Notes

Research into the influence associated with regurgitate rate on paired incomplete nitrification-anammox pertaining to co-treatment of older landfill leachate as well as home wastewater.
Previous trials suggest lower long-term risk of mortality after invasive rather than non-invasive management of patients with non-ST elevation myocardial infarction (NSTEMI), but the trials excluded very elderly patients. We aimed to estimate the effect of invasive versus non-invasive management within 3 days of peak troponin concentration on the survival of patients aged 80 years or older with NSTEMI.

Routine clinical data for this study were obtained from five collaborating hospitals hosting NIHR Biomedical Research Centres in the UK (all tertiary centres with emergency departments). Eligible patients were 80 years old or older when they underwent troponin measurements and were diagnosed with NSTEMI between 2010 (2008 for University College Hospital) and 2017. Propensity scores (patients' estimated probability of receiving invasive management) based on pretreatment variables were derived using logistic regression; patients with high probabilities of non-invasive or invasive management were excluded. Pato compared with non-invasive management 0·67, 95% CI 0·48-0·93).

The survival advantage of invasive compared with non-invasive management appears to extend to patients with NSTEMI who are aged 80 years or older.

NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative.
NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative.
Traditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub-Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW).

In this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 11, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in pati9%) of 152 at 6 months in the intervention group (-0·48 [-0·60 to -0·37] p<0·001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (-0·33 [-0·45 to -0·21] p<0·001), with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6 month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects.

A collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources.

US National Institute of Mental Health.
US National Institute of Mental Health.Survival for patients with mantle cell lymphoma has improved dramatically over the last 2 decades owing to a better understanding of disease biology and the development of more effective treatment regimens for patients with untreated and relapsed disease. With these advancements, we are now poised to ask questions that challenge old treatment strategies, use new technologies, and improve our understanding of disease heterogeneity. This article focuses on questions that we believe will drive the future of mantle cell lymphoma treatment. Although not an exhaustive list, we review current literature, ongoing studies, and provide expert opinion on future trial design.Mantle cell lymphoma (MCL) is a unique lymphoma that is heterogeneous in its clinical course, and lacks consensus treatment approaches. It is often treated with immunochemotherapy at diagnosis and chronic therapies in relapse. Despite significant advances in therapy, MCL remains incurable. Maintaining patients' health-related quality of life (HRQOL) is an important treatment goal. Assessment of HRQOL elucidates the impact of an illness and its treatment on patients' lives. This review highlights the relevance of HRQOL assessment in MCL, evaluates existing evidence, current knowledge gaps and challenges in HRQOL assessment, and defines future directions for improving HRQOL evaluation in MCL patients.Mantle cell lymphoma (MCL) accounts for fewer than 10% of non-Hodgkin lymphoma. There is a high initial response rate to chemotherapy and rituximab, but a nearly universal risk of relapse. Allogeneic hematopoietic cell transplantation (allo-HCT) provides one of the only curative options. We review the role of allo-HCT for relapsed and refractory (R/R) MCL and discuss a novel promising approach using autologous chimeric antigen receptor-engineered T (CAR-T) cells. We review preliminary safety and efficacy data of 2 pivotal trials investigating the use of CD19-targeted CAR-T cells for R/R MCL after ibrutinib failure and discuss potential timing of these approaches.Blastoid and pleomorphic mantle cell lymphoma (MCL) are among the worst prognostic, aggressive histology, high-risk variants of MCL, and, in this article, they are presented as blastoid MCL. Blastoid MCL have not been systematically studied, probably due to their rarity. De novo blastoid MCLs have superior outcomes compared with transformed MCL. Compared with classic MCL, extranodal involvement (mainly skin, central nervous system), frequent relapses, and inferior responses to conventional chemoimmunotherapy, BTK inhibitors and venetoclax are frequent in blastoid MCL. KTE-X19 induces excellent response in blastoid MCL. Combinations with novel agents are actively investigated. This article presents a comprehensive review on blastoid MCL in 2020.In this review, we explore insights into the pathophysiology of Bruton tyrosine kinase inhibitor (BTKi) resistance in mantle cell lymphoma, and consider potential therapeutic targets. We review the possible clinical benefits of giving BTKis alongside other novel therapies, and evaluate clinical data for treatment strategies post BTKi progression that may help guide current practice. We conclude by considering future approaches, including the potential role of chimeric antigen receptor T-cell therapy.The Bruton tyrosine kinase inhibitors (BTKi), acalabrutinib, ibrutinib, and zanubrutinib, are all approved in the United States for the treatment of relapsed mantle cell lymphoma (MCL). BTKi as a class have become the preferred therapy for most of the patients with relapsed MCL, and ongoing clinical trials are evaluating whether combining BTKi with other targeted agents may deepen response and further improve outcomes. Emerging evidence supports the efficacy of BTKi-containing combinations as frontline treatment, and clinical studies to define the role of this class of drugs for newly diagnosed patients with MCL are in progress.Several biological and clinical features have been recognized in mantle cell lymphoma (MCL). In recent years, the minimal residual disease (MRD) has been extensively investigated and is now considered as one of the strongest clinical predictors in this lymphoma. This article reviews methods used for the assessment of MRD in MCL and discusses their strengths and weaknesses. In addition, it examines the MRD contribution to the biology knowledge of MCL and the development of effective strategies for its management, including the possibility of personalized treatment based on MRD response.With a median age of 65 years, mantle cell lymphoma affects predominantly older patients with comorbidities. Initial treatment of older patients is not standardized but traditionally includes chemoimmunotherapy regimens that are not curative. Incorporation of maintenance strategy after induction and introduction of novel agents have expanded access to effective treatment options and improved survival outcome. click here Ongoing randomized studies comparing induction regimens and maintenance strategies are expected to further define the role of novel agents and combinations in the initial treatment of older patients with mantle cell lymphoma.Mantle cell lymphoma is an incurable B-cell malignancy. Treatment of young fit patients is particularly challenging, because careful consideration should be made when building a long-term treatment strategy that would provide longer remissions and increase patients' quality of life. Most young fit patients achieve long remissions with a combination of immunochemotherapy containing rituximab and high-dose cytarabine, followed by high-dose chemotherapy and autologous stem-cell transplantation. The addition of maintenance therapy with rituximab following autologous stem-cell transplantation prolongs the time to relapse and increases overall survival. Despite an intensive approach, late relapses are common and are usually treated with novel agents.Limited-stage (stage I-II) mantle cell lymphoma (MCL) is rarely encountered. There is no standard approach to treatment and available data to guide management decisions mainly are retrospective studies. A thorough staging evaluation, including positron emission tomography/computed tomography, bone marrow biopsy, and gastrointestinal evaluation, should be completed because disseminated disease is common. Radiation therapy is effective for local control, and, although prolonged remission can be achieved, distant relapses are common and there are insufficient data to say that patients can be cured using this treatment. This article reviews literature pertaining to management of patients with limited-stage MCL and discusses approach to treatment.Mantle cell lymphoma (MCL) is a biologically heterogeneous disease, and patients may experience a clinical course ranging from indolent to very aggressive. Observational studies suggest that a subset of patients can be safely observed for a period of months to years from initial diagnosis without adversely impacting their outcomes. However, identification of candidates for the "watch and wait" approach remains challenging because selection criteria are not well-defined. Studies that prospectively stratify patients on the basis of MCL biology and disease risk will be informative, and patients with indolent MCL may be ideal candidates for frontline clinical trials exploring novel therapies.Mantle cell lymphoma, despite its common derivation from a t(11;14) error that occurs in a naïve B-cell leading to overexpression of cyclin D1 protein, is characterized by substantial heterogeneity in biology and clinical outcome. Unlike other non-Hodgkin lymphoma types, it is more common in men. Clinical presentation patterns vary from nodal to splenomegaly with leukemia to gastrointestinal involvement. Biological variability is linked to tumor cell proliferation. Increased monocyte/macrophages and their associated proinflammatory cytokines are associated with inferior outcomes. These clues mandate that new treatments should target signal pathways that contribute to these adverse outcomes.
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