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Early relapse after inpatient treatment is a serious problem in the management of anorexia nervosa (AN). Specialized aftercare interventions have the potential to bridge the gap between inpatient and outpatient care, to prevent relapse and to improve the long-term outcome for patients with AN.
Following the guidelines of the PRISMA statement, we conducted a systematic review, synthesizing the evidence from randomized-controlled trials (RCTs) investigating the efficacy of post-inpatient aftercare treatments for AN.
Our search resulted in seven RCTs and three registered ongoing trials. Pharmacotherapy and low-threshold guided self-help have limited uptake and high dropout. Novel mobile guided self-help approaches seem promising due to high patient satisfaction, but their efficacy has yet to be investigated in larger trials. Cognitive-behavior psychotherapy may be beneficial in delaying relapse, but evidence is based on a single study.
Only a limited number of RCTs investigating aftercare interventions f from aftercare interventions. This calls for better tailoring of interventions to patient needs and the integration of patient perspectives into treatment. Intensified research and care efforts are needed to address the problem of recurrent relapse after intensive inpatient treatment for AN and to eventually improve prognosis for this eating disorder.
We investigated the existence and uniqueness of a fixed point for the mapping satisfying generalized rational type contraction conditions in metric space endowed with partial order. Suitable examples are presented to justify the results obtained.
Some new fixed point results have been obtained for a mapping fulfilling generalized contractions. Selleckchem β-Glycerophosphate The uniqueness of the fixed point is also the part of the study based on an ordered relation. One example is given for a result which is not valid in the usual metric space.
Some new fixed point results have been obtained for a mapping fulfilling generalized contractions. The uniqueness of the fixed point is also the part of the study based on an ordered relation. One example is given for a result which is not valid in the usual metric space.
Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA.
This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, beforeds in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA.
Chinese Clinical Trial Registry, ChiCTR2000038671 . Registered on September 27, 2020.
Chinese Clinical Trial Registry, ChiCTR2000038671 . Registered on September 27, 2020.
Re-expansion pulmonary edema is a rare but potentially fatal (mortality up to 20%) complication of the rapid removal of air, fluid, or other space-occupying lesion from the pleural cavity. This case report highlights the fact that this complication is much more likely to occur when treating large, chronic pneumothoraces, and can occur even if the lung fails to fully re-expand.
A 49-year-old white British man presented to the emergency department with sudden onset of shortness of breath 5days prior to admission. A left-sided pneumothorax was suspected on clinical examination, and chest X-ray confirmed a large, left-sided pneumothorax. A 12 French gauge chest drain was inserted and connected to an underwater seal. Shortly after insertion of the drain, the patient's condition deteriorated rapidly with tachypnea and severe hypoxemia. A diagnosis of re-expansion pulmonary edema was made, and the patient was treated with high-flow oxygen and continuous positive airways pressure.
This case report serves as a reminder of the morbidity and potential mortality associated with a commonly performed medical procedure, and reveals a lack of clear and precise guidance on the management of large, chronic (> 72hours) pneumothoraces in the current British Thoracic Society pleural disease guidelines.
72 hours) pneumothoraces in the current British Thoracic Society pleural disease guidelines.
To identify potential biomarkers to distinguish familial Mediterranean fever (FMF) from sepsis.
We recruited 28 patients diagnosed with typical FMF (according to the Tel Hashomer criteria), 22 patients with sepsis, and 118 age-matched controls. Serum levels of 40 cytokines were analyzed using multi-suspension cytokine array. We performed a cluster analysis of each cytokine in the FMF and sepsis groups in order to identify specific molecular networks. Multivariate classification (random forest analysis) and logistic regression analysis were used to rank the cytokines by importance and determine specific biomarkers for distinguishing FMF from sepsis.
Fifteen of the 40 cytokines were found to be suitable for further analysis. Levels of serum granulocyte-macrophage colony-stimulating factor (GM-CSF), fibroblast growth factor 2, vascular endothelial growth factor, macrophage inflammatory protein-1b, and interleukin-17 were significantly elevated, whereas tumor necrosis factor-α (TNF-α) was significantly lower in patients with FMF compared with those with sepsis. Cytokine clustering patterns differed between the two groups. link2 Multivariate classification followed by logistic regression analysis revealed that measurement of both GM-CSF and TNF-α could distinguish FMF from sepsis with high accuracy (cut-off values for GM-CSF = 8.3 pg/mL; TNF-α = 16.3 pg/mL; sensitivity, 92.9%; specificity, 94.4%; accuracy, 93.4%).
Determination of GM-CSF and TNF-α levels in combination may represent a biomarker for the differential diagnosis of FMF from sepsis, based on measurement of multiple cytokines.
Determination of GM-CSF and TNF-α levels in combination may represent a biomarker for the differential diagnosis of FMF from sepsis, based on measurement of multiple cytokines.
Remitting seronegative symmetrical synovitis with pitting edema (RS
PE) is a rare inflammatory arthritis, with a higher incidence of malignancy. The aim of this study is to identify biomarkers for predicting malignancy in RS
PE.
A total of 51 patients with RS
PE from September 2007 to May 2019 were retrospectively reviewed and followed for up to 5 years, with 15 patients with osteoarthritis (OA) and 14 patients with elderly-onset rheumatoid arthritis (EORA) as disease controls. Serum levels of angiogenesis cytokines were measured by electrochemiluminescent immunoassay and Luminex Human Magnetic Assay. Clinical data and laboratory parameters were analyzed to identify risk factors for malignancy.
A total of forty-eight RS
PE patients (94.1%) were available with follow-up data; 8 patients (16.7%) were diagnosed with malignancy, of which 6 patients were hematological tumor; and 2 patients were solid tumors. Serum levels of basic fibroblast growth factor (bFGF) were exclusively higher in RS
PE patients with malignancy [14.21 (7.52, 23.18) ng/mL] than RS
PE patients without malignancy [4.32 (2.88, 7.42) ng/mL], OA [3.20 (2.20, 5.30) ng/mL], and EORA [3.20 (2.20, 5.30) ng/mL]. The optimal cut-off value of bFGF for malignancy was 10ng/mL in RS
PE. Logistic regression analysis indicated that elevation of bFGF was a risk factor for malignancy in RS
PE.
This study indicated that bFGF was elevated in RS
PE patients with malignancy and could serve as a biomarker for predicting paraneoplastic RS
PE.
This study indicated that bFGF was elevated in RS3PE patients with malignancy and could serve as a biomarker for predicting paraneoplastic RS3PE.
We recently reported that CSF phosphorylated tau (p-Tau
) relative to Aβ
(CSF p-Tau/Aβ
ratio) was less noisy and increased associations with Alzheimer's disease (AD) biomarkers compared to CSF p-Tau
alone. While elevations of CSF p-Tau/Aβ
can occur in amyloid-β (Aβ) negative (Aβ-) individuals, the factors associated with these elevations and their role in neurodegeneration and cognitive decline are unknown. We aim to explore factors associated with elevated tau in CSF, and how these elevated tau are related to neurodegeneration and cognitive decline in the absence of Aβ positivity.
We examined relationships between CSF p-Tau/Aβ
, and CSF Aβ
/Aβ
, Aβ PET, and white matter hyperintensities (WMH) as well as vascular risk factors in 149 cognitively unimpaired and 52 impaired individuals who were presumably not on the Alzheimer's disease (AD) pathway due to negative Aβ status on both CSF and PET. Subgroups had
F-fluorodeoxyglucose (FDG) PET and adjusted hippocampal volume (aHCV), and longitudinale features with AD such as a pattern of metabolic decline and regional brain atrophy.
These data provide surprising clues as to the etiology and significance of tau pathology in the absence of Aβ. It seems likely that, in addition to age, both cerebrovascular disease and subthreshold levels of Aβ are related to this tau accumulation. Crucially, this phenotype of CSF tau elevation in amyloid-negative individuals share features with AD such as a pattern of metabolic decline and regional brain atrophy.
Employment is associated with better outcomes of substance use treatment and protects against relapse after treatment completion. Unemployment rates are high for people with substance use disorders (SUD) who undergo treatment, with Norwegian estimates ranging from 81 to 91%. Evidence-based vocational models are lacking for patients in SUD treatment but exist for patients with psychosis in terms of Individual Placement and Support (IPS). The aim of the IPS for substance use disorders (IPS-SUD) trial is to investigate the effect of IPS in a SUD population.
The IPS-SUD trial is a randomized controlled trial (RCT) comparing IPS to an enhanced control intervention. The study is a seven-site, two-arm, pragmatic, parallel-group, superiority RCT. Participants are randomly assigned (11) to receive either IPS plus treatment as usual (TAU) or to receive a self-help guide book and 12-h workshop plus 1-h individual vocational guidance plus TAU. Aiming to recruit 200 participants, we will be able to detect a 20% differed on February 28, 2020.
ClinicalTrials.gov NCT04289415 . Registered on February 28, 2020.
Serum proteins can be readily assessed during routine clinical care. However, it is unclear to what extent serum proteins reflect the molecular dysregulations of peripheral blood cells (PBCs) or affected end-organs in systemic sclerosis (SSc). We conducted a multiomic comparative analysis of SSc serum profile, PBC, and skin gene expression in concurrently collected samples.
Global gene expression profiling was carried out in skin and PBC samples obtained from 49 SSc patients enrolled in the GENISOS observational cohort and 25 unaffected controls. link3 Levels of 911 proteins were determined by Olink Proximity Extension Assay in concurrently collected serum samples.
Both SSc PBC and skin transcriptomes showed a prominent type I interferon signature. The examination of SSc serum profile revealed an upregulation of proteins involved in pro-fibrotic homing and extravasation, as well as extracellular matrix components/modulators. Notably, several soluble receptor proteins such as EGFR, ERBB2, ERBB3, VEGFR2, TGFBR3, and PDGF-Rα were downregulated.
