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Fibrin Sealant for Prevention of Bile Leakage After Laparoscopic Common Bile Duct Incision: Outcome of a Randomized Controlled Trial.

J Laparoendosc Adv Surg Tech A 2021 Jun 14. Epub 2021 Jun 14.

Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.

There are several methods used to extract common bile duct (CBD) stones encountered during cholecystectomy. Intraoperative cholangiotomy, cholangioscopy, and laparoscopic CBD exploration (LCBDE) are techniques that allow removal of stones from the CBD during the index procedure. However, bile leakage following CBD exploration is a common problem. Read More

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Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study.

World J Gastrointest Surg 2021 May;13(5):476-492

Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan.

Background: The treatment of hepatocellular carcinoma (HCC) ≥ 10 cm remains a challenge.

Aim: To consolidate the role of surgical resection for HCC larger than 10 cm.

Methods: Eligible HCC patients were identified from the Chang Gung Research Database, the largest multi-institution database, which collected medical records of all patients from Chang Gung Memorial Foundation. Read More

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Adverse Pregnancy Outcomes in Endometriosis - Myths and Realities.

Curr Obstet Gynecol Rep 2020 Mar 30;9(1):27-35. Epub 2020 Jan 30.

Department of Epidemiology, Harvard T.H. Chan School of Public Health.

Purpose Of Review: There is increasing interest in the long-term health and comorbid conditions associated with endometriosis for both women and neonates. The purpose of this review was to synthesize and discuss the current state of the literature investigating endometriosis and risk of adverse pregnancy outcomes.

Recent Findings: Methodologic considerations for studying endometriosis and adverse pregnancy outcomes include complexities regarding the comparison population, endometriosis definition, sample size, residual confounding, and interactions. Read More

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Effects of physical exercise on natural killer cell activity during (neo)adjuvant chemotherapy: A randomized pilot study.

Physiol Rep 2021 Jun;9(11):e14919

Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.

Natural killer (NK) cells are a population of innate immune cells known to play a pivotal role against tumor spread. In multiple murine models, it was shown that physical exercise had the potential to increase NK cell antitumor activity through their mobilization and tissue redistribution in an interleukin (IL)-6 and epinephrine-dependent manner. The translation of this finding to patients is unclear. Read More

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Association of losartan with outcomes in metastatic pancreatic cancer patients treated with chemotherapy.

J Clin Transl Res 2021 Apr 24;7(2):257-262. Epub 2021 Mar 24.

University of Kansas Medical Center Division of Medical Oncology, Kansas, USA.

Background: Previous trials have shown improved efficacy of neoadjuvant treatment when combined with angiotensin II receptor antagonist, losartan in patients with locally advanced pancreatic ductal adenocarcinoma (PDA). However, role of losartan is unknown in metastatic PDA. In this retrospective observational study, we examined the relationship between losartan use at time of diagnosis and continued through chemotherapy treatment with clinical outcomes in patients with metastatic PDA that received chemotherapy. Read More

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Adjuvant treatment in lung cancer.

J Clin Transl Res 2021 Apr 16;7(2):175-184. Epub 2021 Apr 16.

Department of Radiation Oncology, Hospital Universitario Santiago de Compostela. Tr Choupana S/N, 15706 Santiago de Compostela, Spain.

Background: Adjuvant treatment for both small-cell and non-small-cell lung cancer is a controversial topic. There are no published results from prospective studies that either confirm or reject the benefit of adjuvant radiotherapy, although the presentation of recent studies at a number of conferences questions whether there should be a change in the paradigm of adjuvant RT for lung cancer.

Aim: The main goal of this study is to review the most relevant publications on the topic, updating the state of the matter regarding adjuvant radiotherapy following lung surgery, and analyzing the role of chemotherapy in the process. Read More

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Personalizing First-Line Systemic Therapy in Metastatic Colorectal Cancer: Is There a Role for Initial Low-Intensity Therapy in 2021 and Beyond? A Perspective From Members of the Australasian Gastrointestinal Trials Group.

Clin Colorectal Cancer 2021 May 11. Epub 2021 May 11.

Department of Medical Oncology, Royal Brisbane Hospital, Herston, Queensland, Australia.

Palliative chemotherapy is the cornerstone of treatment for the majority of patients with metastatic colorectal cancer, with the aim of increasing length and quality of life. Although guidelines outline the available treatment options in the first line, they provide limited guidance on choice and intensity of the chemotherapy backbone. Data from the TRIBE and TRIBE2 studies confirm a survival benefit with triplet FOLFOXIRI and bevacizumab, and this is a preferred option for younger patients with good performance status able to tolerate it. Read More

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Effect of intra-arrest trans-nasal evaporative cooling in out-of-hospital cardiac arrest: a pooled individual participant data analysis.

Crit Care 2021 06 8;25(1):198. Epub 2021 Jun 8.

Department of Medicine Center for Resuscitation Science, Karolinska Institute, Solna, Sweden.

Background: Randomized trials have shown that trans-nasal evaporative cooling initiated during CPR (i.e. intra-arrest) effectively lower core body temperature in out-of-hospital cardiac arrest patients. Read More

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Stroke Recurrence in First-Ever Symptomatic Carotid Web: A Cohort Study.

J Stroke 2021 May 31;23(2):253-262. Epub 2021 May 31.

Neurology Department, Martinique University Hospital, Martinique.

Background And Purpose: Carotid web (CaW) is an intimal variant of fibromuscular dysplasia responsible for ipsilateral cerebral ischemic events (CIE). Symptomatic CaW likely has a high risk of recurrent CIE, but no salient prospective data are available. We aimed to assess recurrence rate and its predictors after a first-ever CIE. Read More

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REMARRY and PURSUIT trials: liquid biopsy-guided rechallenge with anti-epidermal growth factor receptor (EGFR) therapy with panitumumab plus irinotecan for patients with plasma RAS wild-type metastatic colorectal cancer.

BMC Cancer 2021 Jun 7;21(1):674. Epub 2021 Jun 7.

Department of Colorectal Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, Japan.

Background: Previous clinical trials have demonstrated the potential efficacy of rechallenge with anti- epidermal growth factor receptor (EGFR) monoclonal antibodies (mAbs) for patients with RAS/BRAF V600E wild-type metastatic colorectal cancer (mCRC). Moreover, post hoc biomarker analyses of clinical trials has suggested that RAS status in circulating tumor DNA (ctDNA) has a high probability to select patients who could benefit from anti-EGFR mAb rechallenge.

Methods: This trial is composed of 2 phases: a monitoring phase (REMARRY) and a trial phase (PURSUIT). Read More

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Investigating the predictability of crashes on different freeway segments using the real-time crash risk models.

Accid Anal Prev 2021 Jun 2;159:106213. Epub 2021 Jun 2.

Jiangsu Key Laboratory of Urban ITS, Southeast University, Dong Nan Da Xue Road #2, Nanjing, 211189, China; Jiangsu Province Collaborative Innovation Center of Modern Urban Traffic Technologies, Dong Nan Da Xue Road #2, Nanjing, 211189, China; School of Transportation, Southeast University, Dong Nan Da Xue Road #2, Nanjing, 211189, China. Electronic address:

Improvement of the prediction efficiency of crash risks has attracted the attention of numerous studies. Nevertheless, one of the most important factors, crash precursors, were neglected. This study mainly focuses on identifying optimal crash precursors for different freeway section types, as well as providing a threshold selection method for real-time crash risk models. Read More

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Tracheostomy is Safe in Patients With Prolonged Intubation After Coronavirus Disease 2019 Infection.

J Surg Res 2021 Apr 27;266:361-365. Epub 2021 Apr 27.

Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address:

Background: Tracheostomy improves outcomes for critically ill patients requiring prolonged mechanical ventilation. Data are limited on the use and benefit of tracheostomies for intubated, critically ill coronavirus disease 2019 (COVID-19) patients. During the surge in COVID 19 infections in metropolitan New York/New Jersey, our hospital cared for many COVID-19 patients who required prolonged intubation. Read More

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Regorafenib Combined with Other Systemic Therapies: Exploring Promising Therapeutic Combinations in HCC.

J Hepatocell Carcinoma 2021 26;8:477-492. Epub 2021 May 26.

Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Regorafenib was the first drug to demonstrate a survival benefit as a second-line agent after sorafenib failure in patients with unresectable hepatocellular carcinoma (HCC). Recent studies have shown that its mechanism of action is not only limited to its very broad spectrum of inhibition of angiogenesis, tumor proliferation, spread, and metastasis, but also to its immunomodulatory properties that have favorable effects on the very intricate role that the tumor microenvironment plays in carcinogenesis and tumor growth. In this review, we discuss rationale and evidence supporting regorafenib efficacy in HCC and that led to its approval as a second-line treatment, after sorafenib failure. Read More

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Estimating the Real-World Performance of the PROMISE Minimal-Risk Tool: Nanna et al.: PROMISE Risk Score.

Am Heart J 2021 May 30. Epub 2021 May 30.

Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.

Background: Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the PROMISE Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease or downstream cardiovascular adverse outcomes.

Methods: We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Read More

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The 2021 Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Immune Checkpoint Inhibitor-based Combination Therapies for Treatment-naive Metastatic Clear-cell Renal Cell Carcinoma Are Standard of Care.

Eur Urol 2021 May 29. Epub 2021 May 29.

The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address:

The recent randomized controlled phase III CLEAR trial results are the last to complement immune checkpoint inhibitor (ICI)-based doublet combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma. The CLEAR trial demonstrated an improved progression-free survival (PFS), overall survival (OS), and an objective response rate (ORR) benefit for the combination of lenvatinib plus pembrolizumab over sunitinib. The CheckMate-9ER trial update demonstrated an ongoing PFS, OS, and quality-of-life benefit for cabozantinib plus nivolumab over sunitinib as did the update of Keynote-426 for axitinib plus pembrolizumab in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups. Read More

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Depression and Vegetarians: Association between Dietary Vitamin B6, B12 and Folate Intake and Global and Subcortical Brain Volumes.

Nutrients 2021 May 24;13(6). Epub 2021 May 24.

Department of Neuroscience, Functional Pharmacology, Uppsala University, BMC, Box 593, 751 24 Uppsala, Sweden.

Deficiency of vitamin B6 and vitamin B12, mostly in vegetarians, is found to be associated with depression and adverse neurological function. We investigated whether vitamin B6, B12, and folate have an effect on brain structure, especially among depressed people who follow a specific diet. The study sample comprised 9426 participants from the UK Biobank cohort with a mean age of 62. Read More

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Molecular Epidemiological Study of Hand, Foot, and Mouth Disease in a Kindergarten-Based Setting in Bangkok, Thailand.

Pathogens 2021 May 10;10(5). Epub 2021 May 10.

Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.

Hand, foot, and mouth disease (HFMD) is a contagious childhood illness and annually affects millions of children aged less than 5 years across the Asia-Pacific region. HFMD transmission mainly occurs through direct contact (person-to-person) and indirect contact with contaminated surfaces and objects. Therefore, public health measures to reduce the spread of HFMD in kindergartens and daycare centers are essential. Read More

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Green Exercise: Can Nature Video Benefit Isometric Exercise?

Int J Environ Res Public Health 2021 May 22;18(11). Epub 2021 May 22.

Key Lab of Physical Fitness Evaluation and Motor Function Monitoring of General Administration of Sports of China, Institute of Sports Science, College of Physical Education, Southwest University, Chongqing 400715, China.

Green exercise is the combination of physical activity and nature exposure, which has been associated with positive effects on psychophysiological health. This study aimed to investigate the effects of nature video viewing on isometric exercise and find a useful practice for green exercise in urban living. In the current study, 18 male subjects were recruited in a randomized crossover trial and underwent a sequence of wall squat exercises. Read More

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Clinical Characteristics of -Associated Retinopathy and Assignment of Pathogenicity to Novel Deep Intronic and Non-Canonical Splice Site Variants.

Int J Mol Sci 2021 May 20;22(10). Epub 2021 May 20.

Centre for Rare Diseases, University of Tübingen, 72070 Tübingen, Germany.

Mutations in are a rare cause of inherited retinal degeneration. In this study, we present a thorough phenotypic and genotypic characterization of three individuals harboring putatively pathogenic variants in the gene. All patients displayed a similar, slowly progressive retinopathy (cone dystrophy or cone-rod dystrophy) with normal funduscopy but disrupted outer retinal layers on optical coherence tomography and variable age of onset. Read More

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Outcomes of a Multicomponent Safe Surgery Intervention in Tanzania's Lake Zone: A Prospective, Longitudinal Study.

Int J Qual Health Care 2021 May 31. Epub 2021 May 31.

Assist International, Ripon, CA, USA.

Background: Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. We evaluated the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) in Tanzania, hypothesizing it would (1) increase adherence to safety practices, teamwork and communication, and documentation in patient files, and (2) reduce the incidence of maternal sepsis, postoperative sepsis, and surgical site infection.

Methods: We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania's Lake Zone, across a three-month pre-intervention period in 2018 and three-month post-intervention period in 2019. Read More

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Peroral Endoscopic Myotomy for Esophageal Achalasia in Portugal: Outcomes of the First Prospective Series.

GE Port J Gastroenterol 2021 Apr 9;28(3):162-169. Epub 2020 Dec 9.

Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal.

Background: Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. Read More

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Flecainide-induced AV dyssynchrony and atrial latency progression in a patient with a dual-chamber pacemaker.

J Cardiovasc Electrophysiol 2021 May 30. Epub 2021 May 30.

Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA.

Introduction: Flecainide is a class 1C antiarrhythmic primarily usedfor the management of supraventricular arrhythmias. Adverse effects in patientswith pacemakers are poorly described in the current literature. We report acase of worsening intracardiac conduction in a patient with baseline atriallatency. Read More

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Screening for Diabetes Mellitus and Hypertension in Ile-Ife - A World Diabetes Day Experience.

West Afr J Med 2021 May;38(5):434-438

Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.

Background And Objectives: Non-communicable diseases have emerged as major public health concerns in developing nations, where communicable diseases used to be the major contributor to the public health burden. Diabetes and hypertension contribute significantly to this menace, and they are largely undiagnosed in the affected population. We determined the prevalence of previously diagnosed and undiagnosed hypertension and diabetes mellitus in adult Nigerians. Read More

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[Place of coordination of complex pathways in oncology by coordinating privates nurses].

Bull Cancer 2021 May 25. Epub 2021 May 25.

Réseau régional en cancérologie ONCAUVERGNE, 58, rue Montalembert, 63011 Clermont-Ferrand, France.

Background: The complexity of the hospital-city care pathway is a real challenge because of the lack of coordination and communication between many stakeholders. As part of a call for projects from the General Directorate of Healthcare Provision, an experiment involving private oncology coordinating nurses was developed to address this issue. To our knowledge, there is no evaluation so far of such a protocol . Read More

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5-Year Survival Update From KEYNOTE-010: Pembrolizumab Versus Docetaxel for Previously Treated, Programmed Death Ligand 1-Positive Advanced Non-Small-Cell Lung Cancer.

J Thorac Oncol 2021 May 25. Epub 2021 May 25.

The Netherlands Cancer Institute, Amsterdam, Netherlands.

Introduction: In the KEYNOTE-010 study, pembrolizumab improved overall survival (OS) versus docetaxel in patients with previously treated, advanced non‒small-cell lung cancer (NSCLC) with PD-L1 tumor proportion score (TPS) ≥50% and ≥1%. We report 5-year efficacy/safety follow-up for the KEYNOTE-010 study.

Methods: Patients were randomized to pembrolizumab 2 mg/kg or 10 mg/kg Q3W, or docetaxel 75 mg/m Q3W for up to 35 cycles (2 years). Read More

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Adjuvant cyclin-dependent kinase 4/6 inhibition in hormone receptor-positive breast cancer: One Monarch to rule them all?

Cancer 2021 May 28. Epub 2021 May 28.

Department of Medicine, University of Rochester, Rochester, New York.

The use of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors has dramatically improved outcomes for patients with metastatic, hormone receptor (HR)-positive breast cancer. Because of the continued high rate of relapse in patients with node-positive, HR-positive disease, evaluating these agents in the adjuvant setting is the logical next step. Three adjuvant CDK inhibitor trials have been reported to date, with only 1 of them showing a statistical advantage for the CDK inhibitor in comparison with endocrine therapy alone. Read More

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Finite Element Evaluation of the Effect of Adhesive Creams on the Stress State of Dentures and Oral Mucosa.

Appl Bionics Biomech 2021 8;2021:5533770. Epub 2021 May 8.

Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Department of Biological and Macromolecular Materials, Halle, Germany.

The base fit between a removable partial denture (RPD) and the underlying soft tissue plays a significant role in its performance. The application of a denture adhesive is hypothesized to result in better retention of RPDs and, as a result, contribute to lower stress on the oral mucosa. The objectives of this study were to observe and compare the distribution of simulated bite forces applied to the RPD through the abutments and soft tissue for models with and without the use of a denture adhesive. Read More

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The association between four scoring systems and 30-day mortality among intensive care patients with sepsis: a cohort study.

Sci Rep 2021 May 27;11(1):11214. Epub 2021 May 27.

Department of Respiration, The Second Affiliated Hospital, Chongqing Medical University, 74 Linjiang Road, Yuzhong District, Chongqing, 400010, China.

Several commonly used scoring systems (SOFA, SAPS II, LODS, and SIRS) are currently lacking large sample data to confirm the predictive value of 30-day mortality from sepsis, and their clinical net benefits of predicting mortality are still inconclusive. The baseline data, LODS score, SAPS II score, SIRS score, SOFA score, and 30-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) intensive care unit (ICU) database. Receiver operating characteristic (ROC) curves and comparisons between the areas under the ROC curves (AUC) were conducted. Read More

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A Life Saving Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) with Open Groin Technique.

Open Access Emerg Med 2021 18;13:183-188. Epub 2021 May 18.

Department of Surgery, Faculty of Medicine, Khonkaen University, Khon Kaen, Thailand.

A 53-year-old male pedestrian was hit by a car and arrived at our hospital with a blunt abdominal injury and hemorrhagic shock. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was performed in a timely fashion using the open groin technique in the emergency room. The procedure resulted in rapid improvement of hemodynamic status while the bleeding source was controlled. Read More

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The Association Between Preschooler Physical Activity Duration and Intensity and Social Emotional Development: Findings From the PLAYCE Study.

J Phys Act Health 2021 May 26:1-7. Epub 2021 May 26.

Background: Social emotional development is imperative to young children's long-term psychological and physical health. Physical activity (PA) may be important for young children's social emotional development. The association between preschooler PA duration and intensity and social emotional development was investigated. Read More

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