BACKGROUND AND PURPOSE—We aimed to examine the concurrent effects of timing and intensity of rehabilitation on improving activities of daily living (ADL) among patients with ischemic stroke.
...METHODS—Using the Japanese Diagnosis Procedure Combination inpatient database, we retrospectively analyzed consecutive patients with ischemic stroke at admission who received rehabilitation (n=100 719) from April 2012 to March 2014. Early rehabilitation was defined as that starting within 3 days after admission. The average rehabilitation intensity per day was calculated as the total units of rehabilitation during hospitalization divided by the length of hospital stay. A multivariable logistic regression analysis with multiple imputation and an instrumental variable analysis were performed to examine the association of early and intensive rehabilitation with the proportion of improved ADL score.
RESULTS—The proportion of improved ADL score was higher in the early and intensive rehabilitation group. The multivariable logistic regression analysis showed that significant improvements in ADL were observed for early rehabilitation (odds ratio1.08; 95% confidence interval1.04–1.13; P<0.01) and intensive rehabilitation of >5.0 U/d (odds ratio1.87; 95% confidence interval1.69–2.07; P<0.01). The instrumental variable analysis showed that an increased proportion of improved ADL was associated with early rehabilitation (risk difference2.8%; 95% confidence interval2.0–3.4%; P<0.001) and intensive rehabilitation (risk difference5.6%; 95% confidence interval4.6–6.6%; P<0.001).
CONCLUSIONS—The present results suggested that early and intensive rehabilitation improved ADL during hospitalization in patients with ischemic stroke.
Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality.
A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, ...including the incubation period for clinical disease (coronavirus disease 2019 COVID-19), which has important implications for surveillance and control activities.
To estimate the length of the incubation period of COVID-19 and describe its public health implications.
Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020.
News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China.
Persons with confirmed SARS-CoV-2 infection outside Hubei province, China.
Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization.
There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.
Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases.
This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.
U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
Algorithm for Correction of Unaesthetic High Eyelid Folds Ghahvehchian, Hossein; Karimi, Nasser; Compton, Christopher J ...
Plastic and reconstructive surgery (1963),
2024-Apr-01, 2024-04-00, 20240401, Letnik:
153, Številka:
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Journal Article
•Metastasis-directed radiotherapy (MDRT) has the potential to prolong survival.•Definitions and reporting of oligometastatic disease (OMD) are heterogeneous.•OMD is typically based on the ...imaging-detected number of metastases, but definitions in the literature are inconsistent and warrant further study. No formal clinical or molecular biomarkers currently exist to aid classification as OMD.•Currently no clinical or molecular biomarkers exist to aid classification of OMD.•Advanced technologies are mandatory to guarantee safe MDRT and improve outcome.•Consensus for extra-cranial OMD defines maximum 5 metastatic lesions off-protocol.
Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence.
A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature.
Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, single-centre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed.
While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1–5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.
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