Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Nivolumab plus Cabozantinib Joins Immune Checkpoint Inhibition Combination Therapies for Treatment-naïve Metastatic Clear-Cell Renal Cell Carcinoma.

Longer follow-up and new trial data from phase 3 randomised controlled trials investigating immune checkpoint blockade (PD-1 or its ligand PD-L1) in advanced clear-cell renal cell carcinoma (RCC) have recently become available. The CheckMate 9ER trial demonstrated an improved progression-free survival (PFS) and overall survival (OS) benefit for the combination of cabozantinib plus nivolumab. A Keynote-426 update demonstrated an ongoing OS benefit for pembrolizumab plus axitinib in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups, while an update of CheckMate 214 confirmed the long-term benefit of ipilimumab plus nivolumab in IMDC intermediate and poor risk patients.

Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial.

Background: The most appropriate treatment for displaced multiple-fragment proximal humeral fractures in elderly patients is currently unclear. Reverse total shoulder arthroplasty (rTSA) is a promising treatment option that is being used increasingly. The purpose of this study was to compare the outcome of rTSA vs.

[Traumatic brain injury rehabilitation - assessment of quantitative and qualitative research].

The Swedish Agency for Health Technology Assessment and Assessment of Social Services has evaluated quantitative and qualitative research regarding rehabilitation for persons with traumatic brain injury (TBI) through systematic reviews. The results indicate that specialized brain injury rehabilitation for persons with post-concussion symptoms after mild TBI results in improved health, when compared to usual care (results with low certainty according to GRADE). As few high-quality studies were identified, it was not possible to assess the effects of vocational rehabilitation, rehabilitation with case management/coordinator, residential living or specialized brain rehabilitation for persons with moderate to severe TBI.

DNA methylation differences at birth after conception through ART.

Study Question: Is there a relation between ART and DNA methylation (DNAm) patterns in cord blood, including any differences between IVF and ICSI?

Summary Answer: DNAm at 19 CpGs was associated with conception via ART, with no difference found between IVF and ICSI.

What Is Known Already: Prior studies on either IVF or ICSI show conflicting outcomes, as both widespread effects on DNAm and highly localized associations have been reported. No study on both IVF and ICSI and genome-wide neonatal DNAm has been performed.

The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe.

Purpose: The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges.

Methods: In order to identify these trans-national challenges across Europe, an survey was conducted among 23 experts, each answering for one European or aligned country.

Results: A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences.

Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence.

The association between morphology of the brain and symptoms of suspected idiopathic normal pressure hydrocephalus (iNPH) is largely unknown. We investigated how ventricular expansion (width of the temporal horns [TH], callosal angle [CA], and Evans' index [EI]) related to symptom severity in suspected iNPH. Participants (n = 168; 74.

Targeted therapy for metastatic renal cell carcinoma.

Background: Several comparative randomised controlled trials (RCTs) have been performed including combinations of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors since the publication of a Cochrane Review on targeted therapy for metastatic renal cell carcinoma (mRCC) in 2008. This review represents an update of that original review.

Objectives: To assess the effects of targeted therapies for clear cell mRCC in patients naïve to systemic therapy.

[The 2030 Agenda for Sustainable Development - an important opportunity to improve global health].

The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth.

[Acute necrotizing esophagitis - a rare condition that may lead to life-threatening perforation of the esophagus].

Perforated acute necrotizing esophagitis is a condition with several proposed etiological factors, hypothesized to be caused by weakened mucosal defence mechanisms and hemodynamic insult, leading to subsequent ischemia. We present a patient with acute necrotizing esophagitis, where underlying cardiovascular comorbidity and patient delay serve as potential contributing causal factors to the perforation. To prevent subsequent circulo-respiratory collapse and multi-organ failure, emergency esophagectomy was required, given that control of persistent leakage and mediastinitis was unlikely if managed conservatively.

[Type B insulin resistance syndrome].

Type B insulin resistance syndrome (TBIRS) is a very rare autoimmune condition with polyclonal autoantibodies directed against the insulin receptor, which results in severe and refractory hyperglycemia and high mortality. Described here is a patient who, within a few months after the onset of an autoimmune type 1 diabetes, increased her insulin requirements more than 20-fold, and despite this having a considerable difficulty maintaining  her P-glucose < 40-60 mmol/L. On suspicion of TBIRS the patient was started on tapering glucocorticoids to overcome the autoimmune insulin receptor blockade, resulting in an immediate and dramatic effect.

[Neuroleptic malignant syndrome and serotonin syndrome - severe adverse reactions with psychotropic medications].

Neuroleptic malignant syndrome and serotonin syndrome are two conditions that can occur with psychotropic medications. Although both states are associated with psychiatric care they can also occur in somatic settings. The clinical pictures are complex with many different symptoms of varying severity.

[Dengue caused life-threatening arrhythmia].

Dengue is a mosquito-borne viral disease found in tropical and sub-tropical climates worldwide. Due to globalization and climate change dengue is an increasing global concern. Symptoms typically appear 3-14 days after inoculation by the Aedes mosquito and most commonly manifests as a self-limiting febrile illness.

COVID-19: minimising contaminated aerosol spreading during CPAP treatment.

Background: The COVID-19 pandemic has raised concern for healthcare workers getting infected via aerosol from non-invasive respiratory support of infants. Attaching filters that remove viral particles in air from the expiratory limb of continuous positive airway pressure (CPAP) devices should theoretically decrease the risk. However, adding filters to the expiratory limb could add to expiratory resistance and thereby increase the imposed work of breathing (WOB).

[COVID-19 and kidney disease].

Acute kidney injury (AKI), albuminuria and hematuria are common in Covid-19 and have been shown to increase mortality. Assessment with a urinary dipstick and creatinine at admission should be completed with a urinary sediment and quantification of albuminuria if positive. SARS-Cov-2 seems to enter and infect the endothelium and kidney cells, and contributes to damage in addition to hypercoagulability, multi organ failure and hyperinflammation.

Low Risk for Marginal Ulcers in Duodenal Switch and Gastric Bypass in a Well-Defined Cohort of 472 Patients.

Purpose: Marginal ulcer (MU) is well-known complication in bariatric surgery. Several studies are available in Roux-en-Y gastric bypass (RYGBP), while data on the incidence in duodenal switch (DS) is limited. We aimed to compare the incidence of MU between DS and RYGBP in a well-defined cohort and to identify associative factors.

[Hypertension, RAAS blockade and risk in COVID-19 patients].

SARS-coronavirus 2 (SARS-CoV-2) enters the host-cells by binding the transmembraneous angiotensin converting enzyme 2 (ACE2) when causing coronavirus disease 2019 (COVID-19). The role of angiotensin converting enzyme inhibitors (ACE) and angiotensin II receptor blockers (ARB) in COVID-19 is debated. Several well-conducted observational studies show no increased risk from RAAS blockade in COVID-19 patients and are detailed in this brief review.

Keratitis Caused by Candida parapsilosis and Subsequent Corynebacterium macginleyi Infection: Case Report and Short Review.

Keratitis due to Candida parapsilosis or Corynebacterium macginleyi is uncommon. We present a patient with several risk factors who suffered two subsequent corneal infections caused by these pathogens and healed with topical conservative therapy. The important factor was the early detection of infection.

[Endometriosis - new clinical guidelines for better and equal care in Sweden].

Endometriosis is a chronic, inflammatory and estrogen-dependent disease affecting about 10 % of the female  population in fertile ages. There is no cure for endometriosis. The main symptoms include severe menstrual pain, ovulation pain, dyspareunia, dysuria and painful bowel movements.

[The failing right ventricle].

Right-sided heart failure is a common disease that leads to increased morbidity and mortality. Despite this it is ill understood. Echocardiography is currently the primary mode for diagnosis and tricuspid annular plane systolic excursion and fractional area change are good measurements to use for assessment.

Mowat-Wilson syndrome: growth charts.

Background: Mowat-Wilson syndrome (MWS; OMIM #235730) is a genetic condition caused by heterozygous mutations or deletions of the ZEB2 gene. It is characterized by moderate-severe intellectual disability, epilepsy, Hirschsprung disease and multiple organ malformations of which congenital heart defects and urogenital anomalies are the most frequent ones. To date, a clear description of the physical development of MWS patients does not exist.