Πέμπτη 15 Απριλίου 2021

Outcome of acute kidney injury: how to make a difference?

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Acute kidney injury (AKI) is one of the most frequent organ failure encountered among intensive care unit patients. In addition to the well-known immediate complications (hydroelectrolytic disorders, hypervole...
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Complex endovascular repair of type B aortic dissection and predicting left arm ischemia: a case report

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Thoracic endovascular aortic repair (TEVAR) is the gold standard for surgical management of descending thoracic aortic pathology. Depending on the anatomy, TEVAR often requires deployment across the origin of ...
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Development and validation of a novel nomogram for individualized prediction of survival in cancer of unknown primary (CUP)

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Purpose: Prognostic uncertainty is a major challenge for cancer of unknown primary (CUP). Current models limit a meaningful patient-provider dialogue. We aimed to establish a nomogram for predicting overall survival (OS) in CUP based on robust clinicopathological prognostic factors. Experimental Design: We evaluated 521 patients with CUP at MDACC [MD Anderson Cancer Center, Houston, USA] (2012-2016). Baseline variables were analyzed using Cox-regression and nomogram developed using significant predictors. Predictive accuracy and discriminatory performance were assessed by calibration curves, concordance probability estimate (CPE) ({plus minus}standard error [SE]) and concordance statistic (C-index). The model was subjected to bootstrapping and multi-institutional external validations using two independent CUP cohorts: V1 (MDACC [2017], N=103) and V2 (BC Cancer, Vancouver, Canada and Sarah Cannon Cancer Center/Tennessee Oncology, USA, N=302). Re sults: Baseline characteristics of entire cohort (N=926) included: median age (63 years), women (51%), ECOG-PS 0-1 (64%), adenocarcinomas (52%), {greater than or equal to}3 sites of metastases (30%), median follow-up duration and OS of 40.1 and 14.7 months, respectively. Five independent prognostic factors were identified: gender, ECOG-PS, histology, number of metastatic sites and neutrophil-lymphocyte ratio. The resulting model predicted OS with CPE of 0.69 (SE: {plus minus}0.01) [C-index: 0.71 (95%CI:0.68-0.74)] outperforming Culine/Seve prognostic models (CPE: 0.59{plus minus}0.01). CPE for external validation cohorts V1 and V2 were 0.67 ({plus minus}0.02) and 0.70 ({plus minus}0.01), respectively. Calibration curves for 1-year OS showed strong agreement between nomogram prediction and actual observations in all cohorts. Conclusions: Our user-friendly CUP nomogram integrating commonly available baseline factors provides robust personalized prognostication which can aid cli nical decision making and selection/stratification for clinical trials.

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Article intro - Non-Technical Skill Assessment and Mental Load Evaluation in RAMIS

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Nagyné Elek et Haidegger: "Non-Techn ical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery" has just appeared in MDPI Sensors 2021, 21(8), 2666; as part of the Special Issue on Medical Robotics.

Abstract

BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the sur gery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and s oft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.

Should you be interested in publishing with MDPI Sensors, the Medical Robotics Special Issue is open for submissions.

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Neonatal Mast Cells and Transplacental IgE Transfer: A Mechanism of Disease Inheritance or of Passive Infant Barrier Defense?

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Cancers, Vol. 13, Pages 1920: The Role of Rituximab in the Treatment of Primary Central Nervous System Lymphoma

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Cancers, Vol. 13, Pages 1920: The Role of Rituximab in the Treatment of Primary Central Nervous System Lymphoma

Cancers doi: 10.3390/cancers13081920

Authors: Ruben Van Dijck Jeanette K. Doorduijn Jacoline E.C. Bromberg

Primary central nervous system lymphoma (PCNSL) is a type of non-Hodgkin lymphoma limited to the central nervous system. It has a poor prognosis. Consensus has been reached on the treatment of newly diagnosed patients with high-dose methotrexate-based chemotherapy, but whether the addition of the monoclonal anti-CD20 antibody rituximab improves survival, as it does in systemic B-cell non-Hodgkin lymphoma, remains disputed. In this review, we reflect on the available evidence of the use of rituximab in PCNSL. Whether rituximab has any beneficial effect remains uncertain.

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Review of Gastroesophageal Reflux Disease

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JAMA. 2021 Apr 13;325(14):1472. doi: 10.1001/jama.2021.1438.

NO ABSTRACT

PMID:33847719 | DOI:10.1001/jama.2021.1438

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Update on Endoscopic Therapies for the Treatment of GERD: GERDX, MUSE, EsophyX

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Zentralbl Chir. 2021 Apr;146(2):188-193. doi: 10.1055/a-1333-3751. Epub 2021 Apr 13.

ABSTRACT

Gastroesophageal reflux disease (GERD) has been a problem for patients throughout in recent decades worldwide and its prevalence is increasing. Until 20 years ago, the established treatments were the proton pump inhibitors (PPI) and varieties of laparoscopic fundoplication (LF). Increasing experience with endoscopy and knowledge of the oesophagogastric junction (EGJ) has led to new options in the treatment of GERD. However, promising short term effects have been found with radiofrequency ablation (RFA, Stretta device), endoscopic mucosal resection (ARMS) for induction of scar tissue at the lower oesophageal sphincter (LES) and endoscopic suture devices like GERDX, MUSE and EsophyX to reconstruct the flap valve at the EGJ. Long-term follow-up data and randomised controlled studies in comparison to LF are still rare.

PMID:33851381 | DOI:10.1055/a-1333-3751

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Alternative Surgical Anti-Reflux Procedures

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Zentralbl Chir. 2021 Apr;146(2):210-214. doi: 10.1055/a-1369-9732. Epub 2021 Apr 13.

ABSTRACT

Patient satisfaction when treated with acid-suppressing medication for chronic GERD disease is less than 70%. Surgical standardisation, centralisation, improved awareness of patient selection and new surgical methods have stimulated interest in surgical reflux therapy in recent years. Magnetic sphincter augmentation (MSA) seems to be a safe alternative to laparoscopic fundoplication, with reported complication rates of 0.1% and reoperation rates of 3.4% and is also effective (GERD-HRQL improvement from 19.9 to 4.1, p = 0.001 as well PPI cessation and pH normalisation in 79 and 89% of patients, respectively). Electric sphincter augmentation shows promising short-term results in small patient cohorts (92% symptomatic improvement). However, randomised controlled studies comparing these new techniques to the "gold standard" of laparoscopic fundoplication are still missing.

PMID:33851383 | DOI:10.1055/a-1369-9732

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Increase of blood-brain barrier leakage is related to cognitive decline in vascular mild cognitive impairment

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Blood-brain barrier (BBB) breakdown, as an early biomarker for vascular mild cognitive impairment (vMCI), has only been validated by a few studies. The aim of this study was to investigate whether compromised ...
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The initial CT blend sign is not associated with poor patient outcomes after stereotactic minimally invasive surgery

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The initial CT blend sign is an imaging marker that has been used to predict haematoma expansion and poor outcomes in patients with small-volume intracerebral haemorrhage (ICH). However, the association of the...
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Acute motor and sensory axonal neuropathy in association with primary Sjögren’s syndrome: a case report

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Primary Sjögren's syndrome is a chronic, autoimmune, connective tissue disorder that results from the infiltration of exocrine glands, especially the lacrimal and salivary glands, by autoantibodies. Patients w...
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