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    A 25-gene classifier predicts overall survival in resectable pancreatic cancer.
    BMC Med 2017 Sep 20;15(1):170. Epub 2017 Sep 20.
    Département d'Oncologie Moléculaire, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR725, Aix-Marseille Université, Marseille, France.
    Background: Pancreatic carcinoma is one of the most lethal human cancers. In patients with resectable tumors, surgery followed by adjuvant chemotherapy is the only curative treatment. However, the 5-year survival is 20%. Read More

    Macrophage activation-like syndrome: an immunological entity associated with rapid progression to death in sepsis.
    BMC Med 2017 Sep 18;15(1):172. Epub 2017 Sep 18.
    4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
    Background: A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin (IL)-1 blockade in patients with features of the macrophage activation-like syndrome (MALS). This study aimed to investigate the frequency of MALS and to develop a biomarker of diagnosis and prognosis.

    Methods: Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704). Read More

    Borrelia infection and risk of celiac disease.
    BMC Med 2017 Sep 15;15(1):169. Epub 2017 Sep 15.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Background: Environmental factors, including infectious agents, are speculated to play a role in the rising prevalence and the geographic distribution of celiac disease, an autoimmune disorder. In the USA and Sweden where the regional variation in the frequency of celiac disease has been studied, a similarity with the geographic distribution of Lyme disease, an emerging multisystemic infection caused by Borrelia burgdorferi spirochetes, has been found, thus raising the possibility of a link. We aimed to determine if infection with Borrelia contributes to an increased risk of celiac disease. Read More

    Modest heterologous protection after Plasmodium falciparum sporozoite immunization: a double-blind randomized controlled clinical trial.
    BMC Med 2017 Sep 13;15(1):168. Epub 2017 Sep 13.
    Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein 28, Microbiology 268, 6500 HB, Nijmegen, The Netherlands.
    Background: A highly efficacious vaccine is needed for malaria control and eradication. Immunization with Plasmodium falciparum NF54 parasites under chemoprophylaxis (chemoprophylaxis and sporozoite (CPS)-immunization) induces the most efficient long-lasting protection against a homologous parasite. However, parasite genetic diversity is a major hurdle for protection against heterologous strains. Read More

    Core competencies for scientific editors of biomedical journals: consensus statement.
    BMC Med 2017 Sep 11;15(1):167. Epub 2017 Sep 11.
    Chinese Medical Journal, Beijing, China.
    Background: Scientific editors are responsible for deciding which articles to publish in their journals. However, we have not found documentation of their required knowledge, skills, and characteristics, or the existence of any formal core competencies for this role.

    Methods: We describe the development of a minimum set of core competencies for scientific editors of biomedical journals. Read More

    Cost-effectiveness analysis of quadrivalent seasonal influenza vaccines in England.
    BMC Med 2017 Sep 8;15(1):166. Epub 2017 Sep 8.
    Respiratory Diseases Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
    Background: As part of the national seasonal influenza vaccination programme in England and Wales, children receive a quadrivalent vaccine offering protection against two influenza A strains and two influenza B strains. Healthy children receive a quadrivalent live attenuated influenza vaccine (QLAIV), whilst children with contraindications receive the quadrivalent inactivated influenza vaccine (QIIV). Individuals aged younger than 65 years in the clinical risk populations and elderly individuals aged 65+ years receive either a trivalent inactivated influenza vaccine (TIIV) offering protection from two A strains and one B strain or the QIIV at the choice of their general practitioner. Read More

    A 13-gene expression-based radioresistance score highlights the heterogeneity in the response to radiation therapy across HPV-negative HNSCC molecular subtypes.
    BMC Med 2017 Sep 1;15(1):165. Epub 2017 Sep 1.
    Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon, Lyon, F-69008, France.
    Background: Radiotherapy for head and neck squamous cell carcinomas (HNSCC) is associated with a substantial morbidity and inconsistent efficacy. Human papillomavirus (HPV)-positive status is recognized as a marker of increased radiosensitivity. Our goal was to identify molecular markers associated with benefit to radiotherapy in patients with HPV-negative disease. Read More

    Reduced growth velocity across the third trimester is associated with placental insufficiency in fetuses born at a normal birthweight: a prospective cohort study.
    BMC Med 2017 Aug 31;15(1):164. Epub 2017 Aug 31.
    Mercy Perinatal, Mercy Hospital for Women, Melbourne, Australia.
    Background: While being small-for-gestational-age due to placental insufficiency is a major risk factor for stillbirth, 50% of stillbirths occur in appropriate-for-gestational-age (AGA, > 10th centile) fetuses. AGA fetuses are plausibly also at risk of stillbirth if placental insufficiency is present. Such fetuses may be expected to demonstrate declining growth trajectory across pregnancy, although they do not fall below the 10th centile before birth. Read More

    A pragmatic lifestyle modification programme reduces the incidence of predictors of cardio-metabolic disease and dysglycaemia in a young healthy urban South Asian population: a randomised controlled trial.
    BMC Med 2017 Aug 30;15(1):146. Epub 2017 Aug 30.
    Cardiovascular Division, Faculty of Life Science & Medicine, King's College London, London, UK.
    Background: There is an increasing incidence of type 2 diabetes mellitus (T2DM) in young urban South-Asians. We tested the effect of a pragmatic trimonthly lifestyle modification (LSM) programme (P-LSM) versus a less-intensive 12-monthly control LSM (C-LSM) intervention on a primary composite endpoint of predictors of cardio-metabolic disease (new onset T2DM, hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG) and markers of cardio-renal disease) in participants aged 5-40 years with risk factors for T2DM.

    Methods: This was a randomised controlled trial performed at the National Diabetes Centre, Sri-Lanka. Read More

    Gestational diabetes mellitus-right person, right treatment, right time?
    BMC Med 2017 Aug 28;15(1):163. Epub 2017 Aug 28.
    School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
    Background: Personalised treatment that is uniquely tailored to an individual's phenotype has become a key goal of clinical and pharmaceutical development across many, particularly chronic, diseases. For type 2 diabetes, the importance of the underlying clinical heterogeneity of the condition is emphasised and a range of treatments are now available, with personalised approaches being developed. While a close connection between risk factors for type 2 diabetes and gestational diabetes has long been acknowledged, stratification of screening, treatment and obstetric intervention remains in its infancy. Read More

    Trade-off between benefits, harms and economic efficiency of low-dose CT lung cancer screening: a microsimulation analysis of nodule management strategies in a population-based setting.
    BMC Med 2017 Aug 25;15(1):162. Epub 2017 Aug 25.
    Center for Health Economics Research Hannover (CHERH), Leibniz University of Hannover, Otto-Brenner-Str.1, 30159, Hannover, Germany.
    Background: In lung cancer screening, a nodule management protocol describes nodule assessment and thresholds for nodule size and growth rate to identify patients who require immediate diagnostic evaluation or additional imaging exams. The Netherlands-Leuvens Screening Trial and the National Lung Screening Trial used different selection criteria and nodule management protocols. Several modelling studies have reported variations in screening outcomes and cost-effectiveness across selection criteria and screening intervals; however, the effect of variations in the nodule management protocol remains uncertain. Read More

    The contribution of risk factors to socioeconomic inequalities in multimorbidity across the lifecourse: a longitudinal analysis of the Twenty-07 cohort.
    BMC Med 2017 Aug 24;15(1):152. Epub 2017 Aug 24.
    Department of General Practice & Primary Care, University of Glasgow, 1 Horselethill Road, Glasgow, G12 8UX, Scotland.
    Background: Multimorbidity is a major challenge to health systems globally and disproportionately affects socioeconomically disadvantaged populations. We examined socioeconomic inequalities in developing multimorbidity across the lifecourse and investigated the contribution of five behaviour-related risk factors.

    Methods: The Twenty-07 study recruited participants aged approximately 15, 35, and 55 years in 1987 and followed them up over 20 years. Read More

    Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study.
    BMC Med 2017 Aug 23;15(1):161. Epub 2017 Aug 23.
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
    Background: Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). Read More

    Highlights in soft tissue sarcomas and gastrointestinal stromal tumours (GIST) trials reported at ASCO 2017 Annual Meeting.
    BMC Med 2017 Aug 22;15(1):160. Epub 2017 Aug 22.
    Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
    Herein, we summarise the results of the most relevant studies presented at the 2017 ASCO Annual Meeting in the field of soft tissue sarcomas (STSs) and gastrointestinal stromal tumours (GISTs). Innovations on the management of localised disease, highlights from the different experiences in the metastatic setting and large studies on rare histologies will be included. Special attention will be paid to results on immunotherapy, antiangiogenics use in histology with limited sensitivity to standard chemotherapy and new compounds. Read More

    The impact of repeated vaccination on influenza vaccine effectiveness: a systematic review and meta-analysis.
    BMC Med 2017 Aug 21;15(1):159. Epub 2017 Aug 21.
    Public Health Ontario, 480 University Avenue Suite 300, Toronto, Ontario, M5G 1V2, Canada.
    Background: Conflicting results regarding the impact of repeated vaccination on influenza vaccine effectiveness (VE) may cause confusion regarding the benefits of receiving the current season's vaccine.

    Methods: We systematically searched MEDLINE, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature from database inception to August 17, 2016, for observational studies published in English that reported VE against laboratory-confirmed influenza for four vaccination groups, namely current season only, prior season only, both seasons, and neither season. We pooled differences in VE (∆VE) between vaccination groups by influenza season and type/subtype using a random effects model. Read More

    What makes gouty inflammation so variable?
    BMC Med 2017 Aug 18;15(1):158. Epub 2017 Aug 18.
    VA San Diego Healthcare System, 111K, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
    Acute gout arthritis flares contribute dominantly to gout-specific impaired health-related quality of life, representing a progressively increasing public health problem. Flares can be complex and expensive to treat, partly due to the frequent comorbidities. Unmet needs in gout management are more pressing given the markedly increasing gout flare hospital admission rates. Read More

    Circulating tumor DNA for personalized lung cancer monitoring.
    BMC Med 2017 Aug 17;15(1):157. Epub 2017 Aug 17.
    Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 60 Murray St. Box 32, Floor 6, Rm L6-201, Toronto, ON, MST 3L9, Canada.
    Advances in deep sequencing technology have led to developments in personalized medicine. Here, we describe the implications of a recent investigation that sequenced ctDNA from the plasma of non-small cell lung cancer patients to develop personalized ctDNA tests. These 'liquid biopsies' have shown promise in monitoring tumor growth and response to treatment, providing a timely overview of mutations present in the tumor. Read More

    Ibrutinib continues to influence the therapeutic landscape of chronic lymphocytic leukemia: new data presented at ASCO 2017.
    BMC Med 2017 Aug 16;15(1):156. Epub 2017 Aug 16.
    Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Viale Pio X, 88100, Catanzaro, Italy.
    According to data presented at the 2017 American Society of Oncology (ASCO) Annual Meeting, with more than 4 years of follow-up, ibrutinib continues to provide clinical utility in chronic lymphocytic leukemia (CLL). However, treatment of CLL patients with high-risk cytogenetics features remains a challenge and the outcome of these hard-to-treat patients is dismal. At the 2017 ASCO Meeting, results of the GENUINE phase III trial showed that, by adding ublituximab, a glycoengineered, anti-CD20 type 1 monoclonal antibody, to ibrutinib, the overall response rate (ORR), complete response rate (CRR), and minimal residual disease (MRD) negativity may be improved in high-risk CLL patients. Read More

    Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement.
    BMC Med 2017 Aug 15;15(1):155. Epub 2017 Aug 15.
    Whitaker Research Ltd., Bangor, UK.
    Background: Unintended repeat conceptions can result in emotional, psychological and educational harm to young women, often with enduring implications for their life chances. This study aimed to identify which young women are at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what are the barriers to and facilitators for the uptake of these interventions.

    Methods: We conducted a mixed-methods systematic review which included meta-analysis, framework synthesis and application of realist principles, with stakeholder input and service user feedback to address this. Read More

    Gestational hypertensive disorders and retinal microvasculature: the Generation R Study.
    BMC Med 2017 Aug 14;15(1):153. Epub 2017 Aug 14.
    Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
    Background: Changes in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy.

    Methods: This study is part of an ongoing population-based prospective cohort study. Read More

    Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study.
    BMC Med 2017 Aug 11;15(1):154. Epub 2017 Aug 11.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden.
    Background: The risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings. We systematically examined the incidence and risk factors of psoriasis in patients with breast cancer.

    Methods: A Swedish nationwide cohort of 56,235 breast cancer patients (2001-2012) was compared to 280,854 matched reference individuals from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. Read More

    Characterizing measles transmission in India: a dynamic modeling study using verbal autopsy data.
    BMC Med 2017 Aug 10;15(1):151. Epub 2017 Aug 10.
    Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
    Background: Decreasing trends in measles mortality have been reported in recent years. However, such estimates of measles mortality have depended heavily on assumed regional measles case fatality risks (CFRs) and made little use of mortality data from low- and middle-income countries in general and India, the country with the highest measles burden globally, in particular.

    Methods: We constructed a dynamic model of measles transmission in India with parameters that were empirically inferred using spectral analysis from a time series of measles mortality extracted from the Million Death Study, an ongoing longitudinal study recording deaths across 2. Read More

    Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force.
    BMC Med 2017 Aug 9;15(1):150. Epub 2017 Aug 9.
    Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.
    Background: Recently, health screening recommendations have gone beyond screening for early-stage, asymptomatic disease to include "screening" for presently experienced health problems and symptoms using self-report questionnaires. We examined recommendations from three major national guideline organizations to determine the consistency of recommendations, identify sources of divergent recommendations, and determine if guideline organizations have identified any direct randomized controlled trial (RCT) evidence for the effectiveness of questionnaire-based screening.

    Methods: We reviewed recommendation statements listed by the Canadian Task Force on Preventive Health Care (CTFPHC), the United Kingdom National Screening Committee (UKNSC), and the United States Preventive Services Task Force (USPSTF) as of 5 September 2016. Read More

    Pregnancy, pregnancy loss, and the risk of cardiovascular disease in Chinese women: findings from the China Kadoorie Biobank.
    BMC Med 2017 Aug 8;15(1):148. Epub 2017 Aug 8.
    Clinical Trials Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
    Background: Pregnancy and pregnancy loss may be linked to cardiovascular disease (CVD). However, the evidence is still inconsistent, especially in East Asians, whose reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy, miscarriage, induced abortion, and stillbirth with CVD incidence among Chinese women. Read More

    Country of qualification is linked to doctors' General Medical Council performance assessment rate, but is it linked to their clinical competence?
    BMC Med 2017 Aug 7;15(1):149. Epub 2017 Aug 7.
    Hughes Hall, University of Cambridge, Cambridge, CB1 2EW, UK.
    Mehdizah and colleagues recently described the prevalence of General Medical Council regulatory performance assessments by doctors' country of primary medical qualification. This article has caused anger within the UK-international medical community because it identifies graduates of certain countries with significantly raised prevalence.The present article comments on evidence from published Royal College of General Practitioners' data that support these conclusions. Read More

    The clinical utility of the urine-based lateral flow lipoarabinomannan assay in HIV-infected adults in Myanmar: an observational study.
    BMC Med 2017 Aug 4;15(1):145. Epub 2017 Aug 4.
    University of Medicine 2, Yangon, Myanmar.
    Background: The use of the point-of-care lateral flow lipoarabinomannan (LF-LAM) test may expedite tuberculosis (TB) diagnosis in HIV-positive patients. However, the test's clinical utility is poorly defined outside sub-Saharan Africa.

    Methods: The study enrolled consecutive HIV-positive adults at a tertiary referral hospital in Yangon, Myanmar. Read More

    Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis.
    BMC Med 2017 Aug 3;15(1):147. Epub 2017 Aug 3.
    Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
    Background: The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis.

    Method: Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. Read More

    How accurate is the 'Surprise Question' at identifying patients at the end of life? A systematic review and meta-analysis.
    BMC Med 2017 Aug 2;15(1):139. Epub 2017 Aug 2.
    Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
    Background: Clinicians are inaccurate at predicting survival. The 'Surprise Question' (SQ) is a screening tool that aims to identify people nearing the end of life. Potentially, its routine use could help identify patients who might benefit from palliative care services. Read More

    The renin-angiotensin system: a possible new target for depression.
    BMC Med 2017 Aug 1;15(1):144. Epub 2017 Aug 1.
    Deakin University, IMPACT Strategic Research Centre, School of Medicine, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.
    Depression remains a debilitating condition with an uncertain aetiology. Recently, attention has been given to the renin-angiotensin system. In the central nervous system, angiotensin II may be important in multiple pathways related to neurodevelopment and regulation of the stress response. Read More

    The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative.
    BMC Med 2017 Jul 31;15(1):143. Epub 2017 Jul 31.
    Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
    Background: There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis. Read More

    What works for whom in the management of diabetes in people living with dementia: a realist review.
    BMC Med 2017 Jul 28;15(1):141. Epub 2017 Jul 28.
    Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
    Background: Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. Read More

    Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions.
    BMC Med 2017 Jul 27;15(1):140. Epub 2017 Jul 27.
    Primary Care Medicine, Population Health Sciences Division, University of Dundee, Dundee, DD2 4BF, UK.
    Background: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.

    Methods: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). Read More

    Detection of antibiotic resistance is essential for gonorrhoea point-of-care testing: a mathematical modelling study.
    BMC Med 2017 Jul 26;15(1):142. Epub 2017 Jul 26.
    Institute of Social and Preventive Medicine, University of Bern, Bern, 3012, Switzerland.
    Background: Antibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. Read More

    The public health value of vaccines beyond efficacy: methods, measures and outcomes.
    BMC Med 2017 Jul 26;15(1):138. Epub 2017 Jul 26.
    Agence de Médecine Preventive (AMP), Paris, France.
    Background: Assessments of vaccine efficacy and safety capture only the minimum information needed for regulatory approval, rather than the full public health value of vaccines. Vaccine efficacy provides a measure of proportionate disease reduction, is usually limited to etiologically confirmed disease, and focuses on the direct protection of the vaccinated individual. Herein, we propose a broader scope of methods, measures and outcomes to evaluate the effectiveness and public health impact to be considered for evidence-informed policymaking in both pre- and post-licensure stages. Read More

    Impact of ischemic preconditioning on surgical treatment of brain tumors: a single-center, randomized, double-blind, controlled trial.
    BMC Med 2017 Jul 25;15(1):137. Epub 2017 Jul 25.
    Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
    Background: Postoperative ischemia is a frequent phenomenon in patients with brain tumors and is associated with postoperative neurological deficits and impaired overall survival. Particularly in the field of cardiac and vascular surgery, the application of a brief ischemic stimulus not only in the target organ but also in remote tissues can prevent subsequent ischemic damage. We hypothesized that remote ischemic preconditioning (rIPC) in patients with brain tumors undergoing elective surgical resection reduces the incidence of postoperative ischemic tissue damage and its consequences. Read More

    Ethics review in compassionate use.
    BMC Med 2017 Jul 24;15(1):136. Epub 2017 Jul 24.
    Department of Clinical Immunology, Medical University of Warsaw, Nowogrodzka Str. 59, 02-006, Warsaw, Poland.
    Background: Compassionate use is the use of unapproved drugs outside of clinical trials. So far, compassionate use regulations have been introduced in the US, Canada, many European countries, Australia and Brazil, and treatment on a compassionate use basis may be performed in Japan and China. However, there are important differences between relevant regulations in individual countries, particularly that approval by a research ethics committee (institutional review board) is a requirement for compassionate use in some countries (e. Read More

    Surrogate endpoints in oncology: when are they acceptable for regulatory and clinical decisions, and are they currently overused?
    BMC Med 2017 Jul 21;15(1):134. Epub 2017 Jul 21.
    Division of Hematology Oncology, Knight Cancer Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
    Background: Surrogate outcomes are not intrinsically beneficial to patients, but are designed to be easier and faster to measure than clinically meaningful outcomes. The use of surrogates as an endpoint in clinical trials and basis for regulatory approval is common, and frequently exceeds the guidance given by regulatory bodies.

    Discussion: In this article, we demonstrate that the use of surrogates in oncology is widespread and increasing. Read More

    Biological embedding of childhood adversity: from physiological mechanisms to clinical implications.
    BMC Med 2017 Jul 20;15(1):135. Epub 2017 Jul 20.
    Boston Children's Hospital, Boston, Massachusetts, USA.
    Background: Adverse psychosocial exposures in early life, namely experiences such as child maltreatment, caregiver stress or depression, and domestic or community violence, have been associated in epidemiological studies with increased lifetime risk of adverse outcomes, including diabetes, heart disease, cancers, and psychiatric illnesses. Additional work has shed light on the potential molecular mechanisms by which early adversity becomes "biologically embedded" in altered physiology across body systems. This review surveys evidence on such mechanisms and calls on researchers, clinicians, policymakers, and other practitioners to act upon evidence. Read More

    Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes.
    BMC Med 2017 Jul 19;15(1):131. Epub 2017 Jul 19.
    Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany.
    Background: Environmental and lifestyle changes, in addition to the ageing of populations, are generally believed to account for the rapid global increase in type 2 diabetes prevalence and incidence in recent decades.

    Discussion: In this review, we present a comprehensive overview of factors contributing to diabetes risk, including aspects of diet quality and quantity, little physical activity, increased monitor viewing time or sitting in general, exposure to noise or fine dust, short or disturbed sleep, smoking, stress and depression, and a low socioeconomic status. In general, these factors promote an increase in body mass index. Read More

    The role of tumour heterogeneity and clonal cooperativity in metastasis, immune evasion and clinical outcome.
    BMC Med 2017 Jul 18;15(1):133. Epub 2017 Jul 18.
    Translational Cancer Therapeutics Laboratory, The Francis Crick Institute, 1 Midland Rd, London, NW1 1AT, UK.
    Background: The advent of rapid and inexpensive sequencing technology allows scientists to decipher heterogeneity within primary tumours, between primary and metastatic sites, and between metastases. Charting the evolutionary history of individual tumours has revealed drivers of tumour heterogeneity and highlighted its impact on therapeutic outcomes.

    Discussion: Scientists are using improved sequencing technologies to characterise and address the challenge of tumour heterogeneity, which is a major cause of resistance to therapy and relapse. Read More

    Resisting and tolerating P. falciparum in pregnancy under different malaria transmission intensities.
    BMC Med 2017 Jul 17;15(1):130. Epub 2017 Jul 17.
    ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
    Background: Resistance and tolerance to Plasmodium falciparum can determine the progression of malaria disease. However, quantitative evidence of tolerance is still limited. We investigated variations in the adverse impact of P. Read More

    The prognostic value of lymph node yield in the earliest stage of colorectal cancer: a multicenter cohort study.
    BMC Med 2017 Jul 14;15(1):129. Epub 2017 Jul 14.
    Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
    Background: In patients with stage II colorectal cancer (CRC) the number of surgically retrieved lymph nodes (LNs) is associated with prognosis, resulting in a minimum of 10-12 retrieved LNs being recommended for this stage. Current guidelines do not provide a recommendation regarding LN yield in T1 CRC. Studies evaluating LN yield in T1 CRC suggest that such high LN yields are not feasible in this early stage, and a lower LN yield might be appropriate. Read More

    Tall height and obesity are associated with an increased risk of aggressive prostate cancer: results from the EPIC cohort study.
    BMC Med 2017 Jul 13;15(1):115. Epub 2017 Jul 13.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, United Kingdom.
    Background: The relationship between body size and prostate cancer risk, and in particular risk by tumour characteristics, is not clear because most studies have not differentiated between high-grade or advanced stage tumours, but rather have assessed risk with a combined category of aggressive disease. We investigated the association of height and adiposity with incidence of and death from prostate cancer in 141,896 men in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

    Methods: Multivariable-adjusted Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Read More

    Healthcare system responses to intimate partner violence in low and middle-income countries: evidence is growing and the challenges become clearer.
    BMC Med 2017 Jul 12;15(1):127. Epub 2017 Jul 12.
    Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK.
    The damage to health caused by intimate partner violence demands effective responses from healthcare providers and healthcare systems worldwide. To date, most evidence for the few existing, effective interventions in use comes from high-income countries. Gupta et al. Read More

    A nurse-delivered, clinic-based intervention to address intimate partner violence among low-income women in Mexico City: findings from a cluster randomized controlled trial.
    BMC Med 2017 Jul 12;15(1):128. Epub 2017 Jul 12.
    Population Council, Av. Insurgentes Sur No. 2453 Torre Murano, Piso 9, Local 903, Col. Tizapán, Delegación Álvaro Obregón, Mexico City, 01090, Mexico.
    Background: Rigorous evaluations of health sector interventions addressing intimate partner violence (IPV) in low- and middle-income countries are lacking. We aimed to assess whether an enhanced nurse-delivered intervention would reduce IPV and improve levels of safety planning behaviors, use of community resources, reproductive coercion, and mental quality of life.

    Methods: We randomized 42 public health clinics in Mexico City to treatment or control arms. Read More

    Can China achieve a one-third reduction in premature mortality from non-communicable diseases by 2030?
    BMC Med 2017 Jul 11;15(1):132. Epub 2017 Jul 11.
    National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China.
    Background: The United Nation's Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios.

    Methods: We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Read More

    Rapidly increasing end-of-life care needs: a timely warning.
    BMC Med 2017 Jul 10;15(1):126. Epub 2017 Jul 10.
    Faculty of Medicine,University of Queensland, Herston Road, Herston, 4006, Australia.
    Current trends in population ageing show that, in the near future, while more people will live longer, more will also die at any one time. Health systems, as well as individual practitioners, are only just becoming aware of the extent of this problem. Health systems will have to rapidly change practice to manage the number of people dying in the coming years, many with complex multimorbid conditions. Read More

    Use of malaria rapid diagnostic tests by community health workers in Afghanistan: cluster randomised trial.
    BMC Med 2017 Jul 7;15(1):124. Epub 2017 Jul 7.
    London School of Hygiene & Tropical Medicine, London, WC1H 7HT, UK.
    Background: The World Health Organisation (WHO) recommends parasitological diagnosis of malaria before treatment, but use of malaria rapid diagnostic tests (mRDTs) by community health workers (CHWs) has not been fully tested within health services in south and central Asia. mRDTs could allow CHWs to diagnose malaria accurately, improving treatment of febrile illness.

    Methods: A cluster randomised trial in community health services was undertaken in Afghanistan. Read More

    Pre-diagnostic metabolite concentrations and prostate cancer risk in 1077 cases and 1077 matched controls in the European Prospective Investigation into Cancer and Nutrition.
    BMC Med 2017 Jul 5;15(1):122. Epub 2017 Jul 5.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
    Background: Little is known about how pre-diagnostic metabolites in blood relate to risk of prostate cancer. We aimed to investigate the prospective association between plasma metabolite concentrations and risk of prostate cancer overall, and by time to diagnosis and tumour characteristics, and risk of death from prostate cancer.

    Methods: In a case-control study nested in the European Prospective Investigation into Cancer and Nutrition, pre-diagnostic plasma concentrations of 122 metabolites (including acylcarnitines, amino acids, biogenic amines, glycerophospholipids, hexose and sphingolipids) were measured using targeted mass spectrometry (AbsoluteIDQ p180 Kit) and compared between 1077 prostate cancer cases and 1077 matched controls. Read More

    Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options.
    BMC Med 2017 Jul 3;15(1):123. Epub 2017 Jul 3.
    Université Paris Diderot, UFR médicale, Paris, France.
    Gout, the most prevalent inflammatory arthritis worldwide, is associated with cardiovascular and renal diseases, and is an independent predictor of premature death. The frequencies of obesity, chronic kidney disease (CKD), hypertension, type 2 diabetes, dyslipidaemias, cardiac diseases (including coronary heart disease, heart failure and atrial fibrillation), stroke and peripheral arterial disease have been repeatedly shown to be increased in gout. Therefore, the screening and care of these comorbidities as well as of cardiovascular risk factors are of outmost importance in patients with gout. Read More

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