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Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society.

Anaesthesia 2021 May 13. Epub 2021 May 13.

Health and Safety Executive.

The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Read More

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High-dose hypofractionated pencil beam scanning carbon ion radiotherapy for lung tumors: Dosimetric impact of different spot sizes and robustness to interfractional uncertainties.

Phys Med 2021 May 10;85:79-86. Epub 2021 May 10.

CNAO, National Center for Oncological Hadrontherapy, Strada Campeggi 53, I-27100 Pavia, Italy.

Purpose: The robustness against setup and motion uncertainties of gated four-dimensional restricted robust optimization (4DRRO) was investigated for hypofractionated carbon ion radiotherapy (CIRT) of lung tumors.

Methods: CIRT plans of 9 patients were optimized using 4DRRO strategy with 3 mm setup errors, 3% density errors and 3 breathing phases related to the gate window. The prescription was 60 Gy(RBE) in 4 fractions. Read More

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Hybrids between HS-donors and betamethasone 17-valerate or triamcinolone acetonide inhibit mast cell degranulation and promote hyperpolarization of bronchial smooth muscle cells.

Eur J Med Chem 2021 May 5;221:113517. Epub 2021 May 5.

Department of Pharmacy, University of Naples «Federico II», Via D. Montesano 49, Naples, Italy. Electronic address:

Glucocorticoids represent the standard gold treatment of inflammation in asthmatic patients. More recently, HS has been described to exert positive effect on this disease. Bearing in mind that an improved pharmacological activity and a reduced toxicity can be obtained through hybridization of different molecules, simultaneously modulating multiple targets, we designed and synthesized novel betamethasone 17-valerate and triamcinolone acetonide hybrids with well-known HS-donor moieties. Read More

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Lack of prognostic impact of sentinel node micro-metastases in endocrine receptor-positive early breast cancer: results from a large multicenter cohort.

ESMO Open 2021 May 10;6(3):100151. Epub 2021 May 10.

Department of Medical Oncology, CRCM, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.

Background: Prognostic impact of lymph node micro-metastases (pN1mi) has been discordantly reported in the literature. The need to clarify this point for decision-making regarding adjuvant therapy, particularly for patients with endocrine receptor (ER)-positive status and HER2-negative tumors, is further reinforced by the generalization of gene expression signatures using pN status in their recommendation algorithm.

Patients And Methods: We retrospectively analyzed 13 773 patients treated for ER-positive breast cancer in 13 French cancer centers from 1999 to 2014. Read More

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Quantitative assessment of lung involvement on chest CT at admission: Impact on hypoxia and outcome in COVID-19 patients.

Clin Imaging 2021 Apr 29;77:194-201. Epub 2021 Apr 29.

Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.

Background: The aim of this study was to quantify COVID-19 pneumonia features using CT performed at time of admission to emergency department in order to predict patients' hypoxia during the hospitalization and outcome.

Methods: Consecutive chest CT performed in the emergency department between March 1st and April 7th 2020 for COVID-19 pneumonia were analyzed. The three features of pneumonia (GGO, semi-consolidation and consolidation) and the percentage of well-aerated lung were quantified using a HU threshold based software. Read More

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Polymorphism of the DNA repair gene XDP increases the risk of systemic lupus erythematosus but not multiple sclerosis in the Iranian population.

Mult Scler Relat Disord 2021 Apr 28;52:102985. Epub 2021 Apr 28.

Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Background: Xeroderma pigmentosum group D ( XPD ) is an essential component of the nucleotide excision repair (NER) pathway, which can play a major role in DNA repair processes. A deficiency in this pathway was suggested as a causative factor of autoimmune diseases. Therefore, the current study aimed to investigate the relationship between XPD Lys751Gln polymorphism (rs13181) as one of the most common XDP polymorphisms and the risk of two important auto-immune diseases,namely systemic lupus erythematosus (SLE) and multiple sclerosis (MS) in the Iranian population. Read More

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Natalizumab differentially affects plasmablasts and B cells in multiple sclerosis.

Mult Scler Relat Disord 2021 May 1;52:102987. Epub 2021 May 1.

Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark. Electronic address:

Background: Natalizumab treatment increases the frequencies of B cells in blood but reduces IgG in blood and CSF. Plasmablasts are important in the production of IgG, and the development of plasmablasts is CD49d dependent.

Objective: We hypothesized that natalizumab treatment affects the development of plasmablasts. Read More

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Clinical implications of panic attack in Chinese patients with somatoform disorders.

J Psychosom Res 2021 May 10;146:110509. Epub 2021 May 10.

Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address:

Objective: Somatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder.

Methods: In this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M. Read More

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Functional independence measure predicts the outcome of clean intermittent catheterization training in patients with multiple sclerosis.

Ann Phys Rehabil Med 2021 May 10:101539. Epub 2021 May 10.

Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France.

Background: Clean intermittent catheterization (CIC) is the reference treatment of urinary retention in people with multiple sclerosis (pwMS). Predicting which patients could use this treatment, based on their motor and cognitive abilities, is crucial.

Objectives: To determine whether the Functional Independence Measure (FIM), used to assess degree of disability, can predict the outcome of CIC training in pwMS. Read More

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Risk of acute lung injury after esophagectomy.

Semin Thorac Cardiovasc Surg 2021 May 10. Epub 2021 May 10.

Division of Thoracic Surgery, Department of Surgery, Affiliated Hospital of Qingdao University, Qingdao, China; Surgery, Health management center, Affiliated Hospital of Qingdao University, Qingdao, China.

To develop a new approach for identifying acute lung injury (ALI) in surgical ward setting and to assess incidence rate, clinical outcomes, and risk factors for ALI cases after esophagectomy. We also compare the degree of lung injury between operative and non-operative sides. Consecutive esophageal cancer patients (n=1022) who underwent esophagectomy from Dec 2012 to Nov 2018 in our hospital were studied. Read More

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Prevalence, predictors and correlates of religious and spiritual struggles in palliative cancer patients.

J Pain Symptom Manage 2021 May 10. Epub 2021 May 10.

Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois.

Context: Religion and spirituality (r/s) are important resources in coping with cancer. However, there are aspects of r/s, such as religious and spiritual struggles, found to be associated with poorer outcomes. A new measure has been adapted from the Religious and Spiritual Struggles Scale (RSS) to assess r/s struggles: the RSS-14. Read More

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Are extracapsular and intracapsular hip-fracture patients two distinct rehabilitation subpopulations?

Disabil Rehabil 2021 May 13:1-6. Epub 2021 May 13.

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Purpose: To assess whether intracapsular and extracapsular hip fracture patients in a post-acute rehabilitation setting differ in their background characteristics and whether fracture type affects rehabilitation outcome.

Methods: A retrospective cohort study.

Outcome Measures: Functional Independence Measure (FIM), motor FIM (mFIM), mFIM effectiveness, length of stay (LOS), and discharge destination. Read More

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Effects of Short-Term Air Pollution Exposure on Venous Thromboembolism: A Case-Crossover Study.

Ann Am Thorac Soc 2021 May 13. Epub 2021 May 13.

University of Utah, Pulmonary and Critical Care Medicine, Salt Lake City, Utah, United States.

Rationale: Exposure to outdoor air pollution is associated with increased cardiovascular disease, respiratory illness, and mortality. The effect of air pollution on venous thromboembolism (VTE) is less certain.

Objectives: To test for associations between short-term exposure to air pollution and VTE. Read More

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Facial Diplegia as a Rare Late Neurologic Manifestation of SARS-CoV-2 Infection.

J Neurol Res 2020 Dec 9;10(6):235-236. Epub 2020 Dec 9.

Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.

Multiple recent publications have reported numerous neurologic complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Among these is Guillain-Barre syndrome and its variants, including facial diplegia. In this case we present a patient with facial diplegia following a confirmed SARS-CoV-2 infection. Read More

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December 2020

SARS-CoV-2 and Nervous System - Neurological Manifestations in Patients With COVID-19: A Systematic Review.

J Neurol Res 2020 Aug 30;10(4):113-121. Epub 2020 Jun 30.

Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil.

Coronavirus (CoV) is a virus infectious disease with a considerable spectrum of clinical presentations. Symptoms ranged from asymptomatic infection to severe pneumonia that may lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and several clinical complications. Neurologic symptoms related to CoV have been described recently in the literature. Read More

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Pulmonary Embolism in COVID-19 and the Unanswered Questions.

J Med Cases 2020 Jun 28;11(6):174-177. Epub 2020 May 28.

Northwestern Medicine Hospital, Mchenry, IL, USA.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ravaged the global society as we know it. As almost a dozen pharmaceutical agents go into randomized controlled clinical trials, multiple studies have surfaced trying to associate a hypercoagulable state to coronavirus disease 2019 (COVID-19) patients. We report two COVID-19 cases who presented with occlusive pulmonary embolism (PE) strongly supporting a hypercoagulable state incurred by SARS-CoV-2. Read More

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COVID-19 Pneumonia or Hypereosinophilic Syndrome?

J Med Cases 2020 Dec 21;11(12):400-402. Epub 2020 Oct 21.

Deparment of Internal Medicine and Hematology, Liv Hospital ULUS, Istanbul, Turkey.

Hypereosinophilic syndromes (HESs) are a group of disorders characterized by pathological proliferation of eosinophils. Diagnostic criteria include eosinophil count of 1,500/mm or higher, presence of organ involvement and exclusion of other causes of eosinophilia for at least 6 months. A 69-year-old male patient was referred to the pandemic clinic with a preliminary diagnosis of coronavirus disease 2019 (COVID-19) with fever and dyspnea. Read More

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December 2020

Phenome-wide association of 1809 phenotypes and COVID-19 disease progression in the Veterans Health Administration Million Veteran Program.

PLoS One 2021 13;16(5):e0251651. Epub 2021 May 13.

Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America.

Background: The risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death.

Methods And Results: We included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). Read More

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Common genetic variants associated with obesity in an African-American and Hispanic/Latino population.

PLoS One 2021 13;16(5):e0250697. Epub 2021 May 13.

Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America.

Introduction: Over 35% of all adults in the world are currently obese and risk of obesity in racial or ethnic minority groups exist in the US, but the causes of these differences are not all known. As obesity is a leading cause of cardiovascular disease, an improved understanding of risk factors across racial and ethnic groups may improve outcomes.

Objective: The objective of this study was to determine if susceptibility to obesity is associated with genetic variation in candidate single nucleotide polymorphisms (SNPs) in African Americans and Hispanic/Latinos. Read More

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Rates of delayed hemolytic transfusion reactions observed in a trauma center.

Transfusion 2021 May 13. Epub 2021 May 13.

Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA.

Background: Delayed hemolytic transfusion reactions (DHTRs) are reported to be rare occurrences but may be more frequently observed in the trauma setting where patients are heavily transfused, followed over long inpatient admissions, and have frequent subsequent blood counts as they undergo multiple surgical interventions.

Study Design And Methods: We examined the rates of DHTRs on a per transfusion and per patient basis in an academic county hospital with a level 1 trauma center serving a four-state region and over a 3-year period. DHTRs were entered sequentially into a registry as they were observed, and a retrospective review of all new alloantibodies detected was performed to identify any additional DHTRs. Read More

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Targeting Sphingosine-1-Phosphate Signaling in Immune-Mediated Diseases: Beyond Multiple Sclerosis.

Drugs 2021 May 13. Epub 2021 May 13.

San Diego VA Medical Center (SDVAMC), San Diego, CA, USA.

Sphingosine-1-phosphate (S1P) is a bioactive lipid metabolite that exerts its actions by engaging 5 G-protein-coupled receptors (S1PR1-S1PR5). S1P receptors are involved in several cellular and physiological events, including lymphocyte/hematopoietic cell trafficking. An S1P gradient (low in tissues, high in blood), maintained by synthetic and degradative enzymes, regulates lymphocyte trafficking. Read More

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Predicting rapid progression phases in glaucoma using a soft voting ensemble classifier exploiting Kalman filtering.

Health Care Manag Sci 2021 May 13. Epub 2021 May 13.

Kellogg Eye Institute, Ann Arbor, MI, 48105, USA.

In managing patients with chronic diseases, such as open angle glaucoma (OAG), the case treated in this paper, medical tests capture the disease phase (e.g. regression, stability, progression, etc. Read More

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Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn's disease: a case report.

Surg Case Rep 2021 May 13;7(1):122. Epub 2021 May 13.

Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.

Background: The improved prognosis of Crohn's disease may increase the opportunities of surgical treatment for patients with Crohn's disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn's disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally.

Case Presentation: A 51-year-old man had been diagnosed with Crohn's disease 35 years earlier and had undergone several operations for treatment of Crohn's colitis. Read More

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Progress in the Management of Smoldering Multiple Myeloma.

Curr Hematol Malig Rep 2021 May 13. Epub 2021 May 13.

University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 3792, USA.

Purpose Of Review: Smoldering multiple myeloma (SMM) is defined as an asymptomatic clonal proliferation of pre-malignant plasma cells and an increased risk of progression to multiple myeloma (MM) relative to monoclonal gammopathy of undetermined significance. Whether patients with SMM should be treated prior to development of symptomatic disease is fiercely debated and is a highly active area of research.

Recent Findings: The ECOG E3A06 study demonstrated that early treatment with lenalidomide significantly reduced the risk of progression to MM compared to observation in patients with high risk SMM. Read More

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Exploration of current dietetic practices for patients with gynaecological cancers undergoing radiotherapy in Australia: a cross-sectional survey.

Support Care Cancer 2021 May 13. Epub 2021 May 13.

School of Human Movement and Nutrition Sciences, The University of Queensland, Level 2, Connell Building, St Lucia, Brisbane, QLD, 4072, Australia.

Purpose: Radiotherapy for gynaecological cancers often causes gastrointestinal (GI) toxicities such as diarrhoea. Evidence for the potential benefits of dietary interventions on the management of acute GI toxicities is inconclusive and of low quality, with no clear evidence-based guidelines to inform clinical practice. This study aims to provide an overview of current opinions and clinical practice of dietitians treating this cohort and to examine existing models of nutrition care in Australian cancer centres. Read More

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Trimethylamine N-Oxide, a Gut Microbiota-Derived Metabolite, Is Associated with Cardiovascular Risk in Psoriasis: A Cross-Sectional Pilot Study.

Dermatol Ther (Heidelb) 2021 May 13. Epub 2021 May 13.

Department of Dermatology, Medical University of Warsaw, Koszykowa 82a, 02-008, Warsaw, Poland.

Introduction: Trimethylamine N-oxide (TMAO), a gut microbiota metabolite from dietary phosphatidylcholine, is involved in the pathogenesis of atherosclerosis and cardiovascular diseases. Psoriasis is associated with increased cardiovascular risk that is not captured by traditional biomarkers. The aim of the present study was to assess TMAO concentration in psoriasis and evaluate the relationship between TMAO and cardiovascular risk in psoriatic patients. Read More

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Triple Challenge: How Medical Students May Solve 3 Long-Standing Problems Bedeviling Health Systems and Medical Education.

Acad Med 2021 May 11. Epub 2021 May 11.

V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois. J. Jackson is a resident, Boston Children's Hospital and Boston Medical Center. S.A. Santen is senior associate dean and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, and consultant, American Medical Association, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-8327-8002. J. Richardson is director of research and evaluation, Medical Education Outcomes, American Medical Association, Chicago, Illinois. K. Heckman is director of product development, Medical Education Outcomes, American Medical Association, Chicago, Illinois. M.M. Hammoud is professor of obstetrics & gynecology and learning health sciences, Michigan Medicine, Ann Arbor, Michigan, and consultant, American Medical Association, Chicago, Illinois.

Medical education and the health system must address challenges that, despite significant effort, seem unsolvable. Health systems science (HSS)-the fundamental understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery-is increasingly being recognized as a potential source of solutions to these challenges. In this article, the authors review the 43 abstracts submitted to the American Medical Association Accelerating Change in Medical Education 2018 Health Systems Science Student Impact Competition that aligned with the goals of HSS. Read More

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Relevance of Anthropometric Measurements in a Multiethnic Obesity Cohort: Observational Study.

Interact J Med Res 2021 May 13;10(2):e27784. Epub 2021 May 13.

Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: The prevalence of obesity is increasing worldwide, and the Middle East is not an exception to this increasing trend. Obesity increases the risk of multiple metabolic complications, such as diabetes mellitus. Measurement of obesity has primarily relied on the BMI to identify risk; however, both bedside and office-based anthropometric measures of obesity can provide more detailed information on risk. Read More

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