title: Vertical sleeve gastrectomy improves indices of metabolic disease in rodent model of surgical menopause.

text: OBJECTIVE Although women are the most common recipients of weight loss surgeries for the amelioration of the comorbidities of obesity, few studies have addressed the efficacy of these procedures with specific attention to reproductive stage. Here we ask in a rodent model of vertical sleeve gastrectomy (VSG) whether improvements to metabolic health are realized in women having received surgical menopause. Specifically we were interested in knowing whether rats made menopausal through surgical means would exhibit persistent hepatic steatosis as reported in previously pregnant, freely cycling female VSG rats or if it is resolved as reported in male VSG rats. METHODS All the rats first received ovariectomy (OVX) and then were placed on high-fat diet before either sham or VSG surgery (N = 12, 9) and then were monitored for resolution of obesity-related comorbidities. RESULTS VSG was sufficient to reduce weight and adiposity in OVX females in comparison to obese rats (P < 0.001). Glucose tolerance (P < 0.05) was improved in OVX-VSG females with no change in insulin sensitivity. Both circulating (P < 0.01) and hepatic triglyceride (P < 0.01) levels were also reduced after VSG. Liver integrity was improved in OVX-VSG in comparison to OVX-obese as reflected by reduced aspartate aminotransferase levels (P < 0.05). The ability of mitochondria to generate adenosine triphosphate was maintained, and an increase in complex IV may decrease the production of mitochondrial reactive oxygen species. CONCLUSIONS Taken together, VSG in OVX rats experience many positive benefits including the resolution of hepatic steatosis that persists in reproductively intact female rats after VSG.


title: Hierarchical Poincaré analysis for anaesthesia monitoring.

text: Although the degree of dispersion in Poincaré plots of electroencephalograms (EEG), termed the Poincaré-index, detects the depth of anaesthesia, the Poincaré-index becomes estranged from the bispectral index (BIS) at lighter anaesthesia levels. The present study introduces Poincaré-index20-30 Hz, targeting the 20- to 30-Hz frequency, as the frequency range reported to contain large electromyogram (EMG) portions in frontal EEG. We combined Poincaré-index20-30 Hz with the conventional Poincaré-index0.5-47 Hz using a deep learning technique to adjust to BIS values, and examined whether this layered Poincaré analysis can provide an index of anaesthesia level like BIS. A total of 83,867 datasets of these two Poincaré-indices and BIS-monitor-derived parameters were continuously obtained every 3 s from 30 patients throughout general anaesthesia, and were randomly divided into 75% for a training dataset and 25% for a test dataset. Two Poincaré-indices and two supplemental EEG parameters (EMG70-110 Hz, suppression ratio) in the training dataset were trained in a multi-layer perceptron neural network (MLPNN), with reference to BIS as supervisor. We then evaluated the trained MLPNN model using the test dataset, by comparing the measured BIS (mBIS) with BIS predicted from the model (PredBIS). The relationship between mBIS and PredBIS using the two Poincaré-indices showed a tight linear regression equation: mBIS = 1.00 × PredBIS + 0.15, R = 0.87, p < 0.0001, root mean square error (RMSE) = 7.09, while the relationship between mBIS and PredBIS simply using the original Poincaré-index0.5-47 Hz was weaker (R = 0.82, p < 0.0001, RMSE = 7.32). This suggests the 20- to 30-Hz hierarchical Poincaré analysis has potential to improve on anaesthesia depth monitoring constructed by simple Poincaré analysis.


title: PP-9 NORMAL VALUES OF 3D HIGH-RESOLUTION ANORECTAL MANOMETRY IN CHIDREN.

text: BACKGROUND AND AIMS 3D high-resolution anorectal manometry (3D HRAM) provides a 3D topographic image of pressure along the anal canal. The aim of the study was to determine normal values of 3D HRAM in children. METHODS Children without any symptoms arising from the lower gastrointestinal tract were prospectively enrolled in the study. Manometry procedures were performed using a rigid probe (Covidien/Medtronic, Ireland) without premedication. Pressure within the anal canal and 3D images of sphincters were measured. If possible, defecation dynamics and thresholds of sensation were evaluated. Data were expressed as the mean (±SD). RESULTS A total of 61 children (34 males; age: 2-17 years, mean: 8.28 years) were studied. The mean resting and squeeze sphincter pressures were 83.43 (±23.23) mmHg and 191 (±64.21) mmHg, respectively. The mean length of the anal canal was 2.62 (±0.68) cm and correlated with age (r = 0.49, p < 0.0001). The mean rectal balloon volume to elicit recto-anal inhibitory reflex was 15.66 (±10.9) cc. The first sensation, urge and discomfort were observed at 24.42 (±23.98) cc, 45.91 (±34.55) cc and 91.58 (±50.17) cc of the balloon volume, respectively. The mean resting pressure of the puborectalis muscle was 71.54 (±14.58) mmHg while the mean squeeze pressure was 134.10 (±35.2) mmHg. A positive correlation between age and balloon volume needed to elicit discomfort was determined (r = 0.49, p < 0.001). CONCLUSION Normative data of 3D HRAM in children without symptoms arising from the lower gastrointestinal tract were established. There were no significant differences in pressure results between males and females.


title: Natural and experimental Helicobacter pullorum infection in Brown Norway rats.

text: Helicobacter pullorum is an enterohepatic Helicobacter species (EHS) that was recently reported as a naturally acquired infection in mice. Faecal samples from 18 out of 20 Brown Norway (BN) rats, housed in the same barrier as the H. pullorum-infected mice, were positive for H. pullorum using species-specific PCR. In addition, we determined whether H. pullorum was able to persistently colonize the gastrointestinal tract and/or biliary tree and elicit tissue inflammation as well as a serum IgG response in BN rats. Six (four male, two female) 6-week-old, H. pullorum-negative BN rats were orally dosed with 4×10(8) c.f.u. of H. pullorum every other day for a total of three doses. At 2 weeks post-infection, all rats were H. pullorum-positive by faecal PCR. Five out of the six BN rats remained H. pullorum-positive for the entire 30 week study. PCR analysis of tissue collected at necropsy confirmed that the colon and caecum were the primary sites of H. pullorum colonization. Rats that were persistently colonized by H. pullorum had a sustained H. pullorum-specific IgG response measured by ELISA. Intestinal or hepatic pathology associated with H. pullorum infection was not noted. To our knowledge, this is the first report documenting that rats can be persistently colonized with an EHS that also infects humans.


title: Dormant micro arteriovenous malformations lead to recurrent cerebral haemorrhage.

text: INTRODUCTION Some micro arteriovenous malformations (AVMs) located in deep brain are undetectable. How to choose a proper timing to detect these AVMs remains unclear. CASE DESCRIPTION A 21-year-old male patient was admitted to our center for intraventricular haematoma. Digital subtraction angiographies (DSAs) were performed one week and one month respectively after his haemorrhage, but no positive results were obtained. The patient was hospitalized for re-haemorrhage six years later. A micro AVM with two diffused niduses was detected and embolised three months after his re-haemorrhage. The patient recovered without any neurological deficit. DISCUSSION AND EVALUATION Compressive effects of haematoma and spontaneous obliteration of AVMs might play pivotal roles in negative DSA results. CONCLUSIONS Strategic and timely use of DSA could identify some dormant re-haemorrhagic AVMs.


title: Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.

text: The technically easier one-anastomosis (mini) gastric bypass (MGB) is associated with similar metabolic improvements and weight loss as the Roux-en-Y gastric bypass (RYGB). However, MGB is controversial and suspected to result in greater malabsorption than RYGB. In this study, we compared macronutrient absorption and intestinal adaptation after MGB or RYGB in rats. Body weight and food intake were monitored and glucose tolerance tests were performed in rats subjected to MGB, RYGB, or sham surgery. Carbohydrate, protein, and lipid absorption was determined by fecal analyses. Intestinal remodeling was evaluated by histology and immunohistochemistry. Peptide and amino acid transporter mRNA levels were measured in the remodeled intestinal mucosa and those of anorexigenic and orexigenic peptides in the hypothalamus. The MGB and RYGB surgeries both resulted in a reduction of body weight and an improvement of glucose tolerance relative to sham rats. Hypothalamic orexigenic neuropeptide gene expression was higher in MGB rats than in RYGB or sham rats. Fecal losses of calories and proteins were greater after MGB than RYGB or sham surgery. Intestinal hyperplasia occurred after MGB and RYGB with increased jejunum diameter, higher villi, and deeper crypts than in sham rats. Peptidase and peptide or amino acid transporter genes were overexpressed in jejunal mucosa from MGB rats but not RYGB rats. In rats, MGB led to greater protein malabsorption and energy loss than RYGB. This malabsorption was not compensated by intestinal overgrowth and increased expression of peptide transporters in the jejunum.


title: The unacknowledged incidence of laparoscopic stapler malfunction.

text: BACKGROUND Laparoscopic instruments are being used with increasing frequency. Our surgeons recently experienced several independent adverse events involving the laparoscopic linear stapler. Although the Food and Drug Administration maintains a Manufacturer and User Facility Device Experience (MAUDE) database to track such voluntary reports, many events are not reported and the true incidence of adverse events is unknown. We attempted to determine how frequently minimally invasive surgeons have experienced technical problems with a laparoscopic stapler. METHODS Following IRB approval, we electronically distributed an anonymous 10-question survey to the 124 minimally invasive program directors listed in the Fellowship Council database. The questions focused on personal or peer experience with laparoscopic stapler malfunction, frequency and type of malfunction, device manufacturer, whether the operation was altered, and root cause analysis of the event. RESULTS Forty-four of the 124 program directors (35%) completed the survey. The majority reported personal or peer experience (86%) with a linear stapler not releasing (66%) or not firing (73%) after application, with 27% of the respondents noting that this occurred three or more times. The malfunction was not related to type of load, straight (23%) or reticulating (32%) model, or manufacturer (Ethicon 30%, Covidien 36%). One quarter of the respondents noted that the malfunction caused them to significantly alter their operative procedure, and 30% reported that they received no helpful feedback from the manufacturer despite contacting it. CONCLUSIONS Most minimally invasive surgeons have experienced laparoscopic linear stapler malfunction and 25% have had to significantly alter the planned operative procedure due to the malfunction.


title: Radiological approach to COVID-19 pneumonia with an emphasis on chest CT.

text: Coronavirus disease 2019 (COVID-19) has recently become a worldwide outbreak with several millions of people infected and more than 160.000 deaths. A fast and accurate diagnosis in this outbreak is critical to isolate and treat patients. Radiology plays an important role in the diagnosis and management of the patients. Among various imaging modalities, chest CT has received attention with its higher sensitivity and specificity rates. Shortcomings of the real-time reverse transcriptase-polymerase chain reaction test, including inappropriate sample collection and analysis methods, initial false negative results, and limited availability has led to widespread use of chest CT in the diagnostic algorithm. This review summarizes the role of radiology in COVID-19 pneumonia, diagnostic accuracy of imaging, and chest CT findings of the disease.


title: The plight of patients with lupus nephritis in Wuhan, China.

text: The number of cases of SARS-CoV2 infection is rising rapidly globally. Severe disease and high fatality are observed in older patients and with comorbid conditions (1).


title: Global regulation of alternative RNA splicing by the SR-rich protein RBM39.

text: BACKGROUND RBM39 is a serine/arginine-rich RNA-binding protein that is highly homologous to the splicing factor U2AF65. However, the role of RBM39 in alternative splicing is poorly understood. METHODS In this study, RBM39-mediated global alternative splicing was investigated using RNA-Seq and genome-wide RBM39-RNA interactions were mapped via cross-linking and immunoprecipitation coupled with deep sequencing (CLIP-Seq) in wild-type and RBM39-knockdown MCF-7 cells. RESULTS RBM39 was involved in the up- or down-regulation of the transcript levels of various genes. Hundreds of alternative splicing events regulated by endogenous RBM39 were identified. The majority of these events were cassette exons. Genes containing RBM39-regulated alternative exons were found to be linked to G2/M transition, cellular response to DNA damage, adherens junctions and endocytosis. CLIP-Seq analysis showed that the binding site of RBM39 was mainly in proximity to 5' and 3' splicing sites. Considerable RBM39 binding to mRNAs encoding proteins involved in translation was observed. Of particular importance, ~20% of the alternative splicing events that were significantly regulated by RBM39 were similarly regulated by U2AF65. CONCLUSIONS RBM39 is extensively involved in alternative splicing of RNA and helps regulate transcript levels. RBM39 may modulate alternative splicing similarly to U2AF65 by either directly binding to RNA or recruiting other splicing factors, such as U2AF65. GENERAL SIGNIFICANCE The current study offers a genome-wide view of RBM39's regulatory function in alternative splicing. RBM39 may play important roles in multiple cellular processes by regulating both alternative splicing of RNA molecules and transcript levels.


title: Ticagrelor in Acute Stroke or Transient Ischemic Attack in Asian Patients: From the SOCRATES Trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes).

text: BACKGROUND AND PURPOSE In the SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes), ticagrelor was not superior to aspirin. Because of differences in patient demographics and stroke disease pattern in Asia, outcomes of ticagrelor versus aspirin were assessed among Asian patients in a prespecified exploratory analysis. METHODS Baseline demographics, treatment effects, and safety of ticagrelor and aspirin were assessed among Asian patients. Differences in outcomes between groups were assessed using Cox proportional hazard model. RESULTS A total of 3858 (29.2%) SOCRATES participants were recruited in Asia. Among the Asian patients, the primary end point event occurred in 186 (9.6%) of the 1933 patients treated with ticagrelor, versus 224 (11.6%) of the 1925 patients treated with aspirin (hazard ratio, 0.81; 95% confidence interval, 0.67-0.99). The exploratory P value for treatment-by-region interaction was 0.27. The primary end point event rate in the Asian subgroup was numerically higher than that in the non-Asian group (10.6% versus 5.7%; nominal P<0.01). Among the Asian patients, the rate of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeding was similar in the ticagrelor group and the aspirin group (0.6% versus 0.8%; hazard ratio, 0.76; 95% confidence interval, 0.36-1.61). CONCLUSIONS The event rates were numerically higher in the Asian patients. Among the Asian patients with acute stroke or transient ischemic attacks, there was a trend toward a lower hazard ratio in reducing risk of the primary end point of stroke, myocardial infarction, or death in the ticagrelor group. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.


title: Cadaveric validation of porcine model suggests noninvasive positive pressure ventilation may be safe following esophagectomy.

text: BACKGROUND We previously used a pig model to demonstrate that noninvasive positive pressure ventilation (NPPV) may be a safe alternative to endotracheal intubation (ET). We sought to validate our model by quantifying the pressure threshold of esophageal anastomoses in human cadavers as a step before a clinical trial. METHODS We performed stapled side-to-side, functional end-to-end esophageal anastomoses in 10 cadaveric specimens from autopsy. With intraluminal pressure monitoring, we insufflated the anastomosis with air until a leak was observed, and measured the maximum tolerated pressure. RESULTS Cadaveric esophageal anastomoses tolerated 101±39 cmH2O (range, 63-140 cmH2O) of pressure before leak was observed. The maximum pressure threshold ranged from 59 to 246 cmH2O. The leak was always at the anastomosis. There was no significant difference in pressure threshold between cadaveric and previously described porcine anastomoses. CONCLUSIONS We created a human cadaveric model that in conjunction with our porcine data demonstrates that a human esophageal anastomosis can tolerate manifold higher pressures than are delivered to the esophagus by NPPV. This is the final step before a trial of NPPV in patients following esophagectomy.


title: Swallowing behaviours and feeding environment in relation to communication development from early infancy to 6 years of age: a scoping review protocol.

text: INTRODUCTION Understanding the influences of early swallowing function and feeding environment on the development of communication will enhance prevention and intervention initiatives for young children. This scoping review will help elucidate key elements affecting the developmental trajectory of communicative systems, typically robust and well-developed by formal school entry. We aim to (1) map the current state of the literature in a growing field of interest that has the potential to advance knowledge translation, (2) identify existing gaps and (3) provide research direction for future investigations surrounding feeding-swallowing functions and environment that support or forestall communication development in young children. METHODS AND ANALYSIS We are proposing a scoping review to identify the breadth and depth of the existing literature regarding swallowing-feeding functions and environment relative to the onset and progression of communicative behaviours from infancy to 6 (<6;0) years of age. Our protocol delineates rigorous methods according to Arskey and O'Malley's framework and includes elaborations by Levac and colleagues. We will search the literature based on 10 databases, 17 peer-reviewed journals, 4 conference proceedings and 6 grey literature sources. Two authors will independently screen abstracts and review full articles, remaining blind to each other's results. A third author will contribute to resolving any discrepant results from both the abstract and article review. Subsequently, we will extract data and chart information from accepted articles using a pre-established data collection form. We will stratify results according to healthy versus impaired swallowing-feeding functions and communication development. ETHICS AND DISSEMINATION Our scoping review does not require ethical approval. We will disseminate our final study results through international and national conference presentations, publication in a peer-reviewed journal and knowledge translation activities with stakeholders.


title: POMC: The Physiological Power of Hormone Processing.

text: Pro-opiomelanocortin (POMC) is the archetypal polypeptide precursor of hormones and neuropeptides. In this review, we examine the variability in the individual peptides produced in different tissues and the impact of the simultaneous presence of their precursors or fragments. We also discuss the problems inherent in accurately measuring which of the precursors and their derived peptides are present in biological samples. We address how not being able to measure all the combinations of precursors and fragments quantitatively has affected our understanding of the pathophysiology associated with POMC processing. To understand how different ratios of peptides arise, we describe the role of the pro-hormone convertases (PCs) and their tissue specificities and consider the cellular processing pathways which enable regulated secretion of different peptides that play crucial roles in integrating a range of vital physiological functions. In the pituitary, correct processing of POMC peptides is essential to maintain the hypothalamic-pituitary-adrenal axis, and this processing can be disrupted in POMC-expressing tumors. In hypothalamic neurons expressing POMC, abnormalities in processing critically impact on the regulation of appetite, energy homeostasis, and body composition. More work is needed to understand whether expression of the POMC gene in a tissue equates to release of bioactive peptides. We suggest that this comprehensive view of POMC processing, with a focus on gaining a better understanding of the combination of peptides produced and their relative bioactivity, is a necessity for all involved in studying this fascinating physiological regulatory phenomenon.


title: Processing by RNase 1 forms tRNA halves and distinct Y RNA fragments in the extracellular environment.

text: Extracellular RNAs participate in intercellular communication, and are being studied as promising minimally invasive diagnostic markers. Several studies in recent years showed that tRNA halves and distinct Y RNA fragments are abundant in the extracellular space, including in biofluids. While their regulatory and diagnostic potential has gained a substantial amount of attention, the biogenesis of these extracellular RNA fragments remains largely unexplored. Here, we demonstrate that these fragments are produced by RNase 1, a highly active secreted nuclease. We use RNA sequencing to investigate the effect of a null mutation of RNase 1 on the levels of tRNA halves and Y RNA fragments in the extracellular environment of cultured human cells. We complement and extend our RNA sequencing results with northern blots, showing that tRNAs and Y RNAs in the non-vesicular extracellular compartment are released from cells as full-length precursors and are subsequently cleaved to distinct fragments. In support of these results, formation of tRNA halves is recapitulated by recombinant human RNase 1 in our in vitro assay. These findings assign a novel function for RNase 1, and position it as a strong candidate for generation of tRNA halves and Y RNA fragments in biofluids.


title: Robot-assisted laparoscopic Mitrofanoff appendicovesicostomy technique and outcomes of extravesical and intravesical approaches.

text: BACKGROUND With growing experience in pediatric robotic surgery, select centers are now performing robot-assisted, laparoscopic Mitrofanoff appendicovesicostomy (RALMA). OBJECTIVE We present our technique and outcomes of RALMA with or without enterocystoplasties and compare stomal outcomes between two different approaches of the appendicovesical anastomosis: an extravesical (EV) anterior bladder approach and an intravesical (IV) posterior bladder approach. DESIGN, SETTING, AND PARTICIPANTS Data from 18 children who have undergone RALMA since 2008 were retrospectively reviewed. RALMA was performed by one surgeon in an academic setting. SURGICAL PROCEDURE The appendix was anastomosed on the posterior wall of the bladder intravesically when concomitant enterocystoplasty was done. Otherwise, the appendix was anastomosed extravesically on the anterior wall of the bladder. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome measured was the overall continence rate. Secondary outcomes included the overall complication rate and stomal complications. RESULTS AND LIMITATIONS The entire cohort included 18 patients (10 IV, 8 EV). The mean overall operative time was 494.1 min. The mean overall length of hospitalization was 5.2 d. There were five immediate, postoperative complications (all Clavien grade 1): three postoperative ilea, one stomal site infection, and one clogged suprapubic catheter. Median follow-up was 24.2 mo. The overall stomal continence rate was 94.4%. One patient from the IV group required dextranomer/hyaluronic acid copolymer for stomal incontinence. Among the eight patients in the EV cohort, there was one stomal complication of stomal stenosis (Clavien grade 1). Among the 10 patients in the IV cohort, there were two stomal complications requiring revisions (both Clavien grade 3): parastomal hernia and stomal stenosis. Limitations of the study include retrospective design, small number of patients, and lack of direct comparison of approaches given the nature of the surgery. CONCLUSIONS Our updated outcomes of RALMA with or without enterocystoplasty continue to be encouraging, with a 94.4% continence rate. We believe that anterior EV reimplantation is a feasible option in isolated RALMA.


title: COVID-19: A Window of Opportunity for Positive Healthcare Reforms.

text: The current coronavirus disease 2019 (COVID-19) pandemic is testing healthcare systems like never before and all efforts are now being put into controlling the COVID-19 crisis. We witness increasing morbidity, delivery systems that sometimes are on the brink of collapse, and some shameless rent seeking. However, besides all the challenges, there are also possibilities that are opening up. In this perspective, we focus on lessons from COVID-19 to increase the sustainability of health systems. If we catch the opportunities, the crisis might very well be a policy window for positive reforms. We describe the positive opportunities that the COVID-19 crisis has opened to reduce the sources of waste for our health systems: failures of care delivery, failures of care coordination, overtreatment or low-value care, administrative complexity, pricing failures and fraud and abuse. We argue that current events can canalize some very needy reforms to make our systems more sustainable. As always, political policy windows are temporarily open, and so swift action is needed, otherwise the opportunity will pass and the vested interests will come back to pursue their own agendas. Professionals can play a key role in this as well.


Prenatal Air Pollution and Child Lung Function: The Impossible Search for a Vulnerable Trimester.


title: Premature infants born at <25 weeks of gestation may be compromised by currently recommended resuscitation techniques.

text: AIM Standard resuscitation guidelines are based on data from a range of gestational ages. We sought to evaluate the effectiveness of our delivery room resuscitation protocol across a range of gestational ages in preterm infants born at <29 weeks. METHODS We performed an observational study of prospectively collected video recordings of 73 preterm infants. The percentage of bradycardic patients, time to reach target oxygen saturation and the extent of all interventions were compared between three gestational age groups: 22-24 weeks (n = 22), 25-26 weeks (n = 27) and 27-28 weeks (n = 24). RESULTS Although the same resuscitation protocol was followed for all infants, bradycardic infants born <25 weeks responded poorly and required significantly longer to reach oxygen saturation targets of >70%, >80% and >90% (p < 0.03). They required significantly more interventions and had higher rate of death (p < 0.05) and severe intraventricular haemorrhage (p < 0.03). Significantly lower heart rate and oxygen saturation values were found in infants with intraventricular haemorrhage. CONCLUSION Current recommendations for resuscitation may fail to achieve timely lung aeration in infants born at the borderline of viability, leading to higher mortality and morbidity. Sustained inflation and delayed cord clamping may be effective alternatives.


title: Endoscopic haemostasis: an overview of procedures and clinical scenarios.

text: Acute gastrointestinal bleeding is among the most urgent situations in daily gastroenterological practise. Endoscopy plays a key role in the diagnosis and treatment of such cases. Endoscopic haemostasis is probably the most important technical challenge that must be mastered by gastroenterologists. It is essential for both the management of acute gastrointestinal haemorrhage and the prevention of bleeding during high-risk endoscopic procedures. During the last decade, endoscopic haemostasis techniques and tools have grown in parallel with the number of devices available for endotherapy. Haemostatic powders, over-the-scope clips, haemostatic forceps, and other emerging technologies have changed daily practise and complement the standard available armamentarium (injectable, thermal, and mechanical therapy). Although there is a lack of strong evidence-based information on these procedures because of the difficulty in designing statistically powerful trials on this topic, physicians must be aware of all available devices to be able to choose the best haemostatic tool for the most effective procedure. We herein present an overview of procedures and clinical scenarios to optimise the management of gastrointestinal bleeding in daily practise.


title: In Vitro Response of Human Peripheral Blood Mononuclear Cells (PBMC) to Collagen Films Treated with Cold Plasma.

text: The implantation of biomedical devices, including collagen-based implants, evokes an inflammatory response. Despite inflammation playing an important role in the early stages of wound healing, excessive and non-resolving inflammation may lead to the poor performance of biomaterial implants in some patients. Therefore, steps should be taken to control the level and duration of an inflammatory response. In this study, oxygen and nitrogen gas plasmas were employed to modify the surface of collagen film, with a view to modifying the surface properties of a substrate in order to induce changes to the inflammatory response, whilst maintaining the mechanical integrity of the underlying collagen film. The effects of cold plasma treatment and resultant changes to surface properties on the non-specific inflammatory response of the immune system was investigated in vitro in direct contact cell culture by the measurement of protein expression and cytokine production after one and four days of human peripheral blood mononuclear cell (PBMC) culture. The results indicated that compared to oxygen plasma, nitrogen plasma treatment produced an anti-inflammatory effect on the collagen film by reducing the initial activation of monocytes and macrophages, which led to a lower production of pro-inflammatory cytokines IL-1β and TNFα, and higher production of anti-inflammatory cytokine IL-10. This was attributed to the combination of the amino chemical group and the significant reduction in roughness associated with the introduction of the nitrogen plasma treatment, which had an effect on the levels of activation of the adherent cell population.


Pneumonitis and extreme failure to thrive.


title: Work-related Mental Consequences: Implications of Burnout on Mental Health Status Among Health Care Providers.

text: INTRODUCTION Burnout can create problems in every aspect of individual's' human life. It may have an adverse effect on interpersonal and family relations and can lead to a general negative attitude towards life. AIM The purpose of this study is to investigate whether burnout is associated with the mental health status of health care providers. MATERIAL AND METHODS The sample in this study consisted of 240 health care employees. The Greek version of Maslach's Burnout Inventory (MBI) was used for measuring burnout levels and the Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate health care providers' mental health status. Descriptive statistics were initially generated for sample characteristics. Normality was checked by the Kolmogorov-Smirnov test and data was processed with parametric tests. General linear models with MBI dimensions as independent variables and SRSDA subscales as dependent variables were used to determine the relation between burnout and mental health status. Statistics were processed with SPSS v. 17.0 (SPSS, Chicago, IL, USA). Statistical significance was set at p=0.05. RESULTS The average age of the sample is 40.00±7.95 years. Regarding gender the percentage of men is 21.40% (N=49) and of women is 78.60% (N=180). Overall the professional burnout of health care workers is moderate. The mean score for emotional exhaustion is 26.41, for personal accomplishment 36.70 and for depersonalization 9.81. The mean for each subscale of SRSDA is 8.23±6.79 for Depression Beck-21, 3.96±4.26 for Depression Beck-13, 4.91±4.44 for Melancholia, 6.32±4.35 for Asthenia and 6.36±4.72 for Anxiety. The results of general linear models with the MBI dimensions as independent variables and the SRSDA subscales as dependent variables are shown that emotional exhaustion and personal accomplishment are statistically correlated with all subscales of SRSDA, while depersonalization is not correlated with any SRSDA subscale. CONCLUSIONS Burnout appears to implicate mental health status of healthcare providers in work index. Emotional exhaustion is the burnout dimension that is correlated the most with employees' mental health.


title: Robot-assisted laparoscopic radical cystectomy with complete intracorporeal urinary diversion.

text: Robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC-ICUD) has only recently been explored as a viable surgical option for patients with muscle-invasive bladder cancer seeking satisfactory oncologic control while benefiting from minimally invasive surgical techniques. Inspired by earlier open and laparoscopic work, initial descriptions of RARC-ICUD were published in 2003, and have since been followed by multiple larger case series which have suggested promising outcomes for our patients. However, the rate of adoption has remained relatively slow when compared to other robot-assisted procedures such as the radical prostatectomy, likely owing to longer operative times, operative complexity, costs, and uncertainty regarding oncologic efficacy. The operative technique for RARC-ICUD has evolved over the past decade and several high-volume centers have shared tips to improve efficiency and make the operation possible for a growing number of urologists. Though there are still questions regarding economic costs, effectiveness, and generalizability of outcomes reported in published data, a growing dataset has brought us ever closer to the answers. Here, we present our current operative technique for RARC-ICUD and discuss the state of the literature so that the urologist may hold an informed discussion with his or her patients.


title: Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry.

text: BACKGROUND The prevalence, treatment and outcomes of balloon undilatable chronic total occlusions (CTOs) have received limited study. METHODS We examined the prevalence, clinical and angiographic characteristics, and procedural outcomes of percutaneous coronary interventions (PCIs) for balloon undilatable CTOs in a contemporary multicenter US registry. RESULTS Between 2012 and 2017 data on balloon undilatable lesions were available for 425 consecutive CTO PCIs in 415 patients in whom guidewire crossing was successful: 52 of 425 CTOs were balloon undilatable (12%). Mean patient age was 65 ± 10 years and most patients were men (84%). Patients with balloon undilatable CTOs were more likely to be diabetic (67 vs. 41%, P < 0.001) and have heart failure (44 vs. 28%, P = 0.027). Balloon undilatable CTOs were longer (40 mm [interquartile range, IQR 20-50] vs. 30 [IQR 15-40], P = 0.016), more likely to have moderate/severe calcification (87 vs. 54%, P < 0.001), and had higher J-CTO score (3.2 ± 1.1 vs. 2.5 ± 1.3, P < 0.001) and PROGRESS-CTO complications score (3.9 ± 1.7 vs. 3.1 ± 2.0, P < 0.005). They were associated with lower technical and procedural success (92 vs. 98%, P = 0.024; and 88 vs. 96%, P = 0.034, respectively) and higher risk for in-hospital major adverse events (8 vs. 2%, P = 0.008) due to higher perforation rates. The most frequent treatments for balloon undilatable CTOs were high pressure balloon inflations (64%), rotational atherectomy (31%), laser (21%), and cutting balloons (15%). CONCLUSIONS Balloon undilatable CTOs are common and are associated with lower success and higher complication rates.


title: Single-port access laparoscopic staging operation for a borderline ovarian tumor.

text: Minimally invasive surgery is widely used in benign gynecologic diseases and may be used in malignancies. We performed a single-port access laparoscopy staging - bilateral salpingo-oophorectomy, laparoscopy-assisted vaginal hysterectomy, bilateral pelvic lymphadenectomy, infracolic omentectomy, and washing cytology - in a borderline ovarian tumor. The number of harvested pelvic lymph nodes were twenty-three and there were no intraoperative or postoperative complications. Single-port access laparoscopic staging may be performed in selected patients. The efficacy, safety, and potential benefits of this technique should be evaluated in further trials.


title: Development of a 124I-labeled version of the anti-PSMA monoclonal antibody capromab for immunoPET staging of prostate cancer: Aspects of labeling chemistry and biodistribution.

text: Correct staging of prostate cancer is an unmet clinical need. Radionuclide targeting of prostate-specific membrane antigen (PSMA) with 111In-labeled capromab pendetide (ProstaScint) is a clinical option for prostate cancer staging. We propose the use of 124I-labeled capromab to decrease the retention of radioactivity in healthy organs (due to the non-residualizing properties of the radiolabel). The use of 124I as a label should increase imaging sensitivity due to the advantages of PET as an imaging modality. Capromab targets the intracellular domain of PSMA; accumulation of radioactivity in the tumor should not depend on internalization of the antigen/antibody complex. Capromab was iodinated, and its targeting properties were compared with indium labeled counterpart in LNCaP xenografts in dual isotope mode. PSMA-negative xenografts (PC3) were used as a negative control. Radioiodinated capromab bound to PSMA specifically. Biodistribution of 125I/111In-capromab showed a more rapid clearance of iodine radioactivity from liver, spleen, kidneys, bones, colon tissue, as well as tumors. Maximum tumor uptake (13±8% ID/g for iodine and 29±9% ID/g for indium) and tumor-to-non-tumor ratios for both agents were measured 5 days post-injection (pi). High tumor accumulation and low uptake of radioactivity in normal organs were confirmed using microPET/CT 5 days pi of 124I-capromab.


Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During the COVID-19 Pandemic?


title: Predicting burst pressure of radiofrequency-induced colorectal anastomosis by bio-impedance measurement.

text: The present study investigates the relationship between bio-impedance and burst pressure of colorectal anastomosis created by radiofrequency (RF)-induced tissue fusion. Colorectal anastomosis were created with ex vivo porcine colorectal segments, during which 5 levels of compression pressure were applied by a custom-made bipolar prototype, with 5 replicate experiments at each compression pressure. Instant anastomotic tensile strength was assessed by burst pressure. Bio-impedance of fused tissue was measured by Impedance Analyzer across frequency that 100 Hz to 3 MHz. Statistical analysis shows only a weak correlation between bio-impedance modulus and burst pressures at frequency of 445 kHz ([Formula: see text] = -0.426, P = 0.099 > 0.05). In contrast, results demonstrated a highly significant negative correlation between reactance modulus and burst pressures ([Formula: see text] = -0.812, P = 0.000 < 0.05). The decrease in mean reactance modulus with increasing burst pressures was highly significant (P = 0.019 < 0.05). The observed strong negative correlation between reactance modulus and burst pressures at frequency of 445 kHz indicates that reactance is likely to be a good index for tensile strength of RF-induced colorectal anastomosis, and should be considered for inclusion in a feedback loops in devices design.


title: Exercise and cognitive function in people living with HIV: a scoping review.

text: BACKGROUND Since the advent of antiretrovirals, people with HIV are living longer and have improved quality of life. However, 30-60% of these individuals experience cognitive impairment. Fortunately, physical activity has emerged as a management strategy for cognitive impairment. PURPOSE To map the evidence on physical activity and cognition in HIV. METHODS We searched five databases using terms related to physical activity and HIV. Two authors independently reviewed titles and abstracts for studies that addressed physical activity/exercise and cognition in people with HIV. Authors reviewed full texts to identify articles that met our inclusion criteria. One author extracted the data, then we collated the results and summarized the characteristics of included studies. RESULTS Sixteen studies from high-income countries were included; eight were interventional (five randomized controlled trials and three pre-post single group observational studies) and eight were non-interventional studies. The interventional studies included aerobic, resistive, and Tai Chi exercise for 8 weeks to 12 months in duration. Two of eight interventional studies found exercise to benefit self-reported cognition. All eight non-interventional studies showed a positive relationship between physical activity and cognitive function. CONCLUSIONS Results of this study suggest that physical activity may preserve or improve cognition in people living with HIV. Implications for Rehabilitation Physical activity may play a role in preserving or improving cognition in the human immunodeficiency virus population. Exercise should be prescribed for people with human immunodeficiency virus based on the stage of infection. Rehabilitation professionals should follow current exercise guidelines when prescribing exercise for people living with human immunodeficiency virus.


title: Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism.

text: Patients with venous thromboembolism (VTE) are prone to the development of both short-term and long-term complications that can substantially affect their functional capacity and quality of life. Patients with deep vein thrombosis (DVT) often develop recurrent VTE or the post-thrombotic syndrome, whereas patients with pulmonary embolism (PE) can develop long-term symptoms and functional limitations along a broad spectrum extending to full-blown chronic thromboembolic pulmonary hypertension. Clinicians who care for patients showing severe clinical manifestations of DVT and PE are often faced with challenging decisions concerning whether and how to escalate to more aggressive treatments such as those involving the use of thrombolytic drugs. The purpose of this chapter is to provide guidance on how best to individualize care to these patients.


Endoscopic intracavitary vacuum sponge therapy of anastomotic leakage in the proximal colon after right-sided colectomy.


The Eclipse of Degenerative Spine Pathology During COVID-19 Pandemic.


title: The postauricular fascia: classification, anatomy, and potential surgical applications.

text: In recent times, there has been evolving interest in the fascial structure of the ear, especially in relation to otoplasty techniques. Although the fascial tissues used in these procedures are referred to as "postauricular/retroauricular fascia," the sparse anatomical studies that exist use this terminology to describe what is the adjacent thicker and more fibrous structure of the superficial temporal area continuous with the mastoid region, rather than the tissue actually used in these procedures which is adherent to the posterior surface of the ear. There are clear clinical differences in the properties of these two structures, and this study set out to identify the anatomical nature of these differences, looking in detail at the anatomy and vascularity of the fascia directly posterior and adherent to the ear itself, highlighting its unique properties, and how it interfaces with the rest of the fascia. We provide a nomenclature to differentiate the fascia adherent to the posterior of the ear (the intrinsic postauricular fascia) from the more fibrous tissues continuous with the scalp fascia (the extrinsic postauricular fascia). Clinical applications for the fascia are suggested based on the vascularity and anatomy described, and our clinical experience.


title: Aneurysm Study of Pipeline in an Observational Registry (ASPIRe).

text: BACKGROUND AND OBJECTIVE Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. RESULTS One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). CONCLUSIONS Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.


title: Imaging integrin alpha-v-beta-3 expression in tumors with an 18F-labeled dimeric RGD peptide.

text: Integrin αv β3 receptors are expressed on activated endothelial cells during neovascularization to maintain tumor growth. Many radiolabeled probes utilize the tight and specific association between the arginine-glycine-aspartatic acid (RGD) peptide and integrin αv β3 , but one main obstacle for any clinical application of these probes is the laborious multistep radiosynthesis of (18)F. In this study, the dimeric RGD peptide, E-[c(RGDfK)]2, was conjugated with NODAGA and radiolabeled with (18)F in a simple one-pot process with a radiolabeling yield of 20%, the whole process lasting only 45 min. NODAGA-E-[c(RGDfK)]2 labeled with (18)F at a specific activity of 1.8 MBq nmol(-1) and a radiochemical purity of 100% could be achieved. The logP value of (18)F-labeled NODAGA-E-[c(RGDfK)]2 was -4.26 ± 0.02. In biodistribution studies, (18)F-NODAGA-E-[c(RGDfK)]2 cleared rapidly from the blood with 0.03 ± 0.01 percentage injected dose per gram (%ID g(-1)) in the blood at 2 h p.i., mainly via the kidneys, and showed good in vivo stability. Tumor uptake of (18)F-NODAGA-E-[c(RGDfK)]2 (3.44 ± 0.20 %ID g(-1), 2 h p.i.) was significantly lower than that of reference compounds (68) Ga-labeled NODAGA-E-[c(RGDfK)]2 (6.26 ± 0.76 %ID g(-1) ; p <0.001) and (111) In-labeled NODAGA-E-[c(RGDfK)]2 (4.99 ± 0.64 %ID g(-1) ; p < 0.01). Co-injection of an excess of unlabeled NODAGA-E-[c(RGDfK)]2 along with (18)F-NODAGA-E-[c(RGDfK)]2 resulted in significantly reduced radioactivity concentrations in the tumor (0.85 ± 0.13 %ID g(-1)). The αv β3 integrin-expressing SK-RC-52 tumor could be successfully visualized by microPET with (18)F-labeled NODAGA-E-[c(RGDfK)]2 . In conclusion, NODAGA-E-[c(RGDfK)]2 could be labeled rapidly with (18)F using a direct aqueous, one-pot method and it accumulated specifically in αv β3 integrin-expressing SK-RC-52 tumors, allowing for visualization by microPET.


title: An Acute Exposure to Muscle Vibration Decreases Knee Extensors Force Production and Modulates Associated Central Nervous System Excitability.

text: Local vibration (LV) has been recently validated as an efficient training method to improve muscle strength. Understanding the acute effects may help elucidate the mechanism(s). This study aimed to investigate the effects of a single bout of prolonged LV on knee extensor force production and corticospinal responsiveness of vastus lateralis (VL) and rectus femoris (RF) muscles in healthy young and old adults. Across two visits, 23 adult subjects (20-75 years old) performed pre- and post-test measurements, separated by 30-min of either rest (control; CON) or LV. Maximal voluntary contraction (MVC) force was assessed and transcranial magnetic stimulation (TMS) was used to evaluate cortical voluntary activation (VATMS) as well as the motor evoked potential (MEP) and silent period (SP). In 11 young adults, thoracic electrical stimulation was used to assess the thoracic motor evoked potential (TMEP). Although MVC decreased after both CON (-6.3 ± 4.4%, p = 0.01) and LV (-12.9 ± 7.7%, p < 0.001), the MVC loss was greater after LV (p = 0.001). Normalized maximal electromyographic (EMG) activity decreased after LV for both VL (-25.1 ± 10.7%) and RF (-20.9 ± 16.5%; p < 0.001), while it was unchanged after CON (p = 0.32). For RF, the TMEP and MEP/TMEP ratio decreased (p = 0.01) and increased (p = 0.01) after LV, respectively. Both measures were unchanged for VL (p = 0.27 and p = 0.15, respectively). No changes were reported for TMS-related parameters. These results confirm our hypothesis that modulations within the central nervous system would accompany the significant reduction of maximal voluntary force. A reduced motoneuron excitability seems to explain the decreased MVC after prolonged LV, as suggested by reductions in maximal EMG (all subjects) and TMEP area (data from 11 young subjects). A concomitant increased cortical excitability seems to compensate for lower excitability at the spinal level.


title: 'One Health' infectious diseases surveillance in Tanzania: are we all on board the same flight?

text: Infectious diseases account for nearly 40% of the burden of human mortality and morbidity in low-income countries, of which 7% is attributable to zoonoses and 13% to recently emerging diseases from animals. One of the strategic approaches for effective surveillance, monitoring and control of infectious diseases compromising health in both humans and animals could be through a combination of multiple disciplines. The approach can be achieved through a joint effort from stakeholders comprising health professionals (medical and veterinary), social, economic, agricultural, environmental and other interested parties. With resource scarcity in terms of number of staff, skills and facility in low-income countries, participatory multi- sectoral and multidisciplinary approaches in limiting the burden of zoonotic diseases could be worthwhile. We review challenging issues that may limit the 'One Health' approach for infectious diseases surveillance in Tanzania with a focus on Health Policy and how best the human and animal health systems could be complemented or linked to suit the community in need for disease control under the theme's context.


title: Total laparoscopic hysterectomy in obese and morbidly obese women.

text: BACKGROUND The study aimed at estimating the effect of body mass index (BMI), used to classify non-obese, obese, and morbidly obese patients, on clinical outcomes in total laparoscopic hysterectomy (TLH) cases. METHODS This retrospective cohort study included 153 patients who underwent TLH for benign, premalignant, or malignant conditions between August 2010 and June 2013. Patients were divided into 3 groups according to BMI, and the following variables were analyzed: operation time, conversion rate, blood loss, total complications, and length of hospital stay. RESULTS The mean BMI was 33.5 kg/m(2) (range, 22-61). Forty-four patients were non-obese (BMI <30), 73 were obese (30≤ BMI <40), and 36 were morbidly obese (BMI ≥40). In 138 patients (90.2%), hysterectomy was performed using an endoscopic technique. The rate of conversion to laparotomy (9.8%; 95% confidence interval (CI), 5.1-14.5), blood loss (70.5 ml; range, 10-700), total complications (5.9%), and length of hospital stay (2.9 d; range, 1-8) did not vary according to BMI. Operation time was longer in obese (p = 0.003) and morbidly obese (0.002) patients than in non-obese patients. CONCLUSION TLH could be considered a safe and feasible alternative to abdominal hysterectomy in obese and morbidly obese patients.


title: The dual microcatheter technique for transvenous embolization of dural arteriovenous fistulae.

text: BACKGROUND Dural arteriovenous fistulae (dAVFs) comprise 10-15% of all intracranial arteriovenous malformations. The goal of surgical or endovascular intervention is complete obliteration of the fistulous connection(s). In cases where dAVF venous drainage is separate from normal cortical drainage, transvenous embolization can provide fast and effective fistula obliteration. OBJECTIVE To describe a new method of efficient transvenous embolization (the 'dual microcatheter technique') for the treatment of dAVFs. METHODS Three patients with dAVFs were treated using the dual microcatheter technique for transvenous embolization. Two microcatheters were placed in the distal aspect of the dAVF venous pouch, after which coil embolization reduced fistula flow, and liquid embolic agent injection with reflux into arterial feeders completed the obliteration of the fistula. RESULTS Lesion grade ranged from Borden-Shucart grades 2 through 3. In all cases, dAVF venous drainage was isolated from the normal cerebral venous drainage. Dual microcatheter transvenous embolization was successful in all patients, with non-target embolization and no new postoperative deficits. At the last follow-up, all three patients were symptom-free without evidence of radiographic recurrence. CONCLUSIONS The dual microcatheter technique of transvenous dAVF embolization is safe and feasible in cases where dAVF venous outflow is isolated from normal cerebral venous drainage.


title: Successful maintenance of key physiological parameters in preterm lambs treated with ex vivo uterine environment therapy for a period of 1 week.

text: BACKGROUND Extremely preterm infants born at the border of viability (22-24 weeks' gestation) have high rates of death and lasting disability. Ex vivo uterine environment therapy is an experimental neonatal intensive care strategy that provides gas exchange using parallel membranous oxygenators connected to the umbilical vessels, sparing the extremely preterm cardiopulmonary system from ventilation-derived injury. OBJECTIVE In this study, we aimed to refine our ex vivo uterine environment therapy platform to eliminate fetal infection and inflammation, while simultaneously extending the duration of hemodynamically stable ex vivo uterine environment therapy to 1 week. STUDY DESIGN Merino-cross ewes with timed, singleton pregnancies were surgically delivered at 112-115 days of gestation (term is ∼150 days) and adapted to ex vivo uterine environment therapy (treatment group; n = 6). Physiological variables were continuously monitored; humerus and femur length, ductus arteriosus directional flow, and patency were estimated with ultrasound; serial blood samples were collected for hematology and microbiology studies; weight was recorded at the end of the experiment. Control group animals (n = 7) were euthanized at 122 days of gestation and analyzed accordingly. Bacteremia was defined by positive blood culture. Infection and fetal inflammation was assessed with white blood cell counts (including differential leukocyte counts), plasma and lung proinflammatory cytokine measurements, and lung histopathology. RESULTS Five of 6 fetuses in the treatment group completed the 1-week study period with key physiological parameters, blood counts remaining within normal ranges, and no bacteremia detected. There were no significant differences (P > .05) in arterial blood oxygen content or lactate levels between ex vivo uterine environment therapy and control groups at delivery. There was no significant difference (P > .05) in birthweight between control and ex vivo uterine environment groups. In the ex vivo uterine environment group, we observed growth of fetal humerus (P < .05) and femur (P < .001) over the course of the 7-day experimental period. There was no difference in airway or airspace morphology or consolidation between control and ex vivo uterine environment animals, and there was no increase in the number of lung cells staining positive for T-cell marker CD3+. CONCLUSION Five preterm lambs were maintained in a physiologically stable condition for 1 week with significant growth and without clinically significant bacteremia or systemic inflammation. Although substantial further refinement is required, a life support platform based around ex vivo uterine environment therapy may provide an avenue to improve outcomes for extremely preterm infants.


title: Association Between COVID-19 and Kawasaki Disease: Vigilance Required From Otolaryngologists.

text: With the onset of the COVID-19 pandemic, many novel presentations of known conditions are occurring. In the pediatric population, new instances of Kawasaki disease have recently been singled out as presenting in conjunction with or soon after diagnosis of COVID-19. This poses a novel situation, particularly for otolaryngologists, who may be the first to encounter these patients. Otolaryngologists should be cognizant of the coexistence of conditions to allow for timely recognition and optimal management.


title: Patient factors contributing to variation in same-hospital readmission rate.

text: The Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program and the Centers for Medicare & Medicaid Innovations Bundled Payments for Care Improvement Initiative hold hospitals accountable for readmissions that occur at other hospitals. A few studies have described the extent to which hospital readmissions occur at the original place of treatment (i.e., same-hospital readmissions). This study uses data from 16 states to describe variation in same-hospital readmissions by patient characteristics across multiple conditions. We found that the majority of 30-day readmissions occur at the same hospital, although rates varied considerably by condition. A significant number of hospitals had very low rates of same-hospital readmissions, meaning that the majority of their readmissions went to other hospitals. Future research should examine why some hospitals are able to retain patients for a same-hospital readmission and others are not.


title: Roll-in experience from the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study.

text: PURPOSE To describe the experience and results from the roll-in phase of the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study. MATERIALS AND METHODS The CORAL roll-in database was used to describe the baseline characteristics of the patients in the roll-in cohort, all of whom underwent renal artery stent placement; to evaluate CORAL site performance; to compare estimates of lesion (stenosis) severity made by site interventionalists with the central CORAL angiographic core laboratory readings; and to report outcomes after renal artery stent placement. During the roll-in phase, 239 patients (mean age, 70.2 y ± 9.0; 49% male) underwent renal artery stent procedures. Angiographic core laboratory analysis of renal arteriograms was done, and participants were followed at 1 month and 9 months. RESULTS Major angiographic complications were identified in 28 (13%) subjects. Kidney function remained unchanged at the short (2-4 weeks) follow-up interval. Improvement in systolic blood pressure with use of distal embolic protection devices (n = 161) did not show any clinical benefit over nonuse of such devices (n = 78) in this small series. At 9 months, there were significantly more endpoints reported by site in subjects with bilateral renal artery stenosis (P = .01) and prior history of stroke (P = .03). CONCLUSIONS In the roll-in phase of the CORAL study, a significant number of angiographic complications were identified. No effect was seen on estimated glomerular filtration rate after renal artery stent placement, but systolic blood pressure decreased significantly.


title: Tobacco smoking and COVID-19 pandemic: old and new issues. A summary of the evidence from the scientific literature.

text: INTRODUCTION COVID-19 pandemic burst onto the international scene as a new disease not affecting patients uniformly; hence it has risen many questions yet to be clarified. The aim of this study was to outline the main issues that led tobacco smoking being discussed as a potential risk factor associated with COVID-19. METHODS articles from MEDLINE and pre-prints published from January to April 2020 were identified. RESULTS data from China showed that men had more severe outcomes of COVID-19 than women. Since smoking prevalence is very high among Chinese men in comparison to women, it was hypothesized that smoking could be a risk factor for poor prognosis. This was also supported by the higher prevalence of comorbidities, many of which are tobacco-related diseases, in patients with severe COVID-19, who were also more likely to have a smoking history. A meta-analysis confirmed these results reporting an OR=2.25 (95% CI: 1.49-3.39) for developing severe Covid-19 among patients with a smoking history. Some authors, noticing that reported smoking prevalence among hospitalized patients was substantially below smoking prevalence in the corresponding populations, speculated a protective role of nicotine. However, it is likely that low prevalence among hospitalized patients are partially due to many smokers misclassified as nonsmokers. Tobacco smoking seems to cause a dose-dependent upregulation of the angiotensin-converting- enzyme-2 (ACE2), the virus cellular entry receptor, which could explain the higher risk of severe COVID-19 in smokers. CONCLUSIONS There is need for further independent studies to clarify the role of smoking on COVID-19 incidence, progression and mortality.


title: Epidemiology of Obesity in Adults: Latest Trends.

text: PURPOSE OF REVIEW An increasing trend in obesity prevalence since the early 1980s has posed a significant population health burden across the globe. We conducted a systematic review for studies using measured anthropometry to examine trends in obesity in the USA published from 2012 to 2018 and for systematic reviews to document trends in obesity across the globe published from 2014 to 2018. RECENT FINDINGS For the USA, the only nationally representative data source capturing trends in obesity in this period was the National Health and Nutrition Examination Survey, which uses repeated cross-sectional data to document national trends in obesity in the USA. For global trends, the only systematic reviews of obesity across the globe were the Global Burden of Disease Obesity study and the Non-communicable Disease Risk Factor Collaboration study. In general, the population distribution of body mass index (BMI) in the USA has shifted towards the upper end of its distribution over the past three decades. The global distribution has similarly increased, albeit with large regional differences. US and global studies suggest an increasing trend in obesity since the 1980s, and there is a dearth of nationally representative longitudinal studies using measured anthropometry to capture trends in adult obesity in the USA for the same individuals over time. Greater efforts are needed to identify factors contributing to the continued increases in obesity.


Sleep in ICU: atypical sleep or atypical electroencephalography?


Recurrent vulvovaginal candidiasis.


title: Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting.

text: OBJECTIVE The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. METHODS From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. RESULTS CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). CONCLUSION Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.


title: Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience.

text: OBJECTIVE To compare our initial robotic-assisted nephroureterectomy (RAN) experience with a well-established practice of performing laparoscopic nephroureterectomy (LN) to treat upper tract urothelial carcinoma (UTUC). METHODS We reviewed our prospectively maintained minimally invasive surgery database. Patients who underwent RAN from April 2009 to December 2011 were matched by pathologic tumor stage and age (± 10 years) to those who underwent LN. RESULTS Twenty-two matched pairs were evaluated. Mean operative time (298 vs 251 minutes) and estimated blood loss (EBL, 380 vs 233 mL) were significantly higher for RAN, with a greater need for transfusion in this group. Complication rates were similar. The RAN group trended toward more frequent lymph node dissection and greater median node count when lymph node dissection was performed (59% vs 27% [P = .07] and 5.5 vs 1.0 [P = .13]). After a median follow-up of 10 months for RAN and 15 months for LN, no significant difference was seen in the rate of bladder (36% vs 37%) or distant (32% vs 23%) recurrence, with similar median time to any recurrence (9 months vs 4 months, P = .32). CONCLUSION RAN was associated with higher operative time and blood loss likely because of more frequent use of node dissection, robot repositioning, and technical inexperience. Lymph node dissection was more frequently performed with RAN, which reflects surgeon practice patterns. When a lymph node dissection was performed, the median node count was greater with RAN. Our initial experience with RAN suggests that this is an acceptable approach for the management of UTUC.


title: Analysis of left ventricular function of the mouse heart during experimentally induced hyperthyroidism and recovery.

text: Many of the clinical manifestations of hyperthyroidism are due to the ability of thyroid hormones to alter myocardial contractility and cardiovascular hemodynamics, leading to cardiovascular impairment. In contrast, recent studies highlight also the potential beneficial effects of thyroid hormone administration for clinical or preclinical treatment of different diseases such as atherosclerosis, obesity and diabetes or as a new therapeutic approach in demyelinating disorders. In these contexts and in the view of developing thyroid hormone-based therapeutic strategies, it is, however, important to analyze undesirable secondary effects on the heart. Animal models of experimentally induced hyperthyroidism therefore represent important tools for investigating and monitoring changes of cardiac function. In our present study we use high-field cardiac MRI to monitor and follow-up longitudinally the effects of prolonged thyroid hormone (triiodothyronine) administration focusing on murine left ventricular function. Using a 9.4 T small horizontal bore animal scanner, cinematographic MRI was used to analyze changes in ejection fraction, wall thickening, systolic index and fractional shortening. Cardiac MRI investigations were performed after sustained cycles of triiodothyronine administration and treatment arrest in adolescent (8 week old) and adult (24 week old) female C57Bl/6 N mice. Triiodothyronine supplementation of 3 weeks led to an impairment of cardiac performance with a decline in ejection fraction, wall thickening, systolic index and fractional shortening in both age groups but with a higher extent in the group of adolescent mice. However, after a hormonal treatment cessation of 3 weeks, only young mice are able to partly restore cardiac performance in contrast to adult mice lacking this recovery potential and therefore indicating a presence of chronically developed heart pathology.


title: Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry.

text: INTRODUCTION Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. METHODS A multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up. RESULTS A total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259±120 min vs 305±202 min; p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b-3 reperfusion was lower in the EICA occlusion group (70% vs 81%; p=0.03). The favorable outcome (90-day mRS 0-2), intracerebral hemorrhage and procedural complications were similar in both groups. CONCLUSION Atherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b-3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis.


Caring of cancer patients during COVID-19: A real-life challenge.


title: Colonisation of conventional weaned pigs by enteropathogenic Escherichia coli (EPEC) and its hazard potential for human health.

text: Enteropathogenic Escherichia coli (EPEC) bacteria frequently cause severe enteric diseases primarily in children and in young rabbits. Their pathogenicity for pigs has been tested by oral infection of colostrum-deprived newborn, and of severely immunosuppressed weaned pigs, but colonisation of conventional weaned pigs by porcine EPEC has not been experimentally studied. EPEC show similarities to enterohaemorrhagic E. coli (EHEC) additionally carrying shiga toxin genes integrated into the chromosome by lambdoid phages. We have demonstrated earlier that the porcine EPEC prototype strain P86-1390 (O45) could be transduced in vivo (in ligated loops of weaned pigs), by Stx2 phage derived from a human EHEC. Thus, the ability of this porcine EPEC strain to colonise conventional weaned pigs under farming conditions became a question of relevance to human health. To clarify this question, four intragastric infection experiments were performed on a total of 95 conventional weaned pigs. The EPEC P86-1390 and other well-characterised porcine EPEC strains were applied to 54 pigs, leaving 41 weaned pigs as negative controls. In three experiments moderate predispositions were applied: coinfections with enterotoxigenic E. coli (ETEC) or with low-virulence TGE coronavirus, application of fumonisin B1 with a normal therapeutic dose of dexamethasone, and the increase of soybean protein concentration in the feed. A total of 41 weaned pigs served as negative controls inoculated with a commensal porcine E. coli. Housing conditions simulated the farm environment. As an overall result, ileal segments of 18.5% of infected pigs were shown to be colonised by EPEC, while no EPEC were detected in the ilea of controls. Among predisposing factors occurring on farms, feed protein content increased by 20% (26.3% crude protein, provided by 48% soybean meal) seemed to enhance EPEC colonisation and resulted in the mobilisation of spontaneous latent EPEC/ETEC infection. The results indicate that under normal farm conditions porcine EPEC may colonise conventional weaned pigs by inducing ileal attaching effacing (AE) lesions with reasonable frequency, without clinical signs. The results also suggest that conventional weaned pigs may represent undetected reservoirs of porcine EPEC, potentially giving rise to the emergence of new types of EHEC due to natural transduction by Stx phages.


title: An in vitro comparison of tracheostomy tube cuffs.

text: INTRODUCTION The Shiley™ Flexible adult tracheostomy tube with TaperGuard™ cuff has been designed through its geometry, materials, diameter, and wall thickness to minimize micro-aspiration of fluids past the cuff and to provide an effective air seal in the trachea while also minimizing the risk of excessive contact pressure on the tracheal mucosa. The cuff also has a deflated profile that may allow for easier insertion through the stoma site. This unique design is known as the TaperGuard™ cuff. The purpose of the observational, in vitro study reported here was to compare the TaperGuard™ taper-shaped cuff to a conventional high-volume low-pressure cylindrical-shaped cuff (Shiley™ Disposable Inner Cannula Tracheostomy Tube [DCT]) with respect to applied tracheal wall pressure, air and fluid sealing efficacy, and insertion force. METHODS Three sizes of tracheostomy tubes with the two cuff types were placed in appropriately sized tracheal models and lateral wall pressure was measured via pressure-sensing elements on the inner surface. Fluid sealing performance was assessed by inflating the cuffs within the tracheal models (25 cmH2O), instilling water above the cuff, and measuring fluid leakage past the cuff. To measure air leak, tubes were attached to a test lung and ventilator, and leak was calculated by subtracting the average exhaled tidal volume from the average delivered tidal volume. A tensile test machine was used to measure insertion force for each tube with the cuff deflated to simulate clinical insertion through a stoma site. RESULTS The average pressure exerted on the lateral wall of the model trachea was lower for the taper-shaped cuff than for the cylindrical cuff under all test conditions (P<0.05). The taper-shaped cuff also demonstrated a more even, lower pressure distribution along the lateral wall of the model trachea. The average air and fluid seal performance with the taper-shaped cuff was significantly improved, when compared to the cylindrical-shaped cuff, for each tube size tested (P<0.05). The insertion force for the taper-shaped cuff was ~40% less than that for the cylindrical-shaped cuff. CONCLUSION In a model trachea, the Shiley™ Flexible Adult tracheostomy tube with TaperGuard™ cuff, when compared to the Shiley™ Disposable Inner Cannula Tracheostomy tube with cylindrical cuff, exerted a lower average lateral wall pressure and a more evenly distributed pressure. In addition, it provided more effective fluid and air seals and required less force to insert.


title: Overseas visitor deaths in Australia, 2001 to 2003.

text: BACKGROUND The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia. METHODS Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003. RESULTS There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%). CONCLUSIONS Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.


title: New approaches in the treatment of hypertension.

text: Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled blood pressure. The unmet need of controlling blood pressure in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. In this Compendium Review, we discuss new drugs and interventional treatments that are undergoing preclinical or clinical testing for hypertension treatment. New drug classes, eg, inhibitors of vasopeptidases, aldosterone synthase and soluble epoxide hydrolase, agonists of natriuretic peptide A and vasoactive intestinal peptide receptor 2, and a novel mineralocorticoid receptor antagonist are in phase II/III of development, while inhibitors of aminopeptidase A, dopamine β-hydroxylase, and the intestinal Na(+)/H(+) exchanger 3, agonists of components of the angiotensin-converting enzyme 2/angiotensin(1-7)/Mas receptor axis and vaccines directed toward angiotensin II and its type 1 receptor are in phase I or preclinical development. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal failure. Novel interventional approaches in early development include carotid body ablation and arteriovenous fistula placement. Importantly, none of these novel drug or device treatments has been shown to prevent cardiovascular disease outcomes or death in hypertensive patients.


title: Initial experience using microwave ablation therapy for renal tumor treatment: 18-month follow-up.

text: OBJECTIVES To assess efficacy and morbidity of microwave ablation (MWA) for small renal tumors in an initial cohort of patients. MWA is a recently introduced thermal needle ablation treatment modality with theoretical advantages compared with radiofrequency ablation, such as greater intratumoral temperatures, lack of a grounding pad, and superior convection profile. However, experience has been limited in the human kidney. METHODS Ten patients with a single, solid-enhancing renal tumor from June 2008 to November 2008 received laparoscopic or computed tomography-guided percutaneous MWA at a tertiary referral center with ≥14 months of follow-up. MWA was performed using the Valleylab Evident, 915-MHz MWA system at 45 W with intraoperative biopsy before ablation, and peripheral fiberoptic thermometry to determine the treatment endpoints. The patients were followed up with contrast-enhanced computed tomography at 1 month, 6 months to 1 year, and annually to monitor for tumor recurrence. RESULTS The follow-up duration for the 6 male and 4 female patients (mean tumor size 3.65 cm, range 2.0-5.5; mean age 69.8 years) was 17.9 months. The recurrence rate, defined by persistent enhancement, was 38% (3 of 8). The intraoperative and postoperative complication rate was 20% and 40%, respectively. CONCLUSIONS MWA resulted in poor oncologic outcomes with a significant complication rate at an intermediate level of follow-up. However, MWA has promising theoretical advantages and should not be discarded. Additional studies should be considered to better understand the microwave-tissue interaction and treatment endpoints for different size renal masses before widespread use.


Incisional Hernia: Complications & Quality of Life.


title: Co-transplantation of Human Ovarian Tissue with Engineered Endothelial Cells: A Cell-based Strategy Combining Accelerated Perfusion with Direct Paracrine Delivery.

text: Infertility is a frequent side effect of chemotherapy and/or radiotherapy and for some patients, cryopreservation of oocytes or embryos is not an option. As an alternative, an increasing number of these patients are choosing to cryopreserve ovarian tissue for autograft following recovery and remission. Despite improvements in outcomes among patients undergoing auto-transplantation of cryopreserved ovarian tissue, efficient revascularization of grafted tissue remains a major obstacle. To mitigate ischemia and thus improve outcomes in patients undergoing auto-transplantation, we developed a vascular cell-based strategy for accelerating perfusion of ovarian tissue. We describe a method for co-transplantation of exogenous endothelial cells (ExECs) with cryopreserved ovarian tissue in a mouse xenograft model. We extend this approach to employ ExECs that have been engineered to constitutively express Anti-Mullerian hormone (AMH), thus enabling sustained paracrine signaling input to ovarian grafts. Co-transplantation with ExECs increased follicular volume and improved antral follicle development, and AMH-expressing ExECs promoted retention of quiescent primordial follicles. This combined strategy may be a useful tool for mitigating ischemia and modulating follicular activation in the context of fertility preservation and/or infertility at large.


title: [Epidemic characteristics and trend analysis of the COVID-19 in Hubei province].

text: Objective: By describing and analyzing the epidemic characteristics and trends of the attack rate, the crude mortality and relevant indexes in Hubei province during the pandemic of COVID-19 to provide comprehensive evaluations of the epidemic trends and the effects of intervention measures. Methods: Based on the case data reported in Hubei province during the COVID-19 epidemic, combined with the important time of major interventions and event, the cumulative attack rate, the sequential increase rate of new cases, baseline increase rate of new cases, the observation- confirmed case conversion rate, the cumulative crude mortality, the daily severe case rate, and the ratio of death to severe were used to describe and analyze the epidemic characteristics in different phases of the COVID-19 epidemic. Results: The epidemic experienced an outbreak phase from January 10 to February 3 with large amount of case reported, a peak phase from February 4 to February 19 with continuous increasing number of new cases and deaths, a platform phase from February 20 to March 3 with balanced diagnosis and treatment number, and a descending phase from March 4 to March 18 with decreased diagnosis and increased treatment number. Up to March 18, the cumulative attack rate of the COVID-19 epidemic in Hubei province increased from 0.03/10 000 on January 19 to 11.46/10 000, from 0.04/10 000 on January 10 to 45.13/10 000 in Wuhan city, and from 0.002/ 10 000 on January 20 to 3.70/ 10 000 in other areas of Hubei province other than Wuhan city. The increase rate of new cases fluctuated during the epidemic period and reached the highest at February 12 in Hubei province. The cumulative crude mortality in Hubei Province increased rapidly from 1.01% on January 19 to 5.13% on January 26, then decreased to 2.54% on February 13, and then slowly increased to 4.62% on March 18, and similar trend was also observed in Wuhan city. The daily severe rate in Hubei Province increased from 26.88% on January 27 to 34.27% on March 18. The ratio of death to severe decreased from 7.37% on January 23 to 0.35% on March 18. Conclusions: The epidemic cycle of COVID-19 in Hubei province proposed to be 60 days, which was about 1.76 times of the combination of the longest incubation period or isolation period (14 d) and the average hospitalization time of confirmed patients in Hubei province (20 d). It suggested that the major anti-epidemic decisions made in China were effective.


title: Can the Long-Term Complications of Adjustable Gastric Banding Be Overcome? Preliminary Results of Adding Gastric Plication in Patients with Impending Gastric Band Failure.

text: BACKGROUND A small percentage of patients fitted with a gastric band still experience "failure." Here, the authors demonstrate the safety and feasibility of band preserving-laparoscopic gastric plication (BP-LGP), which was designed to improve weight loss and decrease gastric band adjustment frequency and thereby improve patient quality of life. MATERIALS AND METHODS All 6 patients involved in this study had a gastric band in place for more than 1 year; the median interval from gastric banding to BP-LGP was 31.7 months (range, 19.7-49.9 months). Five (83.3%) patients were female. Preoperative median body mass index (BMI) at gastric banding was 35.4 kg/m(2) (range, 31.9-43.9 kg/m(2)), median nadir BMI with the gastric band was 25.7 kg/m(2) (range, 20.9-31.0 kg/m(2)), and percentage excess BMI loss (%EBMIL) ranged from 24.3% to 123.6%. Indications for BP-LGP were as follows: chronic gastric prolapse in 2 patients (33.3%), pouch-esophageal dilatation in 3 (50.0%), and insufficient weight loss in 4 (66.6%), which included 2 patients with weight loss failure (%EBMIL of <30%). RESULTS The 6 patients consecutively underwent surgery from May 2014 to January 2015. No conversion to open surgery was necessary, and no perioperative complication or mortality occurred. Mean operative time was 190 minutes. All patients showed weight loss after revision and showed resolution of troublesome signs and symptoms. Median follow-up after revision was 7.3 months (range, 5.7-10.1 months), median BMI at last follow-up was 27.6 kg/m(2) (range, 22.7-34.0 kg/m(2)), and median %EBMIL was 75.7% (range, 21.0%-103.6%). Median fill volume before revision was 6.1 mL (range, 2.7-11.0 mL), and median fill volume after revision was 0.3 mL (range, 0.0-5.3 mL). Three patients (50%) had an empty band at last follow-up. CONCLUSIONS This novel method of bariatric revision (modified BP-LGP) might have a role as a salvage procedure in patients with impending gastric band failure.


title: Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate.

text: State and local governments imposed social distancing measures in March and April of 2020 to contain the spread of novel coronavirus disease 2019 (COVID-19). These included large event bans, school closures, closures of entertainment venues, gyms, bars, and restaurant dining areas, and shelter-in-place orders (SIPOs). We evaluated the impact of these measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020 and April 27, 2020. An event-study design allowed each policy's impact on COVID-19 case growth to evolve over time. Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1-5 days, 6.8 after 6-10 days, 8.2 after 11-15 days, and 9.1 after 16-20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million). Our paper illustrates the potential danger of exponential spread in the absence of interventions, providing relevant information to strategies for restarting economic activity. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


title: Cleavage of group 1 coronavirus spike proteins: how furin cleavage is traded off against heparan sulfate binding upon cell culture adaptation.

text: A longstanding enigmatic feature of the group 1 coronaviruses is the uncleaved phenotype of their spike protein, an exceptional property among class I fusion proteins. Here, however, we show that some group 1 coronavirus spike proteins carry a furin enzyme recognition motif and can actually be cleaved, as demonstrated for a feline coronavirus. Interestingly, this feature can be lost during cell culture adaptation by a single mutation in the cleavage motif; this, however, preserves a heparan sulfate binding motif and renders infection by the virus heparan sulfate dependent. We identified a similar cell culture adaptation for the human coronavirus OC43.


title: Long-term tolerability of capnography and respiratory inductance plethysmography for respiratory monitoring in pediatric patients treated with patient-controlled analgesia.

text: BACKGROUND The Anesthesia Patient Safety Foundation has advocated the use of continuous electronic monitoring of oxygenation and ventilation to preemptively identify opioid-induced respiratory depression. In adults, capnography is the gold standard in respiratory monitoring. An alternative technique used in sleep laboratories is respiratory inductance plethysmography (RIP). However, it is not known if either monitor is well tolerated by pediatric patients for prolonged periods of time. AIM The goal of this study was to determine whether capnography or RIP is better tolerated in nonintubated, spontaneously breathing pediatric patients being treated with intravenous patient-controlled analgesia (IVPCA). METHODS Nasal cannula capnography with oral sampling and thoracic and abdominal inductance plethysmography bands were placed along with the routine monitors on pediatric patients being treated for acute pain with IVPCA. Study monitors were left in place for as long as they were tolerated by the patient, up to a maximum of 24 consecutive hours. If the patient did not wear a particular study monitor for any reason, but tolerated the remaining monitor, participation in the study continued. If the patient would not wear either monitor, participation was terminated. RESULTS Twenty-six patients (18 female, eight male, average age 10.1 ± 5.5 years) consented to participate, but only 14 patients attempted to wear one or both the devices. Among those who wore either device, median time to device removal was 8.33 h (range 0.3-23.6 h) for capnography and 23.5 h (range 0.7-24 h) for RIP bands. CONCLUSION Children did not tolerate wearing capnography cannulae for prolonged periods of time, limiting the usefulness of this device as a continuous monitor of ventilation in children. RIP bands were better tolerated; however, they require further assessment of their utility. Until more effective, child-friendly monitors are developed and their utility is validated, guidelines recommended for adult patients cannot be extended to children.


title: Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : Protocol for a systematic review.

text: BACKGROUND In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCDs) is growing against an existing burden of other diseases such as HIV/AIDS. Integrated models of care can help address the rising burden of multi-morbidity. Although integration of care can occur at various levels and has been defined in numerous ways, our aim is to assess the effects of integration of service delivery at primary healthcare level in LMICs. METHODS We will consider randomised controlled trials (RCTs), cluster RCTs, non-randomised trials, controlled before-after studies and interrupted time series that examine integrated models of care among people with multi-morbidities, of which diabetes or hypertension is one, living in LMICs. We will compare fully integrated models of care to stand-alone care, partially integrated models of care to stand-alone care and fully integrated models to partially integrated models of care. Primary outcomes include all-cause mortality, disease-specific morbidity, HbA1c, systolic blood pressure and cholesterol levels. Secondary outcomes include access to care, retention in care, adherence, continuity of care, quality of care and cost of care. We will conduct a comprehensive search in the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Control Trials, LILACS, Africa-Wide Information, CINAHL and Web of Science. In addition, we will search trial registries, relevant conference abstracts and check references lists of included studies. Selection of studies, data extraction and assessment of risk of bias will be performed independently by two review authors. We will resolve discrepancies through discussion with a third author. We will contact study authors in case of missing data. If included studies are sufficiently homogenous, we will pool results in a meta-analysis. Clinical heterogeneity related to the population, intervention, outcomes and context will be documented in table format and explored through subgroup analysis. We will assess χ2and I2 tests for statistical heterogeneity. We will use GRADE to make judgements about the certainty of evidence and present findings in a summary of findings table. DISCUSSION In light of limited evidence on the provision of comprehensive care for diabetes and hypertension, and its comorbidity in LMCIs, we believe that the findings of this systematic review will provide a synthesis of evidence on effective models of integrated care for diabetes and hypertension and their comorbidities at primary healthcare level. This will enable policy-makers to device policies and programs that are evidence informed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018099314 .


title: Creation of a percutaneous mesocaval shunt to control variceal bleeding in a child.

text: Although transjugular intrahepatic portosystemic shunt (TIPS) placement is the standard procedure for the treatment of portal hypertension, it is often impossible to perform in patients with extrahepatic portal vein occlusion. In these patients, options for decompressing the liver are few. In this report, we present a novel solution for managing gastro-esophageal hemorrhage in a child with portal hypertension and extrahepatic portal vein occlusion, through the creation of a percutaneous mesocaval shunt.


title: Trying to make sense out of chaos: science, politics and the COVID-19 pandemic.

text: This essay discusses the proliferation of discourses about the COVID-19 pandemic, presenting the challenges both to science and public policies that such an information overload present, having Collins' sociology of expertise as a theoretical framework.