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The role of influence on protein C anticoagulant system and PC deficiency-related thrombophilic risk due to strenuous physical exercise is still under discussion. To investigate the modification of the protein C anticoagulant pathway after vigorous exercise, we measured ProC® Global assay, a protein C activity dependent clotting time, in 20 healthy subjects before and immediately after maximal treadmill exercise, and at 5, 15, 30 and 60 min in the recovery phase. The most evident change was a shortening of ProC® Global clotting time from the average basal value of 123 sec to 84 sec at 30 min in post-exercise. Our study shows that the coagulation unbalance observed after strenuous exercise and with no consequence in healthy individuals with normal PC level, could increase the thrombophilic risk in silent carriers of significant defects of the protein C system and occasionally trigger an episode of deep vein thrombosis. © 2020 Scudiero et al.Direct oral anticoagulants (DOACs) have demonstrated safety and efficacy in stroke prevention in patients with non-valvular atrial fibrillation (NVAF). In terms of safety, there was a significant reduction of intracranial hemorrhages (ICH) in patients treated with DOACs over warfarin. To date, a specific antidote for edoxaban is not yet available. The management of ICH relies on the use of coagulation factors. This article reports a case of a 73-year-old woman with NVAF who had cerebral hematoma in the right intraparenchymal thalamus-capsular area while on therapy with edoxaban 60 mg/day. The computed tomography (CT) brain scan showed hematoma of >18mm diameter. The patient was timely treated with four-factor prothrombin complex concentrate (4F-PCC) at 50 IU/kg. After 6 hrs patient's symptoms alleviated and she was successfully recovered within 6 days. A repeated CT scan of the brain in 3 weeks showed improvement. The patient's treatment with edoxaban 30 mg/day restarted after 8 weeks. © 2020 Galbiati.Major bleeding is one of the most dangerous complications for patients undergoing anticoagulant treatment for VTE. Several clinical scores have been planned to identify patients at higher risk of bleeding, and most of them take into consideration the number of platelets in particular if lower than normal. Here we report the clinical experience made with the RIETE registry concerning anticoagulant treatment in the presence of different values of platelets and their related risk of bleeding. © 2019 Di Micco and Monreal.There has been no improvement in outcome for patients with unresectable locally advanced (stage III) non-small cell lung cancer (NSCLC) for more than 10 years. The standard treatment for these patients is definitive concurrent chemotherapy and radiation (CCRT). Although the goal of treatment in this setting is to achieve a cure, most patients progress and their prognosis is poor, with a 5-year survival rate of 15-30%. There is thus an urgent need for the development of novel anticancer treatments in this patient population. Recent advances in cancer immunotherapy have led to a marked improvement in clinical outcome for advanced NSCLC. Such immunotherapy mainly consists of the administration of immune checkpoint inhibitors (ICIs) such as antibodies to cytotoxic T lymphocyte-associated protein-4 (CTLA-4) or to either programmed cell death-1 (PD-1) or its ligand PD-L1. Durvalumab (MEDI4736) is a high-affinity human immunoglobulin G1 monoclonal antibody that blocks the binding of PD-L1 on tumor cells or antigen-presenting cells to PD-1 on T cells. The PACIFIC study recently evaluated consolidation immunotherapy with durvalumab versus placebo administered after concurrent chemoradiotherapy (CCRT) in patients with unresectable stage III NSCLC. It revealed a significant improvement in both progression-free and overall survival with durvalumab, and this improvement was associated with a favorable safety profile. This achievement has made durvalumab a standard of care for consolidation after CCRT in patients with unresectable stage III NSCLC, and it has now been approved in this setting by regulatory agencies in the United States, Canada, Japan, Australia, Switzerland, Malaysia, Singapore, India, and the United Arab Emirates. In this review, we briefly summarize the results of the PACIFIC trial, including those of post hoc analysis, and we address possible molecular mechanisms, perspectives, and remaining questions related to combined treatment with CCRT and ICIs in this patient population. © 2019 Inoue and Okamoto.Sarcomas are bone and soft tissue tumors that can have significant effects on patient function and quality of life. Like most malignancies, treatment includes a combination of chemotherapy, radiation, and surgical resection, all of which also carry risks and long-term effects. A multidisciplinary rehabilitation plan can help minimize symptoms and sequelae which negatively affect the patient function and quality of life, including pain, chemotherapy-induced peripheral neuropathy, radiation fibrosis, activity restrictions following surgical excision, amputation, bowel and bladder dysfunction, and lymphedema. Patients should be evaluated by a rehabilitation specialist at any point during their diagnosis, treatment, and survivorship phase to determine appropriate interventions to minimize the impact of sarcomas and their treatment on patient function and quality of life. © 2019 Andrews et al.Introduction There is ample evidence that overnight sleep and daytime naps benefit memory retention, compared to comparable amounts of active wakefulness. Yet recent evidence also suggests that a period of post-training rest (eg, quiet wakefulness with eyes closed) provides a similar memory benefit compared to wake. However, the relative benefits of sleep vs quiet waking rest on memory remain poorly understood. Here, we assessed the extent to which sleep provides a unique memory benefit, above and beyond that conferred by quiet waking rest. Methods In a sample of healthy undergraduate students (N=83), we tested the effect of 30 mins of post-learning sleep, rest, or active wake on concept learning (dot pattern classification) and declarative memory (word pair associates) across a 4-hr daytime training-retest interval. Results and Conclusions Contrary to our hypotheses, we found no differences in performance between the three conditions for either task. The findings are interpreted with reference to methodological considerations including the length of the experimental interval, the nature of the tasks used, and challenges inherent in creating experimental conditions that can be executed by participants. © 2020 Tucker et al.Purpose The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China. Methods Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. 3-O-Acetyl-11-keto-β-boswellic molecular weight A thematic framework was used to analyze the detailed interview notes. Results The indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors. Conclusion This indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system. © 2020 Li et al.Background High blood pressure is a health risk for all populations, worldwide. Globally the number of people with uncontrolled hypertension rose by 70% between 1980 and 2008. Objective This paper aims to investigate the association of survival time and fasting blood sugar levels of hypertension patients and identify the risk factors that affect the survival time of the patient. Methods We considered a total of 430 random samples of hypertension patients who were followed-up at Yekatit-12 Hospital in Ethiopia from January 2013 to January 2019. A linear mixed effects model was used for the longitudinal outcomes (fasting blood sugar) with normality assumption, although four parametric accelerated failure time distributions exponential, Weibull, lognormal and loglogistic are studied for the time-to-event data. The Bayesian joint models were defined through latent variables and association parameters and with specified noninformative prior distributions for the model parameters. Simulations are conducted using Gier recommends that all stakeholders should be aware of the consequences of these factors which can influence the survival time of hypertension patients in the study area. © 2020 Erango.Purpose The purpose was to analyze drug prescription and antibiotic use by age and sex in Italy's Campania Region, and to estimate the distribution of prescription rates in children (≤14 years old), adults (between 15 and 65 years old), and older adults (≥65 years old) at a municipality level. Methods This was a retrospective analysis of pharmacy records in Campania (Southern Italy), in 2016. Difference in antibiotic prescriptions in different age groups was assessed by prevalence rates. Age-adjusted prevalence rates were categorized into quintiles and mapped by the patient's municipality of residence. Relationship between prevalence rates for the different age groups was estimated using the non-parametric Spearman rank correlation test. Results There were 2,738,118 were patients with at least one antibiotic prescription. Antibiotics prescription was higher in children aged 70 years. Prevalence rate distribution was different among municipalities in all age groups. A positive correlation between the rank distribution of prevalence rates at municipality level was identified for children and adults (rs=0.56; P less then 0.01), adults and the older adults (rs=0.79; P less then 0.01), and children and the older adults (rs=0.46; P less then 0.01). Among the studied age groups, the most prescribed antibiotic class was penicillin (except the older adults aged ≥85 years) ranging from 45% in children to 27.2% in the older adults. Fluoroquinolones were the least prescribed antibiotic class, ranging from 0.2% in children to 30.2% in the older adults. Conclusion A considerably high use of antibiotic drugs has been detected in Campania Region, with values exceeding the regional and national average. Prescriptions at municipal level differ from one age group to another. Antibiotic use is often unjustified, and to decrease the number of prescriptions and improve their appropriateness, several measures at territorial level are recommended. © 2020 Orlando et al.