Perspectives on Coronavirus Disease 2019 Control Measures for Ophthalmology Clinics Based on a Singapore Center Experience.


title: Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT.

text: BACKGROUND Poor vessel wall apposition of flow diverter (FD) stents poses risks for stroke-related complications when treating intracranial aneurysms, necessitating long-term surveillance imaging. To facilitate quantitative evaluation of deployed devices, a novel algorithm is presented that generates intuitive two-dimensional representations of wall apposition from either high-resolution contrast-enhanced cone-beam CT (VasoCT) or intravascular optical coherence tomography (OCT) images. METHODS VasoCT and OCT images were obtained after FD implant (n=8 aneurysms) in an experimental sidewall aneurysm model in canines. Surface models of the vessel wall and FD device were extracted, and the distance between them was presented on a two-dimensional flattened map. Maps and cross-sections at potential locations of malapposition detected on VasoCT-based maps were compared. The performance of OCT-based apposition detection was evaluated on manually labeled cross-sections using logistic regression against a thresholded (≥0.25 mm) apposition measure. RESULTS VasoCT and OCT acquisitions yielded similar Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT) apposition maps. GRAFT maps from VasoCT highlighted 16 potential locations of malapposition, of which two were found to represent malapposed device struts. Logistic regression showed that OCT could detect malapposition with a sensitivity of 98% and a specificity of 81%. CONCLUSIONS GRAFT delivered quantitative and visually convenient representations of potential FD malapposition and occasional acute thrombus formation. A powerful combination for future neuroendovascular applications is foreseen with the superior resolution delivered by intravascular OCT.


title: Prophylactic and postexposure efficacy of a potent human monoclonal antibody against MERS coronavirus.

text: Middle East Respiratory Syndrome (MERS) is a highly lethal pulmonary infection caused by a previously unidentified coronavirus (CoV), likely transmitted to humans by infected camels. There is no licensed vaccine or antiviral for MERS, therefore new prophylactic and therapeutic strategies to combat human infections are needed. In this study, we describe, for the first time, to our knowledge, the isolation of a potent MERS-CoV-neutralizing antibody from memory B cells of an infected individual. The antibody, named LCA60, binds to a novel site on the spike protein and potently neutralizes infection of multiple MERS-CoV isolates by interfering with the binding to the cellular receptor CD26. Importantly, using mice transduced with adenovirus expressing human CD26 and infected with MERS-CoV, we show that LCA60 can effectively protect in both prophylactic and postexposure settings. This antibody can be used for prophylaxis, for postexposure prophylaxis of individuals at risk, or for the treatment of human cases of MERS-CoV infection. The fact that it took only 4 mo from the initial screening of B cells derived from a convalescent patient for the development of a stable chinese hamster ovary (CHO) cell line producing neutralizing antibodies at more than 5 g/L provides an example of a rapid pathway toward the generation of effective antiviral therapies against emerging viruses.


title: The Comparison of Four-Port, Two-Port Without Suspension Suture and Single Port Laparoscopic Cholecystectomy Results.

text: BACKGROUND Single-port surgery has recently become popular, however, many surgeons have to use additional ports during the surgery due to difficulties. OBJECTIVES We performed two-port MCAP (with an additional port using a multi-channel device through the umbilicus) without a suspension suture in a group of patients. We compared the results of this technique to the LC and SILC techniques. MATERIAL AND METHODS A total of 90 patients with gallbladder disease were included in the study. LC (n = 30) and SILC (n = 30) were performed in two groups. The other group underwent cholecystectomy (MCAP) by using an additional 5 mm port through the subxiphoid region with a multi-channel port through the transumblical. A transabdominal suspension suture was not used for the patients in this group. The surgery duration, estimated blood loss, length of hospitalization, visual analogue scale (VAS) score in the postoperative 1st and 7th day, need for analgesia in the postoperative period and complications, and the conversion rate were compared between the three methods. RESULTS A total of 62 females (68.9%) and 28 males (31.1%) participated in the study. MCAP duration was significantly shorter than LC and SILC (38.1 ± 16.6, 49.4 ± 15.8, 77.8 ± 26.7 min respectively) (p < 0.05). The conversion rate was similar in all three groups. Hernia developed in the port area in two patients after SILC (6.7%). No significant difference was found between the groups for the other data we compared. CONCLUSIONS MCAP seems to be an easier technique with a shorter operation time compared to the other two techniques. However, there is a need for other studies to evaluate the cosmetic results.


title: How I do it: laparoscopic paraesophageal hernia repair.

text: INTRODUCTION Paraesophageal hernias are usually complex anatomic abnormalities of the upper gastrointestinal tract capable of causing symptoms and complications including death. Furthermore, they affect patients who are usually older and have other comorbidities. Preferred treatment approach has evolved over time, with laparoscopic repair being the current preferred technique as it causes less hemodynamic changes and is better tolerated than open repairs. TECHNIQUE In this report, we describe our technique for laparoscopic paraesophageal hernia repair. The most salient technical aspects of this procedure include reduction of the stomach below the diaphragm, circumferential dissection and excision of the hernia sac, closure of the crural defect with our without the addition of mesh, and fundoplication to prevent reflux. CONCLUSION While this procedure has a low morbidity risk and short hospital stay, anatomic recurrence is frequent even when performed by experienced surgeons.


Breast Cancer With a Poor Prognosis Diagnosed After Screening Mammography With Negative Results.


COVID-19: the great unequaliser.


title: Reoperation for pelvic organ prolapse within 10 years of primary surgery for prolapse.

text: INTRODUCTION AND HYPOTHESIS A presumed high failure rate of conventional procedures for prolapse has been part of the rationale for new surgical approaches. The aim of the present retrospective cohort study was to estimate the reoperation rate for prolapse within 10 years of primary surgery for prolapse. METHODS We identified all patients who underwent primary surgery for prolapse at four large regional centers in Austria in 1997 and 1998. Hospital databases were searched to determine whether patients had been reoperated for prolapse through 2008. RESULTS A total of 456 patients underwent a primary operation for prolapse in 1997 and 1998. The most common primary operation was vaginal hysterectomy with colporrhaphy (89 %). We identified 13 reoperations for prolapse, for a 10-year reoperation rate of (at least) 2.9 %. The median interval between primary and secondary surgery was 5.5 years (range 1.5-10 years). CONCLUSION The reoperation rate for prolapse after primary vaginal hysterectomy and colporrhaphy appears to be modest in this series of patients.


Tissue is the Issue, Even During a Pandemic.


title: Role of Mitochondrial Membrane Spherules in Flock House Virus Replication.

text: UNLABELLED Viruses that generate double-stranded RNA (dsRNA) during replication must overcome host defense systems designed to detect this infection intermediate. All positive-sense RNA viruses studied to date modify host membranes to help facilitate the sequestration of dsRNA from host defenses and concentrate replication factors to enhance RNA production. Flock House virus (FHV) is an attractive model for the study of these processes since it is well characterized and infects Drosophila cells, which are known to have a highly effective RNA silencing system. During infection, FHV modifies the outer membrane of host mitochondria to form numerous membrane invaginations, called spherules, that are ∼50 nm in diameter and known to be the site of viral RNA replication. While previous studies have outlined basic structural features of these invaginations, very little is known about the mechanism underlying their formation. Here we describe the optimization of an experimental system for the analysis of FHV host membrane modifications using crude mitochondrial preparations from infected Drosophila cells. These preparations can be programmed to synthesize both single- and double-stranded FHV RNA. The system was used to demonstrate that dsRNA is protected from nuclease digestion by virus-induced membrane invaginations and that spherules play an important role in stimulating RNA replication. Finally, we show that spherules generated during FHV infection appear to be dynamic as evidenced by their ability to form or disperse based on the presence or absence of RNA synthesis. IMPORTANCE It is well established that positive-sense RNA viruses induce significant membrane rearrangements in infected cells. However, the molecular mechanisms underlying these rearrangements, particularly membrane invagination and spherule formation, remain essentially unknown. How the formation of spherules enhances viral RNA synthesis is also not understood, although it is assumed to be partly a result of evading host defense pathways. To help interrogate some of these issues, we optimized a cell-free replication system consisting of mitochondria isolated from Flock House virus-infected Drosophila cells for use in biochemical and structural studies. Our data suggest that spherules generated during Flock House virus replication are dynamic, protect double-stranded RNA, and enhance RNA replication in general. Cryo-electron microscopy suggests that the samples are amenable to detailed structural analyses of spherules engaged in RNA synthesis. This system thus provides a foundation for understanding the molecular mechanisms underlying spherule formation, maintenance, and function during positive-sense viral RNA replication.


Personal Risk and Societal Obligation Amidst COVID-19.


title: Measurement of electrical coupling between cardiac ablation catheters and tissue.

text: Managing cardiac arrhythmias with catheter ablation requires positioning electrodes in contact with myocardial tissue. Objective measures to assess contact and effective coupling of ablation energy are sought. An electrical coupling index (ECI) was devised using complex impedance at 20 kHz to perform in the presence of RF ablation and deliver information about electrical interactions between the tip electrode and its adjacent environment. ECI was derived and compared with clinical judgment, pacing threshold, electrogram amplitude, and ablation lesion depth and transmurality in a porcine model. ECI was also compared with force and displacement using ex vivo bovine myocardial muscle. Mean noncontact ECI was 97.2 ± 14.3 and increased to 145.2 ± 33.6 (p <; 0.001) in clinician assessed (CLIN) moderate contact. ECI significantly improved CLIN's prediction of the variance in pacing threshold from 48.7% to 56.8% ( ). ECI was indicative of contact force under conditions of smooth myocardium. Transmural lesions were associated with higher pre-RF (109 ± 17 versus 149 ± 25, ) and during-RF (82 ± 9 versus 101 ± 17, ) ECI levels. ECI is a tip specific, robust, correlate with contact and ablation efficacy, and can potentially add to clinical interpretation of electrical coupling during electrophysiology procedures.


title: Cardiac Rehabilitation for Women: A Systematic Review of Barriers and Solutions.

text: Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.


title: A clinical review of single-incision laparoscopic surgery.

text: Laparoscopic surgery is one of the most significant surgical advances of the twentieth century. Recently, the focus has been on the development of minimally invasive techniques in the form of single-incision laparoscopic surgery. The single-incision technique provides a less invasive alternative to conventional laparoscopic surgery, requiring only one incision disguised within the umbilical folds in contrast to the three to five incisions in conventional laparoscopic surgery. The availability of a number of specialised ports has aided the development of single-incision laparoscopic surgery, and led to its widespread use. The successful use of single-incision laparoscopic surgery has been reported for a number of surgical procedures, and offers several potential benefits versus conventional laparoscopic surgery, including reduced pain, reduced time to recovery and improved cosmesis. This review of international literature assesses the current status, as well as the experience, of single-incision laparoscopic surgery within general, colorectal, bariatric, metabolic, gynaecological and urological surgery. The challenges faced with single-incision laparoscopic surgery are discussed, as well as the clinical studies that are required in order to establish single-incision surgery as a significant improvement to conventional laparoscopic surgery in terms of reduced pain and improved cosmesis.


title: Intraperitoneal onlay mesh: an experimental study of adhesion formation in a sheep model.

text: PURPOSE Current hernia literature shows that the use of mesh in ventral hernia repair reduces the risk of recurrence significantly. In laparoscopic repair, the mesh is placed intraperitoneally. Accordingly, the close contact between mesh and viscera involves a risk of adhesion formation. In this experimental study, we examined the degree of de novo adhesion formation over time to currently available meshes. METHODS Sixteen sheep each received laparoscopic placement of four (10 x 10 cm) meshes on intact peritoneum. Two different mesh materials (coated vs. non-coated) and two different fixation devices (absorbable/non-absorbable) were investigated. (Parietex Composite, DynaMesh IPOM, ProTack and AbsorbaTack). After 3, 6, 12 and 18 months, four animals, respectively, underwent a new laparoscopy to determine the extent of adhesions to the mesh. RESULTS Parietex Composite significantly reduced the formation of intraabdominal adhesions compared to DynaMesh IPOM. The mean extent of adhesions increases over time without reaching a steady state within the first 12 months after laparoscopic placement. CONCLUSIONS This is the first long-term (18 months) experimental study on adhesion formation in sheep after laparoscopic placement of mesh and may serve as a template for future studies on meshes before marketing.


title: Access to Telemedicine-Are We Doing All That We Can during the COVID-19 Pandemic?

text: The COVID-19 pandemic has resulted in physicians having to switch from in office visits to telemedicine. Unfortunately, physicians and patients did not have adequate time to anticipate barriers to its implementation. Over the last month, one of the major problems has been patient access to telemedicine. Many patients do not own a smartphone or have broadband access. This "digital divide" is not fair to our patients in need-especially those with a cancer diagnosis. Patients deserve access to care. We need to implore insurance companies to provide tablets with wireless capabilities to patients in need.


title: Microsurgical anatomy of the spinal cord in human fetuses.

text: PURPOSE To determine the microsurgical features of the spinal cord and ventral and dorsal rootlets in fetal period. METHODS Twelve formalin-fixed fetuses (six females and six males) with a mean gestational age of 27.0 ± 2.04 weeks (range between 25 and 32 weeks) were dissected to evaluate morphological properties of the spinal cord and rootlets. RESULTS Length and width of each spinal cord segment, number of dorsal and ventral rootlets, length of dorsal root entry and ventral root exit zones of each spinal nerve, spinal cord termination level, and the whole spinal cord length were determined in all fetuses. Contrary to previous reports, the number of ventral rootlets was always more than that of dorsal rootlets in all segments. No statistically significant gender difference was found for all parameters. Rootlet number and segment width in cervical region were larger than those of thoracic, while the lengths of dorsal root entry and ventral root exit zones in thoracic region were longer than those of cervical. In lumbar region, dorsal and ventral rootlet numbers were increasing again, while lengths of dorsal root entry and ventral root exit zones were decreasing. Number of dorsal and ventral rootlets of C5 and C6 segments was statistically higher than other cervical segments. The mean spinal cord length was found as 105.55 ± 11.30 mm and there was a positive significant relationship with gestational age. Conus medullaris level was detected between L1 and L3 segments. CONCLUSION Detailed microsurgical data about the fetal spinal cord and the dorsal and ventral rootlets presented in this study provide significant information which may be essential during surgical interventions in early postnatal period and childhood targeting the spinal cord and spinal nerve roots.


title: A spinal cord window chamber model for in vivo longitudinal multimodal optical and acoustic imaging in a murine model.

text: In vivo and direct imaging of the murine spinal cord and its vasculature using multimodal (optical and acoustic) imaging techniques could significantly advance preclinical studies of the spinal cord. Such intrinsically high resolution and complementary imaging technologies could provide a powerful means of quantitatively monitoring changes in anatomy, structure, physiology and function of the living cord over time after traumatic injury, onset of disease, or therapeutic intervention. However, longitudinal in vivo imaging of the intact spinal cord in rodent models has been challenging, requiring repeated surgeries to expose the cord for imaging or sacrifice of animals at various time points for ex vivo tissue analysis. To address these limitations, we have developed an implantable spinal cord window chamber (SCWC) device and procedures in mice for repeated multimodal intravital microscopic imaging of the cord and its vasculature in situ. We present methodology for using our SCWC to achieve spatially co-registered optical-acoustic imaging performed serially for up to four weeks, without damaging the cord or induction of locomotor deficits in implanted animals. To demonstrate the feasibility, we used the SCWC model to study the response of the normal spinal cord vasculature to ionizing radiation over time using white light and fluorescence microscopy combined with optical coherence tomography (OCT) in vivo. In vivo power Doppler ultrasound and photoacoustics were used to directly visualize the cord and vascular structures and to measure hemoglobin oxygen saturation through the complete spinal cord, respectively. The model was also used for intravital imaging of spinal micrometastases resulting from primary brain tumor using fluorescence and bioluminescence imaging. Our SCWC model overcomes previous in vivo imaging challenges, and our data provide evidence of the broader utility of hybridized optical-acoustic imaging methods for obtaining multiparametric and rich imaging data sets, including over extended periods, for preclinical in vivo spinal cord research.


title: Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes.

text: PURPOSE To describe the surgical technique, to analyze outcomes and to provide an overview of the current status of laparoendoscopic single site (LESS) adrenalectomy. METHODS A comprehensive PubMed search was performed for all relevant urological literature regarding LESS and adrenal surgery. In addition, experience gained at the authors' own institutions was considered. Clinical descriptive and comparative reports on LESS adrenal surgery procedures were analysed. RESULTS LESS adrenal surgery has been effectively performed for a number of indications. A wide variety of approaches (transperitoneal versus retroperitoneal, multichannel trocar versus multiple ports, trans- or extraumbilical) have been described. LESS adrenalectomy seems to be safe, taking more time than the standard laparoscopic counterpart but appears to offer the patient less postoperative discomfort. Technical difficulties of the procedure include the requirement of more time for adjustment of articulating instruments, longer 'one-handed' manipulation time, and a high peroperative tissue re-grasping rate. CONCLUSIONS The feasibility and safety of LESS adrenalectomy has been demonstrated. Only long-term follow-up outcomes will prove its benefits over conventional laparoscopy and define the role and the oncological safety of LESS adrenal surgery.


title: Long-term survival in laparoscopic vs open resection for colorectal liver metastases: inverse probability of treatment weighting using propensity scores.

text: BACKGROUND This study compares long-term outcomes between intention-to-treat laparoscopic and open approaches to colorectal liver metastases (CLM), using inverse probability of treatment weighting (IPTW) based on propensity scores to control for selection bias. METHOD Patients undergoing liver resection for CLM by 5 surgeons at 3 institutions from 2000 to early 2014 were analysed. IPTW based on propensity scores were generated and used to assess the marginal treatment effect of the laparoscopic approach via a weighted Cox proportional hazards model. RESULTS A total of 298 operations were performed in 256 patients. 7 patients with planned two-stage resections were excluded leaving 284 operations in 249 patients for analysis. After IPTW, the population was well balanced. With a median follow up of 36 months, 5-year overall survival (OS) and recurrence-free survival (RFS) for the cohort were 59% and 38%. 146 laparoscopic procedures were performed in 140 patients, with weighted 5-year OS and RFS of 54% and 36% respectively. In the open group, 138 procedures were performed in 122 patients, with a weighted 5-year OS and RFS of 63% and 38% respectively. There was no significant difference between the two groups in terms of OS or RFS. CONCLUSION In the Brisbane experience, after accounting for bias in treatment assignment, long term survival after LLR for CLM is equivalent to outcomes in open surgery.


Advances in Surgical Telemedicine During the Coronavirus Pandemic.


Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).


title: Fatal Outcomes of COVID-19 in Patients with Severe Acute Kidney Injury.

text: The outcome of coronavirus disease 2019 (COVID-19) is associated with organ damage; however, the information about the relationship between acute kidney injury (AKI) and COVID-19 is still rare. We evaluated the clinical features and prognosis of COVID-19 patients with AKI according to the AKI severity. Medical data of hospitalized COVID-19 patients in two university-based hospitals during an outbreak in Daegu, South Korea, were retrospectively analyzed. AKI and its severity were defined according to the Acute Kidney Injury Network. Of the 164 hospitalized patients with COVID-19, 30 patients (18.3%) had AKI; 14, 4, and 12 patients had stage 1, 2, and 3, respectively. The median age was significantly higher in AKI patients than in non-AKI patients (75.5 vs. 67.0 years, p = 0.005). There were 17 deaths (56.7%) among AKI patients; 4 (28.6%), 1 (25.0%), and 12 (100.0%), respectively. In-hospital mortality was higher in AKI patients than in non-AKI patients (56.7% vs. 20.8%, p < 0.001). After adjusting for potential confounding factors, stage 3 AKI was associated with higher mortality than either non-AKI or stage 1 AKI (hazard ratio (HR) = 3.62 (95% confidence interval (CI) = 1.75-7.48), p = 0.001; HR = 15.65 (95% CI = 2.43-100.64), p = 0.004). Among the AKI patients, acute respiratory distress syndrome and low serum albumin on admission were considered independent risk factors for stage 3 AKI (both p < 0.05). Five patients with stage 3 AKI underwent dialysis and eventually died. In conclusion, COVID-19 patients with severe AKI had fatal outcomes.


Pancreaticoduodenectomy for pancreatic cancer after laparoscopic Roux-en-Y gastric bypass.


title: Mass spectrometric determination of disulfide bonds in the biologically active recombinant HBx protein of hepatitis B virus.

text: Many proteins rely on disulfide bonds formed between pairs of cysteines for the stability of their folded state and to keep regulatory control over their functions. The hepatitis B virus-encoded HBx oncoprotein is known to perform an overwhelming array of functions in the cell and has been implicated in the development of hepatocellular carcinoma. However, its structure has not been elucidated. HBx carries nine conserved cysteine residues that have proven to be crucial for its various functions. However, the status of disulfide bonds between the cysteine residues reported in previous studies remains discrepant because of the use of refolded recombinant HBx that may contain non-native disulfides. Now we have determined the disulfide linkages in soluble and biologically active recombinant maltose binding protein-HBx fusion protein using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. We report four disulfide linkages in HBx protein, viz., between Cys(7) and Cys(69), Cys(61) and Cys(115), Cys(78) and Cys(137), and Cys(17) and Cys(143), based on the differential mobility of corresponding disulfide-linked peptide ions under reducing and nonreducing conditions. Cys(148) was observed to be free. Site-directed mutagenesis of Cys(143) and Cys(148) with serine and functional analyses of these mutants affirmed the importance of these residues in the ability of HBx to potentiate Cdk2/cyclin E kinase activity and transcriptionally activate promoter reporter gene activity. Thus, this study identifies native disulfide linkages in the structure of a biologically active viral oncoprotein.


How sewage could reveal true scale of coronavirus outbreak.


title: Effective Strategies for Managing COVID-19 Emergency Restrictions for Adults with Severe ASD in a Daycare Center in Italy.

text: The COVID-19 pandemic has posed a serious challenge for the life and mental health of people with autism spectrum disorder (ASD). COVID-19 sanitary restrictions led to significant changes in the lives of people with ASD, including their routines; similarly, these modifications affected the daily activities of the daycare centers which they attended. The present retrospective study evaluated the impact of COVID-19 restrictions on challenging behaviors in a cohort of people with severe ASD attending a daycare center in Italy at the beginning of the pandemic. During the first two weeks of the pandemic, we did not observe variations in challenging behaviors. This suggests that adaptations used to support these individuals with ASD in adapting to the COVID-19 emergency restrictions were effective for managing their behavior.


title: Central venous access port placement by translumbar approach using angio-CT unit in patients with superior vena cava syndrome.

text: PURPOSE To evaluate the clinical results of central venous access port (CV port) placement by translumbar inferior vena cava cannulation using angio-CT unit for cancer patients with superior vena cava syndrome. MATERIALS AND METHODS A CV port was placed by translumbar inferior vena cava cannulation using an angio-CT unit, in 14 consecutive patients. All patients had occlusion or advanced stenosis of the superior vena cava due to cancer progression. RESULTS The technical success rate of the percutaneous translumbar CV port placement was 100%. The only complication related to port placement was bleeding in the right iliopsoas muscle seen on CT in one patient, but it stopped with conservative treatment. The mean initial device service interval was 125 days (range 6-448 days). Complications in the chronic phase occurred in two patients, one with catheter-related infection and the other with catheter breakage, for a rate of 0.44/1000 catheter days. In the patient with the broken catheter, the port chamber placement site was cut and replaced with a new catheter by guidewire exchange. CONCLUSIONS CV port placement with translumbar inferior vena cava cannulation using an angio-CT unit for cancer patients with superior vena cava syndrome was safe and effective.


title: Response to experimentally induced infection with bovine respiratory syncytial virus following intranasal vaccination of seropositive and seronegative calves.

text: OBJECTIVE To determine whether a combination modified-live bovine respiratory syncytial virus (BRSV) vaccine can stimulate protective immunity in young BRSV-seropositive calves following intranasal (IN) administration. DESIGN Controlled challenge study. ANIMALS 66 Holstein bull calves, 3 to 8 days old. PROCEDURES In experiment 1, BRSV-seropositive and -seronegative calves were vaccinated IN with a commercially available combination modified-live virus vaccine formulated for SC administration; calves underwent BRSV challenge 4.5 months later. In experiment 2, BRSV-seronegative calves were vaccinated IN or SC (to examine the effect of route of administration) with the same combination vaccine that instead had a 1/100 dose of BRSV (to examine the effect of dose); calves underwent BRSV challenge 21 days later. RESULTS In experiment 1, BRSV challenge resulted in severe respiratory tract disease with low arterial partial pressures of oxygen and lung lesions in most calves from all groups. Maximum change in rectal temperature was significantly greater in seropositive IN vaccinated calves, compared with seronegative IN vaccinated and seropositive control calves. Number of days of BRSV shedding was significantly lower in seronegative IN vaccinated calves than in seropositive IN vaccinated and seropositive control calves. In experiment 2, maximum change in rectal temperature was significantly greater in seronegative control calves, compared with seronegative IN and SC vaccinated calves. Shedding of BRSV was significantly reduced in seronegative IN and SC vaccinated calves, compared with control calves; also, lung lesions were reduced in seronegative IN and SC vaccinated calves. CONCLUSIONS AND CLINICAL RELEVANCE Maternal antibodies may inhibit priming of protective responses by IN delivered BRSV vaccines.


title: Bioinformatics tools for analysing viral genomic data.

text: The field of viral genomics and bioinformatics is experiencing a strong resurgence due to high-throughput sequencing (HTS) technology, which enables the rapid and cost-effective sequencing and subsequent assembly of large numbers of viral genomes. In addition, the unprecedented power of HTS technologies has enabled the analysis of intra-host viral diversity and quasispecies dynamics in relation to important biological questions on viral transmission, vaccine resistance and host jumping. HTS also enables the rapid identification of both known and potentially new viruses from field and clinical samples, thus adding new tools to the fields of viral discovery and metagenomics. Bioinformatics has been central to the rise of HTS applications because new algorithms and software tools are continually needed to process and analyse the large, complex datasets generated in this rapidly evolving area. In this paper, the authors give a brief overview of the main bioinformatics tools available for viral genomic research, with a particular emphasis on HTS technologies and their main applications. They summarise the major steps in various HTS analyses, starting with quality control of raw reads and encompassing activities ranging from consensus and de novo genome assembly to variant calling and metagenomics, as well as RNA sequencing.


title: Controlling epidemic viral infection.

text: PURPOSE OF THE REVIEW Due to their different virulence and infectivity, both severe acute respiratory syndrome (SARS) and H1N1 09 revealed different strengths and weaknesses in our ability to contain new viral threats over the past decade. This review focuses on recent literature around attempts to contain the impact of these two viral epidemics that have refined our approach for the future. RECENT FINDINGS Attempts to contain emerging epidemics at the site of origin have so far failed, in part due to resourcing of surveillance. H1N1 09 revealed major problems with rigid pandemic planning and the need for much greater flexibility. Popular attempts to prevent international spread of pandemics have minimal efficacy. Availability of rapid diagnostic tests is critical to optimally managing epidemics and was a major problem with H1N1 09. Healthcare institutions have emerged as a major source of infection. SUMMARY The experience with H1N1 09 and SARS has been very useful in informing us of the strengths and weaknesses of our current approach to emerging epidemics. Key messages are a need for improved surveillance, more flexible planning, improved diagnostic testing and retaining a focus on basic hygiene measures.


title: Under the microscope: From pathogens to probiotics and back.

text: The review centers on the human gastrointestinal tract; focusing first on the bacterial stress responses needed to overcome the physiochemical defenses of the host, specifically how these stress survival strategies can be used as targets for alternative infection control strategies. The concluding section focuses on recent developments in molecular diagnostics; centring on the shifting paradigm from culture to molecular based diagnostics.


title: DNA prime/protein boost vaccination elicits robust humoral response in rhesus macaques using oligomeric simian immunodeficiency virus envelope and Advax delta inulin adjuvant.

text: The partial success of the RV144 trial underscores the importance of envelope-specific antibody responses for an effective HIV-1 vaccine. Oligomeric HIV-1 envelope proteins delivered with a potent adjuvant are expected to elicit strong antibody responses with broad neutralization specificity. To test this hypothesis, two SIV envelope proteins were formulated with delta inulin-based adjuvant (Advax) and used to immunize nonhuman primates. Oligomeric gp140-gp145 from SIVmac251 and SIVsmE660 was purified to homogeneity. Oligomers showed high-affinity interaction with CD4 and were highly immunogenic in rabbits, inducing Tier 2 SIV-neutralizing antibodies. The immunogenicity of an oligomeric Env DNA prime and protein boost together with Advax was evaluated in Chinese rhesus macaques. DNA administration elicited antibodies to both envelopes, and titres were markedly enhanced following homologous protein boosts via intranasal and intramuscular routes. Strong antibody responses were detected against the V1 and V2 domains of gp120. During peak immune responses, a low to moderate level of neutralizing activity was detected against Tier 1A/1B SIV isolates, with a moderate level noted against a Tier 2 isolate. Increased serum antibody affinity to SIVmac251 gp140 and generation of Env-specific memory B cells were observed in the immunized macaques. Animals were subjected to low-dose intravaginal challenge with SIVmac251 one week after the last protein boost. One out of three immunized animals was protected from infection. Although performed with a small number of macaques, this study demonstrates the utility of oligomeric envelopes formulated with Advax in eliciting broad antibody responses with the potential to provide protection against SIV transmission.


title: Structural and Functional Features of the Reovirus σ1 Tail.

text: Mammalian orthoreovirus attachment to target cells is mediated by the outer capsid protein σ1, which projects from the virion surface. The σ1 protein is a homotrimer consisting of a filamentous tail, which is partly inserted into the virion; a body domain constructed from β-spiral repeats; and a globular head with receptor-binding properties. The σ1 tail is predicted to form an α-helical coiled coil. Although σ1 undergoes a conformational change during cell entry, the nature of this change and its contributions to viral replication are unknown. Electron micrographs of σ1 molecules released from virions identified three regions of flexibility, including one at the midpoint of the molecule, that may be involved in its structural rearrangement. To enable a detailed understanding of essential σ1 tail organization and properties, we determined high-resolution structures of the reovirus type 1 Lang (T1L) and type 3 Dearing (T3D) σ1 tail domains. Both molecules feature extended α-helical coiled coils, with T1L σ1 harboring central chloride ions. Each molecule displays a discontinuity (stutter) within the coiled coil and an unexpectedly seamless transition to the body domain. The transition region features conserved interdomain interactions and appears rigid rather than highly flexible. Functional analyses of reoviruses containing engineered σ1 mutations suggest that conserved residues predicted to stabilize the coiled-coil-to-body junction are essential for σ1 folding and encapsidation, whereas central chloride ion coordination and the stutter are dispensable for efficient replication. Together, these findings enable modeling of full-length reovirus σ1 and provide insight into the stabilization of a multidomain virus attachment protein.IMPORTANCE While it is established that different conformational states of attachment proteins of enveloped viruses mediate receptor binding and membrane fusion, less is understood about how such proteins mediate attachment and entry of nonenveloped viruses. The filamentous reovirus attachment protein σ1 binds cellular receptors; contains regions of predicted flexibility, including one at the fiber midpoint; and undergoes a conformational change during cell entry. Neither the nature of the structural change nor its contribution to viral infection is understood. We determined crystal structures of large σ1 fragments for two different reovirus serotypes. We observed an unexpectedly tight transition between two domains spanning the fiber midpoint, which allows for little flexibility. Studies of reoviruses with engineered changes near the σ1 midpoint suggest that the stabilization of this region is critical for function. Together with a previously determined structure, we now have a complete model of the full-length, elongated reovirus σ1 attachment protein.


title: Periodontal effects of 0.25% sodium hypochlorite twice-weekly oral rinse. A pilot study.

text: BACKGROUND AND OBJECTIVE The study aimed to evaluate the effect of 0.25% sodium hypochlorite twice-weekly oral rinse on plaque and gingivitis in patients with minimally treated periodontitis. MATERIAL AND METHODS The study included 30 patients with periodontitis, it lasted 3 mo, and it was performed as a randomized, controlled, single-blinded, clinical trial in parallel groups. Fifteen patients rinsed for 30 s with 15 mL of a fresh solution of 0.25% sodium hypochlorite (test) and 15 patients rinsed with 15 mL of water (control). Clorox(®) regular bleach was the source of the sodium hypochlorite. At baseline and at 2 wk, the study patients received professional subgingival irrigation for 5 min with either 0.25% sodium hypochlorite or water, but no subgingival or supragingival scaling. The presence or absence of supragingival plaque on facial and lingual surfaces was determined by visual inspection; each tooth was dried with air and mouth mirror rotation was used to provide light reflection to identify plaque on smooth surfaces and at the tooth line angles. Gingival bleeding within 30 s after probing to full pocket depth was assessed in six sites of each tooth. Adverse events were evaluated by questionnaire and visual examination. RESULTS All 30 patients in the study completed the baseline and the 2 wk parts of the study and a subset of 12 participants completed the 3 mo part of the study. The sodium hypochlorite rinse group and the water rinse group, respectively, showed increases from baseline to 3 mo of 94% and 29% (3.2-fold difference) in plaque-free facial surfaces, of 195% and 30% (6.5-fold difference) in plaque-free lingual surfaces, and of 421% and 29% (14.5-fold difference) in number of teeth with no bleeding on probing. The differences in clinical improvement between the sodium hypochlorite rinse group and the water rinse group were statistically significant. No adverse events were identified in any of the study patients, except for minor complaints about the taste of bleach. CONCLUSION A twice-weekly oral rinse with 0.25% sodium hypochlorite produced marked decreases in dental plaque level and bleeding on probing and may constitute a promising new approach to the management of periodontal disease. Long-term controlled studies on the effectiveness of sodium hypochlorite oral rinse are needed and encouraged.


Recognising and addressing the impact of COVID-19 on obsessive-compulsive disorder.


title: Endovascular treatment improves cognition after stroke: A secondary analysis of REVASCAT trial.

text: OBJECTIVE To investigate the effect of endovascular treatment on cognitive function as a prespecified secondary analysis of the REVASCAT (Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours) trial. METHODS REVASCAT randomized 206 patients with anterior circulation proximal arterial occlusion stroke to Solitaire thrombectomy or best medical treatment alone. Patients with established dementia were excluded from enrollment. Cognitive function was assessed in person with Trail Making Test (TMT) Parts A and B at 3 months and 1 year after randomization by an investigator masked to treatment allocation. Test completion within 5 minutes, time of completion (seconds), and number of errors were recorded. RESULTS From November 2012 to December 2014, 206 patients were enrolled in REVASCAT. TMT was assessed in 82 of 84 patients undergoing thrombectomy and 86 of 87 control patients alive at 3 months and in 71 of 79 patients undergoing thrombectomy and 72 of 78 control patients alive at 1 year. Rates of timely TMT-A completion were similar in both treatment arms, although patients undergoing thrombectomy required less time for TMT-A completion and had higher rates of error-free TMT-A performance. Thrombectomy was also associated with a higher probability of timely TMT-B completion (adjusted odds ratio 3.17, 95% confidence interval 1.51-6.66 at 3 months; and adjusted ratio 3.66, 95% confidence interval 1.60-8.35 at 1 year) and shorter time for TMT-B completion. Differences in TMT completion times between treatment arms were significant in patients with good functional outcome but not in those who were functionally dependent (modified Rankin Scale score >2). Poorer cognitive outcomes were significantly associated with larger infarct volume, higher modified Rankin Scale scores, and worse quality of life. CONCLUSIONS Thrombectomy improves TMT performance after stroke, especially among patients who reach good functional recovery. CLINICALTRIALSGOV IDENTIFIER NCT01692379. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with stroke from acute anterior circulation proximal arterial occlusion, thrombectomy improves performance on the TMT at 3 months.


title: Intraperitoneal bilirubin administration decreases infarct area in a rat coronary ischemia/reperfusion model.

text: Bilirubin was previously considered a toxin byproduct of heme catabolism. However, a mounting body of evidence suggests that at physiological doses, bilirubin is a powerful antioxidant and anti-atherosclerotic agent. Recent clinical studies have shown that human beings with genetically-induced hyperbilirubinemia (Gilbert Syndrome) are protected against coronary heart disease. The purpose of this study was to investigate whether administration of exogenous bilirubin to normal rats would convey similar protective effects in an experimental model of coronary ischemia. We hypothesized that intraperitoneal bilirubin administration 1 h before injury would decrease infarct area and preserve left ventricular (LV) systolic function when compared to non-treated rats. Coronary ischemia was induced by temporary (30 min) ligation of the left anterior descending coronary artery in control or bilirubin treated rats, followed by a 1-h period of reperfusion. LV function was estimated by measurements of fractional shortening (FS) and fractional area shortening using echocardiography. LV function decreased in both experimental groups after ischemia and reperfusion, although in bilirubin-treated rats FS was less depressed during the period of ischemia (18.8 vs. 25.8%, p = 0.034). Infarct size was significantly reduced in the bilirubin treated group compared to the non-treated group (13.34 vs. 25.5%, p = 0.0067). Based on the results of this study, bilirubin supplementation appears to provide significant decrease in infarct size although protective effects on LV function were noted only during the period of ischemia. This result also suggests that lipid soluble antioxidant bilirubin prevents the oxidation of cardiolipin and decreases the infarct size in the heart during ischemia.


Covid-19: Nightingale hospitals set to shut down after seeing few patients.


title: Minimally invasive thyroid nodulectomy reduces post-operative hypothyroidism when compared with thyroid lobectomy.

text: BACKGROUND It has been a long-standing surgical tenet that the minimum surgical procedure for a single thyroid nodule is lobectomy. Such an approach, however, has been associated with a significant incidence of post-operative hypothyroidism with patients becoming medication dependent for life. Thermal sealing devices have enabled local nodule excision to be undertaken safely with preservation of more residual thyroid mass. The aim of this study was to determine if this approach was associated with a reduction in post-operative hypothyroidism. METHODS This is a retrospective cohort study comprising 351 patients treated between January 2010 and December 2012. Patients were assessed at 6-8-week review. Subclinical hypothyroidism was defined as a thyroid-stimulating hormone (TSH) >4.5 mIU/L, with clinical hypothyroidism defined as both an elevated TSH and presence of clinical symptoms requiring thyroxine replacement. RESULTS One hundred and ninety patients underwent open thyroid lobectomy, 86 a minimally invasive thyroid lobectomy and 75 a minimally invasive nodulectomy. There was no difference in post-operative hypothyroidism after lobectomy whether by the open (22.1%) or minimally invasive (22.1%) technique. However, after minimally invasive nodulectomy, post-operative hypothyroidism was less than one quarter (5.3%) of that following lobectomy overall (22.1%, P < 0.01). There were no differences in post-operative complications between any of the groups. CONCLUSION Minimally invasive local nodule excision can be performed safely, with the potential for significantly reducing the rate of post-operative hypothyroidism. As such, the procedure should be considered for appropriately selected patients.


title: Searching for Models for Psychological Science: A Possible Contribution of Simulation.

text: The problem of the theoretical precariousness of psychology requires defining, at an epistemological level, its concepts and languages and the use of models for finding core concepts and building more or less 'hard' theories. After reviewing some main aims and models of psychology, and comparing them with those of other sciences, the commentary deals with the possibility of simulating life as a tool for building evolutionary psychological models. In particular, evolutionary and developmental robotics and the evo-devo models can simulate the simultaneous adaptation effects of the phylogenetic and ontogenetic development of the embodied mind in response to the characteristics of the environment. The simulation using Artificial Intelligence and robotics could contribute significantly to the definition, experimentation, and validation of the models that make up the theories of psychology in its different domains, enhancing the interdisciplinarity with other sciences that study the same objects. Further studies, both epistemological and empirical, are suggested to confirm whether this evo-devo approach can be integrated with "evolutionary psychology" and contribute to a unifying meta-theory of psychological science.


title: Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation.

text: PURPOSE Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course. METHODS We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010. RESULTS Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis. CONCLUSIONS Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.


title: Effect of one-lung ventilation on end-tidal carbon dioxide during cardiopulmonary resuscitation in a pig model of cardiac arrest.

text: Unrecognized endobronchial intubation frequently occurs after emergency intubation. However, no study has evaluated the effect of one-lung ventilation on end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR). We compared the hemodynamic parameters, blood gases, and ETCO2 during one-lung ventilation with those during conventional two-lung ventilation in a pig model of CPR, to determine the effect of the former on ETCO2. A randomized crossover study was conducted in 12 pigs intubated with double-lumen endobronchial tube to achieve lung separation. During CPR, the animals underwent three 5-min ventilation trials based on a randomized crossover design: left-lung, right-lung, or two-lung ventilation. Arterial blood gases were measured at the end of each ventilation trial. Ventilation was provided using the same tidal volume throughout the ventilation trials. Comparison using generalized linear mixed model revealed no significant group effects with respect to aortic pressure, coronary perfusion pressure, and carotid blood flow; however, significant group effect in terms of ETCO2 was found (P < 0.001). In the post hoc analyses, ETCO2 was lower during the right-lung ventilation than during the two-lung (P = 0.006) or left-lung ventilation (P < 0.001). However, no difference in ETCO2 was detected between the left-lung and two-lung ventilations. The partial pressure of arterial carbon dioxide (PaCO2), partial pressure of arterial oxygen (PaO2), and oxygen saturation (SaO2) differed among the three types of ventilation (P = 0.003, P = 0.001, and P = 0.001, respectively). The post hoc analyses revealed a higher PaCO2, lower PaO2, and lower SaO2 during right-lung ventilation than during two-lung or left-lung ventilation. However, the levels of these blood gases did not differ between the left-lung and two-lung ventilations. In a pig model of CPR, ETCO2 was significantly lower during right-lung ventilation than during two-lung ventilation. However, interestingly, ETCO2 during left-lung ventilation was comparable to that during two-lung ventilation.


Erratum to: Mechanical endovascular thrombectomy for acute ischemic stroke: a retrospective multicenter study in Belgium.


A Rare Case of Scedosporium Otitis in an Immunocompetent Child with Tympanostomy Tubes.


Heat shock protein 70 (hsp70) as an emerging drug target.


title: Dissection of the inferior mesenteric vein versus of the inferior mesenteric artery for the genitourinary function after laparoscopic approach of rectal cancer surgery: a randomized controlled trial.

text: BACKGROUND Total Mesorectal Excision (TME) is the standard surgical technique for the treatment of rectal cancer. However, rates of sexual dysfunction ofup to 50% have been described after TME, and rates of urinary dysfunction of up to 30%. Although other factors are involved, the main cause of postoperative genitourinary dysfunction is intraoperative injury to the pelvic autonomic nerves. The risk is particularly high in the inferior mesenteric artery (IMA). The aim of this study is to compare pre- and post-TME sexual dysfunction, depending on the surgical approach usedin the inferior mesenteric vessels: either directly on the IMA, or from the inferior mesenteric vein (IMV) to the IMA. METHODS Prospective, randomized,controlled study of patients with rectal adenocarcinoma with neoadjuvant chemoradiotherapy, who will be randomly assigned to one of two groups depending on the surgical approach to the inferior mesenteric vessels. The main variable is pre- and postoperative sexual dysfunction; secondary variables are visualization and preservation of the pelvic autonomic nerves, pre- and postoperative urinary dysfunction, and pre- and postoperative quality of life. The sample will comprise 90 patients, 45 per group. DISCUSSION The aim is to demonstrate that the dissection route from the IMV towards the IMA favors the preservation of the pelvic autonomic nerves and thus reducesrates of sexual dysfunction post-surgery. TRIAL REGISTRATION Ethical and Clinical Research Committee, Parc Taulí University Hospital: ID 017/315. ClinicalTrials.gov TAU-RECTALNERV-PRESERV-2018 (TRN: NCT03520088 ) (Date of registration 04/03/2018).


title: Laparoscopic sleeve gastrectomy on a morbidly obese patient with situs inversus totalis: A case study and systematic review of the literature.

text: INTRODUCTION Situs inversus totalis (SIT) is a condition where the internal organs or organ systems are located contra-laterally to the norm, forming a mirror image. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure that has become more common over the last two decades. We report on a morbidly obese patient with SIT who underwent a successful LSG. CASE REPORT A 54-year-old female morbidly obese patient (136k; 167cm; body mass index (BMI): 48kg/m2) was admitted for bariatric surgery. She had congenital SIT, a history of open cholecystectomy and, despite implementing the suggestions of the dietitian and endocrinologist, she had failed to lose weight. A standard LSG was performed successfully using the French method. The patient's postoperative course was uneventful and she was discharged on the 5th postoperative day. She is now in the 4th month with a weight loss of 30kg. DISCUSSION SIT is a rare congenital condition, occurring in 1/10,000 to 1/50,000 live births. Organ function is generally normal, although it may sometimes be accompanied by respiratory or cardiovascular anomalies. Although undertaking LSG on morbidly obese patients with SIT may seem a daunting proposition at first, experienced laparoscopic surgeons can manage this operation with success. CONCLUSION Although SIT is a rare congenital condition, LSG can be performed safely and effectively.


title: European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischaemic stroke.

text: Background Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism is a frequent complication in immobile patients with acute ischemic stroke. This guideline document presents the European Stroke Organisation guidelines for the prophylaxis of VTE in immobile patients with acute ischaemic stroke. Guidelines for haemorrhagic stroke have already been published. Methods A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomised controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation approach. This guideline document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. Results We found mainly moderate quality evidence comprising randomised controlled trials and systematic reviews evaluating graduated compression stockings (GCS), intermittent pneumatic compression (IPC) and prophylactic anticoagulation with unfractionated (UFH) and low molecular weight heparins (LMWH) and heparinoids, but no randomised trials evaluating neuromuscular electrical stimulation (NES). We recommend that clinicians should use IPC in immobile patients, but that they should not use GCS. Prophylactic anticoagulation with UFH (5000U ×2, or ×3 daily) or LMWH or heparinoid should be considered in immobile patients with ischaemic stroke in whom the benefits of reducing the risk of VTE is high enough to offset the increased risks of intracranial and extracranial bleeding associated with their use. Where a judgement has been made that prophylactic anticoagulation is indicated LMWH or heparinoid should be considered instead of UFH because of its greater reduction in risk of DVT, the greater convenience, reduced staff costs and patient comfort associated single vs. multiple daily injections but these advantages should be weighed against the higher risk of extracranial bleeding, higher drug costs and risks in elderly patients with poor renal function associated with LMWH and heparinoids. Conclusions IPC, UFH or LMWH and heparinoids can reduce the risk of VTE in immobile patients with acute ischaemic stroke but further research is required to test whether NES is effective. The strongest evidence is for IPC. Better methods are needed to help stratify patients in the first few weeks after stroke onset, by their risk of VTE and their risk of bleeding on anticoagulants.


title: Intrapulmonary percussive ventilation superimposed on conventional mechanical ventilation: comparison of volume controlled and pressure controlled modes.

text: BACKGROUND Previous bench studies suggest that dynamic hyperinflation may occur if intrapulmonary percussive ventilation (IPV) is superimposed on mechanical ventilation in volume controlled continuous mandatory ventilation (VC-CMV) mode. We tested the hypothesis that pressure controlled continuous mandatory ventilation (PC-CMV) can protect against this risk. METHODS An ICU ventilator was connected to an IPV device cone adapter that was attached to a lung model (compliance 30 mL/cm H2O, resistance 20 cm H2O/L/s). We measured inspired tidal volume (VTI) and lung pressure (Plung). Measurements were first taken with IPV off and the ICU ventilator set to VC-CMV or PC-CMV mode with a targeted VTI of 500 mL. For each mode, an inspiratory time (TI) of 0.8 or 1.5 s and PEEP 7 or 15 cm H2O were selected. The experiments were repeated with the IPV set to either 20 or 30 psi. The dependent variables were differences in VTI (ΔVTI) and Plung with IPV off or on. The effect of VC-CMV or PC-CMV mode was tested with the ICU ventilators for TI, PEEP, and IPV working pressure using repeated measures of analysis of variance. RESULTS At TI 0.8 s and 20 psi, ΔVTI was significantly higher in VC-CMV than in PC-CMV. PEEP had no effect on ΔVTI. At TI 1.5 s and 20 psi and at both TI values at each psi, mode and PEEP had a significant effect on ΔVTI. With the ICU ventilators at TI 1.5 s, PEEP 7 cm H2O, and 30 psi, ΔVTI (mean ± SD) ranged from -27 ± 25 to -176 ± 6 mL in PC-CMV and from 258 ± 369 to 369 ± 16 mL in VC-CMV. The corresponding ranges were -15 ± 17 to -62 ± 68 mL in PC-CMV and 26 ± 21 to 102 ± 95 mL in VC-CMV at TI 0.8 s, PEEP 7 cm H2O, and 20 psi. Similar findings pertained to Plung. CONCLUSIONS When IPV is added to mechanical ventilation, the risk of hyperinflation is greater with VC-CMV than with PC-CMV. We recommend using PC-CMV to deliver IPV and adjusting the trigger variable to avoid autotriggering.


Transcystic access of the common bile duct in a patient with a type III choledochal cyst (choledochocele) and cystolithiasis.


title: Oxygen saturation profile in late-preterm and term infants: a prospective cohort study.

text: OBJECTIVE To determine oxygen saturation profile over 6 h monitoring period in healthy late-preterm and term neonates during the first 48 h of age, and to assess the impact of gestational age, birth weight and method of delivery on this profile. STUDY DESIGN Prospective cohort study of measurement of SpO2 over 6 h in 20 late-preterm (35 to 36 weeks gestation) and 40 term infants within 12 to 48 h of birth was conducted. Infants with cardiorespiratory symptoms or need for cardiorespiratory support at birth were excluded. Percentage time spent at SpO2 >90% and ⩽90% was calculated by gestational age and birth weight. RESULT Late-preterm infants and infants born weighing <2.5 kg spent approximately 7% of the time at SpO2 ⩽90%; this time decreased as gestational age and birth weight increased. Time at SpO2 >90% was significantly different between late-preterm and term infants (93% (5%) vs 96% (3%); P =0.002). Time at SpO2 >90% was not significantly different between males and females (95% (5%) vs 95% (4%), both n=30; P =0.72) or between vaginal births and cesarean births (95% (4%), n=32, vs 95% (4%), n=28; P =0.39). Cumulative time with SpO2 <90 was mean (s.d.) of 25 (18) in preterm vs 13 (10) min in term infants. CONCLUSION Over a 6-h period healthy late-preterm and term infants spent significant time at SpO2 ⩽90%. Lower gestation and lower birth weight were associated with higher time at SpO2 ⩽90%.


title: Dermatology staff participate in fight against Covid-19 in China.

text: In December, 2019, a series of pneumonia cases in Wuhan, China, was caused by a novel coronavirus (Covid-19) [1-2], has become a global health concern [3]. At present the epidemic in China has been well controlled, but Covid-19 are currently spreading in many other countries all over the world. Dermatologists in China have participated in the fight against Covid-19. In this paper we share our experiences in dealing with skin diseases in this special period and hope to provide some references for international colleagues in the epidemic situation.


title: Utility of Intravascular Ultrasound During Carotid Angioplasty and Stenting with Proximal Protection.

text: Carotid artery stenting (CAS) is an established treatment for patients at high-risk for endarterectomy. Patients who undergo CAS have been shown to have periprocedural microembolic events on transcranial Doppler ultrasonography. Flow reversal is often applied in these situations to prevent distal emboli and concurrently allow blood to flush into the common carotid artery. Patients who demonstrate soft plaque morphology that may embolize distally during CAS benefit from flow reversal. Even so, the all-stroke risk in these patients is nearly 1.4%. High-risk patients typically have more difficult plaque morphology; flow reversal decreases the rate of distal emboli but does not offer the intraprocedural visualization seen with intravascular ultrasound (IVUS). In this paper, we illustrate potential periprocedural outcomes associated with stenting of the stenotic carotid bifurcation under flow reversal and how IVUS influenced endovascular management. Three high-risk patients who underwent CAS with direct common carotid artery cutdown approaches due to common carotid ostia disease with flow-reversal proximal embolic protection also had intraprocedural IVUS performed to evaluate plaque morphology and stability before the protection system was removed. Case 1 illustrates no intraluminal thrombus on IVUS, requiring no further intervention after stent placement. Case 2 demonstrates intraluminal thrombus on IVUS requiring a second stent to stabilize plaque. Case 3 shows the inadequate resolution of thrombus after a second stent, which was addressed with balloon angioplasty. In our experience, using IVUS as an adjunct to CAS under proximal embolic protection helped demonstrate plaque morphology and plaque fragmentation after stent placement. These cases illustrate the potential benefit of allowing stabilization of the plaque before flow reversal is stopped.


title: 30-day Mortality Rate of Patients with Hip Fractures during the COVID-19 Pandemic: A Single Centre Prospective Study in the United Kingdom.

text: OBJECTIVES During the COVID-19 pandemic, the care of hip fracture patients remains a clinical priority. Our study aims to investigate the 30-day mortality rate of hip fracture patients during the first thirty days of the pandemic in the UK. METHODS A single-center, observational, prospective study of patients presenting with hip fractures. Data collection started from 'day zero' of the COVID-19 pandemic in the UK and continued for thirty days. We collected data on time-to-surgery, Clinical Frailty Scale (CFS) score, Nottingham Hip Fracture Score (NHFS), COVID-19 infection status, 30-day mortality and cause of death. For comparison, we collected retrospective data during the same thirty-day period in 2018, 2019 and the previous six months (Control groups A, B and C, respectively). RESULTS 43 patients were included in the study. There was no difference in age or gender between the Study and Control groups. The 30-day mortality rate of the Study group was 16.3%, which was higher than Control groups A (P=0.022), B (P=0.003) and C (P=0.001). The prevalence of COVID-19 infection in our Study group was 26%. Of the seven mortalities recorded, four patients tested positive for COVID-19 infection. In our Study group, COVID-19 infection correlated significantly with 30-day mortality (P=0.002, odds ratio 2.4). CONCLUSIONS Our study demonstrated a significant increase in 30-day mortality amongst hip fracture patients during the first thirty days of the COVID-19 pandemic in the UK. A positive COVID-19 test result in patients with hip fractures is associated with a 2.4-fold increase in risk of 30-day mortality. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


COVID-19-associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network.


title: Caring for risky patients: duty or virtue?

text: The emergence several years ago of SARS, with its high rate of infection and death among healthcare workers, resurrected a recurring ethical question: do health professionals have a duty to provide care to patients with deadly infectious diseases, even at some substantial risk to themselves and their families? The conventional answer, repeated on the heels of the SARS epidemic, is that they do. In this paper, I argue that the arguments in support of such a duty are wanting in significant respects, and that the language of duty is simply not adequate to an understanding of all the moral dimensions of professional responses to the care of risky patients. Instead, we should speak the language of virtues and ideals if we want to do justice to the complexity of such harrowing circumstances.


Coronavirus Disease of 2019 in Patients with Well-Controlled Human Immunodeficiency Virus on Antiretroviral Therapy.


title: Sildenafil, a phosphodiesterase type 5 inhibitor, augments sphincter bursting and bladder afferent activity to enhance storage function and voiding efficiency in mice.

text: OBJECTIVES To investigate the influence of low-dose sildenafil, a phosphodiesterase type 5 inhibitor (PDE5-I), on the function of the mouse lower urinary tract (LUT). MATERIALS AND METHODS Adult male mice were decerebrated and arterially perfused with a carbogenated Ringer's solution to establish the decerebrate arterially perfused mouse (DAPM). To allow distinction between central neural and peripheral actions of sildenafil, experiments were conducted in both the DAPM and in a 'pithed' DAPM, which has no functional brainstem or spinal cord. The action of systemic and intrathecal sildenafil on micturition was assessed in urethane-anaesthetised mice. RESULTS In the DAPM, systemic perfusion of sildenafil (30 pm) decreased the voiding threshold pressure [to a mean (sem) 84.7 (3.8)% of control] and increased bladder compliance [to a mean (sem) 140.2 (8.3)% of control, an effect replicated in the pithed DAPM]. Sildenafil was without effect on most voiding variables but significantly increased the number of bursts of the external urethral sphincter (EUS) per void in DAPM [to a mean (sem) 130.1 (6.9)% of control at 30 pm] and in urethane-anaesthetised mice [to a mean (sem) 117.5 (5.8)% of control at 14 ng/kg]. Sildenafil (10 and 30 pm) increased pelvic afferent activity during both bladder filling and the isovolumetric phase [to a mean (sem) 205.4 (30.2)% of control at 30 pm]. Intrathecal application of sildenafil (5 μL of either 150 pm or 1.5 nm) did not alter cystometry and EUS-electromyography variables in urethane-anaesthetised mice. CONCLUSIONS Low-dose sildenafil increases bladder compliance, increases pelvic nerve afferent activity, and augments the bursting activity of the EUS. We propose that the novel actions on afferent traffic and sphincter control may contribute to its beneficial actions to restore storage and voiding efficiency in LUT dysfunction.


title: Imaging, Intervention, and Workflow in Acute Ischemic Stroke: The Calgary Approach.

text: Five recently published clinical trials showed dramatically higher rates of favorable functional outcome and a satisfying safety profile of endovascular treatment compared with the previous standard of care in acute ischemic stroke with proximal anterior circulation artery occlusion. Eligibility criteria within these trials varied by age, stroke severity, imaging, treatment-time window, and endovascular treatment devices. This focused review provides an overview of the trial results and explores the heterogeneity in imaging techniques, workflow, and endovascular techniques used in these trials and the consequent impact on practice. Using evidence from these trials and following a case from start to finish, this review recommends strategies that will help the appropriate patient undergo a fast, focused clinical evaluation, imaging, and intervention.


title: Stress and cognitive functioning during a pandemic: Thoughts from stress researchers.

text: In this commentary we discuss a downstream consequence of increases in stress and anxiety during the COVID-19 pandemic. Stress and anxiety can lead to mind wandering, which in turn competes for limited cognitive resources. We encourage researchers to be understanding and patient concerning the inevitable cognitive impact of the pandemic and subsequent reduced productivity levels from our students, colleagues, and ourselves. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Adenomatous hyperplasia of the mucous glands in captive Archey's frogs (Leiopelma archeyi).

text: AIMS To describe the gross and light microscopic characteristics of skin lesions observed on the ventral skin of captive Archey's frogs (Leiopelma archeyi) between 2000 and 2012, and to investigate their occurrence, possible aetiology and association with survival. METHODS Postmortem skin samples were obtained for histological evaluation from 37 frogs, with and without skin lesions, that died while in captivity at Auckland Zoo between 2000 and 2012. Four frogs with skin lesions were biopsied under general anaesthesia and samples used for both light and transmission electron microscopy. The records of 94 frogs held at the University of Otago and Auckland Zoo between 2000-2012 were reviewed, which included some frogs recently collected from the wild. Information about the occurrence of skin lesions, and mortality associated with skin lesions was collated. RESULTS Grossly the skin lesions varied in appearance; most were circular, pale grey papules, which measured from <0.5-1.5 mm in diameter with no umbilication. The overlying epidermis was not fragile and there was no associated inflammation. Contents often appeared clear or semi-transparent. Lesions were located predominantly on ventral surfaces including trunk, thighs, lower legs and forearms, and gular region, but not on digits. The number ranged from single to multiple, often confluent lesions covering the entire ventral surface of the frog. Histologically the lesions consisted of enlarged proliferating mucous glands that expanded the dermis and elevated the epidermis. They were semi-organised, solid or occasionally cavitated acinar structures with central lumina which sometimes contained mucus. Nuclei showed moderate anisokaryosis and mitotic figures were uncommon. Transmission electron microscopy did not show any infectious agents. Between 2000 and 2012, skin lesions were recorded in 35/94 (37%) frogs. The size and location of skin lesions varied over time, with some resolving and sometimes reappearing. Skin lesions were not associated with an increased risk of death. CONCLUSIONS The skin lesions had the gross and microscopic characteristics of adenomatous hyperplasia of the dermal mucous glands. CLINICAL RELEVANCE The aetiology of this adenomatous hyperplasia is unknown, but factors associated with the captive environment are the most likely cause. This is the first description of adenomatous hyperplasia of the cutaneous mucous glands in amphibians.


title: Acute fatal toxoplasmosis in a Great Spotted Woodpecker (Dendrocopos major).

text: A juvenile male Great Spotted Woodpecker (Dendrocopos major), found dead at a bird feeding station in central Norway in September 2011, was examined postmortem. Its lungs were consolidated and edematous, and its spleen was enlarged. The main histopathologic diagnoses included acute protozoal necrotizing interstitial pneumonia, splenitis, and hepatitis. Toxoplasma gondii parasites were identified with immunohistochemistry in all examined organs: lung, heart, liver, kidney, and spleen. Direct multilocus genotyping of the parasites revealed that the woodpecker was killed by a T. gondii strain belonging to genotype II. This is the first report of naturally acquired fatal generalized toxoplasmosis in a Dendrocopos species.


title: Extra-cerebral oxygenation influence on near-infrared-spectroscopy-determined frontal lobe oxygenation in healthy volunteers: a comparison between INVOS-4100 and NIRO-200NX.

text: INTRODUCTION Frontal lobe oxygenation (Sc O2 ) is assessed by spatially resolved near-infrared spectroscopy (SR-NIRS) although it seems influenced by extra-cerebral oxygenation. We aimed to quantify the impact of extra-cerebral oxygenation on two SR-NIRS derived Sc O2 . METHODS Multiple regression analysis estimated the influence of extra-cerebral oxygenation as exemplified by skin oxygenation (Sskin O2 ) on Sc O2 in 21 healthy subjects exposed to whole-body exercise in hypoxia (Fi O2 = 12%; n = 10) and normoxia (n = 12), whole-body heating, hyperventilation (n = 21), administration of norepinephrine with and without petCO2 -correction (n = 15), phenylephrine and head-up tilt (n = 7). Sc O2 was assessed simultaneously by NIRO-200NX (Sniro O2 ) and INVOS-4100 (Sinvos O2 ). Arterial (Sa O2 ) and jugular bulb oxygen saturations (Sj O2 ) were obtained. RESULTS The regression analysis indicated that Sinvos O2 reflects 46% arterial, 14% jugular, 35% skin and 4% oxygenation of tissues not interrogated. Sinvos O2 follows a calculated estimate of cerebral capillary oxygenation (r = 0·67; P<0·0001). In contrast, the NIRO-200NX-determined Sc O2 did not correlate with the estimate of cerebral oxygenation (r = 0·026; P = 0·71). CONCLUSION For all interventions, 35% of the INVOS-4100 signal reflected extra-cerebral oxygenation while, on the other hand, NIRO-200NX did not follow changes in a calculated estimate of cerebral capillary oxygenation. Thus, the NIRO-200NX and INVOS-4100 do not provide for unbiased evaluation of the cerebral signal.


title: Replication and Transmission of the Novel Bovine Influenza D Virus in a Guinea Pig Model.

text: UNLABELLED Influenza D virus (FLUDV) is a novel influenza virus that infects cattle and swine. The goal of this study was to investigate the replication and transmission of bovine FLUDV in guinea pigs. Following direct intranasal inoculation of animals, the virus was detected in nasal washes of infected animals during the first 7 days postinfection. High viral titers were obtained from nasal turbinates and lung tissues of directly inoculated animals. Further, bovine FLUDV was able to transmit from the infected guinea pigs to sentinel animals by means of contact and not by aerosol dissemination under the experimental conditions tested in this study. Despite exhibiting no clinical signs, infected guinea pigs developed seroconversion and the viral antigen was detected in lungs of animals by immunohistochemistry. The observation that bovine FLUDV replicated in the respiratory tract of guinea pigs was similar to observations described previously in studies of gnotobiotic calves and pigs experimentally infected with bovine FLUDV but different from those described previously in experimental infections in ferrets and swine with a swine FLUDV, which supported virus replication only in the upper respiratory tract and not in the lower respiratory tract, including lung. Our study established that guinea pigs could be used as an animal model for studying this newly emerging influenza virus. IMPORTANCE Influenza D virus (FLUDV) is a novel emerging pathogen with bovine as its primary host. The epidemiology and pathogenicity of the virus are not yet known. FLUDV also spreads to swine, and the presence of FLUDV-specific antibodies in humans could indicate that there is a potential for zoonosis. Our results showed that bovine FLUDV replicated in the nasal turbinate and lungs of guinea pigs at high titers and was also able to transmit from an infected animal to sentinel animals by contact. The fact that bovine FLUDV replicated productively in both the upper and lower respiratory tracts of guinea pigs, similarly to virus infection in its native host, demonstrates that guinea pigs would be a suitable model host to study the replication and transmission potential of bovine FLUDV.


title: Single-incision laparoscopic surgery for right hemicolectomy.

text: HYPOTHESIS Single-incision laparoscopic surgery (SILS) allows surgeons to perform laparoscopic procedures through a single umbilical incision, minimizing surgical trauma. DESIGN We describe herein our methods of SILS right hemicolectomy using a recent case as an example. SETTING SILS appendectomy and cholecystectomy have been performed by our surgical team for longer than 1 year among more than 80 patients. Patient SILS right hemicolectomy was performed in a 38-year-old woman with a history of B-cell lymphoma and ileocecal mass. INTERVENTIONS The operation was performed using a SILS port and an extracorporeal stapled anastomosis. MAIN OUTCOME MEASURES Length of stay and postoperative pain and complications. RESULTS SILS right hemicolectomy took 175 minutes to perform. The patient was discharged on postoperative day 6; a chest infection after surgery had prolonged the length of stay. CONCLUSIONS SILS is an attractive method to further minimize surgical trauma and can be applied in more complex cases, such as colectomy. Large trials are needed to determine the benefits of this new technique.


title: Matrix vaccination guidelines: 2015 ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries.

text: OVERVIEW In 2013, the ABCD published 'Matrix vaccination guidelines: ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries' in a Special Issue of the Journal of Feline Medicine and Surgery (Volume 15, Issue 7, pages 540-544). The ABCD's vaccination recommendations were presented in tabulated form, taking into account that there is no universal vaccination protocol for all cats. To support the veterinarian's decision making, recommendations for four lifestyles were made: for cats with outdoors access, cats kept solely indoors, rescue shelter cats and cats in breeding catteries. This update article follows the same approach, offering current and, where relevant, expanded recommendations.


title: A Higher Preoperative Glycemic Profile Is Associated with Rapid Gastric Emptying After Sleeve Gastrectomy for Obese Subjects.

text: BACKGROUND Recent reports have shown that sleeve gastrectomy (SG) accelerates gastric emptying (GE), but the etiology remains unclear. This study aimed to investigate the factors affecting GE before and after SG. METHODS We enrolled 35 normal weight healthy subjects and 23 obese patients receiving SG. The normal individuals and obese patients before and 3 months after SG received oatmeal-based scintigraphy to measure GE. Gastrointestinal symptoms and circulating levels of peptide YY (PYY) were also measured. RESULTS There were no differences in the GE parameters, including simple half-time at 3 h and percentage of gastric retention at 0.5, 1, 2, and 3 h between healthy controls and pre-SG obese subjects. SG led to accelerated GE, more gastrointestinal symptoms, and increased fasting PYY levels postoperatively. Based on our previously established normal GE values, 18 (78.3%) obese patients with rapid postoperative GE had higher levels of preoperative fasting glucose and glycated hemoglobin, and homeostasis model assessment of the insulin resistance index than those with normal postoperative GE. Twelve (52.2%) obese patients had preoperative diabetes mellitus (DM), and only four (17.4%) remained diabetic after SG. The post-SG gastric retention at 0.5 and 1 h was lower in patients with preoperative DM than in those without preoperative DM. Neither severity of gastrointestinal symptoms nor fasting PYY levels were associated with postoperative GE alterations. CONCLUSION Most of the obese patients had accelerated GE after SG. A higher preoperative glycemic profile was associated with rapid post-SG GE.


title: Prevalence of neutralizing antibodies to common respiratory viruses in intravenous immunoglobulin and in healthy donors in southern China.

text: BACKGROUND Acute respiratory infections (ARIs) are a leading cause of death among children under the age of 5. However, there are no effective drugs for most of these severe viral infections. Passive immunotherapy with convalescent plasma or hyperimmune intravenous immunoglobulin (H-IVIG) is a potential therapeutic option for serious viral infections. It is important to find a suitable source of convalescent plasma and of H-IVIG containing high titer neutralizing antibodies (NAbs). METHODS Sera from 96 healthy adult donors in southern China and commercially available IVIG were analyzed for the titers of NAb to several most common respiratory viruses including respiratory syncytial virus (RSV), seasonal influenza A (InfA), enterovirus 71 (EV71), coxsackievirus A16 (CA16), adenovirus type 3 (Ad3) and a recent epidemic adenovirus type 55 (Ad55) by microneutralization test. RESULTS A high proportion of samples from healthy adult donors were positive for NAbs (>16) to all the viruses except Ad55. A different proportion of these samples had high NAb titers (>512) for InfA (25%), Ad3 (17.71%), RSV (9.38%), EV71 (1.04%), CA16 (3.13%), and Ad55 (4.17%). Commercially available IVIG had high NAb titers to InfA and Ad3 (>1,000) and lower NAb titers to RSV [320], EV71 [160], and CA16 [160]. Strikingly, IVIG also had a high NAb titer to Ad55 (>1,000). CONCLUSIONS Convalescent plasma could be screened from healthy blood volunteers to establish blood banks and to prepare specific H-IVIG for treating severe ARIs caused by common respiratory viruses.


Use and Utility of Administrative Health Data for Stroke Research and Surveillance.


title: The design, synthesis and antiviral evaluation of a series of 5-trimethylsilyl-1-beta-D-(arabinofuranosyl)uracil phosphoramidate ProTides.

text: BACKGROUND Nucleoside analogues always require phosphorylation to be active. This appears to be a particular limitation for uridine-based nucleosides. Our ProTide method allows the direct use of masked membrane-soluble preformed nucleoside phosphates, bypassing the need for the initial phosphorylation step. We herein applied it to some novel 5-trimethylsilyl arabinosyl uridines. METHODS 5-Trimethylsilyl-1-beta-D-(arabinofuranosyl)uracil was prepared in six steps starting from uridine, and five phosphoramidate ProTide derivatives were synthesized. These compounds were investigated for activity against a range of DNA and RNA viruses, including herpes simplex virus type-1 and type-2, vaccinia virus and HIV. RESULTS Overall, these compounds did not show significant antiviral activity against any of the viruses tested. CONCLUSIONS The inactivity of the ProTides of this nucleoside could correspond with poor ProTide activation in vitro, poor onward metabolism or low activity of the putative monophosphate metabolite.


Age, comorbidity, frailty status: effects on disposition and resource allocation during the COVID-19 pandemic.


title: The forgotten guide wire: a rare complication of hemodialysis catheter insertion.

text: A rare complication of a hemodialysis catheter insertion is the loss of the complete guide wire into the circulation. A complete guide wire in the circulation may not necessarily produce symptoms, and it may remain unnoticed for a significant period of time. We present a rare case where a complete guide wire was lost into the circulation during insertion of a hemodialysis catheter into the right femoral vein in a 19-year-old female with systemic lupus erythromatosis. The patient remained asymptomatic through two plasmapheresis treatments over a period of 2 days. The guide wire was eventually retrieved without complications. The factors leading to the wire being forgotten will be reviewed, and the measures initiated to prevent any future occurrence will be addressed.


title: Synthetic Chemical Trade as a Potential Driver of Global Health Disparities and Data Gaps on Synthetic Chemicals in Vulnerable Populations.

text: PURPOSE OF REVIEW Most research on toxic exposures in vulnerable populations focuses on air pollution. Synthetic chemical production, however, is a multi-billion-dollar industry that lacks appropriate international regulation to protect those exposed to toxic chemicals. This paper aims to describe the country-level import and export of key groups of synthetic chemicals using data from the United Nations Comtrade Database and provide a narrative review of the evidence from January 2018 to August 2019 on exposure to, health effects of, and interventions to reduce synthetic chemicals in vulnerable populations around the world. RECENT FINDINGS Generally, a small number of high-income countries export the majority of synthetic chemicals, while most low-income countries import more chemicals than they export, which may contribute to higher levels of synthetic chemicals in those settings. However, few studies have quantified exposures to synthetic chemicals in low- and middle-income countries, the health effects of such exposures, or interventions to mitigate exposures. Synthetic chemicals continue to enter markets despite our limited knowledge of their effects on human health, particularly in the most vulnerable populations. We need more research to understand the health impacts of these pervasive exposures.


title: Proteolytic cleavage of VP1-2 is required for release of herpes simplex virus 1 DNA into the nucleus.

text: In this report we propose a model in which after the herpes simplex virus (HSV) capsid docks at the nuclear pore, the tegument protein attached to the capsid must be cleaved by a serine or a cysteine protease in order for the DNA to be released into the nucleus. In support of the model are the following results. (i) Exposure of cells at the time of or before infection to l-(tosylamido-2-phenyl) ethyl chloromethyl ketone (TPCK), a serine-cysteine protease inhibitor, prevents the release of viral DNA or expression of viral genes. TPCK does not block viral gene expression after entry of viral DNA into the nucleus. (ii) The tegument protein VP1-2, the product of the U(L)36 gene, is cleaved shortly after the entry of the HSV 1 (HSV-1) virion into the cell. (iii) The proteolytic cleavage of VP1-2 does not occur in cells that are infected with HSV-1 under conditions that prevent the release of the viral DNA into the nucleus. (iv) The proteolytic cleavage of VP1-2 occurs only after the capsid is attached to the nuclear pore. Thus, TPCK prevented the release of HSV-1 DNA into the nucleus when added to medium 1 hour after infection with tsB7 at 39.5 degrees C followed by a shift down to the permissive temperature. The ts lesion maps in the U(L)36 gene. At the nonpermissive temperature, the capsids accumulate at the nuclear pore but the DNA is not released into the nucleus.


title: Detection of polyoma and corona viruses in bats of Canada.

text: Several instances of emerging diseases in humans appear to be caused by the spillover of viruses endemic to bats, either directly or through other animal intermediaries. The objective of this study was to detect, identify and characterize viruses in bats in the province of Manitoba and other regions of Canada. Bats were sampled from three sources: live-trapped Myotis lucifugus from Manitoba, rabies-negative Eptesicus fuscus, M. lucifugus, M. yumanensis, M. septentrionalis, M. californicus, M. evotis, Lasionycteris (L.) noctivagans and Lasiurus (Las.) cinereus, provided by the Centre of Expertise for Rabies of the Canadian Food Inspection Agency (CFIA), and L. noctivagans, Las. cinereus and Las. borealis collected from a wind farm in Manitoba. We attempted to isolate viruses from fresh tissue samples taken from trapped bats in cultured cells of bat, primate, rodent, porcine, ovine and avian origin. We also screened bat tissues by PCR using primers designed to amplify nucleic acids from members of certain families of viruses. We detected RNA of a group 1 coronavirus from M. lucifugus (3 of 31 animals) and DNA from an as-yet undescribed polyomavirus from female M. lucifugus (4 of 31 animals) and M. californicus (pooled tissues from two females).


Where have all the children gone? Decreases in paediatric emergency department attendances at the start of the COVID-19 pandemic of 2020.


The current role of total intravenous anesthesia in cardiac surgery: total intravenous anesthesia and cardiopulmonary bypass.


title: Social integration and loneliness among long-term care home residents: protocol for a scoping review.

text: INTRODUCTION Social well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups. METHODS AND ANALYSIS This study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation. ETHICS AND DISSEMINATION Ethics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.


title: Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration - United States, 2020.

text: On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S. health care system's ability to continue providing routine preventive and other nonemergency care. In addition, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities (3). On March 24, CDC posted guidance emphasizing the importance of routine well child care and immunization, particularly for children aged ≤24 months, when many childhood vaccines are recommended.


title: Staphylococcus aureus Colonization and Long-Term Risk for Death, United States.

text: To examine the association of colonization by Staphylococcus aureus and general population mortality, we followed 10,598 adults for 8.5 years on average. Methicillin-susceptible S. aureus colonization was not associated with death. Methicillin-resistant S. aureus carriage predicted death in a crude analysis but not after adjustment for socioeconomic status and co-morbidities.


COVID-19 in children and altered inflammatory responses.


Coronavirus Disease 2019 Pandemic: Potential Collateral Damage on Patients With Operable Pancreatic Cancer.


Response to and Recovery from the COVID-19 Pandemic: What Will It Take?


title: [How to communicate with families of patients in complete isolation during SARS-CoV-2 pandemic multidisciplinary working group "ComuniCoViD".]

text: The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD-19 care settings, due to the obligation to maintain complete social isolation. Healthcare workers are isolated from their families, and must manage the consequences of this isolation just like the patients. They and their families perceive the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the healthcare workers during isolation is especially important when a patient dies, and it may influence the process of grief. This document is intended for all healthcare professionals caring for CoViD-19 patients, particularly those in more severe clinical conditions and it is aimed to help the care team to communicate with families distanced from the patient. The document consists of three parts: 1) presentation of the statements for communicating with patients family members during isolation; 2) discussion of key points as a theoretical framework for the statements; 3) instructions for telephone communication, with a checklist and a worksheet. The document was written by authors from different disciplines (doctors, nurses, psychologists, legal experts) and was then reviewed by a group of experts comprising professionals, people who have experienced ICU hospitalization, and their families. Finally, the document was approved by the National Boards of the Italian Society of Anesthesia and Intensive Care (SIAARTI), Italian Society of Critical Care Nurses (ANIARTI), Italian Society of Emergency Medicine (SIMEU), and Italian Society of Palliative Care (SICP).