title: Tracheal injury detected immediately after median sternotomy by inexperienced surgeons: two case reports.

text: BACKGROUND Although median sternotomy is standard during cardiac surgery, the procedure is associated with a risk of injury to mediastinal organs. Here, we discuss two cases of tracheal injury following median sternotomy during cardiac surgery. CASE PRESENTATION Ventilation failure occurred in a 78-year-old Japanese man and a 71-year-old Japanese man after median sternotomy, and tracheal injury was identified. The sites of injury were directly repaired and covered with mediastinal fat tissue, following which ventilation was successful. The burn-like deposits observed at the site of tracheal injury and on the removed endotracheal tube support the notion that the injuries in our patients were caused by electrocautery prior to median sternotomy. In one case, short sternotracheal distance may have contributed to tracheal injury during post-sternal manipulation. In both cases, the relative inexperience of both surgeons also supports the suspected cause of injury. CONCLUSIONS Tracheal injury represents a potential complication following median sternotomy, especially when performed by inexperienced surgeons or in cases of short sternotracheal distance. Anesthesiologists should consider this rare yet potentially lethal complication.


title: Prosthetic mesh materials used in hernia surgery.

text: It is estimated that 20 million prosthetic meshes are implanted each year worldwide. It is clear that the evolution of meshes is not yet complete and the ideal mesh is yet to be found. There is a vast array of prosthetics available for hernia repair. This review outlines the properties of available meshes and the evidence to be considered when choosing a prosthetic for hernia repair.


title: Learning from the surgeon's real perspective - First-person view versus laparoscopic view in e-learning for training of surgical skills? Study protocol for a randomized controlled trial.

text: Background Surgical proficiency is highly dependent on continuous and efficient training. However, efficacy of training hinges on questions such as accessibility and how intuitively the training can be translated into reality. Minimally invasive surgery (MIS) in particular relies on adequate training modalities in order to compensate for its additional psychomotor and visuospatial challenges. The increasing demand for MIS procedures longs for further enhancement of training and steep learning curves. We are investigating a nouveau training concept that continuously utilizes the first person view as addendum to laparoscopic view. We hypothesize this approach to be more intuitive thus faster and more naturally to apprehend than a laparoscopic view only and aim to establish a new standard to implement into training curricula. Methods and analysis The present study is conducted as a monocentric, two-arm randomized trial. Participants undergo a training curriculum in laparoscopic suturing and knot tying, using e-learning video material with either the first-person perspective of the surgeon or the laparoscopic view only. Primary endpoint is the total training time needed to reach a predefined proficiency level. Participants are evaluated by blinded raters using validated checklists. Number of attempts, procedure and knot quality subscore difference as well as metric parameter analysis from the first and last knots analyzed as secondary endpoints. Furthermore, trainees are assessed with regard to surgical background, basic skills level and spatial awareness. A total sample size of 80 participants for the analysis of the primary endpoint was determined, which will be performed as a two-sided t-test. Ethics and dissemination Ethical approval was obtained from the Ethics Committee of the Medical Faculty at Heidelberg University (Code S-334/2011). This trial was registered with the German Clinical Trials Register (DRKS) in Freiburg, Germany, on May 6th (DRKS00009997). The results will be published and presented at appropriate conferences.


title: Artifact-free and high-temporal-resolution in vivo opto-electrophysiology with microLED optoelectrodes.

text: The combination of in vivo extracellular recording and genetic-engineering-assisted optical stimulation is a powerful tool for the study of neuronal circuits. Precise analysis of complex neural circuits requires high-density integration of multiple cellular-size light sources and recording electrodes. However, high-density integration inevitably introduces stimulation artifact. We present minimal-stimulation-artifact (miniSTAR) μLED optoelectrodes that enable effective elimination of stimulation artifact. A multi-metal-layer structure with a shielding layer effectively suppresses capacitive coupling of stimulation signals. A heavily boron-doped silicon substrate silences the photovoltaic effect induced from LED illumination. With transient stimulation pulse shaping, we reduced stimulation artifact on miniSTAR μLED optoelectrodes to below 50 μVpp, much smaller than a typical spike detection threshold, at optical stimulation of >50 mW mm-2 irradiance. We demonstrated high-temporal resolution (<1 ms) opto-electrophysiology without any artifact-induced signal quality degradation during in vivo experiments. MiniSTAR μLED optoelectrodes will facilitate functional mapping of local circuits and discoveries in the brain.


title: Bipolar sealing of lung parenchyma: tests in an ex vivo model.

text: BACKGROUND Almost every pulmonary lobe resection requires cutting the lung parenchyma in the area of a lung fissure. A monopolar cutter or stapler is often used for this purpose. The seal should be absolutely airtight to prevent post-operative pulmonary fistulas. In the present study, the bipolar sealing technique was evaluated regarding air tightness of the seals during normal ventilation and its burst pressure in an ex vivo animal model. MATERIALS AND METHODS The investigations were carried out on paracardial lung lobes obtained from heart-lung preparations taken from freshly killed pigs at a slaughter house. In the laboratory, each individual lobe was perfused with Ringer's solution at body temperature and protectively ventilated through a tube (frequency: 20 1/min, p insp = 20 mbar, PEEP +5 mbar). Non-anatomic resection was carried out in the periphery of the lung lobe. The two control groups (12 lobes per group; Group 1-stapler, Group 2-parenchyma suture) were compared to three groups in which different bipolar sealing instruments were used. They were Group 3-MARSEAL(®) 10 mm (KLS Martin, Tuttlingen); Group 4-MARSEAL(®) 5 mm; and Group 5-MARCLAMP(®) (KLS Martin, Tuttlingen). The SealSafe(®) G3 electric current was used in all cases. Ventilation was continued for 20 min following parenchymal resection. Parenchymal sealing was then judged visually in a water bath and given a score (0-3). Burst pressure (mbar) was measured by increasing the inspiration pressure stepwise. Group mean values were compared (nonparametric Mann-Whitney U test, p < 0.005). RESULTS Parenchymal seals were airtight under ventilation throughout the observation period in all groups. Mean burst pressures were as follows: Group 1: 47.1 ± 6.2 mbar; Group 2: 32.9 ± 3.9 mbar; Group 3: 38.8 ± 2.2 mbar; Group 4: 25.0 ± 6.4 mbar; and Group 5: 32.9 ± 5.8 mbar. Group 1, the stapler group, thus exhibited the highest burst pressures. Burst pressures for Group 3 were significantly greater than those for Group 2 (p < 0.006). Burst pressures for groups 2 and 5 were similar (p = 0.97). However, the burst pressures for Group 4 were significantly lower than those for Group 2 (p < 0.001). CONCLUSION MARSEAL(®) 10 mm and MARCLAMP(®) achieved adequate burst pressures compared to the two control groups and thus might be suitable for clinical use.


title: Rehabilitation and respiratory management in the acute and early post-acute phase. "Instant paper from the field" on rehabilitation answers to the Covid-19 emergency.

text: Covid-19 is a respiratory infectious disease that can cause respiratory, physical and psychological long-term dysfunctions in patients. First recommendations on respiratory management were published, but they were not based on the specific needs due to Covid-19. In this paper we share the early experiences from the clinical field in Northern Italy, where the epidemic started in February. This paper summarizes the second webinar on Covid-19 (230 live attendees, 11,600 viewers of the recorded version) organized by the Italian Society of Physical and Rehabilitation Medicine about rehabilitation and in particular respiratory management in the acute (Intensive Care Unit - ICU) and immediate post-acute phases. There is the need to prepare for the post-acute phase. ICU length of stay is relatively long, with immobilisation in prone position. Some specific problems are described, including severe muscle weakness and fatigue, joint stiffness, dysphagia, (neuro)psychological problems, impaired functioning concerning mobility, activities of daily life and work. A lot is yet unknown and patients can experience long-term consequences as we know from the literature on the post-intensive care syndrome, but Covid-19 has unique features to be investigated and understood. As one colleague stated during the Covinar: this is a marathon, not a sprint….


title: Complications while waiting for IBD surgery- short report.

text: BACKGROUND AND AIMS While striving to meet the quality standards for oncological care, hospitals prioritize oncological procedures more frequently, resulting in longer waiting times to surgery for benign diseases like inflammatory bowel disease (IBD). The aim of this short-report is to highlight the potential consequences of a longer interval to surgery for IBD patients. METHODS The mean waiting time to elective surgery for IBD patients with active- and inactive disease (e.g. pouch surgery after subtotal colectomy) at the Amsterdam UMC, location AMC, between 2013-2015 were compared to colorectal cancer surgery. The IBD waiting times were correlated to disease complications (e.g. >5% weight loss, abscess formation) and additional health care consumption (e.g. (telephone)outpatient clinic appointment, hospital admission) during these waiting times. RESULTS The mean waiting was 10 weeks (SD 8) for patients with active disease (n=173) and 15 weeks (SD 16) for those with inactive disease (n=97), remarkably higher compared to colorectal cancer patients (5 weeks). While awaiting surgery, 1 out of 8 patients had to undergo surgery in an (semi-)acute setting. Additionally, 19% of patients with active disease had disease complications, and 44% needed additional health care. The rates were comparable for patients with inactive disease. CONCLUSIONS The current waiting time to surgery is not medically justified and creates a burden for health care resources. This issue should be brought to the attention of policy makers, as it requires a structural solution. It is time to also set a maximally acceptable waiting time to surgery for IBD patients.


title: Media alert in an SIS epidemic model with logistic growth.

text: In general, media coverage would not be implemented unless the number of infected cases reaches some critical number. To reflect this feature, we incorporate the media effect and a critical number of infected cases into the disease transmission rate and consider an susceptible-infected-susceptible epidemic model with logistic growth. Our model analysis shows that early media alert and strong media effects are preferable to decrease the numbers of infected cases at endemic equilibria. Furthermore, we noticed that the model may have up to three endemic equilibria and bi-stability can occur in a threshold interval for the critical number. Note that the interval depends on parameters for the focal disease and the media effect. It is possible to roughly estimate the interval for re-emerging diseases in a given region. Therefore, the result could be useful to health policymakers. Global stability is also obtained when the model admits a unique endemic equilibrium.


title: Brain choline concentration. Early quantitative marker of ischemia and infarct expansion?

text: OBJECTIVE Better prediction of tissue prognosis in acute stroke might improve treatment decisions. We hypothesized that there are metabolic ischemic disturbances measurable noninvasively by proton magnetic resonance spectroscopy ((1)H MRS) that occur earlier than any structural changes visible on diffusion-tensor imaging (DTI), which may therefore serve for territorial identification of tissue at risk. METHODS We performed multivoxel (1)H MRS plus DTI within a maximum of 26 hours, and DTI at 3-7 days, after ischemic stroke. We compared choline, lactate, N-acetylaspartate, and creatine concentrations in normal-appearing voxels that became infarcted (infarct expansion) with normal-appearing voxels around the infarct that remained "healthy" (nonexpansion) on follow-up DTI. Each infarct expansion voxel was additionally classified as either complete infarct expansion (infarcted tissue on follow-up DTI covered > or =50% of the voxel) or partial infarct expansion (<50% of voxel). RESULTS In 31 patients (NIH Stroke Scale score 0-28), there were 108 infarct nonexpansion voxels and 113 infarct expansion voxels (of which 80 were complete expansion and 33 partial expansion voxels). Brain choline concentration increased for each change in expansion category from nonexpansion, via partial expansion to complete expansion (2,423, 3,843, 4,158 IU; p < 0.05). Changes in lactate, N-acetylaspartate, and creatine concentrations in expansion category were insignificant although for lactate there was a tendency to such association. CONCLUSIONS Choline concentration measurable with (1)H MRS was elevated in peri-ischemic normal-appearing brain that became infarcted by 3-7 days. The degree of elevation was associated with the amount of infarct expansion. (1)H MRS might identify DTI-normal-appearing tissue at risk of conversion to infarction in early stroke.


title: Germicidal Efficacy and Mammalian Skin Safety of 222-nm UV Light.

text: We have previously shown that 207-nm ultraviolet (UV) light has similar antimicrobial properties as typical germicidal UV light (254 nm), but without inducing mammalian skin damage. The biophysical rationale is based on the limited penetration distance of 207-nm light in biological samples (e.g. stratum corneum) compared with that of 254-nm light. Here we extended our previous studies to 222-nm light and tested the hypothesis that there exists a narrow wavelength window in the far-UVC region, from around 200-222 nm, which is significantly harmful to bacteria, but without damaging cells in tissues. We used a krypton-chlorine (Kr-Cl) excimer lamp that produces 222-nm UV light with a bandpass filter to remove the lower- and higher-wavelength components. Relative to respective controls, we measured: 1. in vitro killing of methicillin-resistant Staphylococcus aureus (MRSA) as a function of UV fluence; 2. yields of the main UV-associated premutagenic DNA lesions (cyclobutane pyrimidine dimers and 6-4 photoproducts) in a 3D human skin tissue model in vitro; 3. eight cellular and molecular skin damage endpoints in exposed hairless mice in vivo. Comparisons were made with results from a conventional 254-nm UV germicidal lamp used as positive control. We found that 222-nm light kills MRSA efficiently but, unlike conventional germicidal UV lamps (254 nm), it produces almost no premutagenic UV-associated DNA lesions in a 3D human skin model and it is not cytotoxic to exposed mammalian skin. As predicted by biophysical considerations and in agreement with our previous findings, far-UVC light in the range of 200-222 nm kills bacteria efficiently regardless of their drug-resistant proficiency, but without the skin damaging effects associated with conventional germicidal UV exposure.


title: Publicly available software tools for decision-makers during an emergent epidemic-Systematic evaluation of utility and usability.

text: Epidemics and emerging infectious diseases are becoming an increasing threat to global populations-challenging public health practitioners, decision makers and researchers to plan, prepare, identify and respond to outbreaks in near real-timeframes. The aim of this research is to evaluate the range of public domain and freely available software epidemic modelling tools. Twenty freely utilisable software tools underwent assessment of software usability, utility and key functionalities. Stochastic and agent based tools were found to be highly flexible, adaptable, had high utility and many features, but low usability. Deterministic tools were highly usable with average to good levels of utility.


title: An in-vitro animal experiment on metal implants' thermal effect on radiofrequency ablation.

text: BACKGROUND To explore metal implants' thermal effect on radiofrequency ablation (RFA) and ascertain distance-thermal relationship between the metal implants and radiofrequency (RF) electrode. METHODS Metal implants models were established in seven in-vitro porcine livers using silver clips or 125I seeds. RFA were conducted centering the RF electrode axis1 cm away from them, with one side containing a metal implants model the test group and the other side the control group. The thermometric needles were used to measure multi-point temperatures in order to compare the time-distance-temperature difference between the two groups. The gross scopes of the ablation of the two groups were measured and the tissues were analyzed for microscopic histology. RESULTS At the ablation times of 8, 12, and 15 min, the average multi-point temperatures of the test group and the control group were 48.2±18.07°C, 51.5±19.57°C, 54.6±19.75°C, and 48.6±17.69°C, 52.2±19.73°C, 54.9±19.24°C, respectively, and the differences were not statistically significant (n=126, P>0.05). At the ablation times of 12 and 15 min, the ablation scopes of the test group and the control group were (horizontal/longitudinal diameter) 1.55/3.48 cm, 1.89/3.72 cm, and 1.56/3.48 cm, 1.89/3.72 cm, respectively, and the differences were not statistically significant (n=14, P>0.05). The two groups had the same manifestations in microscopy. CONCLUSIONS Metal implants do not cause significant thermal effect on RFA.


title: SARS-CoV-2 infection: the same virus can cause different cutaneous manifestations: reply from the authors.

text: Drago et al. are right to point out that our paper did not provide data on enanthems.1,2 As the data collection form did not include the description of mucous membranes, they might not have been explored in many patients. We have reported and included in the supplementary material a few cases that were noticed by their doctors and were the first descriptions of enanthem in COVID-19. Given the low number of cases and their nonsystematic acquisition, we avoided any analysis of these data.


title: Concurrent Respiratory Viruses and Kawasaki Disease.

text: BACKGROUND The diagnosis of Kawasaki disease (KD) remains challenging without a definitive diagnostic test and currently is guided by using clinical patient characteristics and supported by laboratory data. The role of respiratory viruses in the pathogenesis of KD is not fully understood. METHODS Charts of patients with KD admitted to Children's Hospital Colorado from January 2009 to May 2013 were retrospectively reviewed. Patients with KD who had a nasopharyngeal wash submitted for multiplex polymerase chain reaction (PCR) viral testing were included. Clinical characteristics, laboratory data, and outcomes of patients with and without positive respiratory viral PCR results were compared. RESULTS Of 222 patients with KD admitted to the hospital, 192 (86%) had a respiratory viral PCR test performed on or shortly after admission. Ninety-three (41.9%) of the 192 patients with KD had a positive respiratory viral PCR, and the majority were positive for rhinovirus/enterovirus. No statistically significant differences were found in the clinical characteristics and laboratory values between the groups with and without positive respiratory viral PCR findings. Both groups had the same frequency of upper respiratory and gastrointestinal symptoms and had the same incidence of admission to the PICU, intravenous immunoglobulin-resistant disease, and coronary artery lesions. CONCLUSIONS No differences in clinical presentations or outcomes in children with KD stratified according to positive or negative respiratory viral PCR testing were observed. A positive respiratory viral PCR or presence of respiratory symptoms at the time of presentation should not be used to exclude a diagnosis of KD.


title: Can Science Feed on a Crisis? Expectations, the Pine Institute, and the Decline of the French Resin Industry.

text: Argument While science and economy are undoubtedly interwoven, the nature of their relationship is often reduced to a positive correlation between economic and scientific prosperity. It seems that the modern scholarship focusing on "success stories" tends to neglect counterintuitive examples such as the impact of economic crises on research. We argue that economic difficulties, under certain circumstances, may also lead to the prosperous development of scientific institutions. This paper focuses on a particular organism, the Pine Institute in Bordeaux in France. Not only was it a key actor in the process of defining the discipline of resin chemistry, but also it remained for years at the heart of the local resin producing industry. Interestingly, there is an actual inverse correlation between the Institute's budgets and the prices and production of resinous products. The Pine Institute's existence seemed to have been driven by the crisis of the resin industry.


title: Recommendations for a Standardized Avian Coronavirus (AvCoV) Nomenclature: Outcome from Discussions Within the Framework of the European Union COST Action FA1207: "Towards Control of Avian Coronaviruses: Strategies for Vaccination, Diagnosis and Surveillance".

text: Viruses within the Coronaviridae family show variations within their genome sequences, especially within the major structural protein, the Spike (S) glycoprotein gene. Therefore, many different antigenic forms, serotypes, or variant strains of avian coronaviruses (AvCoV) exist worldwide. Only a few of them, the so called protectotypes, cross protect against different serotypes. New serotypes arise by recombination or spontaneous mutations. From time to time, antigenic virus variants appear which differ significantly from known serotypes. The result of this variability is an inconsistent nomenclature and classification of virus strains. Furthermore, there are currently no standard classification methods defined. Within the framework of the COST Action FA1207 "Towards control of avian coronaviruses: strategies for diagnosis, surveillance, and vaccination" (working groups "Molecular virology" and "Epidemiology"), we aimed at defining and developing a unified and internationally standardized nomenclature and classification of AvCoVs. We recommend the use of "CoV Genus/AvCov/host/country/specimen id/year" to refer to AvCoV strains.


Telemedicine Consultations and Diabetes Technology During COVID-19.


title: Diagnosing herpes simplex-1 encephalitis at the time of COVID-19 pandemic

text: CASE REPORT: We describe the case of a 73-year-old woman who was diagnosed with herpes simplex virus-1 encephalitis during the COVID-19 pandemic. The diagnosis was somehow delayed because relatives were initially cautious in bringing the patient to the hospital and, here, the work-up focus was on coronavirusrelated aspects as the patient was initially reputed to be infected with COVID-19. CONCLUSIONS: During the current viral outbreak, physicians should not neglect the possibility of other diseases that represent neurological emergencies and require immediate recognition and treatment.


title: Surgical anatomy of the ovine sural nerve for facial nerve regeneration and reconstruction research.

text: The lack of a clinically relevant animal models for research in facial nerve reconstruction is challenging. In this study, we investigated the surgical anatomy of the ovine sural nerve as a potential candidate for facial nerve reconstruction, and performed its histological quantitative analysis in comparison to the buccal branch (BB) of the facial nerve using cadaver and anesthetized sheep. The ovine sural nerve descended to the lower leg along the short saphenous vein. The length of the sural nerve was 14.3 ± 0.5 cm. The distance from the posterior edge of the lateral malleolus to the sural nerve was 7.8 ± 1.8 mm. The mean number of myelinated fibers in the sural nerve was significantly lower than that of the BB (2,311 ± 381vs. 5,022 ± 433, respectively. p = 0.003). The number of fascicles in the sural nerve was also significantly lower than in the BB (10.5 ± 1.7 vs. 21.3 ± 2.7, respectively. p = 0.007). The sural nerve was grafted to the BB with end-to-end neurorrhaphy under surgical microscopy in cadaver sheep. The surgical anatomy and the number of fascicles of the ovine sural nerve were similar of those reported in humans. The results suggest that the sural nerve can be successfully used for facial nerve reconstruction research in a clinically relevant ovine model.


title: The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties: a prospective cohort study.

text: BACKGROUND AND PURPOSE It has been suggested that the risk of prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA) may be underestimated if based only on arthroplasty registry data. We therefore wanted to estimate the "true" incidence of PJI in THA using several data sources. PATIENTS AND METHODS We searched the Danish Hip Arthroplasty Register (DHR) for primary THAs performed between 2005 and 2011. Using the DHR and the Danish National Register of Patients (NRP), we identified first revisions for any reason and those that were due to PJI. PJIs were also identified using an algorithm incorporating data from microbiological, prescription, and clinical biochemistry databases and clinical findings from the medical records. We calculated cumulative incidence with 95% confidence interval. RESULTS 32,896 primary THAs were identified. Of these, 1,546 had first-time revisions reported to the DHR and/or the NRP. For the DHR only, the 1- and 5-year cumulative incidences of PJI were 0.51% (0.44-0.59) and 0.64% (0.51-0.79). For the NRP only, the 1- and 5-year cumulative incidences of PJI were 0.48% (0.41-0.56) and 0.57% (0.45-0.71). The corresponding 1- and 5-year cumulative incidences estimated with the algorithm were 0.86% (0.77-0.97) and 1.03% (0.87-1.22). The incidences of PJI based on the DHR and the NRP were consistently 40% lower than those estimated using the algorithm covering several data sources. INTERPRETATION Using several available data sources, the "true" incidence of PJI following primary THA was estimated to be approximately 40% higher than previously reported by national registries alone.


title: Symptoms of COVID-19 among older adults: systematic review of biomedical literature.

text: The COVID-19 pandemic is particularly severe in older adults. Our objective was to identify, from international literature, the most common symptoms met in older adults infected with the SARS-CoV-2 virus. This systematic review of the literature was conducted using MEDLINE from December 1, 2019 to April 13, 2020. The analysis of methodological quality used a method dedicated to case series and case reports. Out of 260 articles initially identified, only two studies were finally included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. The symptoms of COVID-19 were as follows: fever, dry cough, dyspnea, asthenia, anorexia, chest tightness, diarrhea, and to a lesser extent myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain and finally vomiting. Lymphopenia was found in the complete blood count. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in the frail oldest-old ones who commonly define the geriatric population. The national survey conducted by the French Society of Geriatrics and Gerontology will help fill this semiological gap.


title: Laparoscopic stomach-partitioning gastrojejunostomy with reduced-port techniques for unresectable distal gastric cancer.

text: BACKGROUND The improvement of quality of life is of great importance in managing patients with far-advanced gastric cancer. We report a new cure and less invasive method of creating a stomach-partitioning gastrojejunostomy in reduced-port laparoscopic surgery for unresectable gastric cancers with gastric outlet obstruction. MATERIALS AND METHODS A 2.5-cm vertical intraumbilical incision was made, and EZ Access (Hakko Co., Ltd., Tokyo, Japan) was placed. After pneumoperitoneum was created, an additional 5-mm trocar was inserted in the right upper abdomen. A gastrojejunostomy was performed in the form of an antiperistaltic side-to-side anastomosis, in which the jejunal loop was elevated in the antecolic route and anastomosed to the greater curvature of the stomach using an endoscopic linear stapler. The jejunal loop together with the stomach was dissected with additional linear staplers just proximal to the common entry hole so that a functional end-to-end gastrojejunostomy was completed. At the same time, the stomach was partitioned using a linear stapler to leave a 2-cm-wide lumen in the lesser curvature. Subsequently, jejunojejunostomy was performed 30 cm distal to the gastrojejunostomy, and the stomach-partitioning gastrojejunostomy resembling Roux-en Y anastomosis was completed. RESULTS All patients resumed oral intake on the day of operation. Neither anastomotic leakage nor anastomotic stricture was observed. CONCLUSIONS Our less invasive palliative operation offers the utmost priority to improve quality of life for patients with unresectable gastric cancer.


Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens.


title: Retrograde endoscopic-assisted esophageal dilation.

text: BACKGROUND Esophageal stricture is a well-known complication of chemoradiotherapy for head and neck malignancies. These strictures almost exclusively occur in the cervical esophagus within the field of radiation. For some patients, identification of the esophageal lumen for antegrade dilation of these strictures can be a challenge, and creation of a false lumen can occur during attempts at dilation. METHODS We report a method of identifying the esophageal lumen using retrograde esophagoscopy through an existing gastrostomy, thereby allowing confident dilation of an esophageal stricture. RESULTS AND DISCUSSION The esophagoscope is used to pass a guide wire from below the stricture, and this guide wire is used for bougie dilation of the stricture. Following retrograde dilation, we often place a modified feeding tube to preserve the lumen for future dilation attempts. CONCLUSION This method can be used to safely place a guide wire for dilation in patients who have a difficult cervical esophageal stricture and an established gastrostomy.


title: Application of modified primary closure of the pelvic floor in laparoscopic extralevator abdominal perineal excision for low rectal cancer.

text: AIM To introduce a novel, modified primary closure technique of laparoscopic extralevator abdominal perineal excision (LELAPE) for low rectal cancer. METHODS We retrospectively analyzed data from 76 patients with rectal cancer who underwent LELAPE from March 2013 to May 2016. Patients were classified into the modified primary closure group (32 patients) and the biological mesh closure group (44 patients). The total operating time, reconstruction time, postoperative stay duration, total cost, postoperative complications and tumor recurrence were compared. RESULTS All surgery was successfully performed. The pelvic reconstruction time was 14.6 ± 3.7 min for the modified primary closure group, which was significantly longer than that of the biological mesh closure group (7.2 ± 1.9 min, P < 0.001). The total operating time was not different between the two groups (236 ± 20 min vs 248 ± 43 min, P = 0.143). The postoperative hospital stay duration was 8.1 ± 1.9 d, and the total cost was 9297 ± 1260 USD for the modified primary closure group. Notably, both of these categories were significantly lower in this group than those of the biological mesh closure group (P = 0.001 and P = 0.003, respectively). There were no differences observed between groups when comparing other perioperative data, long-term complications or oncological outcomes. CONCLUSION The modified primary closure method for reconstruction of the pelvic floor in LELAPE for low rectal cancer is technically feasible, safe and cost-effective.


title: Magnetic interference of cardiac pacemakers from a surgical magnetic drape.

text: Sterile magnetic drapes are frequently used during surgery to hold metal instruments on the sterile field. Magnetic fields may potentially interfere with the function of cardiovascular implantable electronic devices such as pacemakers and implantable cardioverter defibrillators. In this study, we evaluated the potential magnetic interference of magnetic drapes on pacemaker function. A magnetic drape with 70 magnets was placed with its approximate center over the pacemaker of 50 patients during their visit to the cardiology clinic. In those pacemakers that demonstrated magnetic interference, the drape was pulled caudally in 3-cm increments until the interference ceased. If there was no interference, the drape was folded in 2 over the pacemaker. The number of magnets necessary to maintain magnetic interference with the pacemaker was also tested. Magnetic interference was observed in the pacemakers of 47 (94%) patients: 35 with the unfolded drape and another 12 with the folded drape. Patients whose pacemakers had interference with the unfolded drape weighed less (68 ± 15 kg vs 81 ± 19 kg; P = 0.016) than those who had no interference. In 54% of patients, magnetic interference ceased when the drape was pulled 3 cm caudally and at 15 cm, no pacemaker had magnetic interference. Magnetic drapes may cause magnetic interference with cardiac pacemakers, and this interference ceases at a caudal distance of 15 cm. Magnetic interference seems more likely in patients with lower body weight. Careful monitoring of the pulse and electrocardiogram for asynchronous pacing activity should be considered when magnetic drapes are used in patients with cardiovascular implantable electronic devices.


title: Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees.

text: Importance Mistreatment of medical students is pervasive and has negative effects on performance, well-being, and patient care. Objective To document the published programmatic and curricular attempts to decrease the incidence of mistreatment. Data Sources PubMed, Scopus, ERIC, the Cochrane Library, PsycINFO, and MedEdPORTAL were searched. Comprehensive searches were run on "mistreatment" and "abuse of medical trainees" on all peer-reviewed publications until November 1, 2017. Study Selection Citations were reviewed for descriptions of programs to decrease the incidence of mistreatment in a medical school or hospital with program evaluation data. A mistreatment program was defined as an educational effort to reduce the abuse, mistreatment, harassment, or discrimination of trainees. Studies of the incidence of mistreatment without description of a program, references to a mistreatment program without outcome data, or a program that has never been implemented were excluded. Data Extraction and Synthesis Authors independently reviewed all retrieved citations. Articles that any author found to meet inclusion criteria were included in a full-text review. The data extraction form was developed based on the guidelines for Best Evidence in Medical Education. An assessment of the study quality was conducted using a conceptual framework of 6 elements essential to the reporting of experimental studies in medical education. Main Outcomes and Measures A descriptive review of the interventions and outcomes is presented along with an analysis of the methodological quality of the studies. A separate review of the MedEdPORTAL mistreatment curricula was conducted. Results Of 3347 citations identified, 10 studies met inclusion criteria. Of the programs included in the 10 studies, all were implemented in academic medical centers. Seven programs were in the United States, 1 in Canada, 1 in the United Kingdom, and 1 in Australia. The most common format was a combination of lectures, workshops, and seminars over a variable time period. Overall, quality of included studies was low and only 1 study included a conceptual framework. Outcomes were most often limited to participant survey data. The program outcome evaluations consisted primarily of surveys and reports of mistreatment. All of the included studies evaluated participant satisfaction, which was mostly qualitative. Seven studies also included the frequency of mistreatment reports; either surveys to assess perception of the frequency of mistreatment or the frequency of reports via official reporting channels. Five mistreatment program curricula from MedEdPORTAL were also identified; of these, only 2 presented outcome data. Conclusions and Relevance There are very few published programs attempting to address mistreatment of medical trainees. This review identifies a gap in the literature and provides advice for reporting on mistreatment programs.


title: Reorganizing the treatment of cardiovascular disease in response to coronavirus disease 2019; time for the polypill?

text: PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has forced a redesign of healthcare services. Resource reallocation will have consequences on the routine management of chronic diseases, including cardiovascular disease (CVD). We consider how to mitigate potential adverse effects. RECENT FINDINGS Combination therapy is well established in hypertension. Many guidelines recommend dual antihypertensive therapy as the initial treatment step as this results in faster blood pressure control, albeit with limited evidence of improved outcomes. Control of CVD risk factors through multiclass combination therapy (the polypill) was proposed many years ago. This approach has not been adopted by Western healthcare systems despite improving surrogate outcomes. Recently, the PolyIran trials have demonstrated improved CVD outcomes without increased adverse events, in both primary and secondary prevention. SUMMARY The COVID-19 pandemic allows models of chronic healthcare to be rethought. Current practices are resource-intensive and there is a need to simplify titration and monitoring protocols in CVD. Moving toward the use of polypill combinations allied with telehealth consultations may be one solution.


title: Mechanical thrombectomy with 'ADAPT' technique by transcervical access in acute ischemic stroke.

text: BACKGROUND The mechanical thrombectomy (MT) for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected acute stroke patients. MT is typically performed via a transfemoral approach, but catheterization of the occluded vessel can be problematic in cases of extensive vessel tortuosity. We describe a case of MT with the 'ADAPT' technique by direct carotid access due to an inability to catheterize the ICA by a transfemoral approach for acute cerebral ischemia in the setting of left MCA occlusion. Excellent angiographic and good clinical results were obtained without any complications. CASE REPORT An 80-year-old woman was admitted with a stroke by occlusion of the left MCA, with an NIHSS: 11, and an ASPECT: 7 in the CT. Under sedation a transfemoral angiography was performed, but after multiple attempts, it was impossible to make a stable catheterization of the left CCA. A transcervical approach was pursued. With ultrasound guidance the CCA was catheterized. Using the 'ADAPT' technique, we performed a successful MT. Post-procedure angiography (at 14 minutes) demonstrated recanalization of the entire left MCA (TICI: 3), without complications. The carotid access point was closed with a percutaneous closure. Control TC at 24 h showed a slight hypodensity in the left lenticular nucleus, and loss of gray-white matter differentiation in the adjacent cortex. Neurologically, the patient presented with progressive improvement. At discharge, she had an NIHSS: 0, mRS: 0 and Barthel: 100. CONCLUSIONS MT by direct carotid access is an effective alternative technique in those cases where it is not accessible by a transfemoral approach.


title: Effect of Different Concentrations of Propofol Used as a Sole Anesthetic on Pupillary Diameter: A Randomized Trial.

text: BACKGROUND Pupillometry monitoring under general anesthesia is based on the assumption that pupillary diameter variations reflect the adequacy of the provided analgesia to the intensity of the nociceptive surgical stimulus. The accurate interpretation of pupillometric data requires establishing clearly what the expected baseline unstimulated pupillary diameter at each specific level of hypnosis is. Opioids decrease pupillary diameter in a dose-dependent fashion. In contrast, the effects of hypnotic drugs on pupillary diameter are not well known. Our aim was to describe the potential relationship between propofol predicted effect-site concentrations (Cets) ranging from 1 to 3 µg/mL and pupillary diameter. METHODS Patients were randomized to receive propofol by target-controlled infusion at a predicted Cet of 1, 2, or 3 µg/mL (groups P1, P2, and P3, respectively). Pupillary diameter measurements were performed after 10 minutes of steady-state propofol infusion at the randomized Cet. No stimulation was performed during the study. Heart rate and bispectral index (BIS) were continuously recorded. RESULTS Forty patients were included: (13, 14, and 13 in groups P1, P2, and P3, respectively). Mean pupillary diameter was 5.7 mm (1 mm) in group P1, 4.8 mm (1.3 mm) in group P2, and 3.3 mm (0.8 mm) in group P3. Propofol had a dose-dependent effect on pupillary diameter (linear regression R = 0.45, P < .001). Pupillary diameter was positively correlated with the BIS (Spearman r = 0.75 [95% confidence interval (CI), 0.54 to -0.87] P < .001). CONCLUSIONS From 1 to 3 µg/mL of predicted Cet, propofol has a dose-dependent effect on pupillary diameter. Within this concentrations range, there is a positive correlation between BIS and pupillary diameter. The subcortical effect of propofol on pupillary diameter is correlated to its effect on the cortex. Studies assessing pupillary diameter as a marker of the nociception-antinociception balance should be performed in patients with a standardized depth of hypnosis.


title: Changes in Electrical Activity of the Masseter Muscle and Masticatory Force after the Use of the Masseter Nerve as Donor in Facial Reanimation Surgery.

text: Introduction The masseter nerve has been used as a donor nerve for facial reanimation procedures due to the multiple advantages it offers; it has been generally considered that sacrifice of the masseter nerve does not alter the masticatory apparatus; however, there are no objective studies to support this claim. Objective To evaluate the impact that the use of the masseter nerve in dynamic facial reconstruction has on the electrical activity of the masseter muscle and on bite force. Materials and Methods An observational and prospective longitudinal study was performed measuring bite force and electrical activity of the masseter muscles before and 3 months after dynamic facial reconstructive surgery using the masseter nerve. An occlusal analyzer and surface electromyography were employed for measurements. Results The study included 15 patients with unilateral facial paralysis, with a mean age of 24.06 ± 23.43. Seven patients were subjected to a masseter-buccal branch nerve transfer, whereas in eight patients, the masseter nerve was used as a donor nerve for gracilis free functional muscle transfer. Electrical activity of the masseter muscle was significantly reduced after surgery in both occlusal positions: from 140.86 ± 65.94 to 109.68 ± 68.04 ( p = 0.01) in maximum intercuspation and from 123.68 ± 75.64 to 82.64 ± 66.56 ( p = 0.01) in the rest position. However, bite force did not show any reduction, changing from 22.07 ± 15.66 to 15.56 ± 7.91 ( p = 0.1) after the procedure. Conclusion Masseter nerve transfer causes a reduction in electromyographic signals of the masseter muscle; however, bite force is preserved and comparable to preoperative status.


title: Accuracy, precision, and method detection limits of quantitative PCR for airborne bacteria and fungi.

text: Real-time quantitative PCR (qPCR) for rapid and specific enumeration of microbial agents is finding increased use in aerosol science. The goal of this study was to determine qPCR accuracy, precision, and method detection limits (MDLs) within the context of indoor and ambient aerosol samples. Escherichia coli and Bacillus atrophaeus vegetative bacterial cells and Aspergillus fumigatus fungal spores loaded onto aerosol filters were considered. Efficiencies associated with recovery of DNA from aerosol filters were low, and excluding these efficiencies in quantitative analysis led to underestimating the true aerosol concentration by 10 to 24 times. Precision near detection limits ranged from a 28% to 79% coefficient of variation (COV) for the three test organisms, and the majority of this variation was due to instrument repeatability. Depending on the organism and sampling filter material, precision results suggest that qPCR is useful for determining dissimilarity between two samples only if the true differences are greater than 1.3 to 3.2 times (95% confidence level at n = 7 replicates). For MDLs, qPCR was able to produce a positive response with 99% confidence from the DNA of five B. atrophaeus cells and less than one A. fumigatus spore. Overall MDL values that included sample processing efficiencies ranged from 2,000 to 3,000 B. atrophaeus cells per filter and 10 to 25 A. fumigatus spores per filter. Applying the concepts of accuracy, precision, and MDL to qPCR aerosol measurements demonstrates that sample processing efficiencies must be accounted for in order to accurately estimate bioaerosol exposure, provides guidance on the necessary statistical rigor required to understand significant differences among separate aerosol samples, and prevents undetected (i.e., nonquantifiable) values for true aerosol concentrations that may be significant.


Resilience and Emotional Support in Health Care Professionals During the COVID-19 Pandemic.


title: Leadership proficiency in surgery: lessons from the COVID-19 pandemic.

text: Summary The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. We discuss the merits of leadership training for surgical residents and future directions for implementing a leadership curriculum for Canadian residency programs in the competency by design era.


Let's not forget endometriosis and infertility amid the covid-19 crisis.


title: Quantifying the depth of anesthesia based on brain activity signal modeling.

text: Various methods of assessing the depth of anesthesia (DoA) and reducing intraoperative awareness during general anesthesia have been extensively studied in anesthesiology. However, most of the DoA monitors do not include brain activity signal modeling. Here, we propose a new algorithm termed the cortical activity index (CAI) based on the brain activity signals. In this study, we enrolled 32 patients who underwent laparoscopic cholecystectomy. Raw electroencephalography (EEG) signals were acquired at a sampling rate of 128 Hz using BIS-VISTA with standard bispectral index (BIS) sensors. All data were stored on a computer for further analysis. The similarities and difference among spectral entropy, the BIS, and CAI were analyzed. Pearson correlation coefficient between the BIS and CAI was 0.825. The result of fitting the semiparametric regression models is the method CAI estimate (-0.00995; P = .0341). It is the estimated difference in the mean of the dependent variable between method BIS and CAI. The CAI algorithm, a simple and intuitive algorithm based on brain activity signal modeling, suggests an intrinsic relationship between the DoA and the EEG waveform. We suggest that the CAI algorithm might be used to quantify the DoA.


title: Factors affecting the persistence of endangered Ganges River dolphins (Platanista gangetica gangetica).

text: The Ganges-Brahmaputra-Meghna and Karnaphuli (GBMK) River Basin in Nepal, India, and Bangladesh is among the world's most biodiverse river basins. However, human-induced habitat modification processes threaten the ecological structure of this river basin. Among the GBMK's diverse flora and fauna of this freshwater ecosystem, the endemic Ganges River dolphin (Platanista gangetica gangetica; GRD) is one of the most charismatic species in this freshwater ecosystem. Though a >50% population size reduction has occurred since 1957, researchers and decision-makers often overlook the persistence (or evolutionary potential) of this species in the highly fragmented GBMK. We define the evolutionary potential as the ability of species/populations to adapt in a changing environment by maintaining their genetic diversity. Here, we review how evolutionary trap mechanisms affect the dynamics and viability of the GRD (hereafter Ganges dolphin) populations after rapid declines in their population size and distribution. We detected six potential trap mechanisms that might affect the Ganges dolphin populations discretely or in combination: (a) habitat modification; (b) occurrence of finite and geographically restricted local populations; (c) ratio of effective to estimate population size; (d) increasing risk of inbreeding depression in genetically isolated groups; (e) at-risk behavioral attributes; and (f) direct fisheries-dolphin interactions. Because evolutionary traps appear most significant during low water season, they adversely affect demographic parameters, which reduce evolutionary potential. These traps have already caused local extirpation events; therefore, we recommend translocation among populations, including restoring and preserving essential habitats as immediate conservation strategies. Integrative evolutionary potential information based on demographic, genetic, and environmental data is still lacking. Thus, we identify gaps in the knowledge and suggest integrative approaches to understand the future of Ganges dolphins in South Asian waterways.


title: Abbreviated breast dynamic contrast-enhanced MR imaging for lesion detection and characterization: the experience of an Italian oncologic center.

text: BACKGROUND To evaluate the performance of an abbreviated dynamic contrast-enhanced MR imaging (MRI) protocol for breast cancer detection; a comparison with the complete diagnostic protocol has been conducted. METHODS A retrospective analysis on 508 patients was performed. Abbreviated protocol (AP) included one pre-contrast and the first post-contrast T1-weighted series. Complete protocol (CP) consisted of four post-contrast and one pre-contrast T1-weighted series. Diagnostic performance was assessed for AP and CP. Performance comparison was made using McNemar's test for sensitivity and specificity and Moskowitz and Pepe's method as regards negative predictive value (NPV) and positive predictive value (PPV). AP has been realized in two different ways (AP1 and AP2) and they were compared by means of Cohen's κ. RESULTS Both CP and AP revealed 206 of 207 cancers. There were no statistically significant differences between AP and CP diagnostic performance (P > 0.05). NPVs of CP and both versions of AP (99.57 vs. 99.56%, P = 0.39), as well as the specificity (77.08 vs. 75.42%, P = 0.18), were substantially equivalent. Relative predictive value method did not reveal the presence of a statistically significant difference between the PPV of CP and both versions of AP (74.91 vs. 73.57%, P = 0.099). Analysis for single lesion confirmed that both CP and AP had equivalent results: CP and AP revealed 280 of 281 malignancies. NPVs of CP and both AP versions, as well as the specificity (P > 0.05), were substantially equivalent. Relative predictive value method did not reveal the presence of a significant difference between the PPV of CP and both AP versions (70.89 vs. 70.18%, P = 0.25; 70.89 vs. 70.00%, P = 0.13). CONCLUSIONS Abbreviated approach to breast MRI examination reduces the image acquisition and the reading time associated with MR substantially without influencing the diagnostic accuracy (high sensitivity and NPV >99.5%). AP could translate into cost-savings and could enable a higher number of examinations within the same MR session.


title: Pulmonary embolism in COVID-19 patients: a French multicentre cohort study.

text: AIMS While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. METHODS AND RESULTS In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002). CONCLUSION PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.


title: Smell and taste dysfunctions in COVID-19 are associated with younger age in ambulatory settings - a multicenter cross-sectional study.

text: BACKGROUND AND OBJECTIVE Since China's initial anecdotal reports of coronavirus disease 2019 (COVID-19), there have been a growing number of studies describing smell and/or taste dysfunction (STD). Objective: The aim was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS A multicenter cross-sectional study on SARS-CoV-2 positive patients (n=846) and controls (n=143) from 15 Spanish Hospitals. Data of STD with an in-person survey was collected prospectively. STD severity was categorized by visual analogue scale. STD onset time, recovery rate, time to recovery, hospital admission, pneumonia diagnosis, comorbidities, smoking and symptoms were analyzed. RESULTS STD were at least 2-fold more common in COVID-19-positive compared to controls. In COVID-19-positive, hospitalized patients were older, with lower frequency of STD and recovered earlier than out-patients. Stratified analysis by severity of STD showed that more than a half of COVID-19 subjects presented severe loss of smell (53.7%) or taste (52.2%), in >90% this impairment was of both senses. In the multivariate analysis, an older age (>60yo), being hospitalized and an increased level of C-reactive protein were factors associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement of smell (45.6%) and taste (46.1%) at the time of the survey, 90.6% in less than two weeks' post-infection. CONCLUSIONS STD is a common symptom in COVID-19, and mainly present in young and non-hospitalized patients. More studies are needed to evaluate the follow-up of the chemosensory impairment.


title: Coronavirus Disease (COVID-19): A Machine Learning Bibliometric Analysis.

text: BACKGROUND/AIM To evaluate the research trends in coronavirus disease (COVID-19). MATERIALS AND METHODS A bibliometric analysis was performed using a machine learning bibliometric methodology. Information regarding publication outputs, countries, institutions, journals, keywords, funding and citation counts was retrieved from Scopus database. RESULTS A total of 1883 eligible papers were returned. An exponential increase in the COVID-19 publications occurred in the last months. As expected, China produced the majority of articles, followed by the United States of America, the United Kingdom and Italy. There is greater collaboration between highly contributing authors and institutions. The "BMJ" published the highest number of papers (n=129) and "The Lancet" had the most citations (n=1439). The most ubiquitous topic was COVID-19 clinical features. CONCLUSION This bibliometric analysis presents the most influential references related to COVID-19 during this time and could be useful to improve understanding and management of COVID-19.


title: Reusable and Recyclable Graphene Masks with Outstanding Superhydrophobic and Photothermal Performances.

text: The 2019 coronavirus outbreak (COVID-19) is affecting over 210 countries and territories, and it is spreading mainly by respiratory droplets. The use of disposable surgical masks is common for patients, doctors, and even the general public in highly risky areas. However, the current surgical masks cannot self-sterilize in order to reuse or be recycled for other applications. The resulting high economic and environmental costs are further damaging societies worldwide. Herein, we reported a unique method for functionalizing commercially available surgical masks with outstanding self-cleaning and photothermal properties. A dual-mode laser-induced forward transfer method was developed for depositing few-layer graphene onto low-melting temperature nonwoven masks. Superhydrophobic states were observed on the treated masks' surfaces, which can cause the incoming aqueous droplets to bounce off. Under sunlight illumination, the surface temperature of the functional mask can quickly increase to over 80 °C, making the masks reusable after sunlight sterilization. In addition, this graphene-coated mask can be recycled directly for use in solar-driven desalination with outstanding salt-rejection performance for long-term use. These roll-to-roll production-line-compatible masks can provide us with better protection against this severe virus. The environment can also benefit from the direct recycling of these masks, which can be used for desalinating seawater.


title: The '-omics' revolution and oesophageal adenocarcinoma.

text: Oesophageal adenocarcinoma (OAC) is the eighth most common cancer type worldwide with a dismal 5-year survival. Barrett oesophagus, the replacement of the normal squamous epithelia with glandular cells, is the first step in the pathway towards OAC. Although most patients with OAC present de novo, the presence of the easily detectable OAC precursor lesion, Barrett oesophagus, enables the possibility of early detection of high-risk patients who are more likely to progress. Currently, identification of high-risk patients depends on histopathological assessment of dysplasia with no regards to molecular pathogenesis. In the future, screening and risk stratification initiatives for Barrett oesophagus that incorporate molecular profiles might permit improved early diagnosis and intervention strategies with the possibility of preventing OAC. For the majority of patients presenting de novo at an advanced stage, combining so-called -omics datasets with current clinical staging algorithms might enable OACs to be better classified according to distinct molecular programmes, thereby leading to better targeted treatment strategies as well as cancer monitoring regimes. This Review discusses how the latest advances in -omics technologies have improved our understanding of the development and biology of OAC, and how this development might alter patient management in the future.


title: Neutralizing nanobodies bind SARS-CoV-2 spike RBD and block interaction with ACE2.

text: The SARS-CoV-2 virus is more transmissible than previous coronaviruses and causes a more serious illness than influenza. The SARS-CoV-2 receptor binding domain (RBD) of the spike protein binds to the human angiotensin-converting enzyme 2 (ACE2) receptor as a prelude to viral entry into the cell. Using a naive llama single-domain antibody library and PCR-based maturation, we have produced two closely related nanobodies, H11-D4 and H11-H4, that bind RBD (KD of 39 and 12 nM, respectively) and block its interaction with ACE2. Single-particle cryo-EM revealed that both nanobodies bind to all three RBDs in the spike trimer. Crystal structures of each nanobody-RBD complex revealed how both nanobodies recognize the same epitope, which partly overlaps with the ACE2 binding surface, explaining the blocking of the RBD-ACE2 interaction. Nanobody-Fc fusions showed neutralizing activity against SARS-CoV-2 (4-6 nM for H11-H4, 18 nM for H11-D4) and additive neutralization with the SARS-CoV-1/2 antibody CR3022.


title: Estimating the Burden of Pandemic Infectious Disease: The Case of the Second Wave of Pandemic Influenza H1N1 in Forsyth County, North Carolina.

text: BACKGROUND Understanding the burden of influenza A(H1N1)pdm09 virus during the second wave of 2009-2010 is important for future pandemic planning. METHODS Persons who presented to the emergency department (ED) or were hospitalized with fever and/or acute respiratory symptoms at the academic medical center in Forsyth County, North Carolina were prospectively enrolled and underwent nasal/throat swab testing for influenza A(H1N1)pdm09. Laboratory-confirmed cases of influenza A(H1N1)pdm09 virus identified through active surveillance were compared by capture-recapture analysis to those identified through independent, passive surveillance (physician-ordered influenza testing). This approach estimated the number of total cases, including those not captured by either surveillance method. A second analysis estimated the total number of influenza A(H1N1)pdm09 cases by multiplying weekly influenza percentages determined via active surveillance by weekly counts of influenza-associated discharge diagnoses from administrative data. Market share adjustments were used to estimate influenza A(H1N1)pdm09 virus ED visits or hospitalizations per 1,000 residents. RESULTS Capture-recapture analysis estimated that 753 residents (95% confidence interval [CI], 424-2,735) with influenza A(H1N1)pdm09 virus were seen in the academic medical center from September 2009 through mid-April 2010; this result yielded an estimated 4.7 (95% CI, 2.6-16.9) influenza A(H1N1)pdm09 virus ED visits or hospitalizations per 1,000 residents. Similarly, 708 visits were estimated using weekly influenza percentages and influenza-associated discharge diagnoses, yielding an estimated 4.4 influenza A(H1N1)pdm09 virus ED visits or hospitalizations per 1,000 residents. CONCLUSION This study demonstrates that the burden of influenza A(H1N1)pdm09 virus in ED and inpatient settings by capture-recapture analysis was 4-5 per 1,000 residents; this rate was approximately 8-fold higher than that detected by physician-ordered influenza testing.


title: Laparoscopic long sleeve pancreaticogastrostomy (LPG): a novel pancreatic anastomosis following central pancreatectomy.

text: BACKGROUND Central pancreatectomy (CP) is preferred to distal pancreatectomy (DP) for the excision of benign tumours at the neck or body of the pancreas, in order to preserve pancreatic function and the spleen. However, the pancreaticoenterostomy is technically difficult to perform laparoscopically and the postoperative pancreatic fistula (POPF) rate is high. METHODS A novel laparoscopic reconstruction of the pancreatic stump during CP is described, the laparoscopic long sleeve pancreaticogastrostomy (LPG). RESULTS Two males and two females with a median age of 49 years had a laparoscopic CP with LPG. After a median follow-up of 27.5 months, there was no mortality. One patient had a grade A POPF, managed conservatively. CONCLUSIONS The LPG is a safe and technically less demanding method to reconstruct pancreatic drainage laparoscopically.


title: Hand-assisted laparoscopic colorectal surgery.

text: The use of laparoscopic techniques in the treatment of colorectal diseases was first described in the early 1990s. Even though its clinical benefits have been well documented, laparoscopic colorectal surgery has been slow to gain adoption in the surgical community, given its technical demands. To help overcome these challenges while preserving the clinical benefits derived from a minimally invasive approach, hand-assisted laparoscopic surgery (HALS) was proposed. HALS can decrease the learning curve by restoring tactile sensation and improving proprioception, and it may be more accessible for surgeons already in practice. A meta-analysis of the 3 published RCTs comparing hand-assisted laparoscopic to conventional laparoscopic colorectal resection showed a significantly lower rate of conversion in the hand-assist patients, while morbidity rates were equivalent. The meta-analysis further indicated that short-term postoperative benefits of conventional laparoscopic colectomies were preserved and costs were likely to be offset by reduced operative time and specific need of laparoscopic equipment. HALS represents a valuable option for performing colorectal resections.


title: Environmental safety: Air pollution while using MIRUS™ for short-term sedation in the ICU.

text: BACKGROUND MIRUS™ is a device for target-controlled inhalational sedation in the ICU in combination with use of isoflurane, or sevoflurane, or desflurane. The feasibility of this device has recently been proven; however, ICU staff exposure may restrict its application. We investigated ICU ambient room pollution during daily work to estimate ICU personnel exposure while using MIRUS™. METHODS This observational study assessed pollution levels around 15 adult surgical patients who received volatile anaesthetics-based sedation for a median of 11 hours. Measurements were performed by photoacoustic gas monitoring in real-time at different positions near the patient and in the personnel's breathing zone. Additionally, the impact of the Clean Air™ open reservoir scavenging system on volatile agent pollution was evaluated. RESULTS Baseline concentrations [ppm] during intervention and rest periods were isoflurane c ¯ mean = 0.58 ± 0.49, c ¯ max = 5.72; sevoflurane c ¯ mean = 0.22 ± 0.20, c ¯ max = 7.93; and desflurane c ¯ mean = 0.65 ± 0.57, c ¯ max = 6.65. Refilling MIRUS™ with liquid anaesthetic yielded gas concentrations of c ¯ mean = 2.18 ± 1.48 ppm and c ¯ max = 13.03 ± 9.37 ppm in the personnel's breathing zone. Air pollution in the patient's room was approximately five times higher without a scavenging system. CONCLUSION Ambient room pollution was minimal in most cases, and the measured values were within or below the recommended exposure limits. Caution should be taken during refilling of the MIRUS™ system, as this was accompanied by higher pollution levels. The combined use of air-conditioning and gas scavenging systems is strongly recommended.


title: Hepatoprotective effect and its possible mechanism of Coptidis rhizoma aqueous extract on carbon tetrachloride-induced chronic liver hepatotoxicity in rats.

text: ETHNOPHARMACOLOGICAL RELEVANCE Coptidis rhizoma is traditionally used for heat-clearing and toxic-scavenging and it belongs to liver meridian in Chinese medicine practice. Clinically, Coptidis rhizoma can be used for hepatic and biliary disorders, yet details in the therapies of liver diseases and underlying mechanism(s) remain unclear. Our previous study demonstrated that Coptidis rhizoma aqueous extract (CRAE) against CCl(4)-induced acute liver damage was related to antioxidant property. In the present study, the protection of CRAE on chronic liver damage induced by carbon tetrachloride (CCl(4)) in rats and its related mechanism were explored. MATERIALS AND METHODS The CCl(4)-induced chronic liver damage model was established, and CRAE's protective effect was examined. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity, serum and liver superoxide dismutase (SOD) activity were then measured. The histological changes were observed under microscopy and then computed in numerical score. The normal or damaged cells were isolated and related signaling pathway was evaluated. RESULT Serum AST and ALT activities were significantly decreased in rats treated with different doses of CRAE, indicating its protective effect against CCl(4)-induced chronic liver damage. Observation on serum SOD activity revealed that CRAE might act as an anti-oxidant agent against CCl(4)-induced chronic oxide stress. Histological study supported these observations. Erk1/2 inhibition may take part into CRAE's effect on preventing hepatocyte from apoptosis when exposed to oxidative stress. CONCLUSION CRAE showed protective effect against CCl(4)-induced chronic liver damage in rats and its potential as an agent in the treatment of chronic liver diseases by protecting hepatocyte from injury.


Atypical pneumonia diagnosed as COVID-19 by serologic test (patient #1 in Poland).


title: Lockean superaddition and Lockean humility.

text: This paper offers a new approach to an old debate about superaddition in Locke. Did Locke claim that some objects have powers that are unrelated to their natures or real essences? The question has split commentators. Some (Wilson, Stuart, Langton) claim the answer is yes and others (Ayers, Downing, Ott) claim the answer is no. This paper argues that both of these positions may be mistaken. I show that Locke embraced a robust epistemic humility. This epistemic humility includes ignorance of the real essences of bodies, of the causal processes underlying the production of natural phenomena, and of God's method of creation. I show how this epistemic humility offers strong support for an agnostic response to the question of superaddition. Locke did not intend to claim that bodies either do or do not have properties unrelated to their real essences. Instead, his primary goal in discussing the topic was to emphasize the strict limits to human knowledge.


title: [Interpretation of "Guidelines for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Infection by the National Health Commission (Trial Version 5)"].

text: 国家卫生健康委员会（以下简称卫健委）发布了新型冠状病毒肺炎诊疗指南（试行第五版），随着对疾病不断地认识和了解，诊疗指南也随之进行修订。诊疗指南（以下简称指南）的发布指导我们认识疾病、治疗疾病、预防疾病。那么，卫健委发布的第五版指南较第四版指南具体更新了哪些内容，本文进行了解读。.


Coronavirus Disease 2019 (COVID-19) and Cardiac Injury-Reply.


title: Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach.

text: The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. For breast cancer, a key difference is increased use of neoadjuvant systemic therapy due to deferral of many breast surgeries during the pandemic. In some cases, this necessitates increased use of genomic tumor profiling on core biopsy specimens to guide neoadjuvant therapy decisions. Breast cancer treatment during the pandemic requires multidisciplinary input and varies according to stage, tumor biology, comorbidities, age, patient preferences, and available hospital resources. We present here the Johns Hopkins Women's Malignancies Program approach to breast cancer management during the COVID-19 pandemic. We include algorithms based on tumor biology and extent of disease that guide management decisions during the pandemic. These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.


title: Structure-based virtual screening and experimental validation of the discovery of inhibitors targeted towards the human coronavirus nucleocapsid protein.

text: Nucleocapsid protein (NP), an essential RNA-binding viral protein in human coronavirus (CoV)-infected cells, is required for the replication and transcription of viral RNA. Recent studies suggested that human CoV NP is a valid target for antiviral drug development. Based on this aspect, structure-based virtual screening targeting nucleocapsid protein (NP) was performed to identify good chemical starting points for medicinal chemistry. The present study utilized structure-based virtual screening against human CoV-OC43 using the Zinc database, which is performed through docking with varying precisions and computational intensities to identify eight potential compounds. The chosen potential leads were further validated experimentally using biophysical means. Surface plasmon resonance (SPR) analysis indicated that one among the potential leads, 6-chloro-7-(2-morpholin-4-yl-ethylamino) quinoxaline-5,8-dione (small-compound H3), exhibited a significant decrease of RNA-binding capacity of NP by more than 20%. The loss of binding activity was manifested as a 20% decrease in the minimum on-rate accompanied with a 70% increase in the maximum off-rate. Fluorescence titration and X-ray crystallography studies indicated that H3 antagonizes the binding between HCoV-OC43 NP and RNA by interacting with the N-terminal domain of the NP. Our findings provide insight into the development of new therapeutics that disrupt the interaction between RNA and viral NP in the HCoV. The discovery of the new compound would be an impetus to design novel NP inhibitors against human CoV.


Covid-19: Can France's ethical support units help doctors make challenging decisions?


A Canadian framework for managing prostate cancer during the COVID-19 pandemic: Recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association.


Promoting Physical Activity During the COVID-19 Pandemic: Implications for Obesity and Chronic Disease Management.


title: Complications of cerebral angiography in children younger than 3 years of age.

text: OBJECT The therapeutic potential for cerebral angiography (CA) in young children is expanding. However, its use in this patient population is limited by presumed higher complication rates among children. Therefore, to improve the accuracy of counseling of the parents/guardians of these patients and to identify modifiable risk factors, the authors evaluated complications after CA in young children. METHODS The authors reviewed data for 309 consecutive cerebral angiograms obtained in 87 children younger than 36 months of age from 2004 to 2010 at a single institution. They analyzed demographics, diagnosis, angiographic findings, and complications. RESULTS The patient population comprised 40 boys and 47 girls; mean age was 14.36 months (range 1-36 months) and mean weight was 10.8 kg (range 3.7-21.0 kg). For 292 of the 309 procedures, intraarterial chemotherapy was administered; the remaining 17 procedures were for vascular malformations, stroke, tumor embolization, and intracranial hemorrhage. The rate of neurological complications was 0.0%. The rate of nonneurological complications was 2.9%: 7 cases of contrast allergy or bronchospasm, 1 groin hematoma (body weight 7 kg), and 1 transient femoral artery occlusion (body weight 10.8 kg). The rate of radiographic complications was 1.3%: 1 case of transient asymptomatic intraarterial dissection and 3 cases of asymptomatic vasospasm. Postprocedural MRI was performed for 33.3% of patients with no evidence of ischemia. There were no delayed complications. Mean follow-up time was 16.6 months. No association was found between complications and age, duration of anesthesia, number of vessels catheterized, size of the sheath, or diagnostic versus interventional procedures. Despite a trend toward a higher rate of complications for patients who weighed less than 15 kg, this finding was not significant (p = 0.35). CONCLUSIONS The rate of complications for CA in young children is comparable to rates reported for older children and lower than rates reported for adults. When appropriately indicated, CA should not be omitted from the therapeutic strategy of children younger than 36 months of age.


A new varietal of DNA interstrand crosslink repair.


[Single port distal pancreatectomy without spleen preserving].


Emergency Medicine Physician Burnout and Wellness in Canada prior to COVID19: A National Survey.


title: Web-Based Surveillance of Illness in Childcare Centers.

text: School absenteeism is an inefficient and unspecific metric for measuring community illness and does not provide surveillance during summertime. Web-based biosurveillance of childcare centers may represent a novel way to efficiently monitor illness outbreaks year-round. A web-based biosurveillance program ( sickchildcare.org ) was created and implemented in 4 childcare centers in a single Michigan county. Childcare providers were trained to report sick children who required exclusion or had parent-reported absences due to illness. Deidentified data on age range, number of illnesses, and illness categories were collected. Weekly electronic reports were sent to the county public health department. Data for reports were gathered beginning in December 2013 and were summarized using descriptive statistics. A total of 385 individual episodes of illness occurred during the study period. Children with reported illness were infants (16%, n = 61), toddlers (38%, n = 148), and preschoolers (46%, n = 176). Illness categories included: fever (30%, n = 116), gastroenteritis (30%, n = 115), influenzalike illness (8%, n = 32), cold without fever (13%, n = 51), rash (7%, n = 26), conjunctivitis (1%, n = 3), ear infection (1%, n = 5), and other (10%, n = 37). The majority of reports were center exclusions (55%, n = 214); others were absences (45%, n = 171). The detection of a gastroenteritis outbreak by web-based surveillance during winter 2013-14 preceded county health reports by 3 weeks; an additional outbreak of hand-foot-mouth disease was detected during June 2014 when standard school-based surveillance was not available. Web-based biosurveillance of illness in childcare centers represents a novel and feasible method to detect disease trends earlier and year-round compared to standard school-based disease surveillance.


title: Impact of COVID -19 on children: special focus on the psychosocial aspect.

text: Although medical literature shows that children are minimally susceptible to 2019-Corona virus disease (COVID-19), they are hit the hardest by psychosocial impact of this pandemic. Being quarantined in homes and institutions may impose greater psychological burden than the physical sufferings caused by the virus. School closure, lack of outdoor activity, aberrant dietary and sleeping habits are likely to disrupt children's usual lifestyle and can potentially promote monotony, distress, impatience, annoyance and varied neuropsychiatric manifestations. Incidences of domestic violence, child abuse, adulterated online contents are on the rise. Children of single parent and frontline workers suffer unique problems. The children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic, such as child labor, child trafficking, child marriage, sexual exploitation and death etc. Parents, pediatricians, psychologists, social workers, hospital authorities, government and non-governmental organizations have important roles to play to mitigate the psychosocial ill-effects of COVID-19 on children and adolescents. To provide the basic amenities, social security, medical care, and to minimize the educational inequities among the children of the different strata of the society are foremost priorities.


NIH move to ax bat coronavirus grant draws fire.


title: An enhancement strategy for integration of population health into medical school education: employing the framework developed by the Healthy People Curriculum Task Force.

text: The authors describe an enhancement strategy for integration of population health content into the medical school curriculum at The Brody School of Medicine at East Carolina University conducted in 2005-2006. The Clinical Prevention and Population Health Curriculum Framework developed by the Healthy People Curriculum Task Force served as the planning template for curriculum analysis. Key to success was the incorporation of population health as a "curriculum enhancement," as opposed to curricular expansion or substitution. Strategies included introduction of a Case-Based Series in Population-Oriented Prevention (C-POP) in the preclinical years; community assessments, home visits, and public health assignments in the family medicine and pediatrics clinical clerkships; and prevention history-taking. The Brody integrated curriculum included a wide range of topics and clinical experiences specific to prevention and population health; however, the coverage was uneven. Hybrid teaching cases were developed from four C-POP cases which were adapted to existing instructional materials. Students learned to define the determinants of health, disease burden in their community settings, and community strengths and obstacles specific to dealing with chronic conditions. Factors contributing to the successful integration of population health included a receptive primary care medical school, use of the Framework, analysis of gaps between the Framework and the existing curriculum, providing enhancements to the existing curriculum, employment of patient cases, and integrating population health into a variety of classroom and community medical learning experiences. This approach, as opposed to a separate and distinct course, seeks to reinforce the interconnectedness of communities, families, and individuals.


title: Integrating nutrition into health systems: What the evidence advocates.

text: There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration of nutrition-specific interventions with various programmes, including integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with no adverse effects on primary programme delivery. Through the lens of the six WHO building blocks, service delivery and health workforce were found to be well-integrated, but governance, information systems, finance and supplies and technology were less well-integrated. Integrating nutrition-specific interventions into health systems may ensure efficient service delivery while having an impact on nutrition outcomes. There is no single successful model of integration; it varies according to the context and demands of the particular setting in which integration occurs. There is a need for more well-planned programmes considering all the health systems building blocks to ensure compliance and sustainability.


title: Channel-Inactivating Mutations and Their Revertant Mutants in the Envelope Protein of Infectious Bronchitis Virus.

text: It has been shown previously in the severe acute respiratory syndrome coronavirus (SARS-CoV) that two point mutations, N15A and V25F, in the transmembrane domain (TMD) of the envelope (E) protein abolished channel activity and led to in vivo attenuation. Pathogenicity was recovered in mutants that also regained E protein channel activity. In particular, V25F was rapidly compensated by changes at multiple V25F-facing TMD residues located on a neighboring monomer, consistent with a recovery of oligomerization. Here, we show using infected cells that the same mutations, T16A and A26F, in the gamma-CoV infectious bronchitis virus (IBV) lead to, in principle, similar results. However, IBV E A26F did not abolish oligomer formation and was compensated by mutations at N- and C-terminal extramembrane domains (EMDs). The C-terminal EMD mutations clustered along an insertion sequence specific to gamma-CoVs. Nuclear magnetic resonance data are consistent with the presence of only one TMD in IBV E, suggesting that recovery of channel activity and fitness in these IBV E revertant mutants is through an allosteric interaction between EMDs and TMD. The present results are important for the development of IBV live attenuated vaccines when channel-inactivating mutations are introduced in the E protein.IMPORTANCE The ion channel activity of SARS-CoV E protein is a determinant of virulence, and abolishment of channel activity leads to viral attenuation. E deletion may be a strategy for generating live attenuated vaccines but can trigger undesirable compensatory mechanisms through modifications of other viral proteins to regain virulence. Therefore, a more suitable approach may be to introduce small but critical attenuating mutations. For this, the stability of attenuating mutations should be examined to understand the mechanisms of reversion. Here, we show that channel-inactivating mutations of the avian infectious bronchitis virus E protein introduced in a recombinant virus system are deficient in viral release and fitness and that revertant mutations also restored channel activity. Unexpectedly, most of the revertant mutations appeared at extramembrane domains, particularly along an insertion specific for gammacoronaviruses. Our structural data propose a single transmembrane domain in IBV E, suggesting an allosteric interaction between extramembrane and transmembrane domains.


title: Single port laparoscopic myomectomy with intracorporeal suture-tying and transumbilical morcellation.

text: OBJECTIVE To evaluate the feasibility of single-port laparoscopic myomectomy (SPLM) with intracoporeal suture-tying and transumbilical morcellation. STUDY DESIGN We retrospectively reviewed the medical records of 100 consecutive women who underwent SPLM without any combined surgery between January 2010 and July 2011. The medical records were reviewed and the clinical outcomes were analyzed. Single port entry was established using a wound retractor and a surgical glove. After myoma was enucleated from myometrium, intracorporeal suturing and knot tying was done for myometrium repair. Enucleated myoma was extracted through umbilicus using tissue morcellator. Factors investigated included operation time, blood loss, postoperative hospital stay and complications. RESULTS Mean patient age and BMI were 40.4±7.1 years and 23.1±3.5kg/m(2). Mean diameter of largest myoma and number of myomas were 6.6±2.2 (range 2-12) cm and 1.6±1.2 (range 1-7), respectively. Mean weight of myoma was 136.9±118.4 (range 4-684)g. Type of the main myomas were intramural (80/100), submucosal (5/100), subserosal (12/100), and intraligamentary (3/100). Location of the main myomas were anterior (36/100), posterior (24/100), fundal (30/100), and lateral (10/100). Mean operation time and estimated blood loss were 116.3±36.8min and 94.6±74.5mL. Mean hospital stay after the operation was 2±0.4 days. Conversion to double port surgery (one more trocar inserted on suprapubic site) was occurred in 1 patient due to severe pelvic adhesion. No patient experienced major complications, including bowel, ureter, or bladder injuries, or incisional hernia. CONCLUSION SPLM is safe and acceptable for various myoma sites and sizes up to 12cm. Intracorporeal suture-tying and transumbilical morcellation are key technical points of SPLM.


title: Image-guided thermal ablation of lung malignancies.

text: Primary and secondary lung malignancies are often treated with surgery. Many patients are poor surgical candidates owing to advanced age or medical comorbidities. Alternatives to surgery for localized disease include radiation therapy and the newer treatments known as image-guided thermal ablation. Image-guided thermal ablation involves the use of needlelike applicators that are placed directly into tumors by using imaging guidance. Tumors are destroyed by the application of either intense heat or cold. The specific ablative modalities of radiofrequency ablation, microwave ablation, laser ablation, and cryoablation are reviewed with respect to the various clinical indications for treatment of both primary and secondary lung malignancies.


title: Is Roux-Y binding pancreaticojejunal anastomosis feasible for patients undergoing left pancreatectomy? Results from a prospective randomized trial.

text: BACKGROUND After pancreaticoduodenectomy, the Finnish binding pancreaticojejunal anastomosis (FBPJ) seems to reduce the risk for pancreatic fistula (POPF). Our aim was to investigate whether FBPJ is feasible and prevents the risk for POPF even after left pancreatectomy (LP). PATIENTS AND METHODS 47 consecutive patients underwent LP. 27 patients were recruited on the basis of CT and, of these, 16 patients were randomized on the basis of findings during surgery (transection line must be left of portal vein, as 2-3 cm pancreatic mobilization is required for FBPJ) to receive either Roux-Y FBPJ or hand-sewn closure of the pancreatic remnant. RESULTS Only 34% (16/47) of the patients met the randomization criteria. Clinically significant POPF rate was higher in FBPJ group (60%) compared to thand-sewn closure group (13%; P<0.05). POPF rate in FBPJ group was higher even when compared to all patients with hand-sewn closure (60% versus 37%; P<0.05). Overall, FBPJ was technically feasible for only 28% of patients. CONCLUSION FBPJ cannot be recommended for the routine closure of the pancreatic remnant after LP, as it was not technically achievable in 72% of the cases. Moreover, the technique does not seem to reduce the risk for POPF compared to the hand-sewn closure.


title: From lab to bedside: emerging clinical applications of thymosin alpha 1.

text: BACKGROUND Thymosin alpha(1) (Talpha(1)), a synthetic version of a thymic-derived biological response modifier was the first of the thymosins in clinical use. Talpha(1) is approved in over 35 countries for the treatment of hepatitis B and C, and as an immune stimulant and adjuvant. Talpha(1) is also in late-stage clinical testing in the United States and Europe for hepatitis C and stage IV melanoma. OBJECTIVE/METHODS Novel applications and other recently completed trials point to much broader clinical applications of Talpha(1) in the treatment of life-threatening and chronic diseases, and are the subject of this review. RESULT/CONCLUSIONS The most recent reports of clinical trials with Talpha(1) are pointing to important, hitherto unrecognized, applications in a number of diseases and disorders, including septic shock, acute respiratory distress syndrome, peritonitis, acute cytomegalovirus infection, TB, severe acute respiratory syndrome, and lung infections in critically ill patients. It is also emerging as a promising chemoprotection agent in patients undergoing chemotherapy.


title: Failed Mask Ventilation due to Air Leakage around the Orbit in a Patient with a History of Radical Maxillofacial Surgery with Orbital Exenteration.

text: A 72-year-old male (height: 160 cm, weight: 53 kg) was scheduled to undergo left renal and male with ans uterine tract resection. The patient had previously undergone right radical maxillofacial surgery with orbital exenteration 14 years before the present operation to treat squamous cell carcinoma of the right maxillary sinus, with tumour invasion to the orbital floor. An anaesthesiologist encountered difficulty in performing mask ventilation during the induction of anaesthesia in the patient, despite a good mask fit on the face, because the adhesive tape around the orbit had moved. Urgent endotracheal intubation was successful without desaturation. A postoperative examination revealed that a communication between the nasal cavity and the orbit was visible on computed tomograms obtained nine years before the surgery. The patient felt the air leakage around the adhesive tape. The anaesthesiologist should have removed the adhesive tape to directly observe the lesion and should have realised that the communication might cause difficulty in mask ventilation. Careful examination of the airways using computed tomography and precise interviews may improve the understanding of patients' airways and may help avoid similar events.


title: Virus-specific memory CD8 T cells provide substantial protection from lethal severe acute respiratory syndrome coronavirus infection.

text: UNLABELLED Severe acute respiratory syndrome coronavirus (SARS-CoV) caused an acute human respiratory illness with high morbidity and mortality in 2002-2003. Several studies have demonstrated the role of neutralizing antibodies induced by the spike (S) glycoprotein in protecting susceptible hosts from lethal infection. However, the anti-SARS-CoV antibody response is short-lived in patients who have recovered from SARS, making it critical to develop additional vaccine strategies. SARS-CoV-specific memory CD8 T cells persisted for up to 6 years after SARS-CoV infection, a time at which memory B cells and antivirus antibodies were undetectable in individuals who had recovered from SARS. In this study, we assessed the ability of virus-specific memory CD8 T cells to mediate protection against infection in the absence of SARS-CoV-specific memory CD4 T or B cells. We demonstrate that memory CD8 T cells specific for a single immunodominant epitope (S436 or S525) substantially protected 8- to 10-month-old mice from lethal SARS-CoV infection. Intravenous immunization with peptide-loaded dendritic cells (DCs) followed by intranasal boosting with recombinant vaccinia virus (rVV) encoding S436 or S525 resulted in accumulation of virus-specific memory CD8 T cells in bronchoalveolar lavage fluid (BAL), lungs, and spleen. Upon challenge with a lethal dose of SARS-CoV, virus-specific memory CD8 T cells efficiently produced multiple effector cytokines (gamma interferon [IFN-γ], tumor necrosis factor alpha [TNF-α], and interleukin 2 [IL-2]) and cytolytic molecules (granzyme B) and reduced lung viral loads. Overall, our results show that SARS-CoV-specific memory CD8 T cells protect susceptible hosts from lethal SARS-CoV infection, but they also suggest that SARS-CoV-specific CD4 T cell and antibody responses are necessary for complete protection. IMPORTANCE Virus-specific CD8 T cells are required for pathogen clearance following primary SARS-CoV infection. However, the role of SARS-CoV-specific memory CD8 T cells in mediating protection after SARS-CoV challenge has not been previously investigated. In this study, using a prime-boost immunization approach, we showed that virus-specific CD8 T cells protect susceptible 8- to 10-month-old mice from lethal SARS-CoV challenge. Thus, future vaccines against emerging coronaviruses should emphasize the generation of a memory CD8 T cell response for optimal protection.


title: Real-time observations of the impact of COVID-19 on underwater noise.

text: A slowdown in global trade activity due to COVID-19 has led to a reduction in commercial shipping traffic into the Port of Vancouver. The Ocean Networks Canada observatory system provides researchers real-time access to oceanographic data from a wide range of instruments including hydrophones located along the offshore and inshore approaches to Vancouver. Measurements of power spectral density at 100 Hz from four of these bottom mounted hydrophones are presented, along with AIS data and shipping and trade statistics to assess to what extent the economic impact of COVID-19 can be observed acoustically and in near real-time. The quarterly trend in median weekly noise power in the shipping band of frequencies shows that a reduction in noise commensurate with the economic slowdown has been observed at three of the four hydrophone stations.