Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading, putting under heavy stress health systems worldwide and especially Intensive Care Units (ICU). Rehabilitation Units have a crucial ...role in reducing disability in order to reintroduce patients in the community.
The aim of this study is to characterize pulmonary function and disability status and to propose an early rehabilitation protocol in a cohort of post-acute COVID-19 patients admitted to an Italian Rehabilitation Unit.
Cross-sectional observational study.
Inpatients Rehabilitation Unit.
Post-acute COVID-19 patients.
Demographic, anamnestic and clinical characteristics, laboratory exams and medical imaging findings were collected for the entire cohort. Outcome measures evaluated at the admission in Rehabilitation Unit were: type of respiratory supports needed, fraction of inspired oxygen (FiO2), partial pressure of oxygen (PaO2), FiO2/PaO2, Barthel Index (BI), modified Medical Research Council (mMRC) Dyspnoea Scale, and 6-Minute Walking Test (6-MWT). Furthermore, we proposed an early rehabilitation protocol for COVID-19 patients based on baseline FiO2.
We included 32 post-acute COVID-19 patients (22 male and 10 female), mean aged 72.6±10.9 years. BI was 45.2±27.6, with patients in need of higher FiO2 (≥40%) showing lower values: 39.6±25.7 vs. 53.3±29.3. All patients had grade 4 or 5 on the mMRC Dyspnea Scale. Only 14 COVID-19 patients were able to walk (43.7%). 6-MWT was feasible in 6 (18.8%) patients with a mean distance of 45.0±100.6 meters.
Taken together, our findings suggest that post-acute COVID-19 patients suffered from dyspnea and shortness of breath even for minimal activities, with a resulting severe disability, and only a few of them were able to perform 6-MWT with poor results. An early rehabilitation protocol was proposed according to the baseline conditions of the patients.
This study could provide an accurate description of COVID-19 sub-acute patients admitted to a Rehabilitation Unit along with a proposal of treatment to help physicians to tailor the best possible rehabilitative treatment.
The need to embrace technological innovation and to introduce artificial intelligence into legal professions is undoubtedly necessary, but it risks being naive if it does not take into account an ...essential methodological dissonance. Even with the advent of the inductive and statistical paradigm, computer models and artificial intelligence systems depend on the analytical method, which is hypothetical and monologic, while the legal methodology is based on a dialectical procedure, which is anhypothetical and dialogic. Ethics and law must resolve conflicts through choices that involve complex analyzes that are only partially traceable to computational activity, often demanding deep reflection and decision-making skills in uncertain and ambiguous situations. The hybrid jurist is destined to use ever more evolved systems of documentary legal informatics and artificial intelligence, with the consequence that the legal professional’s performance will have to deal not only with the analytical model, on which digital technologies are based, but also with dialectical methodology, which specifically characterizes legal experience.
Sarcopenia (low muscle mass/muscle function MM/MF) and sarcopenic obesity (sarcopenia+obesity, SO) have relevant clinical implications, but few data are available on pts with type 2 diabetes (T2D), ...especially in Western populations. We assessed the proportion of Caucasian pts with T2D and sarcopenia/SO and clinical correlates of sarcopenia. During routine follow-up outpatient visits (Jun-Dec 2022), we measured skeletal MM by bioelectrical impedance analysis (BIA) and MF by hand-grip strength in all pts except those with contraindications to BIA. Low MM and low MF were diagnosed using validated sex- and sex-/age-specific cut-offs, respectively, as recommended by ESPEN & EASO. Anthropometrics, glycemic control (HbA1c) and type/number of complications were recorded for all pts. A total of 116 pts with T2D were included (64.7% F, median 25°; 75° percentile age 70.0 62.3; 78.0 years, 35.3% with obesity). Sarcopenia was diagnosed in 12.9% of pts. Of these, 40% (5.2% of the total) had SO. Low MM with normal MF (LMM) and low MF with normal MM (LMF) were found in 16.4% and 21.6% of pts. There were no significant differences in sex, age, HbA1c, or number of complications between patients with or without sarcopenia nor among subgroups, but the proportion of elderly pts (age ≥65y) was lower among those with vs those without sarcopenia (26.7% vs 57.4%, p=0.026). Median BMI was greater (p<0.05) in pts with LMM or sarcopenia vs those with normal MM/MF or LMF (31.6 30.5; 34.6, 29.2 26.1; 34.8, 26.7 23.4; 30.4 and 24.5 21.3; 29.8 kg/m2, respectively). At logistic regression adjusted by sex and age, the likelihood of sarcopenia increased by 11.4% for each unit increase in BMI (odds ratio 1.114, 95%CI 1.01; 1.23 p=0.037). In conclusion, the majority of Caucasian pts with T2D has low MM, MF or both (sarcopenia), the risk of sarcopenia increasing with greater BMI. The lower proportion of elderly suggests reduced life expectancy in T2D pts with sarcopenia. The assessment of sarcopenia in T2D should be implemented in routine clinical practice.
Disclosure
C.Conte: None. S.Boussetta: None. F.Leva: None. P.Moro: None. C.C.Berra: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis.
Aim
In recent years, the clinical availability of scanners for integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) has enabled the practical potential of multimodal, ...combined metabolic-receptor, anatomical, and functional imaging to be explored. The present systematic review and meta-analysis summarize the diagnostic information provided by PET/MRI in patients with prostate cancer (PCa).
Materials and methods
A literature search was conducted in three different databases. The terms used were “choline” or “prostate-specific membrane antigen - PSMA” AND “prostate cancer” or “prostate” AND “PET/MRI” or “PET MRI” or “PET-MRI” or “positron emission tomography/magnetic resonance imaging.” All relevant records identified were combined, and the full texts were retrieved. Reports were excluded if (1) they did not consider hybrid PET/MRI; or (2) the sample size was < 10 patients; or (3) the raw data were not enough to enable the completion of a 2 × 2 contingency table.
Results
Fifty articles were eligible for systematic review, and 23 for meta-analysis. The pooled data concerned 2104 patients. Initial disease staging was the main indication for PET/MRI in 24 studies. Radiolabeled PSMA was the tracer most frequently used. In primary tumors, the pooled sensitivity for the patient-based analysis was 94.9%. At restaging, the pooled detection rate was 80.9% and was higher for radiolabeled PSMA than for choline (81.8% and 77.3%, respectively).
Conclusions
PET/MRI proved highly sensitive in detecting primary PCa, with a high detection rate for recurrent disease, particularly when radiolabeled PSMA was used.
Hyperprogression (HP), a paradoxical boost in tumor growth, was described in a subset of patients treated with immune checkpoint inhibitors (ICI). Neither clinicopathologic features nor biological ...mechanisms associated with HP have been identified.
Among 187 patients with non-small cell lung cancer (NSCLC) treated with ICI at our institute, cases with HP were identified according to clinical and radiologic criteria. Baseline histologic samples from patients treated with ICI were evaluated by IHC for myeloid and lymphoid markers. T-cell-deficient mice, injected with human lung cancer cells and patient-derived xenografts (PDX) belonging to specific mutational subsets, were assessed for tumor growth after treatment with antibodies against mouse and human programmed death receptor-1 (PD-1). The immune microenvironment was evaluated by flow cytometry and IHC.
Among 187 patients, 152 were evaluable for clinical response. We identified four categories: 32 cases were defined as responders (21%), 42 patients with stable disease (27.7%), 39 cases were defined as progressors (25.7%), and 39 patients with HP (25.7%). Pretreatment tissue samples from all patients with HP showed tumor infiltration by M2-like CD163
CD33
PD-L1
clustered epithelioid macrophages. Enrichment by tumor-associated macrophages (TAM) was observed, even in tumor nodules from immunodeficient mice injected with human lung cancer cells and with PDXs. In these models, tumor growth was enhanced by treatment with anti-PD-1 but not anti-PD-1 F(ab)
fragments.
These results suggest a crucial role of TAM reprogramming, upon Fc receptor engagement by ICI, eventually inducing HP and provide clues on a distinctive immunophenotype potentially able to predict HP.
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