Holckenemark5646

Seizure outcome of autoimmune encephalitis (AE) varies from seizure-free to refractory epilepsy, and the associated factors remain unclear. We aimed to describe seizure characteristics, identify seizure outcome-related factors, and discuss the medication strategy of antiepileptic drugs (AEDs) at the first onset of AE.

We retrospectively studied the data of 86 patients with clinically diagnosed AE. The clinical characteristics were described using a chi-square test. Seizure outcome-related factors were assessed using multivariable logistic regression analysis.

56 patients were finally enrolled, with antibodies to N-methyl-D-aspartate receptor found in 29, to γ-aminobutyric acid receptor B found in 13, and to leucine-rich glioma-inactivated protein 1 found in 14. Status epilepticus occurrence and onset with seizure lead to a poor seizure outcome, while administration of human gamma globulin and a low antibody titer contributed to a good seizure outcome.

In the acute phase, seizure characteristics may be considered in the utilization of AEDs. For patients with seizure-free status in the acute phase, clinical manifestation (onset with seizure or not, whether status epilepticus occurs or not), therapy regimen (human gamma globulin administered or not), and antibody titer may be considered when formulating the strategy for withdrawal of AEDs post-acute phase.

In the acute phase, seizure characteristics may be considered in the utilization of AEDs. selleck screening library For patients with seizure-free status in the acute phase, clinical manifestation (onset with seizure or not, whether status epilepticus occurs or not), therapy regimen (human gamma globulin administered or not), and antibody titer may be considered when formulating the strategy for withdrawal of AEDs post-acute phase.We report an enantioselective cobalt-catalyzed hydrosilylation/cyclization reaction of 1,6-enynes with secondary and tertiary hydrosilanes employing a catalyst generated in situ from the combination of Co(acac)2 and (R,Sp )-Josiphos. A wide range of oxygen-, nitrogen-, and carbon-tethered 1,6-enynes reacted with Ph2 SiH2 , (EtO)3 SiH, or (RO)2 MeSiH to afford the corresponding chiral organosilane products in high yields and up to >99 % ee. This cobalt-catalyzed hydrosilylation/cyclization also occurred with prochiral secondary hydrosilane PhMeSiH2 to yield chiral alkylsilanes containing both carbon- and silicon-stereogenic centers with excellent enantioselectivity, albeit with modest diastereoselectivity. The chiral organosilane products from this cobalt-catalyzed asymmetric hydrosilylation/cyclization could be converted to a variety of chiral five-membered heterocyclic compounds by stereospecific conversion of their C-Si and Si-H bonds without loss of enantiopurity.

Procalcitonin (PCT)-guided antibiotic therapy has emerged as mainstream treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and has been studied in many systematic reviews (SRs), but robust conclusion has not been drawn. Thus, this overview aims to summarize and critically evaluate the methodological and evidence quality of SRs on this topic.

PubMed, EMBASE, Cochrane library, and Web of science were searched for SRs regarding on PCT-guided antibiotic therapy on AECOPD. Two reviewers assessed the quality of SRs in line with AMSTAR-2 tool and evaluated the strength of evidence quality with the grading of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes independently.

Six SRs were published from Jun 2011 to Aug 2019, with from 4 (556 patients) to 15 (2571 patients) randomized controlled trials (RCTs) and retrospective studies. All the included SRs were classified as critical low methodology quality according to A MeaSurement Tool should be carried out on the precise role of PCT-guided antibiotic therapy on AECOPD.A novel method for the concise synthesis of cyclohepta[b]indoles in high yields was developed. The method involves a visible-light-induced, photocatalyzed [2+2]-cycloaddition/ retro-Mannich-type reaction of enaminones. Experimental and computational studies suggested that the reaction is a photoredox process initiated by single-electron oxidation of an enaminone moiety, which undergoes subsequent cyclobutane formation and rapidly fragmentation in a radical-cation state to form cyclohepta[b]indoles.

Early diagnosis or rule-out of acute coronary syndrome (ACS) is a key competence of emergency medicine. Changes in the NSTE-ACS guidelines of the European Society of Cardiology (ESC) in 2015 and 2020 both warranted a henceforth more conservative approach regarding high-sensitivity troponin t (hsTnt) testing. We aimed to assess the impact of more conservative guidelines on the frequency of early rule-out and prolonged observation with repeated hsTnt testing at a high-volume tertiary care emergency department.

We conducted a pre- and post-changeover analysis 3months before and 3months after transition from less (hsTnt cut-off 30ng/L, 3-hour rule-out) to more conservative (hsTnt cut-off 14ng/L, 1-hour rule-out) guidelines in 2015, comparing proportions of patients requiring repeated testing.

We included 5442 cases of symptoms suspicious of acute cardiac origin (3451 before, 1991 after, 2370 (44%) female, age 55 (SD 19) years). The proportion of patients fulfilling early-rule out criteria decreased from 68% (2348 patients) before to 60% (1195 patients) with the 2015 guidelines (P<.01). Those requiring repeated testing significantly (P<.01) increased from 22% (743 patients) to 25% (494 patients). Positive results in repeated testing significantly (P=.02) decreased from 43% (320 patients) to 37% (181 patients). Invasive diagnostics were performed in 91 patients (2.6%) before and in 75 patients (3.8%) after (P=.02) the guideline revision.

The implementation of the more conservative 2015 ESC guidelines led to a minor rise in prolonged observations because of an increase in negative repeated testing and to an increase in invasive procedures.

The implementation of the more conservative 2015 ESC guidelines led to a minor rise in prolonged observations because of an increase in negative repeated testing and to an increase in invasive procedures.