Contents
(Source: Medicine)
Source: Medicine - December 1, 2019 Category: Internal Medicine Source Type: research

Editorial Board
(Source: Medicine)
Source: Medicine - December 1, 2019 Category: Internal Medicine Source Type: research

Palliative care in non-malignant disease
Cancer is still routinely seen as a terminal condition with a historically integrated relationship to palliative care. However, there are a number of life-limiting non-malignant conditions with mortality rates and a symptom burden comparable to those of organ-specific cancers. Although there is increasing involvement in these conditions of palliative care services, this still falls short of the needs of the patient population in the UK. With an ageing demographic, there is an increasing need for a integrated multiagency approach to include specialist and non-specialist palliative care, primary care and specialist groups ca...
Source: Medicine - November 28, 2019 Category: Internal Medicine Authors: Amy EH Kingston, Jennifer Kirkland, Alexandra Hadjimichalis Tags: Physical problems Source Type: research

Breathlessness in advanced disease
Breathlessness is the subjective experience of breathing discomfort, which arises as a distressing symptom in many diseases. It has several pathophysiological causes involving peripheral and central receptors and is modulated by cortical processing including emotions. Older people and patients with sarcopenia or cachexia are more susceptible to breathlessness on exertion. In the last hours of life, breathing can become laboured and noisy, owing to upper airway secretions. Most patients can be assessed by physical examination and simple investigations. (Source: Medicine)
Source: Medicine - November 26, 2019 Category: Internal Medicine Authors: Sam Hjelmeland Ahmedzai Tags: Physical problems Source Type: research

Ethical principles in end-of-life care
The four pillars of medical ethics – autonomy, beneficence, non-maleficence and justice – provide a clinical framework for decision-making. Usually the patient has capacity for making decisions based on being given accurate information in a format that is understandable and applicable to their situation. The Mental Capacity Act 2 005 has created a legal framework for decision-making when people may lack capacity. Capacity may fluctuate, may be partly impaired and must be carefully assessed when all efforts to support a person to make their own decision have failed. (Source: Medicine)
Source: Medicine - November 26, 2019 Category: Internal Medicine Authors: Ilora G Finlay Tags: Ethical issues Source Type: research

Pain control in palliative care
Pain is one of the most feared symptoms of advanced, progressive disease and dying. It is a common but not universal experience in both advanced malignant and non-malignant conditions. A patient-centred approach involving systematic and thorough assessment, management and regular review can provide pain relief for most patients. Even in advanced disease, it is important to identify the underlying cause of the pain. Pharmacological management must be structured around the analgesic ladder, and clear guidance provided. (Source: Medicine)
Source: Medicine - November 25, 2019 Category: Internal Medicine Authors: Kate M. Tredgett Tags: Physical problems Source Type: research

Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - November 24, 2019 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research

Complications of systemic anti-cancer treatment
Systemic anti-cancer treatment (SACT) is a broad term, including both conventional chemotherapy agents and biological agents such as immunotherapy. The diversity of SACT now available has resulted in a wide profile of toxicities, some of which, such as neutropenic sepsis and severe colitis, can be life-threatening. In particular, immunotherapy-related adverse events require specific management with immunosuppression in moderate to severe cases. Prompt identification and management of acute toxicities, and early medical input, is essential to reduce morbidity and mortality. (Source: Medicine)
Source: Medicine - November 23, 2019 Category: Internal Medicine Authors: Charlotte Leach Tags: Physical problems Source Type: research

Nausea and vomiting in palliative care
Nausea and vomiting are common problems in palliative care, occurring in up to 70% of patients with advanced incurable disease. Nausea and vomiting can be disease- or treatment-related. They require a holistic approach to their management, involving a thorough clinical assessment with a focused history, appropriate examination and limited range of key investigations. A knowledge of the receptors likely to be involved in this complex phenomenon is vital to ensure that proper pharmacological (and other) measures are employed. (Source: Medicine)
Source: Medicine - November 23, 2019 Category: Internal Medicine Authors: Paul W. Keeley Tags: Physical problems Source Type: research

Management of less common symptoms in palliative care
Symptom management is the cornerstone of good palliative care. Although symptoms such as pain, nausea and dyspnoea are readily assessed and the frequent focus of research studies, other prevalent symptoms receive less attention in research studies and are often unaddressed in clinical practice. This may be because either the symptom is not highlighted by the patient or the healthcare team feels that treatment options are limited to the extent that symptom enquiry is futile. These symptoms can have a significant impact on remaining quality of life so should be addressed. (Source: Medicine)
Source: Medicine - November 21, 2019 Category: Internal Medicine Authors: Aoife Gleeson Tags: Physical problems Source Type: research

Constipation and malignant bowel obstruction in palliative care
Constipation affects about half of patients with advanced illness and nearly all terminally ill patients receiving opioids. Constipation can be very distressing, leading to abdominal pain/distension, anorexia, nausea/vomiting, faecal impaction, intestinal obstruction, urinary retention and incontinence; reducing quality of life. A thorough assessment is critical to diagnose it, assess its severity, impact and associated symptoms, and find the cause. Management includes explanations to the patient/family, treating reversible causes (where appropriate) and optimizing non-pharmacological treatments and drugs. (Source: Medicine)
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Jason W. Boland, Elaine G. Boland Tags: Physical problems Source Type: research

Care in the last hours and days of life
is a vital part of medical practice. Ensuring a dignified death for people, with appropriate support for those important to them, is a core activity of all healthcare professionals. Once it has been recognized that a person may be dying, it is important that pain and other symptoms are managed appropriately. All medication that needs to be continued should be converted to a parenteral route, usually subcutaneously when administration via the oral route is no longer possible. (Source: Medicine)
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Laura Chapman, John Ellershaw Tags: Physical problems Source Type: research

Emergencies in palliative care
Oncological emergencies are common in patients with advanced cancer and can confer significant physical and psychological burdens. Swift recognition of such events allows rapid contextualized evaluation and management, which may need to be tailored to the individual patient's circumstances. Wherever possible, the anticipation of a potential emergency allows clinicians to pre-empt potential crises. (Source: Medicine)
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Simon Noble Tags: Physical problems Source Type: research

Advance care-planning and clinical decision-making
Advance care-planning (ACP), in the context of healthcare, is an optional process whereby people with decisional capacity at the time of making advance care plans record their preferences, priorities and wishes for a time in the future when they may no longer have capacity for health and/or social care decisions. Although ACP is optional, appropriate patients should be identified and supported, through insightful, compassionate serious illness conversations, to participate in ACP. ACP should act as a steer to inform clinical decision-making at times when patients are, because of lack of capacity, unable to share what matte...
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Nikki Pease Tags: Physical problems Source Type: research

Palliative care: introduction
Good communication lies at the heart of palliative care. The ‘Quality of life gap’ model gives a steer to the palliative care consultation and encourages doctors, where possible, to improve a patient's reality while managing their expectations. It is a doctor's duty to provide information that a patient may want or need, in a format they can understand, s o they can participate in shared decision-making. (Source: Medicine)
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Nikki Pease Tags: Introduction Source Type: research

Interventional management of pain in cancer and palliative care
A significant number of cancer patients suffer from pain caused by the disease or its treatment. The World Health Organization analgesic ladder promotes the use of oral opioids and adjuncts, and reserves interventional procedures as the ‘fourth’ step in the ladder. Although this can to an extent be justified as most patients achieve reasonable analgesia with minimal adverse with oral analgesia, 10% of patients continue to have severe pain and/or experience poor quality of life from drug adverse effects. (Source: Medicine)
Source: Medicine - November 20, 2019 Category: Internal Medicine Authors: Arun K. Bhaskar, Karen H. Simpson Tags: Physical problems Source Type: research

Psychiatric conditions in palliative medicine
Psychiatric conditions are common among patients with advanced illness who are referred to palliative care services. Psychiatric illness can cause considerable distress to both patients and their families. In order to improve end-of-life care for patients, it is necessary to diagnose psychiatric conditions and treat them appropriately. This brief review considers cognitive impairment, delirium, dementia, depression, anxiety and suicidal ideation, outlining the prevalence, aetiology, diagnosis and management of these conditions. (Source: Medicine)
Source: Medicine - November 19, 2019 Category: Internal Medicine Authors: Amy Taylor, Amy Ritchie, Clare White Tags: Physical problems Source Type: research

Haemochromatosis
Hereditary haemochromatosis is now well recognized as an inherited disorder of iron loading that is entirely preventable if recognized early. Diagnosis is non-invasive – HFE genotyping principally for C282Y homozygosity – and treatment simple. Clinicians in primary and secondary care are more attuned to thinking about haemochromatosis, with much earlier presentations the norm; however, the diagnosis is still missed, and irreversible morbidity from joint diseas e affects quality of life. There is a greater opportunity now for non-invasive fibrosis testing to exclude those who might be at risk of hepatocellular c...
Source: Medicine - November 18, 2019 Category: Internal Medicine Authors: William J.H. Griffiths Tags: Metabolic liver disease Source Type: research

Primary sclerosing cholangitis
(PSC) is a chronic, immune-mediated cholestatic liver disease caused by diffuse inflammation and fibrosis that can involve the entire biliary tree. The progressive pathological process obliterates intrahepatic and extrahepatic bile ducts, ultimately leading to biliary cirrhosis, portal hypertension and hepatic failure. The cause is unknown but it is closely associated with inflammatory bowel disease (IBD), particularly ulcerative colitis, which occurs in about 70% of patients. (Source: Medicine)
Source: Medicine - November 11, 2019 Category: Internal Medicine Authors: Roger W. Chapman Tags: Autoimmune liver disease Source Type: research

Gallstones
This article discusses the cause of gallstones, their presentation and their management. (Source: Medicine)
Source: Medicine - November 7, 2019 Category: Internal Medicine Authors: Ian J. Beckingham Tags: Gallstones Source Type: research

IgG4-related disease
Immunoglobulin (Ig) G4-related disease is an immune-mediated fibro-inflammatory condition that can involve virtually every organ system. Our knowledge and understanding of this condition has expanded rapidly over the last decade, with insights into adaptive and innate immunological mechanisms, identification of novel risk factors, definition of disease subsets based on organ distribution, discovery of circulating biomarkers that correlate with disease activity and relapse, and novel treatment approaches. (Source: Medicine)
Source: Medicine - November 6, 2019 Category: Internal Medicine Authors: Emma L. Culver, Helen Bungay, Eve Fryer, Eleanor Barnes Tags: Autoimmune liver disease Source Type: research

Complications of cholestasis
Cholestasis (impairment of, or reduction in, bile flow) can both predispose to the development of chronic liver disease and result in its own specific symptoms. The severity of cholestatic symptoms (which themselves often impair quality of life) is typically independent of the severity of the underlying liver disease, the link with cholestasis therefore frequently being missed. The most characteristic symptoms of cholestasis are pruritus and fatigue, the former being the most responsive to treatment. (Source: Medicine)
Source: Medicine - November 6, 2019 Category: Internal Medicine Authors: Vinod S. Hegade, David EJ. Jones Tags: Management problems in liver disease Source Type: research

Self –assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - November 6, 2019 Category: Internal Medicine Tags: SELF-ASSESSMENT/CPD answers Source Type: research

Wilson's disease
is a rare progressive genetic disorder of copper metabolism associated with hepatolenticular degeneration. Left untreated, it results in severe disability and death. The diagnosis is very easily overlooked but, if discovered early, effective treatments are available to prevent or reverse many manifestations of this disorder. The role of copper in disease pathogenesis, coupled with clinical, biochemical and genetic markers, is pivotal to establishing a clear diagnosis. Medical therapy involves chelating agents (e.g. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Aftab Ala Tags: Metabolic liver disease Source Type: research

Liver disease in pregnancy
Liver disease in the pregnant patient often causes concern. This chapter covers both acute liver pathologies that occur in pregnancy, and pregnancy in mothers with chronic liver disease, focusing on practical diagnostic and management strategies. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Claire J. Grant, Emilie A. Wilkes Tags: Mothers, babies and children Source Type: research

Liver and biliary disease in childhood
Acute liver disease or failure in children is the result of viral hepatitis (A, B, E, seronegative), indeterminate hepatitis or inherited metabolic liver disease. The clinical presentation includes jaundice, coagulopathy and encephalopathy. Uncomplicated acute hepatitis resolves spontaneously, but progressive acute liver failure is fatal in 70% of cases and requires referral to specialized units to prevent complications and for consideration for liver transplantation. Chronic liver disease can result from unresolved neonatal liver disease caused by either inherited cholestasis or α1-antitrypsin deficiency. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Deirdre A. Kelly Tags: Mothers, babies and children Source Type: research

Management of portal hypertension, Budd –Chiari syndrome and portal vein thrombosis
Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on patients ’ prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1–2 years. Acute variceal bleeding is a life-threatening complication, and despite significant improvements in th e management it remains a leading cause of death in patients with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and thera...
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Marcus Robertson, Peter Hayes Tags: Management problems in liver disease Source Type: research

Hepatic encephalopathy
(HE) is a neurocognitive disorder associated with both acute and chronic liver injury. It manifests as a wide spectrum of neuropsychological abnormalities ranging from subtle impairments in executive higher functions through to coma. In acute liver failure, the central role of ammonia in the development of brain oedema remains undisputed. However, the gut microbiome and the presence of systemic inflammation or the development of infection have become increasingly recognized as drivers for developing HE in cirrhosis. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Jennifer M. Ryan, Debbie L. Shawcross Tags: Management problems in liver disease Source Type: research

Autoimmune hepatitis and overlap syndrome
Autoimmune hepatitis (AIH) is an acute or chronic liver disease that causes significant inflammation at a cellular level and leads to cirrhosis if left untreated. The basis of diagnosis is increased liver enzymes and immunoglobulins with positive autoantibodies and necroinflammatory changes on liver biopsy. Clinical presentations can vary. Asymptomatic patients may only have raised liver enzymes detected on routine testing, the other extreme of presentation being represented by fatigue, jaundice and liver failure. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Munira Y. Altarrah, Michael A. Heneghan Tags: Autoimmune liver disease Source Type: research

Acute liver failure: updates in pathogenesis and management
Acute liver failure is a life-threatening illness precipitated by an acute liver injury in patients with no pre-existing liver disease. Acute viral hepatitis and drug-induced liver injury account for most cases, the clinical course characterized by the development of coagulopathy and hepatic encephalopathy, often progressing to multi-organ disease, which is associated with high fatality rates. The outcomes have improved significantly over time with improving standards of organ system support and access to liver transplantation for very sick individuals. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Ahmed Adel Amin, Banwari Agarwal, Rajiv Jalan Tags: Management problems in liver disease Source Type: research

Primary biliary cholangitis
(PBC) is a chronic autoimmune liver disease characterized by lymphocytic destruction of the small, intrahepatic bile ducts, causing chronic cholestasis and progressive fibrosis that eventually leads to biliary cirrhosis. It is a complex disorder resulting from the interaction of genetic and environmental factors and is strongly predominant in female patients (female:male 9:1). Typical symptoms include cholestatic pruritus and the PBC fatigue symptom complex. Features of end-stage liver disease (ESLD) from PBC are the same as those of ESLD from other causes, i.e. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: George Mells Tags: Autoimmune liver disease Source Type: research

Diagnosis and management of ascites and hepatorenal syndrome (acute kidney injury) in cirrhosis
Ascites is the most common complication of cirrhosis and represents a watershed moment, with patients' median survival falling from>12 years for compensated cirrhosis to approximately 2 years. Treatment aims to reduce sodium intake and increase renal sodium excretion with the aldosterone antagonist spironolactone, starting at 100  mg daily; 60% respond. Renal dysfunction affects as many as 20% of hospitalized patients and is a strong predictor of mortality. Liver transplantation represents the best treatment for hepatorenal syndrome (HRS) yet is rarely available, and a combination of vasoconstrictors and albumin ...
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Alastair O'Brien Tags: Management problems in liver disease Source Type: research

Liver and biliary disease in infancy
Liver disease in infancy is a relatively rare but serious cause of morbidity and mortality. Since jaundice is a common finding in the neonatal period, the immediate priority is to differentiate between unconjugated hyperbilirubinaemia, which is generally a benign developmental phenomenon, and conjugated hyperbilirubinaemia (conjugated fraction>20%), which is always pathological. Conjugated hyperbilirubinaemia, suggested by yellow urine and stools that are not yellow or green in an infant of any age, is pathognomonic of liver parenchymal or bile duct disease. (Source: Medicine)
Source: Medicine - November 5, 2019 Category: Internal Medicine Authors: Marianne Samyn, Giorgina Mieli-Vergani Tags: Mothers, babies and children Source Type: research

Liver transplantation
is a successful therapy for end-stage liver disease, hepatocellular carcinoma and acute liver failure. Early referral is essential to allow time for careful assessment. The patient's needs need to be balanced against the predicted outcome after transplantation. The calcineurin inhibitor tacrolimus is the mainstay of immunosuppression in liver transplantation. Outcomes after liver transplantation are excellent but patients do not have a normal quantity or quality of life compared with an age- and sex-matched population. (Source: Medicine)
Source: Medicine - November 4, 2019 Category: Internal Medicine Authors: James W. Ferguson Tags: Transplantation Source Type: research

Effectiveness, cost-utility, and benefits of a multicomponent therapy to improve the quality of life of patients with fibromyalgia in primary care: A mixed methods study protocol: Erratum
No abstract available (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Erratum Source Type: research

Hemolytic jaundice induced by pharmacological dose ascorbic acid in glucose-6-phosphate dehydrogenase deficiency: A case report: Retraction
No abstract available (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Retraction Source Type: research

Pleural small cell carcinoma with massive pleural effusion: A case report
Rationale: Small cell carcinoma (SCC) occurs mostly in the lung, and small cell lung cancer accounts for 13% of newly diagnosed lung cancers. Only 2.5% of SCC occurs in extrapulmonary sites, and SCC of pleural origin is especially very uncommon. Patient concerns: An 85-year-old man presenting with progressive dyspnea for more than 7 days. Diagnoses: Computed tomography scan of the chest showed massive pleural effusion and diffuse nodular thickening of the pleura on the right chest. Sonography-guided needle biopsy of the pleural mass was performed and histologic and immunohistochemical findings revealed SCC. Since n...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Propofol vs desflurane on the cytokine, matrix metalloproteinase-9, and heme oxygenase-1 response during living donor liver transplantation: A pilot study
Conclusion: Propofol-based TIVA attenuated inflammatory response (elevated IL-1RA and IL-10 levels), downregulated MMP-9 response, and increased HO-1 expression with improved recovery of graft function and better microcirculation compared with desflurane anesthesia in liver transplant recipients. (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

The expression and prognostic significance of Drp1 in lung cancer: A bioinformatics analysis and immunohistochemistry
Background: Dynamin-related protein 1 (Drp1) plays important roles in tumorigenesis, including lung cancer. However, the effect of Drp1 in lung cancer remains unclear. The present study was aimed to investigate the clinical significance and effect of Drp1 on prognosis of lung cancer. Methods: Oncomine and The Cancer Genome Atlas (TCGA) databases were selected to predict the differential expression levels of Drp1 in lung cancer. Then, 70 cases of lung cancer and normal tissues were collected and immunohistochemistry was used to detect the expression of Drp1. In addition, Kaplan–Meier Plotter database and TCGA dat...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research

Comparison of postoperative axial stability of intraocular lens and capsulotomy parameters between precision pulse capsulotomy and continuous curvilinear capsulotomy: A prospective cohort study
Conclusions: The overall variability in effective lens position was less when cataract surgery was performed using PPC than when performed using CCC. Circularity was better and had a more predictable size with PPC than with CCC. (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

C-reactive protein/albumin ratio is a prognostic indicator in Asians with pancreatic cancers: A meta-analysis
Conclusion: This meta-analysis suggests that CAR is associated with the survival of pancreatic cancer patients of Asian ethnicity, and a higher CAR may be a potential prognostic indicator in pancreatic cancers. (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Association of HLA-DRB1 genotype with younger age onset and elder age onset rheumatoid arthritis in Japanese populations
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by joint destructions and human leukocyte antigen (HLA)-DRB1 is an important genetic risk factor for RA and influences the phenotype of RA. The clinical features of elder age onset RA (EORA) were known to be different from those of younger age onset RA (YORA). Previous studies reported the different association pattern of DRB1 alleles with YORA or EORA. The associations of DRB1 genotype with these RA subsets remained almost unknown. We investigated the genotype association of DRB1 with YORA or EORA in Japanese populations. HLA genotyping was performe...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Comparison of outcomes between type 2 diabetic and non-diabetic incident hemodialysis patients with functioning arteriovenous fistulas
This study compared clinical outcomes of patient survival and arteriovenous fistula (AVF) patency between incident hemodialysis patients with and without type 2 diabetes mellitus (T2DM). Between January 2011 and December 2013, 384 consecutive incident hemodialysis patients with confirmed first upper-extremity AVF placement were divided into a T2DM group (n = 180, 46.9%) and a non-DM group (n = 204, 53.1%) and analyzed retrospectively. The primary outcome was all-cause mortality, and secondary outcome was AVF patency. Patients in the T2DM group had a higher prevalence of hypertension (P = .02), smoking (P  (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Upregulated expression of G9a is correlated with poor prognosis of gastric cancer patients
As one of the most serious cancers, gastric cancer (GC) represents the third leading cause of malignancy-related deaths. G9a is a histone lysine methyltransferase and has been reported to be involved in the progression of some human cancers. In the present study, we aimed to explore the expression patterns and clinical value of G9a in GC patients. The expression of G9a in 142 paired GC tissues and adjacent non-cancerous tissues (no less than 5 cm from tumor edge) was examined with quantitative real-time polymerase chain reaction (qRT-PCR). To estimate the association of G9a expression with clinical characteristics of GC...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Moxibustion for treating patients with hyperlipidemia: A systematic review and meta-analysis protocol
Conclusions: The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with hyperlipidemia. Ethics and dissemination: This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized. Trial registration number: PROSPERO CRD42019130545. (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Study Protocol Systematic Review Source Type: research

A no-reference respiratory blur estimation index in nuclear medicine for image quality assessment
Few indexes are available for nuclear medicine image quality assessment, particularly for respiratory blur assessment. A variety of methods for the identification of blur parameters has been proposed in literature mostly for photographic pictures but these methods suffer from a high sensitivity to noise, making them unsuitable to evaluate nuclear medicine images. In this paper, we aim to calibrate and test a new blur index to assess image quality. Blur index calibration was evaluated by numerical simulation for various lesions size and intensity of uptake. Calibrated blur index was then tested on gamma-camera phantom acqu...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Quality Improvement Study Source Type: research

The impact of renal function on efficacy and safety of new oral anticoagulant in atrial fibrillation patients: A systemic review and meta-analysis
Background and objectives This meta-analysis was to investigate the efficacy and safety of new oral anticoagulant (NOAC) in atrial fibrillation (AF) patients with renal function insufficiency, and to explore whether renal decline occurs in AF patients with NOAC and its impact on outcomes. Methods and results In AF patients with mild renal insufficiency, the NOAC was associated with significantly lower rates of stroke (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67–0.91; P  (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Association of β-fibrinogen polymorphisms and venous thromboembolism risk: A PRISMA-compliant meta-analysis
Conclusion: FGB -455G>A polymorphism was associated with a decreased risk of VTE among the Caucasian population. (Source: Medicine)
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Endovascular stent repair of celiac arterial aneurysm
The aim of this study was to evaluate the safety and clinical effectiveness of endovascular stent repair of celiac arterial aneurysm (CAA). From January 2015 to December 2018, 11 patients (7 males, 4 females with a mean age of 52.2 ± 7.9 years) underwent endovascular stent repair of CAA in our center. A covered stent was used to occlude the CAA neck. Follow-up was performed 2 weeks and 1, 3, 6, and 12 months following surgery and yearly thereafter. Rates of technical success, treatment-related complications, and long-term outcome were analyzed. Each patient was placed with 1 stent for repair of CAA. Stent was ...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Association between iron metabolism and cognitive impairment in older non-alcoholic fatty liver disease individuals: A cross-sectional study in patients from a Chinese center
This study examined whether iron metabolism is associated with cognitive impairment in older individuals. A cross-sectional study was held in patients from a Chinese center. Individuals with NAFLD aged over 60 years were included if they did not have excessive alcohol intake and were free of stroke or dementia. Their cognitive function was assessed by the same neurologist. 3.0T H proton magnetic resonance spectroscopy (1H-MRS) was performed to evaluate the hippocampus of the participants without contraindication. t test and Chi-square test were used to analyze the data. Binary logistic regression was used for correlation ...
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research