title: Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial.

text: BACKGROUND Laparoscopic repair of ventral and incisional hernias has gained popularity since many studies have reported encouraging results in terms of outcomee and recurrence. Choice of mesh and fixation methods are considered crucial issues in preventing recurrences and complications. Lightweight meshes are considered the first choice due to their biomechanical properties and the ability to integrate into the abdominal wall. Titanium helicoidal tacks still represent the "gold standard" for mesh fixation, even if they have been suggested to be involved in the genesis of post-operative pain and complications. Recently, absorbable tacks have been introduced, under the hypothesis that there will be no need to maintain a permanent fixation device after mesh integration. Nevertheless, there is no evidence that absorbable tacks may guarantee the same results as titanium tacks in terms of strength of fixation and recurrence rates. The primary end point of the present trial is to test the hypothesis that absorbable tacks are non-inferior to titanium tacks in laparoscopic incisional and ventral hernia repair (LIVHR) by lightweight polypropylene mesh, in terms of recurrence rates at 3-year follow-up. Surgical complications, post-operative stay, comfort and pain are secondary end points to be assessed. METHODS/DESIGN Two hundred and twenty patients with ventral hernia will be randomized into 2 groups: Group A (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by titanium tacks; Group B (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by absorbable tacks. DISCUSSION A few retrospective studies have reported similar results when comparing absorbable versus non-absorbable tacks in terms of intraoperative and early post-operative outcomes. These studies have the pitfalls to be retrospective evaluation of small series of patients, and the reported results still need to be validated by larger series and prospective studies. The aim of the present trial is to investigate and test the non-inferiority of absorbable versus non-absorbable tacks in terms of hernia recurrence rates, in order to assess whether the use of absorbable tacks may achieve the same results as non-absorbable tacks in mid-term and long-term settings. TRIAL REGISTRATION NUMBER NCT02076984: 5 June 2014 (ClinicalTrials.gov).


title: Chest CT-based differential diagnosis of 28 patients with suspected corona virus disease 2019 (COVID-19).

text: OBJECTIVES The chest CT findings that can distinguish patients with corona virus disease 2019 (COVID-19) from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative have not previously been described in detail. The purpose of this study was to determine the distinctions among patients with COVID-19 by comparing the imaging findings of patients with suspected confirmed COVID-19 and those of patients initially suspected to haveCOVID-19 who were ultimately negative for the disease. METHODS 28 isolated suspected in-patients with COVID-19 were enrolled in this retrospective study from January 22, 2020, to February 6, 2020. 12 patients were confirmed to have positive severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) RNA results, and 16 patients had negative results. The thin-section CT imaging findings and clinical and laboratory data of all the patients were evaluated. RESULTS There were no significant differences between the 12 confirmed COVID-19 (SARS-Cov-2-positive) patients and 16 SARS-CoV-2-negative patients in epidemiology and most of the clinical features or laboratory data. The CT images showed that the incidence of pure/mixed ground-glass opacities (GGOs) was not different between COVID-19 and SARS-CoV-2-negative patients [9/12 (75.0%) vs 10/16 (62.5%), p = 0.687], but pure/mixed GGOs in the peripheral were more common in patients with COVID-19 [11/12 (91.7%) vs 6/16 (37.5%), p = 0.006]. There were no significant differences in the number of lesions, bilateral lung involvement, large irregular/patchy opacities, rounded opacities, linear opacities, crazy-paving patterns, halo signs, interlobular septal thickening or air bronchograms. CONCLUSIONS Although peripheral pure/mixed GGOs on CT may help distinguish patients with COVID-19 from clinically suspected but negative patients, CT cannot replace RT-PCR testing. ADVANCES IN KNOWLEDGE Peripheral pure/mixed GGOs on-chest CT findings can be helpful in distinguishing patients with COVID-19 from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative.


title: Enhanced viral etiological diagnosis of respiratory system infection outbreaks by use of a multitarget nucleic acid amplification assay.

text: A study was undertaken to assess the utility of the xTAG respiratory viral panel (RVP) for enhanced laboratory investigation of respiratory outbreaks. Specimens (n = 1,108) from 244 suspected respiratory virus outbreaks in 2006 and 2007 in Alberta, Canada, were included in the study. Testing by direct fluorescent antigen detection (DFA) and various in-house nucleic acid amplification tests (NATs) for common respiratory viruses provided an etiological diagnosis in 177 outbreaks (72.5%), with 524 samples testing positive (47.3%) for a respiratory virus. Two hundred samples from 51 unresolved outbreaks were further tested by RVP retrospectively. Fifty-eight samples from 30 unresolved outbreaks had a respiratory virus detected by RVP (47 picornavirus-positive, 9 coronavirus-positive, and 2 influenza virus A-positive samples). Overall, detection of a viral etiological agent was achieved in 90.8% of outbreaks using a combination of DFA, NATs, and RVP. Use of RVP enhances the laboratory investigation of respiratory virus outbreaks and facilitates appropriate patient and outbreak management.


title: Micro- and nanocantilever devices and systems for biomolecule detection.

text: Recent research trends in biosensing have been geared toward developing bioanalytical devices that are label free, small in size, and portable and that can operate in a rapid manner. The performance of these devices has been dramatically improved through the advent of new materials and micro-/nanofabrication technologies. This is especially true for micro-/nanosized cantilever sensors, which undergo a change in mechanical properties upon the specific binding of biomolecules. In this review, we introduce the basic principles of cantilever biosensors in static and dynamic modes. We also summarize a range of approaches to cantilever design, fabrication, and instrumentation according to their applications. More specifically, we describe cantilever-based detections of proteins, DNA molecules, bacteria, and viruses and discuss current challenges related to the targets' biophysical characteristics.


title: Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model.

text: BACKGROUND In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation. METHODS Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams. RESULTS Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly. CONCLUSION We found a proportional correlation between atelectasis and PL during the 'weaning process' in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.


title: Listeria monocytogenes prevalence varies more within fields than between fields or over time on conventionally farmed New York produce fields.

text: Past studies have shown that the on-farm distribution of Listeria monocytogenes is affected by environmental factors (e.g., weather). However, the majority of studies were conducted at large scales (e.g., across farms), while few studies examined drivers of L. monocytogenes prevalence at smaller scales (e.g., within a single field). This study was performed to address this knowledge gap by (i) tracking L. monocytogenes distribution in two fields on one farm over a growing season, and (ii) identifying factors associated with L. monocytogenes isolation from drag swab, soil, and agricultural water samples. Overall, L. monocytogenes was detected in 78% (21/27), 19% (7/36), and 8% (37/486) of water, drag swab, and soil samples, respectively. All isolates were characterized by pulsed-field gel electrophoresis (PFGE). Of the 43 PFGE types identified, 14 were isolated on multiple sampling visits and/or from multiple sample types, indicating persistence in or repeated introduction into the farm environment during the study. Our findings also suggest that L. monocytogenes prevalence, even at the small spatial scale studied here, (i) was not uniform, and (ii) varied more within fields than between fields or over time. This is illustrated by the fact that plot (in-field variation), field (between field variation), and sampling visit (time) accounted for 18%, 2% and 3% of variance in odds of isolating L. monocytogenes, respectively. Moreover, according to random forest analysis, water-related factors were among the top-ranked factors associated with L. monocytogenes isolation from all sample types. For example, the likelihood of isolating L. monocytogenes from drag and soil samples increased monotonically as rainfall increased. Overall, findings from this single-farm study suggests that mitigation strategies for L. monocytogenes in produce fields should focus on water-associated risk factors (e.g., rain, distance to water), and be tailored to specific high-risk in-field areas.


title: Goal-Aligned, Epidemic Intelligence for the Public Health Response to the COVID-19 Pandemic.

text: For the COVID-19 pandemic, and for future pandemics, public health authorities at the local, state, and national levels must develop, deploy, and routinely disseminate, in as timely a manner as possible, a standard set of metrics that are goal-aligned with the public health response and that enable collective action by the whole of society, including the general public. An effective response to the COVID-19 pandemic requires nimble, intensive, and effective public health action to minimize spread, suffering, and deaths-as well as socioeconomic and racial inequities in these outcomes. "Epidemic intelligence"-a well-chosen, publicly facing set of metrics aligned with the goals of the public health response-is an important public good sometimes neglected early in emergency responses. (Am J Public Health. Published online ahead of print July 2, 2020: e1-e3. doi:10.2105/AJPH.2020.305794).


title: BAIAP2 rs8079781, postnatal smoking exposure, and emotional problems in Japanese children aged 5 years: the Kyushu Okinawa Maternal and Child Health Study.

text: BAIAP2 might be implicated in neurodevelopmental and psychiatric conditions via abnormal development of human cerebral asymmetry. The present prebirth cohort study examined the relationship between BAIAP2 single nucleotide polymorphism (SNP) rs8079781 and the risk of behavioral problems in Japanese children aged 5 years. Subjects were 1175 mother-child pairs. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Compared with the CC genotype of SNP rs8079781, at least one T allele was significantly inversely related to childhood emotional problems: the adjusted OR was 0.68 (95% CI 0.46-0.998, P = 0.049). Nevertheless, this significant inverse association disappeared after adjustment for multiple comparisons (adjusted P = 0.245). No associations were observed between SNP rs8079781 and childhood conduct problems, hyperactivity problems, peer problems, or low prosocial behavior. An independent positive relationship was observed between smoking in the household during the first year of life and emotional problems in children with the CC genotype, but not in those with at least one T allele (P for interaction = 0.04). This study is the first to show that at least one T allele of SNP rs8079781 was independently associated with a reduced risk of emotional problems in children aged 5 years, but this inverse association fell below significance after adjustment for multiple comparisons. The influence of smoking in the household during the first year of life might rely on rs8079781.


title: Subjective Changes in Smell and Taste During the COVID-19 Pandemic: A National Survey-Preliminary Results.

text: Since the COVID-19 pandemic began, many individuals have noted acute loss of smell and/or taste, although not all patients with these symptoms are tested for COVID-19. To better characterize all patients with these rare symptoms, a national survey was created. Over 13 days in April 2020, a total of 220 people completed the survey in its entirety, representing a wide geographic distribution across the United States. Of the 220 respondents, 93 (42%) were diagnosed with COVID-19, and 127 (58%) were not. A total of 37.7% of respondents reported changes in smell/taste as the initial or sole presentation of their condition. Most but not all patients had other symptoms suggestive of COVID-19 at the time of chemosensory loss. Despite its inclusion as a major symptom of COVID-19 by the CDC (Centers for Disease Control and Prevention), respondents with additional CDC-defined symptoms associated with COVID-19 were statistically more likely to be tested/diagnosed than those without.


title: Acute respiratory distress syndrome definition: do we need a change?

text: PURPOSE OF REVIEW Since the first description of the acute respiratory distress syndrome (ARDS) in 1967, no specific clinical sign or diagnostic test has yet been described that identifies ARDS. Its diagnosis is based on a combination of clinical, hemodynamic, and oxygenation criteria. The purpose of this review is to examine the current definition for ARDS and to discuss why this definition may not be the most appropriate definition for this syndrome. RECENT FINDINGS We will briefly review our current understanding of ARDS, discuss the problems with its current diagnosis, and present clinical, pathological, and biochemical evidences supporting a more appropriate definition for ARDS. In addition, we will discuss recent efforts to identify biological markers for lung injury in pulmonary edema fluid and blood collected from critically ill patients. SUMMARY On the basis of current evidence, it is time for a change in the ARDS definition. A newer classification system that recognizes different severities of pulmonary dysfunction is needed. Such a system should be able to identify patients that would be most responsive to supportive therapies and those unlikely to benefit because of the severity of their disease.


The value proposition of health care for the patient.


A 6 months old infant with fever, dyspnea and poor feeding, diagnosed with COVID-19.


title: The influence of basic ventilation strategies and anesthetic techniques on cerebral oxygenation in the beach chair position: study protocol.

text: UNLABELLED BACKGROUND Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process. METHODS/DESIGN This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey's HSD procedure for post hoc contrasts. DISCUSSION If simple maneuvers of ventilation or anesthetic technique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position. TRIAL REGISTRATION NCT01535274.


title: COVID-19: guidance for infection prevention and control in nuclear medicine.

text: This guidance document is a brief consensus document covering the range and breadth of nuclear medicine practice in the UK, and identifies a few steps individual nuclear medicine practitioners and departments can take in the best interests of their patients. This guidance document should be used to inform local practice and does not replace local Trust policies or any relevant legislation. At all times, the best interests of the patients should be paramount. Please read this guidance in conjunction with previous editorial (COVID-19- Nuclear Medicine Departments, be prepared! by Huang HL, Allie R, Gnanasegaran G, Bomanji. J Nucl Med Commun 2020; 41:297-299). Although some aspects of this guidance are time-sensitive due to the nature of the global emergency, we believe that there is still sufficient information to provide some key guiding principles.


title: Evaluation of background soil and air polychlorinated biphenyl (PCB) concentrations on a hill at the outskirts of a metropolitan city.

text: Air and soil sampling was conducted inside a forested area for 22 months. The sampling location is situated to the north of a metropolitan city. Average atmospheric gas and particle concentrations were found to be 180 and 28 pg m(-3) respectively, while that of soil phase was detected to be 3.2 ng g(-1) on dry matter, The congener pairs of PCB#4-10 had the highest contribution to each medium. TEQ concentration was 0.10 pg m(-3), 0.07 pg m(-3), 21.92 pg g(-1), for gas, particle and soil phases, respectively. PCB#126 and PCB#169 contributed to over 99% of the entire TEQ concentrations for each medium. Local sources were investigated by conditional probability function (CPF) and soil/air fugacity. Landfilling area and medical waste incinerator, located to the 8 km northeast, contributed to ambient concentrations, especially in terms of dioxin-like congeners. The industrial settlement (called Dilovasi being to the east southeast of 60 km distant) contributed from southeast direction. Further sources were identified by potential source contribution function (PSCF). Sources at close proximity had high contribution. Air mass transportation from Aliaga industrial region (being to the southwest of 300 km distant) moderately contributed to ambient concentrations. Low molecular weight congeners were released from soil body. 5-CBs and 6-CBs were close to equilibrium state between soil/air interfaces. PCB#171 was close to equilibrium and PCB#180 was likely to evaporate from soil, which constitute 7-CBs. PCB#199, representing 8-CBs deposited to soil. 9-CB (PCB#207) was in equilibrium between soil and air phases.


Six ways to juggle science and childcare from home.


title: Short-Term Quality-of-Life Changes after Endoscopic Pituitary Surgery Rated with SNOT-22.

text: Objective Little data exist on short-term quality-of-life (QOL) outcomes, specifically sinonasal measures, after endoscopic pituitary surgery. Design Prospective case series assessed sinonasal QOL before and after the transnasal endoscopic approach to the sella with resection of nasal cavity and sinus tissues. Setting/Participants/Main Outcome Measures A total of 39 adults scheduled to undergo resection for a pituitary mass preoperatively completed the Sinonasal Outcome Test-22 (SNOT-22). Rating various QOL issues, testing repeated postoperatively at 1 month by 37 patients and 3 months by 35 patients, was analyzed (paired Student t test). Results SNOT-22 scores (5-point scale; total: 110) averaged 23.4 preoperatively and 27.6 at 1 month but had significantly improved to 16.2 at 3 months (p = 0.03). Emotional well-being parameters (e.g., sadness, frustration, concentration, productivity, fatigue) significantly improved 3 months postoperatively (p < 0.05). Physiologic parameters (e.g., olfaction, obstruction, postnasal drainage) that had worsened at 1 month (< 0.05) then normalized at 3 months. Conclusion Total ratings for sinonasal QOL shows that SNOT scores were comparable between preoperative and 1-month testing but were improved significantly at 3 months. Individual questions showed marked improvement in emotional well-being and temporary physiologic changes after surgery. Our findings give surgeons information about what patients can expect immediately after transnasal endoscopic pituitary surgery.


title: Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS).

text: BACKGROUND AND OBJECTIVES Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution. METHODS From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted. RESULTS The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30-90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8. CONCLUSIONS Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions.


title: Update on association between Kawasaki disease and infection.

text: The relationship between infection and Kawasaki disease (KD) remains unclear. Infection has long been considered a key predisposing factor for KD. Bacterial and viral agents may be related to the onset of KD because of superantigen and cytokine production. Various bacterial and viral infections have been reported to be associated with KD, but the actual mechanism remains unknown. The higher association between KD and enterovirus has been well documented by using Taiwan National Health Insurance Research Database. However, no evidence has been obtained that various bacterial and viral infections induce KD. Comprehensive research, including infectious agents, should be conducted to elucidate the pathogenesis of KD.


Management of laparoscopic bladder injuries.


Limited maximal mouth opening in patients with spinal muscular atrophy complicates endotracheal intubation: An observational study.


title: Vaginal vault dehiscence after robotic hysterectomy for gynecologic cancers: search for risk factors and literature review.

text: INTRODUCTION Vaginal vault dehiscence following robotic-assisted hysterectomy for gynecologic cancer may be attributed to surgical techniques and postoperative therapeutic interventions. We searched for risk factors in patients with gynecologic cancers and complemented this with a literature review. METHODS Evaluation of prospectively gathered information on all consecutive robotic surgeries for gynecologic cancers was performed in a tertiary academic cancer center between December 2007 and March 2012. The literature was reviewed for articles relevant to "gynecologic oncology" and "robotics" with "vaginal cuff dehiscence" in the English and French languages. Respective authors were contacted to complete relevant information. RESULTS Seven dehiscences were identified of 441 cases with established gynecologic cancers. The closures in these 7 were performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%), combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156, 1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk factors included adjuvant chemotherapy and/or brachytherapy, early resumption of sexual activity, and low body mass index (mean, 23 ± 3.23 kg/m²). Dehiscences occurred regardless of suturing by staff or trainees. Review of operative videos did not reveal a detectable etiologic factor, such as excessive cautery damage to the vaginal cuff or shallow tissue sutured. All 7 colporrhexis repairs were performed through a vaginal approach without the need of laparoscopy or laparotomy. CONCLUSIONS Postoperative chemotherapy, brachytherapy, and early resumption of sexual activities are risk factors for vaginal vault dehiscence. Surgical technique, particularly the use of delayed absorbable sutures, deserves further evaluation.


title: Genetic evidence that Chinese chestnut cultivars in Japan are derived from two divergent genetic structures that originated in China.

text: The Chinese chestnut (Castanea mollissima Bl.) was introduced into Japan about 100 years ago. Since then, a number of Chinese chestnut cultivars and Japanese-Chinese hybrid cultivars have been selected by farmers and plant breeders, but little information has been available about their origins and genetic relationships. A classification based on simple sequence repeat markers was conducted using 230 cultivars including Japanese chestnut (Castanea crenata Sieb. et Zucc.) cultivars originated in Japan, Japanese-Chinese hybrid cultivars, and Chinese chestnut cultivars originated in both Japan and China. First, a search for synonyms (cultivars with identical genotypes) revealed 23 synonym groups among the Chinese chestnut cultivars, and all but one cultivar from each synonym group was omitted from further analyses. Second, genetic structure analysis showed a clear division between Japanese and Chinese chestnut, and most of the Japanese and Chinese cultivars had a simple genetic structure corresponding to the expected species. On the other hand, most Japanese-Chinese hybrid cultivars had admixed genetic structure. Through a combination of parentage and chloroplast haplotype analyses, 16 of the 18 hybrid cultivars in this study were inferred to have parent-offspring relationships with other cultivars originated in Japan. Finally, Bayesian clustering and chloroplast haplotype analysis showed that the 116 Chinese chestnut cultivars could be divided into two groups: one originated in the Hebei region of China and the other originated in the Jiangsu and Anhui regions of China. The Chinese chestnut cultivars selected in Japan showed various patterns of genetic structure including Hebei origin, Jiangsu or Anhui origin, and admixed. The chestnut cultivar genetic classifications obtained in this study will be useful for both Japanese and Chinese chestnut breeding programs.


title: Altered interregional molecular associations of the serotonin transporter in attention deficit/hyperactivity disorder assessed with PET.

text: Altered serotonergic neurotransmission has been found to cause impulsive and aggressive behavior, as well as increased motor activity, all exemplifying key symptoms of ADHD. The main objectives of this positron emission tomography (PET) study were to investigate the serotonin transporter binding potential (SERT BPND ) in patients with ADHD and to assess associations of SERT BPND between the brain regions. 25 medication-free patients with ADHD (age ± SD; 32.39 ± 10.15; 10 females) without any psychiatric comorbidity and 25 age and sex matched healthy control subjects (33.74 ± 10.20) were measured once with PET and the highly selective and specific radioligand [11 C]DASB. SERT BPND maps in nine a priori defined ROIs exhibiting high SERT binding were compared between groups by means of a linear mixed model. Finally, adopted from structural and functional connectivity analyses, we performed correlational analyses using regional SERT binding potentials to examine molecular interregional associations between all selected ROIs. We observed significant differences in the interregional correlations between the precuneus and the hippocampus in patients with ADHD compared to healthy controls, using SERT BPND of the investigated ROIs (P < 0.05; Bonferroni corrected). When correlating SERT BPND and age in the ADHD and the healthy control group, we confirmed an age-related decline in brain SERT binding in the thalamus and insula (R2 = 0.284, R2 = 0.167, Ps < 0.05; Bonferroni corrected). The results show significantly different interregional molecular associations of the SERT expression for the precuneus with hippocampus in patients with ADHD, indicating presumably altered functional coupling. Altered interregional coupling between brain regions might be a sensitive approach to demonstrate functional and molecular alterations in psychiatric conditions. Hum Brain Mapp 38:792-802, 2017. © 2016 Wiley Periodicals, Inc.


COVID-19's Crushing Effects on Medical Practices, Some of Which Might Not Survive.


title: Risk factors and prognosis of late acute rejection in Chinese kidney transplant recipients.

text: AIM Accumulating literature indicates that late acute rejection (LAR) after kidney transplantation portends an unfavourable prognosis. There are no data on the incidence of LAR in Asian subjects, or its risk factors and associated clinical outcomes. METHODS We conducted a retrospective single-centre case-+control study to investigate the incidence, risk factors and prognosis of LAR in Chinese kidney transplant recipients. Subjects with or without LAR were matched for age, gender, era of transplantation, allograft type, and maintenance immunosuppression regimen. RESULTS Thirty-two episodes of LAR occurred within an observation period of 12 years giving an incidence rate of 0.46 episodes per 1000 patient-years. Acute rejection within the first year after transplantation was associated with an increased risk of LAR (OR 3.59, P = 0.041). In patients receiving maintenance immunosuppression regimen with steroid, cyclosporin A (CsA) and mycophenolate or an m-TOR inhibitor, patients with LAR showed lower trough CsA levels prior to and at the time of rejection compared to Controls (86.0 ± 26.1 vs. 105.6 ± 13.3 μg/L, P = 0.049; and 75.7 ± 35.7 vs. 106.0 ± 20.5 μg/L, P = 0.032, respectively). Trough CsA level below 80 μg/L was associated with the development of LAR (OR 10.82, P = 0.032). Patients with LAR showed an inferior allograft survival (P < 0.001) while patient survival rates were similar (P = 0.122). CONCLUSIONS Late acute rejection is uncommon in Chinese kidney transplant recipients but is associated with reduced allograft survival. Risk factors include acute rejection in the first post-transplant year and trough CsA level below 80 μg/L in patients on CsA-based maintenance immunosuppression. Minimization of immunosuppression in apparently stable kidney transplant recipients must be exercised with caution.


title: Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey.

text: Background While specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge, the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults. Methods We administered a web-based questionnaire with items assessing the proportion of practice focused on delivery of care to older adults, adherence to recommended practices for older surgical patients, resource needs to improve care, and practice characteristics. Results Responses were collected between May 24, 2018, and June 29, 2018. A total of 25,587 ASA members were invited to participate, and 1737 answered at least one item (6.8%). 96.4% of respondents reported that they had cared for a patient aged 65 or older within the last year. 47.1% of respondents (95% confidence interval, 44.6%, 49.7%) reported using multimodal analgesia among patients aged 65 and older at least 90% of the time, and 25.5% (95% CI, 23.3%, 27.7%) provided preoperative information regarding postoperative cognitive changes at least 90% of the time. Over 80% of respondents reported that preoperative screening for frailty or dementia, postoperative screening for delirium, and preoperative geriatric consultation occurred in fewer than 10% of cases. Development of practice guidelines for geriatric anesthesia care and expansion of web-based resources were most frequently prioritized by respondents as initiatives to improve care in this domain. Discussion Most survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients.


title: To band or not to band--early results of banded sleeve gastrectomy.

text: Laparoscopic sleeve gastrectomy (LSG) is the procedure with the fastest growing numbers worldwide. Although excellent weight loss can be achieved, one major obstacle of LSG is weight regain due to sleeve dilatation. Banded sleeve gastrectomy (BLSG) has been described as an option to counteract sleeve dilatation and ameliorate weight loss over time. In a retrospective study, we analysed 25 patients who underwent BLSG using a MiniMizer® ring. Twenty five patients who had previously undergone a conventional LSG were selected for matched-pair analysis. Patient follow-up was 12 months in both groups. Mean preoperative BMI was 56.1 ± 7.2 kg/m(2) for BLSG and 57.0 ± 6.3 kg/m(2) for LSG, P = 0.522. Operative time was significantly shorter for BLSG (53 ± 27 min vs. 68 ± 20 min, P = 0.0025). Excess weight loss (%EWL) was equal in both groups with %EWL at 12 months of 58.0 ± 14.6 % for BSLG patients vs. 58.4 ± 19.2 % for LSG patients. There was no procedure-related mortality in either group. At 12 months postoperative, vomiting was significantly increased in BSLG patients (OR 6.75, P = 0.035). New onset reflux was equal in both groups (OR 0.67, P = 0.469). Ring implantation does not increase the duration of surgery or early surgical complications. Weight loss in the first follow-up year is not influenced, but the incidence of vomiting is raised after 12 months when patients start to increase eating volume.


title: A cluster of SARS-CoV-2 infection among Italian tourists visiting India, March 2020.

text: Background & objectives A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India. We report here the epidemiological, clinical, radiological and laboratory findings of the first cluster of SARS-CoV-2 infection among the tourists. Methods Information was collected on demographic details, travel and exposure history, comorbidities, timelines of events, date of symptom onset and duration of hospitalization from the 16 Italian tourists and an Indian with laboratory-confirmed SARS-CoV-2 infection. The clinical, laboratory, radiologic and treatment data was abstracted from their medical records and all tourists were followed up till their recovery or discharge or death. Throat and deep nasal swab specimens were collected on days 3, 8, 15, 18, 23 and 25 to evaluate viral clearance. Results A group of 23 Italian tourists reached New Delhi, India, on February 21, 2020 and along with three Indians visited several tourist places in Rajasthan. By March 3, 2020, 17 of the 26 (attack rate: 65.4%) had become positive for SARS-CoV-2 infection. Of these 17 patients, nine were symptomatic, while eight did not show any symptoms. Of the nine who developed symptoms, six were mild, one was severe and two were critically ill. The median duration between the day of confirmation for COVID-19 and RT-PCR negativity was 18 days (range: 12-23 days). Two patients died with a case fatality of 11.8 per cent. Interpretation & conclusions This study reconfirms higher rates of transmission among close contacts and therefore, public health measures such as physical distancing, personal hygiene and infection control measures are necessary to prevent transmission.


title: Exodontics: extraction of teeth in the dog and cat.

text: Dental disease can have a profound effect on the comfort and well-being of pets. Oral disease can be difficult to detect. Patients often hide their discomfort. The identification and treatment or removal of diseased teeth are the responsibility of the veterinarian. When diseased teeth cannot be saved by specialized care, extraction of teeth is necessary. Proper extraction of teeth in dogs and cats can be challenging and frustrating, but with review of the oral anatomy, proper instrumentation, and gentle tissue-handling techniques, this can be a rewarding part of clinical practice.


title: A simple tool to a complex reality - WhatsApp use in a developing country during COVID-19 pandemic.

text: The consequences of the SARS-CoV-2 pandemic has significantly affected dental practice. Since dental care is considered a high-risk activity (Volgenant et al., 2020), public and private dental clinics are closed to non-urgent cases in many countries. Several new routines and practices have been proposed to reduce this risk in dental offices, but standard dental treatment is expected to happen only after the "first wave" of disease and on an entirely new basis.


title: Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review.

text: BACKGROUND Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. METHODS A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. RESULTS A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. CONCLUSION Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.


Ultrasound-guided CAPD catheter insertion.


title: Coinfection with HIV and SARS-CoV-2 in Wuhan, China: A 12-person case series.

text: BACKGROUND Given the magnitude of the global COVID-19 pandemic, persons living with HIV (PLWH) may become co-infected with SARS-COV-2. SETTING We conducted a survey in Wuhan, China, to characterize the status of co-infected PLWH, their time to clinical improvement, and clinical prognoses. METHODS Using a Wuhan shipping service for antiretroviral medications, the Wuhan LGBT Center screened 2900 PLWH shipping addresses and cross-referenced 36 of them to quarantine sites or hospitals, suggesting possible COVID-19 cases. Via telephone calls and WeChat (social media) messaging, we conducted a survey after obtaining online informed consent. RESULTS We had 12 HIV-infected respondents (10 men, 2 women) who also reported COVID-19. Median age was 36 years (inter-quartile range: 33.0-56.3), mean age 42.4, and range 25-66 years of age. Nine of 10 persons on antiretroviral therapy (ART) presented with only mild COVID-19 symptoms. The tenth person on ART was a 56-year old man who died at home early in the outbreak when healthcare services were overwhelmed. Two additional cases who had been in intensive care with acute COVID-19 were both men, ages 25 and 37; both were ART-naïve until this hospitalization. Excluding the deceased man, 6 of 11 co-infected persons reported feeling depressed even after clinical improvements. CONCLUSION Twelve co-infected persons were identified in Wuhan; nine of 10 were on long-term ART and had favorable outcomes. Two men identified as having started ART only recently were found to have severe symptoms. Our case series suggests the value of ART for potential mitigation of COVID-19 co-infection.


Covid-19: out-of-hours providers are drafted in to manage non-urgent patients in community.


Covid-19: Validity of key studies in doubt after leading journals issue expressions of concern.


title: Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein.

text: Purpose There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. Methods From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3-5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. Results Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. Conclusion For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.


title: Tools for predicting patient-reported outcomes in prostate cancer patients undergoing radical prostatectomy: a systematic review of prognostic accuracy and validity.

text: BACKGROUND Radical prostatectomy is a common surgical procedure performed to treat prostate cancer. Patient-reported outcomes after surgery include urinary incontinence, erectile dysfunction, decreased quality of life and psychological effects. Predictive tools to assess the likelihood of an individual experiencing various patient-reported outcomes have been developed to aid decision-making when selecting treatment. METHODS A systematic review was undertaken to identify all papers describing tools for the prediction of patient-reported outcome measures in men with prostate cancer treated with radical prostatectomy. To be eligible for inclusion, papers had to provide a summary measure of accuracy. PubMed and EMBASE were searched from July 2007. Title/abstract screening, and full-text review were undertaken by two reviewers, while data extraction and critical appraisal was performed by a single reviewer. RESULTS The search strategy identified 3217 potential studies, of which 191 progressed to full-text review and 14 were included. From these studies, 27 tools in total were identified, of which 18 predicted urinary symptoms, six predicted erectile function and one predicted freedom from a group of three outcomes ('trifecta') (biochemical recurrence, incontinence and erectile dysfunction). On the basis of tool accuracy (>70%) and external validation, two tools predicting incontinence and two tools predicting erectile dysfunction are ready for implementation. CONCLUSIONS A small number of tools for the prediction of patient-reported outcomes following radical prostatectomy have been developed. Four tools were found to have adequate accuracy and validation and are ready for implementation for the prediction of urinary incontinence and erectile dysfunction.


title: Laparoscopy-assisted distal gastrectomy for early gastric cancer in the elderly.

text: PURPOSE With an increase in life expectancy, more elderly patients are presenting with gastric cancer. As a result it is yet be resolved whether laparoscopy assisted distal gastrectomy is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes of laparoscopy assisted distal gastrectomy between elderly and nonelderly patients with gastric cancer. MATERIALS AND METHODS The study group was comprised of 316 patients who underwent laparoscopy assisted distal gastrectomy between April 2005 and December 2010. Of these patients, 93 patients whose ages were 65 years or more were compared with 223 patients who were younger. RESULTS There were no differences in the short term outcome or minor complication rate between the elderly patients and the nonelderly patients. The hospital stay was significantly longer and the major complication rate was significantly higher for the elderly patients compared with nonelderly patients. CONCLUSIONS Laparoscopy assisted distal gastrectomy for early gastric cancer in the elderly patients had comparable operation time and blood loss with the nonelderly group. However, the safety and advantage of laparoscopy assisted distal gastrectomy in the elderly patients need to be further studied in higher volume trials.


title: The Use of an Autoregressive Integrated Moving Average Model for Prediction of the Incidence of Dysentery in Jiangsu, China.

text: The aim of this study is to forecast the incidence of bacillary dysentery with a prediction model. We collected the annual and monthly laboratory data of confirmed cases from January 2004 to December 2014. In this study, we applied an autoregressive integrated moving average (ARIMA) model to forecast bacillary dysentery incidence in Jiangsu, China. The ARIMA (1, 1, 1) × (1, 1, 2)12 model fitted exactly with the number of cases during January 2004 to December 2014. The fitted model was then used to predict bacillary dysentery incidence during the period January to August 2015, and the number of cases fell within the model's CI for the predicted number of cases during January-August 2015. This study shows that the ARIMA model fits the fluctuations in bacillary dysentery frequency, and it can be used for future forecasting when applied to bacillary dysentery prevention and control.


More on Neurologic Features in Severe SARS-CoV-2 Infection.


Coronavirus: Lombardy lessons for policy and governance.


title: Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model.

text: PURPOSE Knowledge about the influence of underlying biomaterial on behavior of surgical meshes at the esophageal hiatus is rare, but essential for safe and effective hiatal hernia surgery. This study aimed to characterize the influence of polymer material on mesh behavior at the hiatus. METHODS 24 pigs in three groups of eight underwent implantation of either polypropylene (PP), polyester (PET) or polytetrafluoroethylene (PTFE) mesh placed circularly at the esophageal hiatus. After 8 weeks, necropsy and measurements were performed evaluating mesh deformation, adhesion formation, fixation of the esophagogastric junction and mesh position. Foreign body reaction was assessed by mononuclear cell count and immunostaining of Ki-67. Tissue integration was evaluated by immunostaining of type I and type III collagen fibers. RESULTS Mesh shrinkage was the highest for PTFE, lower for PP and the lowest for PET (34.9 vs. 19.8 vs. 12.1 %; p = 0.002). Mesh aperture for the esophagus showed an enlargement within all groups, which was highest for PTFE compared to PP and PET (100.8 vs. 47.0 vs. 35.9 %; p = 0.001). The adhesion score was highest for PP, lower for PTFE and the lowest for PET (11.0 vs. 9.5 vs. 5.0; p = 0.001) and correlated positively with the score of esophagogastric fixation (r s = 0.784, p < 0.001). No mesh migration, erosion or stenosis of the esophagus occurred. Evaluation of foreign body reaction and tissue integration showed no significant differences. CONCLUSIONS In this experimental setting, PP-meshes showed the most appropriate characteristics for augmentation at the hiatus. Due to solid fixation of the esophagogastric junction and low shrinkage tendency, PP-meshes may be effective in preventing hiatal hernia recurrence. The use of PTFE-mesh at the hiatus may be disadvantageous due to high shrinkage rates and correlating enlargement of the aperture for the esophagus.


title: Resection of distal gastric tube cancer with sentinel node biopsy: a case report and review of the literature.

text: BACKGROUND The frequency of gastric tube cancers has increased with advances in surgical techniques and improvement of survival rates in patients with esophageal cancer. However, a standard surgical treatment has not yet been established. Total resection of the gastric tube with lymphadenectomy has been considered a radical treatment, while repeat surgery with both laparotomy and thoracotomy has been associated with severe complications, including anastomotic leakage, recurrent nerve paralysis, bronchotracheal injury, and damage to other organs. CASE PRESENTATION We present a successful case of a gastric tube cancer that was treated with surgical resection in combination with sentinel node biopsy. The tumor was diagnosed as a type 0-IIc lesion with ulceration, and was located proximal to the pyloric ring. Endoscopic submucosal dissection was not indicated because the primary lesion was submucosally invasive, and undifferentiated. By the dye-guided method, sentinel nodes were detected along the right gastroepiploic artery and vein. Intraoperative pathological examination revealed no metastasis of the sentinel nodes. Resection of the distal gastric tube was safely performed with a Roux-en-Y reconstruction, preserving the right gastroepiploic artery and vein and the perfusion of the proximal gastric tube. CONCLUSION We suggest distal resection of the gastric tube with sentinel node biopsy as a novel surgical method for a cT1N0 gastric tube cancer located in the abdomen.


title: Obesity as a social problem in the United States: application of the public arenas model.

text: Obesity rates in the United States have been rising over the past 35 years, resulting in a subsequent increase in nutrition-related chronic disease morbidity and mortality and significant burdens to families, communities, and health care systems. In working to formulate effective public health policy solutions that address the obesity epidemic, it is important to analyze how obesity has been defined and accepted as a social problem. This article applies Hilgartner and Bosk's public arenas model to examine how obesity is defined in the public arena, how competition plays a role in "framing" the obesity issue, and how operatives influence the ways in which obesity is viewed and understood. Implications for nurses and policy makers are addressed in the context of using the public arenas model as a tool to analyze the social problem of obesity.


title: Survival of two dogs with pyothorax secondary to perforating oesophageal foreign body.

text: CASE REPORT Two dogs with an oesophageal foreign body (FB) were diagnosed with secondary pyothorax at the time of presentation. One dog was managed with surgical FB removal, pleural lavage and thoracostomy tube placement. Following surgery, it was admitted to the intensive care unit for oxygen therapy, antimicrobial and analgesic administration, fluid therapy, thoracic drainage and enteral nutrition. The other dog was managed with endoscopic FB removal, thoracostomy tube placement with continuous suction, and similar aftercare in the intensive care unit. Both survived to discharge from hospital. CONCLUSION This report details the treatment and survival of two dogs with secondary pyothorax associated with oesophageal FB, with successful management through supportive care, oesophageal rest and treatment of infection.


title: Induction and evasion of type I interferon responses by influenza viruses.

text: Influenza A and B viruses are a major cause of respiratory disease in humans. In addition, influenza A viruses continuously re-emerge from animal reservoirs into humans causing human pandemics every 10-50 years of unpredictable severity. Among the first lines of defense against influenza virus infection, the type I interferon (IFN) response plays a major role. In the last 10 years, there have been major advances in understanding how cells recognize being infected by influenza viruses, leading to secretion of type I IFN, and on the effector mechanisms by how IFN exerts its antiviral activity. In addition, we also now know that influenza virus uses multiple mechanisms to attenuate the type I IFN response, allowing for successful infection of their hosts. This review highlights some of these findings and illustrates future research avenues that might lead to new vaccines and antivirals based on the further understanding of the mechanisms of induction and evasion of type I IFN responses by influenza viruses.


title: Current perception of nutrition education in U.S. medical schools.

text: Historically, physicians have perceived the quality of nutrition training during medical school as inadequate. A literature review suggests that this perception has not significantly changed since the 1950s. Many schools have worked to create clinical nutrition curricula for use during medical school. Interestingly, data suggest that medical students' perception of the importance of clinical nutrition can decrease during medical school. Recent data support the importance of targeted nutritional therapy to reduce morbidity and mortality, yet the number of physicians interested in nutrition appears to be declining, and fewer hours of nutrition training are occurring in medical school. One possible solution to improve both training and awareness of the problem is to implement a certification program for both students and preceptors modeled after the Cardiac Life Support training offered by the American Heart Association.


title: Indispensable value of clinical trials in the modernization of traditional Chinese medicine: 12 years' experience at CUHK and future perspectives.

text: The last decade has seen a wealth of information reporting the beneficial effects of Chinese herbal medicines. While a lot more studies were done using in vitro and in vivo research platforms, much fewer investigations were conducted according to evidence-based requirements in clinical settings. The Institute of Chinese Medicine at the Chinese University of Hong Kong (CUHK) has had the opportunity to collaborate with clinicians over the years to initiate and conduct dozens of clinical trials investigating and verifying the therapeutic values of Chinese herbs in selected disease conditions. Of the many disorders, we chose to focus on those that are known for their difficulties achieving perfect results with conventional treatment methods. Examples include non-healing ulcers, allergic conditions, degenerative diseases and cancer. Protective effects of the herbs in such chronic diseases as coronary artery disease and osteoporosis were also part of our focus. Even in healthy individuals and those recovering from chemotherapy, Chinese herbs could help with the immune system and were studied in our clinical trials as well. This paper aims to highlight the important findings from these clinical studies while at the same time, stressing the indispensable value of clinical trials in modernizing the use of Chinese herbs in present-day medicine.


title: The negative impact of COVID-19 on contraception and sexual and reproductive health: Could immediate postpartum LARCs be the solution?

text: The COVID-19 pandemic has taken much of the world by surprise. With over 4 700 000 infections to date across 188 countries and more than 310 000 deaths worldwide over the course of just 5 months, we were remarkably unprepared.[1] Although the focus has rightly been on the provision of adequate health care for those falling ill from the virus and the search for a cure or vaccine, we must be aware that looming in the background are the usual health issues that millions of people face every day, and that these will not go away during the pandemic.


title: Preloss grief in family members of COVID-19 patients: Recommendations for clinicians and researchers.

text: Researchers have long examined grief-related reactions to the diagnosis of a loved one with a terminal illness, including preloss grief (PLG), which is the experience of grief symptoms prior to the loss of a loved one. Families face novel challenges when loved ones with COVID-19 become critically ill-most notably mandated physical separation-and may experience a wide range of PLG responses. This commentary examines the existing literature related to PLG as a means for understanding the psychological impact of COVID-19 deaths, identifies factors professionals can assess for and address when working with a family member of COVID-19 patients, and identifies areas for future research related to COVID-19 and PLG. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: A 5-year observational study of lung-protective ventilation in the operating room: a single-center experience.

text: PURPOSE We assessed the evolution of lung-protective ventilation strategies during anesthesia and identified factors associated with the selection of a nonprotective ventilation strategy. METHODS This retrospective observational study covered a 5-year period from March 2006 to March 2011. It included 45575 adult patients who underwent intubation de novo in the operating room. We considered a tidal volume (VT) greater than 10 mL/kg of ideal body weight (IBW) and/or positive end-expiratory pressure (PEEP) less than 5 cm H2O as not lung protective. We evaluated the use of nonprotective ventilation strategies over time in men and women, by American Society of Anesthesiologists classification, and for elective vs emergent surgery. RESULTS Over the duration of the study, there was a significant reduction in the percentage of patients receiving a VT greater than 10 mL/kg IBW (28.5%-16.3%, P < .001), zero PEEP (27.5%-18.2%, P < .001), and VT greater than 10 mL/kg IBW with PEEP less than 5 cm H2O (13.4%-8.0%, P < .001). The odds of receiving nonprotective ventilation were greater for women than for men, in the first year compared with the last year, and for elective compared with emergent surgery. CONCLUSION Although use of nonprotective ventilation decreased over time, an important percentage of patients continue to receive nonprotective ventilation.


title: Role of electromagnetic navigational bronchoscopy in pulmonary nodule management.

text: The incidence of pulmonary nodules and lung cancer is rising. Some of this increase in incidence is due to improved pick up by newer imaging modalities. However, the goal is to diagnose these lesion, many of which are located in the periphery, by safe and relatively non-invasive methods. This has led to the emergence of numerous techniques such as electromagnetic navigational bronchoscopy (ENB). Current evidence supports a role for these techniques in the diagnostic pathway. However, numerous factor influence the diagnostic accuracy. Thus despite significant advances, more research needs to be undertaken to further improve the currently available diagnostic technologies.


title: 'LESS' radical prostatectomy: a pilot feasibility study with a personal original technique.

text: OBJECTIVE We evaluated the feasibility and the potential advantages of a modification of the single-port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure. PATIENTS AND METHODS Between March and September 2009 we operated on five patients with early-stage prostate cancer (T1c) and a normal body mass index (<25). The procedure was carried out with a specially-designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy. RESULTS All cases were completed successfully in a mean operative time of 225 minutes (range 210-250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow-up of 4 months (range 1-7) all patients have an undetectable prostate-specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil. CONCLUSION Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.


title: Improvements in Patient Monitoring for the Intensive Care Unit: Survey Study.

text: BACKGROUND Due to demographic change and, more recently, the Coronavirus Disease 2019 (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be related to the lack of user involvement in research and development. OBJECTIVE This study focused on satisfaction of ICU staff with the current patient monitoring and their suggestions for future improvements. We aimed to identify aspects disturbing patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff is willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further desired to uncover differences in the responses of the professional groups. METHODS This survey study was realized with ICU staff from four ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire by analyzing a preceding qualitative interview study with ICU staff about clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and Chi-square tests to compare the distributions of item responses of the professional groups. RESULTS Eighty-six of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated to feel confident using the patient monitoring, but high rates of false positive alarms and the many sensor cables were considered to disturb patient care. Wireless sensors, reduction of false positive alarms and hospital standard operating procedures (SOP) for alarm management were demanded. Responses to the display devices proposed for remote patient monitoring were split. Regarding its use, most respondents indicated responsibility for multiple wards or earlier alerting. AI for ICUs would be useful for early detection of complications and increased risk of mortality, as well as to have guidelines for therapy and diagnostics proposed. Transparency, interoperability, usability, and staff training were essential to promote usage of an AI. The majority wanted to learn more about new technologies for ICU and desired more time for it. Physicians had fewer reservations than nurses about using mobile phones for remote monitoring, and AI-based intelligent alarm management. CONCLUSIONS This survey study among ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm SOPs, introducing wireless sensors, preparing for the use of AI, and enhancing digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. CLINICALTRIAL ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.


title: What settings have been linked to SARS-CoV-2 transmission clusters?

text: Background: Concern about the health impact of novel coronavirus SARS-CoV-2 has resulted in widespread enforced reductions in people's movement ("lockdowns"). However, there are increasing concerns about the severe economic and wider societal consequences of these measures. Some countries have begun to lift some of the rules on physical distancing in a stepwise manner, with differences in what these "exit strategies" entail and their timeframes. The aim of this work was to inform such exit strategies by exploring the types of indoor and outdoor settings where transmission of SARS-CoV-2 has been reported to occur and result in clusters of cases. Identifying potential settings that result in transmission clusters allows these to be kept under close surveillance and/or to remain closed as part of strategies that aim to avoid a resurgence in transmission following the lifting of lockdown measures. Methods: We performed a systematic review of available literature and media reports to find settings reported in peer reviewed articles and media with these characteristics. These sources are curated and made available in an editable online database. Results: We found many examples of SARS-CoV-2 clusters linked to a wide range of mostly indoor settings. Few reports came from schools, many from households, and an increasing number were reported in hospitals and elderly care settings across Europe. Conclusions: We identified possible places that are linked to clusters of COVID-19 cases and could be closely monitored and/or remain closed in the first instance following the progressive removal of lockdown restrictions. However, in part due to the limits in surveillance capacities in many settings, the gathering of information such as cluster sizes and attack rates is limited in several ways: inherent recall bias, biased media reporting and missing data.


Dozens of coronavirus drugs are in development - what happens next?


title: Metaphoric language and the articulation of emotions by people affected by motor neurone disease.

text: OBJECTIVE To explore the use of metaphoric language to convey emotion in interviews with people affected by motor neurone disease, a progressive neurological condition that sits between chronic and terminal illness. METHODS Secondary analysis of 46 interviews with people affected by motor neurone disease in the United Kingdom (35 individuals with the condition, 11 carers). RESULTS Metaphor and figurative language was used to communicate the intensely emotional experiences of being diagnosed with and living with motor neurone disease. We focus on three pervasive themes that were threaded throughout the interviews: battling and fighting; the self under attack and journeying through a physical and emotional landscape. DISCUSSION This secondary analysis of qualitative research interviews enriches our understanding of the articulation of emotion in motor neurone disease and adds to the literature on metaphor in chronic illness. Of particular interest is how the metaphors used contrasted with other conditions in the relative absence of metaphors of 'fighting' the disease. Furthermore, we analyse the ways in which participants used metaphors to give voice to emotions that are extremely difficult to articulate in 'literal' language, and how, in doing so, they blurred the distinction between 'physical' symptoms and 'emotional' states. Sensitivity to metaphors may help professionals communicate with people affected by motor neurone disease.


The Psychiatry Institute for Medical Students: a decade of success.


title: In vitro performance of prefilled CO2 absorbers with the Zeus®.

text: Low fresh gas flows (FGFs) decrease the use of anesthetic gases, but increase CO2 absorbent usage. CO2 absorbent usage remains poorly quantified. The goal of this study is to determine canister life of 8 commercially available CO2 absorbent prepacks with the Zeus®. Pre-packed CO2 canisters of 8 different brands were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, LithoLyme, SpiraLith, SpheraSorb, Drägersorb 800+, Drägersorb Free, and CO2ntrol. CO2 (160 mL min- 1) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Zeus® (Dräger, Lubeck, Germany). In part I, canister life of 5 canisters each of 2 different lots of each brand was determined with a 350 mL min- 1 FGF. Canister life is the time it takes for the inspired CO2 concentration (FICO2) to rise to 0.5%. In part II, canister life was measured accross a FGF range of 0.25 to 4 L min- 1 for Drägersorb 800+ (2 lots) and SpiraLith (1 lot). In part III, the calculated canister life per 100 g fresh granule content of the different brands was compared between the Zeus and (previously published data for) the Aisys. In vitro canister life of prefilled CO2 absorber canisters differed between brands, and depended on the amount of CO2 absorbent and chemical composition. Canister life expressed as FCU0.5 (the fraction of the canister used per hour) was proportional to FGF over 0.2-2 L min-1 range only, but was non-linear with higher FGF: FCU0.5 was larger than expected with FGF > 2 L min-1, and even with FGF > minute ventilation FCU0.5 did not become zero, indicating some CO2 was being absorbed. Canister life on a per weight basis of the same brand is higher with the Zeus than the Aisys. Canister life of prefilled CO2 absorber canisters differs between brands. The FCU0.5-FGF relationship is not linear across the entire FGF range. Canister life of prepacks of the same brand for the Zeus and Aisys differs, the exact etiology of which is probably multifactorial, and may include differences in the absolute amount of absorbent and different rebreathing characteristics of the machines.


title: Diagnosis of a naturally occurring dual infection of layer chickens with fowlpox virus and gallid herpesvirus 1 (infectious laryngotracheitis virus).

text: An outbreak of acute respiratory disease in layers was diagnosed as being of dual nature due to fowlpox and infectious laryngotracheitis using a multidisciplinary approach including virus isolation, histopathology, electron microscopy and polymerase chain reaction (PCR). The diagnosis was based on virus isolation of gallid herpesvirus 1 (GaHV-1) in chicken kidney cells and fowlpox virus (FWPV) in 9-day-old chicken embryonated eggs inoculated via the chorioallantoic membrane. The histopathology of tracheas from dead birds revealed intra-cytoplasmic and intra-nuclear inclusions suggestive of poxvirus and herpesvirus involvement. The presence of FWPV was further confirmed by electron microscopy, PCR and histology. All FWPV isolates contained the long terminal repeats of reticuloendotheliosis virus as demonstrated by PCR. GaHV-1 isolates were detected by PCR and were shown to have a different restriction fragment length polymorphism pattern when compared with the chicken embryo origin SA2 vaccine strain; however, they shared the same pattern with the Intervet chicken embryo origin vaccine strain. This is a first report of dual infection of chickens with GaHV-1 and naturally occurring FWPV with reticuloendotheliosis virus insertions. Further characterization of the viruses was carried out and the results are reported here.


title: Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool.

text: BACKGROUND Qualitative evidence synthesis is increasingly used alongside reviews of effectiveness to inform guidelines and other decisions. To support this use, the GRADE-CERQual approach was developed to assess and communicate the confidence we have in findings from reviews of qualitative research. One component of this approach requires an appraisal of the methodological limitations of studies contributing data to a review finding. Diverse critical appraisal tools for qualitative research are currently being used. However, it is unclear which tool is most appropriate for informing a GRADE-CERQual assessment of confidence. METHODOLOGY We searched for tools that were explicitly intended for critically appraising the methodological quality of qualitative research. We searched the reference lists of existing methodological reviews for critical appraisal tools, and also conducted a systematic search in June 2016 for tools published in health science and social science databases. Two reviewers screened identified titles and abstracts, and then screened the full text of potentially relevant articles. One reviewer extracted data from each article and a second reviewer checked the extraction. We used a best-fit framework synthesis approach to code checklist criteria from each identified tool and to organise these into themes. RESULTS We identified 102 critical appraisal tools: 71 tools had previously been included in methodological reviews, and 31 tools were identified from our systematic search. Almost half of the tools were published after 2010. Few authors described how their tool was developed, or why a new tool was needed. After coding all criteria, we developed a framework that included 22 themes. None of the tools included all 22 themes. Some themes were included in up to 95 of the tools. CONCLUSION It is problematic that researchers continue to develop new tools without adequately examining the many tools that already exist. Furthermore, the plethora of tools, old and new, indicates a lack of consensus regarding the best tool to use, and an absence of empirical evidence about the most important criteria for assessing the methodological limitations of qualitative research, including in the context of use with GRADE-CERQual.


Pediatric Hospital Medicine Management, Staffing, and Well-being in the Face of COVID-19.


title: Laparoscopic resection of large gastric gastrointestinal stromal tumours.

text: INTRODUCTION Gastrointestinal stromal tumours (GISTs) are a rare class of neoplasms that are seen most commonly in the stomach. Due to their malignant potential, surgical resection is the recommended method for management of these tumours. Many reports have described the ability to excise small and medium sized GISTs laparoscopically, but laparoscopic resection of GISTs greater than 5 cm is still a matter of debate. AIM To investigate the feasibility and effectiveness of laparoscopic surgical techniques for management of large gastric GISTs greater than 4 cm and to detail characteristics of this type of tumour. MATERIAL AND METHODS The study cohort consisted of 11 patients with suspected gastric GISTs who were treated from 2011 to April 2014 in a single institution. All patients underwent laparoscopic resection of a gastric GIST. RESULTS Eleven patients underwent laparoscopic resection of a suspected gastric GIST between April 2011 and April 2014. The cohort consisted of 6 males and 5 females. Mean age was 67 years (range: 43-92 years). Sixty-four percent of these patients presented with symptomatic tumours. Four (36.4%) patients underwent laparoscopic transgastric resection (LTR), 3 (27.3%) laparoscopic sleeve gastrectomy (LSG), 3 (27.3%) laparoscopic wedge resection (LWR) and 1 (9%) laparoscopic distal gastrectomy (LDG). The mean operative time was 215 min. The mean tumour size was 6 cm (range: 4-9 cm). The mean tumour size for LTR was 5.5 cm (range: 4-6.3 cm), for LWR 5.3 cm (range: 4.5-7 cm), for LSG 6.5 cm (range: 4-9 cm) and for LDG 9 cm. We experienced only minor postoperative complications. CONCLUSIONS Laparoscopic procedures can be successfully performed during management of large gastric GISTs, bigger than 4 cm, and should be considered for all non-metastatic cases. The appropriate approach can be determined by assessing the anatomical location of each tumour.


title: Pain treatment in arthritis-related pain: beyond NSAIDs.

text: Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain.


GI symptoms and fever increase the risk of severe illness and death in patients with COVID-19.


title: Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy.

text: Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. To the best of our knowledge, the literature has yet to address online live supervision including a family, a therapist, a supervisor, and a team all online. With the outbreak of the COVID-19 global pandemic, we - the staff of supervisors at the Barcai Institute in Tel Aviv, Israel - were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses ("practicums") to the virtual arena, adapting the popular application "Zoom" into what we call "PractiZoom." Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering on-line practicum for the online live supervision of therapists with geographically-distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.


title: Global socio-economic losses and environmental gains from the Coronavirus pandemic.

text: On 3 April 2020, the Director-General of the WHO stated: "[COVID-19] is much more than a health crisis. We are all aware of the profound social and economic consequences of the pandemic (WHO, 2020)". Such consequences are the result of counter-measures such as lockdowns, and world-wide reductions in production and consumption, amplified by cascading impacts through international supply chains. Using a global multi-regional macro-economic model, we capture direct and indirect spill-over effects in terms of social and economic losses, as well as environmental effects of the pandemic. Based on information as of May 2020, we show that global consumption losses amount to 3.8$tr, triggering significant job (147 million full-time equivalent) and income (2.1$tr) losses. Global atmospheric emissions are reduced by 2.5Gt of greenhouse gases, 0.6Mt of PM2.5, and 5.1Mt of SO2 and NOx. While Asia, Europe and the USA have been the most directly impacted regions, and transport and tourism the immediately hit sectors, the indirect effects transmitted along international supply chains are being felt across the entire world economy. These ripple effects highlight the intrinsic link between socio-economic and environmental dimensions, and emphasise the challenge of addressing unsustainable global patterns. How humanity reacts to this crisis will define the post-pandemic world.


title: Distal pancreatectomy and splenectomy: a robotic or LESS approach.

text: INTRODUCTION The role and application of robotic surgery are debated, particularly given the expansion of laparoscopy, especially laparoendoscopic single-site (LESS) surgery. This cohort study was undertaken to delineate differences in outcomes between LESS and robotic distal pancreatectomy and splenectomy. METHODS With Institutional Review Board approval, patients undergoing LESS or robotic distal pancreatectomy and splenectomy from September 1, 2012, through December 31, 2014, were prospectively observed, and data were collected. The results are expressed as the median, with the mean ± SD. RESULTS Thirty-four patients underwent a minimally invasive distal pancreatectomy and splenectomy: 18 with robotic and 16 with LESS surgery. The patients were similar in sex, age, and body mass index. Conversions to open surgery and estimated blood loss were similar. There were two intraoperative complications in the group that underwent the robotic approach. Time spent in the operating room was significantly longer with the robot (297 vs 254 minutes, P = .03), although operative duration (i.e., incision to closure) was not longer (225 vs 190 minutes; P = .15). Of the operations studied, 79% were undertaken for neoplastic processes. Tumor size was 3.5 cm for both approaches; R0 resections were achieved in all patients. Length of stay was similar in the two study groups (5 vs 4 days). There was one 30-day readmission after robotic surgery. CONCLUSIONS Patient outcomes are similar with LESS or robotic distal pancreatectomy and splenectomy. Robotic operations require more time in the operating room. Both are safe and efficacious minimally invasive operations that follow similar oncologic principles for similar tumors, and both should be in the surgeon's armamentarium for distal pancreatectomy and splenectomy.


Covid-19: We need to be open about rationing ventilators.


title: Head-of-bed elevation and early outcomes of gastric reflux, aspiration and pressure ulcers: a feasibility study.

text: BACKGROUND Guidelines recommending head of bed (HOB) elevation greater than 30º to prevent ventilator-associated pneumonia conflict with guidelines to prevent pressure ulcers, which recommend HOB elevation less than 30º. OBJECTIVES To examine the feasibility of 45º HOB elevation and describe and compare the occurrence of reflux, aspiration, and pressure ulcer development at 30º and 45º HOB elevation. METHODS A randomized 2-day crossover trial was conducted. HOB angle was measured every 30 seconds. Oral and tracheal secretions were analyzed for pepsin presence. Skin was assessed for pressure ulcers. Wilcoxon signed rank tests and Kendall τ correlations were conducted. RESULTS Fifteen patients were enrolled; 11 completed both days. Patients were maintained at 30º (mean, 30º) for 96% of minutes and at 45º (mean, 39º) for 77% of minutes. No patients showed signs of pressure ulcers. A total of 188 oral secretions were obtained, 82 (44%) were pepsin-positive; 174 tracheal secretions were obtained, 108 (62%) were pepsin-positive. The median percentage of pepsin-positive oral secretions was not significantly higher (P = .11) at 30º elevation (54%) than at 45º elevation (20%). The median percentage of pepsin-positive tracheal secretions was not significantly higher (P = .37) at 30º elevation (71%) than 45º elevation (67%). Deeper sedation correlated with increased reflux (P = .03). CONCLUSIONS HOB elevation greater than 30º is feasible and preferred to 30º for reducing oral secretion volume, reflux, and aspiration without pressure ulcer development in gastric-fed patients receiving mechanical ventilation. More deeply sedated patients may benefit from higher HOB elevations.


title: Evidence-Based Abdominal Wall Reconstruction: The Maxi-Mini Approach.

text: Complex abdominal wall reconstruction is a high-risk procedure, but it can be performed safely if a systematic approach is followed. In this article, the authors present their evidence-based technique for abdominal wall reconstruction. This approach aims at reducing rates of complications and hernia recurrence, starting with critical patient selection; preoperative patient optimization; adherence to intraoperative principles including preservation of vascular perforators through maintenance of composite tissue with limited undermining; direct supported mesh reinforcement of midline musculofascial reapproximation; use of percutaneous transfascial suture mesh fixation; careful attention to dead space obliteration in any plane; and aggressive soft-tissue resection of marginal, undermined, or tenuous skin and subcutaneous tissue. Postoperative strategies to decrease complications are also used. The authors' surgical technique is described in detail, and pilot data are presented to support the authors' approach.


Stem cell-based treatment of kidney diseases.


title: Clinical and Ethical Considerations in Allocation of Ventilators in an Influenza Pandemic or Other Public Health Disaster: A Comparison of the 2007 and 2015 New York State Ventilator Allocation Guidelines.

text: OBJECTIVE During an influenza or COVID-19 pandemic that results in acute respiratory distress, available ventilators will not meet demand. In 2007, the NYS Task Force on Life and the Law and Department of Health released draft Guidelines for ethical allocation of ventilators for adults. In 2015, updated guidelines were released to ensure that: (1) revisions reflect the public's values and (2) the triage protocol is substantiated by evidence-based clinical data. We summarize the development and content of the 2015 Guidelines compared to the 2007 version, emphasizing new/revised aspects of the ethical considerations and clinical protocol. METHODS We compared the 2007 and 2015 guidelines, with particular emphasis on the ethical issues and clinical protocols. RESULTS The 2015 Guidelines retained much of the ethical and clinical framework of the 2007 draft. The triage protocol was revised using evidence-based clinical data. Patients with the highest likelihood of short-term survival with ventilator therapy have priority access. Protocol consists of exclusion criteria, the sequential organ failure assessment (SOFA) score, and periodic clinical assessments. Guidance is provided on secondary triage criteria. Other forms of medical intervention/palliative care and review of triage decisions are discussed. CONCLUSIONS The 2015 Guidelines reflect advances in medicine and societal values and provide an evidenced-based framework to save the most lives. The framework could be adapted in other emergencies, such as the COVID-19 pandemic, that require ventilators.


title: Risk Assessment and Mitigation of the Mycotoxin Content in Medicinal Plants by the Infusion Process.

text: Medicinal plants are often consumed as infusions with boiled water. Scarce information is available in the literature about the migration of mycotoxins into the resulting beverage and/or the effects of the infusion procedure on the final mycotoxin contents. The aim of the present study was to investigate the impact of the infusion process on mycotoxin contents during medicinal plant preparation. For this purpose, the contents of aflatoxins (AFs) [aflatoxin B1 (AFB1), aflatoxin B2 (AFB2), aflatoxin G1 (AFG1), aflatoxin G2 (AFG2)], zearalenone (ZEA), enniatins (ENNs) [enniatin B (ENNB), enniatin B1 (ENNB1), enniatin A (ENNA), enniatin A1 (ENNA1)] and beauvericin (BEA) were analyzed in 224 samples of medicinal plants and in their resulting beverages. The quick, easy, cheap, effective, rugged and safe extraction method (QuEChERS) was applied to the medicinal plants while the dispersive liquid-liquid microextraction procedure (DLLME) was applied to their infusions, and the mycotoxins were determined by liquid chromatography coupled to ion trap tandem mass spectrometry (LC-MS/MS-IT). The results revealed that ZEA, ENNB, ENNB1, AFB2, AFG1 and AFG2 were detected in the beverages with incidences of ≤6% and at concentrations from less than the limit of quantification (LOQ) to 82.2 μg/L. Mycotoxins reduction ranged from 74 to 100% after the infusion process. The risk assessment revealed that the estimated daily intakes (EDIs) obtained for ZEA, ENNB and ENNB1 were far below the tolerable daily intakes (TDIs) established.


title: Size of ruptured intracranial aneurysms: a systematic review and meta-analysis.

text: BACKGROUND There is wide variation in the reported size of ruptured intracranial aneurysms and methods of size estimation. There is widespread belief that small aneurysms < 7 mm do not rupture. Therefore, we performed a systematic review and meta-analysis of the literature to determine the size of ruptured aneurysms according to aneurysm locations and methods of size estimation. METHODS We searched PubMed, Cochrane, CINAHL, and EMBASE databases using a combination of Medical Subject Headings (MeSH) terms. We included articles that reported mean aneurysm size in consecutive series of ruptured intracranial. We excluded studies limited to a specific aneurysm location or type. The random-effects model was used to calculate overall mean size and location-specific mean size. We performed meta-regression to explain observed heterogeneity and variation in reported size. RESULTS The systematic review included 36 studies and 12,609 ruptured intracranial aneurysms. Overall mean aneurysm size was 7.0 mm (95% confidence interval [CI 6.2-7.4]). Pooled mean size varied with location. Overall mean size of 2145 ruptured anterior circulation aneurysms was 6.0 mm (95% CI 5.6-6.4, residual I2 = 86%). Overall mean size of 743 ruptured posterior circulation aneurysms was 6.2 mm (95% CI 5.3-7.0, residual I2 = 93%). Meta-regression identified aneurysm location and definition of size (i.e., maximum dimension vs. aneurysm height) as significant determinants of aneurysm size reported in the studies. CONCLUSIONS The mean size of ruptured aneurysms in most studies was approximately 7 mm. The general wisdom that aneurysms of this size do not rupture is incorrect. Location and size definition were significant determinants of aneurysm size.


title: COVID-19, Australia: Epidemiology Report 19 (Fortnightly reporting period ending 21 June 2020).

text: Notified cases of COVID-19 and associated deaths reported to the National Notifiable Diseases Surveillance System (NNDSS) to 21 June 2020. Confirmed cases in Australia notified up to 7 June 2020: notifications = 7,491; deaths = 102. The incidence of COVID-19 has markedly reduced since a peak in mid-March. A combination of early case identification, physical distancing, public health measures and a reduction in international travel have been effective in slowing the spread of disease in Australia. Of the 215 cases notified between 8 and 21 June, 75% (163 cases) were notified from Victoria. Most of these cases were acquired locally. In contrast, cases notified from other states (NSW, Qld and WA) over this period were mostly overseas-acquired. Of locally-acquired cases in Victoria in this period, 51% were associated with contacts of a confirmed case or in a known outbreak, while 49% were unable to be linked to another case or were under investigation at the time of reporting. There are several clusters across a range of settings, including extended families, hotel quarantine facilities and a retail store, with most cases limited in geographic spread to a number of Local Government Areas around Melbourne. In response, the Victorian Government has re-introduced restrictions for household and outdoor gatherings, has delayed plans to ease other restrictions and has implemented enhanced public health response activities, particularly with regard to testing and contact tracing. A small proportion of overall cases have experienced severe disease, requiring hospitalisation or intensive care, with some fatalities. The crude case fatality rate amongst Australian cases is 1.4%. People who are older and have one or more comorbidities are more likely to experience severe disease. The highest rate of COVID-19 continues to be among people aged 65-79 years. Three-quarters of all cases in this age group have been associated with overseas travel, including several outbreaks linked to cruise ships. The lowest rate of disease is in children under 18 years, a pattern reflected in international reports. Internationally, as of 21 June 2020, the largest numbers of both cases and deaths have been reported in the United States. Of the confirmed cases reported globally, the case fatality rate is approximately 5.3%. Other countries in the Americas region, such as Brazil and Chile, are seeing rapid growth in case numbers. Case numbers in Europe remain relatively steady, while there is significant growth in the South East Asia region, including in India and Bangladesh. Reported cases are increasing in Africa, although the numbers are much smaller. In the Pacific region there are few new cases reported daily.