title: Apolipoprotein D modulates amyloid pathology in APP/PS1 Alzheimer's disease mice.

text: Apolipoprotein D (apoD) is expressed in the brain and levels are increased in affected brain regions in Alzheimer's disease (AD). The role that apoD may play in regulating AD pathology has not been addressed. Here, we crossed both apoD-null mice and Thy-1 human apoD transgenic mice with APP-PS1 amyloidogenic AD mice. Loss of apoD resulted in a nearly 2-fold increase in hippocampal amyloid plaque load, as assessed by immunohistochemical staining. Conversely, transgenic expression of neuronal apoD reduced hippocampal plaque load by approximately 35%. This latter finding was associated with a 60% decrease in amyloid β 1-40 peptide levels, and a 34% decrease in insoluble amyloid β 1-42 peptide. Assessment of β-site amyloid precursor protein cleaving enzyme-1 (BACE1) levels and proteolytic products of amyloid precursor protein and neuregulin-1 point toward a possible association of altered BACE1 activity in association with altered apoD levels. In conclusion, the current studies provide clear evidence that apoD regulates amyloid plaque pathology in a mouse model of AD.


title: Predicting fluid responsiveness in mechanically ventilated children under general anaesthesia using dynamic parameters and transthoracic echocardiography.

text: BACKGROUND Dynamic variables are accurate predictors of fluid responsiveness in adults undergoing mechanical ventilation. They can be determined using respiratory variation in aortic flow peak velocity (▵Vpeak), arterial pulse pressure [▵PP and pulse pressure variation (PPV)], or plethysmographic waveform amplitude [▵POP and pleth variability index (PVI)]. These indices have not been validated in children. We studied the ability of these variables to predict fluid responsiveness in mechanically ventilated children. METHODS All results are expressed as median [median absolute deviation (MAD)]. Thirty mechanically ventilated children were studied after undergoing general anaesthesia. Mechanical ventilation was maintained with a tidal volume of 10 ml kg(-1) of body weight. ▵PP, PPV, ▵POP, PVI, ▵Vpeak, and aortic velocity-time integral were recorded before and after volume expansion (VE). Patients were considered to be responders to VE when the aortic velocity-time integral increased more than 15% after VE. RESULTS VE induced significant changes in ▵PP [13 (MAD 4) to 9 (5)%], PPV [15 (5) to 9 (5)%], ▵POP [15 (10) to 10 (6)%], PVI [13 (6) to 8 (5)%], and ▵Vpeak [16 (9) to 8 (3)%] (P<0.05 for all). Differences in ▵PP, ▵POP, PPV, and PVI did not reach statistical significance. Only ▵Vpeak was significantly different between responders (R) and non-responders (NR) to VE [22 (3) vs 7 (1)%, respectively; P<0.001]. The threshold ▵Vpeak value of 10% allowed discrimination between R and NR. CONCLUSIONS In this study, ▵Vpeak was the most appropriate variable to predict fluid responsiveness.


Exergaming for heart failure: an idea so good it just ought to work.


title: Satisfaction, quality of life and lumbar pain following laparoscopic sacrocolpopexy: suture vs. tackers.

text: OBJECTIVE To compare the operative results and rate of complications, in particular dorsolumbar pain, following laparoscopic sacrocolpopexy (LS) using sutures or tackers. STUDY DESIGN A case-control study: LS using tackers (n=35, tacker group) compared with LS using sutures (n=65, suture group). In addition to clinical evaluation of prolapse, all patients were evaluated for urinary incontinence (ICIQ-SF), dorsolumbar pain, overall quality of life (SF-36 score), and overall improvement in symptoms (PGI-I), one year after LS. RESULTS The patient characteristics (age, initial stage of prolapse,…) were comparable in the two groups, as was operating time (240 vs. 210min, p=0.18). There was no significant between-group difference in terms of anatomical correction (median post-operative ICS stage: 0 in both groups, p=0.26) or post-operative complication rates. The incidence of de novo low back pain appearing after LS was equivalent in both groups (50% vs. 25%, in the tacker and suture groups, respectively, p=0.11). However, there was a significant difference in lumbar pain intensity evaluated using the visual analog scale (4 (IQR 0-6.5) vs. 0 (IQR 0-4) in the tacker and suture groups, respectively; p=0.01), and in post-operative quality of life, which was better in patients in the suture group according to all the questionnaires. CONCLUSION Our study suggests that the use of tackers for prosthesis fixation to the promontory does not increase the incidence of post-operative dorsolumbar pain, but may increase its intensity and decrease quality of life.


An opinion of the Heart Rhythm Section of the Polish Cardiac Society (with an update) on electrotherapy and electrophysiology procedures during the COVID-19 epidemic.


Newborns at risk of COVID-19.


title: Receptor tyrosine kinase inhibitors that block replication of influenza a and other viruses.

text: We have previously reported that two receptor tyrosine kinase inhibitors (RTKIs), called AG879 and tyrphostin A9 (A9), can each block the replication of influenza A virus in cultured cells. In this study, we further characterized the in vitro antiviral efficacies and specificities of these agents. The 50% effective concentration (EC(50)) of each against influenza A was found to be in the high nanomolar range, and the selectivity index (SI = 50% cytotoxic concentration [CC(50)]/EC(50)) was determined to be >324 for AG879 and 50 for A9, indicating that therapeutically useful concentrations of each drug produce only low levels of cytotoxicity. Each compound showed efficacy against representative laboratory strains of both human influenza A (H1N1 or H3N2) and influenza B viruses. Importantly, no drug-resistant influenza virus strains emerged even after 25 viral passages in the presence of AG879, whereas viruses resistant to amantadine appeared after only 3 passages. AG879 and A9 each also exhibited potent inhibitory activity against a variety of other RNA and DNA viruses, including Sendai virus (Paramyxoviridae), herpes simplex virus (Herpesviridae), mouse hepatitis virus (Coronaviridae), and rhesus rotavirus (Reoviridae), but not against Pichinde virus (Arenaviridae). These results together suggest that RTKIs may be useful as therapeutics against viral pathogens, including but not limited to influenza, due to their high selectivity indices, low frequency of drug resistance, and broad-spectrum antiviral activities.


Contribution to the world: a lesson from Dr. Lee Jong-Wook.


title: The membrane protein of severe acute respiratory syndrome coronavirus acts as a dominant immunogen revealed by a clustering region of novel functionally and structurally defined cytotoxic T-lymphocyte epitopes.

text: BACKGROUND Severe acute respiratory syndrome coronavirus (SARS-CoV), which emerged with highly contagious and life-threatening characteristics in 2002, remains a potential risk for future outbreaks. Membrane (M) and envelope (E) proteins are major structural proteins of the SARS-CoV. The M protein has been determined as a protective antigen in humoral responses. However, its potential roles in stimulating cellular immunity remain elusive. METHODS In this study, a panel of peptides derived from M and E proteins were tested by in vitro refolding, T2 cell-binding assays, and responses stimulated by cytotoxic T-lymphocyte (CTL) epitopes in HLA-A2.1/K(b) transgenic mice and human peripheral blood mononuclear cells (PBMCs). RESULTS A nonameric epitope Mn2 and a decameric epitope Md3 derived from the M protein were identified and used for the evaluation of M protein-specific immunity. Responses stimulated by M protein-specific CTL epitopes have been found in the PBMCs of donors who had recovered from SARS infection. Additionally, the transmembrane domain of the M protein may contain a T cell epitope cluster revealed by the immunogenic and structural analysis of a panel of truncated peptides overlapping with Mn2 and Md3. CONCLUSIONS The M protein of SARS-CoV holds dominant cellular immunogenicity. This, together with previous reports of a strong humoral response against the M protein, may help to further explain the immunogenicity of SARS and serves as potential targets for SARS-CoV vaccine design.


title: Is the Medial Sural Artery Perforator Flap a New Workhorse Flap? A Systematic Review and Meta-Analysis.

text: BACKGROUND The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and low donor-site morbidity. This study explores the characteristics and uses of the medial sural artery perforator flap along with postoperative outcomes and complications. METHODS A systematic literature review was performed using PubMed, Embase, and Cochrane Central Register of Controlled Trials to identify all cases of medial sural artery perforator flap reconstruction. Descriptive and meta-analyses were performed on pooled outcomes. Multivariate logistic regression identified factors associated with increased complication rates. RESULTS Thirty-five studies encompassing 526 medial sural artery perforator flaps were included for analysis. The most common reasons for surgery were oncologic (47.6 percent) and traumatic injuries (31.8 percent). The oral cavity was the most common recipient location (45.5 percent). Average flap dimensions were 6.0 ± 2.3 cm × 9.8 ± 3.6 cm, with an average pedicle length of 10.1 ± 6.6 cm. Meta-analysis revealed an overall complication rate of 14.3 percent (Q value = 22.16; p = 0.877; I(2)= -39.9). Use of chimeric medial sural artery perforator flaps was associated with significantly higher rates of complications (OR, 3.92; p = 0.039; 95 percent CI, 1.10 to 13.89). The majority of flap donor sites were closed primarily (68 percent) versus 32 percent that were covered with split-thickness skin grafts. A flap width greater than 5.75 cm had an odds ratio of 5.3 (95 percent CI, 1.3 to 21.8; p = 0.014) of having a donor-site complication if closed primarily. CONCLUSIONS The medial sural artery perforator flap offers thin, pliable tissue with a relatively long pedicle and has minimal donor-site morbidity when the donor site is managed appropriately. As such, it should be considered a workhorse flap for both head and neck and extremity reconstruction.


title: Gastroesophageal reflux and sleep events in obstructive sleep apnea.

text: OBJECTIVE Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) often coexist. We sought to determine the presence and direction of any association between GERD and sleep events in patients with OSA. MATERIALS AND METHODS We conducted a case-crossover study among 18 patients with known OSA and GERD. All study patients underwent overnight simultaneous polysomnography and esophageal pH monitoring. A series of case-crossover analyses was conducted by defining each of the sleep (i.e. arousal, awakening, and apnea) and gastroesophageal reflux (GER) events as the outcome in turn. Respective control time points were randomly selected in all eligible control periods. When a sleep event was the outcome, the GER event was the exposure of interest. When GER was the outcome, each sleep event was assessed as the exposure individually. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Both awakenings and arousals were significantly associated with the subsequent onset of a GER event. The OR for a GER event following an awakening was 5 (95% CI 3.6-6.9) and for a GER event following an arousal was 2.5 (95% CI 1.8-3.4). Apnea did not lead to GER (OR 1.0, 95% CI 0.8-1.4). GER was not more commonly observed before any of the sleep events compared with control periods without sleep events. CONCLUSION In patients with coexisting GERD and OSA, both awakening and arousal preceded GER events, but GER does not appear to precipitate sleep-related events.


title: Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi.

text: OBJECTIVE Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. METHODS Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation. At 1 week after the procedure, each femoral vein was imaged by color Duplex ultrasound and sent for histologic interpretation for differentiation between EHIT and DVT. Five blinded vascular surgery faculty, two vascular surgery fellows, and three vascular surgery residents reviewed the ultrasound images. RESULTS Thrombi associated with radiofrequency ablation demonstrated a greater degree of hypercellular response, fibroblastic reaction, and edema (3.42 vs 2.92; 3.75 vs 2.42; 2.83 vs 1.33). Specimens harvested from the iatrogenic-induced DVT swine demonstrated a more prolific response to trichrome staining (3.42 vs 2.67). Evidence of revascularization was found in all of the EHIT specimens but in 33% of DVT specimens. On the basis of histologic findings, the pathologist predicted correct modality 92% of the time. Subgroup analysis comparing paired specimens from each swine failed to demonstrate any marked pathologic differences. Recorded ultrasound images from EHIT and DVT samples were reviewed by fellows, residents, and vascular surgery staff to determine whether clot was stationary or free-floating (n = 111; 93%), evidence of retracted or adherent vein (n = 105; 88%), and absence of color flow (n = 102; 85%). The degree of occlusion (partial vs total) and degree of distention of a visualized vein were least likely to be agreed on by reviewers (n = 95; 79% each, respectively). In subgroup (DVT vs EHIT) analyses, the percentage agreement was greatest among vascular surgery fellows (89% and 92%) compared with residents (82% and 79%) and faculty (78% and 77%). CONCLUSIONS It is possible to differentiate the thrombus origin on pathologic examination but not clinically on ultrasound. Wide variability exists for ultrasound diagnosis of EHIT and de novo DVT. Care must be taken in evaluating post-treatment duplex scans to not assign diagnosis of EHIT when DVT may well be present and extending into the deep venous system. The modulation of collagen production in the treatment of DVT may be helpful in preventing vascular dysfunction and reducing the post-thrombotic changes. Further studies on injury after radiofrequency ablation and laser ablation are needed.


title: Pathogen- and antibiotic-specific effects of prednisone in community-acquired pneumonia.

text: In a double-blind, randomised, placebo-controlled trial of hospitalised patients with community-acquired pneumonia (CAP), we demonstrated shorter time to clinical stability (TTCS) with adjunct corticosteroid therapy compared with placebo.We did a pre-planned, exploratory analysis of any association between microbiological diagnosis, antibiotic treatment and procalcitonin level and effect of prednisone on TTCS, mortality, and CAP complications (n=726 participants, enrolled between December 2009 and May 2014). Multiplex viral real time PCR was systematically performed in nasopharyngeal swabs beginning November 2011 (n=489). Other investigations and treatments were at the discretion of the physician. Effect modification was tested with inclusion of interaction terms in the statistical models.Reduced TTCS with prednisone was seen in all microbiological, antibiotic, procalcitonin and afebrile patient subgroups. We found evidence for a different prednisone response in patients with pneumococcal pneumonia in whom intravenous antibiotic duration was not shorter (interaction p=0.01) with prednisone, as was observed in the remaining study population. In patients without macrolide treatment, rehospitalisations were not lower with prednisone (interaction p=0.04). After adjustment for multiple testing, these subgroup effects were no longer significant.Prednisone was associated with shorter TTCS independent of CAP aetiology. In pneumococcal pneumonia, prednisone effects on secondary endpoints may be less favourable.


title: Respiratory and ventilator management of COVID-19.

text: The current pandemic of COVID-19 has infected around 2.5 million people with more than 125,000 deaths across the globe till date, and numbers are still rising. The causative organism is a virus of corona family. The International Committee on Taxonomy of Viruses (ICTV) named it severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to its similarities with the virus was caused SARS outbreak (SARS-CoV). Although most of the patients present with less severe symptoms like rhinitis, cough, fever, and mild flu-like symptoms, it may progress to severe acute respiratory illness, pneumonia or acute respiratory distress syndrome (ARDS) mainly in immunocompromised hosts. Severe infections mainly involve lungs, and compromise its capacity of ventilation. Respiratory and mechanical ventilation is one of the important parts of management.


Northern Ireland disease surveillance, July to September 2010.


title: Stage 1 Registered Report: The experiences and perceptions of parent-child interaction therapy for parents of young children with communication difficulties: A qualitative evidence synthesis protocol.

text: Background: Parent-child interaction therapy refers to a group of interventions mediated by trained parents to address areas of developmental difficulties in children. In the field of speech and language therapy it is used in early intervention for children with speech, language and communication difficulties. The intervention involves training parents and caregivers on the importance of responsivity and language input in daily interactions and coaches them on strategies to implement these with the children. As the success of the intervention is heavily influenced by caregiver engagement, understanding and acceptance, it is important to consider their views. However, to date there has been limited work on synthesising parental views of this intervention. Methods: This is a protocol for a qualitative evidence synthesis of peer-reviewed qualitative papers addressing the experiences and perceptions of parent-child interaction therapy for parents of children with communication difficulties. We will complete a systematic search of 11 databases, review the reference lists and complete a cited reference search of all included studies. Two authors will independently screen tests for inclusion, initially by title and abstract, with full-text screening as necessary. Thematic synthesis will be used for all included studies. We will appraise the quality of included studies using CASP and confidence in the review findings using GRADE CERQual. Discussion: As the views of parents are pivotal in the success of this intervention, the findings from this synthesis should help to guide best practice and policy for the future implementation of parent child interaction therapy for children with communication difficulties..


title: Minor Anesthesia-Related Events During Radiofrequency Ablation for Barrett's Esophagus Are Associated with an Increased Number of Treatment Sessions.

text: BACKGROUND There is limited data regarding the prevalence and clinical impact of sedation-related adverse events (SRAEs) during radiofrequency ablation (RFA) for dysplastic Barrett's esophagus (BE). AIM Our primary aim was to measure SRAE during RFA. Secondary aims were to identify risk factors for adverse events, and to determine whether SRAEs impacted the number of RFA treatments to achieve complete eradication of dysplasia (CE-D). METHODS We conducted a retrospective analysis of 120 consecutive patients undergoing initial RFA for dysplastic BE between 2008 and 2014. The main outcome measures were SRAEs and the number of RFA sessions required to achieve CE-D. RESULTS Of 120 initial RFA procedures, 83 % were performed with MAC and 17 % with GET. SRAEs occurred in 32 %, including 25 % of MAC patients (25/100) and 65 % (12/20) GET patients. The most frequent SRAE was hypotension (23 %, n = 27/120), followed by hypoxia (n = 9/120), arrhythmia (n = 4/120), and one unplanned intubation. There were no premature procedure terminations. After adjusting for length of BE mucosa and ASA score, the occurrence of a SRAE was associated with requiring more (>4) RFA sessions to achieve CE-D, OR 3.45 (95 % CI 1.49-7.99). Mean RFA sessions required to achieve CE-D was 5 ± 1 in patients with SRAE, compared to 3 ± 0.7 in patients without SRAE during the first treatment session (p < 0.001). CONCLUSIONS SRAE during RFA for dysplastic BE occurs at a rate typical of other advanced endoscopic procedures. Patients who experience minor events related to anesthesia during the first RFA are likely to require more RFA treatment sessions to achieve CE-D.


title: Impact of porcine epidemic diarrhea virus infection at different periods of pregnancy on subsequent reproductive performance in gilts and sows.

text: Reproductive performance of gilts and sows in a swine commercial herd following an outbreak of porcine epidemic diarrhea virus (PEDV) were investigated. A PEDV outbreak was observed in March 2008 in a swine herd in Thailand. The disease was diagnosed by clinical symptoms, gross and histopathology and viral detection using reverse transcriptase-polymerase chain reaction assay. The intestines of the infected piglets were collected, minced and fed to all of the gilts and sows within 2 weeks after the onset of the PEDV outbreak. Reproductive data were collected during a period from January 2007 to July 2008 and were retrospectively evaluated. The farrowing rate (FR), return rate (RR), abortion rate (AR), number of total piglets born per litter (TB), number of piglets born alive per litter (BA), percentage of stillbirth piglets per litter (SB), percentage of mummified fetus per litter (MM) and piglet's birth weight (BW), before and after the PEDV outbreak were compared. It was found that the impact of PEDV infection on the reproductive performance of gilts and sows depended on the period of pregnancy when the females were exposed to the pathogen, and parity number. The pregnant females infected with PEDV during the first 30 days of pregnancy had a 12.6 percentage point decrease of FR (91.1% vs. 78.5%, P=0.003), a 5.7 percentage point increase of RR (3.5% vs. 9.2%, P=0.01), a 1.3 percentage point increase of AR (2.1% vs. 3.4%, P=0.01) and a 2.0 percentage point increase of MM (3.5% vs. 5.6%, P<0.001). SB increased in the pregnant females that were infected with PEDV during 91-120 days of pregnancy (1.8 percentage points, 4.5% vs. 6.2%, P=0.01). The impacts of PEDV infection on subsequent reproductive performance were more severe in the pregnant gilts than the pregnant sows. PEDV infection during the first 30 days of pregnancy resulted in a decrease of TB by 1.4 (11.7 vs. 10.3 piglets/litter, P<0.001) and a decrease of BA by 2.2 (10.7 vs. 8.5 piglets/litter, P<0.001) in the gilts' litters, while the influence of PEDV infection on TB and BA was not significant in sows (P>0.05). It was concluded that natural infection of PEDV in the pregnant gilts and sows caused a reduction of subsequent reproductive performance.


title: Effectiveness and acceptability of methods of communicating the results of clinical research to lay and professional audiences: protocol for a systematic review.

text: BACKGROUND Phase III randomised controlled trials aim not just to increase the sum of human knowledge, but also to improve treatment, care or prevention for future patients through changing policy and practice. To achieve this, the results need to be communicated effectively to several audiences. It is unclear how best to do this while not wasting scarce resources or causing avoidable distress or confusion. The aim of this systematic review is to examine the effectiveness, acceptability and resource implications of different methods of communication of clinical research results to lay or professional audiences, to inform practice. METHODS We will systematically review the published literature from 2000 to 2018 for reports of approaches for communicating clinical study results to lay audiences (patients, participants, carers and the wider public) or professional audiences (clinicians, policymakers, guideline developers, other medical professionals). We will search Embase, MEDLINE, PsycINFO, ASSIA, the Cochrane Database of Systematic Reviews and grey literature sources. One reviewer will screen titles and abstracts for potential eligibility, discarding only those that are clearly irrelevant. Potentially relevant full texts will then be assessed for inclusion by two reviewers. Data extraction will be carried out by one reviewer using EPPI-Reviewer. Risk of bias will be assessed using the relevant Cochrane Risk of Bias 2.0 tool, ROBINS-1, AXIS Appraisal Tool or Critical Appraisals Skills Programme Qualitative Checklist, depending on study design. We will decide whether to meta-analyse data based on whether the included trials are similar enough in terms of participants, settings, intervention, comparison and outcome measures to allow meaningful conclusions from a statistically pooled result. We will present the data in tables and narratively summarise the results. We will use thematic synthesis for qualitative studies. DISCUSSION Developing the search strategy for this review has been challenging as many of the concepts (patients, clinicians, clinical studies, and communication) are widely used in literature that is not relevant for inclusion in our review. We expect there will be limited comparative evidence, spread over a wide range of approaches, comparators and populations and, therefore, do not anticipate being able to carry out meta-analysis. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews PROSPERO ( CRD42019137364 ).


title: Surgical treatment for nonspecific esophageal motility disorders.

text: PURPOSE Nonspecific esophageal motility disorder (NEMD) is a vague category that includes patients with poorly defined contraction abnormalities observed during esophageal manometry. This study investigated the therapeutic effects of the video-assisted thoracoscopic surgery (VATS) approach using long myotomy and fundopexy for NEMD. METHODS The VATS approach using myotomy and fundopexy was performed for 4 patients of NEMD between 2005 and 2008. A total of 4 patients with NEMD that underwent treatment at our institution were analyzed retrospectively. RESULTS The patients included 2 males and 2 females with a median age of 48 years (range 21-74 years). The median duration of NEMD symptoms was 58 months (range 4-108 months). Dysphagia was a primary symptom in all patients. Chest pain was a primary symptom in 3 of 4 patients (75 %). Treatment with medication was attempted before the operation. The median operative time was 344.5 min (range 210-476 min). The median time before starting oral feeding was 2.5 days (range 2-22 days). All patients achieved a significant improvement of their previous condition. CONCLUSIONS The VATS approach using myotomy and fundopexy for NEMD is a good treatment in cases resistant to medication and balloon dilation.


title: Targeting Vitamin D Deficiency to Limit Exacerbations in Respiratory Diseases: Utopia or Strategy With Potential?

text: Patients with respiratory diseases such as cystic fibrosis, chronic obstructive pulmonary disease, or asthma often experience an acute worsening of respiratory symptoms, termed exacerbations. Although the course of exacerbations is disease specific, they are mostly triggered by a respiratory infection. Exacerbations often require hospitalization and are an important cause of mortality. Treatments of exacerbations aim to minimize the negative impact and to prevent subsequent events. Despite many existing therapy options, many patients do not benefit from therapy and suffer from recurrent events. Vitamin D deficiency is a worldwide problem and is extremely prevalent in these patients. Vitamin D, known for its calcemic effects, also has immunomodulatory and anti-infectious actions and can therefore be a possible agent to treat or prevent exacerbations. This review will focus on vitamin D as a potential candidate to treat or prevent exacerbations in CF, COPD, and asthma.


title: Management of patients with stroke treated with direct oral anticoagulants.

text: Since their market approval, direct oral anticoagulants (DOACs) are being increasingly used for stroke prevention in patients with atrial fibrillation. However, the management of DOAC-treated patients with stroke poses several challenges for physicians in everyday clinical practice, both in the acute setting and in long-term care. This has spurred extensive research activity in the field over the past few years, which we review here.


title: Deafness and mental health: Clinical challenges during the COVID-19 pandemic.

text: The current health crisis scenario has exposed the negative impact on mental health. This commentary highlights the main challenges and barriers that the Deaf community faces in access to health care resources and psychological support during the COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Effects of renal denervation on end organ damage in hypertensive patients.

text: BACKGROUND Renal denervation (RDN) is believed to reduce sympathetic nerve activity and is a potential treatment for resistant hypertension. The present study investigated the effects of RDN on end organ damage (EOD). DESIGN The present study was a prospective cohort study (registered as NCT01427049). METHODS Uncontrolled hypertensive patients underwent a work-up prior to and one year after RDN. Cardiac magnetic resonance (CMR) imaging was used to determine left ventricular (LV)-mass; pulse wave analysis and pulse wave velocity (PWV) were used for evaluation of central blood pressure (BP) and arterial stiffness and 24-hour urine was collected for assessment of urinary albumin excretion. The 24-hour ambulatory BP measurement (ABPM) was used to evaluate the effect of RDN on BP. RESULTS Fifty-four patients gave informed consent for study participation. Mean age was 58 ± 10 years, 50% were male. One year after RDN, mean ABPM decreased by 7 ± 18/5 ± 11 mm Hg (p = 0.01/p < 0.01). In the patients followed-up in a standardised fashion ABPM decreased by 5 ± 18/4 ± 12 mm Hg (n = 34; p = 0.11/p = 0.09). Mean body surface area indexed LV-mass decreased by 3.3 ± 11.5 g/m(2) (corresponding to a 3 ± 11% reduction; p = 0.09). PWV increased by 2.9 (-2.2 to +6.1) m/s (p = 0.04). Augmentation index corrected for 75 beats per min did not change (median increase 3.0 (-7 to +17) mm Hg; p = 0.89). Urinary albumin excretion did not change during follow-up (mean decrease 10 ± 117 mg/24 hour; p = 0.61). CONCLUSION In the current study, we observed a modest effect from renal denervation. Moreover, RDN did not result in a statistical significant effect on end organ damage 12 months after treatment.


title: Response Surface Analysis and Nonlinear Optimization Algorithm for Maximization of Clinical Drug Performance: Application to Extended-Release and Long-Acting Injectable Paliperidone.

text: Model-based approach is recognized as a tool to make drug development more productive and to better support regulatory and therapeutic decisions. The objective of this study was to develop a novel model-based methodology based on the response surface analysis and a nonlinear optimizer algorithm to maximize the clinical performances of drug treatments. The treatment response was described using a drug-disease model accounting for multiple components such as the dosage regimen, the pharmacokinetic characteristics of a drug (including the mechanism and the rate of drug delivery), and the exposure-response relationship. Then, the clinical benefit of a treatment was defined as a function of the diseases and the clinical endpoints and was estimated as a function of the target pharmacodynamic endpoints used to evaluate the treatment effect. A case study is presented to illustrate how the treatment performances of paliperidone extended release (ER) and paliperidone long-acting injectable (LAI) can be improved. A convolution-based approach was used to characterize the pharmacokinetics of ER and LAI paliperidone. The drug delivery properties and the dosage regimen maximizing the clinical benefit (defined as the target level of D2 receptor occupancy) were estimated using a nonlinear optimizer. The results of the analysis indicated that a substantial improvement in clinical benefit (from 15% to 27% for the optimization of the in vivo release and from ∼30% to ∼70% for the optimization of dosage regimen) was obtained when optimal strategies were deployed either for optimizing the in vivo drug delivery properties of ER formulations or for optimizing the dosage regimen of LAI formulations.


title: An evaluation of a zero-heat-flux cutaneous thermometer in cardiac surgical patients.

text: BACKGROUND Although core temperature can be measured invasively, there are currently no widely available, reliable, noninvasive thermometers for its measurement. We thus compared a prototype zero-heat-flux thermometer with simultaneous measurements from a pulmonary artery catheter. Specifically, we tested the hypothesis that zero-heat-flux temperatures are sufficiently accurate for routine clinical use. METHODS Core temperature was measured from the thermistor of a standard pulmonary artery catheter and with a prototype zero-heat-flux deep-tissue thermometer in 105 patients having nonemergent cardiac surgery. Zero-heat-flux probes were positioned on the lateral forehead and lateral neck. Skin surface temperature probes were attached to the forehead just adjacent to the zero-heat-flux probe. Temperatures were recorded at 1-minute intervals, excluding the period of cardiopulmonary bypass, and for the first 4 postoperative hours. Zero-heat-flux and pulmonary artery temperatures were compared with bias analysis; differences exceeding 0.5°C were considered to be potentially clinically important. RESULTS The mean duration in the operating room was 279 ± 75 minutes, and the mean cross-clamp time was 118 ± 50 minutes. All subjects were monitored for an additional 4 hours in the intensive care unit. The average overall difference between forehead zero-heat-flux and pulmonary artery temperatures (i.e., forehead minus pulmonary artery) was -0.23°C (95% limits of agreement of ±0.82); 78% of the differences were ≤0.5°C. The average intraoperative temperature difference was -0.08°C (95% limits of agreement of ±0.88); 84% of the differences were ≤0.5°C. The average postoperative difference was -0.32°C (95% limits of agreement of ±0.75); 84% of the differences were ≤0.5°C. Bias and precision values for neck site were similar to the forehead values. Uncorrected forehead skin temperature showed an increasing negative bias as core temperature decreased. CONCLUSIONS Core temperature can be noninvasively measured using the zero-heat-flux method. Bias was small, but precision was slightly worse than our designated 0.5°C limits compared with measurements from a pulmonary artery catheter.


title: TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care.

text: BACKGROUND AND PURPOSE Stroke Unit care improves stroke prognosis and is recommended for all patients with stroke. In rural areas, population-wide implementation of Stroke Units is challenging. Therefore, the TeleMedical Project for integrative Stroke Care (TEMPiS) was established in 2003 as a TeleStroke Unit network to overcome this barrier in Southeast Bavaria/Germany. Evaluation of its implementation between 2003 and 2005 had revealed improved process quality and clinical outcomes compared with matched hospitals without TeleStroke Units. Data on sustainability of these effects are lacking. METHODS Effects on the stroke care of the local population were analyzed by using data from official hospital reports. Prospective registries from 2003 to 2012 describe processes and outcomes of consecutive patients with stroke and transient ischemic attack treated in TEMPiS hospitals. Quality indicators assess diagnostics, treatment, and outcome. Rates and timeliness of intravenous thrombolysis as well as data on teleconsultations and secondary interhospital transfers were reported over time. RESULTS Within the covered area, network implementation increased the number of patients with stroke and transient ischemic attack treated in hospitals with (Tele-)Stroke Units substantially from 19% to 78%. Between February 2003 and December 2012, 54 804 strokes and transient ischemic attacks were treated in 15 regional hospitals, and 31 864 teleconsultations were performed. Intravenous thrombolysis was applied 3331 stroke cases with proportions increasing from 2.6% to 15.5% of all patients with ischemic stroke. Median onset-to-treatment times decreased from 150 (interquartile range, 127-163) to 120 minutes (interquartile range, 90-160) and door-to-needle times from 80 (interquartile range, 68-101) to 40 minutes (interquartile range, 29-59). CONCLUSIONS TeleStroke Units can provide sustained high-quality stroke care in rural areas.


title: Recent Evidence Regarding the Association Between Migraine and Suicidal Behaviors: A Systematic Review.

text: Objective: The review presents a systematic analysis of literature investigating the association between migraine and suicidal behaviors. Introduction: Migraine is a common neurological disorder. The prevalence of migraines increases with age from adolescence to adulthood in both sexes, and results in a substantial loss of productivity due to missing days of school or work and need for bed rest. Literature prior to 2015 suggests that migraine is a predictor of suicide. Given the worldwide public health interest in suicide prevention, we examined the literature collected from diverse, predominantly non-European, populations post-2015. Methods: The databases used in this systematic review included: Medline, PsycINFO, EMBASE (Ovid), Science Direct (Elsevier), Cochrane, and PubMed for all available years of publication from January 2015 onwards. The review included participants aged 16 and over who had been diagnosed with migraines with the following outcome variables: any suicidality, both fatal and non-fatal; suicidal ideation; and suicidal behavior. Results: The database searches yielded a total of 542 citations. Following title and abstract screening, 460 articles were excluded and a total of 21 citations were evaluated. After full-text review and excluding a further 11 non-eligible studies, a total of 10 studies were eligible for inclusion in the systematic review. Conclusions: Current existing research highlights the important association between the increased risk of suicidal behaviors in the clinical and general population among chronic migraineurs with/without aura worldwide. Future studies are needed to facilitate the development of clinical guidelines for risk assessment, targeted interventions, and evidence-based treatment of migraine to reduce the risk of suicide among this vulnerable population.


title: B cell depletion in murine lupus using cytotoxic T lymphocytes in vivo: Feasibility and benefit.

text: Given the promising results in human lupus with B cell depletion, we tested whether in vivo cytotoxic T lymphocyte (CTL) could eliminate autoreactive B cells in the setting of murine lupus. Using the parent-into-F1 (P → F1) model to generate CTL that eliminate B cells, we found that transfer ofNZB parental splenocytes into lupus-prone female NZB/W F1 mice resulted in profound B cell reduction whereas NZW → F1 mice exhibited defective B cell elimination. Using pre-disease or early disease B/W mice as hosts, NZB → F1 mice exhibited B cell depletion and improved proteinuria but no improvement in survival whereas NZW → F1 mice had significantly reduced proteinuria and prolonged survival. Thus, despite the defective IL-2 environment in B/W F1 mice, generation of CTL and B cell depletion is feasible in NZB → F1 mice. The surprising increase in survival for NZW → F1 mice despite defective B cell elimination suggests that NZW splenocytes may contain a beneficial down regulatory cell.


title: Role of the endoplasmic reticulum-associated degradation (ERAD) pathway in degradation of hepatitis C virus envelope proteins and production of virus particles.

text: Viral infections frequently cause endoplasmic reticulum (ER) stress in host cells leading to stimulation of the ER-associated degradation (ERAD) pathway, which subsequently targets unassembled glycoproteins for ubiquitylation and proteasomal degradation. However, the role of the ERAD pathway in the viral life cycle is poorly defined. In this paper, we demonstrate that hepatitis C virus (HCV) infection activates the ERAD pathway, which in turn controls the fate of viral glycoproteins and modulates virus production. ERAD proteins, such as EDEM1 and EDEM3, were found to increase ubiquitylation of HCV envelope proteins via direct physical interaction. Knocking down of EDEM1 and EDEM3 increased the half-life of HCV E2, as well as virus production, whereas exogenous expression of these proteins reduced the production of infectious virus particles. Further investigation revealed that only EDEM1 and EDEM3 bind with SEL1L, an ER membrane adaptor protein involved in translocation of ERAD substrates from the ER to the cytoplasm. When HCV-infected cells were treated with kifunensine, a potent inhibitor of the ERAD pathway, the half-life of HCV E2 increased and so did virus production. Kifunensine inhibited the binding of EDEM1 and EDEM3 with SEL1L, thus blocking the ubiquitylation of HCV E2 protein. Chemical inhibition of the ERAD pathway neither affected production of the Japanese encephalitis virus (JEV) nor stability of the JEV envelope protein. A co-immunoprecipitation assay showed that EDEM orthologs do not bind with JEV envelope protein. These findings highlight the crucial role of the ERAD pathway in the life cycle of specific viruses.


National COVID numbers - Benford's law looks for errors.


title: Identification of ciliary neurotrophic factor receptor alpha as a mediator of neurotoxicity induced by alpha-synuclein.

text: Accumulating evidence suggests that extracellular alpha-synuclein (eSNCA) plays an important role in the pathogenesis of Parkinson's disease or related synucleinopathies by inducing neurotoxicity directly or indirectly via microglial or astroglial activation. However, the mechanisms by which this occurs remain to be characterized. To explore these mechanisms, we combined three biochemical techniques - stable isotope labeling of amino acid in cell cultures (SILAC), biotin labeling of plasma membrane proteins followed by affinity purification, and analysis of unique proteins binding to SNCA peptides on membrane arrays. The SILAC proteomic analysis identified 457 proteins, of which, 245 or 172 proteins belonged to membrane or membrane associated proteins, depending on the various bioinformatics tools used for interpretation. In dopamine neuronal cells treated with eSNCA, the levels of 86 membrane proteins were increased and 35 were decreased compared with untreated cells. In peptide array analysis, 127 proteins were identified as possibly interacting with eSNCA. Of those, seven proteins were overlapped with the membrane proteins that displayed alterations in relative abundance after eSNCA treatment. One was ciliary neurotrophic factor receptor, which appeared to modulate eSNCA-mediated neurotoxicity via mechanisms related to JAK1/STAT3 signaling but independent of eSNCA endocytosis.


title: A simplified laparoscopic ventral hernia repair: the scroll technique.

text: BACKGROUND Laparoscopic ventral hernia repair has steadily gained recognition as an alternative to the open approach. However, the procedure can be technically challenging. The authors present their simple scroll technique for laparoscopic ventral hernia repair. METHODS A total of 174 patients underwent laparoscopic ventral hernia repair using the scroll technique. The technique entails fixation of the rolled mesh to the anterior abdominal wall before it is unfolded. Patient characteristics, operative time, and complications were analyzed and compared with pooled data from the available literature on laparoscopic ventral hernia repair. RESULTS The mean operative time was comparable with that reported by others (mean, 102 vs. 100 min). The hospital stay was shorter (mean, 1.8 vs. 2.4 h). During a mean follow-up period of 28 months, the recurrence rate was lower than that reported by others (1.7% vs. 4.3%). There were no mortalities and no cases of inadvertent bowel injury. CONCLUSION The authors' scroll technique for laparoscopic repair is simple, feasible, and reproducible, with a short learning curve and a low recurrence rate.


title: Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis.

text: OBJECTIVE: To explore the effect of goal-setting on physical functioning, quality of life and duration of rehabilitation in geriatric rehabilitation compared to care as usual. DATA SOURCES: Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from initiation to October 2018. METHODS: We included randomized controlled trials (RCTs), controlled before-after studies and studies using historic controls of older patients (mean age ⩾55 years) receiving rehabilitation for acquired disabilities. Our primary outcome was physical functioning; secondary outcomes were quality of life and rehabilitation duration. Cochrane guidelines were used to assess the risk of bias of the studies and extract data. Only RCT data were pooled using standardized mean difference (SMD). RESULTS: We included 14 studies consisting of a total of 1915 participants with a mean age ranging from 55 to 83 years. Ten out of the 14 studies had a randomized controlled design, 7 of which could be pooled for the primary outcome. The risk of bias was judged high in several domains in all included studies. The meta-analysis showed no statistically significant differences between goal-setting and care as usual for physical functioning (SMD -0.11 (-0.32 to 0.10)), quality of life (SMD 0.09 (-0.56 to 0.75)) and rehabilitation duration (MD 13.46 days (-2.46 to 29.38)). CONCLUSION: We found low-quality evidence that goal-setting does not result in better physical functioning compared to care as usual in geriatric rehabilitation. For quality of life and duration of rehabilitation, we could not exclude a clinically relevant effect.


title: Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation.

text: PURPOSE Anterior component separation (ACS) with external oblique release for ventral hernia repair has a recurrence rate up to 32%. Hernia recurrence after prior ACS represents a complex surgical challenge. In this context, we report our experience utilizing posterior component separation with transversus abdominis muscle release (PCS/TAR) and retromuscular mesh reinforcement. METHODS Patients with a history of recurrent hernia following ACS repaired with PCS/TAR were retrospectively identified from prospective databases collected at two large academic institutions. Patient demographics, hernia characteristics (using CT scan) and outcomes were evaluated. RESULTS Twenty-nine patients with a history of ACS developed 22 (76%) midline, 3 (10%) lateral and 4 (14%) concomitant recurrences. Contamination was present in 11 (38%) of cases. All were repaired utilizing a PCS/TAR with retromuscular mesh placement (83% synthetic, 17% biologic) and fascial closure. Wound morbidity consisted of 13 (45%) surgical site occurrences including 8 (28%) surgical site infections. Five (17%) patients required 90-day readmission, and two (7%) were related to wound morbidity. One organ space infection with frank spillage of stool resulted in the only instance of mesh excision. This case also represents the only instance of recurrence (3%) with a mean follow-up of 11 (range 3-36) months. CONCLUSION Patients with a history of an ACS who develop a recurrence represent a challenging clinical scenario with limited options for surgical repair. A PCS/TAR hernia repair achieves acceptable outcomes and may in fact be the best approach available.


title: [Investigation on demands for antenatal care services among 2 002 pregnant women during the epidemic of COVID-19 in Shanghai].

text: Objective: To identify problems and demands for antenatal care (ANC) among pregnant women in different trimesters of pregnancy in Shanghai for optimizing ANC service during the epidemic of COVID-19. Method: s Organized by maternal and child health care institute in the 16 districts of Shanghai, a cross sectional study was conducted among pregnant women who came to pregnancy registration in the community health centers or attended ANC in midwifery hospitals from February 7 to February 12, 2020. Consented participating women completed a semi-structured online questionnaire voluntarily. Data was analyzed using frequency,chi-square test and scoring. Result: s A total of 2 002 valid questionnaires were collected from 183 community health centers and 67 midwifery hospitals. About 94.6%(1 894/2 002) of the pregnant women worried about being infected during the COVID-19 epidemic, and 14.7% (294/2 002) demanded for psychological consultation. Time-lapse appointments for ANC were requested by 87.7% (1 756/2 002) of the participants for avoiding presenting themselves in people-density places. Compared with other pregnancy trimesters, pregnant women in the second trimester were more willing to reduce the frequency of ANC (35.2% versus 39.5% versus 48.1%, P<0.01). Compared with multiparas, primiparas were more willing to have online consultation and guidance (49.2% versus 63.8%, P<0.01). Regarding the needs for health knowledge on COVID-19, personal protection against 2019 novel coronavirus (2019-nCoV) was the most concerned for pregnant women, and 71.0% (1 421/2 002) of them preferred to obtain knowledge through health applications, official Weibo and WeChat. Conclusions: Pregnant women in Shanghai critically concern about the risk of 2019-nCoV infections, and highly demand knowledge and measures on prevention and protection from COVID-19. They ask for having time-lapse appointments for ANC and online access to health information and services. Maternal and child care institutes should understand the demands of pregnant women, optimize the means of ANC service, and provide tailored and accessible health education and service for the safety of mother and child.


title: Early arterial stasis during resin-based yttrium-90 radioembolization: incidence and preliminary outcomes.

text: OBJECTIVES This study was conducted to determine the incidence of early stasis in radioembolization using resin yttrium-90 (Y-90) microspheres, to evaluate potential contributing factors, and to review initial imaging outcomes. METHODS Patients in whom early stasis occurred were compared with those in whom complete delivery was achieved for tumour type and vascularity, tumour : normal liver ratio (T : N ratio) at technetium-99m-macroaggregated albumin (Tc-99m-MAA) angiography, previous intra-arterial therapy, and infusion site (left, right or whole liver). Tumour response was evaluated at 3 months and defined according to whether a partial response and stable disease versus progressive disease were demonstrated. RESULTS A total of 71 patients underwent 128 Y-90 infusions in which 26 (20.3%) stasis events occurred. Hypervascular and hypovascular tumours had similar rates of stasis (17.4% versus 27.8%; P = NS). The mean ± standard deviation T : N ratio was 3.03 ± 1.54 and 3.66 ± 2.79 in patients with and without stasis, respectively (P = NS). Stasis occurred in 14 of 81 (17.3%) and 12 of 47 (25.5%) infusions following previous intra-arterial therapy and in therapy-naïve territories, respectively (P = NS). Early stasis occurred in 15 of 41 (36.6%) left, 10 of 65 (15.4%) right and one of 22 (4.5%) whole liver infusions (P < 0.001). Rates of partial response and stable disease were similar in the stasis (88.3%) and non-stasis (76.0%) groups (P = NS). CONCLUSIONS Early stasis occurred in approximately 20% of infusions with similar incidences in hyper- and hypovascular tumours. Whole-liver therapy reduced the incidence of stasis. Stasis did not appear to affect initial imaging outcomes.


title: Magnetic resonance imaging in children with sickle cell disease--detecting alterations in the apparent diffusion coefficient in hips with avascular necrosis.

text: BACKGROUND Avascular necrosis (AVN) is a common morbidity in children with sickle cell disease (SCD) that leads to pain and joint immobility. However, the diagnosis is often uncertain or delayed. OBJECTIVE To examine the ability of apparent diffusion coefficient (ADC) measurements on diffusion-weighted imaging to detect AVN in children with SCD. MATERIALS AND METHODS ADC values were calculated at the hips of normal children (n = 19) and children with SCD who were either asymptomatic with no known previous hip disease (n = 13) or presented for the first time with clinical symptoms of hip pathology (n = 12). ADC values were compared for differences among groups with and without AVN using non-parametric statistical methods. RESULTS The ADC values were elevated in the hips of children with AVN (median ADC = 1.57 × 10(-3) mm(2)/s [95% confidence interval = 0.86-2.10]) and differed significantly in pairwise comparisons (all P < 0.05) from normal children (0.74 [0.46-0.98]), asymptomatic children with SCD (0.55 [0.25-0.85]), and SCD children who had symptoms referable to their hips but did not show findings of hip AVN on conventional MRI or radiographs (0.46 [0.18-0.72]). CONCLUSION Children with sickle cell disease have elevated apparent diffusion coefficient values in their affected hips on initial diagnosis of avascular necrosis.


title: Treatment abandonment in childhood acute lymphoblastic leukaemia in China: a retrospective cohort study of the Chinese Children's Cancer Group.

text: OBJECTIVES Before 2003, most children with acute lymphoblastic leukaemia (ALL) abandoned treatment, with only approximately 30% treated in China. With the development of national insurance for underprivileged patients, we assessed the current frequency and causes of treatment abandonment among patients with ALL who were enrolled in the Chinese Children's Cancer Group ALL protocol between 2015 and 2016. METHODS Demographic, clinical and laboratory data on patients who abandoned treatment, as well as economic and sociocultural data of their families were collected and analysed. General health-related statistics were retrieved from publicly accessible databanks maintained by the Chinese government. RESULTS At a median follow-up of 119 weeks, 83 (3.1%, 95% CI 2.5% to 3.8%) of the 2641 patients abandoned treatment. Factors independently associated with abandonment included standard/high-risk ALL (OR 2.62, 95% CI 1.43 to 4.77), presence of minimal residual disease at the end of remission induction (OR 3.57, 95% CI 1.90 to 6.74) and low-income economic region (OR 3.7, 95% CI 1.89 to 7.05). According to the family members, economic constraints (50.6%, p=0.0001) were the main reason for treatment abandonment, followed by the belief of incurability, severe side effects and concern over late complications. CONCLUSIONS The rate of ALL treatment abandonment has been greatly reduced in China. Standard/high-risk ALL, residence in a low-income region and economic difficulties were associated with treatment abandonment. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-IPR-14005706, pre-results.


title: The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure.

text: The 2019 novel coronavirus (COVID-2019) has led to a serious outbreak of often severe respiratory disease, which originated in China and has quickly become a global pandemic, with far-reaching consequences that are unprecedented in the modern era. As public health officials seek to contain the virus and mitigate the deleterious effects on worldwide population health, a related threat has emerged: global media exposure to the crisis. We review research suggesting that repeated media exposure to community crisis can lead to increased anxiety, heightened stress responses that can lead to downstream effects on health, and misplaced health-protective and help-seeking behaviors that can overburden health care facilities and tax available resources. We draw from work on previous public health crises (i.e., Ebola and H1N1 outbreaks) and other collective trauma (e.g., terrorist attacks) where media coverage of events had unintended consequences for those at relatively low risk for direct exposure, leading to potentially severe public health repercussions. We conclude with recommendations for individuals, researchers, and public health officials with respect to receiving and providing effective communications during a public health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries.

text: BACKGROUND AND PURPOSE Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. METHODS Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index. RESULTS There were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70-82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2-7]) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52-86) days and 349 (IQR, 303-360) days and median mRS were 2 (IQR, 1-4) and 2 (IQR, 1-4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient, -0.731; P<0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 (c-index, 0.837). Similar findings were observed at 1 year. CONCLUSIONS In a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.


title: The human IgG anti-carbohydrate repertoire exhibits a universal architecture and contains specificity for microbial attachment sites.

text: Despite the paradigm that carbohydrates are T cell-independent antigens, isotype-switched glycan-specific immunoglobulin G (IgG) antibodies and polysaccharide-specific T cells are found in humans. We used a systems-level approach combined with glycan array technology to decipher the repertoire of carbohydrate-specific IgG antibodies in intravenous and subcutaneous immunoglobulin preparations. A strikingly universal architecture of this repertoire with modular organization among different donor populations revealed an association between immunogenicity or tolerance and particular structural features of glycans. Antibodies were identified with specificity not only for microbial antigens but also for a broad spectrum of host glycans that serve as attachment sites for viral and bacterial pathogens and/or exotoxins. Tumor-associated carbohydrate antigens were differentially detected by IgG antibodies, whereas non-IgG2 reactivity was predominantly absent. Our study highlights the power of systems biology approaches to analyze immune responses and reveals potential glycan antigen determinants that are relevant to vaccine design, diagnostic assays, and antibody-based therapies.


title: The impact of PARPs and ADP-ribosylation on inflammation and host-pathogen interactions.

text: Poly-adenosine diphosphate-ribose polymerases (PARPs) promote ADP-ribosylation, a highly conserved, fundamental posttranslational modification (PTM). PARP catalytic domains transfer the ADP-ribose moiety from NAD+ to amino acid residues of target proteins, leading to mono- or poly-ADP-ribosylation (MARylation or PARylation). This PTM regulates various key biological and pathological processes. In this review, we focus on the roles of the PARP family members in inflammation and host-pathogen interactions. Here we give an overview the current understanding of the mechanisms by which PARPs promote or suppress proinflammatory activation of macrophages, and various roles PARPs play in virus infections. We also demonstrate how innovative technologies, such as proteomics and systems biology, help to advance this research field and describe unanswered questions.


title: Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States.

text: The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities.


title: Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry.

text: BACKGROUND AND PURPOSE Efficient and timely recanalization is an important goal in acute stroke endovascular therapy. Several studies demonstrated improved recanalization and clinical outcomes with the stent retriever devices compared with the Merci device. The goal of this study was to evaluate the role of the balloon guide catheter (BGC) and recanalization success in a substudy of the North American Solitaire Acute Stroke (NASA) registry. METHODS The investigator-initiated NASA registry recruited 24 clinical sites within North America to submit demographic, clinical, site-adjudicated angiographic, and clinical outcome data on consecutive patients treated with the Solitaire Flow Restoration device. BGC use was at the discretion of the treating physicians. RESULTS There were 354 patients included in the NASA registry. BGC data were reported in 338 of 354 patients in this subanalysis, of which 149 (44%) had placement of a BGC. Mean age was 67.3±15.2 years, and median National Institutes of Health Stroke Scale score was 18. Patients with BGC had more hypertension (82.4% versus 72.5%; P=0.05), atrial fibrillation (50.3% versus 32.8%; P=0.001), and were more commonly administered tissue plasminogen activator (51.6% versus 38.8%; P=0.02) compared with patients without BGC. Time from symptom onset to groin puncture and number of passes were similar between the 2 groups. Procedure time was shorter in patients with BGC (120±28.5 versus 161±35.6 minutes; P=0.02), and less adjunctive therapy was used in patients with BGC (20% versus 28.6%; P=0.05). Thrombolysis in cerebral infarction 3 reperfusion scores were higher in patients with BGC (53.7% versus 32.5%; P<0.001). Distal emboli and emboli in new territory were similar between the 2 groups. Discharge National Institutes of Health Stroke Scale score (mean, 12±14.5 versus 17.5±16; P=0.002) and good clinical outcome at 3 months were superior in patients with BGC compared with patients without (51.6% versus 35.8%; P=0.02). Multivariate analysis demonstrated that the use of BGC was an independent predictor of good clinical outcome (odds ratio, 2.5; 95% confidence interval, 1.2-4.9). CONCLUSIONS Use of a BGC with the Solitaire Flow Restoration device resulted in superior revascularization results, faster procedure times, decreased need for adjunctive therapy, and improved clinical outcome.


title: Regulation of the proapoptotic factor Bax by Ku70-dependent deubiquitylation.

text: The DNA end-joining protein Ku70 is one of several proteins that inhibit apoptosis by sequestering the proapoptotic factor Bax from the mitochondria. However, the molecular mechanism underlying Ku70-dependent inhibition of Bax is not fully understood. Here, we show that the absence of Ku70 results in the accumulation of ubiquitylated Bax. Under normal growth conditions, Bax ubiquitylation promotes its degradation. Upon induction of apoptosis in wild-type cells, a significant reduction in the levels of ubiquitylated Bax was observed, whereas in Ku70(-/-) cells, the ubiquitylated Bax was robustly accumulated. Addition of recombinant Ku70 into a protein extract of Ku70(-/-) cells resulted in a decrease in the levels of ubiquitylated Bax, even in the presence of proteasome inhibitors. Moreover, an in vitro deubiquitylation assay demonstrated that recombinant Ku70 hydrolyzed polyubiquitin chains into monoubiquitin units. Thus, Ku70 regulates apoptosis by sequestering Bax from the mitochondria and mediating Bax deubiquitylation. These results shed light on the role of proteasome inhibitors as tumor suppressors.


title: Detection of the Canine Parvovirus 2c Subtype in Australian Dogs.

text: Canine parvovirus (CPV-2) is an important cause of hemorrhagic enteritis in dogs. In Australia the disease has been associated with CPV-2a and CPV-2b variants. A third more recently emerged variant overseas, CPV-2c, has not been detected in surveys of the Australian dog population. In this study, we report three cases of canine parvoviral enteritis associated with CPV-2c infection; case 1 occurred in an 8-week-old puppy that died following acute hemorrhagic enteritis. Cases 2 and 3 were an 11-month-old female entire Saint Bernard and a 9-month-old male entire Siberian husky, respectively, both which had completed vaccination schedules and presented with vomiting or mild diarrhea only. Full genomic sequencing of parvoviral DNA from cases 1, 2, and 3 revealed greater than 99% homology to known CPV-2c variants and predicted protein sequences from the VP2 region of viral DNA from all three cases identified; glutamic acid residues at the 426 amino acid residue, characteristic of the CPV-2c variant. Veterinary professionals should be aware that CPV-2c is now present in Australia, detected in a puppy and vaccinated young adult dogs in this study. Further characterization of CPV-2c-associated disease and its prevalence in Australian dogs requires additional research.


Aggregating data from COVID-19 trials.


title: Alternative to surgery in early stage NSCLC-interventional radiologic approaches.

text: Interventional radiologists have a variety of techniques in their armamentarium to treat pulmonary tumors. While most therapies are targeted to metastasis or palliation, percutaneous thermal ablation represents a potential therapy for not only palliation, but to treat inoperable early stage disease. Although radiofrequency ablation (RFA) is the most studied of these ablative techniques, newer technologies of thermal ablation, such as microwave and cryoablation have emerged as additional options. In this article, we will review the three different thermal ablative modalities, including patient selection, technique, outcomes, complications, and imaging follow-up. A brief discussion of state of the art techniques such as irreversible electroporation (IRE) and catheter directed therapies will also be included.


title: Structure of the main protease from a global infectious human coronavirus, HCoV-HKU1.

text: The newly emergent human coronavirus HKU1 (HCoV-HKU1) was first identified in Hong Kong in 2005. Infection by HCoV-HKU1 occurs worldwide and causes syndromes such as the common cold, bronchitis, and pneumonia. The CoV main protease (M(pro)), which is a key enzyme in viral replication via the proteolytic processing of the replicase polyproteins, has been recognized as an attractive target for rational drug design. In this study, we report the structure of HCoV-HKU1 M(pro) in complex with a Michael acceptor, inhibitor N3. The structure of HCoV-HKU1 provides a high-quality model for group 2A CoVs, which are distinct from group 2B CoVs such as severe acute respiratory syndrome CoV. The structure, together with activity assays, supports the relative conservation at the P1 position that was discovered by sequencing the HCoV-HKU1 genome. Combined with structural data from other CoV M(pro)s, the HCoV-HKU1 M(pro) structure reported here provides insights into both substrate preference and the design of antivirals targeting CoVs.


title: Social participation in working-age adults with aphasia: an updated systematic review.

text: BACKGROUND A previous systematic review found limited data regarding social participation in working-age people with aphasia (PWA). A review of recent studies may reveal more information on challenges in reestablishing social roles. METHOD The aim was to provide an updated systematic review on social participation in PWA under 65 years of age. Studies from 2005 to 2017 were searched from Scopus, Pubmed, and Psychinfo. Search terms were derived from the International Classification of Functioning, Disability and Health (ICF) and the Aphasia- Framework for Outcomes Measures (A-FROM). Aspects of domestic life, interpersonal relations and interactions, education and employment, and community, civic, and social life were investigated. RESULTS From 2864 initial hits, 11 studies were identified, all of which were on the American Speech-Language-Hearing Association (ASHA) Level III of evidence. The studies indicated that participation in domestic life is reduced and PWA showed reduced social networks, loss of friendships and changes in the quality of marital relations. Few PWA returned to work or spent time on education. Limitations in community, civic, and social life were noted and there were contradictory findings on the impact of contextual factors on social participation. There was an increase in research into contextual factors impacting on social participation in PWA and in the use of conceptual frameworks in the last decade. CONCLUSIONS While the ICF conceptual framework is increasingly used, no studies used the A-FROM. There is greater use of standardized assessments and larger sample sizes.


title: Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study.

text: OBJECTIVES Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.


title: Public health challenges and legacies of Japan's response to the Ebola virus disease outbreak in West Africa 2014 to 2015.

text: The largest outbreak of Ebola virus disease occurred in West Africa in 2014 and resulted in unprecedented transmission even in distant countries. In Japan, only nine individuals were screened for Ebola and there was no confirmed case. However, the government promoted the reinforcement of response measures and interagency collaboration, with training and simulation exercises conducted country-wide. The legacies included: publication of a communication policy on case disclosure, a protocol for collaboration between public health and other agencies, and establishing an expert committee to assemble the limited available expertise. There were challenges in taking proportionate and flexible measures in the management of people identified to be at high risk at entry points to Japan, in the decentralised medical response strategy, and in the medical countermeasures preparedness. The Ebola outbreak in West Africa provided a crucial opportunity to reveal the challenges and improve the preparedness for rare but high impact emerging diseases that are prone to be neglected. Efforts to uphold the lessons learnt and maintain public health preparedness should help prepare for future emerging diseases, including bioterrorist acts and pandemics.


title: Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.

text: BACKGROUND Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer. STUDY DESIGN Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed. RESULTS In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH. CONCLUSIONS In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.


title: Infectious disease risk and international tourism demand.

text: Context For some countries, favourable climatic conditions for tourism are often associated with favourable conditions for infectious diseases, with the ensuing development constraints on the tourist sectors of impoverished countries where tourism's economic contribution has a high potential. This paper evaluates the economic implications of eradication of Malaria, Dengue, Yellow Fever and Ebola on the affected destination countries focusing on the tourist expenditures. Methods A gravity model for international tourism flows is used to provide an estimation of the impact of each travel-related disease on international tourist arrivals. Next the potential eradication of these diseases in the affected countries is simulated and the impact on tourism expenditures is estimated. Findings The results show that, in the case of Malaria, Dengue, Yellow Fever and Ebola, the eradication of these diseases in the affected countries would result in an increase of around 10 million of tourist worldwide and a rise in the tourism expenditure of 12 billion dollars. Conclusion By analysing the economic benefits of the eradication of Dengue, Ebola, Malaria, and Yellow Fever for the tourist sector-a strategic economic sector for many of the countries where these TRD are present-this paper explores a new aspect of the quantification of health policies which should be taken into consideration in future international health assessment programmes. It is important to note that the analysis is only made of the direct impact of the diseases' eradication and consequently the potential multiplicative effects of a growth in the GDP, in terms of tourism attractiveness, are not evaluated. Consequently, the economic results can be considered to be skeleton ones.


title: Supraglottic airways: the history and current state of prehospital airway adjuncts.

text: This review discusses the history, developments, benefits, and complications of supraglottic devices in prehospital care for adults and pediatrics. Evidence supporting their use as well as current controversies and developments in out-of-hospital cardiac arrest and rapid sequence airway management is discussed. Devices reviewed include the Laryngeal Mask Airway, Esophageal Tracheal Combitube, Laryngeal Tube, I-Gel, Air-Q, Laryngeal Mask Airway Fastrach, and the Supraglottic Airway Laryngopharyngeal Tube (SALT).


title: [Several Common Respiratory Viral Pathogens in Hematopoietic Stem Cell Transplantion Patients with Primary Immunodeficiency Disease].

text: OBJECTIVE To investigate the prevalence of respiratory viral infections in patients with primary immunodeficiency disease (PID) during hematopoietic stem cell transplantation. METHODS 108 specimens of nasopharyngeal aspirate were collected from 22 PID patients before and after hematopoietic stem cell transplantation from July 2016 to July 2018 in the Department of Hematology. The TR-PCR was used to detect for respiratory viruses including respiratory syncytial virus(RSV)，human metapneumoviros(hMPV)，coronavirus(CoV) and parainfluenza 1-3 (PIV1-3). And the clinical characteristics and co-infection were analyzed. RESULTS Among the total 108 specimens, viral pathogens were identified in 41 (37.96%) specimens. Among which the pathogens of highest detection rate was RSV (25.9%). Different types of PID showed different virus infection rates, among which the highest infection rate was severe combined immunodeficiency disease (SCID) patients, with the virus detection rate was 57.9%. The incidence of co-infection with two or more than two viruses was 19.5%. CONCLUSION Patients with PID who undergo hematopoietic stem cell transplantation are more susceptible to respiratory viruses. RSV is an important respiratory tract virus pathogen after hematopoietic stem cell transplantation.


title: Molecular determinants for subcellular localization of the severe acute respiratory syndrome coronavirus open reading frame 3b protein.

text: Viruses such as hepatitis C and the severe acute respiratory syndrome coronavirus (SARS-CoV) encode proteins that are distributed between mitochondria and the nucleus, but little is known about the factors that control partitioning between these sites. SARS-CoV encodes a unique accessory gene called open reading frame (ORF) 3b that, like other unique accessory genes in SARS-CoV, likely contributes to viral pathogenicity. The ORF 3b protein is 154 amino acids and is predicted to express from the second ORF in subgenomic RNA3. In this report, we have characterized the molecular components that regulate intracellular localization of the ORF 3b protein. We demonstrate unique shuttling behavior of ORF 3b, whereby the protein initially accumulates in the nucleus and subsequently translocates to mitochondria. Following nuclear localization, ORF 3b traffics to the outer membrane of mitochondria via a predicted amphipathic alpha-helix. Additionally, ORF 3b contains a consensus nuclear export sequence, and we demonstrate that nuclear export and thus mitochondrial translocation are dependent on a leptomycin B-sensitive nuclear export mechanism. We further show that ORF 3b inhibits induction of type I interferon induced by retinoic acid-induced gene 1 and the mitochondrial antiviral signaling protein. Our observations provide insights into the cellular localization of ORF 3b that may enhance our understanding of the mechanisms by which ORF 3b contributes to SARS-CoV pathogenesis. The findings reported here reveal that for multilocalized proteins, consideration of the spatiotemporal distribution may be crucial for understanding viral protein behavior and function.


Treatment of HIV-associated Primary CNS Lymphoma with Antiretroviral Therapy, Rituximab, and High-Dose Methotrexate.


title: Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss.

text: BACKGROUND This retrospective study evaluated long-term weight loss, resolution of comorbidities, quality of life (QoL), and food tolerance after laparoscopic sleeve gastrectomy (LSG). METHODS Between January 2003 and July 2008, 102 patients underwent LSG as a sole bariatric operation. A retrospective review of a prospectively collected database was performed. Demographics, complications, and percentage of excess weight loss (%EWL) were determined. Quality of life was measured using Medical Outcomes Survey Short Form 36 (SF-36) and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaires, which were sent to all patients. The food tolerance score (FTS) was determined and compared with that of nonobese subjects. RESULTS A total of 83 patients (81.4%) were eligible for follow-up evaluation. Their mean initial body mass index (BMI) was 39.3 kg/m(2). No major complications occurred. At a median follow-up point of 49 months (range, 17-80 months), the mean %EWL was 72.3% ± 29.3%. For the 23 patients who reached the 6-year follow-up point, the mean %EWL was 55.9% ± 25.55%. The mean BAROS score was 6.5 ± 2.1, and a "good" to "excellent" score was observed for 75 patients (90.4%). In the comparison of patients with a %EWL greater than 50% and those with a %EWL of 50% or less, the SF-36 scores were statistically different only for "physical functioning" and "general health perception." The mean FTS was 23.8, and 95.2% of the patients described their food tolerance as acceptable to excellent. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure, although a tendency for weight regain is noted after 5 years of follow-up evaluation. Resolution of comorbidity is comparable with that reported in the literature. The LSG procedure results in good to excellent health-related QoL. Food tolerance is lower for patients after LSG than for nonobese patients who had no surgery, but 95.2% described food tolerance as acceptable to excellent.


My fortuitous encounter with dialysis therapy.


title: A comparative study of two- versus one-lung ventilation for needlescopic bleb resection.

text: This prospective study was conducted to evaluate the feasibility of two-lung (TL) ventilation with low tidal volume anaesthesia compared with one-lung (OL) ventilation for needlescopic bleb resection. Patients with spontaneous pneumothorax that underwent bleb resection with a 2-mm thoracoscope were enrolled. During the operation, the tidal volume was set at 4.0 mL·kg⁻¹ in the TL group and 8.0 mL·kg⁻¹ in the OL group; the respiration rate was set at 23 and 12 breaths·min⁻¹, respectively, at the same inspiratory oxygen fraction (50%). A total of 108 patients (55 patients in the TL group and 53 in the OL group) were included in this study. Airway pressure was significantly lower in the TL group (mean ± sd 8.0 ± 3.3 versus 24.0 ± 3.9 mmHg in the OL group; p<0.001). The time from endotracheal intubation to the incision was 17.1 ± 4.0 min in the TL group and 35.3 ± 7.6 min in the OL group, which was significantly different (p<0.001). However, the operation time was not different in comparisons between the two groups. Therefore, the total anaesthesia time was significantly longer in the OL group (77.9 ± 21.6 versus 64.9 ± 14.7 min in the TL group; p = 0.002). Needlescopic bleb resection using TL ventilation anaesthesia with low tidal volume was technically feasible, cost-effective and time-saving compared with OL ventilation anaesthesia.


Vaccines, convalescent plasma, and monoclonal antibodies for covid-19.


title: Association of the global activity limitation indicator with specific measures of disability in adults aged below 65.

text: BACKGROUND health measures as the global activity limitation indicator (GALI) or self-rated health (SRH) allow to quantify and monitor the health of the population. The GALI is widely used in the European Union; however, evidence of its construct validity is still limited. We examine whether the GALI reflects disability in specific living contexts such as self-care, domestic life and work activity, whether it does so consistently across gender and age and its added value concerning SRH. METHODS We used the subsample of adults aged 16-64 years (N = 15 934) from the 2009 European Health Interview Survey in Spain and analyzed the data with logistic regression models using the GALI and SRH as response variables. RESULTS The GALI was strongly and significantly associated with the three measures of disability: self-care (OR = 22.8, 95% CI: 15.9-32.7), domestic life (OR = 16.3, 95% CI: 13.6-19.5) and work activity (e.g. impossibility to work: OR = 41.9, 95% CI: 30.3-57.8; prolonged sick leave: OR = 10.7, 95% CI: 9-12.7). There were significant interactions with age on all three disability measures and with the gender on one (domestic life), although they were small. SRH was also strongly associated with all three disability measures, but to a lesser extent than the GALI. CONCLUSIONS The GALI reflects well and better than SRH, disability in self-care, domestic life and work activity. It is unknown whether the GALI performs equally in other living contexts such as social relations and community life.


title: LESS and NOTES instrumentation: future.

text: PURPOSE OF REVIEW Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) are novel techniques with potential to minimize the morbidity of surgery. Challenging ergonomics, instrument clashing, and the lack of true triangluation still remain great concerns. RECENT FINDINGS New technological developments in instrument design have been created to enhance clinical applicability of these techniques. Further technological advancements including the incorporation of novel robotic surgical platforms (R-LESS) exploit the ergonomic benefits in an attempt to further advance LESS surgery. Promising devices include magnetic anchoring and guidance systems that have the potential to allow external manoeuvring of intracorporeal instruments while facilitating triangulation and reducing clashing. As well, the benefit of miniature in-vivo robots that can be placed endoscopically intra-abdominally and controlled wirelessly will allow internal manipulation of tissue from internal repositionable platforms. SUMMARY It remains to be seen whether LESS or NOTES will prove their clinical benefit over standard laparoscopic or robotic procedures. In this chapter, we review the current LESS and NOTES technology, and focus on new innovations and research in the field.


COVID-19 Related Acute Respiratory Distress Syndrome: Not so Atypical.


Software Solutions for Radiologists to Increase Academic Productivity.


title: White Paper AGA: Advanced Imaging in Barrett's Esophagus.

text: Enhanced imaging technologies such as narrow band imaging, flexible spectral imaging color enhancement, i-Scan, confocal laser endomicroscopy, and optical coherence tomography are readily available for use by endoscopists in routine clinical practice. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image enhancement technologies, focusing on their role in 2 specific clinical conditions (colon polyps and Barrett's esophagus) and on issues relating to training and implementation of these technologies (white papers). Although the majority of the studies that use enhanced imaging technologies have been positive, these techniques ideally need to be validated in larger cohorts and in community centers. As it stands today, detailed endoscopic examination with high-definition white-light endoscopy and random 4-quadrant biopsy remains the standard of care. However, the workshop panelists agreed that in the hands of endoscopists who have met the preservation and incorporation of valuable endoscopic innovation thresholds (diagnostic accuracy) with enhanced imaging techniques (specific technologies), use of the technique in Barrett's esophagus patients is appropriate.


title: Surgical technique: Gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.

text: BACKGROUND Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons. DESCRIPTION OF TECHNIQUE Ten adult cadaver specimens were dissected to determine nerve and blood supply point of entry in the gluteus maximus and tensor fascia lata (TFL) and evaluate the feasibility and safety of transferring these muscles to substitute for the gluteus medius and minimus. In this technique, the anterior portion of the gluteus maximus and the entire TFL are mobilized and transferred to the greater trochanter such that the muscle fiber direction of the transferred muscles closely matches that of the gluteus medius and minimus. METHODS Five patients (five hips) were treated for primary irreparable disruption of the hip abductor muscles using this technique between January 2008 and April 2011. All patients had severe or moderate pain, severe abductor limp, and positive Trendelenburg sign. Patients were evaluated for pain and function at a mean of 28 months (range, 18-60 months) after surgery. RESULTS All patients could actively abduct 3 months postoperatively. At 1 year postoperatively, three patients had no hip pain, two had mild pain that did not limit their activity, three had no limp, and one had mild limp. One patient fell, fractured his greater trochanter, and has persistent limp and abduction weakness. CONCLUSIONS The anterior portion of the gluteus maximus and the TFL can be transferred to the greater trochanter to substitute for abductor deficiency. In this small series, the surgical procedure was reproducible and effective; further studies with more patients and longer followup are needed to confirm this.


[Cluster investigation Technical Guidelines for the 2019 Novel Coronavirus Pneumonia (COVID-19), China (1st Trial Version)].


title: Retrospective study of risk factors for severe SARS-Cov-2 infections in hospitalized adult patients.

text: INTRODUCTION Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spread worldwide. OBJECTIVES To identify the clinical characteristics and risk factors associated with the severe incidence of SARS-CoV-2 infection. PATIENTS AND METHODS All adult patients (≥18 years old) consecutively admitted in Dabieshan Medical Center from January 30, 2020 to February 11, 2020 were collected and reviewed. Only patients diagnosed with COVID-19 according to WHO interim guidance were included in this retrospective cohort study. RESULTS A total of 108 patients with COVID-19 were retrospectively analyzed. Twenty-five patients (23.1%, 25/108) developed severe disease, and of those 12 (48%, 12/25) patients died. Advanced age, co-morbidities with hypertension, higher blood leukocyte count, neutrophil count, higher sensitive C-reactive protein level, D-dimer level, Acute Physiology and Chronic Health Evaluation Ⅱ (APECHE Ⅱ) score and Sequential Organ Failure Assessment (SOFA) score were associated with greater risk of development of severe COVID-19, and so were lower lymphocyte count and albumin level. Multivariable regression showed increasing odds of severe COVID-19 associated with higher SOFA score (OR 2.450, 1.302-4.608; p = 0.005), and lymphocyte count less than 0.8×109 per L (OR 9.017, 2.808-28.857; p <0.001) on admission. The higher SOFA score (OR 2.402, 1.313-4.395; p = 0.004) on admission was identified as risk factor for in-hospital death. CONCLUSIONS Lymphocytopenia and the higher SOFA score on admission could help clinicians to identify patients with high risk for developing severe COVID-19. More related studies are needed in the future.


title: Short-term outcomes after laparoscopic versus open transhiatal resection of Siewert type II adenocarcinoma of the esophagogastric junction.

text: BACKGROUND The potential advantages of laparoscopic surgery (LS) compared with open surgery (OS) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. This study aimed to assess the feasibility and safety of the laparoscopic transhiatal approach for Siewert type II AEG, and compare the short-term outcomes of LS versus OS for Siewert type II AEG. METHODS We retrospectively analyzed 87 consecutive patients with Siewert type II AEG who underwent curative surgery from January 2008 to November 2016. Surgery-related short-term variables were analyzed in LS versus OS. RESULTS Forty-five patients underwent LS, and 42 underwent OS. Compared with OS, LS was associated with significantly less intraoperative blood loss (11 vs. 408 ml, p < 0.001) and extended operation time (256 vs. 226 min, p = 0.001). There was no significant difference between LS and OS in postoperative hospitalization duration (9 vs. 10 days, p = 0.193) or rate of surgical morbidity (≥grade 3) for complications such as anastomotic leakage (4.4 vs. 4.8%, p = 1.000), or pancreatic leakage (4.4 vs. 9.5%, p = 0.423), and there were no pulmonary-associated complications in either group. There was no difference between groups in total number of harvested lymph nodes (24 vs. 29, p = 0.502), but the number of harvested mediastinum LNs was larger in LS (2 vs. 1, p = 0.002). There was no difference between groups in the length of the proximal margin (9 vs. 10 mm, p = 0.246), and the margins were negative in all cases in both groups. CONCLUSIONS Laparoscopic transhiatal resection for Siewert type II AEG is technically challenging, but appears feasible and safe in technical or short-term oncological aspects when performed by an experienced surgical team. A large-scale prospective study is needed to evaluate long-term outcomes.


The coronavirus epidemic will reach Norway.


title: Comparative analysis of the molecular mechanisms of recombination in hepatitis C virus.

text: Genetic recombination is an important evolutionary mechanism for RNA viruses. The significance of this phenomenon for hepatitis C virus (HCV) has recently become evident, with the identification of circulating recombinant forms in HCV-infected individuals and by novel data from studies permitted by advances in HCV cell culture systems and genotyping protocols. HCV is readily able to produce viable recombinants, using replicative and non-replicative molecular mechanisms. However, our knowledge of the required molecular mechanisms remains limited. Understanding how HCV recombines might be instrumental for a better monitoring of global epidemiology, to clarify the virus evolution, and evaluate the impact of recombinant forms on the efficacy of oncoming combination drug therapies. For the latter, frequency and location of recombination events could affect the efficacy of multidrug regimens. This review will focus on current data available on HCV recombination, also in relation to more detailed data from other RNA viruses.


title: Timing of oral refeeding in acute pancreatitis: A systematic review and meta-analysis.

text: BACKGROUND AND AIM The optimal timing of oral refeeding in acute pancreatitis is unclear. This study aimed to perform a systematic review with meta-analysis of randomized controlled trials (RCTs) that compared early oral refeeding with standard oral refeeding in acute pancreatitis. METHODS PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched in order to identify RCTs eligible for inclusion in the systematic review. The weighted mean differences (WMDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Five eligible RCTs were included. Compared with standard oral refeeding, early oral refeeding significantly decreased the length of hospital stay (WMD: -2.22, 95%CI: -3.37 to -1.08, p = 0.0001). Although there was heterogeneity (I2 = 56%, p = 0.06), subgroup analysis of the refeeding criteria (immediate group and hungry group) eliminated the heterogeneity. There was no significant difference between the early refeeding group and standard refeeding groups with respect abdominal pain and distension (OR 1.14; 95%CI 0.65-1.99 and OR 1.53; 95%CI 0.81-2.90). CONCLUSIONS Compared with standard oral refeeding, early oral refeeding safely reduced the length of hospital stay in patients with acute pancreatitis.