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Early and long-term outcomes of conventional and valve-sparing aortic root replacement.

Heart 2022 May 17. Epub 2022 May 17.

Cardiac Anaesthesia, St George's Hospital, London, UK.

Objective: To determine the early and long-term outcomes of conventional aortic root (ARR) and valve-sparing root replacement (VSRR) using a standard perioperative and operative approach.

Methods: We present prospectively collected data of 609 consecutive patients undergoing elective and urgent aortic root surgery (470 ARR, 139 VSRR) between 2006 and 2020. Primary outcomes were operative mortality and incidence of postoperative complications. Read More

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Concordance and discordance in SLE clinical trial outcome measures: analysis of three anifrolumab phase 2/3 trials.

Ann Rheum Dis 2022 May 17. Epub 2022 May 17.

BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA

Objectives: In the anifrolumab systemic lupus erythematosus (SLE) trial programme, there was one trial (TULIP-1) in which BILAG-based Composite Lupus Assessment (BICLA) responses favoured anifrolumab over placebo, but the SLE Responder Index (SRI(4)) treatment difference was not significant. We investigated the degree of concordance between BICLA and SRI(4) across anifrolumab trials in order to better understand drivers of discrepant SLE trial results.

Methods: TULIP-1, TULIP-2 (both phase 3) and MUSE (phase 2b) were randomised, 52-week trials of intravenous anifrolumab (300 mg every 4 weeks, 48 weeks; TULIP-1/TULIP-2: n=180; MUSE: n=99) or placebo (TULIP-1: n=184, TULIP-2: n=182; MUSE: n=102). Read More

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Fifteen-minute consultation: A guide to the paediatric primary survey.

Arch Dis Child Educ Pract Ed 2022 May 17. Epub 2022 May 17.

Emergency Department, Temple Street Children's University Hospital, Dublin, Dublin, Ireland.

It's 21:00 and you receive a stand-by call from the local ambulance service. Peter, a 9-year-old boy, was riding an electric scooter and has collided with a car. He has reduced consciousness, signs of shock and is hypoxic. Read More

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Study protocol for a single-centre randomised controlled trial to investigate the effect of lung recruitment in paediatric patients after cardiac surgery.

BMJ Open 2022 May 17;12(5):e063278. Epub 2022 May 17.

Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.

Introduction: A number of published studies have revealed that lung recruitment can improve oxygenation, shorten the duration of mechanical ventilation (MV) and decrease mortality in adults with acute hypoxaemic respiratory failure, especially patients with acute respiratory distress syndrome. However, few articles have assessed lung recruitment in paediatric patients, especially after cardiac surgery. This clinical trial aimed to determine whether lung recruitment can reduce the duration of MV in paediatric patients with hypoxaemic respiratory failure after cardiac surgery. Read More

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'We just have to make it work': a qualitative study on assistant nurses' experiences of patient safety performance in home care services using forum play scenarios.

BMJ Open 2022 May 17;12(5):e057261. Epub 2022 May 17.

Faculty of Life and Health Sciences, Linnaeus University, Kalmar, Sweden.

Objective: Safety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients' functioning and health. The aim of this study is to explore assistant nurses' adaptive responses to everyday work to ensure safe care in the home care context. Read More

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LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK.

BMJ Open 2022 May 17;12(5):e063505. Epub 2022 May 17.

Department of Surgery and Cancer, Imperial College London, London, UK.

Introduction: Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. Read More

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Accuracy of prehospital clinicians' perceived prognostication of long-term survival in critically ill patients: a nationwide retrospective cohort study on helicopter emergency service patients.

BMJ Open 2022 May 17;12(5):e059766. Epub 2022 May 17.

Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland.

Objectives: Prehospital critical care physicians regularly attend to patients with poor prognosis and may limit the advanced therapies. The aim of this study was to evaluate the accuracy of poor prognosis given by prehospital critical care clinicians.

Design: Cohort study. Read More

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Acupuncture for chronic sciatica: protocol for a multicenter randomised controlled trial.

BMJ Open 2022 May 17;12(5):e054566. Epub 2022 May 17.

International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China

Background: Chronic Sciatica is a disabling condition causing considerable medical, social and financial implications. Currently, there is no recognised long-term effective treatment to alleviate sciatica. Acupuncture has been widely used for treating chronic pains with persistent analgesic effects. Read More

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Relationships between SUVmax of lung adenocarcinoma and different T stages, histological grades and pathological subtypes: a retrospective cohort study in China.

BMJ Open 2022 May 17;12(5):e056804. Epub 2022 May 17.

Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

Objectives: Cancer cell has aberrant metabolism. The purpose of this study aimed to investigate relationships between maximum standard uptake value (SUVmax)of fluoro-2-deoxy-d-glucose and T stages, histological grades and pathological subtypes of lung adenocarcinoma.

Design: Retrospective cohort study, employing the Kruskal-Wallis, Bonferroni-Dunn and Mann-Whitney tests to compare SUVmax of different T stages, histological grades and pathological subtypes of lung adenocarcinoma. Read More

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Comparative efficacy and safety of statins for osteoporosis: a study protocol for a systematic review and network meta-analysis.

BMJ Open 2022 May 17;12(5):e054158. Epub 2022 May 17.

First Clinical College, Hubei University of Chinese Medicine, Wuhan, China

Introduction: Osteoporosis (OP) is a prevalent skeletal disease with high mortality and morbidity, followed by acute and chronic back pain, severe spinal deformity and dysfunction. First-line drugs for OP work through antiresorptive or anabolic mechanisms. Although with good efficacy, these drugs still have certain limitations in clinical application due to delivery routes, medication cycles and cost issues. Read More

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Comparison of biochemical, microbial and mucosal mRNA expression in bile acid diarrhoea and irritable bowel syndrome with diarrhoea.

Gut 2022 May 17. Epub 2022 May 17.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Objective: There are altered mucosal functions in irritable bowel syndrome with diarrhoea (IBS-D); ~30% of patients with IBS-D have abnormal bile acid (BA) metabolism (ABAM) and diarrhoea (summarised as BAD).

Aim: To compare biochemical parameters, gastrointestinal and colonic transit, rectal sensation and pathobiological mechanisms in IBS-D without ABAM and in BAD (serum 7C4>52 ng/mL).

Design: In patients with Rome III criteria of IBS-D, we compared biochemical features, colonic transit, rectal sensation, deep genotype of five BA-related genes, ileal and colonic mucosal mRNA (differential expression (DE) analysis) and stool dysbiosis (including functional analysis of microbiome). Read More

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Clinical relevance of biomarkers in cholangiocarcinoma: critical revision and future directions.

Gut 2022 May 17. Epub 2022 May 17.

Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy

Cholangiocarcinoma (CCA) is a malignant tumour arising from the biliary system. In Europe, this tumour frequently presents as a sporadic cancer in patients without defined risk factors and is usually diagnosed at advanced stages with a consequent poor prognosis. Therefore, the identification of biomarkers represents an utmost need for patients with CCA. Read More

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Hepatic p63 regulates glucose metabolism by repressing SIRT1.

Gut 2022 May 17. Epub 2022 May 17.

Department of Physiology, CIMUS, University of Santiago de Compostela, Santiago de Compostela, Spain

Objective: p63 is a transcription factor within the p53 protein family that has key roles in development, differentiation and prevention of senescence, but its metabolic actions remain largely unknown. Herein, we investigated the physiological role of p63 in glucose metabolism.

Design: We used cell lines and mouse models to genetically manipulate p63 in hepatocytes. Read More

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Postpartum bilateral lung transplantation in COVID-19 associated respiratory failure.

BMJ Case Rep 2022 May 17;15(5). Epub 2022 May 17.

Department of Maternal Fetal Medicine, Henry Ford Health System, Detroit, Michigan, USA.

In critically ill patients with COVID-19, established therapies in the setting of respiratory failure include invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). This case report describes a pregnant woman in her 30s who was hospitalised at 35 weeks gestation with moderate COVID-19 disease. Her condition worsened following delivery, and she required intubation, maximum ventilatory support and ECMO. Read More

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Familial Touraine-Solente-Gole syndrome.

BMJ Case Rep 2022 May 17;15(5). Epub 2022 May 17.

Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India

Touraine-Solente-Gole syndrome is a rare, autosomal dominant multisystem disorder arising from dysregulated prostaglandin synthesis due to underlying genetic defects. Early symptoms are related to skin and soft tissue involvement (coarse facial features, widening of wrists, etc) and may thus be overlooked unless a careful physical examination is carried out. Secondary causes of pachydermoperiosteitis must always be looked for in such patients. Read More

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Iliac vein deep vein thrombosis as an atypical presentation of an adrenocortical carcinoma.

BMJ Case Rep 2022 May 17;15(5). Epub 2022 May 17.

Department of Histopathology, Royal Oldham Hospital, Oldham, UK.

Adrenocortical carcinoma (ACC) is a rare form of cancer with an annual incidence of two per million. The risk of venous thromboembolism increases sevenfold in patients with cancer. This case report describes an iliac vein deep vein thrombosis (DVT) as an atypical presentation of an ACC and highlights the value of further imaging investigation in patients with unprovoked DVTs. Read More

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Cervical spine ligamentum flavum gaps: MR characterisation and implications for interlaminar epidural injection therapy.

Reg Anesth Pain Med 2022 May 17. Epub 2022 May 17.

Department of Radiology, Hospital for Special Surgery, New York, New York, USA.

Background: Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning. Read More

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Activin-A impairs CD8 T cell-mediated immunity and immune checkpoint therapy response in melanoma.

J Immunother Cancer 2022 May;10(5)

School of Life Sciences (SV), ISREC, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland

Background: Activin-A, a transforming growth factor β family member, is secreted by many cancer types and is often associated with poor disease prognosis. Previous studies have shown that Activin-A expression can promote cancer progression and reduce the intratumoral frequency of cytotoxic T cells. However, the underlying mechanisms and the significance of Activin-A expression for cancer therapies are unclear. Read More

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Mitoribosomal defects aggravate liver cancer via aberrant glycolytic flux and T cell exhaustion.

J Immunother Cancer 2022 May;10(5)

Department of Core Laboratory of Translational Research, Biomedical Convergence Research Center, Chungnam National University Hospital, Daejeon, South Korea

Background: Mitochondria are involved in cancer energy metabolism, although the mechanisms underlying the involvement of mitoribosomal dysfunction in hepatocellular carcinoma (HCC) remain poorly understood. Here, we investigated the effects of mitoribosomal impairment-mediated alterations on the immunometabolic characteristics of liver cancer.

Methods: We used a mouse model of HCC, liver tissues from patients with HCC, and datasets from The Cancer Genome Atlas (TCGA) to elucidate the relationship between mitoribosomal proteins (MRPs) and HCC. Read More

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Antigen mimicry as an effective strategy to induce CSPG4-targeted immunity in dogs with oral melanoma: a veterinary trial.

J Immunother Cancer 2022 May;10(5)

Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy

Background: Melanoma is the most lethal form of skin cancer in humans. Conventional therapies have limited efficacy, and overall response is still unsatisfactory considering that immune checkpoint inhibitors induce lasting clinical responses only in a low percentage of patients. This has prompted us to develop a vaccination strategy employing the tumor antigen chondroitin sulfate proteoglycan (CSPG)4 as a target. Read More

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The CAR-HEMATOTOX risk-stratifies patients for severe infections and disease progression after CD19 CAR-T in R/R LBCL.

J Immunother Cancer 2022 May;10(5)

Department of Medicine III, Hematology and Oncology, University Hospital, LMU Munich, Munich, Germany

Background: CD19-directed chimeric antigen receptor T-cell therapy (CAR-T) represents a promising treatment modality for an increasing number of B-cell malignancies. However, prolonged cytopenias and infections substantially contribute to the toxicity burden of CAR-T. The recently developed CAR-HEMATOTOX (HT) score-composed of five pre-lymphodepletion variables (eg, absolute neutrophil count, platelet count, hemoglobin, C-reactive protein, ferritin)-enables risk stratification of hematological toxicity. Read More

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Soluble HLA peptidome of pleural effusions is a valuable source for tumor antigens.

J Immunother Cancer 2022 May;10(5)

Institute of Pulmonary Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel

Background: Soluble human leucocyte antigen (sHLA) molecules, released into the plasma, carry their original peptide cargo and provide insight into the protein synthesis and degradation schemes of their source cells and tissues. Other body fluids, such as pleural effusions, may also contain sHLA-peptide complexes, and can potentially serve as a source of tumor antigens since these fluids are drained from the tumor microenvironment. We explored this possibility by developing a methodology for purifying and analyzing large pleural effusion sHLA class I peptidomes of patients with malignancies or benign diseases. Read More

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Subchondral bone attenuation coefficient utility of the sacroiliac margins to differentiate spondyloarthritis and osteitis condensans ilii.

RMD Open 2022 May;8(1)

Department of Rheumatology, CHU Besancon, Besancon, France

Introduction: Differentiating ankylosing spondylitis (AS) from osteitis condensans ilii (OCI) remains challenging for clinicians. The aim of this study was to determine whether Subchondral Bone Attenuation Coefficient of the SacroIliac margins (SBAC-SI) is different in AS, OCI and diffuse idiopathic skeletal hyperostosis (DISH).

Methods: A monocentric retrospective observational study was performed at the University Hospital of Besançon. Read More

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Network analysis of genes associated with esophageal squamous cell carcinoma progression.

Xu Li Zhenkun Xia

J Investig Med 2022 May 17. Epub 2022 May 17.

Department of Thoracic Surgery, Second Xiangya Hospital, Changsha, China

This study aims to identify possible genes associated with esophageal squamous cell carcinoma (ESCC) by bioinformatics tool and further explore the function of immunoglobulin heavy chain variable family 4 gene (IGHV4)-28 in the ESCC progression.The ESCC-related genes in Cancer Genome Atlas (TCGA) database were analyzed by bioinformatics tools, which finally identified IGHV4-28. The expression levels of IGHV4-28 in TE-4 and EC9706 cells were detected by quantitative reverse transcription-PCR (qRT-PCR). Read More

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Evaluation of glycemic control in critically ill patients with bacteremia: a retrospective, single-center cohort study.

J Investig Med 2022 May 17. Epub 2022 May 17.

Department of Pharmacy, UF Health Jacksonville, Jacksonville, Florida, USA

Dysglycemia is a common complication in hospitalized patients and has been suggested to play a significant role in the pathology and virulence of patients with bacteremia. The literature evaluating this relationship in critically ill patients, however, is limited. This retrospective, single-center cohort study aimed to investigate the relationship of glycemic control with 28-day intensive care unit (ICU)-free days in critically ill patients with bacteremia. Read More

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Non-invasive ventilation for acute hypoxaemic respiratory failure: a propensity-matched cohort study.

BMJ Open Respir Res 2022 May;9(1)

Department of Respiratory Medicine and Respiratory Research Unit, Waikato Hospital, Hamilton, New Zealand.

Background: Non-invasive ventilation (NIV), although effective in treating hypercapnic respiratory failure, has not demonstrated the same efficacy in treating acute hypoxaemic respiratory failure. We aimed to examine the effect of NIV use on ventilator-free days in patients with acute hypoxaemic respiratory failure admitted to the intensive care unit (ICU).

Methods: We conducted a retrospective study of patients admitted to the ICU with acute hypoxaemic respiratory failure at Waikato Hospital, New Zealand, from 1 January 2009 to 31 December 2018. Read More

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Gender-Specific Care for Women in Psychiatric Units.

J Am Acad Psychiatry Law 2022 May 17. Epub 2022 May 17.

Dr. Alvarez-Toro is Adult and Forensic Psychiatrist, Associate Director at The Forensic Psychiatry Fellowship Program, Saint Elizabeths Hospital, Washington, DC.

Structural inequalities in health care often result in female patients' not receiving care tailored to their needs. Women with mental illness in the peripartum period are no exception. Caan and colleagues delve into the benefits of breastfeeding in psychiatric units, highlighting the scarcity of appropriate resources due to the lack of mother-baby units in the United States. Read More

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High-Frequency Percussive Ventilation in Viral Bronchiolitis.

Respir Care 2022 May 17. Epub 2022 May 17.

Department of Pediatrics, Division of Pediatric Critical Care, University of Missouri, Columbia, Missouri.

Background: High-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that has been shown to improve gas exchange in subjects with severe respiratory failure. We hypothesized that HFPV use would improve ventilation and oxygenation in intubated children with acute bronchiolitis.

Methods: In this single-center prospective cohort study we included mechanically ventilated children in the pediatric ICU with bronchiolitis 1-24 months old who were transitioned to HFPV from conventional invasive mechanical ventilation from November 2018-April 2020. Read More

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Reliability of Central Venous Blood Gas Values Compared With Arterial Blood Gas Values in Critically Ill Patients.

Respir Care 2022 May 17. Epub 2022 May 17.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Central venous blood gas (cVBG) values are correlated with arterial blood gas (ABG) values. However, the substitution of cVBG values for ABG values in critically ill patients remains uninvestigated. Thus, we investigated the reliability between cVBG and ABG values and sought to define the conditions that could improve the reliability of cVBG values as a substitute. Read More

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