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The objective: to explore clinico-epidemiological aspects ofparkinsonism in the Yaroslavl region. One thousand patientswere examined in the movement disorders outpatient clinics in20072010. We used standard criteria for the diagnostics ofextrapyramidal disorders and the following scales: UPDRS,HoehnYahr and SchwabEngland. On observation, 53% ofpatients were from Yaroslavl and 37% from the Yaroslavl region.474 (47%) patients were diagnosed with Parkinson disease, 62(6.2%) with vascular parkinsonism, 17 (1.7%) with parkinsonism-plus, 8 (0.8%) with neuroleptic parkinsonism, 1 (0.1%) withpost-encephalitic parkinsonism and 1 (0.1%) with parkinsonismcaused by brain tumor. Women prevailed among Parkinsons diseasepatients (1 : 1.5). Most patients (71%) were from 60 to 75years of age. 18% of patients had stage 5 of PD, 50% had stage 2,27% had stage 3 and 5% had stage 4. A mixed form of the diseaseprevailed (71%); an akinetic-rigid form (23%) and a tremblingform (5%) occurred more rarely. In 58% of patients an intermediaterate of progression was observed, in 22% of patients progressionwas rapid and in 20% of patients it was slow. In general,our results correspond to international findings. Activity of aspecialized movement disorders center improve diagnostics,treatment and quality of life of patients with Parkinsons disease.

Aims: In this observational study, we investigated whether specialized care improves outcomes for acute pancreatitis (AP). Methods: Consecutive patients admitted to two university hospitals with AP were enrolled in this study between 1 January 2016 and 31 December 2016 (Center A: specialized center; Center B: general hospital). Data on demographic characteristics and AP etiology, severity, mortality and quality of care (enteral nutrition and antibiotic use) were extracted from the Hungarian Acute Pancreatitis Registry. An independent sample t-test, Mann-Whitney test, chi-squared test or Fisher's test were used for statistical analyses. Costs of care were calculated and compared in the two models of care. Results: There were 355 patients enrolled, 195 patients in the specialized center (Center A) and 160 patients in the general hospital (Center B). There was no difference in mean age (57.02 ±17.16 vs. 57.31 ±16.50 P=0.872) and sex ratio (56% males vs. 57% males, P=0.837) between centres, allowing a comparison without selection bias. Center A had lower mortality (n=2, 1.03% vs. n=16, 6.25%, p=0.007), more patients received enteral feeding (n=179, 91.8%, vs. n=36, 22.5%, p<0.001) and fewer patients were treated with antibiotics (n=85, 43.6% vs. n=123, 76.9%, p=0.001). In Center A the median length of hospitalization was shorter (Me 6, IQR 5-9 vs. Me 8, IQR 6-11, p=0.02) and the costs of care were by 25% lower. Conclusion: Our data suggests that treatment of AP in specialized centers reduces mortality, length of hospitalization and thus might reduce the costs. [ABSTRACT FROM AUTHOR]

Lymphedema, a chronic debilitating disease, is not always easily diagnosed. A total of 254 new patients ((217 women, 37 men), median (Q1-Q3) age 61 (46-72) years) were referred for suspected limb lymphedema to an exclusively lymphedema-dedicated department for a first consultation (January - March 2015) were included; among 118 with upper limb involvement, 100 (84.7%) were diagnosed with post-breast cancer therapy and four with primary lymphedemas; among 136 with lower limb involvement, 31 (22.8%) were diagnosed with primary lymphedemas and 35 (25.7%) with post-cancer lymphedemas. The main alternative diagnoses were: 32 (45.7%) lipedemas/lipo-lymphedemas and 21 (30%) chronic venous insufficiencies. Age at symptom onset, body mass index, referral origins and first-symptom-to-specializedconsultation intervals differed between primary, post-cancer lymphedema and alternative diagnosis patients. Among the entire cohort, 57 (22.4%) had cellulitis. For all 135 (53.1%) upper or lower limb post-cancer lymphedemas and the 119 (46.9%) others, the median (Q1-Q3) first-symptom-to-specialized-consultation intervals were 1.4 (0.7-3.8) and 4 (1.1-18.8) years, respectively (p < 0.0001). Specialized consultations confirmed primary and post-cancer lymphedema diagnoses and identified others, especially for patients with suspected lower limb lymphedema. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, there has been increasing interest in the use of simultaneous hip and knee arthroplasty compared to staged procedures in patients with bilateral pathology. The aim of this study was to compare simultaneous and staged hip and knee arthroplasty in patients with bilateral pathology by assessing the transfusion rate, postoperative hemoglobin drop, length of stay (LOS), in-hospital complications, 30-day readmissions and early functional outcome. Methods: We conducted a retrospective cohort study that included all patients who were undergoing primary TKA, THA and UKA by a single surgeon in a high-volume arthroplasty center between 2015 and 2020 as simultaneous or staged procedures. Staged bilateral arthroplasties were performed within 12 months and were stratified by the time between procedures. Data were acquired through the electronic files at the Orthopädische Chirurgie München (OCM). For functional outcome, the ability of the patients to walk independently on the ward was compared with the ability to walk a set of stairs alone, which was recorded daily by the attending physiotherapist. Results: In total n = 305 patients were assessed for eligibility and included in this study. One hundred and forty-five patients were allocated to the staged arthroplasty group. This group was subdivided into a hip and a knee group, whereas the knee group was split into TKA and UKA. The second staged procedure was performed within 12 months of the first procedure. One hundred and sixty patients were allocated to the simultaneous arthroplasty group. This group was also subdivided into a hip and knee group, whereas the knee group was split again into a TKA and UKA group. No statistical difference was found between the two groups regarding demographic data. Primary outcome measurements: There was no significant difference in the transfusion rate or complication rate. Secondarily, no statistically significant difference was found between the postoperative hemoglobin drop and the functional outcome, or in the length of stay (LOS) between both groups. Walking the stairs showed a significant difference in the knee group. Conclusions: There were no significant differences observed in the transfusion rate in-hospital complications, or readmission rate between both groups. The early functional outcome showed no significant difference in mobility for all groups. Simultaneous arthroplasty for knee or hip is as safe as a staged procedure, with no higher risk for the patient, in a specialized high-volume center. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Comprehensive interstitial lung disease (ILD) care delivery models have several key components including diagnosis, treatment, monitoring, coordination with other health care providers, patient support/advocacy, education, and research. ILD is rapidly evolving, and specialized centers with ILD-specific expertise have emerged as ways to care for complex patients. The role of the specialized center in care delivery is multifaceted and aimed at improving patient care and advancing the field of ILD. Widespread access to specialized centers is a barrier to ILD care delivery worldwide. Creative and innovative strategies that leverage technology are needed to bridge gaps in ILD care., Competing Interests: Disclosure J.H. Fisher reports no disclosures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear., Methods: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups based on the point of care delivery: critical care medical center (CCMC) or non-CCMC. The primary outcome of this study was in-hospital death. In-hospital death was compared using a multivariable logistic regression analysis. Subgroup analyses were carried out according to patients with severe hypothermia (<28°C) or systolic blood pressure (sBP) of <90 mmHg., Results: A total of 537 patients were included, 413 patients (76.9%) in the CCMC group and 124 patients (23.1%) in the non-CCMC group. The in-hospital death rate was lower in the CCMC group than in the non-CCMC group (22.3% versus 31.5%, P  < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio (AOR) of the CCMC group was 0.54 (95% confidence interval, 0.32-0.90). In subgroup analyses, patients with systolic blood pressure <90 mmHg in the CCMC group were less likely to experience in-hospital death (AOR 0.36; 95% CI, 0.23-0.56). However, no such association was observed among patients with severe hypothermia (AOR 1.08; 95% CI, 0.63-1.85)., Conclusions: Our multicenter study indicated that care at a CCMC was associated with improved outcomes in patients with accidental hypothermia., Competing Interests: Approval of the Research Protocol: The Ethics Committee of each institution (Kyoto Prefectural University of Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Saiseikai Senri Hospital, Rakuwa‐kai Otowa Hospital, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Uji‐Tokushukai Medical Center, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto Medical Center, Saiseikai Shiga Hospital, Kyoto Min‐iren Chuo Hospital, Yodogawa Christian Hospital, and Fukuchiyama City Hospital) approved this study protocol. Informed Consent: Due to the retrospective nature of the study and deidentification of personal data, each committee waived the need for informed consent. Registry and the Registration no. of the Study/trial: N/A. Animal Studies: N/A. Conflict of Interest: None., (© 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)