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Community-Onset Venous Thromboembolism in Children: Pediatric Emergency Medicine Perspectives.

Semin Thromb Hemost 2021 May 10. Epub 2021 May 10.

Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. Read More

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Sepsis and Mortality Prediction in Very Low Birth Weight Infants: Analysis of HeRO and nSOFA.

Am J Perinatol 2021 May 10. Epub 2021 May 10.

Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.

Objective:  Scores to predict sepsis or define sepsis severity could improve care for very low birth weight (VLBW) infants. The heart rate characteristics (HRC) index (HeRO score) was developed as an early warning system for late-onset sepsis (LOS), and also rises before necrotizing enterocolitis (NEC). The neonatal sequential organ failure assessment (nSOFA) was developed to predict sepsis-associated mortality using respiratory, hemodynamic, and hematologic data. Read More

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Healthcare utilization and cost outcomes for a multicenter first seizure and new onset epilepsy clinic.

Epilepsy Behav 2021 May 7;120:107972. Epub 2021 May 7.

Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Northwest, 200 Mullins Dr, Lebanon, OR 97355, United States; Providence Brain and Spine Institute, 9135 SW Barnes Rd., Suite 363, Portland, OR 97225, United States.

Rationale: A First Seizure/New Onset Epilepsy (FS/NOE) protocol was implemented to ensure proper evaluation by an epileptologist and improve overall care for patients. We compared healthcare utilization and cost incurred by patients pre and post protocol implementation.

Methods: Clinical data were retrospectively collected from the EMR and cost data from the financial database. Read More

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PGI inhibits intestinal epithelial permeability and apoptosis to alleviate colitis.

Cell Mol Gastroenterol Hepatol 2021 May 7. Epub 2021 May 7.

Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, Nantes, F-44093, France. Electronic address:

Background And Aims: Inflammatory bowel diseases (IBD) that encompass both ulcerative colitis and Crohn's disease are a major public health problem with an etiology that has not been fully elucidated. There is a need to improve disease outcomes and preventive measures by developing new effective and lasting treatments. While polyunsaturated fatty acid metabolites play an important role in the pathogenesis of several disorders, their contribution to IBD is yet to be understood. Read More

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Longer Operative Time Associated with Prolonged Length of Stay, Non-Home Discharge and Transfusion Requirement after Anterior Cervical Discectomy and Fusion: an Analysis of 24,593 Cases.

Spine J 2021 May 7. Epub 2021 May 7.

Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA; Center for Spine Health, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, USA.

Background: Prolonged operative time of single-level ACDF has been associated with adverse postoperative outcomes. The current literature does not contain a comprehensive quantitative description of these associations PURPOSE: This study characterized the associations between single-level anterior cervical discectomy and fusion(ACDF) operative time and 1)30-day postoperative healthcare utilization, and 2)the incidence of local wound complications, need for transfusion and mechanical ventilation.

Design/setting: Retrospective database analysis PATIENT SAMPLE: The American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database was queried for single-level ACDF cases(2012-2018) using current procedural terminology codes. Read More

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How Does Multiple Listing Affect Lung Transplantation? A Retrospective Analysis.

Semin Thorac Cardiovasc Surg 2021 May 7. Epub 2021 May 7.

Department of Surgery, Division of Cardio-thoracic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Medicine, Pulmonology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address:

The impact of multiple listing (ML) strategies on lung transplantation is unknown. Retrospective review of United Network for Organ Sharing (UNOS) registry for lung transplantation between May 1, 2005 and March 31, 2017 was performed. Characteristics of single (SL) and ML candidates were compared, and incidence density matching was used to select up to 10 controls for each case. Read More

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Re-operative aortic arch surgery in a contemporary series.

Semin Thorac Cardiovasc Surg 2021 May 7. Epub 2021 May 7.

Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address:

Re-operative aortic arch operations (REDO) following previous cardiac surgery are challenging procedures associated with significant morbidity and mortality. We investigated post-operative outcomes for patients undergoing REDO and identified risk-factors for mortality in a contemporary series. From 1/2005-6/2018, 365 consecutive patients at an academic center underwent REDO: 257 HEMIARCH and 108 COMPLETE arch (45 stage I elephant trunk, 63 total arch) replacements. Read More

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Benzodiazepine Use in Opioid Maintenance Treatment Programme: Risks and Clinical Outcomes.

Acta Med Port 2021 Mar 1;34(3):209-216. Epub 2021 Mar 1.

Drug Addiction Treatment Centre. Agualva-Cacém. Cacém. Portugal.

Introduction: The co-association of benzodiazepines and opioids is associated with an increased risk of overdose, death, and poorer psychosocial prognosis. The aim of this study is to characterize the prevalence, pattern of use, and primary clinical outcomes in benzodiazepines users in a public opioid maintenance treatment unit.

Material And Methods: We conducted a cross-sectional study involving 236 patients treated with opioid substitutes (methadone and buprenorphine). Read More

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The Effects of Chronic Exposure to Ambient Traffic-Related Air Pollution on Alzheimer's Disease Phenotypes in Wildtype and Genetically Predisposed Male and Female Rats.

Environ Health Perspect 2021 May 10;129(5):57005. Epub 2021 May 10.

Department of Molecular Biosciences, University of California Davis (UC Davis) School of Veterinary Medicine, Davis, California, USA.

Background: Epidemiological data link traffic-related air pollution (TRAP) to increased risk of Alzheimer's disease (AD). Preclinical data corroborating this association are largely from studies of male animals exposed acutely or subchronically to high levels of isolated fractions of TRAP. What remains unclear is whether chronic exposure to ambient TRAP modifies AD risk and the influence of sex on this interaction. Read More

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Excessive daytime sleepiness, morning tiredness and major adverse cardiovascular events in patients with chronic coronary syndrome.

J Intern Med 2021 May 10. Epub 2021 May 10.

From the, Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden.

Background: Sleep-related breathing disorders (SRBDs), particularly obstructive sleep apnoea, are associated with increased cardiovascular (CV) risk. However, it is not known whether individual questions used for SRBD screening are associated with major adverse CV events (MACE) and death specifically in patients with chronic coronary syndrome (CCS).

Methods: Symptoms associated with SRBD were assessed by a baseline questionnaire in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. Read More

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Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach.

PLoS One 2021 10;16(5):e0250060. Epub 2021 May 10.

Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, estado de São Paulo, Brazil.

Objective: To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU).

Methods: The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. Read More

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Associations of treated and untreated human papillomavirus infection with preterm delivery and neonatal mortality: A Swedish population-based study.

PLoS Med 2021 May 10;18(5):e1003641. Epub 2021 May 10.

Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Treatment of cervical intraepithelial neoplasia (CIN) is associated with an increased risk of preterm delivery (PTD) although the exact pathomechanism is not yet understood. Women with untreated CIN also seem to have an increased risk of PTD. It is unclear whether this is attributable to human papillomavirus (HPV) infection or other factors. Read More

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Microsatellite Instability as a Predictor of Outcomes in Colorectal Cancer in the Era of Immune-Checkpoint Inhibitors.

Curr Drug Targets 2021 Mar 24. Epub 2021 Mar 24.

Head and Neck Surgery, National Institute of Oncology, Budapest, Hungary.

The microsatellite instable phenotype resulting from errors in DNA mismatch repair proteins accounts for as far as 15 to 20% of non-hereditary colon cancers but is scarce in rectal cancer. It has been shown that the increased existence of tumor-specific neoantigens in hypermutated tumors is correlated with higher tumor-infiltrating lymphocytes (TILs) and overexpression of immune checkpoint receptors and ligands, mainly PD-1 and PD-L1. In particular, the data gained up to now gives evidence that neoantigen recognition constitutes a dominant component in the course of immunotherapies. Read More

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Activation of COL11A1 by PRRX1 promotes tumor progression and radioresistance in ovarian cancer.

Int J Radiat Biol 2021 May 10:1-29. Epub 2021 May 10.

Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Nanjing Medical University, No. 262, Zhongshanbei Road, Gulou District, Nanjing 210003, Jiangsu, China.

Purpose: Although radiotherapy is a common treatment option for all kinds of cancer patients, including ovarian cancer, a major obstacle limiting its application is the development of resistance. Therefore, it is urgently needed to clarify the mechanism of radio sensitivity modulation.

Materials And Methods: We obtained open datasets and analyzed the expression of collagen type XI alpha 1 (COL11A1) in ovarian cancer patients with different stages. Read More

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Non-inferiority of fragmented care for high-risk pediatric neuroblastoma patients: a single institution analysis.

Pediatr Hematol Oncol 2021 May 10:1-26. Epub 2021 May 10.

Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina, USA.

Pediatric neuroblastoma (NB) patients receive multi-modal therapy and may experience care fragmented among multiple institutions with a significant travel burden, which has been associated with poor outcomes for some adult cancers. We hypothesized that fragmented care for pediatric NB patients is associated with inferior outcomes compared to treatment consolidated at one location. We reviewed paper and electronic records for pediatric NB patients who received ≥1 hematopoietic stem cell transplant (HSCT) at Duke from 1990-2017. Read More

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Accessing Targeted Therapies: A Potential Roadblock to Implementing Precision Oncology?

JCO Oncol Pract 2021 May 10:OP2000927. Epub 2021 May 10.

Division on Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.

Purpose: Advances in genomic techniques have led to increased use of next-generation sequencing (NGS). We evaluated the extent to which these tests guide treatment decisions.

Methods: We developed and distributed a survey assessing NGS use and outcomes to a survey pool of ASCO members. Read More

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Shifting demographics and comorbidity burden in adult Chinese urban patients with chronic hepatitis B, 2013 and 2016.

J Comp Eff Res 2021 May 10. Epub 2021 May 10.

Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.

Chronic hepatitis B demographics and comorbidity data are limited in China. The China Health Insurance Association claims database from 2013 and 2016 was used to augment the existing data: the proportion of patients aged >45 years increased significantly from 40.3% in 2013 to 49% in 2016 (p < 0. Read More

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Sustaining Meaningful Patient Engagement Across the Lifecycle of Medicines: A Roadmap for Action.

Ther Innov Regul Sci 2021 May 10. Epub 2021 May 10.

EURORDIS-Rare Diseases Europe, Paris, France.

Background: There is increased recognition that incorporating patients' perspectives and insights into the medicines development process results in better health outcomes and benefits for all involved stakeholders. Despite the increased interest and the existence of frameworks and practical recommendations, patient engagement (PE) is not yet considered standard practice. The objective of this work was to provide a roadmap to support systematic change in all stakeholder organisations involved in medicines development across Europe, patients and patient organisations, medicines developers, academia, regulatory authorities, Health Technology Assessment bodies, payers, policy-makers and public research funders, to sustain PE practices. Read More

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Comparison of the Method of Endometrial Preparation Prior to Frozen-Thawed Embryo Transfer: a Retrospective Cohort Study from 9733 Cycles.

Reprod Sci 2021 May 10. Epub 2021 May 10.

Department of Gynecology, The First Affiliated Hospital of Xi'an Medical College, Xi'an City, Shaanxi Province, China.

Our objective was to compare the effectiveness of natural cycles (NC), modified natural cycle (mNC), and artificial cycles (AC) in women undergoing frozen-thawed embryo transfer (FET) after in vitro fertilization (IVF). This is a retrospective cohort study analyzing 9733 women undergoing the first cycle of FET over a 3-year period (June 2014-December 2017) at Northwest Women's and Children's Hospital after IVF-ICSI cycles. The type of endometrial preparation was determined by the treating physician's preference, based on patients' characteristics. Read More

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Differences in treatment patterns and overall survival between grade II and anaplastic pleomorphic xanthoastrocytomas.

J Neurooncol 2021 May 10. Epub 2021 May 10.

Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.

Introduction: Pleomorphic xanthoastrocytomas (PXAs) are classified as a grade II neoplasm, typically occur in children, and have favorable prognoses. However, their anaplastic counterparts remain poorly understood and vaguely characterized. In the present study, a large cohort of grade II PXA patients were compared with primary anaplastic PXA (APXA) patients to characterize patterns in treatment and survival. Read More

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Triggering change in stimulation protocols: a matter of oocyte maturation and beyond.

J Assist Reprod Genet 2021 May 10. Epub 2021 May 10.

Division of Reproductive Endocrinology and Infertility, University of California, San Diego, San Diego, CA, USA.

Since the birth of Louise Brown, in vitro fertilization (IVF) stimulation protocols have evolved significantly. One particular area of focus has been the process of final oocyte maturation, during which the oocyte gains competence to support fertilization and early embryonic development up to implantation. The field of human assisted reproductive technology (ART) is witnessing increased utilization of GnRH agonists (GnRHa) as trigger agents, in addition to or instead of the traditionally used human chorionic gonadotropin (hCG). Read More

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Pilot study of an online training program to increase genetic literacy and communication skills in oncology healthcare professionals discussing BRCA1/2 genetic testing with breast and ovarian cancer patients.

Fam Cancer 2021 May 10. Epub 2021 May 10.

Hereditary Cancer Clinic, Prince of Wales Hospital and Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia.

The increasing use of genetic testing for BRCA1/2 and other pathogenic variants in the management of women with breast and ovarian cancer necessitates increased genetic literacy in oncology healthcare professionals. This pilot study aimed to evaluate an online training program to increase genetic literacy and communication skills in Australian oncology healthcare professionals tasked with discussing and coordinating mainstream genetic testing with breast and ovarian cancer patients. A training website with embedded videos was developed. Read More

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Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria: A Systematic Review and Meta-analysis.

JAMA Netw Open 2021 May 3;4(5):e218409. Epub 2021 May 3.

Department of Urology, Spital-Limmattal, Schlieren, Switzerland.

Importance: Microhematuria (MH) is a common finding that often leads to further evaluation for urinary tract cancers. There is ongoing debate about the extent to which patients with MH should be evaluated for cancer.

Objective: To assess the diagnostic yield for detection of urinary tract cancers, specifically bladder cancer, upper tract urothelial carcinoma (UTUC), and kidney cell carcinoma, among patients evaluated for MH using cystoscopy and computed tomographic (CT) urography. Read More

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Cancer cachexia: molecular mechanism and pharmacological management.

Biochem J 2021 May;478(9):1663-1688

MOE Key Laboratory of Laser Life Science and Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou 510631, China.

Cancer cachexia often occurs in malignant tumors and is a multifactorial and complex symptom characterized by wasting of skeletal muscle and adipose tissue, resulting in weight loss, poor life quality and shorter survival. The pathogenic mechanism of cancer cachexia is complex, involving a variety of molecular substrates and signal pathways. Advancements in understanding the molecular mechanisms of cancer cachexia have provided a platform for the development of new targeted therapies. Read More

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Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial.

JAMA Pediatr 2021 May 10. Epub 2021 May 10.

Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Importance: Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings. Read More

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Biliary Tree Cysts and Surgical Treatment: Outcomes in a Multicentric Study.

J Laparoendosc Adv Surg Tech A 2021 May 7. Epub 2021 May 7.

Division of Hepato-biliary-pancreatic Surgery, Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain.

Biliary tree cysts (BTCs) represent an either localized or multifocal abnormal dilatation of the biliary tree, which entails an increased risk of acute cholangitis and cholangiocarcinoma (2.5%-16%). Its incidence in Western countries is ∼1/100. Read More

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Emergency Department Health Care Utilization and Opioid Administration Among Pediatric Patients With Sickle Cell Vasoocclusive Pain Crisis and Coexisting Mental Health Illness.

Pediatr Emerg Care 2020 Dec 14. Epub 2020 Dec 14.

From the *Department of Emergency Medicine †Children's Minnesota Research Institute ‡Department of Hematology and Oncology, Children's Minnesota, Minneapolis, MN.

Objectives: To determine whether patients with sickle cell disease (SCD) who present to the emergency department (ED) with vasoocclusive pain crises (VOC), and have coexisting mental health (MH) diagnoses, are more likely to have increased health care utilization and more frequent opioid administration compared with those without coexisting MH conditions.

Methods: This is a retrospective study of patients aged 5 to 18 years with SCD who presented to a tertiary care ED with a primary complaint of VOC between January 1, 2013, and December 31, 2017. We excluded patients with sickle cell trait and without a pain management plan in the electronic medical record. Read More

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December 2020

Outcomes of Total Hip Arthroplasty in Patients With Acetabular Protrusio.

J Am Acad Orthop Surg Glob Res Rev 2020 Jul;4(7):e2000121

From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr. Greig, Dr. Hsiue, Mr. Chen, Dr. Trikha, and Dr. Stavrakis), and the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario (Dr. Khoshbin), Canada.

Background: Acetabular protrusio (AP) is associated with distorted anatomic landmarks and insufficient bone stock that increases complexity of total hip arthroplasty (THA). This study used a large national database to compare outcomes after THA in patients with and without AP.

Methods: The Nationwide Readmissions Database was used to identify patients with and without AP who underwent THA from 2010 to 2014. Read More

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Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients.

J Am Acad Orthop Surg Glob Res Rev 2020 Jul;4(7):e2000110

From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Mr. Malpani, Mr. Mercier, Mr. Ottesen, Dr. Nduaguba, and Dr. Grauer), and the Department of Orthopedic Surgery, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA (Dr. John, and Dr. Webb).

Purpose: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improvement Program database.

Methods: Adult patients who underwent DRF ORIF were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Read More

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