The raw costs of mitomycin C (MMC) and oxaliplatin for hyperthermic intraperitoneal chemotherapy (HIPEC) differ substantially. We sought to compare the morbidity and toxicity profiles associated with the use of oxaliplatin and MMC in patients undergoing cytoreductive surgery (CRS) and HIPEC for peritoneal carcinomatosis (PC) of colorectal or appendiceal origin, to evaluate whether the costeffectiveness of these 2 agents should dictate drug choice.
 
  We conducted a retrospective multi-institutional study of all patients with PC of colorectal or appendiceal origin treated with CRS-HIPEC using MMC or oxaliplatin from 2010 to 2015. Demographic, perioperative, morbidity, toxicity and cost data were compared between the 2 treatment groups and between cancer-origin subgroups.
 
  Forty-two patients treated with MMC and 76 treated with oxaliplatin were included in the study. Baseline demographic and tumour characteristics were comparable in the 2 groups, except that the patients treated with MMC had higher Charlson Cd toxicity profiles, regardless of cancer origin. Thus, we propose that cost-effectiveness should ultimately dictate drug selection.
  The aim of this study was to explore the associations of preoperative sarcopenia (muscle mass depletion) and myosteatosis (muscle quality attenuation) with the incidence of postinduction hypotension (PIH) and postoperative complications among patients undergoing major gynecologic surgery.
 
  Based on a previous prospective surgical registry of gynecologic patients, we included patients with an available preoperative abdominal computed tomography (CT) scan performed within 3 months before surgery. The cross-sectional muscle mass and density at the third lumbar vertebra (L3) level were measured from the CT scan. The primary outcome was PIH, which was defined as a blood pressure reduction >30% from baseline. The secondary outcome was postoperative complications based on the Clavien-Dindo classification. Multivariable logistic regression analyses were performed to identify the associations between the muscle parameters and outcomes.
 
  Of the 167 gynecologic surgical patients included in this study, the mean (standard deviation [SD]) age was 53.0 (12.2) years. Sarcopenia was present in 86 (51.5%) patients. Fifty-six (33.5%) patients experienced PIH, and 89 (53.3%) patients experienced different degrees of postoperative complications. Multivariable analysis showed that myosteatosis was significantly associated with an increased risk of PIH (odds ratio [OR] = 2.95, 95% confidence interval [CI], 1.24-7.04; P = .015), and sarcopenia was associated with an increased risk of postoperative complications (OR = 2.30; 95% CI, 1.16-4.57; P = .018).
 
  Muscle assessments using preoperative CT scans may help identify high-risk patients and determine perioperative management strategies among gynecologic patients.
 Muscle assessments using preoperative CT scans may help identify high-risk patients and determine perioperative management strategies among gynecologic patients.A 65-year-old female complained of diffuse and rapidly progressive gingival enlargement. Gingival overgrowth can be caused by medication, infections or systemic diseases.  https://www.selleckchem.com/products/glpg3970.html  In case of generalized, quickly progressive gingival enlargement, acute myeloid leukemia should be considered. Blood results showed an acute myelomonocytic leukemia. Treating the leukemia resolved the symptoms.Approximately 1 in 6 citizens report burn-out symptoms. But what does this mean? Many people sooner or later suffer from fatigue, irritability, and sleeping problems. When do these symptoms become so severe that they become a burn-out? Discussions about the causes and solutions for burn-out are common, but it is important not to lose sight that burn-out has a limited scientific basis. There are changing definitions over time, no reliable diagnostic interview, a large overlap between burn-out and depression, and no evidence-based treatments. Thus, burn-out remains an elusive concept. The impact and suffering of what we call burn-out is undeniably real and poses a great problem, but can we really help people in their recovery if our knowledge of burn-out is so limited? In this perspective, I pose critical questions about the current scientific state of burnout, but also want to argue that there is a constructive way forward based on recently acquired knowledge about stress and its inherent dynamics that perhaps offers a fundamentally different approach to understand burn-out.
  Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL).
 
  To obtain national estimates on clinically suspected Covid-19 mortality in general practice and on intensive and palliative covid-19 care provided by general practitioners (GPs) outside hospital, including palliative medication, availability of personal protective equipment, and reasons for not referring to hospital of vulnerable patients during the first three months of the Covid-19 pandemic in The Netherlands.
 
  Nationwide registration study, in which 2.331 GP practices in The Netherlands participated from March-June 2020.
 
  Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL) through existing digital referral platform ZorgDomein, in which GPs could report PCR-proven and clinically suspected Covid-19 deceased patients to estimate the impact of the Covid-19 pandemic in primary care.
 
  GPs reported 1,566 Covid-19 deceased patients, of which 61% (949/1,566) were clinically sustients' considerations to refrain from hospital care can be used to guide future primary care for vulnerable Covid-19 patients.A 71-year-old man presented with a painful swelling of the tip of his little finger. Infection was considered, but antibiotics and incision did not give relief. Biopsy showed metastasis of anal carcinoma, for which he had been treated 7 years earlier with curative chemoradiotherapy. He underwent amputation of the finger.A 52-year-old men suffered from osteoarthritis of the knee. During knee replacement surgery, the remaining cartilage appeared black. This discoloration and early degeneration of the cartilage is characteristic for the metabolic disorder alkaptonuria in which homogentisic acid accumulates in the body.