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Malignant pleural mesothelioma (MPM) is an aggressive tumor and the prognosis is still dismal despite the various proposed multimodal treatment plans. Currently, new palliative treatments, such as talc pleurodesis, are being explored besides traditional surgery. This review reports survival rates after talc pleurodesis in comparison to surgery in patients with malignant pleural mesothelioma. A systematic literature search yielded 49 articles eligible for this review. The mean survival in the talc pleurodesis group was 14 months compared to 17 and 24 months for the pleurectomy decortication (P/D) group and extrapleural pneumonectomy (EPP) group, respectively. Few studies reported on the 1-, 2-year overall survival for the talc pleurodesis group and the results were very heterogeneous. The pooled 1-year overall survival for the P/D and EPP groups were 55% [credibility limits (CL): 21-87%] and 67% (CL: 3-89%), the pooled 2-year overall survival were 32% (CL: 8-63%) and 36% (CL: 8-54%), respectively. The pooled 1- and 2-year survival for surgery independently from the type of surgery were 62% (CL: 38-84%) and 34% (CL: 16-54%). There was significant heterogeneity in all the analyses. This review shows that there is limited research on the survival rate after talc pleurodesis compared to surgery in the treatment of malignant pleural mesothelioma. A comparison study is necessary to accurately assess the best way to treat MPM patients, including assessment of the quality of life after treatment as an outcome measure., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Although esophageal cancer is rare in the United States, 5-year survival and quality of life (QoL) are poor following esophageal cancer surgery. Although esophageal cancer has been surgically treated with esophagectomy through thoracotomy, an open procedure, minimally invasive surgical procedures have been recently introduced to decrease the risk of complications and improve QoL after surgery. The current study is a systematic review of the published literature to assess differences in QoL after traditional (open) or minimally invasive esophagectomy. We hypothesized that QoL is consistently better in patients treated with minimally invasive surgery than in those treated with a more traditional and invasive approach. Although global health, social function, and emotional function improved more commonly after minimally invasive surgery compared with open surgery, physical function and role function, as well as symptoms including choking, dysphagia, eating problems, and trouble swallowing saliva, declined for both surgery types. Cognitive function was equivocal across both groups. The potential small benefits in global and mental health status among those who experience minimally invasive surgery should be considered with caution given the possibility of publication and selection bias., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Although the association between exposure to asbestos and malignant mesothelioma (particularly malignant pleural mesothelioma) has been well established, the health impact of environmental exposure (EE) to asbestos has been less studied. This review summarizes the most recent studies on the association between malignant mesothelioma and EE with asbestos to identify features associated with EE and quantify the association with malignant mesothelioma. There were 44 studies from 18 countries that met our selection criteria, with a considerable amount of heterogeneity in their study design, measures of exposure, and health outcomes. The male-to-female ratio was close to or less than 1 and generally lower than the ratio reported when both occupational and environmental exposures were considered. Although recent studies have continued to improve our understanding of environmental exposure to asbestos, challenges remain. We have highlighted a few new research directions, such as a need for reliable matrices to identify common and less recognized types of EE, asbestos biomarker studies specifically focusing on EE, and research on populations and geographic areas that have not been previously studied., (Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Rationale: Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce., Objectives: To validate the utility and safety of selecting patients with PE for outpatient treatment by the Hestia criteria and to compare the safety of the Hestia criteria alone with the Hestia criteria combined with N-terminal pro-brain natriuretic peptide (NT-proBNP) testing., Methods: We performed a randomized noninferiority trial in 17 Dutch hospitals. We randomized patients with PE without any of the Hestia criteria to direct discharge or additional NT-proBNP testing. We discharged the latter patients as well if NT-proBNP did not exceed 500 ng/L or admitted them if NT-proBNP was greater than 500 ng/L. The primary endpoint was 30-day adverse outcome defined as PE- or bleeding-related mortality, cardiopulmonary resuscitation, or intensive care unit admission. The noninferiority margin for the primary endpoint was 3.4%., Measurements and Main Results: We randomized 550 patients. In the NT-proBNP group, 34 of 275 (12%) had elevated NT-proBNP values and were managed as inpatients. No patient (0 of 34) with an elevated NT-proBNP level treated in hospital (0%; 95% confidence interval [CI], 0-10.2%), versus no patient (0 of 23) with a post hoc-determined elevated NT-proBNP level from the direct discharge group (0%; 95% CI, 0-14.8%), experienced the primary endpoint. In both trial cohorts, the primary endpoint occurred in none of the 275 patients (0%; 95% CI, 0-1.3%) subjected to NT-proBNP testing, versus in 3 of 275 patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.25). During the 3-month follow-up, recurrent venous thromboembolism occurred in two patients (0.73%; 95% CI, 0.1-2.6%) in the NT-proBNP group versus three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65)., Conclusions: Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin/rctview.asp?TC=2603 (NTR2603).

We describe a case of a 44-year-old woman with a borderline personality disorder and chronic gamma- butyrolactone (GBL) use who presented with progressive dyspnoea and an altered mental status. A high anion gap metabolic acidosis and acute lung injury was diagnosed. We hypothesise this was caused by GBL. In this case report we describe the diagnostic process and possible pathophysiological mechanisms that may have led to this life-threatening condition.

Background and Purpose: Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome., Methods: An extensive literature search was performed using the PubMed, Embase, and Cochrane databases., Results: 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clinically and statistically significant improvement in sporting activity and hip scores were found in 10 studies., Interpretation: Studies with low levels of evidence have shown improvement in various different hip scores and one RCT showed better outcomes with hip resurfacing arthroplasty. There is no high-level evidence to prove that there is improved clinical outcome using hip resurfacing arthroplasty. More randomized research needs to be done.

A 6-year-old girl had an eosinophilic granuloma on the parietal skull due to Langerhans cell histiocytosis.

A representative sample of 611 French pediatricians was interviewed on their knowledge, attitudes, beliefs towards and practices regarding childhood obesity through a 39-item Likert format questionnaire. A vast majority of the respondents regarded obesity as an illness (86.4%), 70.2% were aware that without any treatment an obese child has a high risk to remain obese in adulthood, 84% reported that managing obesity is part of their responsibility in the routine practice and 89.3% affirmed to systematically inform parents of obese children on health risks associated with obesity. At the same time, 82.4% were convinced that managing obesity is bound to fail and only 46.5% that it is professionally gratifying. However, doctors who followed a vocational training dedicated to obesity felt themselves more efficient in managing childhood obesity (p<0.01), those who knew the national recommendations were also less likely to report that the management of childhood obesity leads to a failure (p<0.05). Probably one of the main result of our study concerns doctors' perception of the relative impact of the different etiologic factors of obesity. Beside sedentary life, poor eating behavior, lack of parental concern and heredity which are cited by more than three-fourth of the pediatricians, an economic situation more and more insecure and a food industry increasingly more powerful are reported for the first time by doctors themselves, respectively by 59.9% and 60.8% of them, to kill the goodwill of health professionals. These findings reinforce the idea that the solution to the obesity problem does not lie just within the doctor's office and stress the need for prompt regulatory actions to curb obesity.

Objective: To assess the validity of patient history and physical examination in elderly patients in the diagnosis ofvarious types of urinary incontinence., Design: Literature review., Method: Articles on the diagnosis of urinary incontinence in elderly patients (patient history and/or physical examination versus urodynamic testing) were identified using PubMed, Picarta (a Dutch database) and the reference lists of the articles found. Articles were published between January 1970 and August 2005. The applicability and quality of the articles were assessed using the relevant Cochrane criteria. 'Sufficient diagnostic evidence' was defined as a positive likelihood ratio > 5 and a negative likelihood ratio < 0.02., Results: 5 studies met the eligibility criteria; 4 were performed in the second-line setting and 1 in a general population. All 5 studies involved women aged 55 years or older. None of the 5 studies found a positive or negative likelihood ratio for providing sufficient diagnostic evidence for various types of urinary incontinence. In the study conducted in a general population, the positive and negative likelihood ratios for the presence of stress incontinence according to patient history and physical examination were 3.23 and 0.40, respectively., Conclusion: Few adequate studies have been reported on the validity of clinical evaluation in the diagnosis of urinary incontinence in older women, and no studies have been conducted in men. The validity of clinical evaluation has been demonstrated only in the diagnosis of stress incontinence in older women.