision of the nonunited bone fragment was performed.
Isolated popliteus avulsion fractures are extremely rare injuries that occur primarily in a skeletally immature patient population and for which treatment options are not well understood. Treatment options include conservative management and early surgical intervention, both of which have inherent risks and benefits. We recommend prompt imaging with computed tomography (CT) to better characterize the degree of injury and follow-up CT imaging in patients who do not undergo early surgical intervention.
Isolated popliteus avulsion fractures are extremely rare injuries that occur primarily in a skeletally immature patient population and for which treatment options are not well understood. Treatment options include conservative management and early surgical intervention, both of which have inherent risks and benefits. We recommend prompt imaging with computed tomography (CT) to better characterize the degree of injury and follow-up CT imaging in patients who do not undergo early surgical intervention.
We present a case of a 51-year-old man with a retained supercharged rare earth magnetic finger mass sustained from an explosion injury at a semiconductor processing facility. The patient underwent excision of the rare metal mass, subsequently maintaining digital function without mass recurrence.
Common to the semiconductor industry, neodymium is a rare earth metal and powerful magnet. Particulates are highly combustible, representing a potential explosive biohazard. To date, its toxicity and bioreactivity within the hand have not been thoroughly investigated. This is the first report of the successful surgical treatment of a retained rare earth neodymium magnetic hand mass.
Common to the semiconductor industry, neodymium is a rare earth metal and powerful magnet. Particulates are highly combustible, representing a potential explosive biohazard. To date, its toxicity and bioreactivity within the hand have not been thoroughly investigated. This is the first report of the successful surgical treatment of a retained rare earth neodymium magnetic hand mass.
A 13-year-old male American football player sustained an isolated grade III lateral collateral ligament (LCL) rupture and underwent direct repair with biceps femoris rotation graft augmentation after failure of nonoperative management. The procedure was performed without any complications or graft site morbidity and achieved complete functional resolution.
Isolated LCL injuries in the pediatric population are an extremely rare finding, with no evidence of rotation graft in the literature to date. Most of these cases involve multiligamentous knee injuries in the adult population, and therefore, there is no consensus regarding pediatric repair vs. reconstruction in this presentation.
Isolated LCL injuries in the pediatric population are an extremely rare finding, with no evidence of rotation graft in the literature to date. Most of these cases involve multiligamentous knee injuries in the adult population, and therefore, there is no consensus regarding pediatric repair vs. reconstruction in this presentation.
A retrospective analysis was performed to evaluate the prognostic significance of treatment delays (TDs) for oropharynx carcinoma patients treated with definitive radiotherapy (RT), comparing p16+ versus p16- disease.
Patients treated between 2012 and 2016 were analyzed (n=763). buy STC-15 TD was defined as the time from pathologic diagnosis to initiation of RT. TD thresholds of ≤60, 61 to 90, and >90 days were used to stratify outcomes. Time on treatment (TOT) delays were estimated based on the RT fractionation. TOT delay of 1 to 3 days was compared with >3 days. Predictors of cancer-specific survival (CSS) and locoregional recurrence (LRR) were evaluated on multivariable analysis.
Six hundred fifty (85%) patients had p16+ disease. On multivariable analysis, TOT delay of 1 to 3 days versus <1 day was associated with inferior CSS (hazard ratio [HR]=1.81; 95% confidence interval [CI] 1.02-3.22). TD >90 versus ≤60 days (HR=1.68; 95% CI 0.98-3.04) and 61 to 90 versus ≤60 days (HR=0.94; 95% CI 0.60-1.48) was not associated with CSS. TD >90 versus ≤60 days (HR=1.29; 95% CI 0.66-2.52), TD 61 to 90 versus ≤60 days (HR=0.98; 95% CI 0.64-1.52), TOT 1 to 3 versus <1 day (HR=0.91; 95% CI 0.39-2.11), and TOT >3 versus <1 day (HR=1.79; 95% CI 0.80-3.99) were not associated with LRR. There was no interaction between p16 status and TD in relation to LRR (P=0.27) or CSS (P=0.17).
TDs were not significantly associated with CSS or LRR. TOT of 1 to 3 days was associated with inferior CSS. p16 status should not be a significant factor when triaging RT start dates.
TDs were not significantly associated with CSS or LRR. TOT of 1 to 3 days was associated with inferior CSS. p16 status should not be a significant factor when triaging RT start dates.
In the current study, we have investigated the effects of the different modalities of treatment (volume of radiotherapy [RT], previous surgery) as well as the Gleason score of prostate cancer (PC) on the lymphocyte composition of PC patients undergoing RT.
This is a monoinstitutional study that prospectively included PC patients that underwent RT from January 2016 until December 2017. To compare the different evaluations, the Wilcoxon signed-rank test was used among 2 times (Timepoint 0 to Timepoint 1). Percentage variation was calculated for all the lymphocyte subpopulation and was correlated with clinical parameters (previous surgery, Gleason score, and pelvic irradiation) with the χ2 test. The statistical analysis was repeated also on the stratified dataset according to the above parameters (previous surgery, Gleason score, and whole pelvic radiotherapy [WPRT]).
One hundred and eleven patients were included in the present analysis. All the lymphocyte subpopulations resulted significantly lower after RT. The modifications of several lymphocyte subpopulations correlated with previous surgery, Gleason score, and WPRT, although stratified analysis demonstrated that WPRT showed the greatest correlation.
Our results could be used to design a prospective trial in order to study the use of WPRT on the lymphocyte subpopulations.
Our results could be used to design a prospective trial in order to study the use of WPRT on the lymphocyte subpopulations.
If we may cure metastatic melanoma patients thanks to immune checkpoint inhibitors (ICI), it is fair to say that around 2/3 of the patients present primary or secondary resistance to ICI. Therefore, progresses are needed and numerous new treatments are tested either alone or in combination with cytolytic T-lymphocyte-associated protein 4 (CTLA-4) or (PD)-1 blockade to overcome this resistance. In this review, we focused on new immunotherapeutic approaches studied in advanced melanoma previously treated by anti-PD-1 (Programmed cell Death 1 receptor) or anti-CTLA-4 antibodies.
The different approaches have been classified based on 'the cancer immunity cycle'. These new strategies target either the T-cell priming and activation step, T-cell trafficking and tumor infiltration, or tumor antigen recognition by T-cell and tumor killing.
Most of these novel strategies are based on mAbs targeting T-cell inhibitory or stimulatory coreceptors. The second main focus is based on modifying the tumor micro-environment. Combination strategies seem promising in few patients and suggest that a deeper understanding of the resistance in individual patients is mandatory to go further.
Most of these novel strategies are based on mAbs targeting T-cell inhibitory or stimulatory coreceptors. The second main focus is based on modifying the tumor micro-environment. Combination strategies seem promising in few patients and suggest that a deeper understanding of the resistance in individual patients is mandatory to go further.Oral drug delivery has been recognized as the most desirable drug administration method among other drug delivery routes due to its ease of administration, long shelf life, and low cost. Orally disintegrating tablets disintegrate within seconds in the mouth without the need of water for swallowing. This unique feature of orally disintegrating tablets is favorable to special populations such as geriatric and pediatric patients. Formulation optimization is significant to obtain the optimal combination of tablet constituents, as the tablet composition is influential on dosage-form characteristics. The objective of this study was to investigate the effect of different types of fillers and percentage on the physical properties of orally disintegrating tablets by using amlodipine as the model drug. Blank orally disintegrating tablets containing different fillers, namely, Sorbolac 400, Granulac 200, and CombiLac with different percentages, were prepared using the wet granulation method and were evaluated based on weight variation, hardness, thickness, friability, and disintegration time. Formulation 5 that consists of 25% Granulac 200 showed the optimal result among all formulations with the fastest disintegration time (96.17 s Å 18.40) and sufficient tablet hardness (4.59 kg Å 0.70). Hence, formulation 5 was selected as the optimal formulation and incorporated with amlodipine. From this study, it can be concluded that excipients have an essential role in determining the physical properties of orally disintegrating tablets.Closed-system transfer devices mitigate occupational exposure risks associated with hazardous-drug handling. This study was conducted in a controlled laboratory to evaluate the effectiveness of a needle-free and a needle-based closed-system transfer device in minimizing surface contamination during simulated compounding, preparation, and administration. A needle-based and a needle-free closed-system transfer device underwent three trials per system. Each trial included reconstituting cyclophosphamide in a vial, withdrawing cyclophosphamide from the vial, and pushing cyclophosphamide into an intravenous bag. After every trial, wipe samples were collected from five sources biological safety cabinet workbench (left and right sides), biological safety cabinet grill, biological safety cabinet airfoil, and technicians' gloves. Wipe samples were then analyzed using high-performance liquid chromatography with dual-mass spectrometry to measure cyclophosphamide concentrations. Surface contamination levels from 30 post-Based on surface contamination analyses, this study verified the ability of a needle-free closed-system transfer device in preventing the escape of cyclophosphamide during simulated compounding and preparation. Needle-free closed-system transfer devices warrant consideration for the handling of hazardous drugs.
