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Final Nail in the Coffin.

Authors:
Swati Jha

BJOG 2021 Sep 18. Epub 2021 Sep 18.

Consultant Gynaecologist and Honorary Senior Clinical Lecturer, Sheffield University. Subspecialist in Urogynaecology, Sheffield Teaching Hospitals, Tree Root Walk, Level 4, Jessop Wing, Sheffield, S10 2SF, UK.

Synthetic midurethral slings (MUS) for the management of stress urinary incontinence (SUI) have come under intense scrutiny of late. The NICE (National Institute of Health and Clinical Excellence) guidelines for the management of urinary incontinence over the past 15 years have continued to be cautious in their recommendations of the obturator MUS whilst being supportive of the retropubic (RP) MUS. In the 2006 NICE clinical guidance (CG 40), the advice was to make women aware of the "lack of long-term data" for obturator MUS. Read More

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September 2021

The Use of Radiomic Analysis of Magnetic Resonance Imaging in Predicting Distant Metastases of Rectal Carcinoma following Surgical Resection - A Systematic Review & Meta-Analysis.

Colorectal Dis 2021 Sep 18. Epub 2021 Sep 18.

Discipline of Surgery, Galway University Hospitals, Galway, H91 YR71, Ireland.

Background: Estimating prognosis in rectal carcinoma (RC) is challenging, with distant recurrence (DR) occurring in up to 30% of cases. Radiomics is a novel field using diagnostic imaging to investigate the tumour heterogeneity of cancers and may have the potential to predict DR.

Aims: To perform a systematic review of current literature evaluating the use of radiomics in predicting DR in patients with resected RC. Read More

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September 2021

Interleukin-6 blockade for prophylaxis and management of immune-related adverse events in cancer immunotherapy.

Eur J Cancer 2021 Sep 15;157:214-224. Epub 2021 Sep 15.

Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia. Electronic address:

Background: Immune checkpoint inhibitors (ICIs) have activity across many tumor types, but activation of the immune system may also lead to significant, often steroid-refractory immune-related adverse events (irAEs). We sought to determine the activity of tocilizumab, an anti-interleukin-6 receptor monoclonal antibody, in treatment or prevention of auto-immune irAE in ICI-treated patients.

Methods: Institutional databases from 2 melanoma centers were reviewed for patients treated with ICIs and tocilizumab. Read More

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September 2021

Efficacy and safety of immune checkpoint inhibitors in elderly patients (≥70 years) with squamous cell carcinoma of the head and neck.

Eur J Cancer 2021 Sep 15;157:190-197. Epub 2021 Sep 15.

Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France.

Background: Recent meta-analysis showed that immune checkpoint inhibitors (ICIs) have comparable activity between younger and older patients. However, little is known about efficacy and safety of ICI in elderly patients with relapsed/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). The aim of this study is to compare the efficacy of ICI for patients aged ≥70 y to that for younger patients, while taking into account potential confounding factors. Read More

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September 2021

Magnetic resonance imaging radiomics signatures for predicting endocrine resistance in hormone receptor-positive non-metastatic breast cancer.

Breast 2021 Sep 11;60:90-97. Epub 2021 Sep 11.

Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China; Department of Medical Oncology, Phase I Clinical Trial Centre, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China. Electronic address:

Background: One-third of patients with hormone receptor (HR)-positive breast cancers fail to respond to hormone therapy, and some patients even progress within two years of adjuvant endocrine therapy (ET) toward primary endocrine resistance. However, there is no effective way to predict endocrine resistance.

Objective: To build a model that incorporates the radiomic signature of pretreatment magnetic resonance imaging (MRI) with clinical information to predict endocrine resistance. Read More

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September 2021

Optimising fusion detection through sequential DNA and RNA molecular profiling of non-small cell lung cancer.

Lung Cancer 2021 Aug 25;161:55-59. Epub 2021 Aug 25.

CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, UCL, London, United Kingdom; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address:

Objectives: There is an increasing number of driver fusions in NSCLC which are amenable to targeted therapy. Panel testing for fusions is increasingly appropriate but can be costly and requires adequate good quality biopsy material. In light of the typical mutual exclusivity of driver events in NSCLC, the objective of this study was to trial a novel testing pathway, supported by industrial collaboration, in which only patients negative for driver mutations on DNA-NGS were submitted for fusion panel analysis. Read More

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Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial.

J Clin Anesth 2021 Sep 15;75:110506. Epub 2021 Sep 15.

Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands. Electronic address:

Study Objective: The potential of perioperative goal-directed therapy (PGDT) to improve outcome after high-risk abdominal surgery remains subject of debate. In particular, there is a need for large, multicenter trials focusing on relevant patient outcomes to confirm the evidence found in small, single center studies including minor complications in their composite endpoints. The present study therefore aims to investigate the effect of an arterial waveform analysis based PGDT algorithm on the incidence of major complications including mortality after high-risk abdominal surgery. Read More

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September 2021

Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis.

Respir Med 2021 Sep 8;188:106602. Epub 2021 Sep 8.

St George's University Hospitals NHS Foundation Trust, London, UK.

Introduction: Survivors of COVID-19 infection may develop post-covid pulmonary fibrosis (PCF) and suffer from long term multi-system complications. The magnitude and risk factors associated with these are unknown.

Objectives: We investigated the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection. Read More

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September 2021

Symptom based questionnaires predict frequent exacerbations in severe asthma.

J Allergy Clin Immunol Pract 2021 Sep 15. Epub 2021 Sep 15.

Respiratory Medicine, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS.

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September 2021

Prognostic impact of neoadjuvant chemotherapy in patients with synchronous colorectal liver metastasis: A propensity score matching comparative study.

Int J Surg 2021 Sep 15:106106. Epub 2021 Sep 15.

Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-City 545-8585, Japan. Electronic address:

Background: Synchronous colorectal liver metastasis (SCRLM) is at an advanced tumor stage and requires multidisciplinary treatments. Neoadjuvant chemotherapy (NAC) is thought to be an effective treatment modality, but its prognostic impact is still unclear.

Materials And Methods: Patients with resectable SCRLM presented to eight university hospitals between 2007 and 2017 were retrospectively reviewed. Read More

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September 2021

Reliability of Hospital-Level Mortality in Abdominal Aortic Aneurysm Repair.

J Vasc Surg 2021 Sep 15. Epub 2021 Sep 15.

Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.

Objective: The relationship between volume and surgical outcome has been shown for a variety of surgical procedures. The effect in abdominal aortic aneurysm repair continues to be debated. Reliability adjustment has been used as a method to remove statistical noise from hospital level outcomes but its impact on aortic aneurysm repair is not well understood. Read More

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September 2021

Chemoradiotherapy or surgery for very early oesophageal squamous cancer: can a non-randomised trial give us the answer?

Gastroenterology 2021 Sep 15. Epub 2021 Sep 15.

Consultant, Medical Oncology, Cambridge University Hospitals NHS Trust, Cambridge. Electronic address:

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September 2021

Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden.

Urology 2021 Sep 15. Epub 2021 Sep 15.

Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin.

Objective: To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood.

Methods: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. Read More

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September 2021

Onasemnogene abeparvovec gene therapy for symptomatic infantile-onset spinal muscular atrophy type 1 (STR1VE-EU): an open-label, single-arm, multicentre, phase 3 trial.

Lancet Neurol 2021 Oct;20(10):832-841

Novartis Gene Therapies, Cambridge, UK.

Background: Spinal muscular atrophy is a rare, autosomal recessive, neuromuscular disease caused by biallelic loss of the survival motor neuron 1 (SMN1) gene, resulting in motor neuron dysfunction. In this STR1VE-EU study, we aimed to evaluate the safety and efficacy of onasemnogene abeparvovec gene replacement therapy in infants with spinal muscular atrophy type 1, using broader eligibility criteria than those used in STR1VE-US.

Methods: STR1VE-EU was a multicentre, single-arm, single-dose, open-label phase 3 trial done at nine sites (hospitals and universities) in Italy (n=4), the UK (n=2), Belgium (n=2), and France (n=1). Read More

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October 2021

Primary prevention of ovarian cancer: a patient decision aid for opportunistic salpingectomy.

Am J Obstet Gynecol 2021 Sep 15. Epub 2021 Sep 15.

Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address:

Background: The discovery of the Fallopian tube epithelium as origin of high grade serous ovarian cancer has brought a new option for ovarian cancer prevention. As the Fallopian tubes have no known function after completion of childbearing, they can be removed to reduce the life-time risk of ovarian cancer. Although the lifetime risk in the general population does not justify preventive surgery in itself, salpingectomy can be performed during abdominal surgery for other indications, also known as an opportunistic salpingectomy. Read More

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September 2021

Diagnosis of fungal opportunistic infections in people living with HIV from Guatemala and El Salvador.

Mycoses 2021 Sep 18. Epub 2021 Sep 18.

Mycotic Diseases Branch, CDC, Atlanta, GA, USA.

Objectives: Histoplasmosis and cryptococcosis are important public health problems in people living with HIV (PLHIV) in Central America. Conventional laboratory tests, such as culture and microscopy are not optimal, however, antigen tests are rapid, highly sensitive, and specific for diagnosis of fungal opportunistic infections (OI). The aim of this study was to describe the results of a laboratory-based surveillance system for histoplasmosis and cryptococcosis. Read More

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September 2021

Declining mortality of cerebral venous sinus thrombosis with thrombocytopenia after SARS-CoV-2 vaccination.

Eur J Neurol 2021 Sep 18. Epub 2021 Sep 18.

Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.

Background: High mortality rates have been reported in patients with cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) after vaccination with adenoviral vector SARS-CoV-2 vaccines. The aim of this study was to evaluate whether mortality of patients with CVST-VITT has decreased over time.

Methods: We used the EudraVigilance database of the European Medicines Agency to identify cases of CVST with concomitant thrombocytopenia occurring within 28 days of SARS-CoV-2 vaccination. Read More

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September 2021

Surgical site infections in early onset scoliosis: what are long-term outcomes in patients with traditional growing rods?

Spine Deform 2021 Sep 18. Epub 2021 Sep 18.

Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.

Purpose: Deep surgical site infections (SSIs) are a common and potentially severe complication in early onset scoliosis (EOS) patients. We sought to identify the long-term outcomes following SSI, specific risk factors associated with recurrent infections, and if instrument retention is a prudent SSI management strategy in EOS.

Methods: We performed a retrospective review of all EOS patients who underwent traditional growing rod spine procedures from 2003 to 2017. Read More

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September 2021

Effect of COVID-19 on demand for healthcare in Togo.

Authors:
Yaovi Tossou

Health Econ Rev 2021 Sep 18;11(1):36. Epub 2021 Sep 18.

Member of the Research Centre for Economic Analysis of Public Policies (ANEPP), FASEG/University of Lomé, 01BP1515, Lomé, Togo.

Background: Demand-side barriers to health care are as important as supply-side factors in deterring patients from obtaining effective treatment during COVID-19. Developing countries, including Togo, have focused on reducing the risk of health care utilization during this period by ensuring basic health care services as an important policy to improve health outcomes and meet international obligations to make health services accessible.

Methods: The data used to cover all 44 districts in the six (6) health regions of Togo, are from a national home survey. Read More

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September 2021

Atrial septal defect in adulthood: a new paradigm for congenital heart disease.

Eur Heart J 2021 Sep 18. Epub 2021 Sep 18.

Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.

Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. Read More

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September 2021

Association of dietary fat intake and hepatocellular carcinoma among US adults.

Cancer Med 2021 Sep 18. Epub 2021 Sep 18.

Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Background And Aims: The role of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) remains unclear. We investigated the associations of total fat and fatty acids with risk of HCC among US adults in a hospital-based case-control study.

Methods: We analyzed data from 641 cases and 1034 controls recruited at MD Anderson Cancer Center during 2001-2018. Read More

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September 2021

Post-burn scar malignancy: 5-year management review and experience.

Int Wound J 2021 Sep 18. Epub 2021 Sep 18.

Surgical Oncology, Medical School of Bany-Swif University, Bany-Swif, Egypt.

The study spotlights a severe uncommon post-burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. Read More

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September 2021

Gut barrier and microbiota changes with glycine and branched-chain amino acid supplementation in chronic haemodialysis patients.

J Cachexia Sarcopenia Muscle 2021 Sep 18. Epub 2021 Sep 18.

Genomic Research Lab and Service of Infectious Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.

Background: We have previously shown that glycine increases fat-free mass in chronic haemodialysis patients with features of malnutrition as compared with branched-chain amino acids (BCAAs). This multicentre randomized double-blind crossover study evaluates the impact of these amino acids on the gut barrier and microbiota.

Methods: Haemodialysis patients were included if they had plasma albumin <38 g/L or weight loss >5% of dry body weight, and daily dietary intakes <30 kcal/kg and <1 g protein/kg. Read More

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September 2021

Irritable bowel syndrome is strongly associated with the primary and idiopathic mast cell disorders.

Neurogastroenterol Motil 2021 Sep 17:e14265. Epub 2021 Sep 17.

University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.

Background: Mounting evidence supports a mechanistic association between irritable bowel syndrome (IBS) symptoms and mast cell hyperactivity. Yet, association between IBS and mast cell disorders (MCDs) has not been studied. We examined this association using two large databases and verified with manual chart review. Read More

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September 2021

Responsiveness of hospitals to inpatient and outpatient services in the low- and middle-income countries: A systematic review.

Int J Health Plann Manage 2021 Sep 17. Epub 2021 Sep 17.

Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Responsiveness is the ability of health system to satisfy non-clinical people's expectations. This review aimed at assessing responsiveness of hospitals' services in the low- and middle-income countries, and identifying the influencing factors. This systematic review followed the PRISMA guidelines. Read More

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September 2021

Preterm births in South-West England before and during the COVID-19 pandemic: an audit of retrospective data.

Eur J Pediatr 2021 Sep 17. Epub 2021 Sep 17.

School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.

The COVID-19 lockdown had a series of intended and unintended consequences, including reduced infections and changes in activities and behaviours. Some of these changes may have been beneficial to perinatal outcomes; however, other factors such as reduced access to face-to-face healthcare may have contributed negatively to antenatal care. The aim of this audit was to evaluate neonatal admissions in the South-West of England during the COVID-19 pandemic in 2020 and the previous two years 2018-2019. Read More

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September 2021

The management of moderate acute malnutrition in children aged 6-59 mo in low- and middle-income countries: a systematic review and meta-analysis.

Trans R Soc Trop Med Hyg 2021 Sep 17. Epub 2021 Sep 17.

Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.

Background: Malnutrition is a leading cause of morbidity and mortality in children aged <5 y, especially in low- and middle-income countries (LMICs). Unlike severe acute malnutrition, moderate acute malnutrition (MAM) affects greater numbers globally, and guidelines lack a robust evidence base. This systematic review and meta-analysis assessed the evidence for lipid-based nutrient supplements (LNSs), fortified blended flours (FBFs) and nutrition counselling, in the treatment of MAM. Read More

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September 2021

Analysis of outcomes of emergency general and gastrointestinal surgery during the COVID-19 pandemic.

Br J Surg 2021 Sep 18. Epub 2021 Sep 18.

Statistical Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.

Background: Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection.

Methods: Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). Read More

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September 2021

Angiotensin converting enzyme inhibitors and incidence of lung cancer in a population based cohort of common data model in Korea.

Sci Rep 2021 Sep 17;11(1):18576. Epub 2021 Sep 17.

Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea.

Contradictory findings exist about association of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB) with lung cancer development. This was a retrospective observational cohort study that used data from 7 hospitals in Korea, converted to the Observational Medical Outcomes Partnership Common Data Model. The primary outcome was occurrence of lung cancer. Read More

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September 2021