title: The influence of intraoperative frozen section analysis in patients with total or extended maxillectomy.

text: BACKGROUND Intraoperative frozen sections and final pathology may influence treatment with regards to intraoperative and postoperative treatments, respectively. STUDY DESIGN A retrospective study comparing intraoperative frozen section analysis with final pathologic analysis in patients who had total or extended maxillectomies for malignant disease between 2008 and 2013. RESULTS Twenty-five patients met the inclusion criteria. The mean age was 67.8 years. The majority of patients (76%) had stage IV disease (American Joint Committee on Cancer [AJCC] staging). Intraoperative frozen sections were positive in 24% (n = 6) compared with 60% (n = 15) on final pathologic analysis. Frozen section analysis had a sensitivity of 40%. Positive margins were resected where possible, unless limited by proximity to vital structures. Patients were statistically more likely to follow a recommendation for adjuvant therapy (P < .05) compared with adjuvant chemotherapy (P > .05). CONCLUSIONS Intraoperative frozen section analyses are unreliable in predicting positive margins in patients with late-stage maxillary malignancies. Patients were more likely to accept adjuvant radiation than adjuvant chemotherapy.


Prove or Improve? Less Funding? Use the Capital Available in Homeopathic Practice.


title: Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube: a comparison of feasibility, gas exchange, and airway pressures.

text: OBJECTIVE Gas exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double-lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study prospectively evaluated the in vivo feasibility, gas exchange, and airway pressures during PDT with DLET compared with a conventional endotracheal tube (ETT). METHODS According to eligibility criteria, patients were divided into a case group (those receiving PDT with DLET) and a control group (those receiving PDT with a conventional ETT). The Ciaglia single-dilator technique was used for PDT in both groups. The primary end point of this study was the feasibility of tracheostomy with DLET. The secondary end points were a comparison of gas exchange, airway pressures, minute volume, and tidal volume before, during, and after PDT performed with DLET and conventional ETT. RESULTS Ten patients meeting the inclusion criteria were assigned to each group. PDTs were performed without difficulties in nine patients in the DLET group and 10 patients in the conventional ETT group. During PDT, gas exchange, airway pressures, and minute ventilation remained more stable in the DLET group and were significantly different from those in the conventional ETT group. CONCLUSIONS PDT with DLET can be performed safely without difficulties limiting the technique. Furthermore, during PDT, the use of the DLET resulted in more stable gas exchange, airway pressures, and ventilation than PDT with a conventional ETT. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01691222; URL: www.clinicaltrials.gov.


Distant and delayed (>7 days) hemorrhage after treatment by flow-diverter stents in intracranial aneurysms: a rare but potentially serious complication.


title: AView: An Image-based Clinical Computational Tool for Intracranial Aneurysm Flow Visualization and Clinical Management.

text: Intracranial aneurysms (IAs) occur in around 3% of the entire population. IA rupture is responsible for the most devastating type of hemorrhagic strokes, with high fatality and disability rates as well as healthcare costs. With increasing detection of unruptured aneurysms, clinicians are routinely faced with the dilemma whether to treat IA patients and how to best treat them. Hemodynamic and morphological characteristics are increasingly considered in aneurysm rupture risk assessment and treatment planning, but currently no computational tools allow routine integration of flow visualization and quantitation of these parameters in clinical workflow. In this paper, we introduce AView, a prototype of a clinician-oriented, integrated computation tool for aneurysm hemodynamics, morphology, and risk and data management to aid in treatment decisions and treatment planning in or near the procedure room. Specifically, we describe how we have designed the AView structure from the end-user's point of view, performed a pilot study and gathered clinical feedback. The positive results demonstrate AView's potential clinical value on enhancing aneurysm treatment decision and treatment planning.


title: Crystal structure of human esterase D: a potential genetic marker of retinoblastoma.

text: Retinoblastoma (RB), a carcinoma of the retina, is caused by mutations in the long arm of chromosome 13, band 13q14. The esterase D (ESD) gene maps at a similar location as the RB gene locus and therefore serves as a potential marker for the prognosis of retinoblastoma. Because very little is known about the structure and function of ESD, we determined the 3-dimensional structure of the enzyme at 1.5 A resolution using X-ray crystallography. ESD shows a single domain with an alpha/beta-hydrolase fold. A number of insertions are observed in the canonical alpha/beta-hydrolase fold. The active site is located in a positively charged, shallow cleft on the surface lined by a number of aromatic residues. Superimposition studies helped identify the typical catalytic triad residues--Ser-153, His264, and Asp230--involved in catalysis. Mutagenesis of any of the catalytic triad residues to alanine abolished the enzyme activity. Backbone amides of Leu54 and Met150 are involved in the formation of the oxyanion hole. Interestingly, a M150A mutation increased the enzyme activity by 62%. The structure of human ESD determined in this study will aid the elucidation of the physiological role of the enzyme in the human body and will assist in the early diagnosis of retinoblastoma.


title: Respiratory viruses in nepalese children with and without pneumonia: a case-control study.

text: BACKGROUND The causative role of respiratory viruses detected in upper airway secretions in childhood pneumonia needs further investigation. OBJECTIVE To measure the association between infection with respiratory RNA viruses and pneumonia in children. METHODS From March 2006 to July 2007, we conducted a case-control study of 680 pneumonia cases (WHO criteria) and 680 randomly selected, concurrently sampled age-matched controls among children aged 2-35 months in Bhaktapur, Nepal. A nasopharyngeal aspirate from each child was examined for 7 respiratory viruses using reverse transcription polymerase chain reaction. We calculated the matched odds ratios (MORs) for the detection of the individual viruses from a case compared with a control as measures of pathogenicity using conditional logistic regression. RESULTS At least 1 virus was recovered in 248 (36.5%) cases and 48 (7.1%) controls. The MOR varied from 2.0 to 13.0; the highest associations were observed for parainfluenza virus type 3 (MOR 13.0; 95% confidence interval [CI] 6.0-28.0), respiratory syncytial virus (MOR 10.7; CI 4.6-24.6), and influenza A (MOR 6.3; CI 1.9-21.4). We observed that the association was lower for children age 2-5 months compared with older children for parainfluenza virus type 3 (P value for interaction 0.002). CONCLUSIONS All of the 7 respiratory viruses were associated with pneumonia, but their pathogenicity varied. Parainfluenza type 3, RSV, and influenza A were most strongly associated with pneumonia.


title: Real-world comparison of in-hospital Reveal LINQ insertable cardiac monitor insertion inside and outside of the cardiac catheterization or electrophysiology laboratory.

text: BACKGROUND Traditionally, insertable cardiac monitor (ICM) procedures have been performed in the cardiac catheterization (CATH) or electrophysiology (EP) laboratory. The introduction of the miniaturized Reveal LINQ ICM has led to simplified and less invasive procedures, affording hospitals flexibility in planning where these procedures occur without compromising patient safety or outcomes. METHODS The present analysis of the ongoing, prospective, observational, multicenter Reveal LINQ Registry sought to provide real-world feasibility and safety data regarding the ICM procedure performed in the CATH/EP lab or operating room and to compare it with insertions performed outside of these traditional hospital settings. Patients included had at least a 30-day period after the procedure to account for any adverse events. RESULTS We analyzed 1222 patients (58.1% male, age 61.0 ± 17.1 years) enrolled at 18 centers in the US, 17 centers in Middle East/Asia, and 15 centers in Europe. Patients were categorized into 2 cohorts according to the location of the procedure: in-lab (CATH lab, EP lab, or operating room) (n = 820, 67.1%) and out-of-lab (n = 402, 32.9%). Several differences were observed regarding baseline and procedure characteristics. However, no significant differences in the occurrence of procedure-related adverse events (AEs) were found; of 19 ICM/procedure-related AEs reported in 17 patients (1.4%), 11 occurred in the in-lab group (1.3%) and 6 in the out-of-lab group (1.5%) (P = .80). CONCLUSIONS This real-world analysis demonstrates the feasibility of performing Reveal LINQ ICM insertion procedures outside of the traditional hospital settings without increasing the risk of infection or other adverse events.


title: Rapid heat-treatment attenuation of infectious bronchitis virus.

text: In the present study we describe the rapid development of an attenuated live vaccine for GA08, a new serotype of infectious bronchitis virus, using a heat-treatment method. Incubation of the GA08 strain of IBV at 56 degrees C and passage in embryonated eggs was used as a method to fast track the attenuation process. The virus was incubated in a 56 degrees C water bath and aliquots were removed every 5 min for up to 1 h, and then each aliquot was inoculated into 10-day-old embryonated eggs. Virus with the longest incubation time that produced lesions in the embryos was harvested, again incubated at 56 degrees C as described and passaged in embryonated eggs. Attenuation of the virus, designated GA08/GA08HSp16/08, was verified in 1-day-old specific pathogen free chicks. A 10x dose of the vaccine was found to be safe for 2-week-old broiler chicks of commercial origin. The efficacy of the heat-treated attenuated virus was determined by vaccinating broiler chicks of commercial origin at 1 and 14 days of age intraocularly/intranasally. Vaccinated birds that were challenged with 10(4.5) median embryo infectious doses of pathogenic GA08 virus/bird at 28 days of age were protected from the disease, and challenge virus was only detected in the trachea of one of 21 birds by real-time reverse transcriptase-polymerase chain reaction at 5 days post challenge. The attenuation process took 10 weeks to complete, which is a substantially shorter time than required to attenuate infectious bronchitis virus by serial passage in embryonated eggs without heat treatment (38 weeks or more).


title: Emergency Approval of Chloroquine and Hydroxychloroquine for Treatment of COVID-19.

text: The world is suffering a respiratory pandemic disease caused by a novel coronavirus (2019-nCoV), commonly known as COVID-19 (coronavirus disease 2019). The Food and Drug Administration issued an emergency authorization for chloroquine and hydroxychloroquine as experimental treatments for COVID-19 leading to a shortage of both medications. A literature review conducted in April 2020 shows a lack of high-quality data available, resulting in ambiguous guideline recommendations. Decisions to use either drug should be made with careful consideration of risks versus benefits along with proper monitoring. Because of its higher potency and better safety profile, hydroxychloroquine may be the more reasonable treatment option if treatment is initiated.


Promoting biosecurity by professionalizing biosecurity.


title: Low recurrence rate and low chronic pain associated with inguinal hernia repair by laparoscopic placement of Parietex ProGrip™ mesh: clinical outcomes of 220 hernias with mean follow-up at 23 months.

text: INTRODUCTION The aim of this study was to demonstrate the safety and the efficacy of the self-gripping Parietex ProGrip™ mesh (Sofradim Production, Trévoux, France) used with the laparoscopic approach for inguinal hernia repair. The incidence of chronic pain, post-operative complications, patient satisfaction and hernia recurrence at follow-up after 12 months was evaluated. METHODS Data were collected retrospectively from patient files and were analyzed for 169 male and female patients with 220 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal approach using Parietex ProGrip™ meshes performed in the same clinical center in Germany. Pre-, per- and post-operative data were collected, and a follow-up after 12 months was performed prospectively. Complications, pain scored on a 0-10 numeric rating scale (NRS), patient satisfaction and hernia recurrence were assessed. RESULTS The only complications were minor and were post-operative: hematoma/seroma (3 cases), secondary hemorrhage through the trocar's site (2 cases), hematuria, emphysema in the inguinal regions (both sides) and swelling above the genital organs (1 case for each). At mean follow-up at 22.8 months, there were only 3 reports of hernia recurrence: 1.4 % of the hernias. Most patients (95.9 %) were satisfied or very satisfied with their hernia repair with only 1.2 % reporting severe pain (NRS score 7-10) and 3.6 % reported mild pain. CONCLUSION This study demonstrates that in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietex ProGrip™ self-gripping meshes is rapid, efficient and safe with low pain and low hernia recurrence rate.


title: Bioinformatics Analysis of Proteome Changes in Calu-3 Cell Infected by Influenza A Virus (H5N1).

text: AIM This paper aimed to identify the differentially expressed proteins (DEPs) in Calu-3 cells infected by influenza A virus (IAV) subtype H5N1. METHODS We downloaded proteome data (BTO: 0000762) from the Proteomics Identifications database and identified the DEPs in the IAV-infected Calu-3 cells. Then we constructed a protein-protein interaction network and a transcriptional regulatory network of the proteins. Finally, we performed gene ontology (GO) analysis to study the IAV infection at a functional level. RESULTS A total of 4 protein groups between the normal cells and the Calu-3 cells infected by IAV, severe acute respiratory syndrome or swine influenza were identified. In the networks, we found 5 significant proteins including FAN, CPSF2, AGO1, AGO2 and PAX5. In addition, we demonstrated those proteins were associated with GO terms such as phosphate metabolic process, calcium ion transport, cell division and regulation of cell motion. STAT1, NS2, CD5, NCKX6 and PDGFB were significant DEPs in these GO terms. CONCLUSIONS By referring to the previous studies, we suggest that proteins including FAN, CPSF2, AGO1, AGO2, PAX5, STAT1 and PDGFB can be used as therapeutic targets of IAV infection.


title: Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017.

text: Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.


title: My first call on Covid duty.

text: The Covid-19 pandemic has meant that all available health workers have been summoned to serve the community. Here, I describe my first experience as a resident doctor of shift duty in the Covid ICU of a large municipal hospital in Mumbai, with its accompanying fears and discomforts, all contributing to learning painful but valuable lessons.. Keywords: Covid-19, ICU, pandemic, public health system, learning.


title: Evaluation of pet owner preferences for operative sterilization techniques in female dogs within the veterinary community.

text: OBJECTIVE To describe pet owner preferences within the veterinary community when choosing operative techniques for canine spay. STUDY DESIGN Prospective survey. SAMPLE POPULATION 1234 respondents from 5 veterinary university teaching hospitals in North America. METHODS An electronic survey was distributed to faculty, students, and staff that currently are or previously were dog owners. Responses were analyzed to determine what spay technique respondents would choose for their own dogs. Surgical options offered included open celiotomy, 2-port (TP) laparoscopy, single-port (SP) laparoscopy, and natural orifice transluminal endoscopic surgery (NOTES). RESULTS TP laparoscopic ovariectomy (OVE) was the most popular choice, followed by SP laparoscopic OVE; NOTES was the least popular technique when all surgical options were available. If only minimally invasive surgeries were offered, 0.3% of respondents would refuse surgery. Nearly half (48%) of respondents were willing to spend between $100 and $200 more for a minimally invasive OVE than for an open celiotomy. CONCLUSION Minimally invasive OVE is an acceptable operative approach to those in the veterinary community. Additional study is required to correlate these findings with the general veterinary client population.


title: The reality of pediatric emergency mass critical care in the developing world.

text: INTRODUCTION Public health emergencies resulting from major man-made crises and large-scale natural disasters severely impact developing countries, causing unprecedented rates of indirect mortality and morbidity, especially in children and women. Concomitantly, the state of children's health in the least-developed countries is the worst since the 1950s before the Declaration of Alma Ata. Worldwide decline in public health protections, infrastructures, and systems, and a health worker crisis primarily in Africa and Asia, limit the delivery of intensive and critical care services. METHODS In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subgroups by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6-7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010.The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. TASK FORCE RECOMMENDATIONS Using pandemics as a model of public health emergencies, steps to improve care to the most vulnerable of populations are outlined, including mandates under the International Health Regulations Treaty of 2007 and World Health Organization guidelines. Recommendations include an emphasis on first improving primary care, prevention, and basic emergency care, where possible. Advances in care should move incrementally without compromising primary care resources. A first step in preparing for a pandemic in developing countries involves building capacity in public health surveillance and proven community containment and mitigation strategies. Given the severe lack of healthcare workers in at least 57 countries, the Task Force also supports World Health Organization's recommendations that planning for a public health emergency include means for health workers to collaborate with staff in the military, transport, and education sectors as well as international healthcare workers to maximize the efficiency of scarce human resources. Rapid response teams can be augmented by international subject matter experts if these do not exist at the country level.


title: Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit.

text: Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.


How the COVID-19 pandemic illustrated the importance of emergency medicine, and its vital role as a pillar of the healthcare system.


title: Endovascular treatment of patients with intracranial stenosis with moyamoya-type collaterals.

text: PURPOSE The authors report the endovascular treatment of intracranial stenosis in six patients with moyamoya-type collaterals. PATIENTS All patients previously had experienced a stroke or transient ischemic attack. Lesion locations included a unilateral M1-segment lesion in five patients; and ipsilateral internal carotid artery (ICA)-T, M1 and A1 lesions with contralateral supraclinoid ICA stenosis in one patient. Mean M1 stenosis was 77.3 ± 14.3%. RESULTS Six patients had balloon angioplasty; in one, a Wingspan stent deployed successfully after angioplasty failed to relieve the stenosis. Mean post-treatment stenosis was 41.0 ± 33.0%. In one patient, vessel rupture occurring during angioplasty caused severe disability. Two patients were asymptomatic for 4 years and 6 months, respectively. One asymptomatic patient had severe restenosis re-treated with intracranial stenting. Two patients became symptomatic and had re-treatment at 1 and 2 months, respectively. CONCLUSION Endovascular treatment of intracranial stenosis with moyamoya-type collaterals is possible but is associated with high rates of symptomatic restenosis and target-lesion revascularization.


title: Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development.

text: The SARS-CoV-2 (COVID 19) pandemic has necessitated changes in health care delivery, including increases in delivery of care through asynchronous or virtual means, and deployment of clinicians in different teams and settings. Physical distancing and redeployment of clinicians has also necessitated changes in health care continuing professional development (CPD). Health care delivery and CPD is unlikely to fully return (in the near term, if at all) to prepandemic status. The authors raise questions and opportunities for development and provision of CPD during and after the pandemic.


title: Ethics of controlled human infection to study COVID-19.

text: High social value is fundamental to justifying these studies.


title: Endovascular management of adjacent tandem intracranial aneurysms: utilization of stent-assisted coiling and flow diversion.

text: BACKGROUND Tandem intracranial aneurysms are aneurysms located along a single intracranial vessel. Adjacent tandem aneurysms arise within the same vascular segment and their presence often suggests diffuse parent vessel anomaly. Endovascular management of these rare lesions has not been well studied. In this retrospective observational study, we describe our experience treating adjacent tandem intracranial aneurysms with endovascular embolization. METHODS We retrospectively reviewed records of patients with these lesions who underwent endovascular treatment between 2008 and 2013. RESULTS Thirteen patients (mean age 60.8 years; 12 women) with 28 adjacent tandem aneurysms were treated during the study timeframe. Aneurysms were located along the clinoidal, ophthalmic, and communicating segments of the internal carotid artery in 12 patients and at the basilar apex in one patient. Average size was 8.4 mm. Six patients (12 aneurysms) were treated by flow diversion via the Pipeline embolization device (PED) and seven (16 aneurysms) by stent-assisted coiling, with coils successfully placed in 11 aneurysms. Clinical follow-up was available for an average of 26.1 months; postprocedural angiography was performed for 12 patients. Complete occlusion was achieved in nine of ten (90 %) PED-treated aneurysms and eight of 11 (72.7 %) treated by stent-assisted coiling (p = 0.44). Two patients treated by stent-assisted coiling required re-coiling for aneurysm recanalization. Overall, modified Rankin scale scores were 0-1 for 12 patients and 3 for one patient. CONCLUSIONS Adjacent tandem intracranial aneurysms can be safely and effectively treated by either stent-assisted coiling or flow diversion. We prefer PED flow diversion due to better parent vessel reconstruction and lower recanalization risk.


title: Epidemiological and clinical characteristics of COVID-19 patients in Nantong, China.

text: INTRODUCTION COVID-19 is a newly emerging life-threatening respiratory disease caused by a newly identified coronavirus SARS-CoV-2. METHODOLOGY We included 28 COVID-19 patients admitted to Nantong Third Hospital from January 23 to February 26, 2020. SARS-CoV-2 infection was confirmed using real-time RT-PCR. The demographic, epidemiological, clinical, laboratory parameters were obtained from each patient. RESULTS The vast majority (71.4%) of confirmed COVID-19 patients were brought in from outside of the city, and all others had contact history with these confirmed cases. The median age of patients was 50 years old and half had underlying diseases. The most common symptoms at the onset of illness were fever (96.4%), cough (67.9%), and chilly (28.6%), and 75.0% patients had two or more symptoms. Increased erythrocyte sedimentation rate, serum ferritin and C-reactive protein levels, and reduced absolute counts of total lymphocytes and T lymphocyte subsets were observed among the patients. The vast majority (85.7%) of patients showed bilateral or unilateral pneumonia, and three symptomatic patients and one asymptomatic case did not show abnormalities in their CT image. Among the 28 admitted patients, 24 were discharged as of February 26, 2020, with an average hospital stay of 14.96 (±4.27) days, which was not significantly associated with the interval between the onset of symptoms and admission. CONCLUSIONS In the absence of specific antiviral drugs or a vaccine, quarantine or isolation is the most effective intervention strategy for preventing the spread of the virus. Adequate supportive medical care is crucial for good prognosis of COVID-19 patients.


title: Lateral thermal spread and recurrent laryngeal nerve paralysis after minimally invasive esophagectomy in bipolar vessel sealing and ultrasonic energy devices: a comparative study.

text: BACKGROUND This study aimed to compare the extent of lateral thermal spread of surrounding tissues after the use of advanced bipolar and ultrasonic coagulation and shearing devices. Association between recurrent laryngeal nerve paralysis (RLNP) and such devices was assessed in patients who underwent minimally invasive esophagectomy (MIE). METHODS LigaSure™ (LS) and Sonicision™ (SONIC) were used. In ex vivo experiments using the porcine muscle, blade temperature and tissue temperature were measured using a thermometer after the activation of both devices. For the clinical assessment, 46 consecutive patients who received MIE were retrospectively assessed. RESULTS The temperature generated at the blade of both devices increased with the activation time. The blade temperature of LS was significantly lower than that of SONIC (P < 0.001). The blade temperature of SONIC exceeded 100 °C after 3-s activation. The temperature of surrounding tissues after a single activation of the devices decreased with the tissue distance from activation blade. The temperatures of tissues at 1 and 2 mm away from the blade side of LS were significantly lower than those of SONIC (P = 0.001 and P < 0.001, respectively). The temperature of tissue 2 mm away from the blade side of LS increased 6.4 °C from the baseline temperature. Furthermore, the incidence of RLNP in the LS group was lower than that in the SONIC group (P = 0.044). CONCLUSION This study highlights the necessity of spatial and temporal recognition of the thermal spread of coagulation and shearing devices to reduce the thermal injuries following MIE.


title: Endocrinology in the time of COVID-19: Remodelling Diabetes Services and Promoting Innovation.

text: The COVID-19 pandemic is a major international emergency leading to unprecedented medical, economic and societal challenges. Countries around the globe are facing challenges with diabetes care and are similarly adapting care delivery, with local cultural nuances. People with diabetes suffer disproportionately from acute COVID-19 with higher rates of serious complications and death. In-patient services need specialist support to appropriately manage glycaemia in people with known and undiagnosed diabetes presenting with COVID-19. Due to the restrictions imposed by the pandemic, people with diabetes may suffer longer-term harm caused by inadequate clinical support and less frequent monitoring of their condition and diabetes-related complications. Outpatient services need reorganised to maintain advice and support, focusing on proactive care for the highest risk, making use of telehealth and digital services for consultations, self-management and remote monitoring, where appropriate. Stratification of patients for face-to-face or remote follow-up should be based on a balanced risk assessment. Public health and national organisations have generally responded rapidly with guidance on care management, but the pandemic has created a tension around prioritisation of communicable vs non-communicable disease. Resulting challenges in clinical decision making are compounded by a reduced clinical workforce. For many years, increasing diabetes mellitus incidence has been mirrored by rising preventable morbidity and mortality due to complications, yet innovation in service delivery has been slow. While the current focus is on limiting the terrible harm caused by the pandemic, it is possible that a positive lasting legacy of COVID-19 might include accelerated innovation in chronic disease management.


title: Influence of the nutrition and health information presented on food labels on portion size consumed: a systematic review.

text: Context In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear. Objective This systematic review examined whether food label information influenced portion size consumption. Data sources A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted. Data extraction Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies). Results Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects). Conclusions Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.


title: Robotic surgery in the obese gynecologic patient.

text: Despite robust interest in minimally invasive surgery for obese gynecologic patients, widespread use by gynecologic surgeons has been hindered by the technical difficulty of completing these procedures. The use of robotic assistance to overcome these challenges continues to increase. This study discusses the problem of obesity in the United States, provides basic definitions and calculations related to the disease, reviews some of the literature supporting laparoscopic surgery in obese patients, explores the emergence of robotics in this patient population, and offers "surgical pearls" to aid in the successful completion of minimally invasive robotic gynecologic procedures in heavier patients.


title: Association of vitamin D deficiency with acute lower respiratory tract infections in newborns.

text: OBJECTIVE To determine the association between serum 25-hydroxy vitamin D [25(OH)D] levels and acute respiratory tract infections (ALRTI) in newborns. STUDY DESIGN The study group consisted of 30 term newborns with ALRTI who were admitted to our neonatal intensive care unit. Controls were 30 healthy newborns with the same age as the study group. Newborns and their mothers were tested for serum 25(OH)D levels, with a low level defined as ≤15 ng/mL. RESULTS The groups were similar in gestational week, birthweight, postnatal age and gender. Forty-three of the 60 infants (including study and control) had low 25(OH)D levels. The median 25(OH)D levels were lower [9.5 ng/mL (IQR = 7.9-12.2)] in the study group than those of the control group [15.5 ng/mL (IQR: 12-18)] (p = 0.0001). The median serum 25(OH)D levels in the mothers of the study group were also lower than those in the mothers of the control group [11.6 ng/mL (IQR = 9.4-15.8) and 17.3 ng/mL (IQR = 13.7-20.6), respectively] (p = 0.0001). CONCLUSION Lower blood 25(OH)D levels might be associated with increased risk of ALRTI in term newborn babies. Appropriate vitamin D supplementation during pregnancy and early childhood may enhance newborns' respiratory health.


title: Biomedical engineering and the obesity epidemic: treatments for weight reduction.

text: Obesity is becoming increasingly common, with at least 400 million obese adults worldwide and the World Health Organization (WHO) projecting that this statistic will reach 700 million in another five years. Ironically, despite the fact that a majority of adults in developed nations are overweight or obese, society stigmatizes the obese severely. Still, obese people have more than just social motivations for losing weight; obesity commonly goes hand in hand with life-threatening comorbidities like cardiovascular disease and type 2 diabetes and some forms of cancer. It severely threatens quality of life, limiting the ability to move and work, navigate public places, and provide care for others and is a factor in musculoskeletal disorders like osteoarthritis. Both obesity and its comorbidities lead obese patients to hospitals at greater rates than patients of normal weight, and these factors, along with social pressures, motivate patients and their physicians to pursue solutions for obesity, its comorbidities, or both.


title: Evaluation of pneumonia virus of mice as a possible human pathogen.

text: Pneumonia virus of mice (PVM), a relative of human respiratory syncytial virus (RSV), causes respiratory disease in mice. There is serologic evidence suggesting widespread exposure of humans to PVM. To investigate replication in primates, African green monkeys (AGM) and rhesus macaques (n = 4) were inoculated with PVM by the respiratory route. Virus was shed intermittently at low levels by a subset of animals, suggesting poor permissiveness. PVM efficiently replicated in cultured human cells and inhibited the type I interferon (IFN) response in these cells. This suggests that poor replication in nonhuman primates was not due to a general nonpermissiveness of primate cells or poor control of the IFN response. Seroprevalence in humans was examined by screening sera from 30 adults and 17 young children for PVM-neutralizing activity. Sera from a single child (6%) and 40% of adults had low neutralizing activity against PVM, which could be consistent with increasing incidence of exposure following early childhood. There was no cross-reaction of human or AGM sera between RSV and PVM and no cross-protection in the mouse model. In native Western blots, human sera reacted with RSV but not PVM proteins under conditions in which AGM immune sera reacted strongly. Serum reactivity was further evaluated by flow cytometry using unfixed Vero cells infected with PVM or RSV expressing green fluorescent protein (GFP) as a measure of viral gene expression. The reactivity of human sera against RSV-infected cells correlated with GFP expression, whereas reactivity against PVM-infected cells was low and uncorrelated with GFP expression. Thus, PVM specificity was not evident. Our results indicate that the PVM-neutralizing activity of human sera is not due to RSV- or PVM-specific antibodies but may be due to low-affinity, polyreactive natural antibodies of the IgG subclass. The absence of PVM-specific antibodies and restriction in nonhuman primates makes PVM unlikely to be a human pathogen.


title: Motiva Ergonomix Round SilkSurface Silicone Breast Implants: Outcome Analysis of 100 Primary Breast Augmentations over 3 Years and Technical Considerations.

text: BACKGROUND Macrotextured anatomical implants are frequently used in aesthetic breast surgery; however, several safety concerns linked to this implant type have been raised recently. In an attempt to address these shortcomings, Motiva Ergonomix implants have been introduced. Here, the authors describe the current world's largest experience with these novel devices in aesthetic breast surgery and evaluate the postoperative outcome of 100 primary breast augmentations. METHODS A retrospective assessment of 100 consecutive primary breast augmentation patients over a period of 3 years was conducted. Patients were followed for a minimum of 6 months postoperatively. Demographics, surgical data, and complications were recorded. In addition, a survey regarding the breast augmentation outcome was performed. RESULTS The reasons for surgery were mainly hypoplasia (52 percent) and ptosis (28 percent). All implants were placed by means of an inframammary approach in a submuscular pocket, and the average implant volume was 370 cc (range, 150 to 700 cc) with mostly full projection (65 percent). The revision rate was 7 percent. The authors observed four cases of implant malpositioning, one implant rupture, one implant exchange for aesthetic reasons, and one hematoma evacuation. Nevertheless, the authors achieved a 100 percent satisfaction rate with the postsurgical outcome among both patients and surgeons. CONCLUSIONS Motiva Ergonomix implants provide reliable and satisfying results for both patients and surgeons. They can be used safely and effectively for aesthetic breast surgery. However, like all breast prostheses, Motiva Ergonomix implants are not completely free of complications and should be used only with advanced technique to achieve optimal results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.


title: Opioid therapies and cytochrome p450 interactions.

text: Adverse drug reactions are common and associated with substantial economic and human costs. Particularly among older adult populations, preventable adverse drug reactions are often caused by drug-drug interactions. All analgesics have side effect profiles and many have known drug-drug interactions. Opioids are recognized as a necessary option for managing moderate-to-severe pain, yet many opioid side effects can be enhanced by metabolic interactions within the liver, involving other drugs, diseases, or genetics.


title: Adjusting tidal volume to stress index in an open lung condition optimizes ventilation and prevents overdistension in an experimental model of lung injury and reduced chest wall compliance.

text: INTRODUCTION The stress index (SI), a parameter derived from the shape of the pressure-time curve, can identify injurious mechanical ventilation. We tested the hypothesis that adjusting tidal volume (VT) to a non-injurious SI in an open lung condition avoids hypoventilation while preventing overdistension in an experimental model of combined lung injury and low chest-wall compliance (Ccw). METHODS Lung injury was induced by repeated lung lavages using warm saline solution, and Ccw was reduced by controlled intra-abdominal air-insufflation in 22 anesthetized, paralyzed and mechanically ventilated pigs. After injury animals were recruited and submitted to a positive end-expiratory pressure (PEEP) titration trial to find the PEEP level resulting in maximum compliance. During a subsequent four hours of mechanical ventilation, VT was adjusted to keep a plateau pressure (Pplat) of 30 cmH2O (Pplat-group, n = 11) or to a SI between 0.95 and 1.05 (SI-group, n = 11). Respiratory rate was adjusted to maintain a 'normal' PaCO2 (35 to 65 mmHg). SI, lung mechanics, arterial-blood gases haemodynamics pro-inflammatory cytokines and histopathology were analyzed. In addition Computed Tomography (CT) data were acquired at end expiration and end inspiration in six animals. RESULTS PaCO2 was significantly higher in the Pplat-group (82 versus 53 mmHg, P = 0.01), with a resulting lower pH (7.19 versus 7.34, P = 0.01). We observed significant differences in VT (7.3 versus 5.4 mlKg(-1), P = 0.002) and Pplat values (30 versus 35 cmH2O, P = 0.001) between the Pplat-group and SI-group respectively. SI (1.03 versus 0.99, P = 0.42) and end-inspiratory transpulmonary pressure (PTP) (17 versus 18 cmH2O, P = 0.42) were similar in the Pplat- and SI-groups respectively, without differences in overinflated lung areas at end- inspiration in both groups. Cytokines and histopathology showed no differences. CONCLUSIONS Setting tidal volume to a non-injurious stress index in an open lung condition improves alveolar ventilation and prevents overdistension without increasing lung injury. This is in comparison with limited Pplat protective ventilation in a model of lung injury with low chest-wall compliance.


title: A comparative analysis of recommendations provided by clinical practice guideline for use of natural health products in the treatment of menopause-related vasomotor symptoms.

text: OBJECTIVES To systematically review Clinical Practice Guidelines (CPGs) for the management of menopause-related vasomotor symptoms (VMS) to 1) identify those that include Natural Health Products (NHPs); 2) identify which NHPs were included and the evidence supporting the recommendation for the place in therapy; and 3) compare methodological quality of the CPGs. METHODS PubMed, EMBASE, Web of Science, BMJ Best Practice, DynaMed Plus and websites of gynecological and menopausal societies were searched (Jan 2000-Nov 2018). Records were screened to identify CPGs that were published in English, since 2000 and were for use in North America. CPGs were reviewed for inclusion of NHPs. Data regarding NHPs (evidence, recommendation) were extracted and analyzed. CPGs were critically appraised using the AGREE II tool. RESULTS Five of six CPGs that met general inclusion criteria included NHPs. Black cohosh, isoflavones, soy food/extracts and phytoestrogens were included in all five CPGs. Comparative analysis of recommendations and level of supporting evidence revealed differences. All CPGs included recommendations regarding the use of NHPs in general, although recommendations differed. Four of five CPGs made recommendations for unique NHPs, however, recommendations differed. Using the AGREE II tool, CPGs scored well on domains for purpose and clarity. Lack of detailed description of methodology and author expertise affected scores in other domains. CONCLUSION Five CPGs included general recommendations for the role of NHPs in treating VMS, with recommendations ranging from use with caution to not recommended. There were inconsistencies among CPGs regarding NHPs included and what evidence was used in making recommendations.


Radiologic Findings of Coronavirus Disease (COVID-19): Clinical Correlation Is Recommended.


title: Gastrointestinal manifestations of neuroendocrine tumours: their investigation and management.

text: The incidence of neuroendocrine tumours (NETs) is on the rise in the UK. Patients with NETs need to be managed by a team of clinical specialties. There are a number of challenging gastrointestinal (GI) manifestations related to NETs that can occur in these patients, but a limited literature base exists to guide clinicians.Whilst life expectancy can be several years for patients with NETs, the GI symptoms can have a significant impact on their quality of life. It is therefore imperative to be familiar with the common GI manifestations associated with NETs, so symptoms can be appropriately managed with an overall aim of restoring the patient's quality of life.


title: Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord experience.

text: OBJECTIVE SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referred to as COVID-19 (Coronavirus Disease 19), is a public health emergency as it carries high morbidity, mortality, and has no approved specific pharmacological treatments. In this case series, we aimed to report preliminary data obtained with anti-complement C5 therapy with eculizumab in COVID-19 patients admitted to intensive care unit (ICU) of ASL Napoli 2 Nord. PATIENTS AND METHODS This is a case series of patients with a confirmed diagnosis of SARS-CoV2 infection and severe pneumonia or ARDS who were treated with up to 4 infusions of eculizumab as an off-label agent. Patients were also treated with anticoagulant therapy with Enoxaparin 4000 IU/day via subcutaneous injection, antiviral therapy with Lopinavir 800 mg/day + Ritonavir 200 mg/day, hydroxychloroquine 400 mg/day, ceftriaxone 2 g/day IV, vitamine C 6 g/day for 4 days, and were on Non-Invasive Ventilation (NIV). RESULTS We treated four COVID-19 patients admitted to the intensive care unit because of severe pneumonia or ARDS. All patients successfully recovered after treatment with eculizumab. Eculizumab induced a drop in inflammatory markers. Mean C Reactive Protein levels dropped from 14.6 mg/dl to 3.5 mg/dl and the mean duration of the disease was 12.8 days. CONCLUSIONS Eculizumab has the potential to be a key player in treatment of severe cases of COVID-19. Our results support eculizumab use as an off-label treatment of COVID-19, pending confirmation from the ongoing SOLID-C19 trial.


Disease of the Year: COVID-19 and Its Neuro-ophthalmic Complications.


title: [2019-nCoV: new challenges from coronavirus].

text: The outbreak of pneumonia caused by the novel coronavirus 2019-nCoV in Wuhan, Hubei province of China, at the end of 2019 shaped tremendous challenges to China's public health and clinical treatment. The virus belongs to the β genus Coronavirus in the family Corornaviridae, and is closely related to SARS-CoV and MERS-CoV, causing severe symptoms of pneumonia. The virus is transmitted through droplets, close contact, and other means, and patients in the incubation period could potentially transmit the virus to other persons. According to current observations, 2019-nCoV is weaker than SARS in pathogenesis, but has stronger transmission competence; it's mechanism of cross-species spread might be related with angiotensin-converting enzyme Ⅱ (ACE2), which is consistent with the receptor SARS-CoV. After the outbreak of this disease, Chinese scientists invested a lot of energy to carry out research by developing rapid diagnostic reagents, identifying the characters of the pathogen, screening out clinical drugs that may inhibit the virus, and are rapidly developing vaccines. The emergence of 2019-nCoV reminds us once again of the importance of establishing a systematic coronavirus surveillance network. It also poses new challenges to prevention and control of the emerging epidemic and rapidly responses on scientific research.


title: Stabilized helical peptides: overview of the technologies and therapeutic promises.

text: INTRODUCTION Helical structures in proteins and naturally occurring peptides play a major role in a variety of biological processes by mediating interactions with proteins and other macromolecules such as nucleic acids and lipid membranes. The use of short synthetic peptides encompassing helical segments to modulate or disrupt such interactions, when associated with human diseases, represents great pharmacological interest. AREAS COVERED Multiple chemical approaches have been developed to increase the conformational and metabolic stabilities of helical peptides and to improve their biomedical potential. After a brief overview of these technologies and the most recent developments, this review will focus on the main therapeutic areas and targets and will discuss their promise. EXPERT OPINION Potential benefits associated with increased helix stability extend beyond simple affinity enhancement. Some peptidomimetic helices are being endowed with features desirable for cellular activity such as increased resistance to proteolysis and/or cell permeability. Recent advances in the field of peptide and related peptidomimetic helices are not just conceptual, but are likely to be of practical utility in the process of optimizing peptides as clinical candidates, and developing medium-size therapeutics.


title: Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.

text: BACKGROUND In the PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) trial that evaluated patients with nonvalvular atrial fibrillation (NVAF), left atrial appendage (LAA) occlusion was noninferior to warfarin for stroke prevention, but a periprocedural safety hazard was identified. OBJECTIVES The goal of this study was to assess the safety and efficacy of LAA occlusion for stroke prevention in patients with NVAF compared with long-term warfarin therapy. METHODS This randomized trial further assessed the efficacy and safety of the Watchman device. Patients with NVAF who had a CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and previous stroke/transient ischemic attack) score ≥2 or 1 and another risk factor were eligible. Patients were randomly assigned (in a 2:1 ratio) to undergo LAA occlusion and subsequent discontinuation of warfarin (intervention group, n = 269) or receive chronic warfarin therapy (control group, n = 138). Two efficacy and 1 safety coprimary endpoints were assessed. RESULTS At 18 months, the rate of the first coprimary efficacy endpoint (composite of stroke, systemic embolism [SE], and cardiovascular/unexplained death) was 0.064 in the device group versus 0.063 in the control group (rate ratio 1.07 [95% credible interval (CrI): 0.57 to 1.89]) and did not achieve the prespecified criteria noninferiority (upper boundary of 95% CrI ≥1.75). The rate for the second coprimary efficacy endpoint (stroke or SE >7 days' postrandomization) was 0.0253 versus 0.0200 (risk difference 0.0053 [95% CrI: -0.0190 to 0.0273]), achieving noninferiority. Early safety events occurred in 2.2% of the Watchman arm, significantly lower than in PROTECT AF, satisfying the pre-specified safety performance goal. Using a broader, more inclusive definition of adverse effects, these still were lower in PREVAIL (Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy) trial than in PROTECT AF (4.2% vs. 8.7%; p = 0.004). Pericardial effusions requiring surgical repair decreased from 1.6% to 0.4% (p = 0.027), and those requiring pericardiocentesis decreased from 2.9% to 1.5% (p = 0.36), although the number of events was small. CONCLUSIONS In this trial, LAA occlusion was noninferior to warfarin for ischemic stroke prevention or SE >7 days' post-procedure. Although noninferiority was not achieved for overall efficacy, event rates were low and numerically comparable in both arms. Procedural safety has significantly improved. This trial provides additional data that LAA occlusion is a reasonable alternative to warfarin therapy for stroke prevention in patients with NVAF who do not have an absolute contraindication to short-term warfarin therapy.


title: Effect of target-controlled propofol infusion to reduce the incidence of adverse events for procedural sedation in the emergency department: a systematic review.

text: The administration of propofol target-controlled infusion (TCI) for procedural sedation is standard in a range of hospital settings except for the Emergency Department (ED). Propofol TCI could be an alternative, safer way to provide procedural sedation in the ED compared with other methods of propofol administration. We compare the incidence of adverse events using propofol TCI compared with other methods of propofol administration. We conducted a systematic review of the literature from 1946 to January 2019 identifying studies that compared propofol TCI with other propofol regimens for procedural sedation in the adult population. Studies were assessed for risk of bias using the Cochrane Collaboration risk of bias tool. Seven articles were included. There was significant methodological heterogeneity in all aspects of study designs and definitions of adverse events which precluded a meta-analysis. A systematic review of the studies demonstrated fewer respiratory and cardiovascular adverse outcomes in three of the seven studies. It was not possible to determine if propofol TCI reduces the incidence of adverse events when compared with other sedating regimens using propofol using a descriptive systematic review of the relevant literature. Further research is required to compare the incidence of adverse events using propofol TCI for procedural sedation with other methods of administration in the ED. Future systematic reviews and meta-analysis comparisons would be aided by the use of standard adverse event reporting tools such as that of the Society of Intravenous Anaesthesia.


title: Pipeline Embolization Device as primary treatment for blister aneurysms and iatrogenic pseudoaneurysms of the internal carotid artery.

text: BACKGROUND Blood blister type aneurysms (BBAs) and pseudoaneurysms create a unique treatment challenge. Despite many advances in open surgical and endovascular techniques, this subset of patients retains relatively high rates of morbidity and mortality. Recently, BBAs have been treated with flow-diverting stents such as the Pipeline Embolization Device (PED) with overall positive results. METHODS Four patients presented with dissecting internal carotid artery (ICA) aneurysms treated with the PED (two BBAs presenting with subarachnoid hemorrhage (SAH), two pseudoaneurysms after injury during endoscopic trans-sphenoidal tumor surgery). RESULTS Three patients had a successful angiographic and neurological outcome. One patient with a BBA re-ruptured during initial PED placement, again in the postoperative period, and later died. Primary PED treatment involved telescoping stents in two patients and coil embolization supplementation in one patient. CONCLUSIONS The PED should be used selectively in the setting of acute SAH. Dual antiplatelet therapy can complicate hydrocephalus management, and the lack of immediate aneurysm occlusion creates the risk of short-term re-rupture. PED treatment for iatrogenic ICA pseudoaneurysms can provide a good angiographic and neurological outcome.


Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection.


title: Comparative evaluation of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy.

text: BACKGROUND The advent of laparoscopic surgery has benefited the patient and surgeon; however creation of pneumoperitoneum for same has bearings during the perioperative period. These effects of pneumoperitoneum are associated with significant haemodynamic changes, increasing the morbidity of the patient. AIM The present study compared the efficacy of dexmedetomidine and esmolol on hemodynamic responses during laparoscopic cholecystectomy Materials and Methods: A total of 90 patients aged 20-60 y, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. The patients were randomly divided into three groups of 30 each. Group D received dexmedetomidine loading dose 1 mcg/kg over a period of 15 min and maintenance 0.5 mcg/kg/h throughout the pneumoperitoneum. Group E received esmolol loading dose 1 mg/kg over a period of 5 min and maintenance 0.5 mg/kg/h throughout the pneumoperitoneum. Group C received same volume of normal saline. MEASUREMENTS Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. RESULTS In group D, there was no statistically significant increase in HR and blood pressure after pneumoperitoneum at any time intervals, whereas in Group E, there was a statistical significant increase in MAP after pneumoperitoneum at 15, 45, and 60 min only and HR during the whole pneumoperitoneum period. There was a significant decrease in induction dose of propofol and intraoperative fentanyl requirement in Group D and E, compared to Group C (p<0.0001). CONCLUSION Dexmedetomidine is more effective than esmolol for attenuating the hemodynamic response to pneumoperitoneum in elective laparoscopic cholecystectomy. Dexmedetomidine and esmolol also reduced requirements of anaesthetic agents.


title: Special strategies and management of urological diseases during the COVID-19 pandemic: initial experiences from a Medical Center of China.

text: Although urological diseases are not directly related to coronavirus disease 2019 (COVID-19), urologists need to make comprehensive plans for this disease. Urological conditions such as benign prostatic hyperplasia and tumors are very common in elderly patients. This group of patients is often accompanied by underlying comorbidities or immune dysfunction. They are at higher risk of COVID-19 infection and they tend to have severe manifestations. Although fever can occur along with urological infections, it is actually one of the commonest symptoms of COVID-19; urologists must always maintain a high index of suspicion in their clinical practices. As a urological surgeon, how we can protect medical staff during surgery is a major concern. Our hospital had early adoption of a series of strict protective and control measures, and was able to avoid cross-infection and outbreak of COVID-19. This paper discusses the effective measures that can be useful when dealing with urological patients with COVID-19.


title: Older Adults and the Economic Impact of the COVID-19 Pandemic.

text: The COVID-19 pandemic has impacted communities throughout the United States and worldwide. While the implications of the concomitant economic downturn for older adults are just beginning to be recognized, past experience suggests that the consequences could be devastating for many. Analyses indicate that more than one out of five Americans aged 65 years or older live in counties where high infection rates and high economic insecurity risks occur simultaneously. These findings highlight the overlap between current infection patterns and subsequent challenges to economic security that are impacting older people. Strategies and supports for getting people back to work must take into account the large segment of older people who rely on earnings well into later life. Social Security serves as the foundation of economic security for older adults across the income continuum, but it is frequently insufficient in and of itself, let alone during a crisis. Recognizing the importance of cost of living in shaping economic security highlights the need for the federal and state governments and municipalities to take older people into account in the economic recovery effort.


title: Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer.

text: To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The Second ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on management of patients with non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, early stage disease, locally advanced disease and advanced (metastatic) disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on recommendations for pathology and molecular biomarkers in relation to the diagnosis of lung cancer, primarily non-small-cell carcinomas.


title: Single incision laparoscopic cholecystectomy for patients with Mirizzi syndrome.

text: Since multiport laparoscopic cholecystectomy has become a standard treatment for gallbladder (GB) disease, a single incision laparoscopic surgical technique has been tried to decrease the surgical site pain and achieve a better cosmetic out come in selected patients. The development of devices dedicated for single incision laparoscopic cholecystectomy (SILC) is expanding the indication of this single incision laparoscopic technique to more complicated GB diseases. Mirizzi syndrome (MS) is one of the complex uncommon gallstone diseases in patients undergoing cholecystectomy. Because the laparoscopic procedure has become a routine treatment for cholecystectomy, several studies have reported their experience with the laparoscopic technique for the treatment of MS with a comparable outcome in Csendes type I or II. Because the indication for SILC cholecystectomy is expanded to more complicated GB conditions, and the desire of patients for a less painful, better cosmetic surgical outcome has increased, our medical center used this single incision laparoscopic surgical technique for MS Csendes types I and II patients. Here, we report 2 successful cases of SILC for patients with MS types I and II without significant morbidity.


title: Evidence of pervasive biologically functional secondary structures within the genomes of eukaryotic single-stranded DNA viruses.

text: Single-stranded DNA (ssDNA) viruses have genomes that are potentially capable of forming complex secondary structures through Watson-Crick base pairing between their constituent nucleotides. A few of the structural elements formed by such base pairings are, in fact, known to have important functions during the replication of many ssDNA viruses. Unknown, however, are (i) whether numerous additional ssDNA virus genomic structural elements predicted to exist by computational DNA folding methods actually exist and (ii) whether those structures that do exist have any biological relevance. We therefore computationally inferred lists of the most evolutionarily conserved structures within a diverse selection of animal- and plant-infecting ssDNA viruses drawn from the families Circoviridae, Anelloviridae, Parvoviridae, Nanoviridae, and Geminiviridae and analyzed these for evidence of natural selection favoring the maintenance of these structures. While we find evidence that is consistent with purifying selection being stronger at nucleotide sites that are predicted to be base paired than at sites predicted to be unpaired, we also find strong associations between sites that are predicted to pair with one another and site pairs that are apparently coevolving in a complementary fashion. Collectively, these results indicate that natural selection actively preserves much of the pervasive secondary structure that is evident within eukaryote-infecting ssDNA virus genomes and, therefore, that much of this structure is biologically functional. Lastly, we provide examples of various highly conserved but completely uncharacterized structural elements that likely have important functions within some of the ssDNA virus genomes analyzed here.


Covid-19: How does the NHS test and trace service work?


title: Effective treatment of pancreatic neuroendocrine tumours transfected with the sodium iodide symporter gene by 186Re-perrhenate in mice.

text: PURPOSE ReO(4)(-) has similar kinetics regarding the sodium iodide symporter (NIS) to I(-) and TcO(4)(-) in NIS-expressing tissue. We investigated the therapeutic potential of (186)ReO(4)(-) in NIS-transfected neuroendocrine tumour tissue. METHODS For experiments, the stably NIS-transfected pancreatic neuroendocrine cancer cell line Bon1C was used. NIS-mediated internalization and externalization experiments in vitro and a biodistribution study in nude mice bearing Bon1C xenografts were performed. A therapy study was also conducted consecutively in nude mice xenografted with Bon1C in which the mice were injected intravenously with Na(186)ReO(4). RESULTS In vitro studies showed exponential internalization and efflux kinetics of (186)ReO(4)(-) in the cell line. The biodistribution study showed high uptake of (186)ReO(4)(-) in NIS-expressing tumours. Tumour growth inhibition was significant after injection of (186)ReO(4) in two groups of animals treated with activity levels below the determined maximum tolerable activity as compared to controls. CONCLUSION These results indicate that the use of (186)ReO(4)(-) in the treatment of NIS-expressing neuroendocrine tumours is feasible and support the concept of using NIS as a therapeutic target for (186)ReO(4)(-).


Are We Ready For The Next Pandemic?


title: A clinical study of the LiVac laparoscopic liver retractor system.

text: BACKGROUND All retractors for laparoscopic operations on the gallbladder or stomach apply an upward force to the under-surface of the liver or gallbladder, most requiring an additional skin incision. The LiVac laparoscopic liver retractor system (LiVac retractor) comprises a soft silicone ring attached to suction tubing and connected to a regulated source of suction. The suction tubing extends alongside existing ports. When placed between the liver and diaphragm, and suction applied, a vacuum is created within the ring, keeping these in apposition. Following successful proof-of-concept animal testing, a clinical study was conducted to evaluate the performance and safety of the retractor in patients. METHODS The study was a dual-centre, single-surgeon, open-label study and recruited ten patients scheduled to undergo routine upper abdominal laparoscopic surgery including cholecystectomy, primary gastric banding surgery or fundoplication. The study was conducted at two sites and was approved by the institutions' ethics committees. The primary objective of the study was to evaluate the performance of the LiVac retractor in patients undergoing upper abdominal single- or multi-port laparoscopic surgery. Performance was measured by the attainment of milestones for the retractor and accessory bevel, where used, and safety outcomes through the recording of adverse events, physical parameters, pain scales, blood tests and a post-operative liver ultrasound. RESULTS The LiVac retractor achieved both primary and secondary performance and safety objectives in all patients. No serious adverse events and no device-related adverse events or device deficiencies were reported. CONCLUSION The LiVac retractor achieved effective liver retraction without clinically significant trauma and has potential application in multi- or single-port laparoscopic upper abdominal surgery. As a separate incision is not required, the use of the LiVac retractor in multi-port surgery therefore reduces the number of incisions.


title: A pilot study for one-stop endoscopic total extraperitoneal inguinal hernia repair.

text: BACKGROUND One-stop surgery was developed for patients to undergo surgical evaluation, anesthesia, surgery, and discharge all within 1 day. This study aimed to assess the feasibility, patient satisfaction, and potential of one-stop endoscopic total extraperitoneal (TEP) inguinal hernia surgery. METHODS After general practitioners had been informed, prospectively selected patients with unilateral or bilateral inguinal hernia underwent one-stop surgery by TEP. Pre- and postoperative questionnaires were used to evaluate patient satisfaction. RESULTS During 12 months, 52 patients were referred for one-stop surgery. There were no "no shows". The general practitioner correctly diagnosed inguinal hernia in 51 patients. On the scheduled date, 50 patients successfully underwent surgery using TEP, and 49 of these patients were satisfied with the procedure and would repeat one-stop surgery when indicated. CONCLUSION One-stop endoscopic TEP inguinal hernia surgery is feasible and safe. The majority of patients would give preference to a repeated procedure if necessary. This clinical pathway reduces the number of patient visits to the hospital for inguinal hernia repair and also suggests cost efficiency.


title: Make Your Pitch: A Flexible Assignment for Engaging Students in Aging.

text: Given trends in local, national, and global demographics, a need exists for educators in fields that serve older adults to provide innovative and engaging assignments that are relevant and applicable to the diverse contexts in which students are likely to find themselves as they pursue their careers. This article discusses a novel "elevator pitch" assignment that could be implemented in a number of ways to fit a variety of pedagogical methods and courses and further tailored to serve the needs of diverse student populations. For those working to actively and successfully recruit, train, and retain students in fields that serve older adults, such flexibility of assignments and delivery are likely to be acutely important as institutions, instructors, and students continue to adapt to rapidly changing developments such as those imposed by the COVID-19 pandemic.


title: Clinical evaluation of contemporary oxygenators.

text: Advances in cardiopulmonary bypass equipment have played a critical role in improving outcomes for cardiac surgery patients. Recent advancements include reduced priming volumes, biocompatible coatings and gaseous microemboli handling, as well as the incorporation of an arterial filter into the oxygenator.The purpose of this study was to conduct a comprehensive clinical evaluation of adult oxygenators on the market. Oxygenators assessed included the Sorin Synthesis(®) (n = 30), the Sorin Inspire 6F(®) (n = 10) and Inspire 8F(®) (n = 30), the Terumo FX15(®) (n = 13) and FX25(®) (n = 30), the Maquet Quadrox-i(®) (n = 30) and the Medtronic Fusion(®) (n = 30). Parameters assessed included functional prime volumes, gas exchange, pressure gradients and the effects on patient hematology.The Synthesis had the largest functional prime volume (1426 ml), the FX15 the lowest (956 ml). The Inspire 6F, 8F and Fusion had the greatest O2 transfer. The Sorin oxygenators required the lowest sweep gas flows to obtain a PaCO2 of 40 mmHg. The Sorin oxygenators had the largest pressure gradients. While no differences were observed for hemoglobin and platelet levels post cross-clamp removal, the Sorin Synthesis and Inspire 8F had the largest increases in white blood cell (WBC) counts (122% and 141% of baseline, respectively) and neutrophils (162% and 185% of baseline, respectively).The data demonstrate that no single product is superior in all aspects. The choice of ideal oxygenator depends on the aspect(s) of oxygenator performance the perfusion team believes most clinically acceptable based on available data.


Metagenomic Sequencing Detects Respiratory Pathogens in Hematopoietic Cellular Transplant Patients.


title: Exercise performance over the menstrual cycle in temperate and hot, humid conditions.

text: PURPOSE This study investigated the effects of the menstrual cycle on prolonged exercise performance both in temperate (20°C, 45% relative humidity) and hot, humid (32°C, 60% relative humidity) conditions. METHODS For each environmental condition, 12 recreationally active females were tested during the early follicular (day 3-6) and midluteal (day 19-25) phases, verified by measurement of estradiol and progesterone. For all four tests, thermoregulatory, cardiorespiratory, and perceptual responses were measured during 60 min of exercise at 60% of maximal oxygen consumption followed by an incremental test to exhaustion. RESULTS No differences in exercise performance between menstrual cycle phases were found during temperate conditions (n = 8) despite a higher resting and submaximal exercise core temperature (Tc) in the luteal phase. In hot, humid conditions (n = 8), however, prolonged exercise performance, as exercise time to fatigue, was significantly reduced during the luteal phase. This finding was not only accompanied by higher resting and submaximal exercise Tc but also a higher rate of increase in Tc during the luteal phase. Furthermore, submaximal exercise HR, minute ventilation, and RPE measures were higher during the luteal phase in hot, humid conditions. No significant differences were found over the menstrual cycle in heat loss responses (partitional calorimetry, sweat rate, upper arm sweat composition) and Tc at exhaustion. CONCLUSION In temperate conditions, no changes in prolonged exercise performance were found over the menstrual cycle, whereas in hot, humid conditions, performance was decreased during the luteal phase. The combination of both exercise and heat stress with the elevated luteal phase Tc at the onset of exercise resulted in physiological and perceptual changes and a greater thermosensitivity, which may explain the decrease in performance.


title: Electrophoretic profile of seminal proteins and their correlation with in vitro sperm characters in Black Bengal buck semen.

text: Aim This study aimed to study the electrophoretic properties of seminal plasma and sperm proteins of Black Bengal buck semen and their correlation with in vitro sperm characters and freezability. Materials and Methods Semen ejaculates from nine Black Bengal bucks were collected by artificial vagina (n=20/buck). Ejaculates were evaluated for in vitro sperm characters and electrophoretic profile of seminal protein. In vitro sperm characters were evaluated immediately after collection, after completion of equilibration period, and after freeze-thawing. For seminal protein studies, seminal plasma proteins were precipitated by ice-cold ethanol method, and sperm proteins were extracted by Triton X detergent extraction method. Discontinuous sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was performed to assess the molecular weight of seminal proteins. Correlation between in vitro sperm characters and protein bands was determined by Pearson's correlation coefficient, and two-way ANOVA was applied to find the individual buck differences. Results Significant difference (p<0.01) among the bucks was noticed in the in vitro sperm characters evaluated at all the three stages of semen evaluation such as immediately after collection, after completion of equilibration period, and post-freeze thawing. Progressive loss of sperm motility, membrane integrity, and other in vitro sperm characters were noticed during cryopreservation. A total of ten protein bands in the molecular weight ranging from 17 to 180 kDa were found in the SDS-PAGE of seminal plasma proteins, while nine bands of 17-134 kDa were observed in sperm proteins. Seminal plasma proteins of molecular weight 75, 62-49, 20, and 17 kDa and sperm proteins of 75, 20, and 17 kDa were present in all the nine bucks (100%) screened, and variation among the bucks was noticed for the presence of other proteins. Seminal plasma protein of 180-134 kDa showed a negative correlation with individual motility (-0.716) and functional membrane integrity of sperm cells (-0.724) in post-freeze-thaw analysis and 48 kDa protein had a positive correlation with individual motility (0.649) and functional membrane integrity of sperm cells (0.664) in post-thaw analysis. Sperm proteins of 63 kDa had a negative correlation (-0.616) with sperm concentration in neat semen. Conclusion Variation among the bucks was noticed in the in vitro sperm characters and semen freezability. Correlation between seminal proteins and in vitro sperm characters and semen freezability had been found which might be useful as a tool to select breeding bucks.


title: The Use of Music Playlists for People with Dementia: A Critical Synthesis.

text: The use of pre-recorded music to ease behavioral and psychological symptoms associated with dementia is popular in health-care contexts in both formal music therapy settings and in non-therapist led interventions. However, further understanding of how non-therapist led interventions compare to therapist led interventions is needed. This paper reviews 28 studies that used pre-recorded music with people with dementia using a critical interpretive synthesis model. Results revealed that pre-recorded music can be effective in reducing a variety of affective and behavioral symptoms, in particular agitation, even where a trained music therapist is not present. However, the results are not universally positive, suggesting the need for further clarification of protocols for music use and closer investigation of variables that influence individual responseto music.


Political reverence towards the NHS is a smokescreen.


Annotated patent selections.


title: Rapidly eliminating pathogenic microorganisms in large air space using spraying •OH radicals.

text: A new method for rapidly eliminating pathogenic microorganisms in large air space using spraying •OH radicals is presented in this paper. With a physical method of strong electric-field discharge, large numbers of •OH radicals were produced by the oxygen activated particles of O2+, O( 1D), O( 3P), etc., and the introducing reagent HO2-. The gram-positive bacteria Bacillus subtilis, the gram-negative bacteria Serratia marcescens, and Bacillus spores were used for the eliminating experiments. Results show that the different microorganisms were rapidly killed by •OH radicals with a concentration of 0.8 mg/L and spraying density of 21 μL/m2 within 4 sec. Cell morphological changes were also observed under microscope. The cells of B. subtilis and Bacillus spores in their cellular wall, cellular membrane, or cell protoplasm were greatly destroyed when being exposed to a killing dosage of •OH radicals. [Box: see text].


title: Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol.

text: There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents' and families' preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients' behaviour.


title: Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin.

text: BACKGROUND Due to excellent efficacy for weight loss in the short-term follow-up, sleeve gastrectomy (SG) has gained enormous popularity as bariatric procedure, not only as first step in high-risk or super-obese patients but mainly as a sole and definitive operation in morbidly obese. In contrast to a large number of short and intermediate-term results, no series of SG with a follow-up of 5 years or more has been published so far. METHODS We report on the weight loss results of our first consecutive 26 patients with a complete follow-up of 5 years. Furthermore in a subgroup of 12 patients, plasma ghrelin levels were measured preoperatively, and up to 5 years following SG. RESULTS Weight loss defined as mean percent excess weight loss (%EWL) was found as 57.5 +/- 4.5, 60.3 +/- 5.0, 60.0 +/- 5.7, 58.4 +/- 5.4, and 55.0 +/- 6.8 (not converted, n = 21) for the first 5 years. Weight regain of more than 10 kg from nadir was observed in five (19.2%) of the 26 patients. Four of the patients (15.4%) were converted to gastric bypass due to severe reflux (n = 1, 3.8%) and weight loss failure (n = 3, 11.5%). A total of eight patients (30.8%) were at chronic need for proton pump inhibitor medication due to severe reflux. Plasma ghrelin levels were reduced from 593 +/- 52 to 219 +/- 23 pg/ml 12 months postoperatively, with a slightly, non-significant increase toward the 5-years values of mean 257 +/- 23 pg/ml. CONCLUSIONS At 5-year follow-up, a mean EWL of 55.0 +/- 6.8% was achieved, indicating that SG leads to stable weight loss. Beside significant weight regain, severe reflux might necessitate conversion to gastric bypass or duodenal switch. After an immediate reduction postoperatively, plasma ghrelin levels remained low for the first 5 years postoperatively.


title: Lymphangiography and subsequent sclerotherapy can be easily applied by cannulation of the lymph duct with a catheter for the neonatal central vein.

text: Therapeutic lipiodol lymphangiography for postoperative chyle leakage due to lymph duct damage has recently been attracting attention. Lymph duct puncture is technically complex and difficult. Lymphangiography and sclerotherapy can be easily applied by cannulation with a catheter for the neonatal central vein to the lymph duct under a microscope.


title: Viral RNA at Two Stages of Reovirus Infection Is Required for the Induction of Necroptosis.

text: Necroptosis, a regulated form of necrotic cell death, requires the activation of the RIP3 kinase. Here, we identify that infection of host cells with reovirus can result in necroptosis. We find that necroptosis requires sensing of the genomic RNA within incoming virus particles via cytoplasmic RNA sensors to produce type I interferon (IFN). While these events that occur prior to the de novo synthesis of viral RNA are required for the induction of necroptosis, they are not sufficient. The induction of necroptosis also requires late stages of reovirus infection. Specifically, efficient synthesis of double-stranded RNA (dsRNA) within infected cells is required for necroptosis. These data indicate that viral RNA interfaces with host components at two different stages of infection to induce necroptosis. This work provides new molecular details about events in the viral replication cycle that contribute to the induction of necroptosis following infection with an RNA virus.IMPORTANCE An appreciation of how cell death pathways are regulated following viral infection may reveal strategies to limit tissue destruction and prevent the onset of disease. Cell death following virus infection can occur by apoptosis or a regulated form of necrosis known as necroptosis. Apoptotic cells are typically disposed of without activating the immune system. In contrast, necroptotic cells alert the immune system, resulting in inflammation and tissue damage. While apoptosis following virus infection has been extensively investigated, how necroptosis is unleashed following virus infection is understood for only a small group of viruses. Here, using mammalian reovirus, we highlight the molecular mechanism by which infection with a dsRNA virus results in necroptosis.


[Hybrid transvaginal ventral hernia repair].


title: Passive Immunity for Coronavirus Disease 2019: A Commentary on Therapeutic Aspects Including Convalescent Plasma.

text: In the ongoing pandemic of coronavirus disease 2019 (COVID-19), the novel virus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is infecting a naïve population. The innate immunity of the infected patient is unable to mount an effective defense, resulting in a severe illness with substantial morbidity and mortality. As most treatment modalities including antivirals and anti-inflammatory agents are mostly ineffective, an immunological approach is needed. The mechanism of innate immunity to this viral illness is not fully understood. Passive immunity becomes an important avenue for the management of these patients. In this article, the immune responses of COVID-19 patients are reviewed. As SARS-CoV-2 has many characteristics in common with two other viruses, SARS-CoV that cause severe acute respiratory syndrome (SARS) and MERS-CoV (Middle East respiratory syndrome coronavirus) that causes Middle East respiratory syndrome (MERS), the experiences learned from the use of passive immunity in treatment can be applied to COVID-19. The immune response includes the appearance of immunoglobulin M followed by immunoglobulin G and neutralizing antibodies. Convalescent plasma obtained from patients recovered from the illness with high titers of neutralizing antibodies was successful in treating many COVID-19 patients. The factors that determine responses as compared with those seen in SARS and MERS are also reviewed. As there are no approved vaccines against all three viruses, it remains a challenge in the ongoing development for an effective vaccine for COVID-19.


COVID-19 Across Africa: Epidemiologic Heterogeneity and Necessity of Contextually Relevant Transmission Models and Intervention Strategies.


title: Safety and Efficacy of Simultaneous Biplane Mode of 3-Dimensional Transesophageal Echocardiography-Guided Antegrade Multiple-Inflation Balloon Aortic Valvuloplasty in Patients With Severe Aortic Stenosis.

text: BACKGROUND Balloon aortic valvuloplasty (BAV) is resurging as a bridge treatment in patients with severe aortic stenosis (AS) with a dissemination of transcatheter aortic valve implantation. However, the significantly high periprocedural mortality and complication rates still limit the indications of BAV. Further efforts are needed to improve the safety and efficacy of BAV.Methods and Results:We retrospectively investigated the safety and efficacy of simultaneous biplane mode of 3-dimensional transesophageal echocardiography (biplane-TEE) guided antegrade transseptal multiple-inflation BAV, with gradual upsizing of the balloon, by enrolling 20 consecutive AS patients who underwent BAV. The median age was 83 years, and there were 6 male patients (30.0%). The clinical frailty scale was 4, and the Society of Thoracic Surgeon score was 14.5%. The balloon was inflated at a median of 18 times, which improved the mean aortic valve pressure gradient from 43.0 to 15.2 mmHg (P<0.001). We safely performed BAV in all patients, without periprocedural death or symptomatic stroke, although asymptomatic stroke was detected in 8 patients (42.1%) on diffusion-weighted magnetic resonance imaging. Kaplan-Meier estimates showed that the survival rate was 84.0% and cardiovascular death-free survival was 88.9% at 1-year. CONCLUSIONS Biplane-TEE guided antegrade multiple-inflation BAV might have the potential to improve periprocedural survival without increasing complications, compared with conventional retrograde BAV in patients with severe AS.


title: A Murine Model of Vertical Sleeve Gastrectomy.

text: Bariatric surgery, such as vertical sleeve gastrectomy (VSG), is a surgery of the gastrointestinal tract that is performed for the purpose of weight loss. Bariatric surgery is currently the most effective long-term treatment for obesity. In addition to weight loss, bariatric surgery produces additional health benefits such as remission of type 2 diabetes, remission of hypertension, and decreased risk of developing certain types of cancer. The mechanisms beyond weight loss for these benefits remain incompletely defined. Therefore, animal models of bariatric surgery are being developed and validated to identify the mechanisms leading to these benefits, with the goal of improving understanding of gastrointestinal physiology and identifying new therapeutic targets. VSG has become the most commonly performed bariatric procedure in the clinic in the United States because it is highly effective at producing weight loss and metabolic improvement, and is simpler to perform than other bariatric procedures. Therefore, we have developed and validated a murine model of VSG. This murine VSG model recapitulates many of the effects of VSG seen in humans, including improved glucose and blood pressure regulation. The method is based on isolation of the stomach, ligation of gastric vessels, and removal of 70% of the stomach by transecting along the greater curvature of the stomach. We have successfully applied this surgical protocol to various genetically modified mouse lines to define the mechanistic contributors to the benefits of VSG. Furthermore, this murine VSG model has been combined with other surgical techniques, to achieve deeper mechanistic insight. Therefore, this is a simple and versatile model for studying gastrointestinal physiology and the health benefits of bariatric surgery.


title: Emerging Technologies in Flow Diverters and Stents for Cerebrovascular Diseases.

text: PURPOSE OF REVIEW Stents and flow diverters have revolutionized the treatment of cerebrovascular disease. Guglielmi coils, flexible microcatheters, and first-generation intracranial stents, such as Neuroform (Stryker Neurovascular) and Enterprise stents (Codman/DePuy-Synthes), have paved the way for the development of the Pipeline Embolization Device (PED) (ev3/Covidien/Medtronic) and other endovascular approaches. RECENT FINDINGS This review discusses the historical development of flow diverter technologies from the PED to similar devices, such as the Surpass stent (Stryker Neurovascular), the Flow-Redirection Endoluminal Device (FRED; MicroVention, Inc.), the SILK stent (Balt Extrusion), and the p64 Flow Modulation Device (Phenox). In addition, the potential use of drug-eluting stents and various bioresorbable scaffolds (e.g., poly-L-lactic acid, magnesium), new developments in stent material (e.g., thin-film nitinol), design (e.g., biocompatible polymers, embedded microcircuitry, flow models), and potential applications for flow diverters will be considered. Endovascular treatment of cerebrovascular disease is rapidly advancing via continued development of new technology.


title: Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting.

text: BACKGROUND AND PURPOSE Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. METHODS Prospective and consecutive data of patients <65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography. RESULTS Twenty-four patients were identified (91.6% strokes/8.4% transient ischemic attacks [TIAs]). Median age was 46 (41-59) years, 61% were female, and 75% were black. Median National Institutes of Health Stroke Scale score was 10.5 (3.0-16.0) and ASPECTS (Alberta Stroke Program Early CT Score) was 8 (7-8). There were no parenchymal hemorrhages, and 96% of patients were independent at 3 months. All webs caused <50% stenosis. In patients with bilateral webs (58%), median ipsilateral web length was larger than contralateral (3.1 [3.0-4.5] mm versus 2.6 [1.85-2.9] mm; P=0.01), respectively. Twenty-nine percent of patients had thrombus superimposed on the symptomatic carotid web. A recurrent stroke/TIA involving the territory of the previously symptomatic web occurred in 7 (32%; 6 strokes/1 TIA) patients: 3 <1 week, 2 1 year of follow-up. Two recurrences occurred on dual antiplatelet therapy, 3 on antiplatelet monotherapy, 1 within 24 hours of thrombolysis, and 1 off antithrombotics. Median follow-up was 12.2 (8.0-18.0) months. Sixteen (66%) patients were stented at a median 12.2 (7.0-18.7) days after stroke with no periprocedural complications. No recurrent strokes/TIAs occurred in stented individuals (median follow-up of 4 [2.4-12.0] months). CONCLUSIONS Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting.


title: Comparison of conventional RT-PCR, reverse-transcription loop-mediated isothermal amplification, and SYBR green I-based real-time RT-PCR in the rapid detection of bovine viral diarrhea virus nucleotide in contaminated commercial bovine sera batches.

text: Bovine viral diarrhea virus (BVDV) can contaminate biological products produced in bovine or porcine cells or manufactured using bovine sera. A rapid, specific, sensitive, and practical method of detecting BVDV in bio-products is needed. The purpose of this study was to compare three assays with respect to their ability to accurately detect BVDV in biological samples, namely reverse-transcription loop-mediated isothermal amplification (RT-LAMP), SYBR green I-based real-time RT-PCR, and conventional RT-PCR. All assays detected BVDV nucleotide and differentiated between BVDV-free and -contaminated bovine sera successfully. In addition, the results were specific to BVDV: the amplification of samples containing the closely related classical swine fever virus or other pathogenic bovine viruses yielded negative results. The lowest detection threshold, 10(1) copies, was displayed by the SYBR green I-based real-time RT-PCR and RT-LAMP assay. This assay was also the most effective in the detection of BVDV contamination in a set of commercially available bovine sera. The field conditions suggest that RT-LAMP is specific and sensitive to detecting BVDV in biological samples and may be used for quality control of biomaterials.


title: Development of next-generation respiratory virus vaccines through targeted modifications to viral immunomodulatory genes.

text: Vaccines represent one of the greatest contributions of the scientific community to global health. Yet, many pathogens remain either unchallenged or inadequately hindered by commercially available vaccines. Respiratory viruses pose distinct and difficult challenges due to their ability to rapidly spread, adapt, and modify the host immune response. Considerable research has been directed to understand the role of respiratory virus immunomodulatory proteins and how they influence the host immune response. We review here efforts to develop next-generation vaccines through targeting these key immunomodulatory genes in influenza virus, coronaviruses, respiratory syncytial virus, measles virus, and mumps virus.


title: Real-time PCR-based SARS-CoV-2 detection in Canadian Laboratories

text: With emergence of pandemic COVID-19, rapid and accurate diagnostic testing is essential. This study compared laboratory-developed tests (LDTs) used for the detection of SARS-CoV-2 in Canadian hospital and public health laboratories, and some commercially available real-time RT-PCR assays. Overall, analytical sensitivities were equivalent between LDTs and most commercially available methods.


title: Hand Hygiene and Tuberculosis Risk in Korea: An Ecological Association.

text: Hand hygiene is a basic but effective strategy against infectious disease. This study investigated an ecological association between hand hygiene and tuberculosis (TB) risk in Korea. Hand hygiene data were obtained from the 2015 Community Health Survey. Information on TB incidence and mortality in 2015 were obtained from the National Infectious Diseases Surveillance System and death monitoring database, respectively. In multiple linear regression analysis, frequent hand washing rates after using the restroom (B = -0.78, P = .037), after returning from the outdoors (B = -0.28, P = .049), and with soap or hand sanitizer (B = -0.54, P = .018) were negatively associated with TB incidence. TB mortality were associated with frequent hand washing rates after returning from the outdoors (B = -0.05, P = .035), and with soap or hand sanitizer (B = -0.10, P = .010), respectively. Hand washing was associated with lower TB incidence and mortality at the community level. These results could contribute to develop community-based health promotion strategies.