Notes

Extracellular vesicles from horse mesenchymal stem tissues reduce irritation marker pens inside chondrocytes inside vitro.
The anatomopathological analysis from skin biopsy revealed a multicentric reticulohistiocytosis, considered paraneoplastic in the context. Second follow-up PET/CT after treatment showed a decrease of 18F-FDG uptake in previously affected joints, consistent with the symptoms evolution. 18F-FDG PET/CT could be helpful in the detection and the evaluation of such rare systemic disorder.
A 35-year-old woman was referred to our nuclear medicine center for a ventilation and perfusion (VQ) pulmonary scintigraphy to detect pulmonary embolism. She was treated with low-molecular-weight heparin following a proximal venous thrombosis of the right upper limb and had a previous history of an infiltrating ductal carcinoma of the right breast. Surprisingly, the VQ scintigraphy showed uptake of 99mTc-MAA in several superior vertebrae. A contrast-enhanced CT scan revealed a dilated collateral paravertebral venous system due to the deep vein thrombosis extended from superior vena cava to brachiocephalic trunk. 99mTc-MAA was trapped through the dilated vertebral venous system.
A 35-year-old woman was referred to our nuclear medicine center for a ventilation and perfusion (VQ) pulmonary scintigraphy to detect pulmonary embolism. She was treated with low-molecular-weight heparin following a proximal venous thrombosis of the right upper limb and had a previous history of an infiltrating ductal carcinoma of the right breast. Surprisingly, the VQ scintigraphy showed uptake of 99mTc-MAA in several superior vertebrae. A contrast-enhanced CT scan revealed a dilated collateral paravertebral venous system due to the deep vein thrombosis extended from superior vena cava to brachiocephalic trunk. 99mTc-MAA was trapped through the dilated vertebral venous system.
There is little evidence concerning the impact of acute heart failure (AHF) on the prognosis of atrial fibrillation patients attending the emergency department (ED).

To know the influence of AHF on adverse long-term outcomes in patients presenting with atrial fibrillation in ED.

Secondary analysis of a prospective, multicenter, observational cohort of consecutive atrial fibrillation patients, performed in 62 Spanish EDs.

Patients presenting with atrial fibrillation in ED were divided by the presence or absence of AHF at arrival.

Primary outcome combination of 1-year all-cause mortality, major bleeding, stroke and other major cardiovascular events (MACE). Secondary outcomes each of these events analyzed separately. Cox and logistic regression were used to investigate adjusted significant associations between AHF and outcomes.

Totally, 1107 consecutive ED patients with atrial fibrillation attending ED were analyzed, 262 (23.7%) with AHF. The primary outcome occurred in 433 patients (39.1%), 1-year all-cause mortality in 151 patients (13.6%), major bleeding in 47 patients (4.2 %), stroke in 31 patients (2.8 %) and other MACE in 333 patients (30.1%). AHF was independently related to the primary outcome [odds ratio (OR), 1.422; 95% confidence interval (CI), 1.020-1.981; P = 0.037)] and 1-year MACE (OR, 1.797; 95% CI, 1.285-2.512; P = 0.001), but not to 1-year all-cause mortality, stroke or bleeding.

The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.
The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.
The aim of this study was to evaluate the accuracy of the single upper-arm cuff oscillometric blood pressure (BP) monitor InBody BPBIO750 developed for self-measurement by adults in public spaces (kiosk) according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-22018).

Subjects were recruited to fulfil the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method.

A total of 102 subjects were recruited and 85 were analyzed [mean age 56.7 ± 15.4 (SD) years, 40 men, arm circumference 32.3 ± 5.3 cm, range 22-42 cm]. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 2.2 ± 6.1/-2.2 ± 5.2 mmHg (systolic/diastolic). SR-717 cost For criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 5.00/4.63 mmHg (systolic/diastolic).

The InBody BPBIO750 device fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-22018) in general population and can be recommended for clinical use in adults.
The InBody BPBIO750 device fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-22018) in general population and can be recommended for clinical use in adults.Pembrolizumab is a humanized IgG4 isotype mAb that the targets and blocks the programmed cell death protein 1 receptor on lymphocytes. Its use in treating metastatic melanoma is associated with increased overall survival compared to other older immunotherapies. Several adverse effects have been noted including both systemic and cutaneous manifestations. As a relatively novel treatment option, many new cutaneous manifestations are still being observed, occurring at various times after initiation of therapy. Previously noted cutaneous adverse effects include sarcoid-like reactions, rash, and changes in preexisting lesions or scars. link2 Here we present a case in which biopsy-proven morphea developed after completion of pembrolizumab therapy.Melanotic schwannoma is a rare nerve sheath tumor composed of melanin-producing Schwann cells with the potential for metastasis. These tumors can be associated with familial tumor syndromes and can cause significant symptoms related to nerve compression and mass effect. Due to the rarity of these lesions, they can be initially misidentified as melanocytomas, pigmented dermatofibrosarcoma protuberans, neurofibromas or malignant melanomas. Surgical excision is the mainstay of treatment with limited benefit from adjuvant systemic chemotherapy or radiation. Modern treatments with immune checkpoint blockade have demonstrated significant improvements in progression-free and overall survival for a variety of cancer histologies; however, anti-PD1 therapy has yet to be evaluated in patients with melanotic schwannoma. This report demonstrates a significant improvement in symptomatology and tumor stability with neoadjuvant anti-PD1 therapy for a retrocaval melanotic schwannoma initially masquerading as malignant melanoma. This report demonstrates the potential benefit of a novel therapeutic option for patients with melanotic schwannoma.
The aim of the study was to determine the effect of distance learning on knowledge acquisition in undergraduate second-degree nursing students, a growing population of nursing students.

Distance learning is a convenient way of attaining professional training.

The study was conducted by critical appraisal and data extraction using Joanna Briggs Institute tools for quasi-experimental, qualitative systematic reviews and research synthesis and randomized control research. Risk for bias was determined using the Cochrane collaboration tool.

Eleven studies from five countries are included in the review four quantitative, two qualitative, one mixed-method, and four integrative review. Dates range from 2015 to 2018.

The evidence suggests that knowledge acquisition is not impacted by educational setting alone. Flipped classroom and mixed-method instruction were found to positively impact knowledge acquisition. Distance learning, coupled with traditional face-to-face instruction, has a greater impact on knowledge acquisition than either method alone. Online methodologies improve clinical skill acquisition more than face-to-face instruction.
The evidence suggests that knowledge acquisition is not impacted by educational setting alone. Flipped classroom and mixed-method instruction were found to positively impact knowledge acquisition. Distance learning, coupled with traditional face-to-face instruction, has a greater impact on knowledge acquisition than either method alone. Online methodologies improve clinical skill acquisition more than face-to-face instruction.
Active teaching strategies utilizing high-impact practices to encourage integration of learned material and creative thinking were incorporated into a "care of the older adult" course in a baccalaureate nursing program. The "Shark Tank" assignment requires small groups of students to develop and present an innovation that improves the quality of life for older adults; the class peer reviews the project using a rubric. The "brown bag" assignment requires students to meet with an older adult in their home to conduct a medication reconciliation and teaching session. Both assignments received positive feedback from students in anonymous course evaluations.
Active teaching strategies utilizing high-impact practices to encourage integration of learned material and creative thinking were incorporated into a "care of the older adult" course in a baccalaureate nursing program. link3 The "Shark Tank" assignment requires small groups of students to develop and present an innovation that improves the quality of life for older adults; the class peer reviews the project using a rubric. The "brown bag" assignment requires students to meet with an older adult in their home to conduct a medication reconciliation and teaching session. Both assignments received positive feedback from students in anonymous course evaluations.
BACKGROUND Approximately 50% of Danish stroke patients did not arrive within the 4.5-hour revascularization window in 2018, and only 20% received acute revascularization therapy. Delay in seeking help was a major factor for missing the time window. This study explored patient-reported factors influencing the timing of a decision to seek help. METHODS We performed a qualitative interview study to explore prehospital help-seeking behavior. Inclusion was guided by a purposive sampling of stroke and transient ischemic attack patients and, if necessary, bystanders. Semistructured explorative interviews with 8 patients and 2 bystanders were audio-recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS Analysis yielded 3 main themes (1) symptom interpretation, (2) barriers and enablers to response, and (3) participant suggested optimization of acute stroke response and awareness. DISCUSSION Factors associated with prompt action to seek help were either a perception that the symptom indicated a roke education should include the information that new stroke symptoms may be different from the old ones because different parts of the brain may be affected.
Timing, dose, and route of protein feeding in critically ill patients treated in an ICU is controversial. This is because of conflicting outcomes observed in randomized controlled trials (RCTs). This inconsistency between RCTs may occur as the physiology of protein metabolism and protein handling in the critically ill is substantially different from the healthy with limited mechanistic data to inform design of RCTs. This review will outline the current knowledge and gaps in the understanding of protein absorption and kinetics during critical illness.

Critically ill patients, both children and adults, lose muscle protein because of substantial increases in protein degradation with initially normal, and over time increasing, protein synthesis rates. Critically ill patients appear to retain the capacity to absorb dietary protein and to use it for building body protein; however, the extent and possible benefit of this needs to be elucidated. More sophisticated methods to study protein absorption and digestion have recently been described but these have yet to be used in the critically ill.
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