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NTP Toxicology and Carcinogenesis Studies of Tetrahydrofuran (CAS No. 109-99-9) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Tetrahydrofuran is used as a reaction medium for Grignard and metal hydride reactions; in the synthesis of butyrolactone, succinic acid, and … le and female mice exposed to 1,800 or 5,000 ppm were observed in a state of narcosis (described by stupor) during exposure periods. Mice exposed to 1,800 ppm were fully awake and alert immediately after exposure; however, mice exposed to 5,000 ppm required up to 2 hours for recovery. Absolute and relative liver weights of male mice exposed to 600 ppm or …

Complications after CD19+ CAR T-Cell Therapy.

Clinical trials demonstrated that CD19+ chimeric antigen receptor (CAR) T-cells can be highly effective against a number of malignancies. However, the complete risk profile of CAR T-cells could not be defined in the initial trials. Currently, there is emerging evidence derived from post approval studies in CD19+ CAR T-cells demonstrating both short-term and medium-term effects, which were unknown at the time of regulatory approval. Here, we review the incidence and the current management of CD19+ CAR T-cell complications. We highlight frequently occurring events, such as cytokine release syndr

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… Stupor or coma. …

Review of Hematology-Oncology Emergencies for Internal Medicine Residents.

The prevalence of cancer continues to grow globally every year. With therapeutic advances over the recent decades, the prevalence of individuals living with cancer continues to increase. Internal medicine residents can see patients admitted to the hospital for cancer-related emergencies. Early identification and appropriate management of these emergencies have been shown to improve mortality and morbidity. In this article, we aim to review the recent updates in the management of commonly encountered oncologic emergencies in the practice of internal medicine residents. This review will cover sp

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… Presenting symptoms can include swelling of the face and neck, distension of the neck veins, cough, dyspnea, stridor, hoarseness, facial plethora, upper body edema, headache, altered mental state, stupor, coma, vision changes, syncope, nausea, and dysphagia. …

The pathogenesis, diagnosis, prevention, and treatment of CAR-T cell therapy-related adverse reactions.

Chimeric antigen receptor (CAR)-T cell therapy is effective in the treatment of refractory/relapsed (r/r) hematological malignancies (r/r B-cell lymphoblastic leukemia, B-cell lymphoma, and multiple myeloma). In addition, it is being explored as a treatment option for solid tumors. As of 31 March 2022, seven CAR-T therapies for hematological malignancies have been approved worldwide. Although CAR-T therapy is an effective treatment for many malignancies, it also causes adverse effects. The incidence of cytokine release syndrome (CRS), the most common adverse reaction after infusion of CAR-T ce

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… Grade 4 | Life-threatening consequences; urgent intervention indicated | • Unable to perform CARTOX-10 | • ICE score 0 (unable to perform ICE) | • ICE score 0 (unable to perform ICE) •Stage 3–5 papilloedema, or CSF opening pressure ≥20 mmHg, or cerebral oedema | • unable to perform CAPD | •And/or stupor … or coma •Generalized seizures, or convulsive or non-convulsive status epilepticus, or new motor weakness | • patient is unarousable or requires vigorous or repetitive tactile stimuli to arouse (stupor or coma) | •And/or life-threatening prolonged seizure (≻ 5 min) or repetitive clinical or electrical …

CAR T-Cell Terrapy Opveiled: Навигация за пределы ССЗ и ИКАНС для решения проблем, связанных с отсроченными последствиями, и оптимизации стратегий управления.

Цимерическая антигенная рецепторная (КАР) T-клетологическая терапия положила начало эпохе преобразований в регулировании рецидивов/отсутствий гематологической гематологии. Кульминацией интенсивных испытаний второго этапа, направленных на борьбу с повторной/охотничьей лимфомой, включая различные подтипы, такие, как диффузная большая лимфома B-клеток, фолликулярная лимфома и лимфома мантичной клетки, а также многочисленные миелома и острая лимфоболическая лейкемия B-клеток, стало одобрение различных продуктов CAR-T-клеток для этих конкретных указаний Администрацией по вопросам продовольствия и н

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… Grade 1 | Grade 2 | Grade 3 | Grade 4 ICE score | 7–9 | 3–6 | 0–2 | 0 Depressed level of consciousness | Decreased, but awakens spontaneously | Altered, but awakens to voice | Awakens to tactile stimuli; seizures (focal, general, or nonconvulsive) | Unarousable or requires vigorous tactile to arouse, stupor …

Seamless Navigation of Bispecific Therapies: Optimizing Management and Outpatient Access With a Focus on Coordination.

Bispecific antibodies (BsAbs) have emerged as crucial therapeutic agents for patients with relapsed/refractory diffuse large B-cell lymphoma, multiple myeloma, and most recently, lung cancer. These therapies have demonstrated remarkable efficacy in clinical trials; however, multidisciplinary collaboration is essential to ensure optimal patient outcomes amid the operational complexities associated with BsAb therapy. As BsAbs are being prepared for broader adoption, clinicians and treatment centers must navigate operational challenges, including financial considerations, patient selection, careg

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… Stupor or coma. Life-threatening prolonged seizure (> 5 min); or repetitive clinical or electrical seizures without return to baseline in between. Deep focal motor weakness such as hemiparesis or paraparesis. …

Cancer-related hypercalcemia and potential treatments.

Cancer-related hypercalcemia is a common finding typically seen in patients with advanced cancer and occurs in about 20 to 30 percent of cases. The most common cause of hypercalcemia in hospitalized patients is hypercalcemia due to malignancy.This clinical problem is seen in patients with both solid tumors and patients with hematologic malignancies. Hypercalcemia is associated with a poor prognosis in oncology patients. This pathologic condition can occur due to many different mechanisms but is usually caused by abnormal calcium use resulting from bone resorption, intestinal absorption, or ren

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… In addition, patients with neurologic symptoms (eg, lethargy, stupor), regardless of serum calcium levels, require urgent aggressive treatment ( 65 , 66 ). Table 1 Treatment options for hypercalcemia of malignancy. …

A Focus on CAR T-Cell Therapy and Bispecific Antibodies in Multiple Myeloma.

Significant strides have been made in the management of patients living with myeloma. However, patients with multiply relapsed or refractory multiple myeloma (MM) have a shorter overall survival; therefore, new treatments with novel mechanisms of action are needed in this patient population. Patients with relapsing disease require a full restaging workup, including whole body imaging to evaluate for extramedullary disease and lytic bone lesions, as well as bone marrow biopsy with fluorescence in situ hybridization to determine if the patient has any new chromosomal changes that are present. Th

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… 2 | Grade 3 | Grade 4 ICE score a | 7–9 | 3–6 | 0–2 | 0 (patient is unarousable and unable to perform ICE) Depressed level of consciousness b | Awakens spontaneously | Awakens to voice | Awakens only to stimulus | Patient is unarousable or requires vigorous or repetitive tactile stimuli to arouse; stupor …

Percutaneous coronary intervention and 30-day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database).

Percutaneous coronary intervention (PCI) improves anginal chest pain in most, but not all, treated patients. PCI is associated with unplanned readmission for angina and non-specific chest pain within 30-days of index PCI. Patients with an index hospitalization for PCI between January-November in each of the years 2010-2014 were included from the United States Nationwide Readmissions Database. Of 2 723 455 included patients, the 30-day unplanned readmission rate was 7.2% (n = 196 581, 42.3% female). This included 9.8% (n = 19 183) with angina and 11.1% (n = 21 714) with non-specific chest pain.

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… and history of mental health and substance abuse codes 670 | Miscellaneous mental health disorders 79 | Parkinson's disease 80 | Multiple sclerosis 81 | Other hereditary and degenerative nervous system conditions 82 | Paralysis 83 | Epilepsy, convulsions 84 | Headache including migraine 85 | Coma, stupor …

Preventive Healthcare and Management for Acute Lymphoblastic Leukaemia in Adults: Case Report and Literature Review.

Acute lymphoblastic leukaemia (ALL) is diagnosed by the presence of at least 20% lymphoblasts in the bone marrow. ALL may be aggressive and include the lymph nodes, liver, spleen, central nervous system (CNS), and other organs. Without early recognition and timely treatment, ALL will progress quickly and may have poor prognosis in clinical scenarios. ALL is a rare type of leukaemia in adults but is the most common type in children. Precipitating factors such as environmental radiation or chemical exposure, viral infection, and genetic factors can be associated with ALL. We report a rare case o

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… Severe central nervous system (CNS) and neurologic symptoms include lethargy, confusion, stupor, and coma [ 58 ]. Polyuria, polydipsia, nocturia, hypercalciuria, nephrolithiasis, nephrocalcinosis, and renal failure are complications of hypercalcaemia in the renal system. …

Identifying High-Cost, High-Risk Patients Using Administrative Databases in Tuscany, Italy.

Objective(1) Assessing the performance of the algorithm in terms of sensitivity and positive predictive value, considering General Practitioners' (GPs) judgement as benchmark, and (2) describing adverse events (hospitalisation, death, and health services' consumption) of complex patients compared to the general population.Data sources(i) Tuscany administrative database containing health data (2013-5); (ii) lists of complex patients indicated by GPs; and (iii) annual health registry of Tuscany.Study designThe present study is a validation study. It compares a list of complex patients extracted

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… of unspecified nature or uncertain behaviour Kidn | 156′ | Nephritis; nephrosis; renal sclerosis | 158′ | Chronic kidney disease Neur | 227′ | Spinal cord injury | 653′ | Delirium dementia and amnestic and other cognitive disorders 79′ | Parkinson's disease 80′ | Multiple sclerosis 85′ | Coma; stupor …

Neurologic adverse events of cancer immunotherapy.

Cancer immunotherapy encompasses a wide range of treatment modalities that harness the anti-tumor effects of the immune system and have revolutionized oncological treatment in recent years, with approval for its use in more and more cancers. However, it is not without side effects. Several neurological adverse events have been recognized associated with immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T-cell therapy, the two main classes of cancer immunotherapy. With the increase in the prevalence of oncological diseases and this type of therapy, it is improbable that neu

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… Stupor or coma Seizure | No | No | Any clinical seizure that resolves rapidly or non-convulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (>5 min) or repetitive clinical or electrical seizures without return to baseline in between Motor findings | No | No | No …

Cancer Therapy-Induced Encephalitis.

Encephalitis associated with cancer therapies is a rare but serious complication that can significantly impact patients' quality of life and it requires prompt identification and management. Over the past two decades, immunotherapy-particularly immune checkpoint inhibitors-has become a cornerstone of cancer treatment, with up to half of metastatic cancer patients in economically developed countries now receiving these therapies. The widespread adoption of immunotherapy has led to improved survival rates and long-term remissions, even in patients with advanced metastatic disease. However, as im

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… Stupor or coma Raised intracranial pressure | NA | NA | Focal/local edema on neuroimaging | Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing or cranial nerve VI palsy; or papilledema or Cushing’s triad Seizure | NA | NA | Any clinical seizure that resolves rapidly or non-convulsive …

Chimeric antigen receptor T cell therapy: a new emerging landscape in autoimmune rheumatic diseases.

Chimeric antigen receptor T cell (CAR-T) therapy, an innovative immune cell therapy, has revolutionized the treatment landscape of haematological malignancies. The past 2 years has witnessed the successful application of CD19-targeting CAR constructs in refractory cases of autoimmune rheumatic diseases, including systemic lupus erythematosus, systemic sclerosis and anti-synthetase syndrome. In comparison with existing B cell depletion therapies, targeting CD19 has demonstrated a more rapid and profound therapeutic effect, enabling drug-free remission with manageable adverse events. These promi

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… Stupor or coma Seizures | N/A | N/A | Any clinical seizure focal or generalized that resolves rapidly or non-convulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (>5 min); or repetitive clinical or electrical seizures without return to baseline in between Motor …

Plasmapheresis in the ICU.

Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient's plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. This paper provides a brief review of the principles, current applications, and potential future directions of TPE in critical care settings.

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… HVS can lead to a range of neurological symptoms, including headaches, stupor, dizziness, ataxia (loss of coordination), and seizures. These symptoms occur due to reduced blood flow to the brain resulting from increased blood viscosity. …

Neurology

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… CSF caused by compensatory or obstructive mechanisms leading to varying degrees of dilation of the ventricular system. 34 Enlargement of the cranium, small stature, an open fontanelle, calvarial distortion, divergent strabismus, abnormal behavior, ataxia, seizures, visual deficits, head pressing, and stupor … Diabetic ketoacidosis and diabetic hyperosmolar nonketotic syndrome may produce neurologic dysfunction leading to signs of lethargy, depression, anorexia, and stupor. 138 Coma may result from dehydration of brain cells secondary to chronic hypovolemia, osmotic diuresis, and shifts in fluid balance between …

Саркоидоз и повышенный риск сопутствующих заболеваний и смертности в Швеции.

ВВЕДЕНИЕ: Саркоидоз — это системное воспалительное заболевание с неясной этиологией, включающее образование гранулом. В большинстве случаев оно затрагивает легкие и лимфоузлы в грудной полости. Саркоидоз может протекать в острой или хронической форме, каждая из которых имеет различные клинические проявления и прогноз. МЕТОДЫ: Кейс-контрольное исследование коморбидности и морбидности у лиц, диагностированных с саркоидозом (код ICD10 D86) в Швеции с 2007 по 2016 год. Контроли были сопоставлены с случаями в соотношении 2:1 по возрасту, полу и району диагностики. Данные собрали из Шведского нацио

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… musculoskeletal systems | R29 | 6 | 6 Pain associated with micturition | R30 | 2 | 0 Unspecified haematuria | R31 | 6 | 4 Unspecified urinary incontinence | R32 | 0 | 1 Retention of urine | R33 | 1 | 7 Polyuria | R35 | 2 | 0 Other symptoms and signs involving the urinary system | R39 | 1 | 0 Somnolence, stupor …

Оценка эффективности и безопасности химической антигенной терапии T-Cell терапии у пациентов с множественными миеломными заболеваниями с релапсированными или рефракторными заболеваниями: систематический обзор и мета-анализ.

Множественная миелома (ММ), вторая по распространенности гематологическая гелингология, остается неизлечимой, и ее распространенность растет. Лечение химической антигенной реципиентной клетки (CAR-T клетки) стало новым методом лечения, способным улучшить выживание и качество жизни пациентов с повторной/реактивной множественной миеломой (rMM). В рамках этого систематического обзора и метаанализа, проводимого в соответствии с руководящими принципами ПРИСМА, мы стремимся дать краткий обзор последних изменений в области терапии ЦАР-Т, оценить их потенциальные последствия для клинической практики и

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… However, the most frequent manifestations involve fatigue associated with anemia, bone-related pain attributed to lytic lesions and pathological fractures, edema resulting from renal failure, as well as stupor and behavioral changes due to hypercalcemia [ 7 , 8 ]. …

Toxicity of CAR T-Cell Therapy for Multiple Myeloma.

BackgroundIdecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel) are novel chimeric antigen receptor (CAR)-T cell therapies targeting B-cell maturation antigen (BCMA), and both have recently gained approval by the US Food Drug Administration (FDA) for the treatment of relapsed and refractory multiple myeloma (RRMM).SummaryThese therapies offer unprecedented responses in RRMM but present new challenges including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), non-ICANS neurotoxicity, cytopenias, infections, and hypogammaglobul

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… Stupor or coma Seizure | N/A | N/A | Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention | Life-threatening prolonged seizure (>5 min); or repetitive clinical or electrical seizures without return to baseline in between Motor …

Evaluating the Therapeutic Potential of Idecabtagene Vicleucel in the Treatment of Multiple Myeloma: Evidence to Date.

Over the past two decades, significant progress has been made in the diagnosis, risk assessment and treatment of patients with multiple myeloma, translating into remarkable improvements in survival outcomes. Yet, cure remains elusive, and almost all patients eventually experience relapse, particularly those with high-risk and refractory disease. Immune-based approaches have emerged as highly effective therapeutic options that have heralded a new era in the treatment of multiple myeloma. Idecabtagene vicleucel (ide-cel) is one such therapy that employs the use of genetically modified autologous

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… or Venturi mask | Requiring positive pressure ventilatory support* ICANS | ICE score † | 7–9 | 3–6 | 0–2 | 0 Depressed consciousness not attributable to other cause | Awakens spontaneously | Awakens to voice | Awakens only to tactile stimulus | Arousable with vigorous tactile stimuli, unarousable, stupor …