title: Risk management of free radicals involved in air travel syndromes by antioxidants.

text: Frequent air travelers and airplane pilots may develop various types of illnesses. The environmental risk factors associated with air travel syndromes (ATS) or air travel-related adverse health outcomes raised concerns and need to be assessed in the context of risk management and public health. Accordingly, the aim of the present review was to determine ATS, risk factors, and mechanisms underlying ATS using scientific data and information obtained from Medline, Toxline, and regulatory agencies. Additional information was also extracted from websites of organizations, such as the International Air Transport Association (IATA), International Association for Medical Assistance to Travelers (IAMAT), and International Civil Aviation Organization (ICAO). Air travelers are known to be exposed to environmental risk factors, including circadian rhythm disruption, poor cabin air quality, mental stress, high altitude conditions, hormonal dysregulation, physical inactivity, fatigue, biological infections, and alcoholic beverage consumption. Consequences of ATS attributed to air travel include sleep disturbances (e.g., insomnia), mental/physical stress, gastrointestinal disorders, respiratory diseases, circulatory-related dysfunction, such as cardiac arrest and thrombosis and, at worst, mechanical and terrorism-related airplane crashes. Thus safety measures in the cabin before or after takeoff are undertaken to prevent illnesses or accidents related to flight. In addition, airport quarantine systems are strongly recommended to prepare for any ultimate adverse circumstances. Routine monitoring of environmental risk factors also needs to be considered. Frequently, the mechanisms underlying these adverse manifestations involve free radical generation. Therefore, antioxidant supplementation may help to reduce or prevent adverse outcomes by mitigating health risk factors associated with free radical generation.


Biologics for patients affected by Hidradenitis suppurativa in the COVID-19 era: data from a referral centre of Southern Italy.


Covid-19: trainees will not move jobs in April.


Access to bariatric surgery and patients with diabetes.


title: The outcomes of transcatheter aortic valve replacement in a cohort of patients with end-stage renal disease.

text: OBJECTIVES To examine whether transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for aortic stenosis in patients with end-stage renal disease (ESRD). BACKGROUND Patients with ESRD undergoing surgical aortic valve replacement have an operative mortality approaching 20% and a 10-year survival of approximately 12%. We investigated whether TAVR is a more reasonable option. METHODS This is a multicenter, retrospective study of all patients with ESRD who underwent TAVR in 8 institutions between 12/2011 and 02/2013. Demographic characteristics, mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach. RESULTS Forty-three patients with a mean age 76.2 ± 11.0 years and a mean STS predicted risk of mortality of 15.53 ± 8.70% underwent TAVR. Mean duration of dialysis was 45.2 ± 52.3 months (median 29.5 months). Transfemoral (TF) TAVR was performed in 31/43 (72.1%), transapical in 11/43 (25.6%), and transaortic in 1/43 (2.3%). Operative mortality was 14.0% (6/43) with TF mortality 6.5% (2/31) and 33.3% (4/12) in non-TF patients. Six-month mortality was 11/43 (25.6%: 16.1% TF, 50.0% non-TF). Complications included stroke in 2.3% (1/43) and life-threatening or major bleeding in 14.0% (6/43). Discharge to another healthcare facility was 27.0% (10/37). Readmission within 30 days of procedure for any cause was 18.9% (7/37). CONCLUSIONS Patients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. © 2016 Wiley Periodicals, Inc.


title: Genetic and antigenic heterogeneity of infectious bronchitis virus in South America: implications for control programmes.

text: Infectious bronchitis virus (IBV) is a persistent sanitary problem for the South American poultry industry despite extensive vaccination. The IBV single-stranded RNA genome has high rates of mutation and recombination that generate a notorious virus variability. Since most IBV vaccines are type-specific, there is a need for constant surveillance of the circulating lineages and knowledge about their genetic and antigenic properties. Here we present an integrative analysis that provides the pattern of genetic variation of the South American IBV strains and information about their antigenic characteristics. The genetic analysis was performed using the S1 complete coding sequences of all available South American strains, including newly obtained Argentine and Uruguayan field samples. Our phylogenetic and phylodynamic analyses evidence that three main lineages (GI-1, GI-11 and GI-16) are extensively circulating in South American flocks. Strains of the GI-1 lineage (Massachusetts-type) were detected in Argentina, Brazil, Chile and Colombia. The GI-11 lineage is an exclusively South American lineage that emerged in the 1950s, and is the predominant lineage in Brazil and Uruguay at present. The GI-16 lineage emerged around 1979, and is currently circulating in most South American territories (Argentina, Chile, Uruguay, Colombia and Peru). The virus cross-neutralization test performed here reveals very low antigenic relatedness between GI-11 and GI-16 lineages (i.e. they are different serotypes). The results of this study extend our knowledge about the present and past IBV variability in South America and provide relevant elements to improve the control programmes by considering the genetic and antigenic attributes of IBV.


Airway obstruction in the postanaesthetic care unit of a tertiary care centre: A prospective audit.


title: Patient Characteristics, Procedural and Safety Outcomes of Bariatric Surgery in England: a Retrospective Cohort Study-2006-2012.

text: BACKGROUND The objective of the study is to analyze procedural and safety outcomes associated with bariatric surgery and describe the characteristics of patients undertaking bariatric procedures in England between April 2006 and March 2012. METHODS This is a retrospective cohort study of all adult patients in England diagnosed with obesity and undergoing bariatric surgery as a primary procedure in NHS-funded sites between April 2006 and March 2012 using data sourced from the Hospital Episode Statistics dataset. Length of stay (LOS), 30-day readmission, and post-surgery complication were analyzed as primary outcomes. Socio-demographic background, provider type, procedure volume, and comorbidities were all analyzed as potential explanatory variables. RESULTS Gastric bypass (GBP, 12,628) was the most utilized procedure, followed by gastric banding (GB, 6872) and sleeve gastrectomy (SG, 3251). The most prevalent comorbidity was type 2 diabetes (23%). Inpatient mortality was low (≤ 0.15%) for all procedure types. LOS and the risks of both post-operative complication and 30-day readmission were significantly lower for GB, relative to those for GBP and SG. Ethnicity, geographical area, surgery type, and volume were all associated with LOS, risk of readmission, and complication. Provider type and deprivation were further associated with LOS while age correlated with readmission only. An increasing comorbidity burden was associated with an increased risk of both readmission and complication. CONCLUSIONS Gastric bypass was the most frequently reported procedure in England across the observation period. While utilization across all procedure types increased between 2007 and 2010, overall uptake of bariatric surgery in England represents only a small proportion of the eligible population. Readmission and complication rates were lower for gastric banding relative to those for either gastric bypass or sleeve gastrectomy. The observed inpatient mortality rate was low across all procedure types.


Helping Africa to breathe when COVID-19 strikes.


title: Biomechanical comparison of four technique for pelvic flexure enterotomy closure in horses.

text: OBJECTIVE To compare 4 techniques for pelvic flexure enterotomy closure in horses. STUDY DESIGN Ex-vivo study. SAMPLE POPULATION Cadaveric ascending colon specimens (n = 48 horses). METHODS Pelvic flexure enterotomies of different lengths (5 cm, 10 cm) were performed and closed with 1 of 4 techniques: handsewn 2 layer (HS2); handsewn 1 layer (HS1); skin staples (SKS); or TA90 stapling device (TA90). Time to close each enterotomy, bursting pressure, luminal reduction, and cost were calculated and compared. RESULTS HS2 was significantly more time consuming to perform in the 5 cm group whereas in the 10 cm group, only the HS1 and SKS were faster than the other techniques. Luminal reduction was not different between techniques in either group. HS2 resulted in consistently higher bursting pressure compared with SKS and TA90 in the 5 cm group and compared to all other techniques in the 10 cm group. CONCLUSION The TA90 technique had the lowest bursting pressure and highest cost. The HS2 technique was strongest.


title: Novel laparoscopic narrow band imaging for real-time detection of bile leak during hepatectomy: proof of the concept in a porcine model.

text: INTRODUCTION Bile leakage is a serious complication occurring in up to 10 % of hepatic resections. Intraoperative detection of bile leakage is challenging, and concomitant blood oozing can mask the presence of bile. Intraductal dye injection [methylene blue or indocyanine green (ICG)] is a validated technique to detect bile leakage. However, this method is time-consuming, particularly in the laparoscopic setting. A novel narrow band imaging (NBI) modality (SPECTRA-A; Karl Storz, Tuttlingen, Germany) allows easy discrimination of the presence of bile, which appears in clear orange, by image processing. The aim of this experimental study was to evaluate SPECTRA-A ability to detect bile leakage. METHODS Twelve laparoscopic partial hepatectomies were performed in seven pigs. The common bile duct was clipped distally and dissected, and a catheter was inserted and secured with a suture or a clip. Liver dissection was achieved with an ultrasonic cutting device. Dissection surfaces were checked by frequently switching on the SPECTRA filter to identify the presence of bile leakage. Intraductal ICG injection through the catheter was performed to confirm SPECTRA findings. RESULTS Three active bile leakages were obtained out of 12 hepatectomies and successfully detected intraoperatively by the SPECTRA. There was complete concordance between NBI and ICG fluorescence detection. No active leaks were found in the remaining cases with both techniques. The leaking area identified was sutured, and SPECTRA was used to assess the success of the repair. CONCLUSIONS The SPECTRA laparoscopic image processing system allows for rapid detection of bile leaks following hepatectomy without any contrast injection.


title: Transcervical wedge resection after transcervical extended mediastinal lymphadenectomy.

text: Transcervical extended mediastinal lymphadenectomy (TEMLA) has been shown to be feasible and safe. This approach may be underrecognized for providing excellent access to the pleural space. We present a 60-year-old woman who had a clinical stage T2b N0 M0 adenocarcinoma of her right lower lobe and several ground glass opacities throughout her upper lobes bilaterally. She underwent a TEMLA to confirm absence of lymph node involvement in her mediastinum. During the same anesthetic setting, a transpleural right upper lobe wedge resection via the cervical approach was performed as an extension of her TEMLA. The pathology from this wedge resection demonstrated atypical adenomatous hyperplasia. Ultimately, she underwent a thoracoscopic right lower lobectomy that confirmed that she had a pathologic T2b N0 M0 (5.0 × 4.0 × 3.0 cm) adenocarcinoma. There were no perioperative adverse events with either operation. Transcervical extended mediastinal lymphadenectomy and transcervical lung resections may be performed safely during the same anesthetic setting.


Surfing the Waves of the COVID-19 Pandemic As A Cardiovascular Clinician.


BRAF-Mutated Metastatic Colon Cancers During COVID-19 Pandemic.


title: Inhibition of protein kinase R activation and upregulation of GADD34 expression play a synergistic role in facilitating coronavirus replication by maintaining de novo protein synthesis in virus-infected cells.

text: A diversity of strategies is evolved by RNA viruses to manipulate the host translation machinery in order to create an optimal environment for viral replication and progeny production. One of the common viral targets is the alpha subunit of eukaryotic initiation factor 2 (eIF-2alpha). In this report, we show that phosphorylation of eIF-2alpha was severely suppressed in human and animal cells infected with the coronavirus infectious bronchitis virus (IBV). To understand whether this suppression is through inhibition of protein kinase R (PKR), the double-stranded-RNA-dependent kinase that is one of the main kinases responsible for phosphorylation of eIF-2alpha, cells infected with IBV were analyzed by Western blotting. The results showed that the level of phosphorylated PKR was greatly reduced in IBV-infected cells. Overexpression of IBV structural and nonstructural proteins (nsp) demonstrated that nsp2 is a weak PKR antagonist. Furthermore, GADD34, a component of the protein phosphatase 1 (PP1) complex, which dephosphorylates eIF-2alpha, was significantly induced in IBV-infected cells. Inhibition of the PP1 activity by okadaic acid and overexpression of GADD34, eIF-2alpha, and PKR, as well as their mutant constructs in virus-infected cells, showed that these viral regulatory strategies played a synergistic role in facilitating coronavirus replication. Taken together, these results confirm that IBV has developed a combination of two mechanisms, i.e., blocking PKR activation and inducing GADD34 expression, to maintain de novo protein synthesis in IBV-infected cells and, meanwhile, to enhance viral replication.


title: Stretchable electrets: nanoparticle-elastomer composites.

text: Manipulating charges is fundamental to numerous systems, and this ability is achieved through materials of diverse characteristics. This ability is achieved through materials of diverse characteristics. Electrets are dielectrics that trap charges or dipoles. Applications include electrophotography, microphones, air filters and energy harvesters. To trap charges or dipoles for a long time, electrets are commonly made of hard dielectrics. Stretchable dielectrics are short-lived electrets. The two properties-longevity and stretchability-conflict; existing electrets struggle to attain both. This work describes an approach to developing stretchable electrets. Nanoparticles of hard electret are immobilized in a matrix of dielectric elastomer. The composite divides the labor of two functions: the particles trap charges with longevity, and the matrix enables stretchability. The design considerably broadens the choice of materials to enable stretchable electrets. Silica nanoparticles in polydimethylsiloxane elastomer, achieve charge density ~ 4 × 10-5 Cm-2 and lifetime beyond 60 days. Long-lived, stretchable electrets open extensive opportunities.


title: Factors affecting periprocedural morbidity and mortality and long-term patient survival after arterial embolization of hepatic neuroendocrine metastases.

text: PURPOSE To identify factors affecting periprocedural morbidity and mortality and long-term survival following hepatic artery embolization (HAE) of hepatic neuroendocrine tumor (NET) metastases. MATERIALS AND METHODS This single-center, institutional review board-approved retrospective review included 320 consecutive HAEs for NET metastases performed in 137 patients between September 1996 and September 2007. Forty-seven HAEs (15%) were performed urgently to manage refractory symptoms in inpatients (urgent group), and 273 HAEs (85%) were elective (elective group). Overall survival (OS) was estimated by Kaplan-Meier methodology. Complications were categorized per Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to determine independent predictors for OS, complications, and 30-day mortality. The independent factors were combined to develop clinical risk score groups. RESULTS Urgent HAE (P = .007), greater than 50% liver replacement by tumor (P < .0001), and extrahepatic metastasis (P = .007) were independent predictors for shorter OS. Patients with all three risk factors had decreased OS versus those with none (median, 8.5 vs 86 mo; P < .001). Thirty-day mortality was significantly lower in the elective (1%) versus the urgent group (8.5%; P = .0009). There were eight complications (3%) in the elective group and five (10.6%) in the urgent group (P = .03). Male sex and urgent group were independent factors for higher 30-day mortality rate (P = .023 and P =.016, respectively) and complications (P = .012 and P =.001, respectively). CONCLUSIONS Urgent HAE, replacement of more than 50% of liver by tumor, and extrahepatic metastasis are strong independent predictors of shorter OS. Male sex and urgent HAE carry higher 30-day mortality and periprocedural morbidity risks.


title: Endoscopic TEP inguinal hernia repair in the management of occult obturator and femoral hernias.

text: PURPOSE The gold standard technique for the repair of groin hernias has always been a controversial issue. Richard Ger introduced the endoscopic approach for the repair of groin hernias in 1991.The endoscopic technique follows the basic principle of preperitoneal placement of a polypropylene mesh over the myopectineal orifice. During the course of dissection of the preperitoneal space, occult obturator and femoral hernias were discovered. METHODS Patients who underwent endoscopic totally extraperitoneal repair of inguinal hernias over a period of 2 years were included in this retrospective study. RESULTS A total of 305 cases of groin hernias were operated in 208 patients over a period of 2 years from January 2010 to January 2012 in a single institution. Eleven synchronous clinically occult obturator hernias were found in 8 patients (3.84%) and 5 synchronous clinically occult femoral hernias were found in 5 patients (2.40%) during repair. CONCLUSIONS Preoperative and perioperative findings were discordant in quite a few cases. Preperitoneal dissection discovered coincidental occult hernias in 6.25% of patients.


Coronavirus shows how UK must act quickly before being shut out of Europe's health protection systems.


title: The photo-oxidative destruction of C.I. Basic Yellow 2 using UV/S(2)O(8)(2-) process in an annular photoreactor.

text: The photo-oxidative decolorization of C. I. Basic Yellow 2 (BY2), was investigated using UV radiation in the presence of peroxydisulfate (S(2)O(8)(2-)) in an annular photoreactor at different conditions. S(2)O(8)(2-) and UV-light showed negligible effect when they were used independently. Removal efficiency of BY2 was sensitive to the operational parameters such as initial concentrations of S(2)O(8)(2-), BY2 and pH. The conversion ratios of BY2 at the volumetric flow rates of 330, 500 and 650 mLmin(- 1) were 84%, 78%, 69% in 1 h, respectively. The results showed that in the presence of S(2)O(8)(2-), the photooxidation quantum yield obtained higher than direct photolysis quantum yield, suggesting that photodecay of BY2 was dominated by photooxidation. The electrical energy per order (EE/O) values for decolorization of BY2 solution was calculated. Results show that applying an optimum peroxydisulfate concentration can reduce the EE/O.


Corrigendum to Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient- data meta-analysis of randomized trials.


NIH organizes hunt for drugs.


title: Bioimpedance spectroscopy: A technique to monitor interventions for swelling in minor burns.

text: The control of edema in burn injured patients is a priority as it can impede the wound healing process. Bioimpedance spectroscopy (BIS) has been identified as a method of swelling assessment that has merit after burns. The aim of this study was to examine the reliability and validity of BIS in the measurement of localised burn wound edema across (1) different dressing conditions (no dressing, non silver and silver dressings) and (2) three electrode positions. BIS resistance (R) was hypothesised to be inversely proportional to fluid (edema) volume. BIS was collected in triplicate for all conditions of interest. BIS repeated measures demonstrated excellent concordance for all BIS resistance variables (R0, Ri, Rinf) (intraclass correlation coefficient=0.999-1.00, 95% confidence intervals 0.999-1.00) without a systematic difference. Multilevel mixed effects linear regression analysis examined the effect of electrode position and dressing condition on BIS resistance variables. R0, Ri and Rinf significantly increased with decreasing localised limb segment volume (p≤0.01). Resistance was significantly (1) reduced when a silver dressing was in situ (p<0.01) and (2) increased when a non-silver dressing was insitu (p<0.01). There was a significant interaction between each dressing condition and localised limb segment volume (p<0.01). An algorithm was developed to adjust resistance values when a silver dressing is in use. BIS may be used clinically to monitor localised changes in burn wound edema.


title: Current state of evidence for endolymphatic sac surgery in Menière's disease: a systematic review.

text: Background: Endolymphatic sac surgery is an invasive procedure recommended to patients with Menière's disease. Aims/Objectives: To provide an overview and quality assessment of the existing evidence and to provide an updated assessment of the utility of endolymphatic sac surgery in Menière's disease. Material and Methods: We performed a systematic literature search for systematic reviews and randomized controlled trials (RCTs). The AMSTAR tool was used to assess the quality of systematic reviews and the Cochrane risk of bias tool for RCTs. The overall certainty of effects for the individual outcomes was evaluated using the GRADE approach. Results: One systematic review of high quality matched the inclusion criteria, and included three RCTs. An updated literature search from the last search date of the included review provided no further relevant RCTs. The identified RCTs individually reported a positive effect of both the placebo and active treatment groups following surgery, strongly indicative of a placebo effect. The overall certainty of the effect was very low. Conclusions and significance: There is still a lack of high-quality research suggesting that endolymphatic sac surgery provides a significant amount of symptomatic relief for Menière's patients.


title: Surgical Outcomes of Porcine Acellular Dermis Graft in Anophthalmic Socket: Comparison with Oral Mucosa Graft.

text: PURPOSE We describe our experience with the Permacol graft in anophthalmic socket reconstruction, and compare it to the autologous buccal mucosal graft, emphasizing the postoperative vascularization and contraction of each graft. METHODS This was a retrospective comparative study. We measured the time necessary for the graft surface to be completely vascularized, as well as the fornix depth of the conjunctival sac in anophthalmic patients. RESULTS Ten patients underwent Permacol graft reconstruction, with 44 undergoing buccal mucosal graft reconstruction. Seven eyelids (70%) in the Permacol group had a good outcome, with improvement in lower eyelid position and prosthesis retention. Nine out of 10 eyelids (90%) in this group showed complete vascularization of the graft at 2.6 ± 1.9 months postoperatively, while the grafted buccal mucosa was fully vascularized at 1.1 ± 0.3 months postoperatively (p < 0.01). Postoperative fornix depth in the Permacol group was 9.1 ± 2.2 mm, compared to 14.9 ± 4.5 mm in the buccal mucosal graft group (p < 0.01). Mean increases in fornix depth were 33.1% and 67.9% of the mean vertical length of the implanted graft. CONCLUSIONS The Permacol graft can be useful as spacer graft material in anophthalmic socket patients. It takes longer to vascularize, and undergoes greater graft shrinkage with time, compared to the buccal mucosal graft.


title: Social disparities in patient safety in primary care: a systematic review.

text: BACKGROUND Patient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the attention on social disparities in patient safety has been mainly directed towards the hospital care, often overlooking the primary care setting. Therefore, this paper aims to synthesise social disparities in patient safety in the primary care setting. METHODS The Databases PubMed and Web of Science were searched for relevant studies published between January 1st 2006 and January 31st 2017. Papers investigating racial, gender and socioeconomic disparities in regards to administrative errors, diagnostic errors, medication errors and transition of care errors in primary care were included. No distinction in terms of participants' age was made. RESULTS Women and black patients are more likely to experience patient safety events in primary care, although it depends on the type of disease, treatment, and healthcare service. The available literature largely describes gender and ethnic disparities in the different patient safety domains whilst income and educational level are studied to a lesser extent. CONCLUSIONS The results of this systematic review suggest that vulnerable social groups are likely to experience adverse patient safety events in primary care. Enhancing family doctors' awareness of these inequities is a necessary first step to tackle them and improve patient safety for all patients. Future research should focus on social disparities in patient safety using socioeconomic indicators, such as income and education.


title: Improved dosimetry in prostate brachytherapy using high resolution contrast enhanced magnetic resonance imaging: a feasibility study.

text: PURPOSE To assess detailed dosimetry data for prostate and clinical relevant intra- and peri-prostatic structures including neurovascular bundles (NVB), urethra, and penile bulb (PB) from postbrachytherapy computed tomography (CT) versus high resolution contrast enhanced magnetic resonance imaging (HR-CEMRI). MATERIAL AND METHODS Eleven postbrachytherapy prostate cancer patients underwent HR-CEMRI and CT imaging. Computed tomography and HR-CEMRI images were randomized and 2 independent expert readers created contours of prostate, intra- and peri-prostatic structures on each CT and HR-CEMRI scan for all 11 patients. Dosimetry data including V100, D90, and D100 was calculated from these contours. RESULTS Mean V100 values from CT and HR-CEMRI contours were as follows: prostate (98.5% and 96.2%, p = 0.003), urethra (81.0% and 88.7%, p = 0.027), anterior rectal wall (ARW) (8.9% and 2.8%, p < 0.001), left NVB (77.9% and 51.5%, p = 0.002), right NVB (69.2% and 43.1%, p = 0.001), and PB (0.09% and 11.4%, p = 0.005). Mean D90 (Gy) derived from CT and HR-CEMRI contours were: prostate (167.6 and 150.3, p = 0.012), urethra (81.6 and 109.4, p = 0.041), ARW (2.5 and 0.11, p = 0.003), left NVB (98.2 and 58.6, p = 0.001), right NVB (87.5 and 55.5, p = 0.001), and PB (11.2 and 12.4, p = 0.554). CONCLUSIONS Findings of this study suggest that HR-CEMRI facilitates accurate and meaningful dosimetric assessment of prostate and clinically relevant structures, which is not possible with CT. Significant differences were seen between CT and HR-CEMRI, with volume overestimation of CT derived contours compared to HR-CEMRI.


Evidence base for the use of corticosteroids in septic shock in children.


title: Comparison of two alternative wound closure methods for tumor arthroplasty of the hip: A frequency matched cohort study.

text: OBJECTIVE To examine the effect of an alternative wound closure method after tumor arthroplasty of the hip compared to routine wound closure with skin staples. METHOD Single center, frequency matched cohort study. We reviewed all patients who underwent tumor resection and endoprosthetic reconstruction of the proximal femur for pathologic fracture due to metastatic bone disease or malignant hematologic bone disease at our center between 2010 and 2014. All patients treated with occlusive wound closure (OWC), a combination of intradermal suture, Steri-Strips™, and an occlusive skin adhesive, during this period ( n = 35), were compared to an equally sized frequency matched group of patients having undergone routine wound closure with conventional skin staples. RESULTS Patients with OWC were significantly faster to achieve dry wound status and consequently had significantly shorter administration of antibiotics and hospital stay. Compared to the patients with conventional wound closure with staples, their wounds were already dry after a mean 3.4 days (vs. 6.7 days [95%CI: 3-3.8 vs. 5.5-7.9], p < 0.0001), they received antibiotics for a mean 4.2 days (vs. 6.8 days [95%CI: 3.7-4.8 vs. 5.5-8.0], p < 0.0003) and their mean hospital stay was 6.3 days (vs. 8.0 days [95%CI: 5.5-7 vs. 6.8-9.3], p < 0.015). Prolonged wound discharge (PWD) for 7 days or more was observed in 34% of patients ( n = 12) in the conventional group, whereas this complication was completely absent ( n = 0) in the investigational group. For every three patients treated with OWC, one complication of PWD over 7 days is avoided (number needed to treat = 3). CONCLUSION Compared to conventional staples, OWC appears to significantly reduce wound complications, use of antibiotics, and hospital stay in patients undergoing tumor arthroplasty procedures of the hip. As such, it may also contribute to a reduction of the substantially increased risk for prosthetic joint infection in this patient population.


title: Use of a Powered Stapling System for Minimally Invasive Lung Volume Reduction Surgery: Results of a Prospective Double-Blind Single-Center Randomized Trial.

text: BACKGROUND Video-assisted thoracoscopic surgery (VATS)-lung volume reduction surgery (LVRS) represents an important treatment option for patients with advanced lung emphysema. For VATS lung resection, endoscopic staplers are routinely used. Recently, a new generation of electronically powered stapling systems was developed. In this study, the iDrive powered stapling system (Covidien, Germany) was first tested during VATS-LVRS and compared with a non-electronic conventional device. METHODS Forty patients with advanced emphysema were enrolled in a prospective randomized trial. All patients underwent bilateral VATS-LVRS. Patients were randomized for iDrive use on the right lung (n = 20) or left lung resection (n = 20). A conventional endoscopic stapler (EndoGIA, Covidien) was used for contralateral resection in same patients. Therefore, 40 resections were performed with the iDrive and 40 with the EndoGIA. The duration of surgery, air leakage after extubation, and on postoperative day 1 (POD1), as well as length of chest tube therapy, were documented. RESULTS The application of the new system was uneventful. Mean duration of surgery was 52 ± 2.5 minute in the iDrive group compared with 54 ± 3.8 minute in the EndoGIA-group (p = 0.5). After extubation, the mean air leakage in the iDrive-group did not differ significantly from that in the EndoGIA-group (p = 0.6). This was also observed on POD1 (p = 0.7). Moreover, length of drainage therapy also did not show significant differences between both groups (p = 0.6). CONCLUSION The iDrive powered stapling system offers one-handed, push-button operation, which eliminates the manual firing force and possibly enables more precise resection. In the current study, the novel system led to comparable results with the conventional mechanical stapler without any disadvantages in patients undergoing bilateral VATS-LVRS.


Impact of Gaucher disease on COVID-19.


title: Author Correction: Dual-energy CT perfusion imaging for differentiating WHO subtypes of thymic epithelial tumors.

text: An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Delayed bleeding from the superficial temporal artery after local flap reconstruction.


title: Directional atherectomy of a heavy calcified axillary artery stenosis inducing critical hand ischemia.

text: The presence of a severe calcified peripheral artery lesion is responsible for a poor response to balloon dilation, due to significant acute vessel recoil and frequent flow-limiting dissections requiring stent implantation. This possibility could be associated with very high compression and/or fracture rates particularly in cases of lesion located at the mobile joints. In this setting directional atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the restenosis rate by direct plaque excision. In this report, we present a case of critical hand ischemia due to a heavily calcified axillary artery lesion managed by directional atherectomy and balloon angioplasty followed by immediate angiographic success and sustained clinical benefit up to 3 years of follow-up.


title: Single-port cholecystectomy through the lateral ring of the left inguinal hernia.

text: BACKGROUND Single-port surgery was developed by the evolution of the laparoscopy. The advantage of this new method is mainly cosmetic, but the risk of the hernia-owing to the larger port-increased. CASE REPORT A 71-year-old man was admitted with a left lateral inguinal hernia and gallbladder stones. After preparation of the sac of the hernia, a single-port was inserted into the lateral ring and a cholecystectomy was performed. The operation was completed by the reconstruction of the abdominal wall using a polypropylene mesh. The total operating time was 85 minutes. CONCLUSION In the case of the combined operation, the defect of the abdominal wall could be used as a location of the single port, and the trauma of the abdominal wall could be avoided. This is the first publication about single-port cholecystectomy where the ring of the inguinal hernia was used as a placement site of the single port.


Transendoscopic Electrosurgery for Partial Removal of a Gastric Adenomatous Polyp in a Horse.


title: The scope of tobacco cessation randomized controlled trials in low- to middle-income countries: protocol for a scoping review.

text: BACKGROUND Tobacco consumption is the leading cause of preventable death globally. The global mortality burden of tobacco use lies predominantly in low- to middle-income countries (LMICs). There is much evidence on the effectiveness of tobacco cessation RCTs in high-income nations. However, the evidence base in LMICs is far more limited. To effectively design randomized controlled trials (RCTs) that mitigate tobacco-related harms in LMICs, further understanding of RCTs in this environment will be helpful. We will provide quality evidence regarding the scope of tobacco cessation RCTs in LMICs. METHODS A scoping review of tobacco cessation RCTs will be conducted. MEDLINE, Embase, PsycINFO, Global Health, Web of Science and Sociological Abstracts will be searched to capture current literature. We will review RCTs that have already been done on tobacco cessation in the LMICs. The key outcome will be tobacco cessation in adults. Examples of the key outcome include smoking abstinence and reduction of tobacco use. Study selection will conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and study quality assessed with a modified version of the Cochrane Collaboration's instrument. DISCUSSION As researchers attempt to minimize the harms from tobacco in LMICs, they need to be aware of scientific evidence to develop RCTs to achieve their aim. The review will complement the evidence base on tobacco cessation in LMICs.


title: Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic Total Occlusion Percutaneous Coronary Intervention.

text: Coronary perforation is a potential complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed 2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age was 65 ± 10 years, 85% were men, and 36% had prior coronary artery bypass graft surgery. Technical and procedural success were 88% and 87%, respectively. A major periprocedural adverse cardiovascular event occurred in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%, respectively. Perforation occurred more frequently in older patients and those with previous coronary artery bypass graft surgery (61% vs 35%, p < 0.001). Cases with perforation were angiographically more complex (Multicenter CTO Registry in Japan score 3.0 ± 1.2 vs 2.5 ± 1.3, p < 0.001). Twelve patients (14%) with perforation experienced tamponade requiring pericardiocentesis. Patient age, previous PCI, right coronary artery target CTO, blunt or no stump, use of antegrade dissection re-entry, and the retrograde approach were associated with perforation. Adjusted odds ratio for periprocedural major periprocedural adverse cardiovascular events among patients with perforation was 15.04 (95% confidence interval 7.35 to 30.18). In conclusion, perforation occurs relatively infrequently in contemporary CTO PCI performed by experienced operators and is associated with baseline patient characteristics and angiographic complexity necessitating use of advanced crossing techniques. In most cases, perforations do not result in tamponade requiring pericardiocentesis, but they are associated with reduced technical and procedural success, higher periprocedural major adverse events, and reduced procedural efficiency.


title: Flow dynamics in pediatric rigid bronchoscopes using computer-aided design modeling software.

text: OBJECTIVES/HYPOTHESIS Observed complications during rigid bronchoscopy, including hypercarbia and hypoxemia, prompted us to assess how well rigid bronchoscopes serve as an airway device. We performed computer-aided design flow analysis of pediatric rigid bronchoscopes to gain insight into flow dynamics. STUDY DESIGN We made accurate three-dimensional computer models of pediatric rigid bronchoscopes and endotracheal tubes. SOLIDWORKS (Dassault Systemes, Vélizy-Villacoublay, France) flow analysis software was used to analyze fluid dynamics during pressure-controlled and volume-controlled ventilation. METHODS Flow analysis was performed on rigid bronchoscopes and similar outer diameter endotracheal tubes comparing resistance, flow, and turbulence during two ventilation modalities and in common surgical scenarios. RESULTS Increased turbulent flow was observed in bronchoscopes compared to more laminar flow in endotracheal tubes of similar outer diameter. Flow analysis displayed higher resistances in all pediatric bronchoscope sizes except one (3.0 bronchoscope) compared to similar-sized endotracheal tubes. Loss of adequate ventilation was observed if the bronchoscope was not assembled correctly or if increased peak inspiratory pressures were needed. Anesthesia flow to the patient was reduced by 63% during telescope insertion. CONCLUSIONS Flow analysis illustrates increased turbulent flow and increased airflow resistance in all but one size of pediatric bronchoscopes compared to endotracheal tubes. This increased turbulence and resistance, along with the unanticipated gas distal exit pattern, may contribute to the documented hypercarbia and hypoxemia during procedures. These findings may explain why hypoxemia and hypercarbia are commonly observed during rigid bronchoscopy, especially when positive pressure ventilation is needed. LEVEL OF EVIDENCE NA Laryngoscope, 126:1940-1945, 2016.


title: Herpes Zoster (shingles) complicating the course of COVID19 infection.

text: Different skin presentations and patterns of cutaneous signs were reported in COVID19 patients. Varicella-zoster virus (VZV) infection is responsible for two very common skin conditions. Varicella (chichkenpox) is the initial presentation for infection with VZV and is characterized by a diffuse vesicular rash. It is after this initial attack, that VZV remains latent in the dorsal root ganglia before reactivating to present as herpes zoster (HZ) in middle age groups. Cutaneous skin findings remain to be emerging every day as a marker or a complication of COVID 19. We report a case of HZ complication in a 44 years old COVID 19 positive male.


title: Covid-19, ACE2, and the kidney.

text: We are confronted with the most dramatic pandemic world-wide for the past 100 years. We are armed "to-the-teeth" compared to 1918, we know the agent, the genomic sequence, the bodily entry, the proliferation rate, the damage pathogenesis, and the very nature of our enemy. We can identify its bodily presence and our resistance to it in terms of neutralizing antibody production. Nonetheless, the disease has laid lame the great nations of the current world and crippled the less fortunate countries. The primary disease features are not the kidney. However, the entry point has much to do with renal and cardiovascular disease. The kidney is a common target of corona-virus (SARS-CoV2) disease; the longer-term consequences could be as well.


title: Use of a lung model to assess mechanical in-exsufflator therapy in infants with tracheostomy.

text: BACKGROUND The mechanical in-exsufflator (MIE) is commonly used to augment cough in patients with neuromuscular disease from infancy to adulthood. Little is known about the alveolar pressures, lung volumes, and expiratory flow rates generated by the MIE when used via tracheostomy tube in infants and children. METHODS A high-fidelity mechanical lung model was programmed to simulate infants with tracheostomy tubes. Generated pressures, volumes, and expiratory flows using the MIE device at variable insufflation/exsufflation pressures and times were recorded. The primary measure of interest was maximal expiratory flow (MEF). RESULTS Pressure equilibration across the tracheostomy tube did not occur with insufflation time <1 sec. Longer insufflation time significantly increased measured alveolar pressures, lung volume, and MEF until TLC was reached. Longer exsufflation time did not significantly increase MEF. Higher insufflation pressures resulted in greater lung volumes, with >70% vital capacity attained at insufflation pressures as low as 20 cmH2 O. Though higher insufflation pressures resulted in increased expiratory flow rates, more negative exsufflation pressure had a greater absolute impact on MEF. CONCLUSIONS Using the MIE via tracheostomy tube in an infant lung model, we found that an insufflation time of >1 sec is required for equilibration of insufflation pressure and alveolar pressure. Longer exsufflation time does not significantly alter MEF. Higher insufflation and exsufflation pressures both increased MEF, but greater exsufflation pressure had more substantial impact.


Additional safety consideration for azithromycin in the management of SARS-CoV-2 infection.


title: Minimal Clinically Important Difference for Safe and Simple Novel Acute Ischemic Stroke Therapies.

text: BACKGROUND AND PURPOSE Determining the minimal clinically important difference (MCID) is essential for evaluating novel therapies. For acute ischemic stroke, expert surveys have yielded MCIDs that are substantially higher than the MCIDs observed in actual expert behavior in guideline writing and clinical practice, potentially because of anchoring bias. METHODS We administered a structured, internet-based survey to a cross-section of academic stroke neurologists in the United States. Survey responses assessed demographic and clinical experience, and expert judgment of the MCID of the absolute increase needed in the proportion of patients achieving functional independence at 3 months to consider a novel, safe neuroprotective agent as clinically worthwhile. To mitigate anchoring bias, the survey response framework used a base 1000 rather than base 100 patient framework. RESULTS Survey responses were received from 122 of 333 academic stroke neurologists, there were 23% women, 72.8% had ≥6 years of practice experience, and neurovascular disease accounted for more than half of practice time in >70%. Responder-nonresponder and continuum of resistance tests indicated that responders were representative of the full expert population. Among respondents, the median MCID was 1.3% (interquartile range, 0.8% to >2%). CONCLUSIONS Stroke expert responses to MCID surveys are affected by anchoring and centrality bias. When survey design takes these into account, the expert-derived MCID for a safe acute ischemic stroke treatment is 1.1% to 1.5%, in accord with actual physician behavior in guideline writing and clinical practice. This revised MCID value can guide clinical trial design and grant-funding and regulatory agency decisions.


title: Zoonotic Diseases in Oman: Successes, Challenges, and Future Directions.

text: Objective: This article describes the situation analysis of endemic and emerging zoonoses, and includes prevention and control of zoonoses in Oman. It also suggests possible recommendations toward elimination and risk reduction of emerging zoonoses. Methods: Epidemiologic information has been drawn from official to assess the situation. There has been significant progress in reducing the risk of brucellosis, Middle East Respiratory Syndrome Coronavirus, Crimean-Congo hemorrhagic fever, and cutaneous leishmaniasis. Rabies, West Nile fever, Q fever, and cystic hydatid disease have been confined to wildlife or livestock. Results: There is an increasing threat of emerging and re-emerging zoonoses in Oman due to globalization of travel and trade, development activities, and impact of climate change and vector bionomics. Prevention, control, and subsequent elimination of zoonoses on a sustainable basis shall not be possible without intersectoral collaboration between the human and animal health sectors. There are challenges for establishing such strong collaboration and coordination mechanisms in Oman. Institutional and cultural barriers, data and resource sharing, and national capability for rapid and effective investigation of zoonotic infections and emerging zoonoses in humans and animal reservoirs are among others. Conclusions: In the light of achievements made on the prevention and control of zoonoses in Oman during the past decades, priority zoonoses should be identified for elimination, and continuous efforts should be made to further strengthen a holistic multidisciplinary and multisectorial approach for controlling zoonoses at source. Pivotal interventions would include urgent adoption of "One Health" strategic approach as well as establishment of a robust, integrated surveillance system with a strong laboratory investigation capacity to eliminate priority zoonoses and minimize the risk of entry, establishment, and spread of emerging zoonoses in Oman.


title: Fetal and Neonatal Effects of N-Acetylcysteine When Used for Neuroprotection in Maternal Chorioamnionitis.

text: OBJECTIVE To evaluate the clinical safety of antenatal and postnatal N-acetylcysteine (NAC) as a neuroprotective agent in maternal chorioamnionitis in a randomized, controlled, double-blinded trial. STUDY DESIGN Twenty-two mothers >24 weeks gestation presenting within 4 hours of diagnosis of clinical chorioamnionitis were randomized with their 24 infants to NAC or saline treatment. Antenatal NAC (100 mg/kg/dose) or saline was given intravenously every 6 hours until delivery. Postnatally, NAC (12.5-25 mg/kg/dose, n = 12) or saline (n = 12) was given every 12 hours for 5 doses. Doppler studies of fetal umbilical and fetal and infant cerebral blood flow, cranial ultrasounds, echocardiograms, cerebral oxygenation, electroencephalograms, and serum cytokines were evaluated before and after treatment, and 12, 24, and 48 hours after birth. Magnetic resonance spectroscopy and diffusion imaging were performed at term age equivalent. Development was followed for cerebral palsy or autism to 4 years of age. RESULTS Cardiovascular measures, cerebral blood flow velocity and vascular resistance, and cerebral oxygenation did not differ between treatment groups. Cerebrovascular coupling was disrupted in infants with chorioamnionitis treated with saline but preserved in infants treated with NAC, suggesting improved vascular regulation in the presence of neuroinflammation. Infants treated with NAC had higher serum anti-inflammatory interleukin-1 receptor antagonist and lower proinflammatory vascular endothelial growth factor over time vs controls. No adverse events related to NAC administration were noted. CONCLUSIONS In this cohort of newborns exposed to chorioamnionitis, antenatal and postnatal NAC was safe, preserved cerebrovascular regulation, and increased an anti-inflammatory neuroprotective protein. TRIAL REGISTRATION ClinicalTrials.gov: NCT00724594.


title: Does Routine Endoscopy or Contrast Swallow Study After Esophagectomy and Gastric Tube Reconstruction Change Patient Management?

text: BACKGROUND Anastomotic leakage is a severe complication after esophagectomy. The objective was to investigate the diagnostic and predictive value of routine contrast swallow study and endoscopy for the detection of anastomotic dehiscence in patients after esophagectomy. METHODS All patients who underwent contrast swallow and/or endoscopy within 7 days after oesophagectomy for cancer between January 2005 and December 2009 were selected from an institutional database. RESULTS Some 173 patients underwent endoscopy, and 184 patients underwent a contrast swallow study. The sensitivity of endoscopy for anastomotic leakage requiring intervention is 56 %, specificity 41 %, positive predictive value (PPV) 8 %, and negative predictive value (NPV) 95 %. The sensitivity of contrast swallow study for detecting leakage requiring intervention in patients without signs of leakage was 20 %, specificity 20 %, PPV 3 %, and NPV 97 %. CONCLUSIONS In patients without clinical suspicion of leakage, there is no benefit to perform routine examinations.


title: New therapy options for MRSA with respiratory infection/pneumonia.

text: PURPOSE OF REVIEW Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative agent of nosocomial pneumonia. Because of important clinical consequences of inappropriate treatment, a current review of the potential modifications undergone by S. aureus and adaptation to new treatment options is necessary. RECENT FINDINGS Vancomycin has been considered the treatment of choice for pneumonia due to MRSA. However, detection of a progressive increase in the minimum inhibitory concentration for this antibiotic, its limited access to the lung parenchyma, and its considerable adverse effects have called into question its position. Linezolid has been shown to have a better pharmacokinetic and safety profiles. The prior uncertainty regarding the clinical superiority of linezolid appears to have been resolved with the publication of a recent trial. Linezolid achieved a higher clinical and microbiological response rate (the latter was not statistically significant), together with a lower incidence of all types of renal adverse effects in patients with nosocomial pneumonia, compared with vancomycin. Tigecycline, teicoplanin and quinupristin/dalfopristin were inferior to the compared drug in their respective clinical trials. The clinical efficacy of telavancin was similar to that of vancomycin. The renal adverse effects of telavancin have to be clarified. Other drugs are efficacious against MRSA but their profile should be evaluated in nosocomial pneumonia. SUMMARY Current therapeutic alternatives for nosocomial pneumonia due to MRSA appear to be limited to vancomycin and linezolid. However, vancomycin pitfalls, together with the apparent clinical superiority of linezolid, appear to restrict its indication. Telavancin could be a good alternative in patients without basal renal failure.


title: Co-infections of chickens with Avian Influenza Virus H9N2 and Moroccan Italy 02 Infectious Bronchitis Virus: effect on pathogenesis and protection conferred by different vaccination programs.

text: Since the emergence of low pathogenic avian influenza (LPAI) H9N2 viruses in Morocco in 2016, severe respiratory problems have been encountered in the field. Infectious bronchitis virus (IBV) is often detected together with H9N2, suggesting disease exacerbation in cases of co-infections. This hypothesis was therefore tested and confirmed in laboratory conditions using specific pathogen free chickens. Most common field vaccine programs were then tested to compare their efficacies against these two co-infecting agents. IBV γCoV/chicken/Morocco/I38/2014 (Mor-IT02) and LPAI virus A/chicken/Morocco/SF1/2016 (Mor-H9N2) were thus inoculated to commercial chickens. We showed that vaccination with two heterologous IBV vaccines (H120 at day one and 4/91 at day 14 of age) reduced the severity of clinical signs as well as macroscopic lesions after experimental simultaneous challenge. In addition, LPAI H9N2 vaccination was more efficient at day 7 rather than at day 1 in limiting disease post simultaneous challenge.


title: Preperitoneal surgery using a self-adhesive mesh for inguinal hernia repair.

text: BACKGROUND AND OBJECTIVES Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. METHODS This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from April 4, 2010, through July 22, 2014. Data assessed were age, sex, body mass index (BMI), hernia repair indications, hernia type, pain, paresthesia, occurrence (bilateral or unilateral), recurrence, and patient satisfaction. Descriptive and regression analyses were performed. RESULTS Six hundred forty patients underwent laparoscopic preperitoneal hernia surgery with self-adhesive mesh. The average age was 56 years, nearly all were men (95.8%), and the mean BMI was 26.2 kg/m(2). Cases involved primary hernia more frequently than recurrent hernia (94% vs 6%; P < .05). After surgery, 92% of the patients reported no more than minimal pain, <1% reported paresthesia, and 0.2% had early recurrence. There were 7 conversions to an open procedure. The patients had no adverse reactions to anesthesia and no bladder injury. Postoperative acute pain or recurrence was not explained by demographics, BMI, or preoperative pain. There were significant associations of hernia side, recurrence, occurrence, and sex with composite end points. Nearly all patients (98%) were satisfied with the outcome. CONCLUSION The use of self-adhesive, Velcro-type mesh in laparoscopic TEP inguinal hernia repair is associated with reduced pain; low rates of early recurrence, infection, and hematoma; and improved patient satisfaction.


title: Utilization of the Falciform Ligament to Buttress the Spleen Transection Staple Line During Laparoscopic Partial Splenectomy: A Novel Technique.

text: Preservation of all or part the spleen is desired whenever oncologically acceptable and technically possible. Although a number of techniques for partial splenectomy have been described, the ideal approach remains elusive. We describe a novel technique in which the autologous falciform ligament was harvested, wrapped around the proposed splenic transection site, and secured with sutures to act as a buttress to a splenic transection staple line during a laparoscopic multivisceral resection for gastrocolic fistula secondary to locally advanced colon cancer. The spleen transection staple line was bloodless and the patient's recovery was uneventful. Our novel application of the falciform ligament to buttress the staple line at the time of spleen transection during partial splenectomy appears safe and warrants further assessment.


title: Fusion imaging techniques and contrast-enhanced ultrasound for thermal ablation of hepatocellular carcinoma - A prospective randomized controlled trial.

text: Objectives: This randomized controlled trial (RCT) aims to compare the clinical application values of contrast-enhanced ultrasound (CEUS), computed tomography/magnetic resonance-CEUS (CT/MR-CEUS), and three-dimensional ultrasound-CEUS (3DUS-CEUS) Fusion imaging (FI) techniques in the assistance of thermal ablation for hepatocellular carcinoma (HCC).Methods: A RCT was conducted on 374 patients with 456 HCCs between January 2016 and September 2017. CEUS, CT/MR-CEUS, and 3DUS-CEUS FI techniques were randomly used to assist HCC ablation. All lesions were ablated according to a previously determined plan, and FI groups required a 5-mm ablative margin. The primary endpoints were technical efficacy of thermal ablation and local tumor progression (LTP).Results: According to randomization, 153 (18.8 ± 8.0 cm), 153 (18.3 ± 6.6 cm) and 150 (19.1 ± 6.9 cm) HCCs were assigned to CT/MR-CEUS, 3DUS-CEUS and CEUS groups respectively. Technical efficacy rates (99.3% vs. 100% vs. 100%) were achieved in the three groups, showing no statistical differences (p = 1.000). The median follow-up time was 24 (1-37) months. LTP rates at 1 and 2 years were 3.4%, 12.2% for CT/MR-CEUS FI, 4.8%, 9.0% for 3DUS-CEUS FI, and 8.6%, 19.9% for CEUS, respectively (p = .105). The results of subgroup analysis for LTP were statistically significant when patients with albumin-bilirubin (ALBI) grade 2 and 3 (p = .000), and tumor located at risky positions (p = .042). In addition, the p value in group of multiple tumors was close to .05 (p = .052).Conclusions: All the three techniques are feasible for intraoperative HCC thermal ablation. Compared with CEUS, FI techniques are more suitable in patients with ALBI grade 2 and 3, multiple tumors, and in tumors at risky locations.


Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic.


title: Peptide receptor radionuclide therapy (PRRT) with [(177)Lu-DOTA(0),Tyr(3)]octreotate in combination with RAD001 treatment: further investigations on tumor metastasis and response in the rat pancreatic CA20948 tumor model.

text: BACKGROUND Previously, we reported on the unexpected development of distant metastases in the subcutaneous rat pancreas CA20948 tumor model after 4.5 weeks of treatment with RAD001-only or in combination with [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-DOTATATE) (Cancer Res. 73:12-8, 2013). Moreover, the combination therapy was less effective compared to (177)Lu-DOTATATE-only. In the current study, we address the following questions: (1) Why was the combination therapy less effective? Is (177)Lu-DOTATATE tumor uptake affected by pretreatment with RAD001? (2) Could sudden cessation of RAD001 therapy cause the development of distant metastases? (3) Is (177)Lu-DOTATATE an effective treatment option for these metastases? METHODS Lewis rats (HanHsd or SsNHsd substrain with a slight difference in immune response) bearing subcutaneous CA20948 tumors were treated with either 125 or 275 MBq (177)Lu-DOTATATE, RAD001, or their combination. RAD001 was given twice a week for 4.5 or 12 weeks, whereas (177)Lu-DOTATATE was given as a single injection. When combined, RAD001 was started either 3 days prior to or 3 days post administration of (177)Lu-DOTATATE. SPECT/CT was performed to quantify (177)Lu-DOTATATE tumor uptake. Where indicated, primary tumors were surgically removed when tumor size is >6,000 mm(3) to enable monitoring for possible metastasis. If metastases were suspected, an (111)In-DTPA-octreotide SPECT/CT scan was performed. Seven rats with metastases were treated with 400 MBq (177)Lu-DOTATATE. RESULTS Lu-DOTATATE tumor uptake was not significantly affected by RAD001 pretreatment. The occurrence of metastases after RAD001 treatment was not dose dependent in the dose range tested, nor was it related to the duration of RAD001 treatment. In the experiment in which the LEW/SsNsd substrain was used, only 12.5% of RAD001-treated rats showed complete response (CR), compared to 50% tumor regression in the control group. Re-treatment with a high dose of (177)Lu-DOTATATE resulted in CR in only two out of seven animals. CONCLUSION Less effective anti-tumor effects after the combination of RAD001 + (177)Lu-DOTATATE could not be explained by reduced (177)Lu-DOTATATE tumor uptake after RAD001. Our current data support RAD001-induced immune suppression as the reason for this observation. No evidence was found that cessation of RAD001 treatment caused development of metastases. Metastases appeared to be less sensitive to (177)Lu-DOTATATE treatment than primary tumors.


title: Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case.

text: Closure of the duodenal stump using a stapling device is commonly applied in Roux-en-Y reconstruction after gastrectomy. However, serious and possibly fatal duodenal stump perforation can develop in extremely rare cases. We describe a case of subtotal gastrectomy with Roux-en-Y reconstruction followed by repeated duodenal stump perforations. A 79-year-old man with a long history of diabetes and hypertension was admitted to our institution with epigastralgia and right hypochondralgia. Computed tomography and an upper gastrointestinal imaging series revealed remarkable wall thickening of the gastric antrum and corpus. Upper endoscopy also showed a giant ulcerative lesion in the same area. The lesion was confirmed by histology to be poorly differentiated adenocarcinoma. The patient underwent open subtotal gastrectomy with Roux-en-Y reconstruction. However, duodenal stump perforation occurred repeatedly on postoperative days 1, 3, and 19, which caused peritonitis. The patient was kept alive through duodenal stump repair, an additional resection using a stapling device, and repeated drainage treatments; but he suffered considerable morbidity due to these complications. We report a case of a life-threatening duodenal stump perforation after subtotal gastrectomy, highlighting lessons learned from the profile and clinical course. Abdominal surgeons should be aware of the possibility of this serious complication of duodenal stump perforation, and be able to perform immediate interventions, including life-saving reoperation.


title: Natural occurrence and characterization of two internal ribosome entry site elements in a novel virus, canine picodicistrovirus, in the picornavirus-like superfamily.

text: Dicistroviridae and Picornaviridae are two phylogenetically related families of positive-sense single-stranded RNA viruses in the picornavirus-like superfamily with similar gene contents but different genome organizations and hosts. In a surveillance study involving 1,472 samples from 368 dogs over a 22-month period, we identified a novel picornavirus-like virus from 47 fecal and urine samples by the use of reverse transcription-PCR (RT-PCR). Sequencing and phylogenetic analysis of three complete genomes revealed that, although it seemed that the virus was most closely related to other picornaviruses, P1, P2, and P3 of the virus possessed very low amino acid identities of <30% to those of all other known picornaviruses and that the amino acid identities between the 3D(pol) and 2C of the virus and the RNA-dependent RNA polymerases and helicases of all other picornaviruses were <35%. Distinct from other picornaviruses, the genomes of the virus contain two putative internal ribosome entry sites (IRESs) and two open reading frames, encoding two polyprotein precursors (844 and 1,406 amino acids), separated by an intergenic region (IGR) of 588 bases. A dual-luciferase activity assay using DNA and RNA transfection revealed that both IRESs were functional. Quantitative RT-PCR showed that numbers of viral RNAs ranged from 7.55 × 10(6) to 1.26 × 10(9) copies/ml of urine and 1.82 × 10(6) to 4.97 × 10(10) copies/ml of fecal sample. This is the first report of the natural occurrence of two functional IRESs in nondicistroviruses. Based on our results, we have proposed a novel species, canine picodicistrovirus (CPDV), to describe this novel member of the picornavirus-like superfamily, which could represent a novel family of viruses.


title: Single-incision laparoscopic total colectomy.

text: BACKGROUND AND OBJECTIVES To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic total colectomy. METHODS A total of 22 cases were published between 2010 and 2011, with our patient being case 23. These procedures were performed in the United States and United Kingdom. Surgical procedures included total colectomy with end ileostomy, proctocolectomy with ileorectal anastomosis, and total proctocolectomy with ileopouch-anal anastomosis. Intraoperative and postoperative data are analyzed. RESULTS Twenty-two of the 23 cases were performed for benign cases including Crohns, ulcerative colitis, and familial adenomatous polyposis. One case was performed for adenocarcinoma of the cecum. The mean age was 35.3 years (range, 13 to 64), the mean body mass index was 20.1 (range, 19 to 25), mean operative time was 175.9 minutes (range, 139 to 216), mean blood loss was 95.3mL (range, 59 to 200), mean incision length was 2.61cm (range, 2 to 3). Average follow-up was 4.6 months with 2 reported complications. CONCLUSIONS Single-incision laparoscopic total colectomy is feasible and safe in the hands of an experienced surgeon. It has been performed for both benign and malignant cases. It is comparable to the conventional multi-port laparoscopic total colectomy.


title: Coronavirus disease 2019 in children: Current status

text: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged from China in December 2019. The outbreak further exploded in Europe and America in mid-March 2020 to become a global health emergency. We reviewed recent published articles and on-line open messages on SARS-CoV-2–positive infants and children younger than 20 years of age. Symptoms are usually less severe in children than in adults. Twelve critically or mortally ill children were found in the published or news reports before April 6, 2020. Vertical transmission from the mother to her fetus or neonate has not been proven definitively. However, six early-onset (<7 days) and 3 late-onset neonatal SARS-CoV-2 infections were found in the literature. We also summarized the presentations and contact information of 24 SARS-CoV-2–positive children announced by the Taiwan Centers for Disease Control. Early identification and isolation, adequate management, prevention, and vaccine development are the keys to controlling the disease spread. Clinical physicians should be alert to asymptomatic children with COVID-19. Multidirectional investigations are crucial in the global fight against COVID-19.


title: Single-port Laparoscopic Appendectomy: Beyond the Learning Curve: A Retrospective Comparison With Multi-port Laparoscopic Appendectomy.

text: OBJECTIVES Previous comparisons between single-port laparoscopic appendectomy (SPLA) and multi-port laparoscopic appendectomy have been conflicting and limited. We compare our single-surgeon, SPLA experience with multi-port cases performed during the same time. METHODS A retrospective chart review of 128 single-surgeon single-port and 941 multi-port laparoscopic appendectomy cases from April 2009 to December 2014 was conducted. RESULTS Patient demographics and preoperative laboratory values were comparable. SPLA was associated with shorter operative time (P=0.0001). There was no statistically significant difference in length of hospitalization, postoperative pain medication use, cost, postoperative complication rates (ileus, urinary retention, deep space infection), or readmission between the 2 groups. There were no postoperative incisional hernias in the single-port group. The single-port group had more postoperative oxycodone use (P=0.0110). CONCLUSIONS Our study supports recently published metaanalyses that fail to support older studies demonstrating longer operative times, and higher hernia rates with SPLA.


title: Social Big Data Analysis of Information Spread and Perceived Infection Risk During the 2015 Middle East Respiratory Syndrome Outbreak in South Korea.

text: We investigated online diffusion of information, spread of fear, and perceived risk of infection to Middle East Respiratory Syndrome (MERS) as cases of MERS spread rapidly and dozens of fatalities occurred in South Korea in May-June of 2015. This study retrieved 8,671,695 MERS-related online documents from May 20 to June 18, 2015, from 171 Korean online channels and analyzed such documents by using multilevel models and data mining with Apriori algorithm association analysis. We used R software (version 3.2.1) for the association analysis data mining and visualization. Buzz with negative emotions (i.e., anxiety or fear) was more prevalent in online discussion boards, Twitter, and online cafes than news sites and blogs. News buzz (b = 0.21, p < 0.001), but not rumor buzz (b = 0.06, p = 0.308), was associated with positive MERS emotions (i.e., being calm or composed). The mention of eating immunity-boosting food in the news led to a 94 percent chance of a positive MERS emotion and that such a chance of showing a positive emotion was 4.75 times higher than that without such a mention (support of 0.001, confidence of 0.94, and lift of 4.75). Even with the same precautionary messages that were disseminated, they yielded the opposite emotional reactions to people depending on the channel through which the messages were communicated. In the face of a novel and highly contagious disease such as MERS, the government must deploy a response system that includes provision and dissemination of reliable information and inhibits online diffusion of false information.


title: Impact of viral infection on acute exacerbation of asthma in out-patient clinics: a prospective study.

text: BACKGROUND The prevalence of viral infection triggering asthma exacerbation and its impact on the symptoms and duration of exacerbation are unclear. METHODS Asthma and healthy control subjects were recruited from the First Affiliated Hospital of Guangzhou Medical University between February 2012 and February 2013. Nasal swabs were collected, and respiratory viruses were detected by polymerase chain reaction (PCR). All patients completed questionnaires and a lung function test. Some were followed up for 4 weeks, and symptom changes were evaluated via asthma diaries. RESULTS In total, 70 patients with acute asthma exacerbations were recruited. Among them, 34 patients (48.6%) completed the 4-week follow-up study. Another 65 patients with stable asthma and 134 healthy volunteers were also included in this study. The rate of positive viral detection via PCR in acute asthma exacerbation patients was 34.2% (24/70), which is significantly higher than that of stable asthma (12/65; 18.5%; P=0.038) and normal control patients (18/134; 13.4%; P<0.001). Among the viral-positive subjects, the number of viral copies was significantly higher in acute asthma exacerbation patients [(5.00±4.63) ×10(7) copies/L] (mean ± SD) than those in stable asthma patients [(1.24±1.44) ×10(6) copies/L; P<0.001] or in healthy controls [(1.44±0.44) ×10(6) copies/L; P<0.001], whose viral loads were not significantly different from one another (P=0.774). During the 4-week follow-up period, the cough scores on days 1 and 3 were significantly higher in the viral-positive group than in the viral-negative group (day 1: P=0.016; day 3: P=0.004). However, there were no significant differences between these two groups for other tested symptoms, such as dyspnea and total recovery time (P>0.05). CONCLUSIONS Respiratory viruses may be involved in acute asthma exacerbations, inducing more prominent and persistent cough symptoms.


title: The Lipo-Body Lift: Operative Technique.

text: Bariatric surgery induces massive weight loss, which results in global and complex skin deformities. Lower body lift procedure has become the gold standard for lower trunk reconstruction. The authors describe in this video the lipo-body lift technique in detail. The video is divided into 4 parts: part 1, indications and preoperative markings; part 2, posterior contouring; part 3, anterior contouring; and part 4, preoperative and postoperative results. Patient selection and technical key points of the technique are discussed. The lipo-body lift method is an important component of reconstructive strategies and should be widely offered to patients who experienced massive weight loss.


title: Two-port laparoscopic donor nephrectomy with simple retraction technique.

text: OBJECTIVE To present our experience of 2-port laparoscopic donor nephrectomy (TPLDN) and to introduce a simple retraction suture technique. MATERIAL AND METHODS From October 2010 to November 2010, 10 consecutive, left TPLDNs were performed. The SILS Port was inserted through the umbilicus and was used for 5-mm laparoscope and laparoscopic instruments. A 12-mm trocar, for another working channel, was inserted along the midclavicular line at the umbilicus level. No articulating or bent laparoscopic instruments were needed. Two retraction sutures were used; a 3-0 Prolene suture was passed through the pericolic fat and then brought out of the abdominal wall and secured to the skin. Another suture was passed around the lower pole fat of the kidney, which was then fixed on the abdominal wall with a clamp. RESULTS TPLDN was performed successfully in all patients, with no conversions to a conventional laparoscopic procedure or additional trocar insertion needed. The mean operative time was 152 ± 16.3 minutes, and the mean warm ischemia time was 2.9 ± 0.9. The average estimated blood loss was 77.3 ± 70 mL, and the postoperative hospital stay was 3.6 ± 0.6 days. No perioperative or postoperative complications were observed. Cosmesis was excellent, with a mean incision length of 5.6 ± 0.4 cm. All allografts functioned after transplantation. CONCLUSION Our initial experience suggests that TPLDN appears safe and cosmetically effective and a feasible option for donor nephrectomy. The appropriate use of retraction sutures, during TPLDN, helps to overcome the technical problems associated with the inadequate retraction and exposure.


title: Geriatric Care during Public Health Emergencies: Lessons Learned from Novel Corona Virus Disease (COVID-19) Pandemic.

text: Geriatric care in public health emergencies is a serious concern, while, high case-fatalities among older adults across the globe in COVID-19 pandemic implies lack of preparedness. Most of the countries irrespective of developing and developed one enormously struggling because of an inchoate response system ignorant of geriatric health needs. Therefore, a robust approach is highly essential that requires an integrated emergency preparedness by addressing geriatric care.


title: Foldon unfolding mediates the interconversion between M(pro)-C monomer and 3D domain-swapped dimer.

text: The C-terminal domain (M(pro)-C) of SARS-CoV main protease adopts two different fold topologies, a monomer and a 3D domain-swapped dimer. Here, we report that M(pro)-C can reversibly interconvert between these two topological states under physiological conditions. Although the swapped α(1)-helix is fully buried inside the protein hydrophobic core, the interconversion of M(pro)-C is carried out without the hydrophobic core being exposed to solvent. The 3D domain swapping of M(pro)-C is activated by an order-to-disorder transition of its C-terminal α(5)-helix foldon. Unfolding of this foldon promotes self-association of M(pro)-C monomers and functions to mediate the 3D domain swapping, without which M(pro)-C can no longer form the domain-swapped dimer. Taken together, we propose that there exists a special dimeric intermediate enabling the protein core to unpack and the α(1)-helices to swap in a hydrophobic environment, which minimizes the energy cost of the 3D domain-swapping process.


Spotlight on respiratory viruses 2012: introduction.


Impact of anticoagulation prior to COVID-19 infection: a propensity score-matched cohort study.


title: Leucine-rich α2-glycoprotein as the acute-phase reactant to detect systemic juvenile idiopathic arthritis disease activity during anti-interleukin-6 blockade therapy: A case series.

text: OBJECTIVES To assess the role of leucine-rich α2-glycoprotein (LRG) as a biomarker for monitoring systemic juvenile idiopathic arthritis (s-JIA) disease activity during interleukin (IL)-6 blockade treatment. METHODS We serially measured serum LRG levels in four s-JIA patients treated with the anti-IL-6 receptor antibody tocilizumab and determined the correlation between clinical symptoms and other inflammatory biomarkers and proinflammatory cytokines, including IL-18, IL-6, neopterin, and tumor necrosis factor-α receptor type I and II. The serum levels of LRG and proinflammatory cytokines were determined using enzyme-linked immunosorbent assay. RESULTS Serum LRG levels increased concomitantly with s-JIA disease flare-up and macrophage activation syndrome development. Furthermore, even in the clinically inactive phase, serum LRG levels were well above normal values. There were no correlations between serum LRG levels and indicators of s-JIA disease activity other than aspartate aminotransferase. There were significant positive correlations between serum LRG levels and proinflammatory cytokines. CONCLUSIONS Serum LRG levels might be a unique and potential biomarker of s-JIA disease activity during IL-6 blockade treatment.


title: Feline abdominal ultrasonography: what's normal? what's abnormal? The kidneys and perinephric space.

text: PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the kidneys and perinephric space can provide important information on several conditions including chronic renal disease, hydronephrosis and perinephric pseudocyst formation. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as a medullary rim sign, and pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses ultrasonographic examination of the normal and diseased kidney and perinephric space. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. A subsequent article will address ultrasonography of the collecting system including the renal pelvis and urinary bladder. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.


title: Laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses: 43 cases.

text: OBJECTIVE To document laparoscopic cryptorchidectomy with a vessel-sealing device in dorsal recumbent horses. STUDY DESIGN Retrospective study. ANIMALS Forty-three male horses. METHODS Food was withheld for 36 hours before horses were placed under general anesthesia and positioned in dorsal recumbency. One laparoscopic portal and 2 instrument portals were placed for the laparoscopic procedure. A third instrument portal was created in bilateral cryptorchid horses. A vessel-sealing device was used for hemostasis and transection of retained testes. Descended testes were removed via closed castration with primary closure of the scrotal incision. Time required for removal of the retained testis and perioperative complications were recorded. Short-term (14, 30, 60 days) and long-term follow-up (>1.5 years) consisted of telephone interview with owners and referring veterinarians. RESULTS Forty-three male horses underwent laparoscopic cryptorchidectomy. Thirteen horses were bilateral cryptorchids, 19 were unilateral cryptorchids with a descended testis, and 11 were unilateral cryptorchids with 1 testis previously removed. Inguinal testes, identified in 5 horses, were pulled into the abdomen prior to excision. The vaginal ring was apposed with endoscopic staples in 3 of 5 horses. Mean surgery time was 31.34 ± 7.41 minutes. No intraoperative or immediate postoperative complications were encountered. No short-term or long-term complications were reported. CONCLUSION Laparoscopic cryptorchidectomy can be safely performed with a vessel sealing-device in dorsal recumbent horses. This method was effective and did not result in any complication in our case series.


title: Performance and Impact of a CLIA, Point-of-Care Respiratory PCR Panel in a Pediatric Clinic.

text: BACKGROUND Laboratory-based respiratory polymerase chain reaction (PCR) panels are rarely used in outpatient pediatric practice due to prolonged turn-around times and cost of medical equipment. The BioFire FilmArray Respiratory Panel EZ (RP EZ) is a Clinical Laboratory Improvement Amendments-waived respiratory pathogen PCR panel which rapidly tests for 14 common respiratory organisms. The aim of this study was to identify the distribution of organisms seen in pediatric clinics and to determine if utilization of this point-of-care test improved disease management, while exploring impact on clinic workflow. METHODS From January 2018 through January 2019, when clinically appropriate, patients were tested by the RP EZ and/or antigen tests (Clinic A) or antigen test only (Clinic B). Residual samples from Clinic B antigen tests were frozen and later tested on the RP EZ for definitive pathogen identification. Patient data and prescription records were extracted from the electronic health record. RESULTS A total of 430 patients had RP EZ tests performed, and at least 1 organism was detected in 70.4% of patients. The most common organisms identified were human rhinovirus/enterovirus, influenza, and respiratory syncytial virus. Appropriate treatment occurred for 93.6% of patients when the RP EZ was performed (Clinic A) versus 87.9% of patients who had only antigen tests performed (Clinic B, P = 0.0445). Utilization of RP EZ testing also significantly reduced appointment duration time (48.0 versus 54.9 minutes, P = 0.0009). Three false-positive influenza B results were identified by antigen testing. CONCLUSIONS A point-of-care PCR panel improved patient care by providing an accurate diagnosis and shortened appointment duration.


title: Successful Guselkumab treatment in a psoriatic patient affected with Cornelia de Lange Syndrome, and prosecution during the COVID-19 pandemic.

text: Psychomotor delay and intellectual disability are potential limitations in psoriasis management, due to low compliance, and strict dependence from care givers intervention. We report our successful experience with a 58-year-old woman, who was genetically affected by Cornelia De Lange syndrome, which causes intellectual disability and psychomotor disorders. The patient had been already treated with topical and traditional therapies, without any clinical benefits. Eventually she adhered to guselkumab treatment. The compliance was excellent, significant improvements were observed after only 3 months of treatment, without adverse effects. During follow-up, the COVID-19 pandemic address concern on the possible increased risk of infection due to immunosuppression. In agreement with current Italian recommendations, risk and benefits profile was discussed with the patient's legal tutor and the decision to continue the treatment was taken. Psoriasis complete clarification was maintained during the most difficult period of the Italian outbreak, allowing the patient to remain safely at home. This article is protected by copyright. All rights reserved.


title: Double microcatheter technique for coil embolization of small aneurysms with unfavorable configurations: A comparative study of the aneurysms that are ≤3 mm or >3 mm.

text: INTRODUCTION The endovascular coiling of small ruptured aneurysms with difficult geometries presents a significant treatment challenge. We report our initial experience and the technical details of dual microcatheter coil embolizations that were applied in these difficult lesions. METHOD AND RESULTS Eighty-five small aneurysms (<7 mm) that exhibited difficult configurations, such as a wide neck or an important branch vessel arising from the fundus, were successfully treated using a dual microcatheter technique. The packing attenuation, adverse events during the procedures, and angiographic occlusions from 21 very small aneurysm (≤3 mm) were recorded and compared with our coiling results of 64 small aneurysms (>3 mm, <7 mm). There were no significant differences in intraprocedural ruptures or procedure-related thromboembolisms between the two groups. At the last post-procedure clinical follow-up, a good clinical outcome (an modified Rankin Scale (mRS) of 0-2) was observed in 18 of the patients (85.7%). The recanalization rates at follow-up were significantly lower in the very small aneurysm group compared to the small aneurysm group (p < 0.05) and the mean packing density in the very small aneurysm group was significantly higher compared to the small aneurysm group (35.2% vs 24.8%, p < 0.05). CONCLUSION The dual technique was feasible, safe, and effective for coil embolization of aneurysms with difficult configurations and, in particular, it provided an alternative option for treating very small aneurysms.


title: Emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to tandem occlusion.

text: OBJECTIVE Acute occlusions of the extracranial internal carotid artery (ICA) and a major intracranial artery respond poorly to intravenous tissue plasminogen activator (tPA) and present an endovascular challenge. The aim of our study was to retrospectively delineate the feasibility of the combined use of emergent carotid stenting and intra-arterial (IA) Abciximab with intracranial revascularization in the setting of acute ischemic stroke and carotid occlusions at our institution. METHODS Eleven patients with complete cervical carotid occlusion with or without concomitant intracranial ICA and/or MCA occlusion were identified from a single center, retrospective review of patients admitted to the Stroke unit. We evaluated all cases for complications of emergent cervical ICA recanalization employing carotid stenting and IA Abciximab. RESULTS All patients had complete cervical carotid occlusion with (n = 8) or without (n = 3) concomitant intracranial ICA and/or MCA occlusion. Successful emergent cervical ICA recanalization was achieved in all cases. All patients were administered IA Abciximab (dose range 6-17 mg, average 11.4 mg) immediately following the cervical carotid stenting. There was complete recanalization in all patients with no procedural morbidity or mortality. A single case (1/11, 9%) developed asymptomatic hemorrhagic transformation. Upon discharge, 9 patients (9/11, 82%) had a mRS of 0-2 and 2 patients (2/11, 18%) had a mRS of 3. CONCLUSIONS In acute ICA-MCA/distal ICA occlusions, extracranial stenting followed by intracranial IA Abciximab and thrombectomy appears feasible, effective, and safe. Further evaluation of this treatment strategy is warranted.


title: Microsurgical Removal of Microcatheter in the Middle Cerebral Artery During Resection of an Arteriovenous Malformation Resection.

text: Surgical resection is the current standard of therapy for the treatment of arteriovenous malformation (AVM). Endovascular embolization is commonly used as an adjunct prior to surgical resection because it is believed to reduce the risk of intraoperative bleeding. Embolization has been associated with other complications including visual deficits, vessel perforation, and catheter adhesion. Catheter adhesion in which retained segments are contained within the embolization cast are not necessarily cause for concern, but retention of larger portions may confer an increased risk of thrombus formation. Such cases warrant the removal of the retained segments or the patient may suffer serious complications including death related to cerebrovascular events. In this case report, we describe a unique case of catheter adhesion in which the extension of the feeding catheter and the length of the introducer was left in its entirety down to the entry portion at the level of the groin and later retrieved in its entirety by craniotomy.


title: Human herpesvirus 6 suppresses T cell proliferation through induction of cell cycle arrest in infected cells in the G2/M phase.

text: Human herpesvirus 6 (HHV-6) is an important immunosuppressive and immunomodulatory virus that primarily infects immune cells and strongly suppresses the proliferation of infected cells. However, the mechanisms responsible for the regulation and suppression mediated by HHV-6 are still unknown. In this study, we examined the ability of HHV-6A to manipulate cell cycle progression in infected cells and explored the potential molecular mechanisms. We demonstrated that infection with HHV-6A imposed a growth-inhibitory effect on HSB-2 cells by inducing cell cycle arrest at the G(2)/M phase. We then showed that the activity of the Cdc2-cyclin B1 complex was significantly decreased in HHV-6A-infected HSB-2 cells. Furthermore, we found that inactivation of Cdc2-cyclin B1 in HHV-6A-infected cells occurred through the inhibitory Tyr15 phosphorylation resulting from elevated Wee1 expression and inactivated Cdc25C. The reduction of Cdc2-cyclin B1 activity in HHV-6-infected cells was also partly due to the increased expression of the cell cycle-regulatory molecule p21 in a p53-dependent manner. In addition, HHV-6A infection activated the DNA damage checkpoint kinases Chk2 and Chk1. Our data suggest that HHV-6A infection induces G(2)/M arrest in infected T cells via various molecular regulatory mechanisms. These results further demonstrate the potential mechanisms involved in immune suppression and modulation mediated by HHV-6 infection, and they provide new insights relevant to the development of novel vaccines and immunotherapeutic approaches.


title: Quantifying the source-sink balance and carbohydrate content in three tomato cultivars.

text: Supplementary lighting is frequently applied in the winter season for crop production in greenhouses. The effect of supplementary lighting on plant growth depends on the balance between assimilate production in source leaves and the overall capacity of the plants to use assimilates. This study aims at quantifying the source-sink balance and carbohydrate content of three tomato cultivars differing in fruit size, and to investigate to what extent the source/sink ratio correlates with the potential fruit size. Cultivars Komeet (large size), Capricia (medium size), and Sunstream (small size, cherry tomato) were grown from 16 August to 21 November, at similar crop management as in commercial practice. Supplementary lighting (High Pressure Sodium lamps, photosynthetic active radiation at 1 m below lamps was 162 μmol photons m(-2) s(-1); maximum 10 h per day depending on solar irradiance level) was applied from 19 September onward. Source strength was estimated from total plant growth rate using periodic destructive plant harvests in combination with the crop growth model TOMSIM. Sink strength was estimated from potential fruit growth rate which was determined from non-destructively measuring the fruit growth rate at non-limiting assimilate supply, growing only one fruit on each truss. Carbohydrate content in leaves and stems were periodically determined. During the early growth stage, 'Komeet' and 'Capricia' showed sink limitation and 'Sunstream' was close to sink limitation. During this stage reproductive organs had hardly formed or were still small and natural irradiance was high (early September) compared to winter months. Subsequently, during the fully fruiting stage all three cultivars were strongly source-limited as indicated by the low source/sink ratio (average source/sink ratio from 50 days after planting onward was 0.17, 0.22, and 0.33 for 'Komeet,' 'Capricia,' and 'Sunstream,' respectively). This was further confirmed by the fact that pruning half of the fruits hardly influenced net leaf photosynthesis rates. Carbohydrate content in leaves and stems increased linearly with the source/sink ratio. We conclude that during the early growth stage under high irradiance, tomato plants are sink-limited and that the level of sink limitation differs between cultivars but it is not correlated with their potential fruit size. During the fully fruiting stage tomato plants are source-limited and the extent of source limitation of a cultivar is positively correlated with its potential fruit size.


Vaccination combats antimicrobial resistance.


title: Simultaneous PET/MRI Imaging During Mouse Cerebral Hypoxia-ischemia.

text: Dynamic changes in tissue water diffusion and glucose metabolism occur during and after hypoxia in cerebral hypoxia-ischemia reflecting a bioenergetics disturbance in affected cells. Diffusion weighted magnetic resonance imaging (MRI) identifies regions that are damaged, potentially irreversibly, by hypoxia-ischemia. Alterations in glucose utilization in the affected tissue may be detectable by positron emission tomography (PET) imaging of 2-deoxy-2-(18F)fluoro-ᴅ-glucose ([18F]FDG) uptake. Due to the rapid and variable nature of injury in this animal model, acquisition of both modes of data must be performed simultaneously in order to meaningfully correlate PET and MRI data. In addition, inter-animal variability in the hypoxic-ischemic injury due to vascular differences limits the ability to analyze multi-modal data and observe changes to a group-wise approach if data is not acquired simultaneously in individual subjects. The method presented here allows one to acquire both diffusion-weighted MRI and [18F]FDG uptake data in the same animal before, during, and after the hypoxic challenge in order to interrogate immediate physiological changes.


title: Cost-of-illness of knee osteoarthritis: potential cost savings by not undergoing arthroplasty within the first 2 years.

text: Purpose Although knee arthroplasty (KA) is the largest source of hospitalization costs for knee osteoarthritis (OA), some studies have suggested reducing the use of "low-value" interventions, such as intra-articular hyaluronic acid (HA), to lower health care costs. However, those studies fail to consider that HA has demonstrated benefits in extending time to more costly KA or avoiding KA altogether. We evaluated 1) the overall knee OA costs (direct) within a 2-year period; 2) the relative contribution of HA and KA costs; 3) the direct cost savings from HA patients not undergoing KA. Patients and methods Knee OA patients were identified from the Optum Clinformatics data set, which includes physician, facility, and pharmacy claims data from privately insured patients of all ages. Patients were stratified in the no HA, non-hylan G-F 20, and hylan G-F 20 cohorts. The cumulative costs (payer perspective) were evaluated for all knee OA-related claims (adjusted to Consumer Price Index Jan 2017$) for patients who had at least 2 years follow-up. Costs were stratified into various clinical categories. Results The study cohort included 2,030,497 knee OA patients, of which 65,144 patients (3.2%) underwent KA. The cost of treating knee OA within the 2-year follow-up period was estimated to be $4.99 billion (B). The majority of the costs (69%) were attributed to KA patients (3.2% of patients). In all, 15.9% of the HA patients underwent KA within 2 years, but HA only contributed 1.7% to the total costs for these patients. The remaining 84.1% of HA patients did not undergo KA, which saved an estimated total of $1.54B (average $20,740 per patient) or 83.9%, after accounting for their non-KA therapies. Conclusion Our study estimated substantial cost savings through a large percentage of HA patients not undergoing KA. Although a fraction of patients moved on from their conservative therapy to undergo KA within the 2-year period, HA attributed to <2% of their total treatment costs.