title: Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey.

text: OBJECTIVE To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID-19 pandemic among Latin American gynecological cancer specialists. METHODS Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. RESULTS A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post-cancer treatment follow-up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo-oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). CONCLUSION Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID-19 pandemic, which may reflect the region's particularities.


title: Open ventral hernia repair with component separation.

text: In this article, the authors describe their current operative technique for open ventral hernia repair using component separation. Although methods of anterior component separation are described, in their current practice, the authors primarily use posterior component separation with transversus abdominis release to permit dissection beyond the retrorectus space. This method adheres to the literature-supported principles of a tension-free midline fascial closure with wide mesh overlap of mesh positioned in a sublay position. The authors' experience with this method supports a low recurrence rate and reduced wound morbidity.


title: Co-infection of Coronavirus Disease 2019 and Influenza A: A Report from Iran.

text: BACKGROUND In late December 2019, a viral pneumonia known as coronavirus disease 2019 (COVID-19) originated from China and spread very rapidly in the world. Since then, COVID-19 has become a global concern and health problem. METHODS We present four patients in this study, selected from among patients who presented with pneumonia symptoms and were suspicious for COVID-19. They were referred to the intended centers for COVID-19 diagnosis and management of Shiraz University of Medical Sciences in southern Iran. Two nasopharyngeal and oropharyngeal throat swab samples were collected from each patient and tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using real-time reverse-transcriptase- polymerase-chain-reaction (RT-PCR). The samples were also tested for influenza viruses and the complete respiratory panel. RESULTS In the present report, four patients were diagnosed in the starting days of COVID-19 disease in our center in southern Iran with co-infection of SARS-CoV-2 and influenza A virus. CONCLUSION This co-infection of COVID-19 and influenza A highlights the importance of considering SARS-CoV-2 PCR assay regardless of other positive findings for other pathogens in the primary test during the epidemic.


Lessons from Leicester: a covid-19 testing system that's not fit for purpose.


title: Protecting Children with Long-Term Conditions during the COVID-19 Pandemic.

text: Emeritus Professor Alan Glasper, from the University of Southampton, discusses what can be done to protect certain groups of children with long-term health conditions from catching SARS-Cov-2 disease caused by the novel coronavirus COVID-19. Furthermore, it is now being reported that a number of children appear to be reacting to the new coronavirus by developing a multisystem hyperinflammatory state with similar symptoms to that seen in toxic shock syndrome and which necessitates intensive care (Campbell & Sample, 2020).


title: SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases.

text: Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm. Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall. Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred. Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.


Influence of electromagnetic interference on AED function in metro stations.


title: Psychological resilience and dysfunction among hospitalized survivors of the SARS epidemic in Hong Kong: a latent class approach.

text: OBJECTIVE To examine trajectories of psychological functioning using latent class analysis on a sample of hospitalized survivors of the 2003 severe acute respiratory syndrome (SARS) epidemic in Hong Kong. DESIGN A longitudinal study of 997 survivors, recruited from among 1,331 individuals hospitalized for SARS, were interviewed at 6, 12, and 18 months after hospitalization. MAIN OUTCOME MEASURES Psychological and physical functioning at each time point was measured using the 12-item Medical Outcome Study Short-Form Health Survey (SF-12). RESULTS Four latent classes were identified--chronic dysfunction, delayed dysfunction, recovery, and resilience. All groups had better physical health than the chronic group. Resilient and recovered individuals had greater social support and less SARS-related worry, and resilient individuals were more likely to be male. The resilient group also had greater social support than the delayed group and better physical functioning than the recovered group. CONCLUSION This study demonstrated that longitudinal outcome trajectories following a major health-threat event in an Asian sample bear close resemblance to prototypical trajectories observed in trauma studies using Western samples. Unique predictors of the trajectories included factors observed in previous studies, such as social support, as well as factors of particular relevance to a major disease outbreak, such as SARS-related worry.


title: Development of Competencies for Respiratory Protection for Health Care Workers.

text: According to the Bureau of Labor Statistics, more than 18 million health care workers in the United States are currently employed in the health care field and at risk of infectious respiratory exposure. With the emergence of global infectious diseases such as Ebola and Severe Acute Respiratory Syndrome (SARS), there is a need for increased and more clinically competent use of respiratory protection among healthcare workers. In an effort to improve knowledge about the practice of respiratory protection against respiratory infectious agents, a NIOSH-funded project that included an educational program, observations of HCWs, and focus groups was conducted. This study aimed to develop, implement, and evaluate respiratory protection educational program for HCWs and hospital management. This study identified respiratory protection practice issues among HCWs and strategies for integration of respiratory protection standards and procedures into practice. Findings from these efforts were used to develop respiratory protection competencies. Any worker who has the potential for respiratory exposure to infectious agents should be protected and should be able to demonstrate these specific competencies to achieve a standard level of respiratory protection.


title: Management of Diminutive Colon Polyps Based on Endoluminal Imaging.

text: Diminutive colon polyps, defined as 5 mm or less, are encountered increasingly at colonoscopy. The risk of serious pathology in such polyps is low. There is a risk and cost of resecting all such polyps and sending tissue for pathologic evaluation. Enhancement of endoluminal imaging may enable discrimination of neoplastic vs non-neoplastic polyps. If this discrimination can be performed accurately with high confidence, it may be possible to either resect and discard diminutive adenomas, or inspect and do-not-resect diminutive hyperplastic polyps. In 2011, an expert group recommended thresholds of 90% negative predictive value for adenomas, and 90% accuracy in predicting appropriate surveillance intervals. Since 2011, criteria for polyp discrimination have been published and validated by experts and nonexperts. In vivo studies have been performed to compare endoscopic impression and pathologic diagnosis. An expert panel was convened in late 2014 to review the literature to determine if the proposed thresholds for discrimination can be attained and to recommend the next steps for introducing changes in clinical practice. We conclude that threshold levels can be achieved with several endoscopic image enhancements. The next steps to implementation of practice change include acquiring data on training and competence, determining best practices for auditing performance, understanding patient education needs, and the potential cost benefit of such changes.


title: Laparoendoscopic single-site pyeloplasty.

text: Since the inception of laparoscopic surgery, there has been an ongoing effort to develop an even more 'minimally invasive' approach to surgery. A novel example of such advancement can be found in laparoendoscopic single-site (LESS) surgery. Performing surgery through a single site of access holds the promise of decreased morbidity, lower blood loss, shorter convalescence, and improved cosmesis. Given the nonextirpative nature of the pyeloplasty procedure, this patient cohort has proven to be the ideal candidates for LESS surgery. The driving force behind adaptation of this newer technique can be attributed to innovations in access sites and devices, instrumentation, optics, and robotic-based assistance. There are now several studies in the published literature demonstrating the feasibility and efficacy of LESS pyeloplasty in both children and adults. Although comparative studies have failed to demonstrate any objective advantage of the LESS pyeloplasty operation, it is important to realize that LESS surgery is still a fairly new technique. Further technological developments and additional studies will ultimately define its role in the field of urologic surgery, and subsequently, its application for the pyeloplasty procedure.


title: Use of Isotope-Edited FTIR to Derive a Backbone Structure of a Transmembrane Protein.

text: Solving structures of membrane proteins has always been a formidable challenge, yet even upon success, the results are normally obtained in a mimetic environment that can be substantially different from a biological membrane. Herein, we use noninvasive isotope-edited FTIR spectroscopy to derive a structural model for the SARS coronavirus E protein transmembrane domain in lipid bilayers. Molecular-dynamics-based structural refinement, incorporating the IR-derived orientational restraints points to the formation of a helical hairpin structure. Disulfide cross-linking and X-ray reflectivity depth profiling provide independent support of the results. The unusually short helical hairpin structure of the protein might explain its ability to deform bilayers and is reminiscent of other peptides with membrane disrupting functionalities. Taken together, we show that isotope-edited FTIR is a powerful tool to analyze small membrane proteins in their native environment, enabling us to relate the unusual structure of the SARS E protein to its function.


title: Ventilator-associated lung injury during assisted mechanical ventilation.

text: Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist-control ventilation, pressure assist-control ventilation, pressure support ventilation (PSV), airway pressure release ventilation (APRV), APRV with PSV, proportional assist ventilation (PAV), noisy ventilation, and neurally adjusted ventilatory assistance (NAVA). In summary, we suggest that assisted MV can be used in ARDS patients in the following situations: (1) Pao(2)/Fio(2) >150 mm Hg and positive end-expiratory pressure ≥ 5 cm H(2)O and (2) with modalities of pressure-targeted and time-cycled breaths including more or less spontaneous or supported breaths (A-PCV [assisted pressure-controlled ventilation] or APRV). Furthermore, during assisted MV, the following parameters should be monitored: inspiratory drive, transpulmonary pressure, and tidal volume (6 mL/kg). Further studies are required to determine the impact of novel modalities of assisted ventilation such as PAV, noisy pressure support, and NAVA on VALI.


title: Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device.

text: BACKGROUND The aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD). METHODS In this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice. Computational fluid dynamics analysis was performed to compare the hemodynamic differences such as WSS, Velocity and Pressure among these stents. RESULTS Control referred to the unstented model, the percentage of hemodynamic changes were all compared to Control. A single LVIS stent caused more wall shear stress reduction than double Enterprise stents (39.96 vs. 30.51 %) and velocity (23.13 vs. 18.64 %). Significant reduction in wall shear stress (63.88 %) and velocity (46.05 %) was observed in the double-LVIS stents. A single Pipeline showed less reduction in WSS (51.08 %) and velocity (37.87 %) compared with double-LVIS stent. The double-Pipeline stents resulted in the most reduction in WSS (72.37 %) and velocity (54.26 %). Moreover, the pressure increased with minuscule extent after stenting, compared with the unstented model. CONCLUSIONS This is the first study analyzing flow modifications associated with LVIS stents. We found that the LVIS stent has certain hemodynamic effects on cerebral aneurysms: a single LVIS stent caused more flow reductions than the double-Enterprise stent but less than a Pipeline device. Nevertheless, the double-LVIS stent resulted in a better flow diverting effect than a Pipeline device.


title: Level of concern and precaution taking among Australians regarding travel during pandemic (H1N1) 2009: results from the 2009 Queensland Social Survey.

text: BACKGROUND Global disease outbreaks, such as the recent Pandemic (H1N1) 2009 (the so-called Swine flu), may have an impact on travel, including raising the concerns of travelers. The objective of this study was to examine the level of concern of Australians regarding travel during Pandemic (H1N1) 2009 and how this impacted on their travel. METHODS Data were collected by interviews as part of the Queensland Social Survey (QSS) 2009. Specific questions were incorporated regarding travel and Pandemic (H1N1) 2009. Multivariate logistic regression was used to analyze associations between demographic variables and concern and likelihood of cancelling travel. RESULTS There were 1,292 respondents (41.5% response rate). The sample was nearly equally divided between males and females (50.2% vs 49.8%). Younger people (18-34 y) were under-represented in the sample; older people (> 55 y) were over-represented in the sample. About half (53.2%) of respondents indicated some level of concern about Pandemic (H1N1) 2009 when traveling and just over one-third (35.5%) indicated they would likely cancel their air travel if they had a cough and fever that lasted more than one day. When cross-tabulating these responses, people who expressed concern regarding Pandemic (H1N1) 2009 when they traveled were more likely than those without concern to cancel their air travel if they had a cough and fever lasting more than one day (44.7% vs 27.7%, χ² = 33.53, p < 0.001). People with higher levels of education [adjusted odds ratio (AOR): 0.651], people with higher incomes (AOR: 0.528) and people living outside of metropolitan Southeast Queensland (AOR: 0.589) were less likely to be concerned about Pandemic (H1N1) 2009 when traveling, and younger people (AOR: 0.469) were less likely than others to cancel travel if they had a cough and fever. CONCLUSIONS Pandemic (H1N1) 2009 was of some concern to more than half of Queensland travelers. None-the-less, the majority of Queenslanders would not have postponed their own travel, even if they exhibited symptoms consistent with Pandemic (H1N1) 2009.


Regional Dermabrasion of Nasal Surgical Scars and Rhinophyma Using Electrocautery Scratch Pads.


title: Closure of Direct Inguinal Hernia Defect in Laparoscopic Hernioplasty to Prevent Seroma Formation: A Prospective Double-blind Randomized Controlled Trial.

text: OBJECTIVES Seroma is the most frequent postoperative complication after laparoscopic direct inguinal hernia repair. This randomized controlled trial evaluated the preventive effect of a simple technique by closing the direct hernia defect with barbed suture in laparoscopic direct inguinal hernia. METHODS In total, 60 patients aged 18 years or older who presented to the hernia center department in our hospital between October 1, 2017 and January 1, 2018 with primary direct inguinal hernia were randomized into the defect-closing group (by closing the transversalis) and the control groups. The primary outcomes were to compare the ultrasonic seroma number and volume at the inguinal region at 7 days, 1, and 3 months postoperatively. Secondary outcomes included total operative time, acute pain, chronic pain (pain lasting over 3 mo), hospital stay, recurrence, and any other complications. RESULTS There were no significant differences in baseline demographic characteristics between the 2 groups including age, sex, hernia type, size of hernia defect, surgical approach, and follow-up time. Compared with control group, there were significantly fewer patients with seroma formation at 7 days, 1, and 3 months after the operations in the defect-closing group (P<0.001, <0.001, 0.002, respectively). In addition, ultrasonic seroma volume was less in the defect-closing group on postoperative day 7 (13.33 vs. 30.45 mL; P=0.02). The acute pain and hospital stay were comparable (P=0.61, 0.85, respectively), and no chronic pain, early recurrence or other postoperative complications observed in both groups during the follow-up period. CONCLUSIONS The simple technique of direct hernia defect closure with barbed suture in laparoscopic direct inguinal hernia repair is a secure and effective method, which is easy to perform and could significantly reduce both incidence and volume of seroma formation without increasing the risk of recurrence, acute, and chronic pain.


title: Comparison of maximal inspiratory pressure, tracheal airway occlusion pressure, and its ratio in the prediction of weaning outcome: impact of the use of a digital vacuometer and the unidirectional valve.

text: OBJECTIVE To investigate the predictive value of the maximal inspiratory pressure obtained by a digital vacuometer using a unidirectional valve (P(ImaxUV)) as to weaning outcome, and to compare its performance with the respiratory drive using airway occlusion pressure at 0.1 second (P(0.1)), and P(0.1)/P(ImaxUV). METHODS Patients on mechanical ventilation for > 24 hours who fulfilled the weaning criteria were prospectively enrolled. Measurements of P(ImaxUV) and P(0.1) were accomplished with a digital vacuometer with a unidirectional valve that allows only exhalation. Measured values were electronically recorded and stored on the digital vacuometer measurement device. Cutoff points for the used parameters were: absolute values of P(ImaxUV) > 30 cm H(2)O, P(0.1) < 2.3 cm H(2)O, and P(0.1)/P(ImaxUV) < 0.10. Receiver operating characteristic curves were calculated to compare the predictive values of the indexes. RESULTS One hundred three subjects completed the test. The areas under the receiver operating characteristic curve were 0.79 ± 0.04, 0.65 ± 0.05, and 0.74 ± 0.04 for P(ImaxUV), P(0.1), and P(0.1)/P(ImaxUV), respectively. The area under the receiver operating characteristic curve for P(ImaxUV) was higher than for P(0.1) and P(0.1)/P(ImaxUV), but statistical significance was only found against P(0.1) (P = .007). CONCLUSIONS Every studied index had only a modest performance regarding prediction of weaning outcome. Of note, P(ImaxUV) values obtained by digital technology using a unidirectional valve performed better than historically reported using a conventional techniques, surpassing P(0.1) and P(0.1)/P(ImaxUV) in this regard.


title: Improvement of catheter-related outcomes after application of tunneled cuffed hemodialysis catheter insertion without fluoroscopy.

text: Background Non-tunneled catheters (NTCs) are used for hemodialysis (HD) in many centers in which fluoroscopy is not easily accessed despite high complication rates and conditions requiring long-term HD. Therefore, here we aimed to evaluate the superiority of catheter-related outcomes after the application of tunneled cuffed catheter (TCC) without fluoroscopy versus unconditioned NTC insertion. Methods We divided the participants into two phases: those receiving NTCs between March 2010 and February 2011 (phase I), and those receiving TCCs or NTCs between March 2011 and February 2012 (phase II). Catheter survival, nurse satisfaction, and reasons for catheter removal were analyzed. Results Two hundred and sixty patients in phase I and 300 patients in phase II were enrolled in this study. The success rate of TCC insertion was 99.2%. The catheter survival rate in phase I was 65.5% at 1 month, while that in phase II was 74.9% at 1 month (p=0.023). We compared catheter survival between TCCs and NTCs for all periods regardless of phase. The TCC survival rate was higher than the NTC survival rate (p<0.001). Catheter-associated problems led to catheter removal in 97 patients (26.6%) in phase I and 68 patients (18.5%) in phase II (p=0.009). Among 14 HD nurses, all reported being satisfied with manipulation during pre-/post-HD, manupulation during HD, and overall. Eleven HD nurses (78.6%) reported being satisfied with the workload. Conclusion Compared with unconditional NTC insertion for HD, TCC insertion without fluoroscopy improved the overall catheter survival and nurse satisfaction rates.


title: Hyperoxia Induces Inflammation and Cytotoxicity in Human Adult Cardiac Myocytes.

text: Supplemental oxygen (O2) is used as adjunct therapy in anesthesia, emergency, and intensive care medicine. We hypothesized that excessive O2 levels (hyperoxia) can directly injure human adult cardiac myocytes (HACMs). HACMs obtained from the explanted hearts of transplantation patients were exposed to constant hyperoxia (95% O2), intermittent hyperoxia (alternating 10 min exposures to 5% and 95% O2), constant normoxia (21% O2), or constant mild hypoxia (5% O2) using a bioreactor. Changes in cell morphology, viability as assessed by lactate dehydrogenase (LDH) release and trypan blue (TB) staining, and secretion of vascular endothelial growth factor (VEGF), macrophage migration inhibitory factor (MIF), and various pro-inflammatory cytokines (interleukin, IL; chemokine C-X-C motif ligand, CXC; granulocyte-colony stimulating factor, G-CSF; intercellular adhesion molecule, ICAM; chemokine C-C motif ligand, CCL) were compared among treatment groups at baseline (0 h) and after 8, 24, and 72 h of treatment. Changes in HACM protein expression were determined by quantitative proteomic analysis after 48 h of exposure. Compared with constant normoxia and mild hypoxia, constant hyperoxia resulted in a higher TB-positive cell count, greater release of LDH, and elevated secretion of VEGF, MIF, IL-1β, IL-6, IL-8, CXCL-1, CXCL-10, G-CSF, ICAM-1, CCL-3, and CCL-5. Cellular inflammation and cytotoxicity gradually increased and was highest after 72 h of constant and intermittent hyperoxia. Quantitative proteomic analysis revealed that hypoxic and hyperoxic O2 exposure differently altered the expression levels of proteins involved in cell-cycle regulation, energy metabolism, and cell signaling. In conclusion, constant and intermittent hyperoxia induced inflammation and cytotoxicity in HACMs. Cell injury occurred earliest and was greatest after constant hyperoxia, but even relatively brief repeating hyperoxic episodes induced a substantial inflammatory response.


title: Relationship between pregnancy and coronavirus: what we know.

text: The identification in China in December 2019 of a new coronavirus (SARS-CoV-2) immediately rekindled the spotlight on a problem also addressed in the past during the epidemics of SARS in 2002-2003 and MERS in 2012: the implications of a possible infection during pregnancy, both for pregnant women and for fetuses and infants. Pregnancy is characterized by some changes involving both the immune system and the pulmonary physiology, exposing the pregnant woman to a greater susceptibility to viral infections and more serious complications. The objective of this review is therefore to analyze the relationship between pregnancy and known coronaviruses, with particular reference to SARS-CoV-2.


title: Primary adenocarcinoma of the appendix - a case report.

text: Abstract Primary adenocarcinoma of the vermiform appendix is a rare clinical condition. It usually presents as an acute abdominal process or as a mass in the right lower quadrant. The gross pathologic and microscopic characteristics of this disease are the same as for colon carcinoma and carry a serious prognosis. We report a case of a 64-year old male patient presenting symptoms of acute appendicitis. The patient underwent laparoscopic appendectomy that revealed a severely inflamed appendix. Histopathological examination has shown that it was a poorly differentiated, high grade adenocarcinoma invading the periappendicular fat. According to the histopathological findings, a right hemicolectomy was further advised and performed. Right hemicolectomy is the generally recommended method of treatment for invasive adenocarcinoma of the appendix.


Leveraging video telehealth for the transitional pain service in response to COVID-19.


title: A pilot study of cerebrovascular reactivity autoregulation after pediatric cardiac arrest.

text: AIM Improved survival after cardiac arrest has placed greater emphasis on neurologic resuscitation. The purpose of this pilot study was to evaluate the relationship between cerebrovascular autoregulation and neurologic outcomes after pediatric cardiac arrest. METHODS Children resuscitated from cardiac arrest had autoregulation monitoring during the first 72h after return of circulation with an index derived from near-infrared spectroscopy in a pilot study. The range of mean arterial blood pressure (MAP) with optimal vasoreactivity (MAPOPT) was identified. The area under the curve (AUC) of the time spent with MAP below MAPOPT and MAP deviation below MAPOPT was calculated. Neurologic outcome measures included placement of a new tracheostomy or gastrostomy, death from a primary neurologic etiology (brain death or withdrawal of support for neurologic futility), and change in the Pediatric Cerebral Performance Category score (ΔPCPC). RESULTS Thirty-six children were monitored. Among children who did not require extracorporeal membrane oxygenation (ECMO), children who received a tracheostomy/gastrostomy had greater AUC during the second 24h after resuscitation than those who did not (P=0.04; n=19). Children without ECMO who died from a neurologic etiology had greater AUC during the first 48h than did those who lived or died from cardiovascular failure (P=0.04; n=19). AUC below MAPOPT was not associated with ΔPCPC when children with or without ECMO were analyzed separately. CONCLUSIONS Deviation from the blood pressure with optimal autoregulatory vasoreactivity may predict poor neurologic outcomes after pediatric cardiac arrest. This experimental autoregulation monitoring technique may help individualize blood pressure management goals after resuscitation.


title: Two Rare Cases of Posttraumatic Peripheral Artery Pseudoaneurysm.

text: Posttraumatic pseudoaneurysms of the lower limb are increasingly recognized due to the development of cross-sectional imaging. Two cases of anterior tibial artery pseudoaneurysm after blunt trauma are presented. The diagnostic technique of choice is Doppler ultrasound (US). In some cases, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) is needed to identify the feeding vessel. The treatment of choice is not yet determined. Ultrasound-guided thrombin injection is widely used as first-line treatment, but some cases are refractory to this treatment. Further investigation and optimization of therapeutic technique to definitely exclude the pseudoaneurysm from the circulation may result in faster and more cost-effective treatment than US-guided thrombin injection.


title: Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience.

text: BACKGROUND Patients with Roux-en-Y gastric bypass (RYGB) develop pancreatobiliary issues after surgery. Endoscopic management via the conventional route with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) is quite limited due to the altered anatomy. Laparoscopic-assisted ERCP (LA-ERCP) via the excluded stomach has been highly successful. Reported use of laparoscopic-assisted EUS (LA-EUS) is extremely rare. METHODS A retrospective review was conducted at two tertiary referral centers for cases that involved laparoscopic-assisted ERCP and EUS. Patient demographic data were collected along with data regarding procedure, indication, complications and length of stay. RESULTS A total of 16 cases involving 15 patients were identified: 11 cases of LA-ERCP and five cases of combined LA-EUS plus LA-ERCP were performed. Four patients had previously undergone failed endoscopy via the conventional route (27 %). There was a 100 % biliary/pancreatic cannulation and intervention rate. There were no endoscopic-related complications. Therapeutic interventions included laparoscopic cholecystectomy, lysis of adhesions, biliary and pancreatic sphincterotomy, biliary and pancreatic stent placement, stone removal including mechanical lithotripsy and EUS biopsy and diagnosis of pancreatic cancer. Average discharge was on postoperative day 3.4. However, 50 % were discharged after 1 day. CONCLUSIONS LA-ERCP and combined LA-EUS plus LA-ERCP are safe and highly successful diagnostic and therapeutic modalities for a wide variety of pancreatobiliary ailments in RYGB patients.


title: Special Ambulatory Gynecologic Considerations in the Era of COVID-19 and Implications for Future Practice.

text: The COVID-19 pandemic has altered medical practice in unprecedented ways. While much of the emphasis in obstetrics and gynecology to date has been on the as yet uncertain impacts of COVID-19 in pregnancy and on changes to surgical management, the pandemic has broad implications for ambulatory gynecologic care as well. In this article we review important ambulatory gynecologic topics including safety and metal health, reproductive life planning, sexually transmitted infections, and routine screening for breast and cervical cancer. For each topic, we review how care may be modified during the pandemic, provide recommendations when possible for how to ensure continued access to comprehensive healthcare at this time, and discuss ways that future practice may change. Social distancing requirements may place patients at higher risk for intimate partner violence and mental health concerns; threaten continued access to contraception and abortion services; impact prepregnancy planning; interrupt routine screening for breast and cervical cancer; increase risk of sexually-transmitted infection acquisition and decrease access to treatment; and exacerbate already underlying racial and minority disparities in care and health outcomes. We advocate for increased use of telemedicine services with increased screening for intimate partner violence and depression using validated questionnaires. Appointments for long-acting contraceptive insertion can be prioritized. Easier access to patient-controlled injectable contraception and pharmacist-provided hormonal contraception can be facilitated. Reproductive healthcare access can be ensured through reducing needs for ultrasound and laboratory testing for certain eligible patients desiring abortion and conducting phone follow-up for medication abortions. Priority for in-person appointments should be given to patients with sexually-transmitted infection symptoms, particularly if at risk for complications, while also offering expedited partner therapy. While routine mammography screening and cervical cancer screening may be safely delayed, we discuss society guideline recommendations for higher-risk populations. There may be an increasing role for patient-collected human papilloma virus self-samples using new cervical cancer screening guidelines that can be expanded in light of the pandemic situation. While the pandemic has strained our healthcare system, it also affords ambulatory clinicians with opportunities to expand care to vulnerable populations in ways that were previously underutilized to attempt to improve health equity.


title: Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control.

text: Ebola virus disease (EVD) is a life-threatening zoonosis caused by infection with the Ebola virus. Since the first reported EVD outbreak in the Democratic Republic of the Congo, several small outbreaks have been reported in central Africa with about 2,400 cases occurring between 1976 and 2013. The 2013-2015 EVD outbreak in west Africa is the first documented outbreak in this region and the largest ever with over 27,000 cases and more than 11,000 deaths. Although EVD transmission rates have recently decreased in west Africa, this crisis continues to threaten global health and security, particularly since infected travelers could spread EVD to other resource-limited areas of the world. Because vaccines and drugs are not yet licensed for EVD, outbreak control is dependent on the use of non-pharmaceutical interventions (e.g., infection control practices, isolation of EVD cases, contact tracing with follow-up and quarantine, sanitary burial, health education). However, delays in diagnosing and reporting EVD cases in less accessible rural areas continue to hamper control efforts. New advances in rapid diagnostics for identifying presumptive EVD cases and in mobile-based technologies for communicating critical health-related information should facilitate deployment of an early response to prevent the amplification of sporadic EVD cases into large-scale outbreaks.


title: Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses.

text: PURPOSE Radical nephrectomy has traditionally been preferred to partial nephrectomy in patients with localized renal cell cancer because of its simplicity and established cancer control. Recent data suggest that these patients have significant competing risks of death, some of which may be increased by chronic renal insufficiency. Therefore, we compared overall survival, cancer specific survival and cardiac specific survival in patients undergoing partial or radical nephrectomy for cT1b tumors. MATERIALS AND METHODS From 1999 to 2006, 1,004 patients with renal masses between 4 and 7 cm underwent extirpative surgery, partial nephrectomy (524) or radical nephrectomy (480). We generated a propensity model based on preoperative patient characteristics, and then modeled survival with the additional variables of pathological stage and new baseline renal function. RESULTS On multivariate analysis cancer specific survival was equivalent for patients treated with partial nephrectomy or radical nephrectomy. Those patients undergoing radical nephrectomy lost significantly more renal function than those undergoing partial nephrectomy. The average excess loss of renal function observed with radical nephrectomy was associated with a 25% (95% CI 3-73) increased risk of cardiac death and 17% (95% CI 12-27) increased risk of death from any cause on multivariate analysis. CONCLUSIONS Partial nephrectomy offers cancer specific survival equivalent to that of radical nephrectomy and is technically feasible in at least 50% of patients with cT1b tumors. Preservation of renal function was significantly better in patients treated with partial nephrectomy. Postoperative renal insufficiency was a significant independent predictor of overall and cardiovascular specific survival, and efforts should be made to limit the renal function loss associated with surgery for localized renal masses.


title: The LUNG SAFE: a biased presentation of the prevalence of ARDS!

text: The recent Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) challenges current data on the prevalence of acute respiratory distress syndrome (ARDS). The LUNG SAFE investigators claimed that their data demonstrated the predictive validity of the Berlin criteria. Also, the LUNG SAFE showed a disturbingly large gap between scientific evidence and medical practice. All of these statements demand that we question the interpretations of the study's findings.


title: Hemodynamic and Bispectral Changes During Pin Insertion in Craniotomy - Effect of Locally Infiltrated Bupivacaine.

text: Introduction Cranial pins insertion is a method for head stabilization and together with the scalp incision is one of the biggest noxious stimulus associated with arousal and rapid increase of the blood pressure leading to pathological increase of the intracranial pressure. The aim of this investigation is to study the superiority of the locally infiltrated anesthetic bupivacaine just before the skull pin insertion and the scalp incision in craniotomy under general anesthesia. Methods In the study thirty patients of both genders aged 24-72 years were included. They were categorized as ASA 1 and 2 and divided into two group of 15 patients each, group B (bupivacaine) and group S (saline). We recorded the bispectral (BIS) index, the mean arterial pressure (MAP) and the pulse rate (PR) in five time intervals: t 0-2 min before pin insertion; t 1-2 min after pin insertion; t 2-5 min after; t 3-10 min after and t 4-15 min after. Results Significant difference p<0.05 was achieved in group S for all three followed parameters: blood pressure, heart rate and bispectral index. The difference is present in all four time intervals compared to the initial one before the pin insertion. With further analysis it was demonstrated that the investigated BIS index participates the most in the overall significance in group F. Conclusion The scalp infiltration with local anesthetic bupivacaine results with stable hemodynamic parameters and stable intracranial pressure during the painful procedures as craniotomy.


In Silico assessment of the impact of 2019 novel coronavirus (2019-nCoV) genomic variation on published real-time quantitative polymerase chain reaction detection assays.


title: Laparoscopic splenectomy: Current concepts.

text: Since early 1990's, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes.


title: The potential role of sciatic nerve stiffness in the limitation of maximal ankle range of motion.

text: It is a long held belief that maximal joint range of motion (ROM) is restricted by muscle tension. However, it exists indirect evidence suggesting that this assumption may not hold true for some joint configurations where non-muscular structures, such as the peripheral nerves, are stretched. Direct evidences are lacking. This study aimed to determine whether a static stretching aiming to load the sciatic nerve without stretch within plantar flexors is effective to: (i) alter nerve stiffness; and (ii) increase the ankle's maximal ROM. Passive maximal ankle ROM in dorsiflexion was assessed with the hip flexed at 90° (HIP-flexed) or neutral (HIP-neutral, 0°). Sciatic nerve stiffness was estimated using shear wave elastography. Sciatic nerve stretching induced both a 13.3 ± 7.9% (P < 0.001) decrease in the nerve stiffness and a 6.4 ± 2.6° increase in the maximal dorsiflexion ROM assessed in HIP-flexed. In addition, the decrease in sciatic nerve stiffness was significantly correlated with the change in maximal ROM in dorsiflexion (r = -0.571, P = 0.026). These effects occurred in the absence of any change in gastrocnemius medialis and biceps femoris stiffness, and ankle passive torque. These results demonstrate that maximal dorsiflexion ROM can be acutely increased by stretching the sciatic nerve, without altering the muscle stiffness.


title: Adherence to positive airway pressure treatment among minority populations in the US: A scoping review.

text: Minority individuals in the United States (US) have an increased prevalence of obstructive sleep apnea (OSA) compared to their white/Caucasian counterparts. In general, adherence to positive airway pressure (PAP) therapy is poor and some studies suggest that PAP use among minority individuals is inferior to that of whites. However, there has not been a review of the evidence that addresses racial-ethnic disparities for PAP adherence in the treatment of OSA, and no review has systematically examined the contributing factors to poor adherence among minority individuals compared to whites. We searched the literature for studies published between January 1990 to July 2016 that included objective PAP use comparisons between adult US minority individuals and whites. Twenty-two studies met the inclusion criteria. All studies compared the PAP adherence of blacks to whites. Seven studies compared the PAP adherence of additional minority groups to that of whites. Sixteen of the 22 studies (73%) showed worse PAP adherence in blacks compared to whites. Four studies found equivalent PAP use in US Hispanics compared to whites. Little is known about the PAP adherence of other US minority groups. We present a framework and research agenda for understanding PAP use barriers among US minority individuals.


title: Intraoperative air leak test was useful for the detection of a small biliary fistula: A rare case of non-parasitic hepatic cysts with biliary communication.

text: INTRODUCTION Symptomatic non-parasitic hepatic cysts with biliary communication are rare and no standard treatment has been established yet. Careful attention should be paid to avoidance of postoperative bile leakage during surgical treatment. PRESENTATION OF CASE We report the case of a 74-year-old man who visited our department complaining of right upper abdominal pain and elevated serum levels of the liver enzymes. Computed tomography revealed hepatic cysts including a large one measuring 16cm in diameter in Segments IV and VIII. Percutaneous drainage of the cyst revealed bile-staining of the cyst fluid. Endoscopic retrograde cholangiography demonstrated the presence of a cyst-biliary communication. We performed open deroofing of the cyst. During the operation, the biliary fistula was invisible, however, air injection into the bile duct through the stump of the cystic duct caused release of air bubbles from the cyst cavity, which allowed us to detect the small biliary orifice and repair it successfully by suture. DISCUSSION We utilized the intraoperative air leak test, which has previously been reported to be effective for preventing postoperative bile leakage in patients undergoing hepatectomy to detect of a small cyst-biliary communication in a case undergoing non-parasitic hepatic cyst surgery. CONCLUSION An intraoperative air leak test may be a useful test during surgical treatment of non-parasitic hepatic cysts with biliary communication.


title: SARS-CoV-2 more than a respiratory virus: Its potential role in neuropathogenesis.

text: Coronavirus disease-19 (COVID-19) pandemic has emerged as one of the major outbreaks to be mentioned in history in coming times. Like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a respiratory virus infecting the lungs with fever, dry cough and acute pneumonia being the major symptoms. It infects the epithelial cells expressing Angiotensin converting enzyme 2 (ACE2) receptor, which is crucial for the viral entry. Based on evolving clinical evidence, it is now unfitting to label SARS-CoV-2 as just a respiratory virus, as lately there are various reports that substantiate its pathogenicity in other organs of the body, including brain. In this review, we discuss the epidemiology of SARS-CoV-2 in comparison to SARS and MERS along with possibilities of viral entry into central nervous system (CNS) tissues. The review provides detailed information about the virulence, epidemiology and insights into molecular pathways involved in the infectivity of the SARS-CoV-2 virus, along with in-depth view of current concepts about the neurological significance of the SARS-CoV-2 virus and its neuropathological competence. The review also touches upon our current understanding of placental transmission of SARS-CoV-2, an important aspect of vertical transmission. Furthermore, the review provides the current update on strategies that have been used, being used or under trial for treating the disease.


title: Iliac artery stenosis complicating iliac vein stenting in a patient with a history of radiation and cancer: case report and literature review.

text: Radiation-associated venous stenosis is not as well described in the literature as radiation-induced arteritis and is mainly limited to case reports. Treatment of radiation-associated venous stenosis may be challenged by the patient's comorbidities, such as cancer, compressive tumor, or secondary thrombophilia. The endovascular treatment of venous occlusions is now widespread and is usually the preferred modality. This is especially true for lesions of the iliac venous system. However, the development of arterial stenosis after iliac vein stenting has not previously been reported in the literature as a complication. We present a case of left common iliac artery stenosis developing immediately after left iliac vein stenting for stenosis that developed secondary to extensive pelvic surgery and targeted radiotherapy. This case report illustrates the challenges in treating an iliac vein stenosis in a hostile pelvis, reports a previously unidentified complication of iliac vein stenting, documents the first reported cases of using kissing balloons in an artery and adjacent venous segment, and reviews the literature in regard to iliac vein and inferior vena cava stenting in patients with a history of neoplasm and radiation treatment.


title: A Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined With Isolated Aortic Valve Disease.

text: Isolated aortic valve diseases can lead to atrial fibrillation (AF) by causing left atrium pressure overload and enlargement. At present, most patients with preoperative AF and isolated aortic valve disease have undergone a Cox-maze IV procedure through a left atriotomy under cardiopulmonary bypass with aortic cross-clamping. Here, we describe a novel modified epicardial radiofrequency ablation procedure performed on a beating heart without aortic cross-clamping or opening the left atrium. This technique has proved to be safe and feasible, with good clinical outcomes. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.


title: COVID-19 S: A new proposal for diagnosis and structured reporting of COVID-19 on computed tomography imaging.

text: PURPOSE Because of the widespread use of CT in the diagnosis of COVID 19, indeterminate presentations such as single, few or unilateral lesions amount to a considerable number. We aimed to develop a new classification and structured reporting system on CT imaging (COVID-19 S) that would facilitate the diagnosis of COVID-19 in the most accurate way. METHODS Our retrospective cohort included 803 patients with a chest CT scan upon suspicion of COVID 19. The patients' history, physical examination, CT findings, RT PCR, and other laboratory test results were reviewed, and a final diagnosis was made as COVID 19 or non-COVID 19. Chest CT scans were classified according to the COVID 19 S CT diagnosis criteria. Cohen's kappa analysis was used. RESULTS Final clinical diagnosis was COVID-19 in 98 patients (12%). According to the COVID-19 S CT diagnosis criteria, the number of patients in the normal, compatible with COVID 19, indeterminate and alternative diagnosis groups were 581 (72.3%), 97 (12.1%), 16 (2.0%) and 109 (13.6%). When the indeterminate group was combined with the group compatible with COVID 19, the sensitivity and specificity of COVID-19 S were 99.0% and 87.1%, with 85.8% positive predictive value (PPV) and 99.1% negative predictive value (NPV). When the indeterminate group was combined with the alternative diagnosis group, the sensitivity and specificity of COVID-19 S were 93.9% and 96.0%, with 94.8% PPV and 95.2% NPV. CONCLUSION COVID-19 S CT classification system may meet the needs of radiologists in distinguishing COVID-19 from pneumonia of other etiologies and help optimize patient management and disease control in this pandemic by the use of structured reporting.


Covid-19: Third of surgeons do not have adequate PPE, royal college warns.


Este artículo analiza la cobertura mediática del avance de la pandemia de Covid-19 en Argentina y la medida de aislamiento social preventivo y obligatorio decretada por el gobierno nacional. Destaca tendencias problemáticas y buenas prácticas según un enfoque teórico-normativo, y las vincula con las características históricas del sistema de medios en el país. Utiliza una perspectiva teórico-metodológica que concibe a la comunicación como un derecho humano fundamental, esencial en una sociedad democrática y a los medios de comunicación de masas como vehículo fundamental para su ejercicio, y se apoya en las recomendaciones formuladas por organismos internacionales, organizaciones de la sociedad civil e instituciones nacionales. Se sostiene que los medios de comunicación de masas en la Argentina tienen la oportunidad histórica de mostrar la relevancia de su aporte no sólo para que enfrentar esta coyuntura, sino también para que salgamos de ella como una sociedad mejor y más justa.


title: No-touch ablation in hepatocellular carcinoma has the potential to prevent intrasubsegmental recurrence to the same degree as surgical resection.

text: AIM The aim of this study was to clarify the utility of a no-touch pincer ablation procedure that uses bipolar electrodes to prevent intrasubsegmental tumor recurrence after radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) compared to surgical resection. METHODS We evaluated 175 consecutive patients with HCC (single nodule, tumor diameter ≤ 30 mm) who underwent surgical resection (146 received partial resection) and 313 patients who received RFA; 277 patients received touch ablation using a monopolar or bipolar RFA device, and 36 received no-touch ablation using a bipolar RFA device. Pretreatment arterial and portal phase dynamic computed tomography (CT) or magnetic resonance imaging (MRI) images were classified into four enhancement patterns: Type 1 and Type 2 are homogeneous enhancement patterns without or with increased arterial blood flow, respectively; Type 3 is a heterogeneous enhancement pattern with a septum-like structure; and Type 4 is an irregularly shaped ring structure enhancement pattern. RESULTS Cumulative recurrence rates significantly differed between procedures (surgical resection, 7.5%; no-touch ablation, 2.9%; and touch ablation, 17.7% at the third year; P = 0.005). Multivariate Cox proportional hazards analysis revealed that enhancement pattern type (Type 3: hazard ratio [HR], 2.95; P = 0.002; and Type 4: HR, 3.88, P = 0.002), treatment procedure (touch ablation: HR, 3.36; P < 0.001), and serum α-fetoprotein level (≥30 μg/L: HR, 1.87; P = 0.009) were significant predictors of intrasubsegmental recurrence. No significant differences between no-touch ablation and surgical resection were observed. CONCLUSION The no-touch pincer ablation procedure has the potential to prevent intrasubsegmental recurrence after RFA for patients with HCC to the same degree as partial resection.


Virtually Perfect? Telemedicine for Covid-19.


title: Radiolabeled mannosylated dextran derivatives bearing an NIR-fluorophore for sentinel lymph node imaging.

text: Current methods for sentinel lymph node (SLN) mapping involve the use of radioactivity detection with technetium-99m sulfur colloid and/or visually guided identification using a blue dye. To overcome the kinetic variations of two individual imaging agents through the lymphatic system, we report herein on two multifunctional macromolecules, 5a and 6a, that contain a radionuclide ((99m)Tc or (68)Ga) and a near-infrared (NIR) reporter for pre- and/or intraoperative SLN mapping by nuclear and NIR optical imaging techniques. Both bimodal probes are dextran-based polymers (10 kDa) functionalized with pyrazole-diamine (Pz) or 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) chelating units for labeling with fac-[(99m)Tc(CO)3](+) or (68)Ga(III), respectively, mannose units for receptor targeting, and NIR fluorophore units for optical imaging. The probes allowed a clear visualization of the popliteal node by single-photon emission computed tomography (SPECT/CT) or positron emission tomography (PET/CT), as well as real-time optically guided excision. Biodistribution studies confirmed that both macromolecules present a significant accumulation in the popliteal node (5a: 3.87 ± 0.63% IA/organ; 6a: 1.04 ± 0.26% IA/organ), with minimal spread to other organs. The multifunctional nanoplatforms display a popliteal extraction efficiency >90%, highlighting their potential to be further explored as dual imaging agents.


title: Surgical management of Peyronie's disease.

text: Peyronie's disease (PD) has a significant impact on the quality of life of both patients and their partners due to the compromised sexual function and physical deformation resulting from the condition. PD is a connective tissue disorder marked by fibrotic healing of the tunica albuginea, leading to penile deformities including curvature, shortening, loss of girth, hourglass appearance, and hinging. Despite the multiple medical therapies available, surgery is the gold standard of treatment once the plaque has stabilized. We present a review of the disease process, preoperative evaluation, operative planning, surgical treatments with outcomes and complications, and nascent developments in surgical management and graft development. Options include tunical lengthening procedures, tunical shortening procedures, and penile prosthesis. Decision-making is governed by degree of curvature, erectile function, and associated penile deformities. In cases with curvature of less than 60-70 degrees, adequate penile length, and no hourglass deformity, patients are candidates for tunical shortening procedures. Patients with curvature greater than 60-70 degrees, penile hourglass or hinge-destabilizing deformities, and adequate erectile function should be counseled with regard to tunical lengthening procedures. Patients with poor preoperative erectile function should undergo inflatable penile prosthesis placement, with possible secondary straightening procedures. Technique selection should be based upon surgeon preference, expertise, and experience, as evidence does not necessarily support one procedure over another.


title: Multipurpose internal retractor for Single-incision surgery (SIS): single-institution case series.

text: Single-incision laparoscopic surgery (SIS) is less invasive than standard laparoscopic surgery; however, it is more difficult due to restriction of motion and the impossibility to use assistants. To overcome these obstacles, we developed a self-sustaining multipurpose internal retractor by attaching a Lone Star retractor hook to a laparoscopic bulldog clamp. Herein, we report our SIS experience using our novel retractor. Between October 2008 and April 2011, 104 patients underwent SIS using the internal retractor: 67 bandings (43% simultaneous hiatal hernia repair), 8 sleeve gastrectomies, 27 cholecystectomies, and 2 Nissen fundoplication. Mean age was 40 (range, 21 to 85) and mean body mass index was 40 kg/m (range, 20 to 64 kg/m). No intraoperative complications were observed from the use of the retractor but 2 cases required additional retraction due to liver size. This retractor has been successfully used for different SIS procedures showing to be safe, adaptable, and easy to use, lessening some challenges of SIS.


title: Duodenoduodenostomy for obstruction of the sigmoid flexure of the duodenum in cattle.

text: OBJECTIVE To describe clinical findings, surgical treatment, and outcome associated with duodenoduodenostomy for treatment of duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum. STUDY DESIGN Retrospective study (1996-2016). ANIMALS Fourteen Holstein cattle. METHODS Medical records of cows treated at 3 academic surgical referral centers with duodenoduodenostomy for duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum were reviewed. Data that were collected included signalment, physical examination results, laboratory results, diagnostic findings, treatments, and survival to discharge. Owners were contacted for follow-up information. RESULTS Affected cattle ranged in age from 4 months to 5 years. Electrolyte abnormalities, including severe hypochloremia, were present in all cases. Abnormalities included cranial duodenal distension without concurrent distension of the descending duodenum and palpable focal adhesions in the region of the sigmoid flexure of the duodenum. Duodenoduodenostomy involved a stapled (n = 11) or sutured (n = 3) side-to-side anastomosis between the cranial duodenum and descending duodenum. Thirteen of 14 cattle that were treated with duodenoduodenostomy survived to hospital discharge. Long-term follow-up was available in 8 cows, and 7 of those 8 survived for at least 1 year. CONCLUSION Short- and long-term survival were favorable after duodenoduodenostomy in cattle with adhesions associated with the sigmoid flexure of the duodenum. CLINICAL SIGNIFICANCE Duodenoduodenostomy results in acceptable survival and future productivity in cows with obstruction at the sigmoid flexure of the duodenum.


title: Mapping causal functional contributions derived from the clinical assessment of brain damage after stroke.

text: Lesion analysis reveals causal contributions of brain regions to mental functions, aiding the understanding of normal brain function as well as rehabilitation of brain-damaged patients. We applied a novel lesion inference technique based on game theory, Multi-perturbation Shapley value Analysis (MSA), to a large clinical lesion dataset. We used MSA to analyze the lesion patterns of 148 acute stroke patients together with their neurological deficits, as assessed by the National Institutes of Health Stroke Scale (NIHSS). The results revealed regional functional contributions to essential behavioral and cognitive functions as reflected in the NIHSS, particularly by subcortical structures. There were also side specific differences of functional contributions between the right and left hemispheric brain regions which may reflect the dominance of the left hemispheric syndrome aphasia in the NIHSS. Comparison of MSA to established lesion inference methods demonstrated the feasibility of the approach for analyzing clinical data and indicated its capability for objectively inferring functional contributions from multiple injured, potentially interacting sites, at the cost of having to predict the outcome of unknown lesion configurations. The analysis of regional functional contributions to neurological symptoms measured by the NIHSS contributes to the interpretation of this widely used standardized stroke scale in clinical practice as well as clinical trials and provides a first approximation of a 'map of stroke'.


title: [Beliefs and attitudes of health workers and nursing students toward an influenza pandemic in a region of Spain].

text: A survey was carried out during March-May 2017 to analyze the beliefs and attitudes of health workers and nursing students in the face of an influenza pandemic in Las Palmas de Gran Canaria, Spain. A high percentage doubted that there is a vaccine to protect them against an influenza pandemic, although workers showed greater certainty than students concerning access to a vaccine. Health workers showed themselves as more responsible for their work than students; i.e., 46.7% would be in favor of penalizing anyone who refused to go to work because there is a high percentage that put work before their responsibility toward themselves and their families. In conclusion, this study suggests promoting initiatives for reducing absenteeism, identifying those factors that would facilitate it, and having a contingency plan prepared in the event of an influenza pandemic.


Role of Social Media and Telemedicine in Diagnosis & Management of COVID-19; An Experience of the Iranian Society of Radiology.


title: Domesticated transposase Kat1 and its fossil imprints induce sexual differentiation in yeast.

text: Transposable elements (TEs) have had a major influence on shaping both prokaryotic and eukaryotic genomes, largely through stochastic events following random or near-random insertions. In the mammalian immune system, the recombination activation genes1/2 (Rag1/2) recombinase has evolved from a transposase gene, demonstrating that TEs can be domesticated by the host. In this study, we uncovered a domesticated transposase, Kluyveromyces lactis hobo/Activator/Tam3 (hAT) transposase 1 (Kat1), operating at the fossil imprints of an ancient transposon, that catalyzes the differentiation of cell type. Kat1 induces mating-type switching from mating type a (MATa) to MATα in the yeast K. lactis. Kat1 activates switching by introducing two hairpin-capped DNA double-strand breaks (DSBs) in the MATa1-MATa2 intergenic region, as we demonstrate both in vivo and in vitro. The DSBs stimulate homologous recombination with the cryptic hidden MAT left alpha (HMLα) locus resulting in a switch of the cell type. The sites where Kat1 acts in the MATa locus most likely are ancient remnants of terminal inverted repeats from a long-lost TE. The KAT1 gene is annotated as a pseudogene because it contains two overlapping ORFs. We demonstrate that translation of full-length Kat1 requires a programmed -1 frameshift. The frameshift limited Kat1 activity, because restoring the zero frame causes switching to the MATα genotype. Kat1 also was transcriptionally activated by nutrient limitation via the transcription factor mating type switch 1 (Mts1). A phylogenetic analysis indicated that KAT1 was domesticated specifically in the Kluyveromyces clade of the budding yeasts. We conclude that Kat1 is a highly regulated transposase-derived endonuclease vital for sexual differentiation.


title: Correction to: Phylogenetic Insight into Zika and Emerging Viruses for a Perspective on Potential Hosts.

text: The article Phylogenetic Insight into Zika and Emerging Viruses for a Perspective on Potential Hosts, written by Diana S. Weber, Karen A. Alroy, and Samuel M. Scheiner, was originally published Online First without open access.


N-95 respirator: gain in protection, pain in the face?


title: Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers.

text: BACKGROUND Although laparoscopic distal gastrectomy has been widely accepted in clinical practice, laparoscopic total gastrectomy (LTG) is not yet familiar because of the difficulty in esophagojejunostomy. The purpose of this study was to evaluate perioperative and short-term outcomes of our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. METHODS Of 98 consecutive patients who underwent LTG for gastric cancer in our department between August 2002 and December 2010, 94 patients underwent esophagojejunostomy with a linear stapling device. After October 2007, we modified the esophagojejunostomy; ie, the most recent 57 patients underwent transection of the esophagus in the ventrodorsal direction and insertion of a linear stapler from the anterior wall of the Roux limb to the posterior wall so as to make an inverted T-shaped anastomosis. We evaluated the results in these 57 patients (recent group) and compared them with the results in the earlier 37 patients (early group). RESULTS The mean operative time in the recent group was 368 to 94.6 min, and the mean estimated blood loss was 57 to 33 g; both were comparable with those in the early group. Neither open conversion nor intraoperative complications were encountered. Two patients experienced anastomotic leakage in the earlier group, but anastomotic leakage did not occur in the recent group. No mortality was encountered. CONCLUSION We herein report our procedure of intracorporeal gastrojejunostomy using linear staplers after LTG. Our procedure of esophagojejunostomy using linear staplers is safe and feasible and has acceptable morbidity.


title: Identifying the trends in wound-healing patents for successful investment strategies.

text: BACKGROUND Recently, the need for rapid wound-healing has significantly increased because of the increasing number of patients who are diagnosed with diabetes and obesity. These conditions have contributed to a surge in the number of patients with chronic wounds worldwide. Furthermore, many cost-effective wound-healing technologies have been developed in order to keep up with the increased demand. In this paper, we performed a quantitative study of the trends associated with wound-healing technologies using patent data. METHODOLOGY We analyzed the trends considering four different groups of patent applicants: firms, universities, research institutes, and individuals using a structural topic model. In addition, we analyzed the knowledge flow between patent applicants using citation analysis, and confirmed the role of applicants in the knowledge-flow network using k-means clustering. As a result, the primary wound-healing technology patents applied for by the four groups varied considerably, and we classified the roles of patent applicants were found in the knowledge-flow network. CONCLUSIONS Our results showed the organizations that are leading each area of wound-healing technology. Furthermore, from the results, we identified specific institutions that are efficient for spreading knowledge related to wound-healing technology based on the patents. This information can contribute to the planning of investment strategies and technology policies related to wound-healing.


title: Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis.

text: BACKGROUND Prolonged grief disorder (PGD) is a bereavement-specific syndrome expected to be included in the forthcoming ICD-11. Defining the prevalence of PGD will have important nosological, clinical, and therapeutic implications. The present systematic review and meta-analysis aimed to estimate the prevalence rate of PGD in the adult bereaved population, identify possible moderators, and explore methodological quality of studies in this area. METHODS A systematic literature search was conducted in PubMed, PsycINFO, Embase, Web of Science, and CINAHL. Studies with non-psychiatric, adult populations exposed to non-violent bereavement were included and subjected to meta-analytic evaluation. RESULTS Fourteen eligible studies were identified. Meta-analysis revealed a pooled prevalence of PGD of 9.8% (95% CI 6.8-14.0). Moderation analyses showed higher mean age to be associated with higher prevalence of PGD. Study quality was characterized by low risk of internal validity bias but high risk of external validity bias. LIMITATIONS The available studies are methodologically heterogeneous. Among the limitations are that only half the studies used registry-based probability sampling methods (50.0%) and few studies analyzed non-responders (14.3%). CONCLUSIONS This first systematic review and meta-analysis of the prevalence of PGD suggests that one out of ten bereaved adults is at risk for PGD. To allocate economic and professional resources most effectively, this result underscores the importance of identifying and offer treatment to those bereaved individuals in greatest need. Due to heterogeneity and limited representativeness, the findings should be interpreted cautiously and additional high-quality epidemiological research using population-based designs is needed.


Severity of COVID-19 and diabetes mellitus: there is still a lot to be learned.


title: Development of an infection screening system for entry inspection at airport quarantine stations using ear temperature, heart and respiration rates.

text: After the outbreak of severe acute respiratory syndrome (SARS) in 2003, many international airport quarantine stations conducted fever-based screening to identify infected passengers using infrared thermography for preventing global pandemics. Due to environmental factors affecting measurement of facial skin temperature with thermography, some previous studies revealed the limits of authenticity in detecting infectious symptoms. In order to implement more strict entry screening in the epidemic seasons of emerging infectious diseases, we developed an infection screening system for airport quarantines using multi-parameter vital signs. This system can automatically detect infected individuals within several tens of seconds by a neural-network-based discriminant function using measured vital signs, i.e., heart rate obtained by a reflective photo sensor, respiration rate determined by a 10-GHz non-contact respiration radar, and the ear temperature monitored by a thermography. In this paper, to reduce the environmental effects on thermography measurement, we adopted the ear temperature as a new screening indicator instead of facial skin. We tested the system on 13 influenza patients and 33 normal subjects. The sensitivity of the infection screening system in detecting influenza were 92.3%, which was higher than the sensitivity reported in our previous paper (88.0%) with average facial skin temperature.


title: Midterm cerebral outcomes of Stanford type A aortic dissection in patients who underwent novel triple-branched stent graft implantation combined with intraoperative monitoring of regional cerebral oxygen saturation.

text: OBJECTIVE The aim of this study was to evaluate the cerebral outcomes of patients underwent novel triple-branched stent graft implantation combined with the intraoperative monitoring of regional cerebral oxygen saturation. METHODS One hundred thirty-seven consecutive patients who underwent the surgery of triple-branched stent graft implantation in our department were enrolled in this retrospective case-control study. The patients in group A received brain protection based on the intraoperative monitoring of regional cerebral oxygen saturation and the patients in group B received conventional brain protection. The general clinical data, the types of corrective surgeries, the intraoperative situations, the postoperative complications, and the midterm outcomes of the patients were analyzed. RESULTS The incidence of postoperative cerebral dysfunction in the patients of group A was significantly lower than that in the patients in group B (3.2% vs 14.9%, P = .020). We found significant differences in the incubation times (30.3 ± 22.1 vs 42.3 ± 27.9 hours, P = .014), the lengths of intensive care unit stay (58.0 ± 54.3 vs 79.7 ± 55.5 hours, P = .004), and the hospital stays (19.3 ± 6.7 vs 24.9 ± 17.3 days, P = .045). A descending trend in the mortality rates was observed between the patients in the two groups based on the 20 months of observation; however, this trend was not statistically significant (1.6% vs 6.8%, P = .218). CONCLUSIONS The novel triple-branched stent graft implantation procedure combined with intraoperative monitoring of the regional cerebral oxygen saturation was an effective treatment for Stanford type A aortic dissection, with a relatively low incidence of postoperative cerebral dysfunction.


title: Paclitaxel-releasing balloon in femoropopliteal lesions using a BTHC excipient: twelve-month results from the BIOLUX P-I randomized trial.

text: PURPOSE To evaluate the safety and efficacy of the novel Passeo-18 Lux paclitaxel-coated balloon compared with the Passeo-18 uncoated balloon in patients with symptomatic de novo or restenotic femoropopliteal lesions. METHODS Sixty patients (34 men; mean age 70.7 ± 10.1 years) in 5 European centers were enrolled in the BIOLUX P-I trial (ClinicalTrials.gov identifier NCT01056120) and randomized 1:1 to either the paclitaxel-coated balloon or the uncoated balloon. The primary endpoint was late lumen loss at 6 months. Secondary endpoints were binary restenosis at 6 months, clinically driven target lesion revascularization (TLR), change in ankle-brachial index and Rutherford classification, and major adverse events at 6 and 12 months. RESULTS At 6 months, patients treated with paclitaxel-coated balloons had a significantly lower late lumen loss (0.51 ± 0.72 vs. 1.04 ± 1.00 mm, p = 0.033) and binary restenosis (11.5% vs. 34.6%, p = 0.048) than the control group. Correspondingly, clinically driven TLR was lower in the paclitaxel-coated balloon group at 12 months [15.4% vs. 41.7% (p = 0.064) for the intention-to-treat population and 16.0% vs. 52.9%, (p = 0.020) for the as-treated population]. No death and one minor amputation were observed compared with two deaths and two minor amputations in the control group. No major amputations or thrombosis were reported. CONCLUSION The Passeo-18 Lux paclitaxel-coated balloon has been proven to be safe and effective in patients with femoropopliteal lesions, with superior performance outcomes compared with treatment with an uncoated balloon.


Laboratory abnormalities in patients with COVID-2019 infection.


Excess Deaths From COVID-19 and Other Causes, March-April 2020.


title: The myth of pulmonary metastasectomy.

text: Pulmonary metastasectomy is widely and increasingly practiced in the belief that this intervention can cure patients with colorectal cancer, and that without it few survive 5 years. No good evidence exists supporting such convictions, indeed recent trial results challenge them. What evidence underpins this acceptance of illusory truths or misconceptions?


title: Livebirth and utero-placental insufficiency in Papio hamadryas baboons with uterus angiosome perfused by bilateral utero-ovarian microsurgical anastomoses alone.

text: STUDY QUESTION Can the baboon uterus support a gestation to livebirth with an angiosome using microsurgically anastomosed utero-ovarian vessels and lacking uterine arteries and veins? SUMMARY ANSWER Our angiosome model allows healthy livebirth albeit with risk of fetal growth restriction and stillbirth. WHAT IS KNOWN ALREADY Uterine transplant can provide livebirth in humans, but requires a living donor to undergo a prolonged laparotomy for hysterectomy. In an attempt to avoid the time-consuming dissection of the uterine vein, our group has previously shown maintenance of baboon uterine menstrual function after ligation of the uterine vein and after ligation of both the uterine artery and uterine vein. STUDY DESIGN, SIZE, DURATION In a 19-month timespan, three baboons underwent laparotomy to surgically alter uterine perfusion, and pregnancy outcomes were monitored after spontaneous mating in a breeding colony. PARTICIPANTS/MATERIALS, SETTING, METHODS Three nulligravid female Papio hamadryas baboons in a breeding colony underwent laparotomy to ligate uterine arteries and veins along with colpotomy and cervico-vaginal anastomosis. During the same surgery, the utero-ovarian arteries and veins were microsurgically transected and re-anastomosed to themselves. Intraoperative organ perfusion was confirmed with laser angiography. After a recovery period, monitoring of menstrual cycling via menstrual blood flow and sex-skin cycling occurred, as well as uterine viability via sonography and cervical biopsy. Each baboon was released to the breeding colony for spontaneous mating and pregnancies dated by menstrual calendar and compared with early ultrasound. Delivery outcomes were monitored in each including neonate weight and placental pathology. In the event of a stillbirth, the animal was returned to the breeding colony for repeat mating attempts. After achieving a livebirth, the maternal baboon was removed from the study. MAIN RESULTS AND THE ROLE OF CHANCE Each baboon in the trial underwent successful surgery with all uteri demonstrating viability and return of menstrual function within 10 weeks of surgery. Pregnancies occurred within two menstrual cycles in breeding colony. Baboons one and two initially had vaginal breech stillbirths, both with appearance of placental insufficiency, and one with fetal growth restriction. Baboon three underwent scheduled cesarean delivery resulting in a normally grown livebirth. Baboon one had a subsequent pregnancy resulting in a livebirth via cesarean delivery. LIMITATIONS, REASONS FOR CAUTION Stillbirth in two of four gestations, and fetal growth restriction in one of four, are the largest concerns in our perfusion model. It remains uncertain whether the stillbirths resulted from placental insufficiency, or birth trauma from breech deliveries. WIDER IMPLICATIONS OF THE FINDINGS The success of two livebirths warrants further attempts at improving consistency of our proposed uterine angiosome. This may allow living uterine donors to undergo less-invasive and shorter donor hysterectomy procedures. STUDY FUNDING/COMPETING INTEREST(S) The study had no external sponsors, and was supported by the Cleveland Clinic Foundation. Some equipment was loaned without cost to the research team including a laser angiography system courtesy of Novadaq Technologies, Inc. (Missaugua, ON, Canada) and a surgical microscope courtesy of DB Surgical (Coral Springs, FL, USA). B.B., K.A., M.S., K.R., M.M., P.F.E., A.T. and T.F. have no conflicts of interest. M.L.S. and S.Z. report activity as consultants for Medtronic-Covidien, and S.Z. also is a consultant to Applied Medical.


title: CMS Responds to COVID-19 Crisis by Revising Regulations.

text: The Centers for Medicare & Medicaid Services (CMS) and other federal agencies are busy churning out regulations and guidance documents in response to the COVID-19 crisis. CMS now requires plans to waive cost sharing for COVID-19-related immunizations, testing, and treatment and suspend utilization review requirements related to drug-supply limits unless these limits are related to patient safety.


Gastrointestinal: Ileo-anal J-pouch intraluminal bridge causing obstruction and bleeding.


Allocation of Resources During Crisis: Data Infused With Wisdom, Ethics, and Transparency.


title: Near-infrared spectroscopy to indicate selective shunt use during carotid endarterectomy.

text: OBJECTIVES This study assessed the value of cerebral near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) in relation to electroencephalography (EEG) changes for the detection of cerebral hypoperfusion necessitating shunt placement during carotid endarterectomy (CEA). METHODS This was a prospective cohort study. Patients with a sufficient TCD window undergoing CEA from February 2009 to June 2011 were included. All patients were continuously monitored with NIRS and EEG. An intraluminal shunt was placed, selectively determined by predefined EEG changes in alpha, beta, theta, or delta activity. Relative changes in regional cerebral oxygen saturation (rSO2) in the frontal lobe and mean blood flow velocity (Vmean) 30 seconds before carotid cross-clamping versus 2 minutes after carotid cross-clamping were related to shunt placement. Receiver operating characteristic curve analysis was performed to determine the optimal thresholds. Diagnostic values were reported as positive and negative predictive value (PPV and NPV). RESULTS Of a cohort of 151 patients, 17(11%) showed EEG changes requiring shunt placement. The rSO2 and Vmean decreased more in the shunt group than in the non-shunt group (mean ± standard error of the mean) 21 ± 4% versus 7 ± 5% and 76 ± 6% versus 12 ± 3%, respectively (p < .005), Receiver operating characteristic curve analysis revealed a threshold of 16% decrease in rSO2 (PPV 76% and NPV 99%) and 48% decrease in Vmean (PPV 53% and NPV 99%) as the optimal cut-off value to detect cerebral ischemia during CEA under general anesthesia. CONCLUSIONS Compared with EEG, we found moderate PPV but high NPV for NIRS and TCD to detect cerebral ischemia during CEA under general anesthesia, meaning that both techniques independently may be suitable to exclude patients for unnecessary shunt use and to direct the use of selective shunting. However, the optimal thresholds for NIRS remain to be determined.


title: The feasibility of robotic left-side hepatectomy with comparison of laparoscopic and open approach: Consecutive series of single surgeon.

text: BACKGROUND Recent studies report safety and effectiveness of robotic hepatectomy. In present study, we describe our initial experiences with robotic hepatectomy, focusing on left-side procedures. METHODS A retrospective review was conducted of 13, 10, and 11 consecutive patients who underwent robotic, laparoscopic, and open left-side hepatectomy by the single surgeon. RESULTS There were no significant differences in the estimated blood loss, application of Pringle maneuver, postoperative hospital stays, number of IV analgesic injections, or postoperative complications between the robotic and laparoscopic groups. The robotic group had a smaller number of patients applied a Pringle maneuver (8.3 vs 90.9%, P < 0.001), a shorter postoperative hospital stays (7.0 vs 9.0 days, P = 0.044), and a less use of IV analgesics (2.8 vs 8.2, P = 0.005) than the open group. CONCLUSIONS From our initial experiences, a robotic left-side hepatectomy seems to be a feasible and safe procedure when compared with the laparoscopic and open left-side hepatectomies.


title: Predictors Of Treatment Failure After Radiofrequency Ablation For Intramucosal Adenocarcinoma in Barrett Esophagus: A Multi-institutional Retrospective Cohort Study.

text: Radiofrequency ablation (RFA), with or without endoscopic mucosal resection (EMR), is a safe, effective, and durable treatment option for Barrett esophagus (BE)-associated dysplasia (DYS), but few studies have identified predictors of treatment failure in BE-associated intramucosal adenocarcinoma (IMC). The aim of this study was to determine the rate of IMC eradication when using RFA±EMR and to identify clinical and pathologic predictors of treatment failure. A retrospective review of medical records and a central review of index histologic parameters were performed for 78 patients who underwent RFA±EMR as the primary treatment for biopsy-proven IMC at 4 academic tertiary medical centers. Complete eradication (CE) (absence of IMC/DYS on first follow-up endoscopy) was achieved in 86% of patients, and durable eradication (DE) (CE with no recurrence of IMC/DYS until last follow-up) was achieved in 78% of patients, with significant variation between the 4 study sites (P=0.03 and 0.09 by analysis of variance for DE and CE, respectively). Use of EMR before RFA significantly reduced the risk for treatment failure for IMC/DYS (hazard ratio, 0.15; 95% confidence interval, 0.05-0.48; P=0.001), whereas IMC involving ≥50% of the columnar metaplastic area on index examination significantly increased the risk for treatment failure (hazard ratio, 4.24; 95% confidence interval, 1.53-11.7; P=0.005). Endoscopic and pathologic factors associated with treatment failure in BE-associated IMC treated with RFA±EMR may help identify the subset of IMC patients for whom a more aggressive initial approach may be justified.


title: Multi frequency phase fluorimetry (MFPF) for oxygen partial pressure measurement: ex vivo validation by polarographic clark-type electrode.

text: BACKGROUND Measurement of partial pressure of oxygen (PO2) at high temporal resolution remains a technological challenge. This study introduces a novel PO2 sensing technology based on Multi-Frequency Phase Fluorimetry (MFPF). The aim was to validate MFPF against polarographic Clark-type electrode (CTE) PO2 measurements. METHODOLOGY/PRINCIPAL FINDINGS MFPF technology was first investigated in N = 8 anaesthetised pigs at FIO2 of 0.21, 0.4, 0.6, 0.8 and 1.0. At each FIO2 level, blood samples were withdrawn and PO2 was measured in vitro with MFPF using two FOXY-AL300 probes immediately followed by CTE measurement. Secondly, MFPF-PO2 readings were compared to CTE in an artificial circulatory setup (human packed red blood cells, haematocrit of 30%). The impacts of temperature (20, 30, 40°C) and blood flow (0.8, 1.6, 2.4, 3.2, 4.0 L min(-1)) on MFPF-PO2 measurements were assessed. MFPF response time in the gas- and blood-phase was determined. Porcine MFPF-PO2 ranged from 63 to 749 mmHg; the corresponding CTE samples from 43 to 712 mmHg. Linear regression: CTE = 15.59+1.18*MFPF (R(2) = 0.93; P<0.0001). Bland Altman analysis: meandiff 69.2 mmHg, rangediff -50.1/215.6 mmHg, 1.96-SD limits -56.3/194.8 mmHg. In artificial circulatory setup, MFPF-PO2 ranged from 20 to 567 mmHg and CTE samples from 11 to 575 mmHg. Linear regression: CTE = -8.73+1.05*MFPF (R(2) = 0.99; P<0.0001). Bland-Altman analysis: meandiff 6.6 mmHg, rangediff -9.7/20.5 mmHg, 1.96-SD limits -12.7/25.8 mmHg. Differences between MFPF and CTE-PO2 due to variations of temperature were less than 6 mmHg (range 0-140 mmHg) and less than 35 mmHg (range 140-750 mmHg); differences due to variations in blood flow were less than 15 mmHg (all P-values>0.05). MFPF response-time (monoexponential) was 1.48±0.26 s for the gas-phase and 1.51±0.20 s for the blood-phase. CONCLUSIONS/SIGNIFICANCE MFPF-derived PO2 readings were reproducible and showed excellent correlation and good agreement with Clark-type electrode-based PO2 measurements. There was no relevant impact of temperature and blood flow upon MFPF-PO2 measurements. The response time of the MFPF FOXY-AL300 probe was adequate for real-time sensing in the blood phase.


title: Fat Grafting Can Induce Browning of White Adipose Tissue.

text: Background Fat grafting is commonly used when treating soft-tissue defects. However, much of the basic biology behind fat transfer is still uncovered. Adipocytes can be divided into energy storing white and energy burning brown adipose cells. It is now well known, that also adult humans have metabolically active brown adipose tissue (BAT) within white adipose tissue (WAT). Previously our group showed that transfer of metabolically inactive WAT into a new environment increased the metabolic activity of the fat grafts to resemble the activity in the recipient site and that different WAT depots have variation in the metabolic activity. This led us to speculate, whether the metabolic increase of the graft is a result of "browning" of the transferred WAT toward beige adipose tissue. Methods We investigated the metabolic and histological characteristics and BAT marker Ucp1 gene expression in different types of WAT grafts placed either in subcutaneous or muscle tissue in mice. Metabolic activity of the grafts was investigated by FDG-PET/CT at 4- and 12-week time-points. Results The glucose uptake of all transferred fat types was increased when compared with respective control WAT regardless of transfer location. Ucp1 gene and protein expression was increased in 4 of 15 intramuscularly placed fat graft samples and showed histological resemblance to BAT with multilocular cells. Conclusions Grafting of metabolically inactive fat intramuscularly may induce browning of fat grafts toward more active beige adipose tissue. This opens up new research areas in exploiting fat grafting in metabolic diseases.


title: Strong antimicrobial coatings: single-walled carbon nanotubes armored with biopolymers.

text: Large scale biomimetic single-walled carbon nanotube (SWNT) coatings with significant antimicrobial activity, high Young's Modulus, and controlled morphology were fabricated using layer-by-layer assembly. Thickness was controlled within 1.6 nm and SWNT orientation was controlled using a directed air stream. This unique blend of multifunctionality and vertical and lateral control of a bottom-up assembly process is a significant advancement in developing macroscale assemblies with the combined attributes of SWNTs and natural materials.


title: Rice stripe virus hitchhikes the vector insect vitellogenin ligand-receptor pathway for ovary entry.

text: It is known that plant arboviruses infect insect vector cells by endocytosis; however, the cellular receptors that mediate endocytosis have not been well defined. In our recently published work and this study, by clarifying the vertical transmission mechanism of Rice stripe virus (RSV) in Laodelphax striatellus, we provide a novel paradigm for how arboviruses enter insect germ-line cells. Instead of direct interaction with a viral receptor, the virus binds to a secreted ligand protein, hitchhiking the ligand-receptor pathway to achieve cell entry. Vitellogenin (Vg) is an indispensable protein for embryo development that is synthesized extra-ovarially and taken up by germ-line cells through Vg receptor (VgR)-mediated endocytosis. After revealing that RSV invades L. striatellus ovary by a specific molecular interaction with the insect Vg in haemolymph, this study addressed VgR's function in mediating the RSV invasion of the germarium nurse cells, further confirming the ligand's receptor-mediated viral cell-invasion mechanism. Understanding the viral ovary-entry pathways in vectors will help to find suitable measures to block the trans-generation transmission of the viruses. This article is part of the theme issue 'Biotic signalling sheds light on smart pest management'.


Waiting for Certainty on Covid-19 Antibody Tests - At What Cost?


Survival of patients diagnosed with subsets of lymphoid neoplasms and acute myeloid leukemia from 2000 to 2010 in the Vale do Paraíba, State of São Paulo are we going the right way?


Esophageal Perforation After Pneumatic Dilation for Achalasia: Successful Closure With an Over-the-Scope Clip.


title: Spillover Effects on Caregivers' and Family Members' Utility: A Systematic Review of the Literature.

text: BACKGROUND A growing body of research has identified health-related quality-of-life effects for caregivers and family members of ill patients (i.e. 'spillover effects'), yet these are rarely considered in cost-effectiveness analyses (CEAs). OBJECTIVE The objective of this study was to catalog spillover-related health utilities to facilitate their consideration in CEAs. METHODS We systematically reviewed the medical and economic literatures (MEDLINE, EMBASE, and EconLit, from inception through 3 April 2018) to identify articles that reported preference-based measures of spillover effects. We used keywords for utility measures combined with caregivers, family members, and burden. RESULTS Of 3695 articles identified, 80 remained after screening: 8 (10%) reported spillover utility per se, as utility or disutility (i.e. utility loss); 25 (30%) reported a comparison group, either population values (n = 9) or matched, non-caregiver/family member or unaffected individuals' utilities (n = 16; 3 reported both spillover and a comparison group); and 50 (63%) reported caregiver/family member utilities only. Alzheimer's disease/dementia was the most commonly studied disease/condition, and the EQ-5D was the most commonly used measurement instrument. CONCLUSIONS This comprehensive catalog of utilities showcases the spectrum of diseases and conditions for which caregiver and family members' spillover effects have been measured, and the variation in measurement methods used. In general, utilities indicated a loss in quality of life associated with being a caregiver or family member of an ill relative. Most studies reported caregiver/family member utility without any comparator, limiting the ability to infer spillover effects. Nevertheless, these values provide a starting point for considering spillover effects in the context of CEA, opening the door for more comprehensive analyses.


title: Porcine deltacoronavirus enters cells via two pathways: A protease-mediated one at the cell surface and another facilitated by cathepsins in the endosome.

text: Porcine deltacoronavirus (PDCoV) is a pathogen belonging to the genus Deltacoronavirus that in 2014 caused outbreaks of piglet diarrhea in the United States. To identify suitable therapeutic targets, a more comprehensive understanding of the viral entry pathway is required, particularly of the role of proteases. Here, we identified the proteases that activate the viral spike (S) glycoprotein to initiate cell entry and also pinpointed the host-cellular pathways that PDCoV uses for entry. Our results revealed that cathepsin L (CTSL) and cathepsin B (CTSB) in lysosomes and extracellular trypsin in cell cultures independently activate the S protein for membrane fusion. Pretreating the cells with the lysosomal acidification inhibitor bafilomycin-A1 (Baf-A1) completely inhibited PDCoV entry, and siRNA-mediated ablation of CTSL or CTSB expression significantly reduced viral infection, indicating that PDCoV uses an endosomal pathway for entry. Of note, trypsin treatment of cell cultures also activated PDCoV entry, even when the endosomal pathway was inhibited. This observation indicated that trypsin-induced S protein cleavage and activation in cell cultures enables viral entry directly from the cell surface. Our results provide critical insights into the PDCoV infection mechanism, uncovering two distinct viral entry pathways: one through cathepsin L and cathepsin B in the endosome and another via a protease at the cell surface. Because PDCoV infection sites represent a proteases-rich environment, these findings suggest that endosome inhibitor treatment alone is insufficient to block PDCoV entry into intestinal epithelial cells in vivo Therefore, approaches that inhibit viral entry from the cell membrane should also be considered.