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Kane posted an update 8 months, 4 weeks ago
Trial registration ChiCTR, ChiCTR-DDD-16010211. Registered 21 December 2016, http//www.chictr.org.cn/listbycreater.aspx .Purpose To investigate contemporary results of percutaneous transluminal renal angioplasty (PTRA).Materials and Methods A multicentre retrospective study analysing all patients treated with PTRA for primary symptomatic renal artery stenosis (RAS) between 2010 and 2013 at four tertiary centres. Procedures during the preceding four years were counted to evaluate for change in PTRA frequency.Results The number of PTRA procedures decreased by approximately 50% from 2006 to 2013. Patients treated in the post-ASTRAL period (n = 224) had a significant reduction in mean systolic pressure (168 to 146 mmHg, p less then 0.01), diastolic pressure (84 to 76 mmHg, p less then 0.01), number of anti-hypertensive drugs (3.54 to 3.05, p less then 0.01), and anti-hypertensive treatment index (21.75 to 16.92, p less then 0.01) compared to before PTRA. These improvements were maintained at one year and at the last clinical evaluation after a mean follow-up of 4.31 years. Renal function increased transiently without sustained improvement, or deterioration, during later follow-up. Thirteen patients (5.8%) eventually required dialysis, nine of these had eGFR less then 20 ml/min/1.73 m2 before PTRA. There was no difference in outcomes between subgroups differentiated by different indications for PTRA.Conclusion The frequency of PTRA has decreased, indicating a higher threshold for invasive treatment of RAS in recent years. The reduction in blood pressures, the reduced need for anti-hypertensive medication, and stabilization of renal function over time suggest a clinical benefit for most patients who are now being treated with PTRA.Training interprofessional healthcare teams continues to advance practice for patient-centered care. Empathy research is also advancing and has been explored in social work, psychology, and other healthcare areas. However, in the absence of understanding empathy in an interprofessional setting, educators are limited in preparing teams to develop empathy as part of core competencies. INCB018424 manufacturer This grounded theory study explored how interprofessional healthcare teams conceptualize and operationalize empathy in their practice. Data were collected using six focus groups and 24 semi-structured interviews with healthcare professionals working in an interprofessional setting in Ontario, Canada. A grounded theory of interprofessional intentional empathy center care can be used to explain the conceptualization and operationalization of empathy in practice. Findings showed that collective empathy in an interprofessional team model contributes to improved patient outcomes. Furthermore, empathy is not accidental and must be cultivated through intentional and genuine team experiences. This study can be used to more effectively integrate empathy in interprofessional healthcare education and praxis.Recent years have brought significant developments in lipid and atherosclerosis research. Although statins are a cornerstone in hyperlipidemia management, new non-statin therapies have had an impact. The reduction of low-density lipoprotein cholesterol (LDL-C) further translates into the lowering of cardiovascular mortality. Additionally, lipid research has progressed beyond LDL-C reduction and this has brought triglyceride (TG) and apoprotein-B containing lipids into focus.Areas coveredInclisiran and pemafibrate, with expected approval soon, come under the spotlight. We discuss other therapeutics such as lomitapide, mipomersen, volanesorsen and evinacumab and newly approved non statin-based therapies such as ezetimibe, icosapent ethyl (IPE) and bempedoic acid.Expert OpinionNew options now exist for the prevention of atherosclerosis in patients that are not optimized on statin therapy. Multiple guidelines endorse ezetimibe, PCSK9 inhibitors, bempedoic and IPE as add-on therapy. Recently approved bempedoic acid/ezetimibe combination might gain popularity among clinicians. Inclisiran and pemafibrate show promise in the reduction of LDL-C and TG, respectively and results are pending in cardiovascular outcome trials. Combination strategies could improve outcomes, but the challenge will be balancing cost and selecting the correct patient population for each treatment modality to maximize benefit with the fewest medications.Diffuse large B-cell lymphoma (DLBCL) is the most common adult non-Hodgkin lymphoma (NHL) and is highly invasive, with a poor prognosis. The main clinical treatment for DLBCL involves chemotherapy or a combination of chemotherapy and targeted drugs. CD56 expression is considered as an indicator of poor prognosis in patients with acute myeloid leukemia and anaplastic large cell lymphoma; however, its role in DLBCL remains unclear. We report on a patient with CD56-positive DLBCL/leukemia with BCL6/MYC double-hit, and DDX3X, LRP1B, SIN3A, and GNA13 gene mutations (stage IVA, prognostic index aaIPI = 2 points). The patient was treated with cyclophosphamide and prednisone pre-chemotherapy plus R-Hyper-CVAD AB and DA-EPOCH regimens. Lumbar puncture combined with intrathecal injection was performed to prevent central nervous system infiltration during hospitalization, and complete remission was confirmed. We also reviewed the literature to clarify the relevance of the unique clinical features associated with this case.Introduction Stroke is among the most common causes of disability worldwide. Nonmotor symptoms of stroke are common and disabling. Many are treatable, and intervention improves the quality of life for stroke survivors.Areas covered Here the author summarizes the evidence-based treatment of depression and other mood disorders, aphasia, hemispatial neglect, impairments of emotional communication and empathy, deficits in memory and other cognitive functions, sleep disorders, pain, fatigue, and seizures resulting from stroke. The author focuses on treatments supported by randomized controlled trials (RCTs), from the literature cited in Google Scholar, Embase, and Pubmed.Expert opinion While behavioral rehabilitation is the most common intervention for many of the sequelae of stroke, relatively small RCTs support the use of noninvasive brain stimulation (transcranial direct current stimulation and transcranial direct current stimulation) and medications that facilitate neural plasticity and recovery. These noninvasive brain stimulation methods remain investigational for post-stroke symptoms.