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The aim of this study is to evaluate the prevalence, determinants and prognostic value of pain at diagnosis in patients with desmoid-type fibromatosis (DF). We selected patients from the ALTITUDES cohort (NCT02867033), managed by surgery, active surveillance or systemic treatments, with pain assessment at diagnosis. Patients were invited to fill QLQ-C30 questionnaire and Hospital Anxiety Depression Scale. Determinants were identified using logistic models. Prognostic value on event-free survival (EFS) was evaluated using the Cox model. Overall, 382 patients were included in the current study (median age: 40.2 years; 117 men). The prevalence of pain was 36%, without significant difference according to first-line treatment (P = .18). In the multivariate analysis, pain was significantly associated with tumor size >50 mm (P = .013) and tumor site (P < .001); pain was more frequent in the neck and shoulder locations (odds ratio: 3.05 [1.27-7.29]). Pain at baseline was significantly associated with poor quality of life (P < .001), depression (P = .02), lower performance status (P = .03) and functional impairment (P = .001); we also observed a nonsignificant association with anxiety (P = .10). In the univariate analysis, baseline pain was associated with poor EFS; the 3-year EFS was 54% in patients with pain compared to 72% in those without pain. After adjustment for sex, age, size and line of treatment, pain was still associated with poor EFS (hazard ratio: 1.82 [1.23-2.68], P = .003). One third of recently diagnosed patients with DF experienced pain, especially those with larger tumors and neck/shoulder locations. Pain was associated with unfavorable EFS after adjustment for the confounders.  相似文献   
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Journal of Neurology - The epileptogenicity of recombinant tissue-plasminogen activator (rt-PA) has been suggested, but seizures were not evaluated in randomised controlled trials. To evaluate...  相似文献   
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According to global neuronal workspace (GNW) theory, conscious access relies on long-distance cerebral connectivity to allow a global neuronal ignition coding for conscious content. In patients with schizophrenia and bipolar disorder, both alterations in cerebral connectivity and an increased threshold for conscious perception have been reported. The implications of abnormal structural connectivity for disrupted conscious access and the relationship between these two deficits and psychopathology remain unclear. The aim of this study was to determine the extent to which structural connectivity is correlated with consciousness threshold, particularly in psychosis. We used a visual masking paradigm to measure consciousness threshold, and diffusion MRI tractography to assess structural connectivity in 97 humans of either sex with varying degrees of psychosis: healthy control subjects (n = 46), schizophrenia patients (n = 25), and bipolar disorder patients with (n = 17) and without (n = 9) a history of psychosis. Patients with psychosis (schizophrenia and bipolar disorder with psychotic features) had an elevated masking threshold compared with control subjects and bipolar disorder patients without psychotic features. Masking threshold correlated negatively with the mean general fractional anisotropy of white matter tracts exclusively within the GNW network (inferior frontal-occipital fasciculus, cingulum, and corpus callosum). Mediation analysis demonstrated that alterations in long-distance connectivity were associated with an increased masking threshold, which in turn was linked to psychotic symptoms. Our findings support the hypothesis that long-distance structural connectivity within the GNW plays a crucial role in conscious access, and that conscious access may mediate the association between impaired structural connectivity and psychosis.  相似文献   
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BackgroundInclusion Health aims to address and prevent the health harms of extreme inequity faced by excluded groups, including those affected by homelessness, drug addiction, imprisonment, and sex work. Engagement workshops with these groups have shown discordance between published research and what research they think is important. We aimed to involve these excluded groups and the wider service, policy, charity, and academic community who work with them to co-develop research and advocacy priorities.MethodsUsing a co-production approach, we held a 1-day event in London, UK, that involved inclusive, participatory, and consensus-building activities. We facilitated workshops on preventing exclusion, improving services for excluded groups, and escaping exclusion. We recorded participants’ views as observations, field notes, and ranked-lists of problems and suggested solutions. Professional artists captured frustrations and hopes for the future by drawing a visual representation. We conducted rapid thematic analysis of discussions on the day and triangulated these sources of information to develop research and advocacy priorities.FindingsApproximately 100 people attended, with at least 20 people with experience of exclusion. The other participants represented the National Health Service, various charity organisations, national, regional, and local government representatives, and several academic institutions. Emerging priorities included the following: tackling the upstream causes of exclusion (political determinants, poverty, and traumatic childhoods); addressing public and professional ignorance, indifference, and stigma by creating inclusion-focused public messages; making services more accessible and integrated through infrastructure (eg, national registries of services); putting excluded groups at the heart of health research, service development, and decision making, through the development of training for recruitment and co-design; and creating better routes out of exclusion.InterpretationDespite challenges in finding a common language, co-production effectively developed an Inclusion Health agenda aligned with the perceived needs of excluded groups and those who work with them. Funding agencies and the public health community should deliver this research agenda to improve the health and lives of people affected by exclusion.FundingUniversity College London Grand Challenges.  相似文献   
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