45,065 results match your criteria secondary tertiary


Defining the risk profile of women with stage 1 hypertension: A time to event analysis.

Am J Obstet Gynecol MFM 2021 Apr 17:100376. Epub 2021 Apr 17.

Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO.

Background: Chronic hypertension complicates up to 5% of pregnancies and is increasing in prevalence. Women with hypertension have increased risks of serious maternal morbidity and mortality in pregnancy including the development of preeclampsia. In 2017, new guidelines reclassified blood pressure into four categories: normal (<120/<80 mmHg), elevated (120-129/<80 mmHg), stage 1 hypertension (130-139/80-89 mmHg), and stage 2 hypertension (>140/>90 mmHg). Read More

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Increased mortality in patients with standard EEG findings of 'diffuse slowing'.

Ann Clin Psychiatry 2021 May;33(2):93-100

Department of Psychiatry, Department of Neurosurgery, Department of Anesthesia, Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

Background: We aimed to confirm the association between slow brain wave activity typically described as "diffuse slowing" on standard electroencephalogram (EEG) and patient outcomes, including mortality.

Methods: This retrospective study was conducted with patient chart data from March 2015 to March 2017 at a tertiary care academic hospital in the midwestern United States. In total, 1,069 participants age ≥55 years on an inpatient floor or ICU received a standard 24-hour EEG. Read More

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A matter of size? Health-related quality of life after radical prostatectomy for patients with giant prostates.

Prostate 2021 Jun;81(8):443-451

Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.

Background: Evidence regarding the impact of giant prostate volume (PV) on outcome after radical prostatectomy (RP) is controversial with a lack of evidence on the impact of PV on health-related quality of life (HRQOL). We aimed to assess the impact of giant PV on HRQOL and functional outcomes for men with prostate cancer (PC) undergoing RP.

Methods: Giant PV was defined based on the 95th percentile of PV measured by specimen weight of 3929 patients that underwent RP between 2013 and 2018 in a large tertiary care center. Read More

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The PanSurg-PREDICT Study: Endocrine Surgery During the COVID-19 Pandemic.

World J Surg 2021 Apr 20. Epub 2021 Apr 20.

Department of Endocrine Surgery, Hammersmith Hospital, 72 Du Cane Rd, London, W12 0HS, UK.

Background: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice.

Methods: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. Read More

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Biological structure and function emerge from scaling unsupervised learning to 250 million protein sequences.

Proc Natl Acad Sci U S A 2021 Apr;118(15)

Department of Computer Science, New York University, New York, NY 10012.

In the field of artificial intelligence, a combination of scale in data and model capacity enabled by unsupervised learning has led to major advances in representation learning and statistical generation. In the life sciences, the anticipated growth of sequencing promises unprecedented data on natural sequence diversity. Protein language modeling at the scale of evolution is a logical step toward predictive and generative artificial intelligence for biology. Read More

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Exploring the non-covalent interactions behind the formation of amine-water complexes: the case of N-allylmethylamine monohydrate.

Phys Chem Chem Phys 2021 Mar 23;23(12):7368-7375. Epub 2021 Mar 23.

Department of Chemistry, University of Manitoba, Winnipeg, Manitoba R3T 2N2, Canada.

The conformational landscape of the monohydrated complex of N-allylmethylamine (AMA-w) was investigated for the first time using rotational spectroscopy from 8-20 GHz and quantum chemistry calculations. From a total of nine possible energy minima within 10 kJ mol, transitions for the two most stable conformers of AMA-w were detected, and assigned aided by DFT and ab initio MP2 predictions. The observed rotational transitions displayed characteristic hyperfine splittings due to the presence of the N quadrupolar nucleus. Read More

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STRUCTURAL ASPECTS OF THE PRIMARY TISSUES OF THE CUCURBITA PEPO L. ROOT WITH SPECIAL REFERENCE TO THE PHLOEM.

New Phytol 1986 Jan;102(1):175-192

Department of Botany, The Ohio State University, Columbus, Ohio 43210, USA.

The primary phloem and associated tissues in the root of Cucurbita pepo L. were examined by light and transmission electron microscopy to provide information on the feasibility of symplastic transport from the sieve-tube members to the cortex in this organ. The structure, distribution and frequency of cytoplasmic connections between the various cell types of the root are reported as well as the cytological characteristics of the various cells. Read More

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January 1986

Gestational Diabetes and Fetal Growth in Twin compared with Singleton Pregnancies.

Am J Obstet Gynecol 2021 Apr 16. Epub 2021 Apr 16.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

Background: Gestational diabetes (GDM) is associated with accelerated fetal growth in singleton pregnancies, but may impact twin pregnancies differently due to the slower growth of twin fetuses during the third trimester and their greater predisposition to fetal growth restriction.

Objective: To evaluate the association of GDM with longitudinal fetal growth in twin pregnancies, and to compare this association with that observed in singleton pregnancies STUDY DESIGN: This was a retrospective cohort study of all women with a singleton or twin pregnancy who were followed at single tertiary referral center between Jan-2011 and Apr-2020. Data on estimated fetal weight and individual fetal biometric indices were extracted from ultrasound exams of eligible women. Read More

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Evaluation of implementation of the primary, secondary and tertiary prevention measures of the Surveillance Program of Gestational and Congenital Toxoplasmosis in the city of Londrina-PR.

Transbound Emerg Dis 2021 Apr 19. Epub 2021 Apr 19.

Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina.

Toxoplasmosis acquired during pregnancy is one that can lead to death or malformations of the fetus and it is complex disease to diagnose. The objective of the study was to evaluate the Surveillance Program of Gestational and Congenital Toxoplasmosis. To assess primary prevention, 424 pregnant women were interviewed regarding their knowledge of prevention measures in 2019. Read More

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In silico Structural, Functional and Phylogenetic Analyses of cellulase from Ruminococcus albus.

J Genet Eng Biotechnol 2021 Apr 19;19(1):58. Epub 2021 Apr 19.

Department of Animal Sciences, Faculty of Agriculture and Environment, Agricultural University of Tirana, Koder Kamez, 1029, Tirana, Albania.

Background: Cellulose is the primary component of the plant cell wall and an important source of energy for the ruminant and microbial protein synthesis in the rumen. Cell wall content is digested by anaerobic fermentation activity mainly of bacteria belonging to species Fibrobacter succinogenes, Ruminicoccus albus, Ruminococcus flavefaciens, and Butyrivibrio fibrisolvens. Bacteria belonging to the species Ruminococcus albus contain cellulosomes that enable it to adhere to and digest cellulose, and its genome encodes cellulases and hemicellulases. Read More

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Hexameric Lanthanide-Organic Capsules with Tertiary Structure and Emergent Functions.

J Am Chem Soc 2021 Apr 19. Epub 2021 Apr 19.

State Key Laboratory of Structural Chemistry, Fujian Institute of Research on the Structure of Matter, Chinese Academy of Sciences, Fuzhou 350002, People's Republic of China.

Biological macromolecules always function through a collective behavior of the aggregated constituents, which usually are self-assembled together via noncovalent interactions. Likewise, artificial supramolecular assemblies, whose properties and functions are mainly derived from their primary and secondary structures, may also aggregate into high-order architectures with emergent functions not available on the individual components. Here we report the first example of an insulin-like hexamerization of lanthanide triple helicates toward a 4 nm diameter hexameric capsule via consecutive metal-directed and anion-directed assembly processes. Read More

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Improving Transitions of Care between the Intensive Care Unit and General Internal Medicine Ward. A Demonstration Study.

ATS Sch 2020 Jul 16;1(3):288-300. Epub 2020 Jul 16.

Interdepartmental Division of Critical Care and.

In-hospital transfers such as from the intensive care unit (ICU) to the general internal medicine (GIM) ward place patients at risk of adverse events. A structured handover tool may improve transitions from the ICU to the GIM ward. To develop, implement, and evaluate a customized user-designed transfer tool to improve transitions from the ICU to the GIM ward. Read More

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The degree and appropriateness of computed tomography utilization for diagnosis of headaches in Ghana.

Heliyon 2021 Apr 7;7(4):e06722. Epub 2021 Apr 7.

Department of Radiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.

Introduction: Headache is a common and sometimes debilitating medical condition. Patients presenting with no neurologic anomaly, nontraumatic primary headache require careful evaluation before neuroimaging. National Guidelines standardizing exploitation of Computed Tomography (CT), the most utilized imaging modality in this clinical scenario, has not been established in Ghana, a developing country with limited healthcare resources. Read More

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Tertiary peritonitis: A disease that should not be ignored.

World J Clin Cases 2021 Apr;9(10):2160-2169

Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil.

Intra-abdominal infections can be classified into uncomplicated or complicated (peritonitis). Peritonitis is divided into primary, secondary, and tertiary. Tertiary peritonitis is the less common but the most severe among peritonitis stratifications, being defined as a recurrent intra-abdominal infection that occurs 48 h after a well-succeeded control of a secondary peritonitis. Read More

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An algorithm for differentiating food antigen-related gastrointestinal symptoms.

Gastroenterol Hepatol Bed Bench 2021 ;14(1):8-16

Grigore T Popa" University of Medicine and Pharmacy, Iasi, Romania.

Aim: The aim of this clinical audit was to assess patient-reported outcomes on the effect of dietary intervention, to enhance our understanding of possible treatment options in irritable bowel syndrome (IBS).

Background: A large number of food-related gastro-intestinal disorders have been attributed to IBS for decades.

Methods: Patient-reported outcomes from the records of 149 IBS patients treated at secondary and tertiary Gastroenterology outpatients in two UK hospitals between January 2014 and July 2016 were audited. Read More

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January 2021

Maternal and fetal outcomes in pregnant females with rheumatic heart disease.

Indian Heart J 2021 Mar-Apr;73(2):185-189. Epub 2021 Jan 16.

Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Background: Cardiac diseases are seen in 1-3% of pregnancies. In developing countries rheumatic heart disease (RHD) contributes a major cause of cardiac disorders.

Objective: To study the maternal and fetal outcome in women with valvular heart disease or prosthetic heart valve replacement secondary to RHD in a tertiary care center. Read More

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January 2021

Carryover effects minimized the positive effects of treated wastewater on anuran development.

J Environ Manage 2021 Apr 16;289:112571. Epub 2021 Apr 16.

Department of Biology, University of the South, Sewanee, TN, 37383, USA.

Constructed wetlands (CWs) are a potential solution for wastewater treatment due to their capacity to support native species and provide tertiary wastewater treatment. However, CWs can expose wildlife communities to excess nutrients and harmful contaminants, affecting their development, morphology, and behavior. To examine how wastewater CWs may affect wildlife, we raised Southern leopard frogs, Lithobates sphenocephalus, in wastewater from conventional secondary lagoon and tertiary CW treatments for comparison with pondwater along with the presence and absence of a common plant invader to these systems - common duckweed (Lemna minor) - and monitored their juvenile development for potential carryover effects into the terrestrial environment. Read More

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Out-of-pocket expenditure for administration of benzathine penicillin G injections for secondary prophylaxis in patients with rheumatic heart disease: A registry-based data from a tertiary care center in Northern India.

Indian Heart J 2021 Mar-Apr;73(2):169-173. Epub 2020 Dec 7.

University of California San Francisco, San Francisco, CA, USA. Electronic address:

Background: Costs can be a major barrier to medication adherence in low and middle-income countries and are an important target for policy-level interventions. The use of benzathine penicillin G (BPG) for secondary prevention of rheumatic heart disease (RHD) averts substantial morbidity and mortality, yet the total out-of-pocket costs for patients receiving this intervention are unknown.

Objective: To estimate the total out-of-pocket costs for obtaining BPG prophylaxis among RHD patients in India. Read More

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December 2020

Teprotumumab for patients with active thyroid eye disease: a pooled data analysis, subgroup analyses, and off-treatment follow-up results from two randomised, double-masked, placebo-controlled, multicentre trials.

Lancet Diabetes Endocrinol 2021 Apr 15. Epub 2021 Apr 15.

Kellogg Eye Center-Michigan Medicine and University of Michigan, Ann Arbor, MI, USA.

Background: Thyroid eye disease manifests inflammation and treatment-resistant proptosis and diplopia. Teprotumumab, an insulin-like growth factor-1 receptor inhibiting monoclonal antibody, was approved in the USA on Jan 21, 2020, on the basis of two randomised trials. In this analysis we evaluated the short-term and long-term aggregate response to teprotumumab from the two trials, focusing on proptosis and diplopia. Read More

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Implementing practices focused on workplace health and psychological wellbeing: A systematic review.

Soc Sci Med 2021 Apr 1;277:113888. Epub 2021 Apr 1.

Employment Systems and Institutions Group, Norwich Business School, University of East Anglia, NR4 7TJ, United Kingdom.

Rationale: Workplace health and wellbeing practices (WHWPs) often fail to improve psychological health or wellbeing because of implementation failure. Thus, implementation should be evaluated to improve the effectiveness of WHWPs.

Objective: We conducted a systematic review to identify critical success factors for WHWP implementation and gaps in the evidence. Read More

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Internal cavity amplification of shell-like ferritin regulated with the change of the secondary and tertiary structure induced by PEF technology.

Int J Biol Macromol 2021 Apr 14. Epub 2021 Apr 14.

National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian 116034, PR China. Electronic address:

In this study, the effect of pulsed electric field (PEF) on apparent morphology and molecular structure of shell-like ferritin obtained from horse spleen was determined by circular dichroic (CD), fluorescence spectroscopy, Raman spectroscopy, cold field emission scanning electron microscopy (CF-SEM) and transmission electron microscopy (TEM), and verified by molecule dynamics (MD) simulation. After PEF treatment, the α-helix content of the samples reached a minimum value at 10 kV/cm, which indicated that the ferritin structure has been partially unfolded. However, the α-helix content peaked again after resting for 2 h at 25 ± 1 °C. Read More

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Prospective Inverse Probability of Treatment-Weighting Analysis of the Clinical Outcome of Red Blood Cell Transfusion Practice in Critically Ill Children.

Indian J Pediatr 2021 Apr 17. Epub 2021 Apr 17.

Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605 006, India.

Objective: To study the clinical outcomes of red blood cell (RBC) transfusion practices in critically ill children.

Method: This prospective cohort study was conducted in a tertiary care pediatric intensive care unit (PICU) from March-2015 to January-2018. Inverse probability of treatment weighting (IPTW) using propensity score analysis was used. Read More

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Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature.

CVIR Endovasc 2021 Apr 17;4(1):36. Epub 2021 Apr 17.

Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Background: Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment.

Methods: This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Read More

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Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery.

Int Urogynecol J 2021 Apr 17. Epub 2021 Apr 17.

Department of Surgery, Division of Colorectal Surgery, Stanford University School of Medicine, Stanford, CA, USA.

Introduction And Hypothesis: Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence.

Methods: A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Read More

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Impact of COVID-19 Governmental Restrictions on Emergency General Surgery Operative Volume and Severity.

Am Surg 2021 Apr 16:31348211011113. Epub 2021 Apr 16.

Department of Trauma, Critical Care, and General Surgery, 4352Mayo Clinic Rochester, MN, USA.

Background: To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years.

Methods: This retrospective cohort study compares patients who underwent emergency general surgery operations at a tertiary hospital from March 1st to May 31st of 2020 to 2019. Average emergent cases per day were analyzed, comparing identical date ranges between 2020 (pandemic group) and 2019 (control group). Read More

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Reductive Arylation of Aliphatic and Aromatic Aldehydes with Cyanoarenes by Electrolysis for the Synthesis of Alcohols.

Org Lett 2021 Apr 16. Epub 2021 Apr 16.

State Key Lab of Urban Water Resource and Environment, School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen, 518055, China.

An electroreductive arylation reaction of aliphatic and aromatic aldehydes as well as ketones with electro-deficient (hetero)arenes is described. A variety of cyano(hetero)arenes and carbonyl compounds, especially aliphatic aldehydes, have been examined, providing secondary and tertiary alcohols in moderate to good yields. Mechanistic studies, including cyclic voltammetry (CV), electron paramagnetic resonance (EPR), and divided-cell experiments, support the generation of aliphatic ketyl radicals and persistent heteroaryl radical anions via cathodic reduction followed by radical-radical cross-coupling. Read More

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An Innovative Model of Behavior Management to Address Behavioral Emergencies in the Acute Medical Inpatient Setting: Pilot Data.

J Clin Psychol Med Settings 2021 Apr 15. Epub 2021 Apr 15.

University of Virginia School of Medicine, Charlottesville, VA, USA.

Workplace violence in healthcare is a significant and costly problem. The majority of violent events that occur in the medical inpatient setting are perpetrated by patients against staff and occur during a behavioral emergency. The primary purpose of this study was to evaluate the impact of an innovative model of behavior management on occurrence of behavioral emergencies and staff comfort and competence in managing difficult patient behaviors. Read More

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Compensatory Transition of Bile Acid Metabolism from Fecal Disposition of Secondary Bile Acids to Urinary Excretion of Primary Bile Acids Underlies Rifampicin-Induced Cholestasis in Beagle Dogs.

ACS Pharmacol Transl Sci 2021 Apr 22;4(2):1001-1013. Epub 2021 Mar 22.

Key Laboratory of Drug Targeting and Drug Delivery System, Ministry of Education, West China School of Pharmacy, Sichuan University, No. 17 People's South Road, Chengdu 610041, China.

Drug induced cholestasis (DIC) is complexly associated with dysbiosis of the host-gut microbial cometabolism of bile acids (BAs). Murine animals are not suitable for transitional studies because the murine BA metabolism is quite different from human metabolism. In this work, the rifampicin (RFP) induced cholestasis was established in beagle dogs that have a humanlike BA profile to disclose how RFP affects the host-gut microbial cometabolism of BAs. Read More

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Risk Factors Associated with Preterm Delivery in Singleton Pregnancy in a Tertiary Care Hospital in South India: A Case Control Study.

Int J Womens Health 2021 9;13:369-377. Epub 2021 Apr 9.

Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, 682041, Kerala, India.

Background: Preterm delivery is a major obstetric complication and a leading cause of neonatal mortality and morbidity. It is also associated with significant costs in terms of psychological and financial hardship, to the families.

Objective: The primary objective of this study was to determine the risk factors associated with all preterm deliveries in singleton pregnancy in a tertiary care hospital and the secondary objective was to determine the fetal outcomes among women with preterm delivery. Read More

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Clinical utility of ANA-ELISA vs ANA-immunofluorescence in connective tissue diseases.

Sci Rep 2021 Apr 15;11(1):8229. Epub 2021 Apr 15.

Department of Medicine, Division of Rheumatology, Hamad Medical Corporation, P. O. BOX 3050, Doha, Qatar.

We investigated the performance of ANA-ELISA for CTDs screening and diagnosis and comparing it to the conventional ANA-IIF. ANA-ELISA is a solid-phase immune assay includes 17 ANA-targeted recombinant antigens; dsDNA, Sm-D, Rib-P, PCNA, U1-RNP (70, A, C), SS-A/Ro (52 and 60), SS-B/La, Centromere B, Scl-70, Fibrillarin, RNA Polymerase III, Jo-1, Mi-2, and PM-Scl. During the period between March till December 2016 all requests for ANA from primary, secondary, and tertiary care centers were processed with both techniques; ANA-IIF and ANA-ELISA. Read More

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