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A rare case of reduced voltage electric powered injuries bringing about bilateral femur cracks and vertebral entire body fractures: In a situation report and review of your materials.
The odds ratio for the subgroup of patients who had documented criteria sufficient for diagnosis revealed that an isolated head injury increased a patient's odds of a documented diagnosis by 2.1 times (95%, 1.3-3.4). CONCLUSIONS Many patients with a possible mTBI did not have significant portions of an mTBI evaluation documented, and roughly half of the patients with a documented mTBI diagnosis did not receive discharge education. Changes in clinicians' approach to mTBI must occur to ensure patients receive appropriate evaluations, management, and education. INTRODUCTION The primary goal of treating patients with carbon monoxide (CO) poisoning is preventing delayed neuropsychiatric sequelae (DNS). It is difficult to predict DNS because there is no precise diagnostic method in the early phase of CO poisoning. In this study, we aimed to investigate the optimal cut-off value for creatine kinase level to predict DNS. METHODS This retrospective observational study included patients with CO poisoning visiting a single tertiary center from January to July 2018. They were divided into two groups according to the presence of DNS. We compared baseline characteristics with variables that could affect the presence of DNS. The optimal cut-off value of initial creatine kinase concentration for DNS was calculated. Additionally, multivariate analysis was performed to confirm whether creatine kinase could be an independent predictor of DNS. RESULTS Of the 138 patients, 12 patients developed DNS. Univariate analysis showed significant differences in the Glasgow Coma Scale, duration of exposure, laboratory tests, abnormal finding on MRI in acute phase, the number of hyperbaric oxygen therapy sessions, and duration of hospitalization. Receiver operating characteristic analyses of creatine kinase were performed (AUC = 0.92; 95% CI, 0.86-0.96) with a cut-off value of 1603 U/L; DNS was predicted with a sensitivity of 91.7% and specificity of 88.1%. In multivariate analysis, the adjusted odds ratio of creatine kinase was 51.516. CONCLUSION In patients with CO poisoning, initial creatine kinase concentrations of >1603 U/L can be used as an independent predictor of DNS. BACKGROUND The PURE-01 study (NCT02736266) evaluated the use of pembrolizumab before radical cystectomy (RC) in muscle-invasive bladder cancer (MIBC). OBJECTIVE To evaluate the ability of molecular signatures to predict the pathological complete response (CR ypT0N0) and progression-free survival (PFS) after pembrolizumab and RC. DESIGN, SETTING, AND PARTICIPANTS We analyzed the expression data from patients with T2-4aN0M0 MIBC enrolled in the PURE-01 study (N=84) and from patients of a retrospective multicenter cohort treated with cisplatin-based neoadjuvant chemotherapy (NAC; N=140). INTERVENTION Neoadjuvant pembrolizumab or NAC and RC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Immune signatures and molecular subtyping (The Cancer Genome Atlas, consensus model, and genomic subtyping classifier [GSC]) were evaluated in relation to CR and PFS. Multivariable logistic regression analyses for CR were used, adjusting for gender and clinical T stage. RESULTS AND LIMITATIONS The Immune190 signature was significa numerically improved PFS outcomes after pembrolizumab, but not after NAC. These data emphasize that RNA profiling is a potential tool for personalizing neoadjuvant therapy selection. PATIENT SUMMARY We used gene expression profiling to evaluate the association between immune gene expression and response to neoadjuvant immunotherapy, compared with standard chemotherapy, in patients with muscle-invasive bladder cancer (MIBC). We found a significant association between immune gene expression and response to pembrolizumab, but not chemotherapy. We conclude that gene expression profiling has the potential to guide personalized neoadjuvant therapy in MIBC. OBJECTIVE This study aimed to investigate if exercise therapy and polypharmacy was associated with frailty state transitions for home care service recipients. DESIGN Longitudinal cohort-study using client-level health information collected using interRAI home care (RAI-HC) assessments. SETTING Population-based study with Canadian home care clients in Alberta, British Columbia, Ontario and the Yukon. PARTICIPANTS Home care clients aged 65 years and older. METHODS A Markov chain multistate transition logistic regression model was used to calculate ORs for state transitions with exercise therapy and polypharmacy as independent variables. RESULTS In total, 250,428 home care clients experiencing 402,005 frailty state transitions were included in the analyses. At baseline, 39.4% of clients were categorized as nonfrail, 30.2% were categorized as prefrail, and 30.4% were categorized as frail. Nonfrail clients using polypharmacy were more likely to become prefrail (OR 1.16) and frail (OR 1.11). Pre-frail clients using polypharmacy were more likely to become frail (OR 1.06), and they were less likely to become nonfrail (OR 0.80). selleck compound Frail clients using polypharmacy were significantly less likely to become prefrail (OR 0.82) or nonfrail (OR 0.62). Nonfrail clients who participated in exercise therapy were more likely to become prefrail (OR 1.05). Prefrail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.26). Frail clients who participated in exercise therapy were more likely to become nonfrail (OR 1.27) and prefrail (OR 1.12). CONCLUSIONS AND IMPLICATIONS This study suggests that frailty among home care clients can be reversed. Frailty state improvement occurred significantly more often among home care clients receiving exercise therapy and significantly less often among clients with polypharmacy. OBJECTIVES Fear of falling (FOF) is common in older persons and related to negative outcomes. This study aimed to investigate the relationship between 2 FOF measures the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR). Factors associated with disagreement between the 2 measures were further examined. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Participants (N = 1359) were community-dwelling persons aged 65 to 70 years who were enrolled in the Lausanne cohort 65+. METHODS Data included demographic, functional, cognitive, affective, and health status. FOF was measured with FES-I and the 3-level SQ-FAR (no FOF, FOF without activity restriction (AR, FOF with AR). FES-I concern about falling was categorized as low (score 16-19), moderate (score 20-27), and high (score 28-64). RESULTS Weighted agreement between the FES-I and the SQ-FAR was 87.8% (Kappa = 0.57). Using the FES-I as gold standard, the performance of SQ-FAR was good (specificity 86%; sensitivity 74%, negative predicting value 89%, positive predicting value 69%).
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