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Stress Fracture of the Femoral Shaft in Paget's Disease of Bone: A Case Report.

J Bone Metab 2021 May 31;28(2):171-178. Epub 2021 May 31.

Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Paget's disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. Read More

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Ensure an "Ultrasound Window" on the Patient's Neck to Evaluate Cerebral Blood Flow!

Thorac Cardiovasc Surg 2021 Jun 15. Epub 2021 Jun 15.

Department of Pediatric Anesthesiology, University Hospital Bonn, Bonn, Germany.

Near-infrared spectroscopy (NIRS) does not provide information about changes in oxygenation in whole-brain areas. Although the branching vessels of the aortic arch are not always easy to identify using transesophageal echocardiography (TEE), the blood flow status of cervical arteries can always be assessed by applying an ultrasound probe via the "ultrasound window" on the patient's neck, which can be ensured by devising alternative insertion approaches of the central venous catheter. This method is very simple but compensates for the limitations of the combination of NIRS and TEE, especially during cardiac surgery with cardiopulmonary bypass management using selective cerebral perfusion. Read More

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[Postoperative dumping-syndrome with relevant impairment of glucose homeostasis - relief by continuous glucose monitoring and individual therapy with GLP-1 receptor agonists].

Z Gastroenterol 2021 Jun 15;59(6):556-559. Epub 2021 Jun 15.

Innere Medizin, Krankenhaus St. Marienwörth, Bad Kreuznach, Germany.

Dumping syndromes are a common side effect after partial or total gastric resection. The symptoms may be diverse, with vasomotoric reactions, collapse tendencies and digestive disorders (early dumping) as well as blood sugar derailment as a result of too fast absorption of glucose (late dumping).Entrenched therapy concepts, including personalized nutritional concepts and the use of medication as octreotide or diazoxide, will not always lead to the desired results. Read More

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[Unusual cause of a PCT-elevation].

Dtsch Med Wochenschr 2021 Jun 15;146(12):818-820. Epub 2021 Jun 15.

Klinik für Innere Medizin II, Universitätsklinikum Freiburg.

Introduction:  Procalcitonin (PCT) is an established marker for bacterial infection. Elevation of PCT can occur due to various reasons and is not specific, as we outline in the following case report.

History:  We report on a 29 year old patient, who was presented by the psychiatric department because of obscure abdominal pain, nausea and vomiting since two days. Read More

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Autonomy and consent assessment for electroconvulsive therapy (ECT). A retrospective study of medical records.

Int J Law Psychiatry 2021 Jun 11;77:101716. Epub 2021 Jun 11.

University of Oslo, Faculty of Medicine, Centre for Medical Ethics, Oslo, Norway. Electronic address:

The Norwegian Mental Health Act allows involuntary treatment for patients who lack consent capacity, however it allows only administration of pharmaceutical treatment and nutrition and not ECT. In lack of specific regulations, the legal access to ECT without valid consent has been grounded on the general rule of necessity in the Norwegian Penal code. This restriction and lack of legal regulation has implications for patients' rights and legal security. Read More

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Subcuticular sutures versus staples for skin closure after primary hip arthroplasty.

Acta Orthop Belg 2021 Mar;87(1):55-64

High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. Read More

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The Last Bastion of Paternalism? A Reflection on Proceduralism, Power, and Privilege.

J Clin Ethics 2021 ;32(2):173-181

Center for Bioethics and Humanities, SUNY Upstate Medical, 618 Irving Ave., Syracuse, New York 13210 USA.

The two cases presented here may at first seem very different: one patient was an adult, making autonomous decisions for herself and her fetus; the other was a child too young to meaningfully participate in the most significant decisions regarding his health. In both cases, healthcare professionals had to determine the extent to which the parents of a dying fetus or child should be permitted to make agonizing choices about how long to maintain hope and what that death will look like; and in both, health professionals' prognostications influenced their judgments about the patients' best interests and whether they were candidates for certain interventions. While members of both healthcare teams questioned the patients' and families' ability to objectively consider the risks and benefits, the families were focused on the need to be able to live with the decisions made, regardless of outcome. Read More

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A Knowledge Distillation Ensemble Framework for Predicting Short and Long-term Hospitalisation Outcomes from Electronic Health Records Data.

IEEE J Biomed Health Inform 2021 Jun 15;PP. Epub 2021 Jun 15.

The ability to perform accurate prognosis of patients is crucial for proactive clinical decision making, informed resource management and personalised care. Existing outcome prediction models suffer from a low recall of infrequent positive outcomes. We present a highly-scalable and robust machine learning framework to automatically predict adversity represented by mortality and ICU admission from time-series vital signs and laboratory results obtained within the first 24 hours of hospital admission. Read More

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LRH-1 high expression in the ovarian granulosa cells of PCOS patients.

Endocrine 2021 Jun 15. Epub 2021 Jun 15.

Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.

Purpose: Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders with heterogeneity. There are also reports that liver receptor homolog 1 [LRH-1 or nuclear receptor subfamily 5 group A member 2] plays an important role in the reproductive system. But up to now, there are no reports related to the link with PCOS and LRH-1. Read More

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Comparison of patient- and clinician-reported outcome measures in lower back rehabilitation: introducing a new integrated performance measure (t2D).

Qual Life Res 2021 Jun 15. Epub 2021 Jun 15.

Ludwig Boltzmann Institute for Rehabilitation Research, Reizenpfenninggasse 1, 1140, Vienna, Austria.

Purpose: Patient- and clinician-reported outcome measures (PROMs, CROMs) are used in rehabilitation to evaluate and track the patient's health status and recovery. However, controversy still exists regarding their relevance and validity when assessing a change in health status.

Methods: We retrospectively analyzed the changes in a CROM (Fingertip-To-Floor Test - FTF) and PROMs (ODI, HAQ-DI, NPRS, EQ5D) and the associations between these outcomes in 395 patients with lower back pain (57. Read More

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Hepatic Encephalopathy: From Metabolic to Neurodegenerative.

Neurochem Res 2021 Jun 15. Epub 2021 Jun 15.

Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, 900, rue Saint-Denis Pavillon R, R08.422, Montreal, QC, H2X-0A9, Canada.

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome of both acute and chronic liver disease. As a metabolic disorder, HE is considered to be reversible and therefore is expected to resolve following the replacement of the diseased liver with a healthy liver. However, persisting neurological complications are observed in up to 47% of transplanted patients. Read More

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Efficacy and safety of heat-sensitive moxibustion in the treatment of neurogenic bladder after spinal cord injury: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2021 Jun;100(24):e26424

The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China.

Background: Spinal cord injury (SCI) is one of the most disabling and destructive neurological diseases. Neurogenic bladder dysfunction (NBD) is one of the serious complications after SCI, 80% of patients after SCI will have neurogenic bladder symptoms. NBD after SCI may lead to urinary retention, urinary incontinence, and urinary tract infection. Read More

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Sphenoid sinus pseudoaneurysm with carotid cavernous fistula presenting with delayed subarachnoid hemorrhage: A case report.

Medicine (Baltimore) 2021 Jun;100(24):e26383

Department of Radiology.

Rationale: Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. Read More

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Atezolizumab and bevacizumab-induced encephalitis in advanced hepatocellular carcinoma: Case report and literature review.

Medicine (Baltimore) 2021 06;100(24):e26377

Department of Hepatology and Gastroenterology, Charité University Medicine Berlin.

Introduction: On the basis of the results of the IMBRAVE-150 trial, the combination of atezolizumab, a programmed cell death ligand 1 (PD-L1) antibody, as well as bevacizumab, a vascular endothelial growth factor (VEGF) antibody, represents a promising novel first-line therapy in patients with advanced hepatocellular carcinoma (HCC). Despite favorable safety data, serious adverse events have been described. However, central nervous system complications such as encephalitis have rarely been reported. Read More

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Clinical assessment of prophylactic chemotherapy in treating with hydatidiform mole: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2021 Jun;100(24):e26341

Department of Obstetrics and Gynecology, the First People's Hospital of Nantong, Nantong, Jiangsu, China.

Background: Hydatidiform mole (HM) is more common as molar pregnancy. It is a disease classified under the category of gestational trophoblastic diseases, which could metastasize after originating in the placenta. A majority of females suffering from molar pregnancies are curable by evacuating retained products of conception and the patient's fertility is preserved. Read More

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Meningoencephalitis in relapsing polychondritis: A case report.

Medicine (Baltimore) 2021 Jun;100(24):e26315

Department of Neurology, Fukushima Medical University School of Medicine, Fukushima.

Rationale: Aseptic meningoencephalitis is a rare central nervous system complication of relapsing polychondritis (RP).

Patient: We report a 61-year-old Japanese male patient with spiking fever and impaired consciousness. Neurological examination revealed meningealirritation, and cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with elevated protein (199 mg/dL) and interleukin-6 (3810 pg/mL). Read More

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Development of a preoperative prediction model for new-onset diabetes mellitus after partial pancreatectomy: A retrospective cohort study.

Medicine (Baltimore) 2021 Jun;100(24):e26311

Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine.

Abstract: Pancreatectomy is an invasive surgery that is sometimes associated with complications. New-onset diabetes mellitus sometimes develops after partial pancreatectomy and severely affects the patient's quality of life. This study aimed to develop a preoperative prediction model of new-onset diabetes mellitus after partial pancreatectomy, which will help patients and surgeons to achieve more easily better common decisions on regarding whether to perform partial pancreatectomy. Read More

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Phenotypic spectrum and mechanism analysis of Schaff Yang syndrome: A case report on new mutation of MAGEL2 gene.

Medicine (Baltimore) 2021 Jun;100(24):e26309

Department of Endocrinology, Shandong Provincial Hospital affiliated to Shandong First Medical University.

Rationale: The Schaaf-Yang syndrome (SYS) is an autosomal dominant multi-system genetic disease caused by melanoma antigen L2 (MAGEL2) gene mutations imprinted by mothers and expressed by fathers on the 15q11-15q13 chromosomes in the critical region of Prader-Willi. MAGEL2 is a single exon gene and one of the protein-coding genes of the Prader-Willi domain. MAGEL2 is a matrilineal imprinted gene (i. Read More

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Adherence to and patient's knowledge of self-management of subcutaneous biologic therapy in chronic inflammatory rheumatic diseases: results of a multicentre cross-sectional study.

Clin Exp Rheumatol 2021 May 28. Epub 2021 May 28.

Department of Rheumatology - Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, and INSERM (UMR1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France.

Objectives: Non-adherence to biologic therapy is an issue in chronic inflammatory rheumatic diseases (CIRDs) and might be related to poor patient knowledge of the risk of these therapies. Our aim here was to evaluate the level of patient adherence to and knowledge of self-care safety skills for biologic therapy.

Methods: This was a multicentre, cross-sectional study in which out-patients visited an office- or hospital-based rheumatologist. Read More

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Personal responsibility for health? A phenomenographic analysis of general practitioners' conceptions.

Scand J Prim Health Care 2021 Jun 15:1-10. Epub 2021 Jun 15.

Department of Research and Development, Region Kronoberg, Växjö, Sweden.

Objective: To analyse and describe general practitioners' perceptions of the notion of a 'personal responsibility for health'.

Design: Interview study, phenomenographic analysis.

Setting: Swedish primary health care. Read More

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Mobility Assistive Device Use in Older Adults.

Am Fam Physician 2021 Jun;103(12):737-744

Central Michigan University College of Medicine, Saginaw, MI, USA.

Many individuals need a mobility assistive device as they age. These devices include canes, crutches, walkers, and wheelchairs. Clinicians should understand how to select the appropriate device and size for individual patients (or work with a physical therapist) and prescribe the device using the patient's health insurance plan. Read More

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Knowledge and Attitudes Toward Renal Transplantation in Individuals Undergoing Transplant Evaluation.

Prog Transplant 2021 Jun 15:15269248211024613. Epub 2021 Jun 15.

5715Belmont University School of Nursing, Nashville, TN, USA.

Introduction: The underutilization of kidney transplant as the preferred treatment for end-stage kidney disease is influenced by a lack of knowledge, poor attitudes, and various socio-demographic characteristics. Negative attitudes toward renal transplant disengage patients from the evaluation process and often hinder their likelihood of receiving a transplant.

Purpose: Determine whether a standardized educational session successfully improves knowledge and attitudes toward kidney transplant. Read More

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Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) for Tinnitus: A Retrospective Study.

Ear Nose Throat J 2021 Jun 15:1455613211016896. Epub 2021 Jun 15.

Department of Hearing and Speech Science, Xinhua College, Sun Yat-sen University, Guangzhou, China.

Objective: Current studies still find insufficient evidence to support the routine use of repetitive transcranial magnetic stimulation (rTMS) in tinnitus. This study aimed to assess response of tinnitus to treatment with rTMS and identify factors influencing the overall response.

Methods: Between January 2016 and May 2017, 199 tinnitus patients were identified from a retrospective review of the electronic patient record at the Sun Yat-sen Memorial Hospital. Read More

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Daratumumab provides a survival benefit in relapsed and refractory Multiple Myeloma, independent of baseline clinical characteristics: A meta-analysis.

Pharmacol Res Perspect 2021 Aug;9(4):e00797

Radiology Department, The People's Hospital of Pingyi County, Linyi, China.

Daratumumab was approved in patients with relapsed or refractory multiple myeloma (MM) who previously received proteasome inhibitors or immunomodulatory drugs. However, the efficacy and safety of the addition of daratumumab in subpopulations of patients with relapsed or refractory MM is still unknown. We systematically searched MEDLINE, EMBASE, and Cochrane for randomized controlled trials (inception to September 2020). Read More

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A cross-standardized flow cytometry platform to assess phenotypic stability in B-ALL xenografts.

Cytometry A 2021 Jun 14. Epub 2021 Jun 14.

Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.

With the continued poor outcome of relapsed acute lymphoblastic leukemia (ALL), new patient-specific approaches for disease progression monitoring and therapeutic intervention are urgently needed. Patient-derived xenografts (PDX) of primary ALL in immune-deficient mice have become a powerful tool for studying leukemia biology and therapy response. In PDX mice, the immunophenotype of the patient's leukemia is commonly believed to be stably propagated. Read More

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"Accutane Check": Insights into youth sentiment toward isotretinoin from a TikTok trend.

Pediatr Dermatol 2021 Jun 14. Epub 2021 Jun 14.

Program for Clinical Research and Technology, Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA.

Social media platforms such as TikTok allow patients to exchange and share health information. In this study, we sought to understand how teenagers and young adults utilize TikTok to engage with acne and isotretinoin information. Analysis of the top 50 TikTok videos on an isotretinoin trend demonstrated over 18-million likes and 137-thousand comments. Read More

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Deep Learning in Classification of Covid-19 Coronavirus, Pneumonia and Healthy Lungs on CXR and CT Images.

J Med Biol Eng 2021 Jun 10:1-9. Epub 2021 Jun 10.

Division of Graduate Studies, Tijuana Institute of Technology, Baja CA 22414 Tijuana, Mexico.

Purpose: In this paper, the transfer learning method has been implemented to chest X-ray (CXR) and computed tomography (CT) bio-images of diverse kinds of lungs maladies, including CORONAVIRUS 2019 (COVID-19). COVID-19 identification is a difficult assignment that constantly demands a careful analysis of a patient's clinical images, as COVID-19 is found to be very alike to pneumonic viral lung infection. In this paper, a transfer learning model to accelerate prediction processes and to assist medical professionals is proposed. Read More

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A machine learning approach to predict healthcare cost of breast cancer patients.

Sci Rep 2021 Jun 14;11(1):12441. Epub 2021 Jun 14.

Basque Center for Applied Mathematics, Bilbao, Spain.

This paper presents a novel machine learning approach to perform an early prediction of the healthcare cost of breast cancer patients. The learning phase of our prediction method considers the following two steps: (1) in the first step, the patients are clustered taking into account the sequences of actions undergoing similar clinical activities and ensuring similar healthcare costs, and (2) a Markov chain is then learned for each group to describe the action-sequences of the patients in the cluster. A two step procedure is undertaken in the prediction phase: (1) first, the healthcare cost of a new patient's treatment is estimated based on the average healthcare cost of its k-nearest neighbors in each group, and (2) finally, an aggregate measure of the healthcare cost estimated by each group is used as the final predicted cost. Read More

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Clinical practice guideline for transcatheter versus surgical valve replacement in patients with severe aortic stenosis in Latin America.

Heart 2021 Jun 14. Epub 2021 Jun 14.

Internal Medicine, Hospital Alemán, Buenos Aires, Argentina.

In elderly (75 years or older) patients living in Latin America with severe symptomatic aortic stenosis candidates for transfemoral approach, the panel suggests the use of transcatheter aortic valve implant (TAVI) over surgical aortic valve replacement (SAVR). This is a conditional recommendation, based on moderate certainty in the evidence (⨁⨁⨁Ο).This recommendation does not apply to patients in which there is a standard of care, like TAVI for patients at very high risk for cardiac surgery or inoperable patients, or SAVR for non-elderly patients (eg, under 65 years old) at low risk for cardiac surgery. Read More

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COVID-19-induced postural orthostatic tachycardia syndrome treated with ivabradine.

BMJ Case Rep 2021 Jun 14;14(6). Epub 2021 Jun 14.

Cardiology, Mercy University Hospital, Cork, Ireland.

A 22-year-old woman was referred with exertional dyspnoea and chest tightness 3 weeks following a diagnosis of COVID-19. Evaluation revealed a resting sinus tachycardia and criteria for postural orthostatic tachycardia syndrome were met. After non-pharmacological interventions failed to yield symptomatic improvement, ivabradine was commenced. Read More

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