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The Impact of worldwide Spine Alignment on Position Spinopelvic Place Change Right after Total Stylish Arthroplasty.
76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.OBJECTIVES To evaluate the prognostic significance of lymphovascular invasion (LVI) for patients with gastric cancer (GC). METHODS A total of 1,720 consecutive patients who underwent curative gastrectomy were retrospectively identified. The association between LVI and clinicopathologic characteristics was determined and its impact on survival outcome was evaluated. RESULTS LVI was detected in 21.3% of GC patients, 5.9% of patients with early GC, 24.0% of patients with advanced GC, and 6.7% of node-negative patients using H&E staining. Tumor size (odds ratio [OR], 1.509; 95% confidence interval [CI], 1.159-1.965; P less then .01), differentiated type (OR, 1.817; 95% CI, 1.377-2.398; P less then .001), and the depth of tumor invasion (OR, 3.011; 95% CI, 2.174-4.171; P less then .001) were independent predictive factors for LVI. LVI-positive patients have a poorer prognosis than LVI-negative patients, irrespective of tumor stage or lymph node metastasis. LVI was an independent prognostic factor for patients with GC (hazard ratio, 1.299; 95% CI, 1.112-1.518; P less then .001). CONCLUSIONS LVI provided additional prognostic information for GC patients, and LVI-positive patients should be considered candidates for adjuvant chemotherapy. © American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail [email protected] Severity stratification scores developed in Intensive Care Units (ICUs) are used in interventional studies to identify the most critically ill. Studies that evaluate accuracy of these scores in ICU patients admitted with pneumonia are lacking. This study aims to determine performance of severity scores as predictors of mortality in critically ill patients admitted with pneumonia. METHODS Prospective cohort study in a general ICU in Brazil. ICU severity scores (SAPS 3 and qSOFA), prognostic scores of pneumonia (CURB-65 and CRB-65), clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed. RESULTS A total of 200 patients were included between August 2015 and July 2018 with a median age of 81 years (IQR 67-90) and female predominance (52%) primarily admitted from the emergency department (65%) with community acquired pneumonia (80.5%). Poor discriminative performance in predicting mortality was found with SAPS 3, CURB-65, CRB-65 and qSOFA. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia specific ICU severity score (Pneumonia SHOCK score) that outperformed SAPS3, CURB-65 and CRB-65 (AUC 0.80 vs 0.74, 0.65 and 0.63, respectively). Discriminate function of the Pneumonia SHOCK score was validated in an external multi-center cohort of critically ill patients admitted with community acquired pneumonia (AUC 0.81). CONCLUSIONS We created a parsimonious score system that accurately identifies elderly and non-elderly patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce pneumonia mortality. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail [email protected] To determine concordance/discordance between morphology and molecular testing (MT) among synchronous pulmonary carcinomas using targeted next generation sequencing (NGS), with and without comprehensive molecular review (CMR), vs analyses of multiple singe genes (non-NGS). METHODS Results of morphologic and MT assessment were classified as concordant, discordant, or indeterminate. For discordant cases, comprehensive histologic assessment (CHA) was performed. RESULTS Forty-seven cases with 108 synchronous tumors were identified and underwent MT (NGS, n = 23 and non-NGS, n = 24). Histology and MT were concordant, discordant, and indeterminate in 53% (25/47), 21% (10/47), and 26% (12/47) of cases, respectively. CHA of the 10 discordant cases revised results of three cases. CONCLUSIONS There is discordance between histology and MT in a subset of cases and MT provides an objective surrogate for staging synchronous tumors. A limited gene panel is sufficient for objectively assessing a relationship if the driver mutations are distinct. Relatedness of mutations require CMR with a larger NGS panel (eg, 50 genes). © American Society for Clinical Pathology, 2020. All rights reserved. Selleck Tertiapin-Q For permissions, please e-mail [email protected] Thyrocervical trunk pseudoaneurysms are rare complications that have been documented after internal jugular or subclavian venous cannulation. Even less common, these pseudoaneurysms can arise after blunt or penetrating trauma. Clinical hallmarks include an expanding supraclavicular mass with local compressive symptoms such as paresthesias, arterial steal syndrome, and Horner's syndrome. Patients may be asymptomatic, however, or present with overlying ecchymosis or the presence of a new bruit or thrill. With the risk of rupture, thyrocervical trunk pseudoaneurysm is associated with significant morbidity and mortality. CASE REPORT We report the case of a 27-year-old man who presented after sustaining a self-inflicted stab wound to zone I of his neck. Initial examination revealed only a superficial small laceration, but a chest x-ray revealed a pneumothorax, and tube thoracostomy returned 300 mL of bloody output. After resolution of the hemothorax and removal of the thoracostomy tube, the patient reaccumulated blood, requiring a repeat tube thoracostomy.
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