Transanal total mesorectal excision: how are we doing so far?

Aim: This subgroup analysis of a prospective multicentre cohort study aims to compare postoperative morbidity between transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME).

Method: The study was designed as a subgroup analysis of a prospective multicentre cohort study. Patients undergoing TaTME or LaTME for rectal cancer were selected.

De-novo mutations in patients with chronic ultra-refractory epilepsy with onset after age five years.

We set out to investigate whether a de-novo paradigm could explain genetic causes of chronic ultra-refractory epilepsy, with onset later than the typical age for the epileptic encephalopathies. We performed exome sequencing on nine adult patients with MRI-negative epilepsy and no preceding intellectual disability. All had an onset of seizures after five years old and had chronic ultra-refractory epilepsy defined here as having failed more than six anti-epileptic drugs and currently experiencing ≥4 disabling seizures per month.

Treatment of acute hepatitis C genotypes 1 and 4 with 8 weeks of grazoprevir plus elbasvir (DAHHS2): an open-label, multicentre, single-arm, phase 3b trial.

Background: Direct-acting antivirals effectively treat chronic hepatitis C virus (HCV) infection but there is a paucity of data on their efficacy for acute HCV, when immediate treatment could prevent onward transmission. We assessed the efficacy of grazoprevir plus elbasvir treatment in acute HCV infection and investigated whether treatment can be shortened during the acute phase of HCV infection.

Methods: The Dutch Acute HCV in HIV study number 2 (DAHHS2) study was a single-arm, open-label, multicentre, phase 3b trial.

[A man with a painful shoulder and numb hand].

A 57-year-old man suffered from an anterior luxation of the left shoulder with a dislocated fracture of the greater humeral tubercle after a fall. His left hand was cold, numb and no arterial pulsations could be detected. After shoulder reposition, the hand became warmer and the numbness disappeared.

Lower retention after retrograde coronary venous infusion compared with intracoronary infusion of mesenchymal stromal cells in the infarcted porcine myocardium.

Background: Commonly used strategies for cell delivery to the heart are intramyocardial injection and intracoronary (IC) infusion, both having their advantages and disadvantages. Therefore, alternative strategies, such as retrograde coronary venous infusion (RCVI), are explored. The aim of this confirmatory study was to compare cardiac cell retention between RCVI and IC infusion.

[Medicalisation and inappropriate care within the Netherlands mental health system: the role of disorder-focused thinking and reimbursement].

A disorder-focused approach in mental healthcare in the Netherlands, combined with a disorder-linked reimbursement system, risks medicalisation of stress-related mental variations that may result from the current societal pressures to be beautiful and successful. Furthermore, a disorder-linked reimbursement system may lead to inappropriate treatment, dictated by group-based guidelines tied to DSM-classifications rather than the complexities and contexts of individual needs for care. Finally, there can be both over- and under-treatment as a result of a free-market healthcare system in which quality of care is equated with symptom reduction.

[The polypill for cardiovascular disease: why is it used so infrequently?].

Cardiovascular polypills or fixed-dose combination (FDC) therapy have been advocated to improve treatment and prevention of cardiovascular disease since 2003. Yet, it is still used infrequently in current practice. This is in contrast to the widespread use of fixed-dose drug combinations for HIV, tuberculosis, and malaria worldwide.

Long-term follow-up after MIPO Philos plating for proximal humerus fractures.

Introduction: Minimally invasive plate osteosynthesis (MIPO) has been described as a suitable technique for the treatment of proximal humerus fractures, but long-term functional results have never been reported. The aim of this study was to describe the long-term functional outcome and implant-related irritation after MIPO for proximal humerus fractures.

Methods: A long-term prospective cohort analysis was performed on all patients treated for a proximal humerus fracture using MIPO with a Philos plate (Synthes, Switzerland) between December 2007 and October 2010.

An International Delphi Survey for the Definition of New Classification Criteria for Familial Mediterranean Fever, Mevalonate Kinase Deficiency, TNF Receptor-associated Periodic Fever Syndromes, and Cryopyrin-associated Periodic Syndrome.

Objective: Provisional evidence-based classification criteria for hereditary periodic fever (HPF) have been recently developed. However, no consensus on how to combine clinical criteria, laboratory tests, and results of molecular analysis has been reached. The objective of this study is to understand which variables physicians consider important for the classification of patients with HPF.

Displaced medial clavicle fractures: operative treatment with locking compression plate fixation.

Objectives: Medial clavicle fractures are rare injuries and historically treated non-operatively. Displaced medial clavicle fractures, however, have a higher incidence of delayed- or non-union compared to non- displaced medial clavicle fractures and might benefit from operative treatment. We describe below a new technique for treating intra-articular fractures or extra-articular fractures with a small medial fragment using special locking plates and present the results of our operatively treated patients.

Feasibility of magnetic resonance imaging-only rectum radiotherapy with a commercial synthetic computed tomography generation solution.

Background And Purpose: Synthetic computed tomography (sCT) images enable magnetic resonance (MR)-based dose calculations. This work investigated whether a commercially available sCT generation solution was suitable for accurate dose calculations and position verification on patients with rectal cancer.

Material And Methods: For twenty rectal cancer patients computed tomography (CT) images were rigidly registered to sCT images.

Social brain, social dysfunction and social withdrawal.

The human social brain is complex. Current knowledge fails to define the neurobiological processes underlying social behaviour involving the (patho-) physiological mechanisms that link system-level phenomena to the multiple hierarchies of brain function. Unfortunately, such a high complexity may also be associated with a high susceptibility to several pathogenic interventions.

Functional Effects of the Adams Procedure: A Retrospective Intervention Study.

 Injury to the distal radioulnar joint (DRUJ) causes swelling and ulnar-sided wrist pain. The Adams procedure stabilizes the DRUJ and shows promising short-term results.  We studied the long-term functional outcome in patients who underwent the Adams procedure.

Acute gastric necrosis caused by a -hemolytic streptococcus infection: a case report and review of the literature.

Acute necrotizing gastritis, which appears to be a variant of phlegmonous gastritis is the rarest cause of gastric necrosis. We report a case of a 57-year-old female patient with an acute necrotizing gastritis caused by a Group A β-hemolytic streptococcus. The case presented herein is of unusual interest because only a limited number of case reports on this etiology have been published.

Emergence of ESBL-producing Escherichia coli ST131-C1-M27 clade colonizing patients in Europe.

Background: The ST131 Escherichia coli clone is associated with the global dissemination of ESBLs. It has been hypothesized that ST131 could take advantage of better colonizing abilities. However, the data on colonization prevalence of ESBL-ST131 in European hospitals are scarce.

Introducing high-flow nasal cannula oxygen therapy at the intermediate care unit: expanding the range of supportive pulmonary care.

Background: Non-invasive respiratory support is a frequent indication for intermediate care unit (IMCU) admission. Extending the possibilities of respiratory support at the IMCU with high-flow nasal cannula oxygen therapy (HFNC) may prevent intensive care unit (ICU) transfer and invasive ventilation. However, the safety and limitations of HFNC administration in the stand-alone IMCU setting are not yet studied.

In silico validation of the Autoinflammatory Disease Damage Index.

Introduction: Autoinflammatory diseases can cause irreversible tissue damage due to systemic inflammation. Recently, the Autoinflammatory Disease Damage Index (ADDI) was developed. The ADDI is the first instrument to quantify damage in familial Mediterranean fever, cryopyrin-associated periodic syndromes, mevalonate kinase deficiency and tumour necrosis factor receptor-associated periodic syndrome.

ADAPT technique with ACE68 and ACE64 reperfusion catheters in ischemic stroke treatment: results from the PROMISE study.

Background And Purpose: The recent randomized trials demonstrated the benefit of mechanical thrombectomy in stroke therapy. However, treatment using different strategies is an ongoing area of investigation. The PROMISE study analyzed the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 reperfusion catheters in aspiration thrombectomy of stroke, using A Direct Aspiration First Pass Technique (ADAPT).

Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting.

Objective: To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting.

Methods: From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017.

Effect of everolimus on renal function in patients with tuberous sclerosis complex: evidence from EXIST-1 and EXIST-2.

Background: A reduction in renal angiomyolipoma volume observed with everolimus (EVE) treatment in patients with tuberous sclerosis complex (TSC) has been postulated to translate to clinical benefit by reducing the risk of renal hemorrhage and chronic renal failure.

Methods: The long-term effects of EVE on renal function (∼4 years of treatment) were examined in patients treated with EVE in the Phase 3 EXIST-1 and EXIST-2 studies. Patients in EXIST-1 had TSC and subependymal giant cell astrocytoma (SEGA), and patients in EXIST-2 had renal angiomyolipoma and a definite diagnosis of TSC or sporadic lymphangioleiomyomatosis.

[Intimacy and sexuality in older people: 10 tips].

Intimacy and sexuality often suffer as a result of cancer, chronic disease and medical interventions. A relatively large number of older people are confronted with disruptions to intimacy and sexuality because of high rates of illness and medication use in this age group. Although intimacy and sexuality are an important aspect of quality of life for a considerable number of older people, it seems as though many medical professionals ignore this subject.

[The accuracy of patients' perceptions of the risks associated with localised prostate cancer treatments].

Objective: To assess the accuracy of patients' perceptions of the risks associated with localised prostate cancer treatments (radical prostatectomy [RP], radiotherapy [RT], and active surveillance [AS]), and to identify correlates of misperceptions.

Patients And Methods: We used baseline data (questionnaires completed after treatment information was provided but before treatment) of 426 patients with newly diagnosed localised prostate cancer who participated (87% response rate) in a prospective, longitudinal, multicentre study. Patients' pretreatment perceptions of differences in adverse outcomes of treatments were compared to those based on the literature.

[When is carotid endarterectomy actually indicated for stenosis?].

Criteria for carotid endarterectomy are based on the results of clinical trials that were conducted more than two decades ago. In the meantime medical treatment has improved, and surgery can be performed more safely. As such, it is currently unknown which patients should be recommended to undergo carotid surgery.

[Remifentanil during labour; has its place in pain relief during labour been decided?].

Patient-controlled analgesia using remifentanil (remifentanil PCA) has been used as a new form of pain relief during labour since soon after its release on the market. Reduction in pain scores lasts for 1 to 2 hours, and the analgesia is inferior to that of an epidural. Remifentanil PCA can be an alternative for epidural analgesia in cases where the woman cannot or does not want to receive epidural anaesthesia.