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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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Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Pediatric Venous Thromboembolism Treatment and Thromboprophylaxis: A Systematic Review of the Literature.

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

Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida.

Venous thromboembolism (VTE) in children can lead to significant morbidity and mortality. Traditionally, treatment for thrombotic events in pediatric patients has been limited mainly to unfractionated heparin, low-molecular-weight heparin (LMWH), or vitamin K antagonists. Since the first non-vitamin K antagonist oral anticoagulant (NOAC) was approved for adult use, these agents have gained popularity for a variety of indications. Read More

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Arterial Thrombosis in Patients with Antiphospholipid Syndrome: A Review and Meta-Analysis.

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

Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.

There is a scarcity of high-quality randomized controlled trials (RCTs) comparing antithrombotic regimens for secondary prevention of arterial thrombosis (AT) in antiphospholipid syndrome (APS). We reviewed different antithrombotic regimens used for this purpose. We searched for studies on management of AT in APS on PubMed and Web of Science. Read More

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Pan-cancer application of a lung-adenocarcinoma-derived gene-expression-based prognostic predictor.

Brief Bioinform 2021 May 10. Epub 2021 May 10.

Lund University, Sweden.

Gene-expression profiling can be used to classify human tumors into molecular subtypes or risk groups, representing potential future clinical tools for treatment prediction and prognostication. However, it is less well-known how prognostic gene signatures derived in one malignancy perform in a pan-cancer context. In this study, a gene-rule-based single sample predictor (SSP) called classifier for lung adenocarcinoma molecular subtypes (CLAMS) associated with proliferation was tested in almost 15 000 samples from 32 cancer types to classify samples into better or worse prognosis. Read More

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Survival Outcomes of Hemoperfusion and Hemodialysis versus Hemodialysis in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis.

Blood Purif 2021 May 10:1-13. Epub 2021 May 10.

Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.

Background: The maintenance treatment of ESRD puts a great burden on individual patients, society, and the country of China as a whole. Hemoperfusion plus hemodialysis (HP + HD) in ESRD patients can yield modified outcomes such as prolonged life expectancy and improved dialysis quality and quality of life. This study aimed to systematically analyze the effect of HP + HD on the overall survival (OS) rates of ESRD patients and to provide support for clinical decision-making. Read More

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Comparisons of Efficacy and Safety between Triple (Inhaled Corticosteroid/Long-Acting Muscarinic Antagonist/Long-Acting Beta-Agonist) Therapies in Chronic Obstructive Pulmonary Disease: Systematic Review and Bayesian Network Meta-Analysis.

Respiration 2021 May 10:1-13. Epub 2021 May 10.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-Gu, Seoul, Republic of Korea.

Background: Various combinations of inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta-agonist (LABA) have been used as triple therapy for stable chronic obstructive pulmonary disease (COPD).

Objective: Our study was conducted to answer whether there were significant differences among various combinations in efficacy, for reducing exacerbation or mortality, and in safety, for increasing cardiovascular events or pneumonia.

Method: We searched parallel-group randomized controlled trials (RCTs) comparing ICS/LAMA/LABA with other inhaled drugs in patients with stable COPD for at least 12 weeks in PubMed, EMBASE, the Cochrane Library, and clinical trial registries from inception to December 31, 2019. Read More

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The role of local therapy in the treatment of solitary melanoma progression on immune checkpoint inhibition: A multicentre retrospective analysis.

Eur J Cancer 2021 May 7;151:72-83. Epub 2021 May 7.

Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 AZ Leiden, the Netherlands.

Introduction: In patients with metastatic melanoma, progression of a single tumour lesion (solitary progression) after response to immune checkpoint inhibition (ICI) is increasingly treated with local therapy. We evaluated the role of local therapy for solitary progression in melanoma.

Patients And Methods: Patients with metastatic melanoma treated with ICI between 2010 and 2019 with solitary progression as first progressive event were included from 17 centres in 9 countries. 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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Accelerated treatment with rtPA for pulmonary embolism induced circulatory arrest.

Thromb Res 2021 May 1;203:74-80. Epub 2021 May 1.

Amsterdam UMC, Department of Intensive Care Medicine, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.

Patients with circulatory arrest due to pulmonary embolism (PE) should be treated with fibrinolytics. Current guidelines do not specify which regimen to apply, and it has been suggested that the regimen of 100 mg rtPA/2 h should be used, because this is recommended for hemodynamic instable PE in the ESC/ERS Guideline. This two hour regimen, however, is incompatible with key principles of cardiopulmonary resuscitation (CPR), such as employment of interventions that allow fast evaluation of effectiveness, and limitation of the total duration of CPR to avoid poor neurological outcomes. Read More

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The expression of NTAL and its protein interactors is associated with clinical outcomes in acute myeloid leukemia.

Mol Cell Proteomics 2021 May 7:100091. Epub 2021 May 7.

Department of Biochemistry and Immunology, Ribeirão Preto Medical School , University of São Paulo, Ribeirão Preto, Brazil;; Department of Internal Medicine, Ribeirão Preto Medical School and Center for Cell Based Therapy, University of São Paulo, Ribeirão Preto, Brazil;. Electronic address:

Non-T cell activation linker (NTAL) membrane protein depletion from lipid rafts by alkylphospholipids or downregulation by shRNA-knockdown decreases cell viability through regulation of the Akt/PI3K pathway in mantle cell lymphoma and acute promyelocytic leukemia cells. Here, we confirmed that the knockdown of NTAL in acute myeloid leukemia (AML) cell lines was associated with decreased cell proliferation and survival. Similarly, a xenograft model using AML cells transduced with NTAL-shRNA and transplanted into NSG immunodeficient mice led to a 1. Read More

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Clinical Characteristics and Outcomes of Eyes with Intraocular Inflammation after Brolucizumab: Post Hoc Analysis of HAWK and HARRIER.

Ophthalmol Retina 2021 May 7. Epub 2021 May 7.

Ophthalmology, Sorbonne University, APHP, Paris, France.

Purpose: This analysis of the pivotal phase III HAWK and HARRIER trials aimed to provide insights on the timing of presentation, management, and outcomes of intraocular inflammation (IOI)-related adverse events (AEs), as reported by investigators in these trials.

Design: Post hoc analysis of investigator-reported IOI-related AEs in HAWK and HARRIER.

Participants: Of 1088 brolucizumab-treated eyes (3 mg or 6 mg), 49 eyes experienced at least 1 IOI-related AE and were included in this analysis. 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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eGFR Variability in Patients with Heart Failure and Chronic Kidney Disease.

J Card Fail 2021 May 7. Epub 2021 May 7.

Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address:

Background: Greater variability in estimated glomerular filtration rate (eGFR) is associated with higher mortality in patients with chronic kidney disease (CKD). Heart failure (HF) is common in CKD and may increase variability through changes in hemodynamic and volume regulation. We sought to determine if patients with versus without HF have higher kidney function variability in CKD, and to define the association with mortality. Read More

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Association between ß-Blockers and Outcomes in HFpEF - Current Insights from the SwedeHF Registry.

J Card Fail 2021 May 7. Epub 2021 May 7.

Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Swede; Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.

Background: ß-blockers have an uncertain effect in heart failure with a preserved ejection fraction of 50% or higher (HFpEF).

Methods: We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF) enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (β-blocker use versus no-use), we assessed the primary outcome first HF hospitalization, the co-primary outcome cardiovascular (CV) death, and the secondary outcomes all-cause hospitalization and all-cause death. Read More

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Papillary Thyroid Microcarcinomas: Does Sub-typing Predict Aggressive Clinical Behavior?

Hum Pathol 2021 May 7. Epub 2021 May 7.

Hospital of the University of Pennsylvania, 6 Founders 3400 Spruce Street Philadelphia, PA 19104, United States.

The most common malignant neoplasm affecting the thyroid gland is papillary thyroid carcinoma (PTC). PTC can demonstrate a number of morphologic variants including but not limited to classic, follicular, and tall cell. Each of these morphologic sub-types carry distinct clinical characteristics such that certain variants, like tall cell, behave more aggressively than others. Read More

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Extrapleural Pneumonectomy versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma.

Ann Thorac Surg 2021 May 7. Epub 2021 May 7.

Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address:

Background: Whether extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication (P/D) is the optimal resection for malignant pleural mesothelioma (MPM) remains controversial. We therefore compared perioperative outcomes and long-term survival of patients who underwent EPP vs P/D.

Methods: Patients with the diagnosis of MPM who underwent either EPP or P/D from 2000 to 2019 were identified from our departmental database. Read More

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Sex Differences in Ascending Aortic and Arch Surgery: A Propensity-matched Comparison of 1153 Pairs.

Ann Thorac Surg 2021 May 7. Epub 2021 May 7.

Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute; Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Texas.

Background: We investigated the relationship of sex with clinical outcomes after proximal aortic (ascending and arch) operations, and whether sex-specific preoperative factors are associated with mortality.

Methods: Of 3745 patients who underwent elective, urgent, and emergency proximal aortic operations over a 20-year period, 1153 pairs of men and women were propensity-matched, and their early and long-term outcomes were compared. Kaplan-Meier survival analysis was used to estimate late survival. Read More

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Association of sex with outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Am J Med 2021 May 7. Epub 2021 May 7.

Manzoni Hospital, Lecco, Italy. Electronic address:

Background: Worse outcomes have been reported for women, compared to men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in one-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). Read More

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Socioeconomic factors and adherence to CPAP - the population-based DISCOVERY study.

Chest 2021 May 7. Epub 2021 May 7.

Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Box 188, SE-221 00, Lund, Sweden.

Background: Early identification of poor adherence to continuous positive airway pressure (CPAP) treatment is of major clinical importance to optimize treatment outcomes in patients with obstructive sleep apnea (OSA).

Research Question: How does socioeconomic factors influence CPAP adherence?

Study Design And Methods: Nationwide, population-based cohort study on patients with OSA on CPAP reported to the Swedish quality registry Swedevox between 2010 and 2018 was cross-linked with individual socioeconomic data from Statistics Sweden. Socioeconomic factors associated with CPAP adherence were identified using a multivariable linear regression model, adjusted for age and gender. 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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Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey-a cross-sectional web-based population survey.

Respirology 2021 May 10. Epub 2021 May 10.

Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.

Background And Objective: Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated.

Methods: The National Breathlessness Survey was a cross-sectional, web-based survey conducted in October 2019. 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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Prognostic significance of right ventricular function during exercise in asymptomatic/minimally symptomatic patients with nonobstructive hypertrophic cardiomyopathy.

Echocardiography 2021 May 10. Epub 2021 May 10.

Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.

Background: The risk stratification of hypertrophic cardiomyopathy (HCM) without left ventricular outflow tract (LVOT) obstruction and the utility of exercise stress echocardiography (ESE) remains unclear. We investigated the value of right ventricular (RV) function and RV-pulmonary artery (PA) coupling during exercise in asymptomatic/minimally symptomatic patients with nonobstructive HCM (nHCM).

Method And Results: This retrospective study evaluated 74 HCM patients (age 63 ± 13 years, 65% men) without LVOT obstruction (≥30 mmHg) who underwent​ ESE. Read More

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Self-reported medication adherence among patients with diabetes or hypertension, Médecins Sans Frontières Shatila refugee camp, Beirut, Lebanon: A mixed-methods study.

PLoS One 2021 10;16(5):e0251316. Epub 2021 May 10.

Department of Global Health, University of Washington, Seattle, Washington, United States of America.

Introduction: Low adherence to medications, specifically in patients with Diabetes (DM) and Hypertension (HTN), and more so in refugee settings, remains a major challenge to achieving optimum clinical control in these patients. We aimed at determining the self-reported medication adherence prevalence and its predictors and exploring reasons for low adherence among these patients.

Methods: A mixed-methods study was conducted at Médecins Sans Frontières non-communicable diseases primary care center in the Shatila refugee camp in Beirut, Lebanon in October 2018. Read More

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Association between early intensive care or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure.

PLoS One 2021 10;16(5):e0251505. Epub 2021 May 10.

Department of Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan.

The management of acute decompensated heart failure often requires intensive care. However, the effects of early intensive care unit/coronary care unit admission on activities of daily living (ADL) in acute decompensated heart failure patients have not been precisely evaluated. Thus, we retrospectively assessed the association between early intensive care unit admission and post-discharge ADL performance in these patients. Read More

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