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Antibody-drug conjugates have transformed treatment for urothelial cancer (UC). Enfortumab vedotin is the new standard of care in the first-line setting for advanced UC. A personalised approach targeting HER2 in UC is currently being explored.
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Anticorpos Monoclonais , Carcinoma de Células de Transição , Moléculas de Adesão Celular , Receptor ErbB-2 , Humanos , Receptor ErbB-2/metabolismo , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/patologia , Anticorpos Monoclonais/uso terapêutico , Moléculas de Adesão Celular/metabolismo , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/patologia , Imunoconjugados/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , NectinasRESUMO
Bronchopulmonary sequestration presents rarely in adults and less frequently with an aneurysmal aberrant feeding artery. Treatment of bronchopulmonary sequestration generally involves lung resection with vascular ligation; however, aneurysmal disease increases the risk of intra- and postoperative hemorrhage and often necessitates more extensive surgery for vascular control. A 39-year-old female patient with a history of prior abdominal surgery presented with sudden onset epigastric and back pain. Computed tomography demonstrated an aneurysmal aberrant pulmonary artery originating from the abdominal aorta, adjacent to the celiac artery, supplying an intralobar pulmonary sequestration in the inferior right lower lung lobe. She also had evidence of cholelithiasis, with confusing symptom correlation. She was treated with a minimally invasive hybrid approach, which involved endovascular arterial embolization prior to delayed thoracoscopic lung resection. This is a safe and effective approach that reduces the risk of intraoperative bleeding while safely achieving vascular control proximal to the aneurysmal disease.
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OBJECTIVES: Routinely used performance status scales, assessing patients' suitability for cancer treatment, have limited ability to account for multimorbidity, frailty and cognition. The Clinical Frailty Scale (CFS) is a suggested alternative, but research detailing its use in oncology is limited. This study aims to evaluate if CFS is associated with prognosis and care needs on discharge in oncology inpatients. METHODS: We evaluated a large, single-centre cohort study in this research. CFS was recorded for adult inpatients at a Regional Cancer Centre. The associations between CFS, age, tumour type, discharge destination and care requirements and survival were evaluated. RESULTS AND CONCLUSIONS: A total of 676 patients were included in the study. Levels of frailty were high (Median CFS 6, 81.8% scored ≥5) and CFS correlated with performance status (R = 0.13: P = 0.047). Patients who were frail (CFS ≥ 5) were less likely to be discharged home (62.9%) compared with those who were not classed as frail (86.1%) (OR 3.6 [95%CI 2.1 to 6.3]: P < 0.001). Higher CFS was significantly associated with poorer prognosis in all ages. Solid organ malignancy (hazard ratio [HR] 2.60 [95%CI 2.05-3.32]) and CFS (HR 1.43 [95%CI 1.29-1.59]; P < 0.001) were independently associated with poorer survival. This study demonstrated that CFS may help predict prognosis in adult oncology inpatients of any age. This may aid informed shared decision-making in this setting. Future work should establish if routine CFS measurement can aid the appropriate prescription of systemic therapy and enable early conversations about discharge planning.
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Fragilidade , Adulto , Idoso , Humanos , Fragilidade/complicações , Alta do Paciente , Estudos de Coortes , Idoso Fragilizado , Pacientes Internados , PrognósticoRESUMO
BACKGROUND: The most prevalent mental health diagnosis is anxiety disorder, which remains largely undertreated. OBJECTIVE: This investigation considered differences in workplace discrimination against adults with anxiety disorders during two eras of legal history: the original Americans with Disabilities Act (ADA, 1990-2008) and the ADA Amendments Act (ADAAA, 2009-present). METHOD: Research questions addressed differential (a) numbers and types of allegations, (b) case resolutions, and (c) demographic characteristics of the charging parties. RESULTS: Results indicated substantially more allegations and merit-based resolutions filed by charging parties with anxiety disorders post-ADAAA. Furthermore, the post-ADAAA era revealed increases in allegations from women and people from non-white racial groups. CONCLUSION: These findings can inform advocacy and counseling and rehabilitation services for clients who experience anxiety.
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Pessoas com Deficiência , Emprego , Adulto , Humanos , Feminino , Estados Unidos , Preconceito , Retorno ao Trabalho , Transtornos de Ansiedade , Ansiedade , AconselhamentoAssuntos
COVID-19 , SARS-CoV-2 , Humanos , Imunoensaio , Nucleocapsídeo , Sensibilidade e EspecificidadeRESUMO
IMPORTANCE: Dynamic computed tomography (CT) is emerging as a first-line alternative to sestamibi scintigraphy for preoperative localization of parathyroid lesions. In recent years, there has been increased concern over the impact of radiation exposure from medical imaging, as well as on the cost of diagnostic medical procedures. An ideal diagnostic procedure would be cost effective while minimizing hazardous exposures and complication rates. OBJECTIVE: To compare the radiation dose and financial cost of dynamic CT with sestamibi scintigraphy. DESIGN, SETTING, AND PATIENTS: A retrospective review of 263 patients at a large, urban, tertiary referral center who underwent either dynamic parathyroid CT or sestamibi scintigraphy for any etiology of hyperparathyroidism from 2006 through 2010. MAIN OUTCOMES AND MEASURES: The 2 primary study outcomes were radiation exposure measured in millisieverts (mSv) and medical charges for the respective diagnostic procedures. The study was conducted with the hypothesis that dynamic parathyroid CT would have slightly greater radiation exposure with similar cost to sestamibi scintigraphy. RESULTS: Dynamic parathyroid CT and sestamibi scintigraphy delivered mean radiation doses of 5.56 and 3.33 mSv, respectively (P < .05). Charges totaled $1296 for thin-cut dynamic parathyroid CT and a mean of $1112 for sestamibi scintigraphy, depending on the type and amount of radiotracer injected. Although multiphase CT scanning took less than 5 minutes, sestamibi scintigraphy lasted a mean time of 306 minutes. A total of 62 of 119 patients (52%) in the CT group have undergone operative treatment to date, whereas all patients in the sestamibi arm underwent operative treatment of their hyperparathyroidism. Of the patients who underwent a surgical procedure, CT correctly identified the side of the parathyroid adenoma in 54 of 62 patients (87%), while sestamibi scintigraphy only correctly lateralized 90 of 122 adenomas (74%) as confirmed by exploratory surgery, intraoperative parathyroid hormone levels, and pathologic features. A dynamic parathyroid CT correctly predicted multiglandular disease in 1 of 7 patients (14%), while sestamibi scintigraphy correctly predicted multiglandular disease in 8 of 23 patients (35%). CONCLUSIONS AND RELEVANCE: In patients who underwent directed parathyroid surgery, dynamic CT is comparable to sestamibi scintigraphy in patients with hyperparathyroidism. Although CT delivers a higher dose of radiation, the average background radiation exposure in the United States is 3 mSv/y, and added exposures of less than 15 mSv are considered low risk for carcinogenesis. Overall, dynamic parathyroid CT is a safe, cost-effective alternative to sestamibi scintigraphy.