title: Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity.

text: BACKGROUND Extensive deep venous thrombosis (DVT) during pregnancy is usually treated with anticoagulation alone, risking significant post-thrombotic syndrome (PTS) in young patients. Catheter-directed thrombolysis (CDT) and operative venous thrombectomy have been safely and effectively used in nonpregnant patients, demonstrating significant reduction in post-thrombotic morbidity. This report reviews short- and long-term outcomes of 13 patients with extensive DVT of pregnancy treated with a strategy of thrombus removal. METHODS From 1999 to 2013, 13 patients with iliofemoral DVT during pregnancy were offered CDT, pharmacomechanical thrombolysis (PMT), and/or venous thrombectomy. Gestational age ranged from 8 to 34 weeks. Fetal monitoring was performed throughout hospitalization. Radiation exposure was minimized with pelvic lead shields, focal fluoroscopy, and limited angiographic runs. Follow-up included objective vein evaluation using venous duplex and PTS assessment using the Villalta scale. RESULTS CDT and/or PMT were used in 11 patients. Two patients underwent venous thrombectomy alone, and one patient had operative thrombectomy as an adjunct to CDT and PMT. Each patient had complete or near-complete thrombus resolution and rapid improvement in clinical symptoms. Eight of 11 having CDT or PMT underwent venoplasty and stenting of the involved iliac veins. Twelve of the 13 delivered healthy infants at term. One patient opted for termination of her pregnancy. Mean patient and gestational ages were 26 years and 26 weeks, respectively. Mean follow-up was 1.3 years, with only one recurrence. Duplex ultrasonography demonstrated patent veins in all but one patient and normal valve function in 10 patients. Eleven patients had Villalta scores <5 (considered normal), with a mean score of 0.7. CONCLUSIONS Extensive DVT of pregnancy can be effectively and safely treated with a strategy of thrombus removal, resulting in a patent venous system, normal valve function in many, prevention of PTS, and reduction in recurrence.


Learn from Rwanda's success in tackling COVID-19.


title: The Covid-19 panic and the global North-South divide - A perspective.

text: J Krishnamurti, a renowned philosopher, describes fear as the transition from the convictions of the Known to the flux of the Unknown1. The weakening of the interspecies transmission barrier between the animal and human interface has strengthened this fear. Consequently, our impulsive selves have taken precedence over our reflective voices.


title: Staying safe during COVID-19: How a pandemic can escalate risk for intimate partner violence and what can be done to provide individuals with resources and support.

text: The emergence of COVID-19 presents unprecedented challenges in keeping individuals experiencing intimate partner violence (IPV) safe in the United States and abroad. This commentary explores how COVID-19 may be increasing risk for IPV and what strategies may be used presently, and in the future, to mitigate IPV risk during crises. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: The voltage-gated proton channel hHv1 is functionally expressed in human chorion-derived mesenchymal stem cells.

text: The voltage-gated proton channel Hv1 is widely expressed, among others, in immune and cancer cells, it provides an efficient cytosolic H+extrusion mechanism and regulates vital functions such as oxidative burst, migration and proliferation. Here we demonstrate the presence of human Hv1 (hHv1) in the placenta/chorion-derived mesenchymal stem cells (cMSCs) using RT-PCR. The voltage- and pH-dependent gating of the current is similar to that of hHv1 expressed in cell lines and that the current is blocked by 5-chloro-2-guanidinobenzimidazole (ClGBI) and activated by arachidonic acid (AA). Inhibition of hHv1 by ClGBI significantly decreases mineral matrix production of cMSCs induced by conditions mimicking physiological or pathological (inorganic phosphate, Pi) induction of osteogenesis. Wound healing assay and single cell motility analysis show that ClGBI significantly inhibits the migration of cMSCs. Thus, seminal functions of cMSCs are modulated by hHv1 which makes this channel as an attractive target for controlling advantages/disadvantages of MSCs therapy.


title: Liver transplantation in an ICU dominated by COVID-19.

text: The Letter from D'Antiga L about concerns of transplanting patients in the context of COVID19 pandemic is very interesting [1]. COVID-19 designates the infection caused by the SARS-Cov2 virus. This illness originated in December, 2019, in Wuhan, China. Since then, it has been identified in more than 150 countries. The first case of COVID-19 in Portugal was notified in March 02, 2020.


Cities - try to predict superspreading hotspots for COVID-19.


title: Comparative analysis of two-piece extended peritoneal dialysis catheters with remote exit-site locations and conventional abdominal catheters.

text: BACKGROUND An alternative peritoneal catheter exit-site location is sometimes needed in patients with obesity, floppy skin folds, intestinal stomas, urinary and fecal incontinence, and chronic yeast intertrigo. Two-piece extended catheters permit remote exit-site locations away from problematic abdominal conditions. OBJECTIVE The effect on clinical outcomes by remotely locating catheter exit sites to the upper abdomen or chest was compared to conventional lower abdominal sites. METHODS In a nonrandomized design, peritoneal access was established with 158 extended catheters and 270 conventional catheters based upon body habitus and special clinical needs. Prospective data collection included patient demographics, infectious and mechanical complications, and catheter survival. RESULTS Kaplan-Meier survival time until first exit-site infection was longer for extended catheters (p = 0.03). Poisson regression showed no difference in exit site, subcutaneous tunnel, and peritonitis infection rates; however, the proportion of catheters lost during peritonitis episodes was significantly greater for extended catheters (p = 0.007) and appeared to be due primarily to coagulase-negative staphylococcus organisms. Poisson regression showed interactions of body mass index (BMI) and diabetic status in determining catheter loss from peritonitis for both catheter types (p = 0.02). Extended catheter patients had higher BMI and diabetes prevalence (p < 0.0001). Overall extended catheter survival at 1, 2, and 3 years (92%, 80%, 71%) trended lower than conventional devices (93%, 87%, 80%; p = 0.0505). CONCLUSIONS Extended catheters enable peritoneal access for patients in whom conventional catheter placement would be difficult or impossible. Certain patient and extended-catheter characteristics may contribute to loss from peritonitis.


title: Four arm robotic-assisted pulmonary resection-right upper lobectomy: how to do it.

text: Numerous published articles have shown the safety and efficacy of robotic lung resection, including lobectomy. Several techniques have been described by different authors to perform a robot assisted lung lobectomy. We adopted four arms robotic procedure. We usually perform three ports (10-15 mm) and an anterior 3 to 4 cm utility incision. This technique allows to safely proceed with an anterior to posterior approach to the hilum. In this study, we present in clear and sequential steps, the procedure to perform a right upper lobectomy for early stage lung cancer. We also supply a high-quality video, operative tips and a preference cards.


title: A flu by any other name: why the World Health Organization should adopt the World Meteorological Association's storm naming system as a model for naming emerging infectious diseases.

text: This article explores the factors that contributed to the use of different names for H1N1 by diverse actors in the early stages of the pandemic of 2009 and discusses the implications of inconsistent naming practices for the public's understanding of the virus and the credibility of scientists and health authorities. The authors propose a naming protocol for novel variants modeled after the World Meteorological Association's practice for naming weather events, a model that would enable accurate transmission of technical information among experts and provide a stable name for public use, even in the context of incomplete or changing scientific understanding of the nature of the pathogen.


title: Transection of a Coopdech bronchial blocker tip during bronchial resection for right upper lobectomy: a case report.

text: A bronchial blocker (BB) is preferred for lung separation in patients with difficult airways. However, BBs, unlike double-lumen tubes, must be placed in the bronchus of the lung being operated on, hence can be damaged by surgical manipulation. Intubation was unexpectedly difficult in this male patient, so a Coopdech BB was placed in the right mainstem bronchus through a single-lumen tracheoscopic ventilation tube for a thoracoscopic right upper lobectomy. During the bronchial resection, however, the distal tip of the BB was transected and pinched in the staple line, so the staple line was partially opened, and the BB was withdrawn into the trachea. The opened bronchial stump was sutured manually under apnea without conversion to an open thoracotomy, and there was no significant air leakage through the suture line. This case underlines the importance of frequently evaluating the position of a BB during lung surgery.


title: Review: influenza virus in pigs.

text: Influenza virus disease still remains one of the major threats to human health, involving a wide range of animal species and pigs play an important role in influenza ecology. Pigs were labeled as "mixing vessels" since they are susceptible to infection with avian, human and swine influenza viruses and genetic reassortment between these viruses can occur. After the H1N1 influenza pandemic of 2009 with a swine origin virus, the most recent research in "influenzology" is directed at improving knowledge of porcine influenza virus infection. This tendency is probably due to the fact that domestic pigs are closely related to humans and represent an excellent animal model to study various microbial infectious diseases. In spite of the role of the pig in influenza virus ecology, swine immune responses against influenza viruses are not fully understood. Considering these premises, the aim of this review is to focus on the in vitro studies performed with porcine cells and influenza virus and on the immune responses of pigs against human, avian and swine influenza viruses in vivo. The increased acceptance of pigs as suitable and valuable models in the scientific community may stimulate the development of new tools to assess porcine immune responses, paving the way for their consideration as the future "gold standard" large-animal model in immunology.


title: Proficiency-based Fundamentals of Laparoscopic Surgery skills training results in durable performance improvement and a uniform certification pass rate.

text: BACKGROUND The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training. METHODS For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure. RESULTS None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points. CONCLUSION The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.


title: Comparison of vocal cord view between neutral and sniffing position during orotracheal intubation using fiberoptic bronchoscope: a prospective, randomized cross over study.

text: BACKGROUND In intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view. METHODS Fifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score. RESULTS A total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation. CONCLUSIONS Neutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions. TRIAL REGISTRATION Clinical Trials.gov identifier: NCT02931019 , registered on October 12, 2016.


title: Intragastric endoscopic assisted single incision surgery for gastric leiomyoma of the esophagogastric junction.

text: Single port laparoscopic surgery is becoming an alternative to conventional laparoscopic surgery as a new approach where all the conventional ports are gathered in just one multichannel port through only one incision. Appling this technical development, we have developed a new technique based on an intragastric approach using a single port device assisted by endoscopy (I-EASI: intragastric endoscopic assisted single incision surgery) in order to remove benign gastric lesions and GIST tumors placed in the posterior wall of the stomach or close to the esophagogastric junction or the gastroduodenal junction. We present a patient with a submucosal gastric tumor placed near the esophagogastric junction removed with this new approach.


title: α-Lipoic acid induces Endoplasmic Reticulum stress-mediated apoptosis in hepatoma cells.

text: Hepatocellular carcinoma (HCC) is the most common liver cancer and a major cause of adult death. The current treatments for HCC suffer from drug resistance and poor prognosis; therefore, novel therapeutic agents are urgently needed. Phytochemicals have been proposed to treat a range of cancers. Among them, α-lipoic acid (α-LA), a naturally synthesized antioxidant found in various dietary animal and plant sources, prevents oxidant-mediated cell death in normal cells while inducing apoptosis in several cancer cell lines. Previously, we demonstrated that the treatment of hepatoma cells with α-LA induced apoptosis, which was preceded by the generation of reactive oxygen species (ROS) and activation of the p53 protein, a known inducer of mitochondria-mediated apoptosis. Several studies have shown that ROS-induced apoptosis is associated with endoplasmic reticulum (ER) stress and Unfolded Protein Response (UPR) activation. Herein, we investigated if α-LA-induced apoptosis in hepatoma cell lines was ER stress- and UPR-mediated by gene expression profiling analyses. UPR and ER stress pathways were the most up-regulated after treatment with α-LA. This finding, which has been confirmed by expression analyses of ER- and UPR-associated proteins, provides a better understanding of the molecular mechanisms behind the anti-tumoral action of α-LA on hepatoma cells.


title: Extracranial carotid artery aneurysms in two of three monozygotic triplets with tuberous sclerosis complex.

text: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder with multisystem clinical manifestations. Dysplastic proliferations of small blood vessels including hemangiomas are common; however, anomalies of medium- and large-size vessels are rare. The only extracranial carotid artery aneurysm in a patient with TSC was reported in 1998. Since then, 19 cases have documented intracranial aneurysms in patients with TSC. The case of two of three identical triplet sisters with TSC who were treated for extracranial carotid artery aneurysms is presented. To the authors' knowledge, this is the first reported case of monozygotic siblings who both manifested this rare expression of TSC.


title: Telehealth Is a Sustainable Population Health Strategy to Lower Costs and Increase Quality of Health Care in Rural Utah.

text: PURPOSE A telehealth oncology practice was created to care for patients in rural communities to improve access to health care, decrease financial burdens, and save time. PATIENTS AND METHODS Patients with cancer at Sevier Valley Hospital in Richfield, Utah, were treated with a real-time video-based telehealth program under the care of an oncologist at a tertiary medical center. Data on financial savings, travel hours, mileage avoided, carbon emissions reduced, and revenue retained by Sevier Valley Hospital were collected from 2015 to 2018. RESULTS From 2015 to 2018, 119 patients with cancer in Richfield, Utah, were treated with telehealth for oncology visits, accounting for 1,025 patient encounters. On average, patients saved 4 hours and 40 minutes and 332 miles roundtrip per encounter. In total, patients' savings were estimated to be $333,074. Carbon emissions were reduced by approximately 150,000 kg. Of new patient referrals, 59% were for solid tumors (70 of 119 referrals; 42 metastatic and 28 nonmetastatic cancers), and 41% were hematology consultations (49 of 119 referrals; 28 classical and 21 malignant hematologic conditions). We estimate that Sevier Valley Hospital retained $3,605,500 in revenue over this 4-year period. CONCLUSION Using a telehealth program in rural Utah, patients with cancer benefited from substantial time and monetary savings. The local medical center was able to retain revenue it would have otherwise lost to outsourcing cancer care. Recent regulatory changes to address the COVID-19 pandemic should increase the number of patients with cancer treated via telehealth nationwide.


title: Best practices consensus protocol for peritoneal dialysis catheter placement by interventional radiologists.

text: Peritoneal dialysis (PD) catheters can be placed by interventional radiologists, an approach that might offer scheduling efficiencies, cost-effectiveness, and a minimally invasive procedure. In the United States, changes in the dialysis reimbursement structure by the Centers for Medicare and Medicaid Services are expected to result in the increased use of PD, a less costly dialysis modality that offers patients the opportunity to receive dialysis in the home setting and to have more independence for travel and work schedules, and that preserves vascular access for future dialysis options. Placement of PD catheters by interventional radiologists might therefore be increasingly requested by nephrology practices, given that recent publications have demonstrated the favorable impact on PD practices of an interventional radiology PD placement capability. Earlier reports of interventional radiology PD catheter placement came from single-center practices with smaller reported experiences. The need for a larger consensus document that attempts to establish best demonstrated practices for radiologists is evident. The radiologists submitting this consensus document represent a combined experience of more than 1000 PD catheter placements. The authors submit these consensus-proposed best demonstrated practices for placement of PD catheters by interventional radiologists under ultrasonographic and fluoroscopic guidance. This technique might allow for expeditious placement of permanent PD catheters in late-referred patients with end-stage renal disease, thus facilitating urgent-start PD and avoiding the need for temporary vascular access catheters.


title: Insights into SARS-CoV-2, the Coronavirus Underlying COVID-19: Recent Genomic Data and the Development of Reverse Genetics Systems.

text: The emergence and rapid worldwide spread of a novel pandemic of acute respiratory disease - eventually named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) - across the human population has raised great concerns. It prompted a mobilization around the globe to study the underlying pathogen, a close relative of severe acute respiratory syndrome coronavirus (SARS-CoV) called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous genome sequences of SARS-CoV-2 are now available and in-depth analyses are advancing. These will allow detailed characterization of sequence and protein functions, including comparative studies. Care should be taken when inferring function from sequence information alone, and reverse genetics systems can be used to unequivocally identify key features. For example, the molecular markers of virulence, host range and transmissibility of SARS-CoV-2 can be compared to those of related viruses in order to shed light on the biology of this emerging pathogen. Here, we summarize some recent insights from genomic studies and strategies for reverse genetics systems to generate recombinant viruses, which will be useful to investigate viral genome properties and evolution.


title: COVID-19 in Post-Operative Patients: Imaging Findings.

text: Background: Coronavirus 2019 (COVID-19) in the post-operative period is challenging. Its clinical manifestations may have similarities to other septic, thoracic, or gastrointestinal post-surgical complications. Additionally, the post-operative period may be a time of increased risk for severe manifestations of COVID-19. We sought to evaluate the frequency of COVID-19 in a cohort of patients who had recently had operations who were undergoing imaging for acute symptoms and the role of chest computed tomography (CT) in this setting. Patients and Methods: We included all patients who had chest CT for acute symptoms in the 15 days after a surgical procedure between March 1 and 31, 2020. Results: Of 46 patients with acute post-operative symptoms requiring chest imaging, eight (17%) were ultimately diagnosed with COVID-19. Among them, five (62%) required mechanical ventilation and two (25%) died. All had abnormal chest CT with typical findings of COVID-19 in 87%. Computed tomography provided an alternate diagnosis in 53% of patients who did not have COVID-19. The average time between a COVID-19-positive chest CT and the polymerase chain reaction (PCR) confirmation was 1.2 days (range, 0-4 days). Conclusion: COVID-19 is a serious post-operative condition associated with significant morbidity and mortality. Chest CT provides prompt diagnosis of COVID-19. In centers with a high prevalence of COVID-19, chest acquisition should be included in CT scans done for acute post-operative symptoms.


Covid-19: GPs can stop health checks for over 75s and routine medicine reviews.


title: Acute stroke from paradoxical embolism of dense fibrous tissue following pacemaker lead extraction: salvation by mechanical thrombectomy.

text: Systemic embolization is a dreaded complication of transvenous lead extraction (TLE), even without visible vegetations. Preoperative patent foramen ovale evaluation is important, justifying neurological surveillance or consideration of surgical extraction in selected cases. In case of stroke after TLE, mechanical thrombectomy is a successful therapy, and should be readily available.


title: Comparison of barbed suture versus traditional suture in laparoendoscopic single-site myomectomy.

text: OBJECTIVE To compare the surgical outcomes between uterine wall repairs using barbed suture versus traditional suture during laparoendoscopic single-site myomectomy (LESS-M). STUDY DESIGN Data were prospectively collected from 60 consecutive patients with uterine myomas at three institutions. Patients were managed by LESS-M with either traditional suture (the first 30 patients) or barbed suture (the next 30 patients). Operative time, blood loss, and technical difficulty were assessed for each patient. RESULTS Patient characteristics (age, body mass index, other demographic data, number of myomas, and location and size of the largest myoma) were similar between the two study groups. No significant differences in operative complications, failure rate of the intended surgeries, degree of postoperative pain, or hospital stay duration were observed between the two groups. The use of barbed suture significantly reduced the suturing time for treating the uterine wall defects (P=0.014), as well as the total operative time (P=0.027). The use of barbed suture was also associated with less operative blood loss (P=0.040) and less technical difficulty (P=0.001) compared with traditional suture. CONCLUSION The use of barbed suture in LESS-M effectively reduces the time required for suturing, thereby decreasing the total operative time, the operative blood loss, and the surgical difficulty.


title: On the Role of the Pedunculopontine Nucleus and Mesencephalic Reticular Formation in Locomotion in Nonhuman Primates.

text: UNLABELLED The mesencephalic reticular formation (MRF) is formed by the pedunculopontine and cuneiform nuclei, two neuronal structures thought to be key elements in the supraspinal control of locomotion, muscle tone, waking, and REM sleep. The role of MRF has also been advocated in modulation of state of arousal leading to transition from wakefulness to sleep and it is further considered to be a main player in the pathophysiology of gait disorders seen in Parkinson's disease. However, the existence of a mesencephalic locomotor region and of an arousal center has not yet been demonstrated in primates. Here, we provide the first extensive electrophysiological mapping of the MRF using extracellular recordings at rest and during locomotion in a nonhuman primate (NHP) (Macaca fascicularis) model of bipedal locomotion. We found different neuronal populations that discharged according to a phasic or a tonic mode in response to locomotion, supporting the existence of a locomotor neuronal circuit within these MRF in behaving primates. Altogether, these data constitute the first electrophysiological characterization of a locomotor neuronal system present within the MRF in behaving NHPs under normal conditions, in accordance with several studies done in different experimental animal models. SIGNIFICANCE STATEMENT We provide the first extensive electrophysiological mapping of the two major components of the mesencephalic reticular formation (MRF), namely the pedunculopontine and cuneiform nuclei. We exploited a nonhuman primate (NHP) model of bipedal locomotion with extracellular recordings in behaving NHPs at rest and during locomotion. Different MRF neuronal groups were found to respond to locomotion, with phasic or tonic patterns of response. These data constitute the first electrophysiological evidences of a locomotor neuronal system within the MRF in behaving NHPs.


title: A Simple and Practical Scoring System for Radiosurgical Treatment in Patients with Brain Metastases.

text: BACKGROUND The study aimed to investigate the prognostic factors for patients with brain metastases undergoing radiosurgical treatment and to introduce a simple and practical scoring system for the prediction of survival time. METHODS We retrospectively analyzed data for 311 patients treated with Gamma Knife radiosurgery at a single institute. The mean age at time of treatment was 60 years (range 23-86 years), and the median Karnofsky performance status (KPS) score was 90 (range 60-100). Using a new prognostic index, the prognostic index for brain metastases (PIBM), the patients were categorized into 3 groups according to the primary tumor status and KPS score. We performed survival analysis and compared the prognostic ability of the PIBM with other published indices. RESULTS During the median follow-up duration of 8.2 months (range 0.1-109 months), the median overall survival time was 9.1 months. Stable primary tumor status (hazard ratio [HR] 0.497, 95% confidence interval [CI] 0.321-0.769, p = 0.002) and KPS score ≥90 (HR 1.407, 95% CI 1.018-1.946, p = 0.039) significantly predicted longer overall survival. The PIBM showed the lowest Akaike information criterion value and the highest integrated area under the curve value compared with other prognostic indices. CONCLUSIONS The PIBM may be a more accurate prognostic indicator than other published indices. Although this new and practical prognostic index requires further validation in larger cohort studies, we suggest that the PIBM could be useful to predict survival time and inform appropriate management of patients with brain metastases.


title: Functional outcome after Ivor Lewis esophagectomy for cancer.

text: BACKGROUND Little is known on functional outcome after Ivor Lewis esophagectomy (ILE) with intrathoracic anastomosis. METHODS Patients who underwent ILE were identified from a prospective database. Clinicopathological data were retrieved and compared with functional outcome data based on patient self-assessment by a standard questionnaire. Predictive factors for selected functional complaints were identified with logistic regression analyses. RESULTS Three hundred and twenty-two patients (80.4% male, mean age 62 years) were studied. Indications for surgery were adenocarcinoma (62.4%), squamous cell carcinoma (28%), and HG Barrett dysplasia (7%). Preoperative chemoradiation (CRT) was administered to 42.5% of patients. Anastomotic leakage occurred in 5.6% and was associated with higher age and diabetes mellitus. Functional symptoms identified were reflux (39%), delayed gastric emptying (37%), dumping (21.4%), and anastomotic stenosis (16%). In the multivariate models, anastomotic stenosis was associated with smaller stapler diameter and presence of esophagitis. Postoperative reflux was associated with higher BMI, whereas dumping was predicted by female gender and age. The quality of life questionnaires revealed a good general health status in 82% of the patients. CONCLUSIONS Functional complaints after ILE consist of reflux, delayed gastric emptying, dumping, and dysphagia, and are affected by age, gender, BMI, diabetes mellitus, and stapler diameter.


title: Kidney diseases in the time of COVID-19: major challenges to patient care.

text: The current COVID-19 pandemic has affected everyone, but presents profound consequences for patients with kidney disease, health care providers, and biomedical researchers. In this Viewpoint, I will discuss a number of kidney-specific aspects of COVID-19 infection, noting therapeutic and basic research opportunities.


title: Helping children cope with the COVID-19 pandemic.

text: Numerous societal changes in response to the COVID-19 pandemic, such as school closings and event cancellations, have caused anxiety and fear for children and young people. There are ways to help young people cope with the current situation including establishing an open dialogue, creating a structured daily routine with a schedule with assigned roles, and using social media and video conferencing to remain socially connected.


title: Selection Paradigms for Large Vessel Occlusion Acute Ischemic Stroke Endovascular Therapy.

text: BACKGROUND Optimal patient selection methods for thrombectomy in large vessel occlusion stroke (LVOS) are yet to be established. We sought to evaluate the ability of different selection paradigms to predict favorable outcomes. METHODS Review of a prospectively collected database of endovascular patients with anterior circulation LVOS, adequate CT perfusion (CTP), National Institutes of Health Stroke Scale (NIHSS) ≥10 from September 2010 to March 2016. Patients were retrospectively assessed for thrombectomy eligibility by 4 mismatch criteria: Perfusion-Imaging Mismatch (PIM): between CTP-derived perfusion defect and ischemic core volumes; Clinical-Core Mismatch (CCM): between age-adjusted NIHSS and CTP core; Clinical-ASPECTS Mismatch (CAM-1): between age-adjusted NIHSS and ASPECTS; Clinical-ASPECTS Mismatch (CAM-2): between NIHSS and ASPECTS. Outcome measures were inclusion rates for each paradigm and their ability to predict good outcomes (90-day modified Rankin Scale 0-2). RESULTS Three hundred eighty-four patients qualified. CAM-2 and CCM had higher inclusion (89.3 and 82.3%) vs. CAM-1 (67.7%) and PIM (63.3%). Proportions of selected patients were statistically different except for PIM and CAM-1 (p = 0.19), with PIM having the highest disagreement. There were no differences in good outcome rates between PIM(+)/PIM(-) (52.2 vs. 48.5%; p = 0.51) and CAM-2(+)/CAM-2(-) (52.4 vs. 38.5%; p = 0.12). CCM(+) and CAM-1(+) had higher rates compared to nonselected counterparts (53.4 vs. 38.7%, p = 0.03; 56.6 vs. 38.6%; p = 0.002). The abilities of PIM, CCM, CAM-1, and CAM-2 to predict outcomes were similar according to the c-statistic, Akaike and Bayesian information criterion. CONCLUSIONS For patients with NIHSS ≥10, PIM appears to disqualify more patients without improving outcomes. CCM may improve selection, combining a high inclusion rate with optimal outcome discrimination across (+) and (-) patients. Future studies are warranted.


title: Current advances in single-port laparoscopic surgery.

text: PURPOSE Single-port laparoscopic surgery has the intention to further minimize the access trauma similar to natural orifice transluminal endoscopic surgery. While special trocars and instruments are needed, the spectrum of clinical indications corresponds to the conventional laparoscopic surgery. This review gives an overview of the current applications and advances in single-port laparoscopic surgery. METHODS The PubMed database was searched for "single incision laparoscopic surgery" or "single port" and different operations (e.g., cholecystectomy, colectomy, and appendectomy). The references and our own experiences were considered for historic development and current advances. RESULTS The spreading of single-port laparoscopic surgery is not as fast as expected. References show that operations using a single-port technique are feasible, safe, and efficient. More technical difficulties for the surgeon and higher costs must be considered. A better cosmetic result, less postoperative pain, and a faster recovery could be potential benefits for the patients. CONCLUSIONS Current advances in single-port laparoscopic surgery are difficult to define. The most common procedures are single-port laparoscopic cholecystectomies, colectomies, and appendectomies. Significant clinical benefits have not yet been proven even in prospective, randomized studies.


title: Use of Simple Neck Extension to Improve Guiding Catheter Accessibility in Tortuous Cervical Internal Carotid Artery for Endovascular Embolization of Intracranial Aneurysm: A Technical Note.

text: BACKGROUND In endovascular embolization of intracranial aneurysms, a tortuous cervical internal carotid artery can limit guiding catheter access to a sufficiently high position. Although intermediate distal access catheters can go beyond the tortuous segment of internal carotid arteries, they may increase the risk of procedure-related complications, require significantly complex technical procedures, and limit the use of adjunctive techniques. Using simple neck extension alone, we successfully improved guiding catheter access in 2 patients. METHODS Through a provocative test, we confirmed suitability of manual neck extension in 2 patients with severe posterior curvature of a tortuous internal carotid artery. Intraoperatively, we manually extended the neck and stretched the curvatures. We guided a 6F guiding catheter superiorly and performed coil embolization with an occlusion balloon catheter in 1 case and with the balloon-assisted neck remodeling technique in 1 case. RESULTS Coil embolization was completed without any adverse events in both cases. CONCLUSIONS The simple neck extension technique successfully improved accessibility of the guiding catheter. As the need for safe and highly skilled intervention increases, our technique may be useful because it can reduce procedure-related complications and allow balloon-assisted techniques.


title: Oral ribavirin for paramyxovirus infection after alemtuzumab-containing reduced-intensity conditioning HCT regimen.

text: Aerosolized ribavirin has been used in pediatric immunocompromised patients to treat acute respiratory viral infections, but oral ribavirin may be a less expensive alternative that allows for outpatient therapy. Oral ribavirin has compared favorably to aerosolized ribavirin in adult studies, but data on safety are lacking in pediatric populations. Four cases are described in which oral ribavirin was used to treat viral respiratory infections in recipients of allogeneic hematopoietic stem cell transplants at a Children's Hospital, demonstrating safety and feasibility.


title: Detection of feline coronavirus RNA, spike gene mutations, and feline coronavirus antigen in macrophages in aqueous humor of cats in the diagnosis of feline infectious peritonitis.

text: Uveitis is common in cats, and is often a feature of feline infectious peritonitis (FIP). We evaluated 3 tools for detection of feline coronavirus (FCoV) in aqueous humor: 1) a 7b gene reverse-transcription real-time PCR (7b-RT-rtPCR) assay to detect FCoV RNA, 2) a spike gene mutation RT-rtPCR (S-RT-rtPCR) assay to detect 2 point mutations in the spike gene of FCoV in cats positive by 7b-RT-rtPCR, and 3) immunocytochemistry (ICC) for detection of FCoV antigen in aqueous humor macrophages. We studied 58 cats, including 31 cats with FIP and 27 control cats. FIP was excluded by postmortem examination and negative immunohistochemistry (IHC). Aqueous humor samples obtained postmortem were assessed using 7b-RT-rtPCR in all cats, and positive samples were evaluated with S-RT-rtPCR. ICC evaluation of aqueous humor samples from 36 of the 58 cats was done using an avidin-biotin complex method and monoclonal anti-FCoV IgG 2A. Sensitivity, specificity, and negative and positive predictive values were calculated including 95% CIs. 7b-RT-rtPCR had a specificity of 100.0% (95% CI: 87.2-100.0) and sensitivity of 35.5% (95% CI: 19.2-54.6). Specificity of S-RT-rtPCR could not be determined because there were no FCoV 7b-RT-rtPCR-positive samples in the control group. Sensitivity of S-RT-rtPCR was 12.9% (95% CI 3.6-29.8). Sensitivity and specificity of ICC were 62.5% (95% CI: 40.6-81.2) and 80.0% (95% CI: 44.4-97.5), respectively. The combination of 7b-RT-rtPCR and IHC could be useful in diagnosing FIP; S-RT-rtPCR did not add value; and ICC of aqueous humor samples cannot be recommended for the diagnosis of FIP.


Existence of SARS-CoV-2 in Wastewater: Implications for Its Environmental Transmission in Developing Communities.


title: Male Infertility Is Responsible for Nearly Half of the Extinction Observed in the Mouse Collaborative Cross.

text: The goal of the Collaborative Cross (CC) project was to generate and distribute over 1000 independent mouse recombinant inbred strains derived from eight inbred founders. With inbreeding nearly complete, we estimated the extinction rate among CC lines at a remarkable 95%, which is substantially higher than in the derivation of other mouse recombinant inbred populations. Here, we report genome-wide allele frequencies in 347 extinct CC lines. Contrary to expectations, autosomes had equal allelic contributions from the eight founders, but chromosome X had significantly lower allelic contributions from the two inbred founders with underrepresented subspecific origins (PWK/PhJ and CAST/EiJ). By comparing extinct CC lines to living CC strains, we conclude that a complex genetic architecture is driving extinction, and selection pressures are different on the autosomes and chromosome X Male infertility played a large role in extinction as 47% of extinct lines had males that were infertile. Males from extinct lines had high variability in reproductive organ size, low sperm counts, low sperm motility, and a high rate of vacuolization of seminiferous tubules. We performed QTL mapping and identified nine genomic regions associated with male fertility and reproductive phenotypes. Many of the allelic effects in the QTL were driven by the two founders with underrepresented subspecific origins, including a QTL on chromosome X for infertility that was driven by the PWK/PhJ haplotype. We also performed the first example of cross validation using complementary CC resources to verify the effect of sperm curvilinear velocity from the PWK/PhJ haplotype on chromosome 2 in an independent population across multiple generations. While selection typically constrains the examination of reproductive traits toward the more fertile alleles, the CC extinct lines provided a unique opportunity to study the genetic architecture of fertility in a widely genetically variable population. We hypothesize that incompatibilities between alleles with different subspecific origins is a key driver of infertility. These results help clarify the factors that drove strain extinction in the CC, reveal the genetic regions associated with poor fertility in the CC, and serve as a resource to further study mammalian infertility.


title: An Image Fusion System for Estimating the Therapeutic Effects of Radiofrequency Ablation on Hepatocellular Carcinoma.

text: BACKGROUND During ultrasound-guided radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), high echoic areas due to RFA-induced microbubbles can help calculate the extent of ablation. However, these areas also decrease visualization of target tumors, making it difficult to assess whether they completely cover the tumors. To estimate the effects of RFA more precisely, we used an image fusion system (IFS). PATIENTS AND METHODS We enrolled patients with a single HCC who received RFA with or without the IFS. In the IFS group, we drew a spherical marker along the contour of a target tumor on reference images immediately after administering RFA so that the synchronized spherical marker represented the contour of the target tumor on real-time ultrasound images. When the high echoic area completely covered the marker, we considered the ablation to be complete. We compared outcomes between the IFS and control groups. RESULTS We enrolled 25 patients and 20 controls, and the baseline characteristics were similar between the two groups. The complete ablation rates during the first RFA session were significantly higher in the IFS group compared with those in the control group (88.0% vs. 60.0%, P = 0.041). The number of RFA sessions was significantly smaller in the IFS group compared with that in the control group (1.1 ± 0.3 vs. 1.5 ± 0.7, P = 0.016). CONCLUSIONS The study suggested that the IFS enables a more precise estimation of the effects of RFA on HCC, contributing to enhanced treatment efficacy and minimized patient burden.


title: Treatment of advanced pancreatic carcinoma with 90Y-Clivatuzumab Tetraxetan: a phase I single-dose escalation trial.

text: PURPOSE Humanized antibody hPAM4 specifically binds a mucin glycoprotein expressed in pancreatic adenocarcinomas. This phase I study evaluated a single dose of (90)Y-clivatuzumab tetraxetan ((90)Y-labeled hPAM4) in patients with advanced pancreatic cancer. EXPERIMENTAL DESIGN Twenty-one patients (4 stage III; 17 stage IV) received (111)In-hPAM4 for imaging and serum sampling before (90)Y-hPAM4. Study procedures evaluated adverse events, safety laboratories, computed tomography (CT) scans, biomarkers, pharmacokinetics, radiation dosimetry, and immunogenicity (HAHA). RESULTS (111)In-hPAM4 showed normal biodistribution with radiation dose estimates to red marrow and solid organs acceptable for radioimmunotherapy and with tumor targeting in 12 patients. One patient withdrew before (90)Y-hPAM4; otherwise, 20 patients received (90)Y doses of 15 (n = 7), 20 (n = 9), and 25 mCi/m(2) (n = 4). Treatment was well tolerated; the only significant drug-related toxicities were (NCI CTC v.3) grade 3 to 4 neutropenia and thrombocytopenia increasing with (90)Y dose. There were no bleeding events or serious infections, and most cytopenias recovered to grade 1 within 12 weeks. Three patients at 25 mCi/m(2) encountered dose-limiting toxicity with grade 4 cytopenias more than 7 days, establishing 20 mCi/m(2) as the maximal tolerated (90)Y dose. Two patients developed HAHA of uncertain clinical significance. Most patients progressed rapidly and with CA19-9 levels increasing within 1 month of therapy, but 7 remained progression-free by CT for 1.5 to 5.6 months, including 3 achieving transient partial responses (32%-52% tumor diameter shrinkage). CONCLUSION (90)Y-Clivatuzumab tetraxetan was well tolerated with manageable hematologic toxicity at the maximal tolerated (90)Y dose, and is a potential new therapeutic for advanced pancreatic cancer.


title: A duplex real-time PCR assay based on TaqMan technology for simultaneous detection and differentiation of canine adenovirus types 1 and 2.

text: Canine adenoviruses are a major cause of disease in dogs, coyotes, red foxes and wolves, as well as in other carnivores and marine mammals. Canine adenovirus type 1 (CAdV-1) and canine adenovirus type 2 (CAdV-2) cause infectious canine hepatitis (ICH) and infectious tracheobronchitis (ITB), respectively. In this study, a duplex real-time PCR assay for simultaneous detection and characterisation of CAdV-1 and CAdV-2 was developed by using a single primer pair and virus-specific probes. The assay was validated testing standard DNAs produced on purpose and clinical samples of various matrices known to be positive for CAdV-1, CAdV-2 or both viruses. Precise calculation of DNA loads in samples containing a wide range of viral amounts was allowed by generating a standard curve for absolute quantification. The assay was proven to be highly specific, since no cross-reactions with the different CAdV type was observed, and sensitive, being able to detect less than 10 copies of CAdV-1/CAdV-2 DNA. The low intra-assay and interassay coefficient of variations demonstrated a high repeatability, thus confirming the potential use of this assay for quantitative detection of CAdV-1 and CAdV-2 for rapid diagnosis and epidemiological investigations.


title: Human dose confirmation for self-expanding intra-abdominal foam: A translational, adaptive, multicenter trial in recently deceased human subjects.

text: BACKGROUND Noncompressible abdominal bleeding accounts for significant mortality in both military and civilian populations. There is an emergent need for a temporary hemostatic intervention whenever surgical care is not immediately available. Our team previously described a self-expanding polyurethane foam for the treatment of exsanguinating abdominal hemorrhage. The objective of this study was to translate a safe and effective swine dose into an appropriate human dose through foam administration in recently deceased humans with representative tissue compliance. METHODS With institutional review board oversight and informed consent at three centers, terminal patients were identified. Within 3 hours of death, the abdomen was accessed, and fluid was added to simulate hemorrhage. Foam was percutaneously administered using a prototype delivery system at multiple doses (45, 55, 65, 75, and 100 mL). Intra-abdominal pressure was monitored for 15 minutes, and then, foam was removed via laparotomy to assess abdominal tissue contact. RESULTS Twenty-one recently deceased patients ranging in age from 20 years to 92 years and body mass index from 18 kg/m to 39 kg/m were enrolled in the study. Foam was administered at a mean (SD) of 146 (34) minutes after death. Three subjects were screen failures, and three subjects were excluded from the analysis because of experimental errors. Change in intra-abdominal pressure and semiquantitative organ contact were used as surrogates to compare findings between humans and swine. Doses of 45, 55, and 65 mL resulted in peak pressures of 37 (20), 28 (8.1), and 33 (20) mmHg, respectively, within the acceptable range established in swine studies. Foam deployments of 75 mL and 100 mL exceeded acceptable pressures defined in swine. Higher foam doses tended to improve contact with the diaphragm, paracolic gutters, and liver. CONCLUSION The use of recently deceased humans demonstrates a novel approach to device evaluation in representative human anatomy, particularly when tissue compliance is critical. Sixty-five milliliters was determined to be the clinically appropriate dose for foam treatment in bleeding human patients.


title: Plant-produced anti-dengue virus monoclonal antibodies exhibit reduced antibody-dependent enhancement of infection activity.

text: The mAb E60 has the potential to be a desirable therapeutic molecule since it efficiently neutralizes all four serotypes of dengue virus (DENV). However, mammalian-cell-produced E60 exhibits antibody-dependent enhancement of infection (ADE) activity, rendering it inefficacious in vivo, and treated animals more susceptible to developing more severe diseases during secondary infection. In this study, we evaluated a plant-based expression system for the production of therapeutically suitable E60. The mAb was transiently expressed in Nicotiana benthamianaWT and a ∆XFT line, a glycosylation mutant lacking plant-specific N-glycan residues. The mAb was efficiently expressed and assembled in leaves and exhibited highly homogenous N-glycosylation profiles, i.e. GnGnXF3 or GnGn structures, depending on the expression host. Both E60 glycovariants demonstrated equivalent antigen-binding specificity and in vitro neutralization potency against DENV serotypes 2 and 4 compared with their mammalian-cell-produced counterpart. By contrast, plant-produced E60 exhibited reduced ADE activity in Fc gamma receptor expressing human cells. Our results suggest the ability of plant-produced antibodies to minimize ADE, which may lead to the development of safe and highly efficacious antibody-based therapeutics against DENV and other ADE-prone viral diseases. Our study provides so far unknown insight into the relationship between mAb N-glycosylation and ADE, which contributes to our understanding of how sugar moieties of antibodies modulate Fc-mediated functions and viral pathogenesis.


title: Successful laparoscopic extirpation of a large omental lipoblastoma in a child.

text: Omental lipoblastoma is extremely rare among benign tumors. We herein report the case of a child who underwent laparoscopic extirpation of a large omental lipoblastoma. A 4-year-old girl was diagnosed with an intra-abdominal solid tumor. Abdominal imaging revealed a fat density mass that was well encapsulated and measured 18 × 15 × 7.5 cm in size. Considering the MRI findings and movability of the tumor, we strongly suspected that the lesion was an omental lipoblastoma. We initially decided to perform laparoscopic exploration and, if possible, extirpation of the solid tumor sequentially. A total of five trocars were used, and the tumor was found to originate from the omentum. We successfully performed complete resection of the tumor laparoscopically. A histological examination revealed lipoblastoma. For large abdominal tumors in children, the laparoscopic approach is recommended as the first procedure when the tumor is preoperatively considered to be benign and resectable.


title: Effectiveness of bacterial disinfectants on surfaces of mechanical ventilator systems.

text: BACKGROUND Pathogens in healthcare settings can be transmitted via skin contact and environmental media. This study investigates bacterial contamination rate on surfaces of mechanical ventilator systems and bedside equipment. An experimental study evaluates the effectiveness of 75% alcohol in killing bacteria on surfaces. METHODS Surface swab sampling was conducted on ventilator systems and patient bedside equipment for detection of bacterial contamination. Surfaces of ventilator systems, such as faceplates, Y-pieces, and water traps, were swab sampled at 0.5, 8, and 24 hours after initial disinfection using a solution containing 0.5% sodium hypochlorite and pasteurization. The 75% alcohol aerosol was sprayed on the surfaces of faceplates, Y-pieces, and water traps on ventilator systems at 24 hours after initial disinfection, and then bacterial levels on the surfaces were evaluated. RESULTS Detection rates of Staphylococcus aureus were measured on the handrails of mechanical ventilators (64.7%), Y-pieces of breathing circuits (86.7%), and resuscitators (60.0%). Pseudomonas aeruginosa was identified on the surfaces of Y-pieces (6.7%) and water traps (13.3%) of breathing circuits, and also on suction systems (6.7%) and resuscitators (13.3%). The positive rate for total bacterial count was clearly increased on the surfaces of faceplates, Y-pieces, and water traps at 8 hour following disinfection by 0.5% sodium hypochlorite solution and pasteurization. Concentrations of S. aureus on surfaces decreased following treatment with 75% alcohol. However, considerable P. aeruginosa growth on water trap surfaces was observed after treatment with 75% alcohol. CONCLUSIONS The surfaces of ventilator systems, including faceplates, Y-pieces, and water traps, must be disinfected frequently (at least every 8 h) to control bacterial growth. Disinfection using 75% alcohol spray with air drying effectively decreased S. aureus on ventilator system surfaces.


title: Differences in tissue oxygenation and changes in total hemoglobin signal strength in the brain, liver, and lower-limb muscle during hemodialysis.

text: Near-infrared spectroscopy has been used to measure regional saturation of oxygen (rSO2) based on the total hemoglobin (t-Hb) signal strength. To date, few studies have investigated the changes of systemic oxygenation and t-Hb signal strength during hemodialysis (HD). This study aimed to (1) monitor rSO2 and t-Hb signal strength in the brain, liver, and lower-limb muscle during HD and (2) clarify the differences in rSO2 and t-Hb signal strength in each compartment. Fifty-three patients receiving 4-h HD were included and divided into three groups according to the compartments in which tissue oxygenation was measured as follows: brain (n = 44), liver (n = 42), and lower-limb muscle (n = 40). The rSO2 and t-Hb signal strength was monitored using an INVOS 5100c (Covidien Japan, Tokyo, Japan). The rSO2 levels were significantly lower in the brain than in the liver from HD initiation to the end (HD initiation: rSO2 in the brain and liver, 46.5 ± 1.3 and 52.4 ± 1.7%, respectively, p = 0.031). Furthermore, compared to the t-Hb signal strength ratio [value at t (min) during HD/initial value before HD] in the brain during HD, there were significant increases in the liver and lower-limb muscle, respectively. In conclusion, deterioration of cerebral oxygenation was remarkable compared to the hepatic oxygenation in HD patients. Our results, which revealed significant differences among the t-Hb signal strength ratios in the brain, liver, and lower-limb muscle during HD, might reflect the non-uniform body-fluid reduction within systemic tissues induced by ultrafiltration.


Pulmonary embolism and COVID-19. Persistent pulmonary hypertension?


title: Association of clot burden score with radiographic and clinical outcomes following Solitaire stent retriever thrombectomy: analysis of the SWIFT PRIME trial.

text: BACKGROUND The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. OBJECTIVE To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial. METHODS CBS was calculated for the endovascular arm (IV tissue plasminogen activator plus Solitaire stent retriever) of SWIFT PRIME using baseline CTA. The cohort of 69 patients was divided into three groups according to their CBS values: CBS 0-5 (n=14), CBS 6-7 (n=23), and CBS 8-9 (n=32). RESULTS The mean age of the 69 patients who formed the study cohort was 63.2±13.1 years, mean National Institutes of Health Stroke Scale score was 16.8±4.5, and 55% of the patients were male. There was no difference in clinical characteristics among the three groups, except for the baseline Alberta Stroke Program Early CT Score (p=0.049). The site of proximal occlusion varied significantly among the three groups (p<0.001). Rates of successful recanalization (TICI 2b/3), complete recanalization (TICI 3 only) and of good clinical outcome at 3 months were similar among the three groups (p=0.24, p=0.35, and p=0.52, respectively). CONCLUSIONS The combination of IV thrombolysis and stent retriever thrombectomy with the Solitaire device is highly effective in achieving successful recanalization and a good clinical outcome throughout the entire range of CBS values.


title: POFA trial study protocol: a multicentre, double-blind, randomised, controlled clinical trial comparing opioid-free versus opioid anaesthesia on postoperative opioid-related adverse events after major or intermediate non-cardiac surgery.

text: INTRODUCTION Reducing opioid consumption during and after surgery has been recommended for more than 10 years. Opioid-free anaesthesia (OFA) is a multimodal anaesthesia associating hypnotics, NMDA antagonists, local anaesthetics, anti-inflammatory drugs and α-2 agonists. Proofs of the effect of OFA on reducing opioid-related adverse effects after major or intermediate non-cardiac surgery are still scarce. We hypothesised that the reduced opioid consumption allowed by OFA compared with standard of care will be associated with a reduction of postoperative opioid-related adverse events. METHODS/ANALYSIS The POFA trial is a prospective, randomised, parallel, single-blind, multicentre study of 400 patients undergoing elective intermediate or major non-cardiac surgery. Patients will be randomly allocated to receive either a standard anaesthesia protocol or an OFA. The primary outcome measure is the occurrence of a severe postoperative opioid-related adverse event within the first 48 hours after extubation defined as: postoperative hypoxaemia or postoperative ileus or postoperative cognitive dysfunction. In addition, each component of the primary outcome measure will be analysed separately. Data will be analysed on the intention-to-treat principle and a per-protocol basis. ETHICS AND DISSEMINATION The POFA trial has been approved by an independent ethics committee for all study centres. Participant recruitment begins in November 2017. Results will be published in international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT03316339; Pre-results.


title: Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review.

text: Arterial aneurysms are uncommon among patients with dural arteriovenous fistulae (DAVFs), and there is limited information available to guide treatment decisions in such cases. We performed a systematic review of the literature, including a case of a DAVF associated with a flow-related intraorbital ophthalmic artery (OA) aneurysm that we have recently managed. The purpose of our study was to clarify epidemiology, natural history, and management of these lesions. A total of 43 published cases of DAVF associated aneurysms were found in 26 studies on the topic. Anterior cranial fossa was the most common location (40%), and ethmoidal branches were the most common arterial feeders (55%). In about 63% of cases, the aneurysm was located on artery unrelated to DAVF supply. Approximately 10% of intracranial DAVFs were associated with aneurysms located in the intraorbital OA. Overall, 70% of lesions were Borden type III, and 50% of patients presented with hemorrhage. In approximately 17% of cases, the source of bleeding was a feeding artery aneurysm. All of the reported intraorbital OA aneurysms associated with DAVFs remained stable during follow-up. DAVF associated aneurysms are fairly rare. Anterior cranial fossa location and direct cortical venous drainage are common among these lesions. The aneurysms are less likely to be located on feeding arteries, and hemorrhagic presentation related to flow-related aneurysm rupture is uncommon.


title: Respiratory syncytial virus and recurrent wheeze in healthy preterm infants.

text: BACKGROUND Respiratory syncytial virus (RSV) infection is associated with subsequent recurrent wheeze. Observational studies cannot determine whether RSV infection is the cause of recurrent wheeze or the first indication of preexistent pulmonary vulnerability in preterm infants. The monoclonal antibody palivizumab has shown efficacy in preventing severe RSV infection in high-risk infants. METHODS In the double-blind, placebo-controlled MAKI trial, we randomly assigned 429 otherwise healthy preterm infants born at a gestational age of 33 to 35 weeks to receive either monthly palivizumab injections (214 infants) or placebo (215 infants) during the RSV season. The prespecified primary outcome was the total number of parent-reported wheezing days in the first year of life. Nasopharyngeal swabs were taken during respiratory episodes for viral analysis. RESULTS Palivizumab treatment resulted in a relative reduction of 61% (95% confidence interval, 56 to 65) in the total number of wheezing days during the first year of life (930 of 53,075 days in the RSV-prevention group [1.8%] vs. 2309 of 51,726 days [4.5%] in the placebo group). During this time, the proportion of infants with recurrent wheeze was 10 percentage points lower in patients treated with palivizumab (11% vs. 21%, P=0.01). CONCLUSIONS In otherwise healthy preterm infants, palivizumab treatment resulted in a significant reduction in wheezing days during the first year of life, even after the end of treatment. These findings implicate RSV infection as an important mechanism of recurrent wheeze during the first year of life in such infants. (Funded by Abbott Laboratories and by the Netherlands Organization for Health Research and Development; MAKI Controlled Clinical Trials number, ISRCTN73641710.).


Incidence of SARS-CoV-2 vertical transmission: a meta-analysis.


title: Commentary on the coronavirus pandemic: Nigeria.

text: About a week after the confirmation of Nigeria's index case of COVID-19 on February 27, 2020, the Nigerian federal government set up a 12-member Presidential Task Force for the Control of the Coronavirus. The country's borders were closed on March 23, and the lockdown of cities was also implemented. The unanticipated disruption of scholarly or professional advancement for the 94% of university students who are not currently learning may increase the burden of mental illness among these students and predispose them to social vices. Two suicide deaths occurred during the lockdown. Poverty, lack of trust in the government, ignorance, denial and misplaced religious zealotry negatively impact on the behavior of Nigerians. Fear-induced behavioral changes such as consuming lemon, ginger, garlic, local herbs, and other substances for protection have also become rampant. Loss of income due to the lockdown and the accompanying destitution can also be a pathfinder for numerous other sicknesses and deaths. For the benefit of enhanced prevention and control of infection, only government-funded hospitals and a few designated privately owned hospitals have been permitted to provide continued services at this time. The number of shifts in these hospitals were adjusted such that there are fewer health care professionals in the hospital at a given time. This strategy has inhibited treatment and care for certain groups of people who are not COVID-19 patients. Efforts are being made to develop telehealth services, but most rural residents may not benefit from them. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Single-incision laparoscopic left adrenalectomy.

text: BACKGROUND Single-incision laparoscopic surgery (SILS) has gained an interest and popularity in the recent years. Although minimally invasive adrenal surgery replaced the open adrenalectomy, SILS adrenalectomy is a step forward technique that improves the cosmesis, decreases acsess related morbidity, and increases the postoperative recovery. We report our first experience with single-incision transperitoneal left adrenalectomy in a patient with Conns' syndrome. CASE A 46-year-old female patient with a diagnosis of Conns' syndrome underwent single-incision transperitoneal laparoscopic left adrenalectomy. SILS port (Covidien, Norwalk, CT) was used through a 2-cm incision and additional one 5-mm trocar used through one of the holes of SILS port to solve the smoke problem. The operative time was ended in 50 minutes, and no peroperative complication was encountered. The patient was discharged at the second postoperative day. CONCLUSION SILS adrenalectomy is a safe procedure for a benign adrenal lesion in experienced hands. Further studies are needed to evaluate the special benefits of this technique.


title: Therapeutic value of small molecule inhibitor to plasminogen activator inhibitor-1 for lung fibrosis.

text: Fibrosis is a final stage of many lung diseases, with no effective treatment. Plasminogen activator inhibitor-1 (PAI-1), a primary inhibitor of tissue-type and urokinase-type plasminogen activators (tPA and uPA, respectively), plays a critical role in the development of fibrosis. In this study, we explored the therapeutic potential of an orally effective small molecule PAI-1 inhibitor, TM5275, in a model of lung fibrosis induced by transforming growth factor-β1 (TGF-β1), the most potent and ubiquitous profibrogenic cytokine, and in human lung fibroblasts (CCL-210 cells). The results show that an intranasal instillation of AdTGF-β1(223/225), an adenovirus expressing constitutively active TGF-β1, increased the expression of PAI-1 and induced fibrosis in murine lung tissue. On the other hand, treating mice with 40 mg/kg of TM5275 for 10 days, starting 4 days after the instillation of AdTGF-β1(223/225), restored the activities of uPA and tPA and almost completely blocked TGF-β1-induced lung fibrosis, as shown by collagen staining, Western blotting, and the measurement of hydroxyproline. No loss of body weight was evident under these treatment conditions with TM5275. Furthermore, we show that TM5275 induced apoptosis in both myofibroblasts (TGF-β1-treated) and naive (TGF-β1-untreated) human lung fibroblasts, and this apoptosis was associated with the activation of caspase-3/7, the induction of p53, and the inhibition of α-smooth muscle actin, fibronectin, and PAI-1 expression. Such an inhibition of fibrotic responses by TM5275 occurred even in cells pretreated with TGF-β1 for 6 hours. Together, the results suggest that TM5275 is a relatively safe and potent antifibrotic agent, with therapeutic potential in fibrotic lung disease.


title: Impact of Focused Intraoperative Transthoracic Echocardiography by Anesthesiologists on Management in Hemodynamically Unstable High-Risk Noncardiac Surgery Patients.

text: OBJECTIVES Focused transthoracic echocardiography (TTE) is used perioperatively for surgical patients. Intraoperative application of TTE is feasible, but its benefits remain unclear. The intention of this study was to investigate the effect of intraoperative TTE on the management of high-risk noncardiac surgery patients. DESIGN A prospective interventional study. SETTING Single-center university hospital. PARTICIPANTS Fifty consecutive hemodynamically unstable high-risk patients anesthetized for noncardiac surgery. INTERVENTIONS Focused TTE was performed on hemodynamically unstable anesthetized patients whenever circulatory instability (defined as hypotension or low cardiac output) occurred intraoperatively. A cardiac output monitoring system using pulse contour analysis was established before induction of anesthesia. The intended therapy for stabilizing the patient was documented; however, the management actually administered was guided by the results of the TTE. Differences between the 2 lines of management were documented and analyzed. MEASUREMENTS AND MAIN RESULTS Intraoperative TTE was applied successfully in all 50 unstable patients. In 33 patients (66%, 95% confidence interval, 52.11-77.61) TTE led to a change of management. Altogether, 82 episodes of hemodynamic instability were recorded, including 38 episodes (46.34%, 95% confidence interval, 35.95-57.06) in which TTE led to a change of treatment. The most common pathologic finding was hypovolemia (66%); in contrast, in 22%, right-heart overload or right-heart failure (4%) was detected. CONCLUSIONS Focused TTE by anesthesiologists can provide new information that may alter the hemodynamic management of unstable high-risk noncardiac surgery patients in the operating room.


title: Collagen-Based Substrates with Tunable Strength for Soft Tissue Engineering.

text: Through the use of mechanical reinforcement of collagen matrices, mechanically strong and compliant 3D tissue mimetic scaffolds can be generated that act as scaffolds for soft tissue engineering. Collagen has been widely used for the development of materials for repair, augmentation or replacement of damaged or diseased tissue. Herein we describe a facile method for the layer-by-layer fabrication of robust planar collagen fiber constructs. Collagen gels cast in a phosphate buffer were dried to form dense collagen mats. Subsequent gels were layered and dried atop mats to create multilayer constructs possessing a range of tunable strengths (0.5 - 11 MPa) and stiffness (1 - 115 MPa). Depending on processing conditions and crosslinking of constructs, strain to failure ranged between 9 to 48%. Collagen mats were constructed into hernia patches that prevented hernia recurrence in Wistar rats.


Towards the prophylactic and therapeutic use of human neutralizing monoclonal antibodies for Middle East respiratory syndrome coronavirus (MERS-CoV).


title: The supply chain of medicinal controlled substances: addressing the Achilles heel of drug diversion.

text: The escalation of prescription drug abuse in the U.S. has attracted the attention of public health and safety officials as well as others puzzled by how such a tightly regulated enterprise could so easily be breached by those seeking controlled substances for nonmedical use. Prescribers and patients who use, misuse, or, in some cases, redistribute or divert these drugs have figured prominently in government strategies aimed at addressing this issue. This review departs from this paradigm and focuses on wholesale drug distributors, a highly efficient and largely behinds-the-scene link in the supply chain of controlled substances. By law, distributors are required to identify and report to the Drug Enforcement Administration (DEA) orders for controlled substances that are suspicious and may indicate drug diversion. Ten cases are examined in which distributors were each charged with failing to prevent the diversion of millions of doses of controlled substances. Special attention is given to a payment system employed by the industry that may encourage this unlawful commerce. Court records, agency and industry reports, and other published sources are used to document referenced cases and their disposition, and recommendations are offered for improving distributors' compliance with the law.


title: Imaging examination, diagnosis, and control and prevention of nosocomial infection for coronavirus disease 2019: Expert consensus of Hunan radiologist.

text: The outbreak of coronavirus disease 2019 (COVID-19) is a huge threat to global public health because it develops rapidly. There is no specific treatment so far. Chest imaging examination is an important auxiliary examination method in diagnosis of COVID-19. To further standardize the imaging examination and diagnosis of COVID-19, Hunan Society of Radiology together with Imaging Technology Professional Committee of Hunan Medical Association reach an expert consensus document on imaging examination, diagnosis, and control and prevention of nosocomial infection for COVID-19. This document summarizes the epidemiological characteristics, clinical features, imaging examination procedure, imaging findings, CT staging, the value of imaging examination, and the methods for control and prevention of nosocomial infection for COVID-19 during imaging examination. Furthermore, it extends the clinical characteristics and imaging manifestations of COVID-19 in children.


title: Use of reverse transcriptase-polymerase chain reaction-restriction fragment length polymorphism to examine the interaction between infectious bronchitis virus strains Massachusetts 41 and JMK in ovo.

text: The reverse transcriptase-polymerase chain reaction-restriction fragment length polymorphism (RTPCR-RFLP) technique has been developed and used in the serotype diagnosis of infectious bronchitis virus (IBV) infection. In this report, we first demonstrate that the RT-PCR-RFLP was sensitive in detecting both Massachusetts 41 (Mass 41) and JMK strains of IBV singly; the detection limit for both was approximately 0.15ng viral RNA using gel electrophoresis. Subsequently, the ability of the technique to semi-quantify the relative amounts of Mass 41 and JMK RNA in their mixture was shown by performing RT-PCR-RFLP on various combinations of serially diluted known amounts of Mass 41 and JMK RNA. Results indicated that both Mass 41 and JMK can be detected and semi-quantified when there is less than 10(3)-fold difference between the two viral RNA template inputs, which are above the lower detection limit. Based on this result, the interaction between Mass 41 and JMK in ovo was examined by inoculating 10-day-old embryos with various combinations of different EID(50) titers of Mass 41 and JMK. RT-PCR-RFLP results showed that Mass 41 dominates over JMK in an EID(50) titerdependent fashion, but not the reverse. To further investigate the underlying mechanism, replication efficiency of Mass 41 and JMK was compared at 6, 12, 18, 24, 36 and 48h after inoculation of embryos with 10(5.3) EID(50) of individual Mass 41 and JMK. No significant difference (P > 0.05) on replication efficiency between these two serotypes was found based on the results of total RNA concentration and RT-PCR results of 10-fold dilution of RNA at the indicated time points. By inoculating heat-inactivated Mass 41 with live JMK into embryos, only JMK was detected by RT-PCR-RFLP and no dominating interference was observed. Data suggest that the dominance is not due to the replication efficiency of Mass 41 and JMK; a receptor-mediated mechanism might be responsible for it.


title: Paradoxical cerebral fat embolism in revision hip surgery.

text: The incidence of clinical fat embolism syndrome (FES) is low (<1%) whilst fat embolism (FE) of marrow fat appears to occur more often (Mellor and Soni (2001)). Paradoxical brain FE may occur in patients undergoing hip orthopedic surgery who have an undocumented patent foramen ovale (PFO). We report a case of an eighty-year-old male patient, who underwent a scheduled revision hip surgery suffering a paradoxical cerebral FE.


title: Metrics of early childhood growth in recent epidemiological research: A scoping review.

text: Metrics to quantify child growth vary across studies of the developmental origins of health and disease. We conducted a scoping review of child growth studies in which length/height, weight or body mass index (BMI) was measured at ≥ 2 time points. From a 10% random sample of eligible studies published between Jan 2010-Jun 2016, and all eligible studies from Oct 2015-June 2016, we classified growth metrics based on author-assigned labels (e.g., 'weight gain') and a 'content signature', a numeric code that summarized the metric's conceptual and statistical properties. Heterogeneity was assessed by the number of unique content signatures, and label-to-content concordance. In 122 studies, we found 40 unique metrics of childhood growth. The most common approach to quantifying growth in length, weight or BMI was the calculation of each child's change in z-score. Label-to-content discordance was common due to distinct content signatures carrying the same label, and because of instances in which the same content signature was assigned multiple different labels. In conclusion, the numerous distinct growth metrics and the lack of specificity in the application of metric labels challenge the integration of data and inferences from studies investigating the determinants or consequences of variations in childhood growth.


Booming biosafety labs probed.


Reply to Re: COVID-19 and the Urology Match: Perspectives and a Call to Action.


title: Association between hemodynamic modifications and clinical outcome of intracranial aneurysms treated using flow diverters.

text: Treatment of intracranial aneurysms (IAs) has been revolutionized by the advent of endovascular Flow Diverters (FDs), which disrupt blood flow within the aneurysm to induce pro-thrombotic conditions, and serves as a scaffold for endothelial ingrowth and arterial remodeling. Despite good clinical success of FDs, complications like incomplete occlusion and post-treatment rupture leading to subarachnoid hemorrhage have been reported. In silico computational fluid dynamic analysis of the pre- and post-treated geometries of IA patients can shed light on the contrasting blood hemodynamics associated with different clinical outcomes. In this study, we analyzed hemodynamic modifications in 15 IA patients treated using a single FD; 10 IAs were completely occluded (successful) and 5 were partially occluded (unsuccessful) at 12-month follow-up. An in-house virtual stenting workflow was used to recapitulate the clinical intervention on these cases, followed by CFD to obtain pre- and post-treatment hemodynamics. Bulk hemodynamic parameters showed comparable reductions in both groups with average inflow rate and aneurysmal velocity reduction of 40.3% and 52.4% in successful cases, and 34.4% and 49.2% in unsuccessful cases. There was a substantial reduction in localized parameter like vortex coreline length and Energy Loss for successful cases, 38.2% and 42.9% compared to 10.1% and 10.5% for unsuccessful cases. This suggest that for successfully treated IAs, the localized complex blood flow is disrupted more prominently by the FD as compared to unsuccessful cases. These localized hemodynamic parameters can be potentially used in prediction of treatment outcome, thus aiding the clinicians in a priori assessment of different treatment strategies.


title: Prevention of retinopathy of prematurity in preterm infants through changes in clinical practice and SpO₂technology.

text: AIM To identify whether pulse oximetry technology is associated with decreased retinopathy of prematurity (ROP) and laser treatment. METHODS Inborn infants <1250 g who had eye exams were compared at two centres in three periods. In Period 1, SpO₂ target was ≥93% and pulse oximetry technology was the same in both Centres. In Period 2, guidelines for SpO₂ 88-93% were implemented at both centres and Centre B changed to oximeters with signal extraction technology (SET(®)) while Centre A did not, but did so in Period 3. One ophthalmology department performed eye exams using international criteria. RESULTS In 571 newborns <1250 g, birth weight and gestational age were similar in the different periods and centres. At Centre A, severe ROP and need for laser remained the same in Periods 1 and 2, decreasing in Period 3-6% and 3%, respectively. At Centre B, severe ROP decreased from 12% (Period 1) to 5% (Period 2) and need for laser decreased from 5% to 3%, remaining low in Period 3. CONCLUSION In a large group of inborn infants <1250 g, a change in clinical practice in combination with pulse oximetry with Masimo SET, but not without it, led to significant reduction in severe ROP and need for laser therapy. Pulse oximetry selection is important in managing critically ill infants.


title: The Use of Barbed Suture for Intracorporeal Mechanical Anastomosis During a Totally Laparoscopic Right Colectomy: Is It Safe? A Retrospective Nonrandomized Comparative Multicenter Study.

text: BACKGROUND A totally laparoscopic right colectomy could be perceived as a more challenging procedure over a laparoscopic-assisted right colectomy owing to the difficulty of intracorporeal anastomosis and the closure of the enterotomy. The aim of this study is to evaluate the safety and efficacy of the barbed auto-locking absorbable suture for the closure of an anastomotic stapler-access enterotomy during a totally laparoscopic right colectomy. METHODS From January 2010 to April 2016, data from patients who had undergone a laparoscopic right colectomy in 2 different departments of 2 institutions (the Department of General and Minimally Invasive Surgery, San Camillo Hospital in Trento and the Department of Surgical Specialties and Nephrology, University Federico II in Naples) were retrospectively analyzed. We compared the data of patients in whom the stapler-access enterotomy was closed through a conventional absorbable suture (Group A), with the data of patients in whom a stapler-access enterotomy was closed through a V-Loc 180 suture (Group B). Biometric features and intraoperative and postoperative data were collected and analyzed. RESULTS The 2 groups (Group A: 40 patients; Group B: 40 patients) were comparable for biometric features and postoperative outcomes. The anastomosing time was lower in Group B. A statistically significant difference was noted in the mean operative time between Groups A and B (Group A = 134.92 ± 34.17; Group B = 120.92 ± 23.27, P = .035). Only one anastomotic leakage per group was recorded, each treated with an anastomosis redo. During the reoperations, we find in both groups an intact stapler-access enterotomy. CONCLUSION On retrospective analysis, barbed suture appears to be safe and efficient for closure of the stapler-access enterotomy during totally laparoscopic right colectomy.


title: The androgen receptor regulates a druggable translational regulon in advanced prostate cancer.

text: The androgen receptor (AR) is a driver of cellular differentiation and prostate cancer development. An extensive body of work has linked these normal and aberrant cellular processes to mRNA transcription; however, the extent to which AR regulates posttranscriptional gene regulation remains unknown. Here, we demonstrate that AR uses the translation machinery to shape the cellular proteome. We show that AR is a negative regulator of protein synthesis and identify an unexpected relationship between AR and the process of translation initiation in vivo. This is mediated through direct transcriptional control of the translation inhibitor 4EBP1. We demonstrate that lowering AR abundance increases the assembly of the eIF4F translation initiation complex, which drives enhanced tumor cell proliferation. Furthermore, we uncover a network of pro-proliferation mRNAs characterized by a guanine-rich cis-regulatory element that is particularly sensitive to eIF4F hyperactivity. Using both genetic and pharmacologic methods, we demonstrate that dissociation of the eIF4F complex reverses the proliferation program, resulting in decreased tumor growth and improved survival in preclinical models. Our findings reveal a druggable nexus that functionally links the processes of mRNA transcription and translation initiation in an emerging class of lethal AR-deficient prostate cancer.


title: Admission of patients with STEMI since the outbreak of the COVID-19 pandemic. A survey by the European Society of Cardiology.

text: The paper describes the results of an ESC Covid survey.


title: Infection control practices and zoonotic disease risks among veterinarians in the United States.

text: OBJECTIVE-To assess the knowledge and use of infection control practices (ICPs) among US veterinarians. DESIGN-Anonymous mail-out population survey. PROCEDURES-In 2005 a questionnaire was mailed to US small animal, large animal, and equine veterinarians who were randomly selected from the AVMA membership to assess precaution awareness (PA) and veterinarians' perceptions of zoonotic disease risks. Respondents were assigned a PA score (0 to 4) on the basis of their responses (higher scores representing higher stringency of ICPs); within a practice type, respondents' scores were categorized as being within the upper 25% or lower 75% of scores (high and low PA ranking, respectively). Characteristics associated with low PA rankings were assessed. RESULTS-Generally, respondents did not engage in protective behaviors or use personal protective equipment considered appropriate to protect against zoonotic disease transmission. Small animal and equine veterinarians employed in practices that had no written infection control policy were significantly more likely to have low PA ranking. Male gender was associated with low PA ranking among small animal and large animal veterinarians; equine practitioners not working in a teaching or referral hospital were more likely to have low PA ranking than equine practitioners working in such institutions. CONCLUSIONS AND CLINICAL RELEVANCE-Results indicated that most US veterinarians are not aware of appropriate personal protective equipment use and do not engage in practices that may help reduce zoonotic disease transmission. Gender differences may influence personal choices for ICPs. Provision of information and training on ICPs and establishment of written infection control policies could be effective means of improving ICPs in veterinary practices.


title: Research advances in esophageal diseases: bench to bedside.

text: Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research.


title: When and how to perform a biopsy on a chronic wound.

text: PURPOSE To enhance the learner's competence with knowledge of biopsy techniques and when to perform biopsies on specific chronic wounds. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Distinguish between different types of chronic wounds that require biopsies. 2. Apply knowledge of biopsy techniques to obtain quality results. 3. Analyze various types of chronic wounds to determine the appropriate type of biopsy needed.


HIV vaccine failure, coronavirus papers and a unprecedented glimpse of the Sun.


title: Hospital Emergency Readiness Overview study.

text: In 2001, a survey of Canadian emergency departments indicated significant deficiencies in disaster preparedness. Since then, there have been efforts on the part of Provincial governments to remedy this situation. This survey repeats the original study with minor modifications to determine if there has been improvement. The Hospital Emergency Readiness Overview study demonstrates that despite improvements, there remain gaps in Canadian healthcare facility readiness for disaster, specifically one involving contaminated patients. It also highlights the lack of any standardized assessment of healthcare facilities' chemical, biological, radiological, or nuclear readiness.


title: Antiviral activity of Paulownia tomentosa against enterovirus 71 of hand, foot, and mouth disease.

text: The bark, leaves, and flowers of Paulownia trees have been used in traditional Chinese medicine to treat infectious and inflammatory diseases. We investigated the antiviral effects of Paulownia tomentosa flowers, an herbal medicine used in some provinces of P. R. China for the treatment of skin rashes and blisters. Dried flowers of P. tomentosa were extracted with methanol and tested for antiviral activity against enterovirus 71 (EV71) and coxsackievirus A16 (CAV16), the predominant etiologic agents of hand, foot, and mouth disease in P. R. China. The extract inhibited EV71 infection, although no effect was detected against CAV16 infection. Bioactivity-guided fractionation was performed to identify apigenin as an active component of the flowers. The EC50 value for apigenin to block EV71 infection was 11.0 µM, with a selectivity index of approximately 9.3. Although it is a common dietary flavonoid, only apigenin, and not similar compounds like naringenin and quercetin, were active against EV71 infection. As an RNA virus, the genome of EV71 has an internal ribosome entry site that interacts with heterogeneous nuclear ribonucleoproteins (hnRNPs) and regulates viral translation. Cross-linking followed by immunoprecipitation and reverse transcription-polymerase chain reaction (RT-PCR) analysis showed that EV71 RNA was associated with hnRNPs A1 and A2. Apigenin treatment disrupted this association, indicating that apigenin suppressed EV71 replication through a novel mechanism by targeting the trans-acting factors. This study therefore validates the effects of Paulownia against EV71 infection. It also yielded mechanistic insights on apigenin as an active compound for the antiviral activity of P. tomentosa against EV71 infection.


title: Canada: public health genomics.

text: Canada has a diverse population of 32 million people and a universal, publicly funded health care system provided through provincial and territorial health insurance plans. Public health activities are resourced at provincial/territorial level with strategic coordination from national bodies. Canada has one of the longest-standing genetics professional specialty organizations and is one of the few countries offering master's level training designed specifically for genetic counselors. Prenatal screening is offered as part of routine clinical prenatal services with variable uptake. Surveillance of the effect of prenatal screening and diagnosis on the birth prevalence of congenital anomalies is limited by gaps and variations in surveillance systems. Newborn screening programs vary between provinces and territories in terms of organization and conditions screened for. The last decade has witnessed a four-fold increase in requests for genetic testing, especially for late onset diseases. Tests are performed in provincial laboratories or outside Canada. There is wide variation in participation in laboratory quality assurance schemes, and there are few regulatory frameworks in Canada that are directly relevant to genetics testing services or population genetics. Health technology assessment in Canada is conducted by a diverse range of organizations, several of which have produced reports related to genetics. Several large-scale population cohort studies are underway or planned, with initiatives to harmonize their conduct and the management of ethical issues, both within Canada and with similar projects in other countries.


An Introduction to the EFSUMB Guidelines on Interventional Ultrasound (INVUS).


title: Interventions to promote access to eye care for non-Indigenous, non-dominant ethnic groups in high-income countries: a scoping review protocol.

text: INTRODUCTION For many people, settling in a new country is associated with a new identity as an 'ethnic minority', one that can remain through future generations. People who are culturally distinct from the dominant population group may experience a variety of barriers to accessing healthcare, including linguistic and cultural barriers in communication, navigation of an unfamiliar health system and unconscious or overt discrimination. Here, we outline the protocol of a scoping review to identify, describe and summarise interventions aimed at improving access to eye care for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS AND ANALYSIS We will search MEDLINE, Embase and Global Health from their inception to July 2019. We will include studies of any design that describe an intervention to promote access to eye care for non-Indigenous, non-dominant ethnic groups. Two authors will independently review titles, abstracts and full-text articles for inclusion. Reference lists from all included articles will also be searched. In cases of disagreement between initial reviewers, a third author will help resolve the conflict. For each included article, we will extract data about the target population, details of the intervention delivered and the effectiveness of or feedback from the intervention. Overall findings will be summarised with descriptive statistics and thematic analysis. ETHICS AND DISSEMINATION This review will summarise existing literature and as such ethics approval is not required. We will publish the review in an open-access, peer-reviewed journal, and draft appropriate summaries for dissemination to the wider community. This wider community could include clinicians, policymakers, health service managers and organisations that work with non-dominant ethnic groups. Our findings will also feed into the ongoing Lancet Global Health Commission on Global Eye Health.


title: Protecting short-term intravascular ear catheters in healthy rabbits.

text: Researchers may place a catheter in the ear vessel of a rabbit for a short period of time in order to collect repeated blood samples without extensive restraint of the animal. Maintaining such a catheter in a healthy rabbit can be challenging, as the animal may scratch at the ear, removing the catheter or forming a large hematoma that might impede blood sampling. The authors developed a technique for protecting the indwelling catheter by cutting a section of moleskin to the same shape as the ear and gluing it to the surface of the ear and the catheter. They applied this technique to collect multiple blood samples during 12-h periods from nine rabbits in a pharmacokinetics study. Catheters remained patent in five rabbits for 12 h, in two rabbits for 8 h, in one rabbit for 6 h and in one rabbit for 4 h. This technique allowed for collection of repeated blood samples and prevented the rabbits from interfering with the catheter while allowing them to move freely during the sampling period.