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The Role of Apolipoprotein E ε4 in Early and Late Mild Cognitive Impairment.

Eur Neurol 2021 Aug 2:1-9. Epub 2021 Aug 2.

General Medical Wards, The Affiliated Children's Hospital of Chongqing Medical University, Chongqing, China.

Background: Apolipoprotein E (APOE) ε4 is highly associated with mild cognitive impairment (MCI). However, the specific influence of APOE ε4 status on tau pathology and cognitive decline in early MCI (EMCI) and late MCI (LMCI) is poorly understood. Our goal was to evaluate the association of APOE ε4 with cerebrospinal fluid (CSF) tau levels and cognition in EMCI and LMCI patients in the Alzheimer's Disease Neuroimaging Initiative database, and whether this association was mediated by amyloid-β (Aβ). Read More

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Larotrectinib in a Patient With Advanced Pleomorphic Liposarcoma of the Uterus.

J Natl Compr Canc Netw 2021 Jul 28;19(7):775-779. Epub 2021 Jul 28.

3Division of Medical Oncology, The Ohio State University Wexner Medical Center and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio.

Pleomorphic liposarcoma of the uterus (PLU) is an extremely rare disease with poor prognosis. Limited treatment options exist for these patients, and disease recurrence usually occurs rapidly within months of initial diagnosis. Few case reports of metastatic PLU are available in the literature. Read More

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Mammographic and sonographic findings in the breast and axillary tail following a COVID-19 vaccine.

Clin Imaging 2021 Jul 26;80:202-204. Epub 2021 Jul 26.

Mayo Clinic, Department of Breast Imaging and Intervention, Rochester, MN, United States of America. Electronic address:

Axillary lymphadenopathy on breast imaging after recent coronavirus disease 2019 (COVID-19) vaccination has been reported in the literature as immunization has become more widespread. While muscle edema at the injection site has been observed on MRI secondary to an immune response, ipsilateral breast imaging observations of edema have not been reported to be seen with the COVID-19 vaccinations to date. Mammographic findings such as trabecular and skin thickening, along with increased echogenicity on ultrasound, can be seen with edema secondary to capillary leak or poor lymphatic drainage, and should be considered as a possible etiology for the observed breast edema following a recent COVID-19 vaccine. Read More

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Self-efficacy, coping strategies and quality of life in women and men requiring assisted reproductive technology treatments for anatomical or non-anatomical infertility.

Eur J Obstet Gynecol Reprod Biol 2021 Jul 21;264:241-246. Epub 2021 Jul 21.

Infertility and IVF Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; University of Bologna - DIMEC, Bologna, Italy.

Objective: To examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility.

Study Design: Cross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Read More

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Cost-effectiveness of point-of-care creatinine testing to assess kidney function prior to contrast-enhanced computed tomography imaging.

Eur J Radiol 2021 Jul 27;142:109872. Epub 2021 Jul 27.

Centre for Health Economics, University of York, Heslington, UK.

Background: Patients undergoing contrast-enhanced computed tomography (CECT) imaging in a non-emergency outpatient setting often lack a recent estimated Glomerular Filtration Rate measurement. This may lead to inefficiencies in the CECT pathway. The use of point-of-care (POC) creatinine tests to evaluate kidney function in these patients may provide a safe and cost-effective alternative to current practice, as these can provide results within the same CECT appointment. Read More

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MYC, BCL2, and BCL6 expression as prognostic indicators in primary central nervous system lymphoma: A systematic review and meta-analysis.

Clin Neurol Neurosurg 2021 Jul 22;208:106838. Epub 2021 Jul 22.

Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin 300350, China. Electronic address:

Background: We conducted a meta-analysis to comprehensively assess the predictive role of MYC, BCL2, and BCL6 genetic alterations and protein expression in PCNSL for clinical application.

Methods: A systematic retrieval was performed on PubMed, Embase, the Cochrane library, Web of Science, Scopus, and 2 Chinese databases. Cohort studies discussing the prognostic impact of MYC, BCl2, or BCL6 genetic alterations or gene expression in PCNSL were selected. Read More

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Immune environment of the brain in schizophrenia and during the psychotic episode: a human post-mortem study.

Brain Behav Immun 2021 Jul 30. Epub 2021 Jul 30.

Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine University of Southampton, Southampton, UK. Electronic address:

A causal relationship between immune dysregulation and schizophrenia has been supported by genome-wide association studies and epidemiological evidence. It remains unclear to what extent the brain immune environment is implicated in this hypothesis. We investigated the immunophenotype of microglia and the presence of perivascular macrophages and T lymphocytes in post-mortem brain tissue. Read More

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Prognostic and clinicopathological significance of TMEFF2, SMOC-2, and SOX17 expression in endometrial carcinoma.

Exp Mol Pathol 2021 Jul 30:104670. Epub 2021 Jul 30.

Department of Gynecology and Obstetrics, Faculty of Medicine, Zagazig University, Egypt.

Background there is a need for novel biomarkers and targeting therapies for predicting Endometrial carcinoma (EC) progression and recurrence. TMEFF2 is a gene that was found to play a role in EMT. SMOC-2 is expressed in embryogenesis and it was identified as a recent stem cell-related gene that has a role in cancer progression. Read More

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Optimal Noninvasive Medicare Access Promotion: Patients with Thoracic Restrictive Diseases A Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.

Chest 2021 Jul 28. Epub 2021 Jul 28.

Northwestern University, Chicago, IL.

The existing coverage criteria for Non-Invasive Ventilation (NIV) do not recognize the benefits of early initiation of NIV for those with Thoracic Restrictive Disease (TRD) and do not address the unique needs for daytime support as the patient's progress to ventilator dependence. This document summarizes the work of the Thoracic Restrictive Disease Technical Expert Panel working group. The most pressing current coverage barriers identified were: 1) Delays in implementing NIV treatment 2) Lack of coverage for many non-progressive Neuro-Muscular Disease (NMD) and 3) Lack of clear policy indications for Home -Mechanical Ventilation (HMV) Support in TRD. Read More

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Optimal Noninvasive Medicare Access Promotion: Patients with Central Sleep Apnea A Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.

Chest 2021 Jul 28. Epub 2021 Jul 28.

Department of Medicine, Veterans Affairs Medical Center, Martinsburg, WV.

This document summarizes suggestions of the central sleep apnea (CSA) technical expert panel (TEP) working group. This paper shares our vision for bringing the right device to the right patient at the right time. For patients with CSA, current coverage criteria do not align with guideline treatment recommendations. Read More

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Executive Summary: Optimal Noninvasive Ventilation Medicare Access Promotion (ONMAP).

Chest 2021 Jul 28. Epub 2021 Jul 28.

University of California San Diego, La Jolla, CA.

The current national coverage determinations (NCDs) for noninvasive ventilation for patients with thoracic restrictive disorders (TRD), chronic obstructive pulmonary disease (COPD) and hypoventilation syndromes (HS) were formulated in 1998. New original research, updated formal practice guidelines, and current consensus expert opinion have accrued that are in conflict with the existing NCDs. Some inconsistencies in the NCDs have been noted, and diagnostic and therapeutic technology has also advanced in the last quarter century. Read More

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Optimal Noninvasive Medicare Access Promotion: Patients with COPD Technical Expert Panel Report from the American College of Chest Physicians, the American Association for Respiratory Care, the American Academy of Sleep Medicine, and the American Thoracic Society.

Chest 2021 Jul 28. Epub 2021 Jul 28.

National Jewish Health, Denver, CO.

This document summarizes the work of the Chronic Obstructive Pulmonary Disease (COPD) Technical Expert Panel working group. For patients with COPD, the most pressing current coverage barriers identified were onerous diagnostic requirements focused on oxygenation (rather than ventilation), and difficulty obtaining bilevel devices with backup rate capabilities. Because of these difficulties, many patients with COPD were instead sometimes prescribed home mechanical ventilators. Read More

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A Structured Program Maximizes Benefit of Lung Cancer Screening in an Area of Endemic Histoplasmosis.

Ann Thorac Surg 2021 Jul 30. Epub 2021 Jul 30.

University of Cincinnati, Department of Surgery, Division of Thoracic Surgery, Cincinnati, OH, USA. Electronic address:

Background: Lung cancer screening with low-dose computed tomography has demonstrated at least a 20% decrease in lung cancer-specific mortality, but has the potential harm of unnecessary invasive procedures due to false positive results. We report the outcomes of a structured multi-disciplinary lung cancer screening program in an area of endemic histoplasmosis.

Methods: A retrospective review of patients undergoing lung cancer screening from December 2012 to March 2019 was conducted. Read More

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Elective nodal radiotherapy in prostate cancer.

Lancet Oncol 2021 Aug;22(8):e348-e357

Department of Radiation Oncology, Gustave Roussy Institute, Paris, France.

In patients with prostate cancer who have a high risk of pelvic nodal disease, the use of elective whole pelvis radiotherapy is still controversial. Two large, randomised, controlled trials (RTOG 9413 and GETUG-01) did not show a benefit of elective whole pelvis radiotherapy over prostate-only radiotherapy. In 2020, the POP-RT trial established the role of elective whole pelvis radiotherapy in patients who have more than a 35% risk of lymph node invasion (known as the Roach formula). Read More

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Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials.


Lancet Oncol 2021 Aug;22(8):1139-1150

Background: Trastuzumab targets the extracellular domain of the HER2 protein. Adding trastuzumab to chemotherapy for patients with early-stage, HER2-positive breast cancer reduces the risk of recurrence and death, but is associated with cardiac toxicity. We investigated the long-term benefits and risks of adjuvant trastuzumab on breast cancer recurrence and cause-specific mortality. Read More

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Pertuzumab and trastuzumab for HER2-positive, metastatic biliary tract cancer (MyPathway): a multicentre, open-label, phase 2a, multiple basket study.

Lancet Oncol 2021 Jul 30. Epub 2021 Jul 30.

Sarah Cannon Research Institute, Nashville, TN, USA; Tennessee Oncology, Nashville, TN, USA.

Background: Systemic therapies for metastatic biliary tract cancers are few, and patients have a median overall survival of less than 1 year. MyPathway evaluates the activity of US Food and Drug Administration-approved therapies in non-indicated tumours with potentially actionable molecular alterations. In this study, we present an analysis of patients with metastatic biliary tract cancers with HER2 amplification, overexpression, or both treated with a dual anti-HER2 regimen, pertuzumab plus trastuzumab, from MyPathway. Read More

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Feasibility of long-term home noninvasive ventilation program in a general pediatric unit: 21 years' experience in Hong Kong.

Pediatr Pulmonol 2021 Aug 2. Epub 2021 Aug 2.

Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR.

Background: Long-term home noninvasive ventilation (NIV) is increasingly employed in children with sleep-disordered breathing and chronic respiratory failure. While studies suggest its successful implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades. Read More

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Anti-Glomerular Basement Membrane Disease (Goodpasture Disease): From Pathogenesis to Plasma Exchange to IdeS.

Ther Apher Dial 2021 Aug 2. Epub 2021 Aug 2.

Department of Medicine, University of Cambridge, Cambridge, United Kingdom.

Anti-glomerular basement membrane (GBM) disease (Goodpasture disease) often presents with severe kidney failure and pulmonary hemorrhage. Anti-GBM antibodies are pathogenic, and other autoantibodies such as laminin-521 have been identified recently, potentially indicating a subset with a more severe disease phenotype and poor prognosis. Around 30-40% of patients are also anti-neutrophil cytoplasmatic antibody (ANCA)-positive and this subset combines features of anti-GBM disease and ANCA-associated vasculitis, with particular impact on long-term treatment. Read More

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SHARPIN regulates the development of clear cell renal cell carcinoma via promoting pVHL ubiquitination and degradation.

Yin Rusha Shuai Liu

Cancer Sci 2021 Aug 2. Epub 2021 Aug 2.

Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China.

SHANK-associated RH domain interacting protein (SHARPIN) plays an important role in carcinogenesis, as well as inflammation and immunity. Our study explored the effects and underlying mechanisms of SHARPIN in clear cell renal cell carcinoma (ccRCC). By analyzing the TCGA database, we found that upregulated SHARPIN in patients with ccRCC led to a poor prognosis. Read More

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Integrated care pathways in neurosurgery: A systematic review.

PLoS One 2021 2;16(8):e0255628. Epub 2021 Aug 2.

Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.

Introduction: Integrated care pathways (ICPs) are a pre-defined framework of evidence based, multidisciplinary practice for specific patients. They have the potential to enhance continuity of care, patient safety, patient satisfaction, efficiency gains, teamwork and staff education. In order to inform the development of neurosurgical ICPs in the future, we performed a systematic review to aggregate examples of neurosurgical ICP, to consider their impact and design features that may be associated with their success. Read More

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Patterns of T and B cell responses to Mycobacterium tuberculosis membrane-associated antigens and their relationship with disease activity in rheumatoid arthritis patients with latent tuberculosis infection.

PLoS One 2021 2;16(8):e0255639. Epub 2021 Aug 2.

Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.

This study was aimed at exploring whether latent tuberculosis infection (LTBI) contributes to the pathogenesis of immune-mediated inflammatory diseases in a TB endemic setting. We screened 198 rheumatoid arthritis (RA) patients with tuberculin skin test (TST) and studied 61 (median DAS28-ESR = 6.3) who were positive. Read More

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Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study.

PLoS Med 2021 Aug 2;18(8):e1003708. Epub 2021 Aug 2.

Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom.

Background: The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD).

Methods And Findings: Using data from The Health Improvement Network (THIN) in the United Kingdom (2000-2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490). Read More

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Clinical Usefulness of Nested Reverse-Transcription Polymerase Chain Reaction for the Diagnosis of Severe Fever with Thrombocytopenia Syndrome.

Am J Trop Med Hyg 2021 Aug 2. Epub 2021 Aug 2.

Department of Internal Medicine, Chosun University, Gwangju, South Korea.

Severe fever with thrombocytopenia syndrome (SFTS), caused by SFTS virus (SFTSV) is an emerging tick-borne infectious disease. Few studies have assessed the clinical usefulness of nested reverse-transcription polymerase chain reaction (RT-PCR) for diagnosing SFTS. We performed conventional RT-PCR targeting the M segment, nested RT-PCR targeting M and S segments, and real-time RT-PCR targeting the S segment of SFTSV for four patients with suspected SFTS. Read More

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Chikungunya Fever in Southern Thailand, 2018.

Am J Trop Med Hyg 2021 Aug 2. Epub 2021 Aug 2.

Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Infection by the mosquito-borne chikungunya virus (CHIKV) causes acute febrile illness and debilitating arthralgia. Outbreaks are sometimes not recognized because of its clinical resemblance to the more common dengue fever ubiquitous in tropical countries. An upsurge of dengue-like illness was reported in Satun province located in southern Thailand during the rainy season in 2018. Read More

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Adipocytes are larger in lymphedematous extremities than in controls.

J Plast Surg Hand Surg 2021 Aug 2:1-8. Epub 2021 Aug 2.

Department of Clinical Sciences, Lund University, Malmö, Sweden.

Lymphedema is caused by dysfunctional lymph vessels or as a complication of cancer treatment leading to edema and adipose tissue deposition. One hypothesis is that adipocyte hypertrophy contributes to the volume increase in lymphedema. The aim of the study was to compare adipocyte size in arm and leg lymphedema and controls. Read More

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Population pharmacokinetics and dosing optimization of vancomycin in infants, children and adolescents with augmented renal clearance.

Antimicrob Agents Chemother 2021 Aug 2:AAC0089721. Epub 2021 Aug 2.

Department of Clinical Pharmacy, Clinical Trial Center, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China.

Augmented renal clearance (ARC) can cause underexposure to vancomycin, thereby increasing the risk of treatment failure. Our objective was to evaluate population pharmacokinetics and optimize the dosing regimen of vancomycin in the pediatric population with ARC. Sparse pharmacokinetic sampling and therapeutic drug monitoring (TDM) data were collected from pediatric patients with ARC treated with vancomycin. Read More

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Rehabilitative Exercise Training for Burn Injury.

Sports Med 2021 Aug 2. Epub 2021 Aug 2.

KBR, Human Physiology, Performance, Protection and Operations Laboratory, NASA Johnson Space Center, 2101 NASA Parkway, Houston, TX, 77058, USA.

Due to improvements in acute burn care over the last few decades, most patients with severe burns (up to 90% of the total body surface) survive. However, the metabolic and cardiovascular complications that accompany a severe burn can persist for up to 3 years post injury. Accordingly, there is now a greater appreciation of the need for strategies that can hasten recovery and reduce long-term morbidity post burn. Read More

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NSAIDs and COVID-19: A Systematic Review and Meta-analysis.

Drug Saf 2021 Aug 2. Epub 2021 Aug 2.

Bordeaux PharmacoEpi, Inserm CIC 1401, University of Bordeaux, 146 rue Leo Saignat, 33076, Bordeaux, France.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been discouraged for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, fearing that they could increase the risk of infection or the severity of SARS-CoV-2.

Methods: Original studies providing information on exposure to NSAIDs and coronavirus disease 2019 (COVID-19) outcomes were retrieved and were included in a descriptive analysis and a meta-analysis with Cochrane Revue Manager (REVMAN 5.4), using inverse variance odds ratio (OR) with random- or fixed-effects models. Read More

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Time Trend of the Sensitivity of the Pneumococcal Urinary Antigen Test for Diagnosing Pneumococcal Community-Acquired Pneumonia: An Analysis of 15-Year, Prospective Cohort Data.

Infect Dis Ther 2021 Aug 2. Epub 2021 Aug 2.

Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.

Introduction: Whether the sensitivity of the BinaxNOW Streptococcus pneumoniae urinary antigen test kit (BinaxNOW), adjusted by some variables including vital signs, laboratory examinations and pneumonia severity, has been decreasing is unknown. The aim of the present study was to investigate whether BinaxNOW sensitivity has decreased recently and to identify the predictors of the BinaxNOW result, including the time trend.

Methods: This prospective cohort study enrolled consecutive patients with pneumococcal community-acquired pneumonia who were hospitalised at Kurashiki Central Hospital from January 2001 to December 2015. Read More

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