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Identification of a novel presumed cardiac sarcoidosis category for patients at high risk of disease.

Int J Cardiol 2021 Apr 17. Epub 2021 Apr 17.

Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, United States.

Background: Histologic evidence is required for a definitive diagnosis of cardiac sarcoidosis (CS) by published guidelines; however, the sporadic nature of the disease may produce false negative biopsy results, causing CS to be underdiagnosed. We sought to establish a clinical category of CS absent histologic findings.

Methods: Patients evaluated for CS were stratified into 3 groups: probable CS and definite CS based on Heart Rhythm Society (HRS) criteria and presumed CS, ie, patients without any histologic evidence of sarcoidosis, but with unexplained high-grade atrioventricular block or ventricular arrhythmia and findings suggestive of CS on either cardiac magnetic resonance imaging or positron emission tomography. Read More

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Fertility outcomes after hysteroscopic removal of intrauterine leiomyomas and polyps.

Minerva Obstet Gynecol 2021 Apr 20. Epub 2021 Apr 20.

Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy.

Introduction: Thanks to the progress of science, it is now understood that a successful implantation not only depends on the quality of the embryo, but also on having a receptive endometrium. During the years, several authors have reviewed the important role of the uterine factor, ranging from the congenital anomalies, such as uterine septa and subsepta, and acquired conditions such as endometrial polyps and submucous myomas. Currently, hysteroscopy has proved to be a powerful and accurate tool for visualizing the uterine cavity and treating intrauterine pathologies. Read More

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Prevalence and prognostic associations of cardiac abnormalities among hospitalized patients with COVID-19: a systematic review and meta-analysis.

Sci Rep 2021 Apr 19;11(1):8449. Epub 2021 Apr 19.

Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, 1000, Manila, Philippines.

Although most patients recover from COVID-19, it has been linked to cardiac, pulmonary, and neurologic complications. Despite not having formal criteria for its diagnosis, COVID-19 associated cardiomyopathy has been observed in several studies through biomarkers and imaging. This study aims to estimate the proportion of COVID-19 patients with cardiac abnormalities and to determine the association between the cardiac abnormalities in COVID-19 patients and disease severity and mortality. Read More

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The deposition of atmospheric ammonia and its effects on plants.

New Phytol 1993 Oct;125(2):283-305

Department of Botany, University of Queensland, Brisbane, Qld 4072, Australia.

Across Europe, total nitrogen deposition is increasing and, of this total, atmospheric ammonia can contribute up to 50-80%. Average deposition of ammonia in the UK is likely to be around 15-20 kg ha yr , while in The Netherlands, which has some of the highest rates of deposition, this value is likely to be between 40 and 50 kg ha yr . It is argued that because of the processes of assimilation and nitrification this ammonia is an acidifying pollutant. Read More

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October 1993

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Front Pediatr 2021 31;9:650326. Epub 2021 Mar 31.

Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, United States.

Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Read More

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A case report on a protracted course of a hidden insulinoma.

Ann Med Surg (Lond) 2021 Apr 24;64:102240. Epub 2021 Mar 24.

Endocrine Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), 47000, Jalan Hospital, Sungai Buloh, Selangor, Malaysia.

Introduction: Insulinoma is a functioning pancreatic neuroendocrine tumor primarily leading due to hypoglycemia due to hypersecretion of insulin. This case illustrates the real challenges faced in the detection of an occult insulinoma, which resulted in a protracted course of the disease.

Case Presentation: A 33-year-old female presented with recurrent hypoglycemia. Read More

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Non-Alcoholic Fatty Liver Disease, Insulin Resistance, Metabolic Syndrome and their Association with Vascular Risk.

Metabolism 2021 Apr 14:154770. Epub 2021 Apr 14.

Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02115, USA.

The prevalence of non-alcoholic fatty liver disease (NAFLD), one of the most common liver diseases, is rising. About 25% of adults worldwide are probably affected by NAFLD. Insulin resistance (IR) and fat accumulation in the liver are strongly related. Read More

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A Clinical and Biologic Review of Keratoacanthoma.

Br J Dermatol 2021 Apr 16. Epub 2021 Apr 16.

Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.

Keratoacanthoma (KA) is a common skin tumor that remains controversial regarding classification, epidemiology, diagnosis, prognosis, and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in the elderly and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. Read More

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Hip fractures in cyclist - a six-year cohort study at a single large volume trauma centre.

Injury 2021 Apr 7. Epub 2021 Apr 7.

Consultant Orthopaedic Surgeon, Peterborough City Hospital, North West Anglia NHS Foundation Trust, UK; Hip Fracture Unit, Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough and Stamford Hospital NHS Foundation Trust, Bretton Gate, Peterborough PE3 9GZ, UK. Electronic address:

Cycling has gained in popularity as a recreational activity and method or travel, in part due to its recognised health benefits in maintenance of good cardiovascular strength and also for environmental issues. As a consequence of this, there is unfortunately an increased number of cycling related injuries. One particular injury incurred is a proximal femoral fracture, but there is little information in the literature with regarding this and its management. Read More

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Sustained intrinsic WNT and BMP4 activation impairs hESC differentiation to definitive endoderm and drives the cells towards extra-embryonic mesoderm.

Sci Rep 2021 Apr 15;11(1):8242. Epub 2021 Apr 15.

Research Group Reproduction and Genetics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Laarbeeklaan 103, Jette, 1090, Brussels, Belgium.

We identified a human embryonic stem cell subline that fails to respond to the differentiation cues needed to obtain endoderm derivatives, differentiating instead into extra-embryonic mesoderm. RNA-sequencing analysis showed that the subline has hyperactivation of the WNT and BMP4 signalling. Modulation of these pathways with small molecules confirmed them as the cause of the differentiation impairment. Read More

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Association of Endocrine Therapy and Dementia in Women with Breast Cancer.

Breast Cancer (Dove Med Press) 2021 7;13:219-224. Epub 2021 Apr 7.

Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Purpose: Prior studies have reported differing results regarding the association between endocrine therapy (ET) in the treatment of breast cancer and dementia risk. However, existing findings may be limited by common sources of bias and confounding. Here we investigate the association of ET utilized in the definitive setting to treat non-metastatic breast cancer with dementia risk accounting for multiple potential sources of bias and confounding. Read More

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Minimally invasive versus conventional sternotomy for Mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral).

BMJ Open 2021 Apr 14;11(4):e047676. Epub 2021 Apr 14.

Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.

Introduction: Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure. Read More

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Efficacy of the iDBT-Pain skills training intervention to reduce emotional dysregulation and pain intensity in people with chronic pain: protocol for a single-case experimental design with multiple baselines.

BMJ Open 2021 Apr 14;11(4):e041745. Epub 2021 Apr 14.

Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia

Introduction: Difficulties in emotional regulation are key to the development and maintenance of chronic pain. Recent evidence shows internet-delivered dialectic behaviour therapy (iDBT) skills training can reduce emotional dysregulation and pain intensity. However, further studies are needed to provide more definitive evidence regarding the efficacy of iDBT skills training in the chronic pain population. Read More

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Consensus on pre-operative total knee replacement education and prehabilitation recommendations: a UK-based modified Delphi study.

BMC Musculoskelet Disord 2021 Apr 14;22(1):352. Epub 2021 Apr 14.

School of Healthcare, University of Leeds, Leeds, UK.

Background: Over 90,000 total knee replacement (TKR) procedures are performed annually in the United Kingdom (UK). Patients awaiting TKR face long delays whilst enduring severe pain and functional limitations. Almost 20% of patients who undergo TKR are not satisfied post-operatively. Read More

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Physician-Staffed Ambulance and Increased In-Hospital Mortality of Hypotensive Trauma Patients Following Prolonged Prehospital Stay: A Nationwide Study.

J Trauma Acute Care Surg 2021 Apr 12. Epub 2021 Apr 12.

Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan Department of Emergency Medicine, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.

Background: The benefits of physician-staffed emergency medical services (EMS) for trauma patients remain unclear due to conflicting results on survival. Some studies suggested potential delays in definitive hemostasis due to prolonged prehospital stay when physicians are dispatched to the scene. We examined hypotensive trauma patients who were transported by ambulance, with the hypothesis that physician-staffed ambulances would be associated with increased inhospital mortality, compared with EMS-personnel-staffed ambulances. Read More

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Regular treatment with formoterol and an inhaled corticosteroid versus regular treatment with salmeterol and an inhaled corticosteroid for chronic asthma: serious adverse events.

Cochrane Database Syst Rev 2021 Apr 14;4:CD007694. Epub 2021 Apr 14.

Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK.

Background: Asthma is characterised by chronic inflammation of the airways and recurrent exacerbations with wheezing, chest tightness, and cough. Treatment with inhaled steroids and bronchodilators can result in good control of symptoms, prevention of further morbidity, and improved quality of life. However, an increase in serious adverse events with the use of both regular formoterol and regular salmeterol (long-acting beta₂-agonists) compared with placebo for chronic asthma has been demonstrated in previous Cochrane Reviews. Read More

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Psychosocial interventions for siblings of children with cancer: A mixed methods systematic review.

Psychooncology 2021 Apr 2. Epub 2021 Apr 2.

School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objective: This review systematically (1) describes the characteristics of psychosocial interventions for siblings of children with cancer (SCC); (2) assesses the effect of the psychosocial interventions on SCCs' outcomes, and (3) describes SCCs' experiences and perceptions of these interventions.

Methods: Seven databases were systematically searched for relevant literature. We included both quantitative and qualitative studies of psychological interventions designed to improve the adjustment of SCCs. Read More

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Phase III randomized trial evaluating chemotherapy followed by pelvic re-irradiation versus chemotherapy alone as pre-operative treatment for locally recurrent rectal cancer - GRECCAR 15 Trial Protocol.

Colorectal Dis 2021 Apr 12. Epub 2021 Apr 12.

Radiotherapy Department, Haut-Lévèque Hospital, avenue Magellan, 33604, Pessac CHU Bordeaux, France.

Aim: Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer. Radiotherapy is an important component of treatment in LRRC. However, there is little high quality evidence on the role of re-irradiation in this cohort. Read More

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Immunoglobulin (Ig) G4-related sclerosing cholangitis in patients resected for presumed perihilar cholangiocarcinoma: a 10-year experience.

Ann Transl Med 2021 Mar;9(5):415

Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China.

Background: This study aimed to investigate the incidence of immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC) in patients resected for perihilar cholangiocarcinoma (PHC) in a designated hospital from 2010 to 2019. We also aimed to evaluate the diagnostic dilemma of IgG4-SC clinically.

Methods: Between January 2010 and December 2019, all patients who underwent radical resection due to presumed PHC were included. Read More

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Defining mechanical instability in tuberculosis of the spine: a systematic review.

EFORT Open Rev 2021 Mar 1;6(3):202-210. Epub 2021 Mar 1.

Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Uttarakhand, India.

Over the years, a number of authors have used different working definitions of instability in tuberculosis of the spine (TB spine). However, no clear consensus exists to define instability in TB spine. The current systematic review addresses the question 'What defines instability in TB spine'?A comprehensive medical literature search was carried out to identify all the studies which defined instability in the setting of spinal TB. Read More

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Medicinal Plants in COVID-19: Potential and Limitations.

Front Pharmacol 2021 24;12:611408. Epub 2021 Mar 24.

Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia.

Currently, the search to identify treatments and vaccines for novel coronavirus disease (COVID-19) are ongoing. Desperation within the community, especially among the middle-and low-income groups acutely affected by the economic impact of forced lockdowns, has driven increased interest in exploring alternative choices of medicinal plant-based therapeutics. This is evident with the rise in unsubstantiated efficacy claims of these interventions circulating on social media. Read More

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Posttraumatic Stress Disorder Brain Transcriptomics: Convergent Genomic Signatures Across Biological Sex.

Biol Psychiatry 2021 Feb 22. Epub 2021 Feb 22.

Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Psychiatry Service, Veterans Administration Connecticut Healthcare System, West Haven, Connecticut; Veterans Administration National Center for PTSD, West Haven, Connecticut. Electronic address:

While a definitive understanding of the molecular pathology of posttraumatic stress disorder (PTSD) is far from a current reality, it has become increasingly clear that many of the molecular effects of PTSD are sex specific. Women are twice as likely as men to develop PTSD after a traumatic event, and neurobiological evidence suggests that there are structural differences between the brains of males versus females with PTSD. Recent advances in genomic technologies have begun to shed light on the sex-specific molecular determinants of PTSD, which seem to be governed predominantly by dysfunction of GABAergic (gamma-aminobutyric acidergic) signaling and immune function. Read More

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February 2021

Experimental evidence of memory-based foraging decisions in a large wild mammal.

Proc Natl Acad Sci U S A 2021 Apr;118(15)

Department of Organismic and Evolutionary Biology, Harvard University, Cambridge MA 02138.

Many animals restrict their movements to a characteristic home range. This constrained pattern of space use is thought to result from the foraging benefits of memorizing the locations and quality of heterogeneously distributed resources. However, due to the confounding effects of sensory perception, the role of memory in home-range movement behavior lacks definitive evidence in the wild. Read More

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Variation in opioid utilization among neonates with gastroschisis.

J Pediatr Surg 2021 Mar 26. Epub 2021 Mar 26.

Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.250, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.

Purpose: Repetitive painful stimuli and early exposure to opioids places neonates at risk for neurocognitive delays. We aimed to understand opioid utilization for neonates with gastroschisis.

Methods: We performed a retrospective review of infants with gastroschisis at a tertiary children's hospital (2017-2019). Read More

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Mortality in mechanically ventilated patients with COVID-19: a systematic review.

Expert Rev Med Devices 2021 Apr 9. Epub 2021 Apr 9.

Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Introduction: The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.

Areas Covered: This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and the follow-up periods in patients receiving mechanical ventilation ranged widely. Read More

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Death Due to Adrenal Crisis: Case Report and a Review of the Forensic Literature.

Am J Forensic Med Pathol 2021 Apr 7. Epub 2021 Apr 7.

From the Department of Pathology, State University of New York, Syracuse, NY.

Abstract: Adrenal crisis is a life-threatening manifestation of acute adrenal insufficiency. One of the most important underlying causes is Addison disease (primary adrenal insufficiency).A 42-year-old White woman with a medical history of Addison disease on chronic steroid therapy was admitted to the emergency department due to sustained episodes of cardiopulmonary arrest. Read More

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Primary Cleft Rhinoplasty: Long-Term Outcomes of a Single Technique Used Over 2 Decades.

Ann Plast Surg 2021 Mar 18. Epub 2021 Mar 18.

From the Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.

Background: Primary cleft rhinoplasty has become widely accepted owing to evidence of improved outcomes and need for fewer revisions. Several techniques have been described, but few surgeons have reported long-term outcomes of repairs performed via a single method. The present study examines long-term outcomes of a single surgeon's experience over 22 years using the same primary cleft rhinoplasty technique. Read More

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An International Evidence Based Reappraisal of Genes Associated with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) using the ClinGen Framework.

Circ Genom Precis Med 2021 Apr 8. Epub 2021 Apr 8.

Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam & Department of Genetics, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands.

- Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by ventricular arrhythmias and progressive ventricular dysfunction. Genetic testing is recommended and a pathogenic variant in an ARVC-associated gene is a major criterion for diagnosis according to the 2010 Task Force Criteria (TFC). As incorrect attribution of a gene to ARVC can contribute to misdiagnosis, we assembled an international multidisciplinary ARVC ClinGen Gene Curation Expert Panel to reappraise all reported ARVC genes. Read More

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Axonal sensorimotor polyneuropathy after starting guselkumab.

J Dermatolog Treat 2021 Apr 8:1-7. Epub 2021 Apr 8.

Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Guselkumab is an IL-23 inhibitor that binds to the p19 subunit of IL-23 that is highly efficacious and well tolerated for the treatment of moderate-to-severe plaque psoriasis. We report a 20-year-old male who developed sensorimotor axonal polyneuropathy starting treatment with guselkumab, confirmed by neurological examination and serial neurophysiologic studies. His symptoms improved within 5 months of stopping the treatment. Read More

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Epidemiology of Marginal Zone Lymphoma.

Ann Lymphoma 2021 Mar 30;5. Epub 2021 Mar 30.

Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

In 2016 there were an estimated 7,460 newly diagnosed patients with marginal zone lymphoma (MZL) in the US, which comprised 7% of all mature non-Hodgkin lymphomas (NHL). Based on data from the US SEER-18 program from 2001-2017, the age-standardized incidence rate for MZL was 19.6 per 1,000,000 person-years; 9% of MZL cases were splenic MZL (SMZL), 30% nodal MZL (NMZL), and 61% extranodal MZL (EMZL) of mucusa-associated lymphoid tissue (MALT). Read More

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