title: Assessing Knowledge, Attitudes and Practices of dental practitioners regarding the COVID-19 pandemic: A multinational study.

text: BACKGROUND Coronavirus Disease 2019 (COVID-19) has been declared a global public health emergency that is affecting people across the globe. OBJECTIVES The aim of this study was to assess the Knowledge, Attitudes and Practices (KAP) of dental practitioners regarding the Coronavirus Disease 2019 (COVID-2019) pandemic. MATERIAL AND METHODS An online questionnaire was distributed among dentists across the globe using a combination of convenience and snowball sampling. The questionnaire was divided into 4 sections: the 1st one contained personal information, whereas the 2nd, 3rd and 4th sections assessed knowledge (11 questions), attitudes (6 questions) and practices (7 questions) of the dentists. The data was subjected to the Shapiro-Wilk test, one-way analysis of variance (ANOVA), multivariate linear regression, and Pearson's correlation; 95% confidence interval (CI) was calculated and odds ratio (OR) was obtained. The analysis was done using IBM SPSS for Windows, v. 21.0. RESULTS The total number of the responses received (860) was divided with regard to various continents (Asia, Americas - North and South, Europe, Africa, and other - Australia and Antarctica). The largest number of dentists came from the Asian continent (264; 30.7%). Most dentists had a degree of MDS (Master of Dental Science) (301; 35.0%), followed by BDS (Bachelor of Dental Surgery) (282; 32.8%) and DDS (Doctor of Dental Surgery) (226; 26.3%). High/Good knowledge and practice scores were observed among 92.7% and 79.5 % of the dentists, respectively. Good knowledge scores were significantly associated with qualifications (p = 0.04) and years of practice (p = 0.02); good practice scores were associated with qualifications only (p = 0.03). CONCLUSIONS The dentists were found to have good knowledge and practice scores, which is important to combat COVID-19. They are advised to follow the Centers of Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines in their clinics, and sensitize their staff so that no stone is left unturned in defeating this pandemic.


title: Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus.

text: The coronavirus pandemic has created worldwide shortages of N95 respirators. We analyzed 4 decontamination methods for effectiveness in deactivating severe acute respiratory syndrome coronavirus 2 virus and effect on respirator function. Our results indicate that N95 respirators can be decontaminated and reused, but the integrity of respirator fit and seal must be maintained.


Polypropylene Suture Guided Microdochectomy for Pathologic Nipple Discharge


title: Prospective study on embolization of intracranial aneurysms with the pipeline device: the PREMIER study 1 year results.

text: BACKGROUND Preliminary clinical studies on the safety and efficacy of the pipeline embolization device (PED) for the treatment of small/medium aneurysms have demonstrated high occlusion rates with low complications. OBJECTIVE To evaluate the safety and effectiveness of the PED for treatment of wide necked small and medium intracranial aneurysms. METHODS PREMIER is a prospective, multicenter, single arm trial. Patients were treated with the PED for unruptured wide necked aneurysms, measuring ≤12 mm along the internal carotid artery or vertebral artery, between July 2014 and November 2015. At 1 year post-procedure, the primary effectiveness endpoint was complete occlusion (Raymond grade 1) without major parent vessel stenosis (≤50%) or retreatment, and the primary safety endpoint was major stroke in the territory supplied by the treated artery or neurologic death. RESULTS A total of 141 patients were treated with PEDs (mean age 54.6±11.3 years, 87.9% (124/141) women). Mean aneurysm size was 5.0±1.92 mm, and 84.4% (119/141) measured <7 mm. PED placement was successful in 99.3% (140/141) of patients. Mean number of PEDs implanted per patient was 1.1±0.26; a single PED was used in 92.9% (131/141) of patients. At 1 year, 97.9% (138/141) of patients underwent follow-up angiography with 76.8% (106/138) of patients having met the study's primary effectiveness endpoint. The combined major morbidity and mortality rate was 2.1% (3/140). CONCLUSIONS Treatment of wide necked small/medium aneurysms with the PED results in high rates of complete occlusion without significant parent vessel stenosis and low rates of permanent neurologic complications. TRIAL REGISTRATION NCT02186561.


Tough times call for rapid techniques: combating the novel coronavirus.


title: Thermal ablation of lung tissue: in vivo experimental comparison of microwave and radiofrequency.

text: This study was designed to compare feasibility, safety, and effectiveness of microwave (MW) ablation versus radiofrequency (RF) ablation of lung tissue in a rabbit model. Twenty New Zealand White rabbits were submitted to MW (n = 10, group A) or RF ablation (n = 10, group B). The procedures were performed with a prototype MW ablation device with a 1.6-cm radiating section antenna (Valleylab MW Ablation System) and with a 2-cm exposed-tip RF electrode (Cool-tip RF Ablation System). At immediate computed tomography increase in density, maximum diameters (D1-D3) of ablation zones were measured and ablation volume was calculated. Histopathologic assessment was performed 3 and 7 days after the procedure. Technical success was achieved in nine of 10 rabbits in each group. One death occurred in group B. Complications included pneumothorax (group A, n = 4; group B, n = 4), abscess (group A, n = 1; group B, n = 1), and thoracic wall burn (group A, n = 4). No significant differences were demonstrated in attenuation increase (P = 0.73), dimensions (P = 0.28, 0.86, 0.06, respectively, comparing D1-D3) and volume (P = 0.17). At histopathology, ablation zones were similar, with septal necrosis, edema, hemorrhage, and peripheral lymphocytic infiltrate. Complete thrombosis of more than 90% of vessels up to 2 mm in diameter was depicted at the periphery of the ablation zone in group A specimens. In group B specimens, complete thrombosis was depicted in 20% of vessels. Feasibility and safety of MW and RF ablation are similar in a lung rabbit model. MW ablation produces a greater damage to peripheral small vessels inducing thrombosis.


title: Rapid evaporative ionisation mass spectrometry of electrosurgical vapours for the identification of breast pathology: towards an intelligent knife for breast cancer surgery.

text: BACKGROUND Re-operation for positive resection margins following breast-conserving surgery occurs frequently (average = 20-25%), is cost-inefficient, and leads to physical and psychological morbidity. Current margin assessment techniques are slow and labour intensive. Rapid evaporative ionisation mass spectrometry (REIMS) rapidly identifies dissected tissues by determination of tissue structural lipid profiles through on-line chemical analysis of electrosurgical aerosol toward real-time margin assessment. METHODS Electrosurgical aerosol produced from ex-vivo and in-vivo breast samples was aspirated into a mass spectrometer (MS) using a monopolar hand-piece. Tissue identification results obtained by multivariate statistical analysis of MS data were validated by histopathology. Ex-vivo classification models were constructed from a mass spectral database of normal and tumour breast samples. Univariate and tandem MS analysis of significant peaks was conducted to identify biochemical differences between normal and cancerous tissues. An ex-vivo classification model was used in combination with bespoke recognition software, as an intelligent knife (iKnife), to predict the diagnosis for an ex-vivo validation set. Intraoperative REIMS data were acquired during breast surgery and time-synchronized to operative videos. RESULTS A classification model using histologically validated spectral data acquired from 932 sampling points in normal tissue and 226 in tumour tissue provided 93.4% sensitivity and 94.9% specificity. Tandem MS identified 63 phospholipids and 6 triglyceride species responsible for 24 spectral differences between tissue types. iKnife recognition accuracy with 260 newly acquired fresh and frozen breast tissue specimens (normal n = 161, tumour n = 99) provided sensitivity of 90.9% and specificity of 98.8%. The ex-vivo and intra-operative method produced visually comparable high intensity spectra. iKnife interpretation of intra-operative electrosurgical vapours, including data acquisition and analysis was possible within a mean of 1.80 seconds (SD ±0.40). CONCLUSIONS The REIMS method has been optimised for real-time iKnife analysis of heterogeneous breast tissues based on subtle changes in lipid metabolism, and the results suggest spectral analysis is both accurate and rapid. Proof-of-concept data demonstrate the iKnife method is capable of online intraoperative data collection and analysis. Further validation studies are required to determine the accuracy of intra-operative REIMS for oncological margin assessment.


title: In vitro comparison of V-Loc™ versus Biosyn™ in a one-layer end-to-end anastomosis of equine jejunum.

text: OBJECTIVE To compare a unidirectional barbed suture (V-Loc™) to its suture material equivalent (Biosyn™) in a single-layer end-to-end anastomosis of equine jejunum. STUDY DESIGN Experimental in vitro study. ANIMALS Jejunal sections from adult horses (n = 5) without gastrointestinal disease. METHODS Jejunal end-to-end anastomoses (n = 9) were performed for each group (V-Loc™, Biosyn™) with a continuous Lembert pattern with an interruption every 120°. Anastomosis construction time, luminal diameter, and number of suture bites were recorded. Anastomosis constructs were distended with fluid at 1 L/min until failure. Location and intraluminal pressure at failure were recorded and all measurements were compared between groups. RESULTS V-Loc™ anastomoses were significantly faster to perform (13.1 ± 0.35 minutes) when compared to the Biosyn™ group (15.6 ± 0.72 minutes; P = .0004). No differences were observed for anastomotic index or number of suture bites. V-Loc™ anastomosis constructs had a significantly decreased bursting pressure (160 ± 11.6 mmHg) compared to Biosyn™ constructs (184 ± 16.9 mmHg; P = .01). CONCLUSIONS V-Loc™ allowed faster construction time and did not cause a decreased anastomosis luminal diameter when compared with Biosyn™. V-Loc™ had a decreased bursting strength compared with Biosyn™, albeit well above pathologic pressures encountered clinically. Use of V-Loc™ may be beneficial for decreasing the amount of exposed suture material because of the absence of knots after construction and has the potential to result in decreased adhesions.


title: Surgical and concomitant epicardial-endocardial (hybrid) ablation of persistent and long-standing persistent atrial fibrillation.

text: Catheter ablation of atrial fibrillation (AF) has been shown to be effective for paroxysmal AF. However, for patients with persistent or longstanding persistent AF, the success rates for catheter ablation is low. The Cox-Maze procedure is the most effective non-pharmacological treatment of AF. However, due to the need for open-heart surgery and the morbidity associated with the surgical Cox-Maze procedure, minimally invasive and epicardial-endocardial (hybrid) ablation procedures have been developed. This article will review the main surgical and hybrid approaches used for the treatment of persistent and long-standing persistent AF.


title: Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis.

text: BACKGROUND Five percent of adult patients undergoing noncardiac inpatient surgery experience a major pulmonary complication. The authors hypothesized that the choice of neuromuscular blockade reversal (neostigmine vs. sugammadex) may be associated with a lower incidence of major pulmonary complications. METHODS Twelve U.S. Multicenter Perioperative Outcomes Group hospitals were included in a multicenter observational matched-cohort study of surgical cases between January 2014 and August 2018. Adult patients undergoing elective inpatient noncardiac surgical procedures with general anesthesia and endotracheal intubation receiving a nondepolarizing neuromuscular blockade agent and reversal were included. Exact matching criteria included institution, sex, age, comorbidities, obesity, surgical procedure type, and neuromuscular blockade agent (rocuronium vs. vecuronium). Other preoperative and intraoperative factors were compared and adjusted in the case of residual imbalance. The composite primary outcome was major postoperative pulmonary complications, defined as pneumonia, respiratory failure, or other pulmonary complications (including pneumonitis; pulmonary congestion; iatrogenic pulmonary embolism, infarction, or pneumothorax). Secondary outcomes focused on the components of pneumonia and respiratory failure. RESULTS Of 30,026 patients receiving sugammadex, 22,856 were matched to 22,856 patients receiving neostigmine. Out of 45,712 patients studied, 1,892 (4.1%) were diagnosed with the composite primary outcome (3.5% sugammadex vs. 4.8% neostigmine). A total of 796 (1.7%) patients had pneumonia (1.3% vs. 2.2%), and 582 (1.3%) respiratory failure (0.8% vs. 1.7%). In multivariable analysis, sugammadex administration was associated with a 30% reduced risk of pulmonary complications (adjusted odds ratio, 0.70; 95% CI, 0.63 to 0.77), 47% reduced risk of pneumonia (adjusted odds ratio, 0.53; 95% CI, 0.44 to 0.62), and 55% reduced risk of respiratory failure (adjusted odds ratio, 0.45; 95% CI, 0.37 to 0.56), compared to neostigmine. CONCLUSIONS Among a generalizable cohort of adult patients undergoing inpatient surgery at U.S. hospitals, the use of sugammadex was associated with a clinically and statistically significant lower incidence of major pulmonary complications. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Approximately 5% of patients experience a major pulmonary complication after noncardiac surgeryInadequate reversal of neuromuscular blockade increases the risk of pulmonary complicationsIn the United States, sugammadex is used with similar frequency as neostigmine at many hospitalsSugammadex provides more rapid and effective restoration of neuromuscular tone without systemic anticholinergic activity; however, neostigmine currently remains the mainstay of practice WHAT THIS ARTICLE TELLS US THAT IS NEW: In a multicenter observational matched cohort study of noncardiac surgery, sugammadex administration was associated with a 30% reduced risk of pulmonary complications, a 47% reduced risk of pneumonia, and a 55% reduced risk of respiratory failure compared to neostigmine.


title: Human coronavirus in young children hospitalized for acute respiratory illness and asymptomatic controls.

text: BACKGROUND Human coronaviruses (HCoVs) have been detected in children with upper and lower respiratory symptoms, but little is known about their relationship with severe respiratory illness. OBJECTIVE To compare the prevalence of HCoV species among children hospitalized for acute respiratory illness and/or fever (ARI/fever) with that among asymptomatic controls and to assess the severity of outcomes among hospitalized children with HCoV infection compared with other respiratory viruses. METHODS From December 2003 to April 2004 and October 2004 to April 2005, we conducted prospective, population-based surveillance of children <5 years of age hospitalized for ARI/fever in 3 US counties. Asymptomatic outpatient controls were enrolled concurrently. Nasal/throat swabs were tested for HCoV species HKU1, NL63, 229E, and OC43 by real-time reverse-transcription polymerase chain reaction. Specimens from hospitalized children were also tested for other common respiratory viruses. Demographic and medical data were collected by parent/guardian interview and medical chart review. RESULTS Overall, HCoV was detected in 113 (7.6%) of 1481 hospitalized children (83 [5.7%] after excluding 30 cases coinfected with other viruses) and 53 (7.1%) of 742 controls. The prevalence of HCoV or individual species was not significantly higher among hospitalized children than controls. Hospitalized children testing positive for HCoV alone tended to be less ill than those infected with other viruses, whereas those coinfected with HCoV and other viruses were clinically similar to those infected with other viruses alone. CONCLUSIONS In this study of children hospitalized for ARI/fever, HCoV infection was not associated with hospitalization or with increased severity of illness.


title: Reproducibility of upper leg EMG frequency content during cycling.

text: Reproducibility of frequency content from surface electromyography (sEMG) signals has not been assessed and it is unknown if incremental load testing design could affect sEMG in cycling. The goals of this study were to assess the reproducibility of measures from sEMG frequency content between sessions and to compare these frequency components between a ramp and a step incremental cycling test. Eighteen cyclists performed four incremental load cycling tests to exhaustion. Two tests were performed using a step increment (load started at 100 W for 3 min followed by increments of 30 W every 3 min) and two were performed using a ramp increment (load started at 100 W for 1 min followed by increments of 30 W·min-1). sEMG was monitored bilaterally for the rectus femoris and vastus lateralis throughout the tests and converted into overall activation (whole signal bandwidth), high- and low-frequency contents. The reproducibility of the frequency content ranged from none to strong (ICC = 0.07-0.90). Vastus lateralis activation was larger at the step compared to the ramp test (P < 0.01), without differences for rectus femoris (P = 0.22-0.91) and for the high-frequency (P = 0.28-0.95) and low-frequency contents (P = 0.13-0.94). sEMG from vastus lateralis and rectus femoris presented none to strong reproducibility. Vastus lateralis is more activated in step test design.


title: An attenuated Salmonella-vectored vaccine elicits protective immunity against Mycobacterium tuberculosis.

text: There is a need to develop protective vaccines against tuberculosis (TB) that elicit full immune responses including mucosal immunity. Here, a live attenuated Salmonellatyphimurium aroA SL7207 vector TB vaccine, namely SL(E6-85B), harboring the Mycobacterium tuberculosis (M. tb) H37Rv ESAT6-Ag85B fusion gene was developed. The experimental data demonstrated that this SL(E6-85B) vaccine, or when it is combined with BCG vaccination, induced the strongest TB Ag-specific mucosal, humoral, and cellular immune responses comprised of increased proliferation of T cells, IFN-gamma expression, granzyme B production, as well as the greatest IFN-gamma production of effector-memory T (T(EM)) or effector CD8(+) T cell responses and exerted high protective efficacy in mice against virulent M. tb H37Rv challenge compared to the other vaccinated groups (mice immunized with SL(Ag85B), a DNA vaccine or BCG only). This strategy may represent a novel promising mucosal vaccine candidate for the prevention of TB which are inexpensive to produce, efficacious, and able to be given orally rather than by injection.


Global epidemics: how well can we cope?


title: Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches.

text: Backgrounds/Aims In adult choledochal cysts, complete excision of cyst with Roux-en-Y hepaticojejunostomy by laparoscopy is typically been performed, but there is now a trend towards adopting robot-assisted resection. Methods From January 2014 to December 2017, 22 patients who underwent robotic procedure were classified as Group 1, and 34 patients who underwent the same laparoscopic procedure as Group 2. In addition, from September 2009 to July 2011, 13 patients who underwent laparoscopic procedure were classified as Group 3. The perioperative outcomes and short-term postoperative morbidity levels were evaluated in three groups. Results In all groups, there were more women than men, and the mean age and BMI did not differ significantly. Since 2014, jejunojejunostomy was performed extracorporeally and the mean operation time was shorter in Group 1 (258.5±52.9 min) and Group 2 (236.2±62.9 min) than Group 3 (395.2±85.9 min). [p=0.00 (1 vs 3), 0.00 (2 vs 3)] The median hospital stay was 7 days in Group 1 and 2, and shorter than 9 days in Group 3. [p=0.00 (1 vs 3), 0.011 (2 vs 3)] In Group 1, there were three postoperative complications, which included cholangitis, bile leakage and umbilical herniation, respectively). In Group 2, there were seven of postoperative complications, which included choledochojejunostomy site stricture & intrahepatic duct stone, choledochojejunostomy site stone, jejunal branch bleeding, portal vein thrombus, acute pancreatitis, adhesive ileus, and A-loop syndrome. In Group 3, there were three of postoperative complications, which included 2 hepaticojejunostomy site stricture and 1 paralytic ileus. Conclusions Robot-assisted resection of a choledochal cyst with Roux-en-y hepaticojejunostomy is a safe and feasible approach with short-term results that are comparable to those of laparoscopic surgery.


title: Photoplethysmographic waveform characteristics of newborns with coarctation of the aorta.

text: OBJECTIVE Fetal echocardiography, physical examination and pulse oximetry detect only half of coarctation of aorta (CoA) cases. We aimed to quantify delayed arrival and diminished amplitude of lower extremity photoplethysmographic (PPG) pulses relative to the right hand in affected patients. STUDY DESIGN We studied 8 CoA infants and 32 healthy controls. The pulse arrival time difference between foot and hand (f-hTD) and pulse amplitude ratio (F/H) were measured on PPG signal waveforms by digitally-determining maxima and minima of systolic decrease of light transmission. Mann-Whitney test was used for group comparisons. RESULTS In comparison to healthy newborns, CoA infants' PPG waveforms demonstrated prolonged f-hTD (mean±s.d. of 73.2±26.6 versus 35.2±8.3 ms, P<0.001) and lower F/H (0.57±0.26 versus 0.99±0.58, P=0.014). CONCLUSIONS F-hTD and F/H are quantifiable from hand- and foot-derived PPG waveforms and are significantly different in CoA versus healthy newborns. Larger studies are needed to validate PPG for improved critical congenital heart disease screening.


title: A systematic review of school-based eHealth interventions targeting alcohol use, smoking, physical inactivity, diet, sedentary behaviour and sleep among adolescents: a review protocol.

text: BACKGROUND Six key behavioural risk factors (risky alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. School-based interventions targeting these multiple health risk behaviours among adolescents have the potential to halt the trajectory towards later disease, whilst online and mobile technology interventions offer advantages in terms of student engagement, reach and scalability. Despite this, the efficacy of eHealth school-based interventions targeting these six health risk behaviours among adolescents has not been evaluated. The proposed systematic review aims to address this by determining the nature and efficacy of existing eHealth school-based interventions targeting multiple health risk behaviours among adolescents. METHODS A systematic search of the MEDLINE, Embase, PsycINFO and Cochrane Library databases will be conducted to identify eligible published papers. Eligible studies will be randomised controlled trials, including cluster randomised controlled trials, of interventions targeting two or more of the following lifestyle risk behaviours: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviour and sleep. Eligible studies will be those evaluating interventions delivered in a secondary school setting among participants 11-18 years of age, via an eHealth platform (Internet, computers of mobile technology). Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. Study outcomes will be summarised in a narrative synthesis, and meta-analyses will be conducted where it is appropriate to combine studies. DISCUSSION It is anticipated that the results from this review will serve to inform the development of future eHealth multiple health behaviour interventions for adolescents by identifying common characteristics of effective programs and highlighting knowledge gaps in the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017072163.


title: Comparative in silico design and validation of GPS™ CoVID-19 dtec-RT-qPCR Test.

text: AIMS Providing a ready-to-use RT-qPCR method fully validated to detect the SARS-CoV-2 with a higher exclusivity than this shown by early published RT-qPCR designs. METHODS AND RESULTS The specificity of the GPS™ CoVID-19 dtec-RT-qPCR Test by analysis of sequence alignments was approached and compared with other RT-qPCR designs. The GPS™ CoVID-19 dtec-RT-qPCR Test was validated following criteria of UNE/EN ISO 17025:2005 and ISO/IEC 15189:2012. Diagnostic validation was achieved by two independent reference laboratories, the Instituto de Salud Carlos III, (Madrid, Spain), the Public Health England (Colindale, London, UK), and received the label CE-IVD. The GPS™ design showed the highest exclusivity and passed all parameters of validation with strict acceptance criteria. Results from reference laboratories 100 % correlated with these obtained by using reference methods and showed 100 % of diagnostic sensitivity and specificity. CONCLUSIONS The CE-IVD GPS™ CoVID-19 dtec-RT-qPCR Test, available worldwide with full analytical and diagnostic validation, is the more exclusive for SARS-CoV-2 by far. SIGNIFICANCE Considering the CoVID-19 pandemic status, the exclusivity of RT-qPCR tests is crucial to avoid false positives due to related coronaviruses. IMPACT OF STUDY This work provides of a highly specific and validated RT-qPCR method for detection of SARS-CoV-2, which represents a case of efficient transfer of technology successfully used since the pandemic was declared.


Single-port laparoscopic surgery: an overview.


title: Single versus double stapling anastomotic technique in rectal cancer surgery.

text: PURPOSE The present study was designed to investigate whether there is a difference in the anastomotic leakage rate (AL) between the single stapling (CSA) and double stapling (DSA) anastomosis techniques. METHODS One hundred consecutive rectal cancer patients who underwent rectal resection with primary anastomosis were enrolled in this study. RESULTS The overall rate of clinical anastomotic leakage in both groups was 7 % (7/100); 6 % (3/50) in the CSA group and 8 % (4/50) in the DSA group. The anastomotic technique did not have any significant influence on the rate of AL. All AL were seen in low anastomoses (7 cm and below). The rate of AL in patients with a diverting stoma (13 %, 3/23) was not significantly different from that of the patients without (5.2 %, 4/77) (p = 0.195). The mean length of the operation was significantly shorter in the DSA group compared to the CSA group, at 127 and 141 min, respectively (p = 0.005). There were significantly higher rates of AL in patients receiving preoperative long course radiotherapy (15.4 %, 6/39) compared with those who did not receive radiotherapy (1.63 %, 1/61) (p = 0.014). CONCLUSIONS The CSA and DSA techniques are equally safe for the creation of a rectal anastomosis, without any significant difference in the AL rate. However, we recommend using the DSA technique because it has other definite advantages. In cases of neoadjuvant treatment and a low anastomosis, proximal diversion is recommended.


Anesthetic considerations in Netherton Syndrome.


title: [Managing cardiac patients post-COVID-19 pandemic: a proposal by the ANMCO Veneto Region].

text: The COVID-19 post-lockdown period and the subsequent progressive withdrawal of the quarantine measures are currently allowing the gradual resumption of the ordinary clinical activities, which have been suppressed during the COVID-19 pandemic. In this phase, it is crucial to minimize the risk of infection to limit COVID-19-related morbidity and mortality and the number of new cases. Indeed, COVID-19 manifestations may be equivocal, including asymptomatic or mildly symptomatic patients. In order to ensure the safety of patients and healthcare providers, therefore, it is mandatory to stratify the risk of post-COVID-19 pandemic infection during the clinical and instrumental evaluation of cardiac patients, who are at low risk for COVID-19. Here we discuss the most common diagnostic procedures and therapeutic activities, the type of personal protective equipment according to the different tests, the timetable of the different diagnostic examinations, the tele-health services or alternative strategies, and the structural and management requirements, that should be applied to protect patients and healthcare providers in the post-COVID-19 era.


Covid-19: ensuring equality of access to testing for ethnic minorities.


Diastereoselective allylation of carbonyl compounds and imines: application to the synthesis of natural products.


title: Climate change but not unemployment explains the changing suicidality in Thessaloniki Greece (2000-2012).

text: INTRODUCTION Recently there was a debate concerning the etiology behind attempts and completed suicides. The aim of the current study was to search for possible correlations between the rates of attempted and completed suicide and climate variables and regional unemployment per year in the county of Thessaloniki, Macedonia, northern Greece, for the years 2000-12. MATERIAL AND METHODS The regional rates of suicide and attempted suicide as well as regional unemployment were available from previous publications of the authors. The climate variables were calculated from the daily E-OBS gridded dataset which is based on observational data RESULTS Only the male suicide rates correlate significantly with high mean annual temperature but not with unemployment. The multiple linear regression analysis results suggest that temperature is the only variable that determines male suicides and explains 51% of their variance. Unemployment fails to contribute significantly to the model. There seems to be a seasonal distribution for attempts with mean rates being higher for the period from May to October and the rates clearly correlate with temperature. The highest mean rates were observed during May and August and the lowest during December and February. Multiple linear regression analysis suggests that temperature also determines the female attempts rate although the explained variable is significant but very low (3-5%) CONCLUSION Climate variables and specifically high temperature correlate both with suicide and attempted suicide rates but with a different way between males and females. The climate effect was stronger than the effect of unemployment.


title: Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

text: BACKGROUND Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) account for one-quarter of cases of acute respiratory failure in intensive care units (ICUs). A third to half of patients will die in the ICU, in hospital or during follow-up. Mechanical ventilation of people with ALI/ARDS allows time for the lungs to heal, but ventilation is invasive and can result in lung injury. It is uncertain whether ventilator-related injury would be reduced if pressure delivered by the ventilator with each breath is controlled, or whether the volume of air delivered by each breath is limited. OBJECTIVES To compare pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) in adults with ALI/ARDS to determine whether PCV reduces in-hospital mortality and morbidity in intubated and ventilated adults. SEARCH METHODS In October 2014, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Isssue 9), MEDLINE (1950 to 1 October 2014), EMBASE (1980 to 1 October 2014), the Latin American Caribbean Health Sciences Literature (LILACS) (1994 to 1 October 2014) and Science Citation Index-Expanded (SCI-EXPANDED) at the Institute for Scientific Information (ISI) Web of Science (1990 to 1 October 2014), as well as regional databases, clinical trials registries, conference proceedings and reference lists. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs (irrespective of language or publication status) of adults with a diagnosis of acute respiratory failure or acute on chronic respiratory failure and fulfilling the criteria for ALI/ARDS as defined by the American-European Consensus Conference who were admitted to an ICU for invasive mechanical ventilation, comparing pressure-controlled or pressure-controlled inverse-ratio ventilation, or an equivalent pressure-controlled mode (PCV), versus volume-controlled ventilation, or an equivalent volume-controlled mode (VCV). DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected trials, assessed risk of bias and extracted data. We sought clarification from trial authors when needed. We pooled risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data with their 95% confidence intervals (CIs) using a random-effects model. We assessed overall evidence quality using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS We included three RCTs that randomly assigned a total of 1089 participants recruited from 43 ICUs in Australia, Canada, Saudi Arabia, Spain and the USA. Risk of bias of the included studies was low. Only data for mortality and barotrauma could be combined in the meta-analysis. We downgraded the quality of evidence for the three mortality outcomes on the basis of serious imprecision around the effect estimates. For mortality in hospital, the RR with PCV compared with VCV was 0.83 (95% CI 0.67 to 1.02; three trials, 1089 participants; moderate-quality evidence), and for mortality in the ICU, the RR with PCV compared with VCV was 0.84 (95% CI 0.71 to 0.99; two trials, 1062 participants; moderate-quality evidence). One study provided no evidence of clear benefit with the ventilatory mode for mortality at 28 days (RR 0.88, 95% CI 0.73 to 1.06; 983 participants; moderate-quality evidence). The difference in effect on barotrauma between PCV and VCV was uncertain as the result of imprecision and different co-interventions used in the studies (RR 1.24, 95% CI 0.87 to 1.77; two trials, 1062 participants; low-quality evidence). Data from one trial with 983 participants for the mean duration of ventilation, and from another trial with 78 participants for the mean number of extrapulmonary organ failures that developed with PCV or VCV, were skewed. None of the trials reported on infection during ventilation or quality of life after discharge. AUTHORS' CONCLUSIONS Currently available data from RCTs are insufficient to confirm or refute whether pressure-controlled or volume-controlled ventilation offers any advantage for people with acute respiratory failure due to acute lung injury or acute respiratory distress syndrome. More studies including a larger number of people given PCV and VCV may provide reliable evidence on which more firm conclusions can be based.


title: Dilatation of Sleeve Gastrectomy: Myth or Reality?

text: OBJECTIVES The success of longitudinal sleeve gastrectomy (LSG) is perceived as being potentially limited by dilatation of the remaining gastric tube during the follow-up. The aim of this prospective study was to determine the incidence and the characteristics of sleeve dilatation during the first post-operative year. MATERIALS AND METHODS Gastric volumetry using 3D gastric computed tomography with gas expansion was performed in 54 successive subjects who underwent an LSG for morbid obesity at 3 and 12 months following surgery. Total gastric volume, volume of the gastric tube and the antrum, and diameter of the gastric tube were assessed after multiplanar reconstructions. An increase of at least 25 % of the total gastric volume was considered as sleeve dilatation. Percentage of excess BMI loss (%EBMIL) and daily caloric intakes were recorded during the first 18 months. RESULTS Sixty-one percent of the subjects experienced sleeve dilatation 1 year after surgery. The gastric tube was mainly involved in the sleeve dilatation process (+91 %). Sleeve dilatation occurred especially in subjects with smaller total gastric volume at baseline (189 vs 236 ml, p = 0.02). Daily caloric intake was similar between the groups at each point of the follow-up. No difference concerning %EBMIL was observed between the groups during the 18 months of follow-up. CONCLUSIONS Sleeve dilatation occurred in more than 50 % of the patients. Dilatation was not necessarily linked to an increase of daily caloric intake and insufficient weight loss during the first 18 months following surgery. Small LSG at baseline is at higher risk of dilatation.


title: Double stent assisted coiling of intracranial bifurcation aneurysms in Y and X configurations with the Neuroform ATLAS stent: immediate and mid term angiographic and clinical follow-up.

text: PURPOSE Self-expandable stents have broadened the spectrum of endovascular treatment of intracranial aneurysms. However, procedures involving double stenting in Y/X configurations carry a relatively high risk of procedural complications. The Neuroform ATLAS, the evolution of Neuroform EZ, is a nitinol self-expanding hybrid/open cell stent which can be delivered through a low profile 0.017 inch catheter. We present our experience in the treatment of intracranial aneurysms with this stent in Y and X configurations. MATERIALS AND METHODS We prospectively maintained a database from consecutive patients who underwent double stent assisted coiling with the Neuroform ATLAS, from July 2015 to February 2019. Clinical and angiographic results were analyzed. RESULTS 55 patients harboring 55 bifurcation aneurysms were treated with double stenting: 52 'Y' configurations, 3 'X' configurations. Deployment was successful in all cases. Post-treatment control angiography showed complete occlusion in 33 cases (60%), neck remnant in 8 cases (14.5%), and incomplete occlusion in 14 cases (25.4%). The overall symptomatic periprocedural complication rate was 12.7%. 38 aneurysms underwent follow-up (69%, mean duration 16 months): 33 aneurysms (87%) were completely occluded, 3 aneurysms (8%) had a neck remnant, and 2 aneurysms (5%) were incompletely occluded. CONCLUSION The Neuroform ATLAS is an effective device for treatment of bifurcation aneurysms, allowing good conformability, a high level of navigability, and easy mesh crossing to perform Y/X stenting procedures. The rate of procedural complications remains non-negligible, and an indication for a double stenting procedure should be carefully discussed in a multidisciplinary meeting.


title: Computational study of dispersion and extent of mutated and duplicated sequences of the H5N1 influenza neuraminidase over the period 1997-2008.

text: Study of mutational changes in neuraminidase (NA) gene sequences is important to track the effectiveness of the inhibitors to the H5N1 avian flu virus that targets this component of the viral apparatus. Our analysis based on numerical characterization studies of 682 complete neuraminidase gene and protein sequences available in the database, updated to March 2009, and which extends our previous work based on a sample of 173 sequences has revealed several interesting features. We have noticed that identical sequences have appeared over significant distances in space and time, raising the need for a deeper understanding of the longevity of such viral strains in the environment. Structural sections like transmembrane, stalk, body, and C-terminal tail regions have shown independent recombinations between strains from various species including human and avian hosts highlighting influenza's flexibility in host selection and recombination. Our analysis confirmed a biased nature in mutational accumulation in structural segments: a highly conserved 50-base C-terminal tail section identified in our earlier paper seems to accumulate mutational changes at a rate of about a fifth to an eighth of transmembrane and stalk regions, although the length is about half of these. Parallel study of the equivalent section to the C-terminal region in protein sequences reveals only 13 separate varieties, and all the other 669 sequences are duplicates to three of these varieties showing the highly conserved nature of this segment. Our analysis of active site related bases and amino acids showed highly conserved characteristic of those constructs, whereas the rest of the segments demonstrated rather large mutational changes. These kinds of high level of mutation in major part of the H5N1 NA sequences and recombinations within structural segments coupled with strong conservation of a few select segments show that the potential of rapid mutations to more virulent forms of this variety of avian flu continue to remain of concern, especially with the possibility of long duration dormancy of some of these viral strains, whereas islands of highly conserved segments could signify potential regions for inhibitor designs.


title: Evaluating the national PPE guidance for NHS healthcare workers during the COVID-19 pandemic.

text: Tragically, many of the infections and deaths recorded in the global coronavirus disease 2019 (COVID-19) pandemic have occurred in healthcare workers. Some have attributed this to inadequate provision of personal protective equipment (PPE). In the UK, several organisations have voiced their concerns that the national PPE guidance issued by Public Health England is inadequate. Despite recent revisions to these guidelines, concerns remain that they offer insufficient protection to frontline NHS healthcare workers. In this report, we evaluate whether these concerns are merited, through critical appraisal of the available evidence, review of international PPE guidance, and consideration of the ethical implications.


Long-acting drug acts like a short-term AIDS vaccine.


title: Sleep-stage dynamics in patients with chronic fatigue syndrome with or without fibromyalgia.

text: STUDY OBJECTIVES Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained conditions that often have overlapping symptoms, including sleep-related complaints. However, differences between the 2 conditions have been reported, and we hypothesized that dynamic aspects of sleep would be different in the 2 groups of patients. PARTICIPANTS Subjects were 26 healthy control subjects, 14 patients with CFS but without FM (CFS alone), and 12 patients with CFS and FM (CFS+FM)-all women. MEASUREMENTS AND RESULTS We studied transition probabilities and rates between sleep stages (waking, rapid eye movement [REM] sleep, stage 1 [S1], stage 2 [S2], and slow-wave sleep [SWS]) and duration distributions of each sleep stage. We found that the probability of transition from REM sleep to waking was significantly greater in subjects with CFS alone than in control subjects, which may be the specific sleep problem for people with CFS alone. Probabilities of (a) transitions from waking, REM sleep, and S1 to S2 and (b) those from SWS to waking and S1 were significantly greater in subjects with CFS+FM than in control subjects; in addition, rates of these transitions were also significantly increased in subjects with CFS+FM. Result (a) might indicate increased sleep pressure in subjects with CFS+FM whereas result (b) may be the specific sleep problem of subjects with CFS+FM. We also found that shorter durations of S2 sleep are specific to patients with CFS+FM, not to CFS alone. CONCLUSIONS These results suggest that CFS and FM may be different illnesses associated with different problems of sleep regulation.


Hip Fracture Surgery vs Elective Total Hip Replacement--Reply.


title: Vaccines for SARS-CoV-2: Lessons from Other Coronavirus Strains.

text: The emergence of the strain of coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its impact on global health have made imperative the development of effective and safe vaccines for this lethal strain. SARS-CoV-2 now adds to the list of coronavirus diseases that have threatened global health, along with the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses that emerged in 2002/2003 and 2012, respectively. As of April 2020, no vaccine is commercially available for these coronavirus strains. Nevertheless, the knowledge obtained from the vaccine development efforts for MERS and SARS can be of high value for COVID-19 (coronavirus disease 2019). Here, we review the past and ongoing vaccine development efforts for clinically relevant coronavirus strains with the intention that this information helps in the development of effective and safe vaccines for COVID-19. In addition, information from naturally exposed individuals and animal models to coronavirus strains is described for the same purpose of helping into the development of effective vaccines against COVID-19.


From bench to bedside - Development of an integrated COVID-19 patient flow management system.


title: Very low-calorie diet mimics the early beneficial effect of Roux-en-Y gastric bypass on insulin sensitivity and β-cell Function in type 2 diabetic patients.

text: Marked improvement in glycemic control occurs in patients with type 2 diabetes mellitus shortly after Roux-en-Y gastric bypass surgery (RYGB) and before there is major weight loss. The objective of this study was to determine whether the magnitude of this change is primarily due to caloric restriction or is unique to the surgical procedure. We studied eleven subjects who underwent RYGB and fourteen subjects mean-matched for BMI, HbA1c, and diabetes duration who were admitted to our inpatient research unit and given a very low-calorie diet (VLCD) of 500 kcal/day with a macronutrient content similar to that consumed by patients after RYGB. Frequently sampled intravenous glucose tolerance tests were performed before and after interventions. Both groups lost an equivalent amount of weight over a mean study period of 21 days. Insulin sensitivity, acute insulin secretion after intravenous glucose administration, and β-cell function as determined by disposition index improved to a similar extent in both groups. Likewise, changes in fasting glucose and fructosamine levels were similar. Based on these data, VLCD improves insulin sensitivity and β-cell function just as well as RYGB in the short term.


New fee structure proposed by FDA might lead to more talk.


title: COVID-19 in the UK and Occupational Health and Safety: Predictable not Inevitable Failures by Government, and Trade Union and Nongovernmental Organization Responses.

text: This commentary examines the occupational health and safety issues faced by the UK workers in the COVID-19 pandemic, against the background of government cuts in health care and in occupational health and safety budgets, and a deregulatory climate. The UK government has been obsessed, blinkered, and distracted by the desire to leave the European Union (Brexit). The state of knowledge about the virus, especially from international agencies that identified pandemic threats and strategies to combat it, is outlined. UK politicians, government bodies, medical and scientific advisors, and employers periodically ignored or abused that knowledge. Regulatory and ministerial inaction and errors on the workplace virus risks emerged. In contrast, several trade unions, health professional bodies, and nongovernmental organizations identified COVID-19 threats from poor personal protection equipment, working practices, and knowledge gaps and offered solutions for health care workers, social care workers, production workers, and service workers in "essential" occupations.


title: 2014 MERS-CoV outbreak in Jeddah--a link to health care facilities.

text: BACKGROUND A marked increase in the number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred in Jeddah, Saudi Arabia, in early 2014. We evaluated patients with MERS-CoV infection in Jeddah to explore reasons for this increase and to assess the epidemiologic and clinical features of this disease. METHODS We identified all cases of laboratory-confirmed MERS-CoV infection in Jeddah that were reported to the Saudi Arabian Ministry of Health from January 1 through May 16, 2014. We conducted telephone interviews with symptomatic patients who were not health care personnel, and we reviewed hospital records. We identified patients who were reported as being asymptomatic and interviewed them regarding a history of symptoms in the month before testing. Descriptive analyses were performed. RESULTS Of 255 patients with laboratory-confirmed MERS-CoV infection, 93 died (case fatality rate, 36.5%). The median age of all patients was 45 years (interquartile range, 30 to 59), and 174 patients (68.2%) were male. A total of 64 patients (25.1%) were reported to be asymptomatic. Of the 191 symptomatic patients, 40 (20.9%) were health care personnel. Among the 151 symptomatic patients who were not health care personnel, 112 (74.2%) had data that could be assessed, and 109 (97.3%) of these patients had had contact with a health care facility, a person with a confirmed case of MERS-CoV infection, or someone with severe respiratory illness in the 14 days before the onset of illness. The remaining 3 patients (2.7%) reported no such contacts. Of the 64 patients who had been reported as asymptomatic, 33 (52%) were interviewed, and 26 of these 33 (79%) reported at least one symptom that was consistent with a viral respiratory illness. CONCLUSIONS The majority of patients in the Jeddah MERS-CoV outbreak had contact with a health care facility, other patients, or both. This highlights the role of health care-associated transmission. (Supported by the Ministry of Health, Saudi Arabia, and by the U.S. Centers for Disease Control and Prevention.).


title: Quantitative assessment of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse using support vector machines.

text: INTRODUCTION AND HYPOTHESIS The objective of this study was to quantitatively assess the ability of new MRI-based measurements to differentiate low and high stages of pelvic organ prolapse. New measurements representing pelvic structural characteristics are proposed and analyzed using support vector machines (SVM). METHODS This retrospective study used data from 207 women with different types and stages of prolapse. Their demographic information, clinical history, and dynamic MRI data were obtained from the database. New MRI measurements were extracted and analyzed based on these reference lines: pubococcygeal line (PCL), mid-pubic line (MPL), true conjugate line (TCL), obstetric conjugate line (OCL), and diagonal conjugate line (DCL). A classification model using SVM was designed to assess the impact of the features (variables) in classifying prolapse into low or high stage. RESULTS The classification model using SVM can accurately identified anterior prolapse with very high accuracy (>0.90), and apical and posterior prolapse with good accuracy (0.80 - 0.90). Two newly proposed MRI-based features were found to be significant in the identification of anterior and posterior prolapse: the angle between TCL and MPL for anterior prolapse, and the angle between DCL and PCL for posterior prolapse. The overall accuracy of posterior prolapse identification increased from 47% to 80% when the newly proposed MRI-based features were taken into consideration. CONCLUSIONS The proposed MRI-based measurements are effective in differentiating low and high stages of pelvic organ prolapse, particularly for posterior prolapse.


title: Positive Public Health Ethics: Toward Flourishing and Resilient Communities and Individuals.

text: The COVID-19 pandemic is a global contagion of unprecedented proportions and health, economic, and social consequences. As with many health problems, its impact is uneven. This article argues the COVID-19 pandemic is a global health injustice due to moral failures of national governments and international organizations to prepare for, prevent and control it. Global and national health communities had a moral obligation to act in accordance with the current state of knowledge of pandemic preparedness. This obligation-a positive duty to develop and implement systems to reduce threats to and safeguard individuals' and, communities' abilities to flourish-stems from theories of global health justice and governance. The COVID-19 pandemic revealed and amplified the fragility and deficiencies in our global and domestic health institutions and systems. Moving forward, positive public health ethics is needed to set ethical standards for building and operating robust public health systems for resilient individuals and communities.


title: Validating a low-cost laser speckle contrast imaging system as a quantitative tool for assessing retinal vascular function.

text: The ability to monitor progression of retinal vascular diseases like diabetic retinopathy in small animal models is often complicated by their failure to develop the end-stage complications which characterize the human phenotypes in disease. Interestingly, as micro-vascular dysfunction typically precedes the onset of retinal vascular and even some neurodegenerative diseases, the ability to visualize and quantify hemodynamic changes (e.g. decreased flow or occlusion) in retinal vessels may serve as a useful diagnostic indicator of disease progression and as a therapeutic outcome measure in response to treatment. Nevertheless, the ability to precisely and accurately quantify retinal hemodynamics remains an unmet challenge in ophthalmic research. Herein we demonstrate the ability to modify a commercial fundus camera into a low-cost laser speckle contrast imaging (LSCI) system for contrast-free and non-invasive quantification of relative changes to retinal hemodynamics over a wide field-of-view in a rodent model.


title: Dacron Skirt Reconstruction of the Left Ventricular Outflow Tract: Extending the Capabilities of a Valved Conduit.

text: Aortic root reconstruction in the setting of redo aortic valve procedures or infective endocarditis may be technically challenging, particularly because of variable destruction or distortion of the left ventricular outflow tract. Homograft aortic root replacement is an excellent option for aortic root abscesses but is limited by homograft availability. We describe a simple technique of a bioprosthetic valved conduit constructed on the table using a Dacron (DuPont, Wilmington, DE) skirt below the valve. The use of the Dacron skirt facilitates easy reconstruction of the left ventricular outflow tract.


title: Cytotoxicity of Cyanoacrylate-Based Tissue Adhesives and Short-Term Preclinical In Vivo Biocompatibility in Abdominal Hernia Repair.

text: BACKGROUND Cyanoacrylate(CA)-based tissue adhesives, although not widely used, are a feasible option to fix a mesh during abdominal hernia repair, due to its fast action and great bond strength. Their main disadvantage, toxicity, can be mitigated by increasing the length of their alkyl chain. The objective was to assess the in vitro cytotoxicity and in vivo biocompatibility in hernia repair of CAs currently used in clinical practice (Glubran(n-butyl) and Ifabond(n-hexyl)) and a longer-chain CA (OCA(n-octyl)), that has never been used in the medical field. METHODS Formaldehyde release and cytotoxicity of unpolymerized(UCAs) and polymerized CAs(PCAs) were evaluated by macroscopic visual assessment, flow cytometry and Alamar Blue assays. In the preclinical evaluation, partial defects were created in the rabbit abdominal wall and repaired by fixing polypropylene prostheses using the CAs. At 14 days post-surgery, animals were euthanized for morphology, macrophage response and cell damage analyses. RESULTS Formaldehyde release was lower as the molecular weight of the monomer increased. The longest side-chain CA(OCA) showed the highest cytotoxicity in the UCA condition. However, after polymerization, was the one that showed better behavior on most occasions. In vivo, all CAs promoted optimal mesh fixation without displacements or detachments. Seroma was evident with the use of Glubran, (four of six animals: 4/6) and Ifabond (2/6), but it was reduced with the use of OCA (1/6). Significantly greater macrophage responses were observed in groups where Glubran and Ifabond were used vs. sutures and OCA. TUNEL-positive cells were significantly higher in the Glubran and OCA groups vs. the suture group. CONCLUSIONS Although mild formaldehyde release occurred, OCA was the most cytotoxic during polymerization but the least once cured. The CAs promoted proper mesh fixation and have potential to replace traditional suturing techniques in hernia repair; the CAs exhibited good tissue integration and effective short-term biocompatibility, with the slightest seroma and macrophage response induced by OCA.


title: Viral interference and the live-attenuated intranasal influenza vaccine: Results from a pediatric cohort with cystic fibrosis.

text: BACKGROUND The objective of this study was to explore the effects of viral co-detection in individuals recently vaccinated with the live-attenuated intranasal influenza virus vaccine (LAIV) on the detection of influenza RNA. METHODS Before the 2013-2014 influenza season, nasal swabs were obtained from 59 pediatric participants with cystic fibrosis (CF) and 17 of their healthy siblings immediately before vaccination and 4 times during the week of follow-up. Real-time RT-PCR assays were used to detect influenza RNA. Co-detection of a non-influenza respiratory virus (NIRV) at the time of vaccination was determined by a multiplex RT-PCR assay. Differences in the proportions and rates of influenza detection and their 95% credible intervals (CrI) were estimated. RESULTS Influenza RNA was detected in 16% fewer participants (95% CrI: -7, 39%) throughout follow-up in the NIRV-positive group compared with the NIRV-negative group (59% vs. 75%). This was also observed in participants with CF alone (66% vs. 74%; RD = 8% 95% CrI: -16, 33%) as well as in healthy participants only (75% vs. 30%; RD = 45%, 95% CrI: -2, 81%). Influenza was detected in NIRV-negative subjects for 0.49 d more compared with NIRV-positive subjects (95% CrI: -0.37, 1.26). CONCLUSION The observed proportion of subjects in whom influenza RNA was detected and the duration of detection differed slightly between NIRV- positive and -negative subjects. However, wide credible intervals for the difference preclude definitive conclusions. If true, this observed association may be related to a recent viral respiratory infection, a phenomenon known as viral interference.


title: Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness.

text: Since the early 1970s there has been an ongoing debate regarding the wisdom of promoting unassisted spontaneous breathing throughout the course of critical illness in patients with severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. Historically, the term "disuse atrophy" has described a situation wherein sustained inactivity of the respiratory muscles (ie, passive ventilation) results in deconditioning and weakness. More recently it has been referred to as "ventilator-induced diaphragmatic dysfunction." In contrast, "use atrophy" describes a situation where chronic high-tension inspiratory work causes structural damage to the diaphragm and weakness. Both laboratory and clinical studies demonstrated that relatively brief periods of complete respiratory muscle inactivity, as well as intense muscle loading, result in acute inflammation, loss of muscle mass, and weakness. Yet in critical illness other factors also affect respiratory muscle function, including prolonged use of neuromuscular blocking agents, administration of corticosteroids, and sepsis. This makes the attribution of acquired respiratory muscle weakness and ventilator-dependence to either ventilator-induced diaphragmatic dysfunction or loaded breathing extremely difficult. Regardless, the clinical implications of this research strongly suggest that passive mechanical ventilation should be avoided whenever possible. However, promotion of unassisted spontaneous breathing in the acute phase of critical illness also may carry a substantial risk of respiratory muscle injury and weakness. Use of mechanical ventilation modes in a manner that induces spontaneous breathing effort, while simultaneously reducing the work load on the respiratory muscles, is probably sufficient to minimize both problems.


title: Abdominal near-infrared spectroscopy in preterm infants: a comparison of splanchnic oxygen saturation measurements at two abdominal locations.

text: BACKGROUND Splanchnic tissue oxygenation monitoring has been performed at both the liver and the infra-umbilical regions. It is unknown whether these measurements could be substituted one for the other when interpreting splanchnic oxygenation since they have not been measured simultaneously before. AIMS To evaluate the feasibility and safety of liver and infra-umbilical near-infrared spectroscopy (NIRS) monitoring in preterm infants with suspected necrotizing enterocolitis (NEC) and to assess the correlation and agreement between NIRS measurements performed simultaneously at the two abdominal locations. STUDY DESIGN AND SUBJECTS This study was part of a prospective observational cohort study. Preterm infants who were suspected of NEC or who had been diagnosed with NEC were included. OUTCOME MEASURES Liver oxygen saturation and infra-umbilical oxygen saturation were monitored simultaneously and continuously for 48h by NIRS. RESULTS NIRS monitoring was performed in 20 out of 24 infants for the entire 48-hour study period. No adverse effects were observed. Values of liver and infra-umbilical oxygen saturation correlated weakly (Spearman's rho=0.244, P<.001). On the Bland-Altman plot liver oxygen saturation was higher than infra-umbilical oxygen saturation (mean difference 6.6%, SD 22.5%). CONCLUSIONS Using NIRS as method for monitoring oxygen saturation simultaneously in both the liver and infra-umbilical regions is safe and feasible. Additionally, we demonstrated that values of liver and infra-umbilical oxygen saturation cannot be randomly substituted one for the other for the purpose of assessing splanchnic oxygenation.


title: The CREST-2 experience with the evolving challenges of COVID-19: A clinical trial in a pandemic.

text: The COVID-19 pandemic has disrupted the lives of whole communities and nations. The multinational multicenter National Institute of Neurological Disorders and Stroke (NINDS) Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) stroke prevention trial rapidly experienced the effects of the pandemic, and had to temporarily suspend new enrollments and shift patient follow-up activities from in-person clinic visits to telephone contacts. There is an ethical obligation to the patients to protect their health while taking every feasible step to ensure that the goals of the trial are successfully met. Here we describe the effects of the pandemic on the trial and steps that are being taken to mitigate the effects of the pandemic so that trial objectives can be met.


title: A guide to enteral access procedures and enteral nutrition.

text: The advent of total parenteral nutrition in the late 1960s meant that no situation remained in which a patient could not be fed. Unfortunately, total parenteral nutrition was complicated by serious infective and metabolic side effects that undermined the beneficial effects of nutrient repletion. Consequently, creative ways of restoring upper gut function were designed, based on semielemental diets and novel feeding tube systems. The employment of specific protocols and acceptance of increased gastric residual volumes has allowed most patients in intensive care to be fed safely and early by nasogastric tube. However, nasogastric feeding is unsuitable for patients with severely compromised gastric emptying owing to partial obstruction or ileus. Such patients require postpyloric tube placement with simultaneous gastric decompression via double-lumen nasogastric decompression and jejunal feeding tubes. These tubes can be placed endoscopically 40-60 cm past the ligament of Treitz to enable feeding without pancreatic stimulation. In patients whose disorders last more than 4 weeks, tubes should be repositioned percutaneously, by endoscopic, open or laparoscopic surgery. Together, the advances in enteral access have improved patients' outcomes and led to a 70-90% reduction in the demand for total parenteral nutrition.


title: Enhanced muscular oxygen extraction in athletes exaggerates hypoxemia during exercise in hypoxia.

text: High rate of muscular oxygen utilization facilitates the development of hypoxemia during exercise at altitude. Because endurance training stimulates oxygen extraction capacity, we investigated whether endurance athletes are at higher risk to developing hypoxemia and thereby acute mountain sickness symptoms during exercise at simulated high altitude. Elite athletes (ATL; n = 8) and fit controls (CON; n = 7) cycled for 20 min at 100 W (EX100W), as well as performed an incremental maximal oxygen consumption test (EXMAX) in normobaric hypoxia (0.107 inspired O2 fraction) or normoxia (0.209 inspired O2 fraction). Cardiorespiratory responses, arterial Po2 (PaO2), and oxygenation status in m. vastus lateralis [tissue oxygenation index (TOIM)] and frontal cortex (TOIC) by near-infrared spectroscopy, were measured. Muscle O2 uptake rate was estimated from change in oxyhemoglobin concentration during a 10-min arterial occlusion in m. gastrocnemius. Maximal oxygen consumption in normoxia was 70 ± 2 ml·min(-1·)kg(-1) in ATL vs. 43 ± 2 ml·min(-1·)kg(-1) in CON, and in hypoxia decreased more in ATL (-41%) than in CON (-25%, P < 0.05). Both in normoxia at PaO2 of ∼95 Torr, and in hypoxia at PaO2 of ∼35 Torr, muscle O2 uptake was twofold higher in ATL than in CON (0.12 vs. 0.06 ml·min(-1)·100 g(-1); P < 0.05). During EX100W in hypoxia, PaO2 dropped to lower (P < 0.05) values in ATL (27.6 ± 0.7 Torr) than in CON (33.5 ± 1.0 Torr). During EXMAX, but not during EX100W, TOIM was ∼15% lower in ATL than in CON (P < 0.05). TOIC was similar between the groups at any time. This study shows that maintenance of high muscular oxygen extraction rate at very low circulating PaO2 stimulates the development of hypoxemia during submaximal exercise in hypoxia in endurance-trained individuals. This effect may predispose to premature development of acute mountain sickness symptoms during exercise at altitude.


title: Contribution of CD137L to Sensory Hypersensitivity in a Murine Model of Neuropathic Pain.

text: CD137L (4-1BBL) is a costimulatory molecule whose signaling can promote monocyte/macrophage functions; however, CD137L-mediated microglial response and its role in neuropathic pain remain unknown. We investigated CD137L following peripheral nerve injury-induced neuropathic pain using a spinal nerve L5 transection (L5Tx) murine model in both sexes. First, C57BL/6_CD137L knock-out (KO) mice displayed decreased mechanical and diminished heat hypersensitivity compared to wild-type (WT) controls, beginning on day 3 to up to day 35 post-L5Tx. Purified anti-mouse CD137L neutralizing monoclonal antibody (0.1 or 0.5 µg) was also used to identify CD137L's window of action in BALB/c mice. Anti-CD137L antibody was intrathecally administered either from day 0 (before surgery) to day 7 (early treatment), or from day 6 to 13 post-L5Tx (late treatment), and nociceptive thresholds were assessed before surgery to up to day 35 post-surgery. Early treatment with anti-CD137L reduced L5Tx-induced mechanical but not heat hypersensitivity, while later treatment did not alter either sensitivity. Pro- versus anti-inflammatory responses within the lumbar spinal cord following L5Tx were further evaluated via quantitative real-time PCR (qRT-PCR) and immunohistochemistry (IHC) in time-course studies. Following L5Tx, female CD137L KO mice did not show increased iNOS mRNA and had reduced numbers of IL-1β+ cells compared to WT. At 21 d post-surgery, CD137L KO mice had higher total numbers of arginase (Arg)-1+ cells and Arg-1+ microglia. Altogether, results indicate that spinal cord CD137L contributes to the development of peripheral nerve injury-induced neuropathic pain, which may be in part mediated through CD137L's modulation of the pro- and anti-inflammatory balance within the spinal cord.


title: Ly6cLo non-classical monocytes promote resolution of rhesus rotavirus-mediated perinatal hepatic inflammation.

text: Perinatal hepatic inflammation can have devastating consequences. Monocytes play an important role in the initiation and resolution of inflammation, and their diverse functions can be attributed to specific cellular subsets: pro-inflammatory or classical monocytes (Ly6cHi) and pro-reparative or non-classical monocytes (Ly6cLo). We hypothesized that inherent differences in Ly6cHi classical monocytes and Ly6cLo non-classical monocytes determine susceptibility to perinatal hepatic inflammation in late gestation fetuses and neonates. We found an anti-inflammatory transcriptional profile expressed by Ly6cLo non-classical monocytes, and a physiologic abundance of these cells in the late gestation fetal liver. Unlike neonatal pups, late gestation fetuses proved to be resistant to rhesus rotavirus (RRV) mediated liver inflammation. Furthermore, neonatal pups were rendered resistant to RRV-mediated liver injury when Ly6cLo non-classical monocytes were expanded. Pharmacologic inhibition of Ly6cLo non-classical monocytes in this setting restored susceptibility to RRV-mediated disease. These data demonstrate that Ly6cLo monocytes promote resolution of perinatal liver inflammation in the late gestation fetus, where there is a physiologic expansion of non-classical monocytes, and in the neonatal liver upon experimental expansion of these cells. Therapeutic strategies directed towards enhancing Ly6cLo non-classical monocyte function may mitigate the detrimental effects of perinatal liver inflammation.


title: The effect of syringe size on reliability and safety of low-flow infusions.

text: OBJECTIVE To determine the effect of syringe size on safety and reliability of low-flow infusions at rates relevant to hemodynamically unstable infants. DESIGN : In vitro study using readily available clinical equipment. SETTING Medical-surgical pediatric intensive care unit of a university-affiliated hospital. PATIENTS/SUBJECTS None. INTERVENTIONS Three-, 12-, and 60-mL syringes (Kendall Monoject) with extension tubing were mounted in identical Baxter AS50 infusion pumps. We determined time to alarm after occlusion of the distal tubing. We described and validated a method using capillary tubes to determine startup time to reach steady-state flow and variability of steady-state flow. Data were analyzed using single-factor analysis of variance or linear regression, as appropriate. MEASUREMENTS AND MAIN RESULTS At 5 mL/hr flow, time to alarm occlusion (mean +/- sd) was 1:08 +/- 0:42, 3:35 +/- 0:58, and 27:06 +/- 3:26 minutes for 3-, 12-, and 60-mL syringes, respectively (p < .00001). At a lower flow of 0.2 mL/hr, none of the pumps alarmed despite 30 mins of distal occlusion, regardless of syringe size. Validation testing of the capillary tube volumetric method revealed a sd <5% of the average fluid column displacement. Startup time to reach steady-state flow of 0.2 mL/hr for 60-mL syringes was 76 +/- 40 mins and significantly exceeded 24 +/- 10 mins for 3-mL syringes (p = .041). In one test using a 60-mL syringe, flow remained below 20% of steady state for >3 hrs. Average steady-state flow was similar for the three syringe sizes (p = .2861), but sd of steady-state flow was directly related to syringe size and regressed to a line with r = 1. CONCLUSIONS Syringe size is related to time to reach steady-state flow, time to alarm occlusion, and variability of low-flow infusions.


title: Northern Ireland disease surveillance report, January to March 2016.

text: Abomasitis in calvesAortic aneurysm in a dairy cowAbortion due to Salmonella Brandenberg in ewesStreptococcus dysgalactia polyarthritis in lambs These are among matters discussed in the Northern Ireland animal disease surveillance quarterly report for January to March 2016.


title: Suction regulators: a potential vector for hospital-acquired pathogens.

text: The role of suction regulators in nosocomial infections has, to our knowledge, not been studied. A sampling of devices used in hospitals was conducted. Many regulators (173 [37%] of 470) were found to be colonized. A suction circuit model revealed that pathogens can disseminate throughout the circuit (retrograde and antegrade), colonizing an experimental patient stomach.


title: Longer procedural times are independently associated with symptomatic intracranial hemorrhage in patients with large vessel occlusion stroke undergoing thrombectomy.

text: BACKGROUND Time to reperfusion is an essential factor in determination of outcomes in acute ischemic stroke (AIS). OBJECTIVE To establish the effect of the procedural time on the clinical outcomes of patients with AIS. METHODS Data from all consecutive patients who underwent mechanical thrombectomy between September 2010 and July 2012 were analysed retrospectively. The variable of interest was procedural time (defined as time from groin puncture to final recanalization time). Outcome measures included the rates of symptomatic intracranial hemorrhage (sICH, defined as any parenchymal hematoma-eg, PH-1/PH-2), final infarct volume, 90-day mortality, and independent functional outcomes (modified Rankin Scale 0-2) at 90 days. RESULTS The cohort included 242 patients with a mean age of 65.5±14.2 and median baseline National Institutes of Health Stroke Scale score 20. 51% of the patients were female. The mean procedure time was significantly shorter in patients with a good outcome (86.7 vs 73.1 min, respectively, p=0.0228). Patients with SICH had significantly higher mean procedure time than patients without SICH (79.67 vs 104.5 min, respectively; p=0.0319), which remained significant when controlling for the previous factors (OR=0.974, 95% CI 0.957 to 0.991). No correlation was found between the volume of infarction and the procedure time (r=0.10996, p=0.0984). No association was seen between procedure time and 90-day mortality (77.8 vs 88.2 min in survivals vs deaths, respectively; p=0.0958). CONCLUSIONS Our data support an association between the risk of SICH and a longer procedure time, but no association between procedural times and the final infarction volume or long-term functional outcomes was found.


title: Combined Optical Coherence and Fluorescence Microscopy to assess dynamics and specificity of pancreatic beta-cell tracers.

text: The identification of a beta-cell tracer is a major quest in diabetes research. However, since MRI, PET and SPECT cannot resolve individual islets, optical techniques are required to assess the specificity of these tracers. We propose to combine Optical Coherence Microscopy (OCM) with fluorescence detection in a single optical platform to facilitate these initial screening steps from cell culture up to living rodents. OCM can image islets and vascularization without any labeling. Thereby, it alleviates the need of both genetically modified mice to detect islets and injection of external dye to reveal vascularization. We characterized Cy5.5-exendin-3, an agonist of glucagon-like peptide 1 receptor (GLP1R), for which other imaging modalities have been used and can serve as a reference. Cultured cells transfected with GLP1R and incubated with Cy5.5-exendin-3 show full tracer internalization. We determined that a dose of 1 μg of Cy5.5-exendin-3 is sufficient to optically detect in vivo the tracer in islets with a high specificity. In a next step, time-lapse OCM imaging was used to monitor the rapid and specific tracer accumulation in murine islets and its persistence over hours. This optical platform represents a versatile toolbox for selecting beta-cell specific markers for diabetes research and future clinical diagnosis.


title: Conical neck is strongly associated with proximal failure in standard endovascular aneurysm repair.

text: OBJECTIVE Hostile proximal aortic neck (HN) challenges the suitability for standard endovascular aneurysm repair (EVAR) of patients at high risk for "open" repair. However, there has been little if any focus placed on the individual role of the "nonlength" HN features in EVAR outcomes. The aim of this study was to evaluate their individual and potentially predictive role in outcomes of EVAR under HN conditions. METHODS Data of 156 consecutive EVAR patients with short (<15 mm) HN, treated with the Endurant device (Medtronic Cardiovascular, Santa Rosa, Calif) at three European academic vascular centers between 2007 and 2015, were collected and retrospectively analyzed. All patients had at least one of the four well-known nonlength HN criteria (width >32 mm or bulge, angulation >60 degrees, reverse taper anatomy, and circumferential thrombus or calcification >50%) and underwent standard EVAR without additional techniques, such as use of chimney grafts or endoanchors. Primary end points were absence of type IA endoleak at 1 month and midterm follow-up and aneurysm sac stabilization or shrinkage. Secondary end points were 30-day mortality, overall survival, and secondary interventions related to EVAR. The study cohort was classified in two subgroups related to neck length (length <10 mm and length between 10 and 14 mm) as well as in two subgroups according to on-label or off-label stent graft use. RESULTS Mean clinical and radiologic follow-up was 41.1 ± 24.7 and 31.7 ± 19.0 months, respectively. Overall EVAR-related mortality was 1.9% (n = 3). The total type IA endoleak rate was 5.8% (n = 9). In four patients, the type IA endoleak was detected intraoperatively and solved by endovascular means. A type IA endoleak was detected in three patients at 1 month and in two patients at 2-year follow-up. During follow-up, five patients showed an increase of aneurysm diameter due to type II endoleak and were treated by secondary endovascular reinterventions. The total number of all EVAR-related secondary procedures in the midterm was 12 (7.7%). Univariate analysis showed that the center of treatment and the clinical or anatomic features were not associated with adverse outcomes. Multiple regression and Cox regression analysis of HN features revealed that reverse taper anatomy (conical neck) was the single and significantly associated predictor of proximal EVAR failure (P < .012). Width >32 mm, angulation >60 degrees, and calcification or thrombus were not associated with adverse outcomes. Analysis between HN length cohorts and between on-label and off-label subgroups revealed no difference in outcomes. CONCLUSIONS A conical neck in hostile anatomies represents the single strongest factor associated with proximal failure of standard EVAR. This finding should be considered and highlighted apart from the length of the infrarenal neck to prevent midterm failure of standard EVAR.


Covid-19: Doctors performing resuscitation need higher level of PPE, says royal college.


Reshaping the future of ethnobiology research after the COVID-19 pandemic.


title: Direct Comparison of SARS-CoV-2 Analytical Limits of Detection across Seven Molecular Assays.

text: Analytical sensitivity for SARS-CoV-2 detection is a key performance metric for evaluation of viral detection assays. We determined analytical limits of detection for seven SARS-CoV-2 assays using serial dilutions of pooled patient material quantified with droplet digital PCR. Limits of detection ranged from ≤10-74 copies/mL for commercial high-throughput laboratory analyzers (Roche Cobas, Abbott m2000, Hologic Panther Fusion) and 167-511 copies/mL for sample to answer (Diasorin Simplexa, Genmark ePlex) and point of care instruments (Abbott ID NOW). The CDC assay yielded limits of detection ranging from 85-499 copies/mL, depending on the extraction method and thermocycler used. These results can help to inform the assay choice for testing approaches to manage the current COVID-19 outbreak.


Feasibility and early outcomes of single-port access total laparoscopic hysterectomy among Chinese patients.


title: Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation.

text: INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is increasingly used in cardiac arrest (CA). Adequacy of carotid and coronary blood flows (CaBF, CoBF) and coronary perfusion pressure (CoPP) in ECMO treated CA is not well established. This study compares femoro-femoral (FF) to femoro-subclavian (FS) ECMO and intraaortic balloon counterpulsation (IABP) contribution based on CaBF, CoBF, CoPP, myocardial and brain oxygenation in experimental CA managed by ECMO. METHODS In 11 female pigs (50.3 ± 3.4 kg), CA was randomly treated by FF versus FS ECMO ± IABP. Animals under general anesthesia had undergone 15 minutes of ventricular fibrillation (VF) with ECMO flow of 5 to 10 mL/kg/min simulating low-flow CA followed by continued VF with ECMO flow of 100 mL/kg/min. CaBF and CoBF were measured by a Doppler flow wire, cerebral and peripheral oxygenation by near infrared spectroscopy. CoPP, myocardial oxygen metabolism and resuscitability were determined. RESULTS CaBF reached values > 80% of baseline in all regimens. CoBF > 80% was reached only by the FF ECMO, 90.0% (66.1, 98.6). Addition of IABP to FF ECMO decreased CoBF to 60.7% (55.1, 86.2) of baseline, P = 0.004. FS ECMO produced 70.0% (49.1, 113.2) of baseline CoBF, significantly lower than FF, P = 0.039. Addition of IABP to FS did not change the CoBF; however, it provided significantly higher flow, 76.7% (71.9, 111.2) of baseline, compared to FF + IABP, P = 0.026. Both brain and peripheral regional oxygen saturations decreased after induction of CA to 23% (15.0, 32.3) and 34% (23.5, 34.0), respectively, and normalized after ECMO institution. For brain saturations, all regimens reached values exceeding 80% of baseline, none of the comparisons between respective treatment approaches differed significantly. After a decline to 15 mmHg (9.5, 20.8) during CA, CoPP gradually rose with time to 68 mmHg (43.3, 84.0), P = 0 .003, with best recovery on FF ECMO. Resuscitability of the animals was high, both 5 and 60 minutes return of spontaneous circulation occured in eight animals (73%). CONCLUSIONS In a pig model of CA, both FF and FS ECMO assure adequate brain perfusion and oxygenation. FF ECMO offers better CoBF than FS ECMO. Addition of IABP to FF ECMO worsens CoBF. FF ECMO, more than FS ECMO, increases CoPP over time.


title: Employee absenteeism based on occupational health visits in an urban tertiary care Canadian hospital.

text: (1) To merge Occupational Health (OH) and Human Resources (HR) administrative data to describe reasons for absenteeism among hospital employees and (2) to consider the advantages and disadvantages of using these combined data for surveillance of health care workers. This study utilized a retrospective cohort design, involving a record linkage of two administrative databases at a Canadian general hospital: OH and HR. Data were included for the period of June 1, 2004, to May 31, 2005. Data linkage was performed using sex, postal code, and date of birth. The most common self-reported reasons for absence were respiratory illness (31%), gastrointestinal illness (17%), and musculoskeletal injuries/disabilities (15%). Employees working in the Department of General Medicine experienced the highest number of times absent--1.9 per 1,000 work hours. The department with the highest percentage of staff not reporting to OH was General Medicine (43%). This research highlights the issue of absenteeism among health care workers and the need to improve reporting of illness and injury to OH for surveillance efficacy. Further, a public health surveillance system that monitors OH visits among health care workers can facilitate public health practice.


title: Unidirectional barbed suture for vaginal cuff closure without backward stitch in total laparoscopic hysterectomy.

text: AIM To evaluate the safety and efficacy of unidirectional barbed suture technique for vaginal cuff closure in total laparoscopic hysterectomy (TLH). METHODS In a retrospective chart review, data were analyzed from 165 patients who underwent a TLH with an unidirectional barbed suture technique for vaginal cuff closure from January 2012 to June 2016 at tertiary-care university-based teaching hospital and academic affiliated hospital. Vaginal cuff was closed by single layer 3/0 V-Loc unidirectional 9″, 180 day Absorbable Wound Closure Device (Covidien Healthcare, Mansfield, MA) and the suture was not stitched backward to secure distal end. RESULTS A total of 165 patients were included and the median age was 50 years (range, 35-84 years). The median completion time for hysterectomy time was 100 min (range, 40-240 min) and the median vaginal cuff closure time was 7 min (range, 4-15 min). The median estimated blood loss was 87.8 mL (range 30-250 mL) and the median uterine weight was 200 g (range, 40-900 g). Intraoperative complication included bladder perforation (1.2%) and postoperative complications were vaginal cuff dehiscence (1.8%), cuff cellulitis (0.6%), vesicovaginal fistula (0.6%) and unexplained fever (0.6%). CONCLUSION According to the results of current study, the use of unidirectional barbed suture without backward stitching appears to be safe for the vaginal cuff closure in TLH.


title: Serum Hydrogen Sulfide and Outcome Association in Pneumonia by the SARS-CoV-2 Coronavirusxs.

text: BACKGROUND The pneumonia of COVID-19 illness has often a subtle initial presentation making mandatory the use of biomarkers for evaluation of severity and prediction of final patient disposition. We evaluated the use of hydrogen sulfide (H2S) for the outcome of COVID-19 pneumonia. MATERIALS & METHODS We studied 74 patients with COVID-19. Clinical data were collected, and survival predictors were calculated. Blood was collected within 24 hours after admission (day 1) and on day 7. H2S was measured in sera by monobromobimane derivation (MBB) followed by high performance liquid chromatography and correlated to other markers like procalcitonin (PCT) and C- reactive protein (CRP). Tumor necrosis factor alpha (TNFα) and interleukin (IL)-6 were also measured in serum. RESULTS Survivors had significantly higher H2S levels on day 1 and 7 after admission. A cut-off point of 150.44 μM could discriminate survivors from non-survivors with 80% sensitivity, 73.4% specificity and negative predictive value 95.9%. Mortality after 28 days was 32% with admission levels lower or equal to 150.44 μΜ and 4.1% with levels above 150.44 μΜ (p: 0.0008). Mortality was significantly greater among patients with a decrease of H2S levels from day 1 to day 7 greater or equal to 36% (p: 0.0005). Serum H2S on day 1 was negatively correlated with IL- 6 and CRP and positively correlated with the absolute lymphocyte count in peripheral blood. CONCLUSION It is concluded that H2S is a potential marker for severity and final outcome of pneumonia by the SARS-CoV-2 coronavirus. Its correlation with IL- 6 suggests anti-inflammatory properties.


title: Surgical Smoke Evacuators Reduce the Risk of Fires From Alcohol-Based Skin Preparations.

text: Surgical smoke evacuators may reduce the concentration of alcohol vapors from skin preparations at the site of electrosurgical device activation, decreasing operating room fire risk. Our aim was to compare the incidence of flames with and without smoke evacuation in a porcine ex vivo model. A monopolar device was activated after application of either 70% isopropyl alcohol/2% chlorhexidine gluconate (CHG-IPA) or 74% isopropyl alcohol/0.7% iodine povacrylex (iodine-IPA) skin preparations. No suction was compared with standard wall suction and 2 monopolar devices with built-in smoke evacuators. Flames were generated in 60% of CHG-IPA and 47% of iodine-IPA tests without suction. Wall suction did not significantly reduce fires (CHG-IPA 43% vs. 60%, P=0.30; iodine-IPA 57% vs. 47%, P=0.61). Use of both smoke evacuation devices reduced fires for CHG-IPA (17% vs. 60%, P=0.001 and 20% vs. 60%, P=0.004) but not for iodine-IPA. Smoke evacuation devices reduce fire risk when used with a chlorhexidine-alcohol skin preparation.


title: Transcriptome changes associated with Tomato spotted wilt virus infection in various life stages of its thrips vector, Frankliniella fusca (Hinds).

text: Persistent propagative viruses maintain intricate interactions with their arthropod vectors. In this study, we investigated the transcriptome-level responses associated with a persistent propagative phytovirus infection in various life stages of its vector using an Illumina HiSeq sequencing platform. The pathosystem components included a Tospovirus, Tomato spotted wilt virus (TSWV), its insect vector, Frankliniella fusca (Hinds), and a plant host, Arachis hypogaea (L.). We assembled (de novo) reads from three developmental stage groups of virus-exposed and non-virus-exposed F. fusca into one transcriptome consisting of 72 366 contigs and identified 1161 differentially expressed (DE) contigs. The number of DE contigs was greatest in adults (female) (562) when compared with larvae (first and second instars) (395) and pupae (pre- and pupae) (204). Upregulated contigs in virus-exposed thrips had blastx annotations associated with intracellular transport and virus replication. Upregulated contigs were also assigned blastx annotations associated with immune responses, including apoptosis and phagocytosis. In virus-exposed larvae, Blast2GO analysis identified functional groups, such as multicellular development with downregulated contigs, while reproduction, embryo development and growth were identified with upregulated contigs in virus-exposed adults. This study provides insights into differences in transcriptome-level responses modulated by TSWV in various life stages of an important vector, F. fusca.


title: Ethical dilemmas in clinical care during COVID-19 pandemic.

text: In a short span of a few weeks, the COVID-19 pandemic has affected the entire world like no other event in modern history. Healthcare institutions and providers have been at the forefront of containing the ravages of this disease, and are experiencing unprecedented challenges. Medical decision making has become all the more complex because of the moral weight of difficult decisions that need to be made. This paper discusses three areas where ethical decision making is extremely important: dealing with those patients with COVID-19 who no longer have access to their doctors; following ethical criteria for assigning risky duties to healthcare professionals; and in making life and death decisions while allocating scarce resources. This paper describes a national level guidance document for the COVID-19 pandemic that is designed to facilitate ethical decision-making.


title: Single access retroperitoneoscopic adrenalectomy: initial experience.

text: Today, endoscopic adrenalectomy has become a gold standard in endocrine surgery. To minimize the morbidity and improve cosmesis, single access retroperitoneoscopic adrenalectomy (SARA) has been developed as an alternative to traditional multiport laparoscopy and single port access (SPA) surgery, potentially exploiting even more the already proven benefits of minimally invasive surgery. We applied the SARA technique to adrenalectomy using the posterior retroperitoneal approach. The aim is to highlight the current situation regarding the feasibility and safety of single access retroperitoneoscopic adrenalectomy and to present our initial experience. Between October 2010 and February 2011, a 74-year-old woman (body mass index (BMI) - 31 kg/m(2)) with pheochromocytoma (1.2 cm in size) and 3 women, aged 45, 46 and 66 years (BMI - 27, 32, 33 kg/m(2)), respectively, and all diagnosed with Conn's adenoma (from 1.2 cm to 2.0 cm in size), underwent single access retroperitoneoscopic adrenalectomies. Operations were performed using conventional laparoscopic (STORZ) equipment. No conversions to the open or conventional retroperitoneal approach were necessary. There were no perioperative or postoperative complications. Operating time ranged from 60 min to 80 min. All patients left the hospital 2 days after surgery. The single access retroperitoneoscopic technique has been successfully applied to adrenalectomy as an available alternative to multiport laparoendoscopic adrenalectomy and single port access surgery. Exposure, visualization and dissection are the same as in retroperitoneal endoscopic adrenalectomy. The SARA surgery offers patient benefits such as faster convalescence, decreased postoperative scarring, better cosmetic effect and financial benefit.


title: Using Patient Engagement Platforms in the Postoperative Management of Patients.

text: PURPOSE OF REVIEW The purpose of this review is to contextualize the topic of patient engagement in orthopedic surgery. There will be a specific focus on patient engagement platforms and the impact on outcomes and orthopedic clinical workflows. RECENT FINDINGS In an attempt to engage patients and optimize the orthopedic perioperative surgical home, patient engagement platforms have emerged in the form of portals, mobile health applications, and chatbots. Collectively, these platforms have improved patient satisfaction scores and outcomes. Patient portals, mobile health applications, and chatbots can engage orthopedic patients and improve the effectiveness of the perioperative orthopedic surgical home. There are specific differences in these applications that should be noted and accounted for. When deciding to incorporate one of these systems into your practice, it is paramount to identify what you are looking to improve upon within your health system and choose a platform accordingly.


2013: The year of renal denervation?


title: Endoscopic anatomy of the cervical vertebral canal in the horse: a cadaver study.

text: REASON FOR PERFORMING STUDY Localisation of spinal cord compression in horses with cervical vertebral stenotic myelopathy is inexact. Vertebral canal endoscopy has been used in man to localise spinal cord lesions and has the potential to become a useful diagnostic technique in horses. OBJECTIVE To establish a surgical approach via the atlanto-occipital space to the cervical vertebral canal in equine cadavers and describe the endoscopic anatomy of the cervical epidural and subarachnoid spaces. METHODS The cadavers of 25 mature horses were used to assess 3 surgical methods to approach the cervical vertebral canal, including 2 minimally invasive and one open technique. Once the approach had been made, a flexible videoendoscope was inserted into the epidural space (epiduroscopy) or the subarachnoid space (myeloscopy) and advanced caudally until the intervertebral space between C7 and T1 was reached. RESULTS The epidural and subarachnoid spaces could not be accessed reliably using the minimally invasive techniques. Furthermore, damage to the nervous tissues was a frequent complication with these procedures. The open approach allowed successful insertion of the videoendoscope into the epidural and subarachnoid spaces in all horses and no inadvertent damage was observed. Anatomical structures that could be seen in the epidural space included the dura mater, nerve roots, fat and the ventral internal vertebral venous plexus. In the subarachnoid space, the spinal cord, nerve roots, blood vessels, denticulate ligaments and external branch of the accessory nerve were seen. CONCLUSIONS Using the open approach, epiduroscopy and myeloscopy over the entire length of the cervical vertebral canal are possible in the mature horse. POTENTIAL RELEVANCE Cervical vertebral canal endoscopy may become a valuable tool to localise the site of spinal cord injury in horses with cervical vertebral stenotic myelopathy and could aid in the diagnosis of other diseases of the cervical spinal cord.


title: An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model.

text: Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.