title: An Acute Mouse Spinal Cord Slice Preparation for Studying Glial Activation ex vivo.

text: Pathological conditions such as amyotrophic lateral sclerosis, spinal cord injury and chronic pain are characterized by activation of astrocytes and microglia in spinal cord and have been modeled in rodents. In vivo imaging at cellular level in these animal models is limited due to the spinal cord's highly myelinated funiculi. The preparation of acute slices may offer an alternative and valuable strategy to collect structural and functional information in vitro from dorsal, lateral and ventral regions of spinal cord. Here, we describe a procedure for preparing acute slices from mouse spinal cord (Garré et al., 2016). This preparation should allow further understanding of how glial cells in spinal cord respond acutely to various inflammatory challenges.


An infectious disease epidemic and resilience to suicide.


title: Does ovarian suspension following laparoscopic surgery for endometriosis reduce postoperative adhesions? An RCT.

text: STUDY QUESTION Is temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis an effective method for reducing the prevalence of postoperative ovarian adhesions? SUMMARY ANSWER Temporary ovarian suspension for 36-48 h following laparoscopic treatment of severe endometriosis does not result in a significant reduction of postoperative ovarian adhesions. WHAT IS KNOWN ALREADY Pelvic adhesions often develop following laparoscopic surgery for severe pelvic endometriosis. Adhesions can cause chronic pelvic pain and fertility problems compromising the success of treatment. Small observational studies suggested that temporary postoperative ovarian suspension to the abdominal wall may significantly reduce the prevalence of postoperative ovarian adhesions. STUDY DESIGN, SIZE, DURATION This was a prospective within group comparison double-blind RCT. We recruited premenopausal women with severe pelvic endometriosis who required extensive laparoscopic surgery with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion were determined at surgery. A total of 55 women were randomized to unilateral ovarian suspension for 36-48 h, 52 of which were included in the final analysis. Both ovaries were routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each woman was randomized to having only one ovary suspended postoperatively. The suture suspending the contralateral ovary was cut and a new transabdominal suture was inserted to act as a placebo. Both sutures were removed 36-48 h after surgery prior to discharge. Three months after surgery, all women attended for a detailed transvaginal ultrasound scan to assess ovarian mobility. Both the women and the ultrasound operators were blinded as to the side of postoperative ovarian suspension. The primary outcome was the prevalence of ovarian adhesions as described on ultrasound examination. Secondary outcomes were the severity of adhesions and the presence and intensity of postoperative pain. PARTICIPANTS/MATERIALS, SETTING, METHODS All 55 participants had severe pelvic endometriosis confirmed at laparoscopy. As each participant had only one of their ovaries suspended at the end of surgery, they acted as their own control. MAIN RESULTS AND THE ROLE OF CHANCE The median interval between ovarian suspension and postoperative scan was 99 days (interquartile range 68-114). There was no significant difference (P = 0.23) in the prevalence of postoperative ovarian adhesions between the suspended (20/52) and unsuspended (27/52) side (38.5 versus 51.9%) [odds ratio 0.56 (95% confidence interval 0.22-1.35)]. LIMITATIONS, REASONS FOR CAUTION Ovaries were suspended postoperatively for 36-48 h. Longer suspension could result in lower prevalence of postoperative adhesions. WIDER IMPLICATIONS OF THE FINDINGS The value of temporary ovarian suspension in women having surgery for mild-to-moderate endometriosis should be investigated further. The potential benefits of other adhesion prevention strategies, such as surgical barrier agents, in women undergoing surgical treatment for severe pelvic endometriosis should also be explored. STUDY FUNDING/COMPETING INTERESTS E.S. received honoraria from Ethicon for provision of training to healthcare professionals and consultancy fees from Bayer. W.H. was supported by the research fund provided by the Gynaecology Ultrasound Centre, London UK. A.C. is on the advisory board for surgical innovations for which he receives an annual honorarium. A.C. also received support for courses and education from Storz and Johnson and Johnson and support for clinical nursing from Covidien and Lotus. The other authors declared no competing interests. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN24242218.


title: How transparent film applied on dermatologic imaging devices in order to prevent infections affects image quality?

text: BACKGROUND In the clinical practice, transparent films are used as sterile interfaces in in vivo dermatologic imaging in order to prevent the transmissions of infections. However, in our experience, the use of a transparent film can alter skin images. Our study aimed to compare the optical quality of a series of different plastic films used as interfaces in order to understand if some might be more suitable for imaging. MATERIALS AND METHODS We tested the optical properties of 11 different protective transparent films that are marketed in France with a transparency meter and a spectrophotometer. RESULTS Transmission, minimal diffusion, amount of gray, and contrast were obtained for each transparent film. Transmission ranged from 93.24% to 96.88% (mean 95.36; standard deviation SD 1.02), minimal diffusion from 88.28% to 123.87% (mean 101.04; standard deviation SD 10.02) and contrast from 11.01 to 15.88 (mean 13.93 and SD 1.3). For some films, the transmission was lower at lower wavelengths. CONCLUSION All tested films had excellent optical properties. However, some of them had better optical qualities and seemed more suitable for their use in dermatologic imaging.


title: Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature.

text: BACKGROUND First-time peripheral intravenous catheter (PIVC) insertion success is dependent on patient, clinician, and product factors. Failed PIVC insertion are an under-recognized clinical phenomenon. OBJECTIVE To provide a scoping review of decision aids for PIVC insertion including tools, clinical prediction rules, and algorithms (TRAs) and their findings on factors associated with insertion success. METHODS In June 2016, a systematic literature search was performed using the medical subject heading of peripheral catheterization and tool* or rule* or algorithm*. Data extraction included clinician, patient, and/or product variables associated with PIVC insertion success. Information about TRA reliability, validity, responsiveness, and utility was also extracted. RESULTS We screened 36 studies, and included 13 for review. Seven papers reported insertion success ranging from 61%-90% (4030 insertion attempts), 6 on validity, and 5 on reliability, with none reporting on responsiveness and utility. Failed insertions were associated with obesity (odds ratio [OR], 0.71-1.7; 2 studies) and smaller gauge PIVCs (OR, 6.4; 95% Confidence Interval [CI}, 3.4-11.9). Successful inser tions were associated with visible veins (OR, 0.87-3.63; 3 studies) or palpable veins (OR, 0.79-5.05; 3 studies) and inserters with greater procedural volume (OR, 4.4; 95% CI, 1.6-12.1) or who predicted that insertion would be successful (OR, 1.06; 95% CI, 1.04-1.07). Definitions of insertion difficulty are heterogeneous such as time to insert to a number of failed attempts. CONCLUSIONS Few well-validated reliable TRAs exist for PIVC insertion. Patients would benefit from a validated, clinically pragmatic TRA that matches insertion difficulty with clinician competency.


title: Immunoinflammatory response and bioactive potential of GuttaFlow bioseal and MTA Fillapex in the rat subcutaneous tissue.

text: To evaluate the effect of GuttaFlow bioseal (GFB) and MTA Fillapex (MTAF) in comparison with Endofill (EF) in the subcutaneous tissue. Polyethylene tubes with GFB, MTAF, EF or empty tubes (control group; CG) were implanted into subcutaneous of rats. After 7, 15, 30 and 60 days, the capsule thickness, inflammatory reaction, interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), caspase-3, TUNEL-positive cells, von Kossa and ultrastructural features were evaluated. The data were statistically analyzed (p ≤ 0.05). At all periods, the number of IL-6- and VEGF-immunolabelled cells, and capsule thickness were lower in GFB than MTAF, which was lower than EF (p < 0.0001). At 60 days, the number of inflammatory cells was similar in GFB and MTAF (p = 0.58). Significant differences in the number of TUNEL- and caspase-3-positive cells were not observed among GFB, MTAF and CG whereas the highest values were found in EF specimens. The EF specimens exhibited several cells with condensed chromatin, typical of apoptosis. von Kossa-positive and birefringent structures were only observed in GFB and MTAF, suggesting the presence of calcite crystals. Taken together, these results show that cellular and structural damage induced by GFB and MTAF sealers were recovery over time. Moreover, these sealers express bioactive potential in subcutaneous tissue.


title: Radiology department preparedness for COVID-19 - experience of a central-London hospital.

text: The COVID-19 pandemic has placed significant strain on healthcare systems across the world, requiring rapid adaptation and a change in approach to the delivery of healthcare services. Although not always immediately at the frontline, radiology has a key role in the effort against the SARS-CoV-2 virus. Radiology preparedness, including the development of a set of policies and procedures designed to acquire and maintain enough capacity to support the ongoing care needs of patients both with and without COVID-19, is essential in this modern-day healthcare crisis of unprecedented magnitude.


title: Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

text: A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.


Hydroxychloroquine and coronavirus disease 19.


title: Intraspecies diversity of SARS-like coronaviruses in Rhinolophus sinicus and its implications for the origin of SARS coronaviruses in humans.

text: The Chinese rufous horseshoe bat (Rhinolophus sinicus) has been suggested to carry the direct ancestor of severe acute respiratory syndrome (SARS) coronavirus (SCoV), and the diversity of SARS-like CoVs (SLCoV) within this Rhinolophus species is therefore worth investigating. Here, we demonstrate the remarkable diversity of SLCoVs in R. sinicus and identify a strain with the same pattern of phylogenetic incongruence (i.e. an indication of recombination) as reported previously in another SLCoV strain. Moreover, this strain possesses a distinctive 579 nt deletion in the nsp3 region that was also found in a human SCoV from the late-phase epidemic. Phylogenetic analysis of the Orf1 region suggested that the human SCoVs are phylogenetically closer to SLCoVs in R. sinicus than to SLCoVs in other Rhinolophus species. These findings reveal a closer evolutionary linkage between SCoV in humans and SLCoVs in R. sinicus, defining the scope of surveillance to search for the direct ancestor of human SCoVs.


title: Robotics confers an advantage in right hemicolectomy with intracorporeal anastomosis when matched against conventional laparoscopy.

text: Comparisons between robotic and laparoscopic right hemicolectomy have been confounded by variations in operative technique. This study evaluates the two procedures after standardizing the intraoperative steps and perioperative management. Patients who underwent robotic right hemicolectomy with intracorporeal bowel anastomosis between July 2015 and June 2017 were matched with a laparoscopic group. Perioperative management was in accordance to an enhanced recovery protocol. Outcomes and histopathological data were compared. Thirty-two patients were included. Amongst the patients who did not undergo complete mesocolic excision, the median operative time did not differ between the two groups (p = 0.413). The robotic group recorded a statistically shorter time for intracorporeal anastomosis (13 vs 19 min, p = 0.024). Postoperative recovery and complication rates were similar, except for a greater lymph node harvest in the robotic group (41 vs 31, p = 0.038). Robotic surgery achieves short-term results comparable to existing conventional laparoscopy, notwithstanding the advantages of enhanced ergonomics.


title: Gadobenate dimeglumine (MultiHance) in MR angiography: an in-vitro phantom comparison with gadopentetate dimeglumine (Magnevist) at different concentrations.

text: BACKGROUND Numerous clinical studies suggest that gadobenate dimeglumine is diagnostically superior to other gadolinium chelates for MR imaging applications, including contrast-enhanced MR angiography (CE-MRA). However, confirmatory in-vitro phantom studies have thus far been lacking. PURPOSE To evaluate the difference in signal intensity achieved with the high-relaxivity MR contrast agent gadobenate dimeglumine (MultiHance) relative to that achieved with the standard-relaxivity non-specific agent gadopentetate dimeglumine (Magnevist) at different concentrations using an in-vitro phantom study design. MATERIAL AND METHODS Test tubes with whole human blood were prepared with concentrations of gadobenate dimeglumine or gadopentetate dimeglumine ranging from 0 to 12 mM. A three-dimensional (3D) T1-weighted gradient echo sequence normally used for CE-MRA of the renal arteries was performed at flip angles of 25° and 35°. The signal-to-noise ratio (SNR) was calculated for all concentrations of both contrast agents. Furthermore a Look-Locker sequence was used and quantitative T1 mapping was performed for all the test tubes. The contrast agent concentration in the aorta was simulated using previously published data on T1 in the aorta during the first pass of a contrast agent. The differences between gadobenate dimeglumine and gadopentetate dimeglumine were compared at the simulated concentrations. RESULTS The SNR achieved with gadobenate dimeglumine was consistently greater than that achieved with gadopentetate dimeglumine at all concentrations. An improvement of 15-25% in SNR was obtained when increasing the flip angle from 25° to 35°. The relative improvement in SNR with gadobenate dimeglumine relative to gadopentetate dimeglumine ranged from 25-72% and was markedly greater at lower concentrations with a flip angle of 35°. CONCLUSION Our findings suggest that the relative benefit of gadobenate dimeglumine over gadopentetate dimeglumine for CE-MRA applications is greater at lower concentrations.


title: Studies on viral pneumonia related to novel coronavirus SARS-CoV-2, SARS-CoV, and MERS-CoV: a literature review.

text: Coronaviruses are a class of RNA viruses that can cause respiratory and intestinal infections in animals and humans. SARS-CoV, MERS-CoV and a novel coronavirus (SARS-CoV-2 [2019-nCoV]) belong to the family Coronaviridae and the genus Betacoronavirus. At present, the understanding of SARS-CoV-2 is getting deeper and deeper. In order to better prevent and treat SARS-CoV-2, this article compares the infectivity, pathogenicity, and related clinical characteristics of the three human pathogenic coronaviruses, SARS-CoV-2, SARS-CoV and MERS-CoV to help us further understand the pathogenic characteristics of novel coronaviruses.


title: Molecular docking revealed the binding of nucleotide/side inhibitors to Zika viral polymerase solved structures.

text: A new Zika virus (ZIKV) outbreak started in 2015. According to the World Health Organization, 84 countries confirmed ZIKV infection. RNA-dependent RNA polymerase (RdRp) was an appealing target for drug designers during the last two decades. Through molecular docking, we screened 16 nucleotide/side inhibitors against ZIKV RdRp. While the mode of interaction with ZIKV is different from that in the hepatitis C virus (HCV), nucleotide/side inhibitors in this study (mostly anti-HCV) showed promising binding affinities (-6.2 to -9.7 kcal/mol calculated by AutoDock Vina) to ZIKV RdRp. Setrobuvir, YAK and, to a lesser extent, IDX-184 reveal promising results compared to other inhibitors in terms of binding ZIKV RdRp. These candidates would be powerful anti-ZIKV drugs.


title: Using multiplexed assays of oncogenic drivers in lung cancers to select targeted drugs.

text: IMPORTANCE Targeting oncogenic drivers (genomic alterations critical to cancer development and maintenance) has transformed the care of patients with lung adenocarcinomas. The Lung Cancer Mutation Consortium was formed to perform multiplexed assays testing adenocarcinomas of the lung for drivers in 10 genes to enable clinicians to select targeted treatments and enroll patients into clinical trials. OBJECTIVES To determine the frequency of oncogenic drivers in patients with lung adenocarcinomas and to use the data to select treatments targeting the identified driver(s) and measure survival. DESIGN, SETTING, AND PARTICIPANTS From 2009 through 2012, 14 sites in the United States enrolled patients with metastatic lung adenocarcinomas and a performance status of 0 through 2 and tested their tumors for 10 drivers. Information was collected on patients, therapies, and survival. INTERVENTIONS Tumors were tested for 10 oncogenic drivers, and results were used to select matched targeted therapies. MAIN OUTCOMES AND MEASURES Determination of the frequency of oncogenic drivers, the proportion of patients treated with genotype-directed therapy, and survival. RESULTS From 2009 through 2012, tumors from 1007 patients were tested for at least 1 gene and 733 for 10 genes (patients with full genotyping). An oncogenic driver was found in 466 of 733 patients (64%). Among these 733 tumors, 182 tumors (25%) had the KRAS driver; sensitizing EGFR, 122 (17%); ALK rearrangements, 57 (8%); other EGFR, 29 (4%); 2 or more genes, 24 (3%); ERBB2 (formerly HER2), 19 (3%); BRAF, 16 (2%); PIK3CA, 6 (<1%); MET amplification, 5 (<1%); NRAS, 5 (<1%); MEK1, 1 (<1%); AKT1, 0. Results were used to select a targeted therapy or trial in 275 of 1007 patients (28%). The median survival was 3.5 years (interquartile range [IQR], 1.96-7.70) for the 260 patients with an oncogenic driver and genotype-directed therapy compared with 2.4 years (IQR, 0.88-6.20) for the 318 patients with any oncogenic driver(s) who did not receive genotype-directed therapy (propensity score-adjusted hazard ratio, 0.69 [95% CI, 0.53-0.9], P = .006). CONCLUSIONS AND RELEVANCE Actionable drivers were detected in 64% of lung adenocarcinomas. Multiplexed testing aided physicians in selecting therapies. Although individuals with drivers receiving a matched targeted agent lived longer, randomized trials are required to determine if targeting therapy based on oncogenic drivers improves survival. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01014286.


Update in critical care 2008.


title: Infection prevention and control in cystic fibrosis: a systematic review of interventions.

text: INTRODUCTION Cystic fibrosis is a life-limiting genetic condition characterized by recurrent pulmonary infection. Acquisition of infection can occur from environmental reservoirs, person-to-person transmission and from the healthcare environment. Primary prevention of infections through infection prevention and control measures is an important strategy in cystic fibrosis care. Areas covered: Here we present a systematic review of the evidence base around infection prevention and control in cystic fibrosis. We found 36 studies and 7 guidelines that met our inclusion criteria. Strategies covered include cohort segregation, individual segregation, hand hygiene, facemasks, combination strategies, equipment strategies, and adherence. Quality of evidence overall was deemed low or very low. Most guideline recommendations have little or no evidence to support them. Expert opinion: Although low quality, there is an abundance of evidence suggesting segregation is beneficial in reducing pathogen spread. Undertaking high-quality studies may, therefore, be ethically challenging. Large-scale registry studies may provide a better strategy for answering questions on the efficacy of infection control policy. With the rise of antibiotic resistance, effective eradication of cystic fibrosis pathogens is becoming more difficult so primary prevention through infection control will become increasingly important over the coming years.


title: In situ tissue engineering: endothelial growth patterns as a function of flow diverter design.

text: BACKGROUND Vascular remodeling in response to implantation of a tissue engineering scaffold such as a flow diverter (FD) leads to the cure of intracranial aneurysms. We hypothesize that the vascular response is dependent on FD design, and CD34+ progenitor cells play an important role in the endothelialization of the implant. METHODS Sixteen rabbit aneurysms were randomly treated with two different single-layer braided FDs made of cobalt-chrome alloys. The FD-48 and FD-72 devices had 48 and 72 wires, respectively. Aneurysm occlusion rate was assessed during the final digital subtraction angiogram at 10, 20, 30, and 60 days (n=2 per device per time point). Implanted vessels were analyzed with scanning electron microscopy for tissue coverage, endothelialization, and immuno-gold labeling for CD34+ cells. RESULTS Complete aneurysm occlusion rates were similar between the devices; however, complete or near complete occlusion was more frequently observed in aneurysms with neck ≤4.2 mm (p=0.008). Total tissue coverage at 10 days over the surface of the FD-48 and FD-72 devices was 56.4±11.6% and 76.6±3.6%, respectively. Endothelial cell growth over the surface was time-dependent for the FD-72 device (Spearman's r=0.86, p=0.013) but not for the FD-48 device (Spearman's r=-0.59, p=0.094). The endothelialization score was marginally correlated with the distance from the aneurysm neck for the FD-48 device (Spearman's r=1, p=0.083) but not for the FD-72 device (Spearman's r=0.8, p=0.33). CD34+ cells were present along the entirety of both devices at all time points. CONCLUSIONS This study gives preliminary evidence that temporal and spatial endothelialization is dependent on FD design. Circulating CD34+ progenitor cells contribute to endothelialization throughout the healing process.


title: Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005-2017.

text: Using 16S rRNA and rpoB gene sequencing, we identified 6 patients infected with Elizabethkingia bruuniana treated at E-Da Hospital (Kaohsiung, Taiwan) during 2005-2017. We describe patient characteristics and the molecular characteristics of the E. bruuniana isolates, including their MICs. Larger-scale studies are needed for more robust characterization of this pathogen.


title: Two-port totally extraperitoneal inguinal hernia repair: a 10-year experience.

text: PURPOSE To evaluate the feasibility, safety, and long-term outcomes of laparoscopic two-port totally extraperitoneal (TEP) inguinal hernia repair. METHODS A 10-year retrospective analysis from 2004 to 2013 of patients undergoing two-port TEP performed by a single surgeon at three surgical centers. RESULTS 336 consecutive patients underwent two-port TEP repairing 478 hernias. 315 (93.8 %) patients were male and 21 (6.2 %) were female. Mean age ± SD was 47 ± 14 years and mean body mass index ± SD was 28.0 ± 4.7 kg/m(2). Indications for surgery included primary repair 303 (90.2 %), recurrence from open repair 28 (8.3 %), and incarcerated inguinal hernia 5 (1.5 %). 194 (57.7 %) cases were unilateral and 142 (42.3 %) were bilateral. Operative time ± SD was 38.7 ± 14.9 min for unilateral repair and 43.4 ± 17.6 min for bilateral repair. Two-port TEP was successful in 316 (94.0 %). 20 (6.0 %) cases required the addition of a third port. 2 (0.6 %) cases were converted to open repair. Mean follow-up time ± SD was 5.4 ± 2.7 years. Postoperative complications included urinary retention 5 (1.5 %), seroma 7 (2.1 %), hematoma 1 (0.3 %), surgical site infection 4 (1.2 %), and chronic inguinal pain 3 (0.9 %). 11 (2.3 %) hernias recurred. CONCLUSION Two-port TEP appears to be a feasible, safe, and effective method for laparoscopic inguinal hernia repair and should be considered a viable, less invasive alternative to conventional three-port techniques.


Cigarette Smoking and COVID-19: A Complex Interaction.


title: Surgical sterilization of male and female grey squirrels (Sciurus carolinensis) of an urban population introduced in Italy.

text: We report a successful surgical sterilization procedure for population control of 324 male and female free-ranging grey squirrels (Sciurus carolinensis) in Genoa (Italy). We describe the clinical procedure from the trapping of the animals to their surgical sterilization and release in another part of the city. Live-trapped squirrels were transported to the veterinary clinic within 1-2 hr of capture and maintained in a hospitalization room reserved for them. The waiting period before surgery was kept below 12 hr. The developed procedure has resulted in a survival of 94% of trapped squirrels from surgery to animal release. Sterilized squirrels started to feed in a very short time (1.0-1.5 hr), and after 2-3 days, it was possible to release them in a new area. Amoxicillin was used as a long-acting postoperative antibiotic to reduce the period of captivity. The successful surgical procedure described here can provide an important additional tool for the management of introduced populations of squirrels. We showed that the surgical sterilization of some hundred squirrels is clinically possible and could be included in management strategies aimed at removing critical populations of these species. Moreover, the data allow dosages and operational times in order to provide economic viability assessment of future population control measures.


title: Dental Care Provision during Coronavirus Disease 2019 (COVID-19) Pandemic: The Importance of Continuous Support for Vulnerable Patients.

text: As a result of the ongoing 2019 coronavirus disease (COVID-19) pandemic, the medical and dental services across the world have to tackle unprecedented situations, providing essential care and professional support. The global health care crisis caused directly by the vast number of severe COVID-19 cases, and indirectly by reduced access to health care, as well as by limited secondary care provision, had a major impact on specialist services, and subsequently the deterioration of medical and dental conditions, particularly in vulnerable persons. In particular, at present, special care dentistry seems to play a unique role, dealing with a wide range of patients with underlying medical conditions and co-morbidities, phobic individuals, and persons with learning/physical disabilities. The effective adaptation of health services to the current new reality, based on an empathetic approach and recent guidelines, would allow us to maintain an adequate care provision, minimizing the long-term impact of the pandemic.


title: [SARS-CoV-2 infection (COVID-19): what can we expect?]

text: - Case numbers in China are clearly declining, case numbers in many European regions are no longer increasing exponentially.- Data on mortality from SARS-CoV-2 infection are contradictory; mortality is certainly lower than for SARS and MERS, but probably higher than for most seasonal flu outbreaks in recent years- The main complication of SARS-CoV-2 infection is pneumonia with development of acute respiratory distress syndrome (ARDS)- Asymptomatic and oligosymptomatic courses with virus shedding are not uncommon; they may be more frequent in children than in adults. Virus excretion in asymptomatic people and in the pre-symptomatic phase of an infection is relevant for transmission- An effective antiviral therapy has not yet been established. Steroids for anti-inflammatory therapy are not recommended- It is very important to prepare all actors in the health care system for a longer-term burden of inpatients and complications and to create the necessary capacities. Low-threshold diagnostic testing and rapid detection of infection chains remain essential for better control of the pandemic. An effective vaccine is urgent.


title: Neuroendovascular optical coherence tomography imaging and histological analysis.

text: BACKGROUND Intravascular optical coherence tomography (OCT) is a recently developed optical imaging technique that provides high-resolution cross-sectional in situ images from intact tissue based on tissue reflectance of near-infrared or infrared light. OBJECTIVE To report on the feasibility of neuroendovascular OCT imaging and compare the neuroendovascular OCT findings with histology in nondiseased vessels in an animal, cadaveric, and clinical study. METHODS Catheter-based in vivo endovascular OCT imaging was performed in the common carotid arteries of 2 pigs and in the intracranial carotid arteries of 3 patients. The endovascular OCT device was delivered to the desired location via groin access and using standard endovascular procedures. Images were obtained via rotational and translational scanning using external motors. In vivo findings were reproduced using ex vivo OCT imaging in corresponding animal and human (cadaveric) harvested tissue segments. These segments underwent histological examination for comparison. RESULTS The structural compositions of the OCT-imaged segments of the common carotid arteries in pigs as well as the petrous and cavernous intracranial carotid arteries in patients were visualized at high resolution (8 μm). The in vivo images were identical to those obtained ex vivo, demonstrating the imaging capabilities of the endovascular OCT device. The OCT images correlated well with the images obtained after histological sectioning and visualized in vivo the laminar vascular structure. CONCLUSION Neuroendovascular OCT imaging is feasible for clinical use and can detect with high resolution the structure of arterial segments. Understanding OCT imaging in nondiseased arteries is important in establishing baseline findings necessary for interpreting pathological processes. This allows neuroendovascular optical biopsies of vascular tissue to be obtained without the need for excision and processing.


title: A Reliable Method: Purse-String Hemostasis for Arteriovenous Fistula or Arteriovenous Graft Cannulation after Percutaneous Transluminal Angioplasty.

text: Percutaneous transluminal angioplasty (PTA) is the most common therapy used to treat dialysis patients with an occluded arteriovenous fistula (AVF) or arteriovenous graft (AVG). AVF or AVG hemostasis after PTA is time consuming, and it may be complicated with acute thrombosis of the AVF or AVG and re-bleeding from the puncture site. In this study, we prospectively studied 145 hemodialysis patients with occluded AVF or AVG using a modified purse-string suture with short tubing tourniquet technique for hemostasis following PTA, during which we used heparin and urokinase infusion. The results indicated that the modified technique for hemostasis of AVF orAVG was effective and safe in achieving immediate hemostasis withoutmanual compression in all patients.


title: Clinical characteristics of COVID-19 in Saudi Arabia: A national retrospective study.

text: BACKGROUND The global battle to contain the novel coronavirus disease 2019 (COVID-19) pandemic rages on. Previous studies described the clinical characteristics of COVID-19, but knowledge gaps remain in the Middle East region. Identifying these features will help in mapping the disease and guiding pandemic management. A multi-center, retrospective cross-sectional study was initiated to describe the demographic data, clinical characteristics, and outcomes of COVID-19 cases across all the regions of Saudi Arabia. METHODS The analysis included all laboratory-confirmed positive COVID-19 patients from the 1st of March 2020 to 31st of March 2020 across all regions of Saudi Arabia. Demographic data, clinical characteristics, incubation periods, laboratory findings, and patient outcomes data were retrieved from 1519 cases in the Health Electronic Surveillance Network Database. RESULTS The median age was 36 years and 54.3% (n = 825) of the patients were men. Patients working in health care facilities represented 12.5% of the cases (n = 190) and 9.3% of cases were asymptomatic. The median incubation period was 6 days. The most common symptoms were cough (89.4%), fever (85.6%), and sore throat (81.6%); 20.1% of the patients had underlying comorbidities. Hypertension was seen in 8.8% and diabetes in 7.6% of all the cases. The percentage of cases with temperatures >38֯C was 20.3% (n = 129), and 1.6% of patients had heart rates ≥125 beats/min and 4.7% of them had respiratory rates of >24 breaths/min. Lymphocytopenia occurred in 37.5% of cases. Overall, 71.6% of patients were admitted to hospitals and 4.7% required ICU treatment. We could not completely assess the clinical courses or final outcomes of COVID-19 patients. CONCLUSION In this multi-center retrospective study, fever and cough were common symptoms. Special attention should be addressed toward asymptomatic carriers and workers in health care facilities as they play a key role in disease transmission.


Transmission of SARS-CoV-2 in Domestic Cats.


title: The norepinephrine transporter in attention-deficit/hyperactivity disorder investigated with positron emission tomography.

text: IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) research has long focused on the dopaminergic system's contribution to pathogenesis, although the results have been inconclusive. However, a case has been made for the involvement of the noradrenergic system, which modulates cognitive processes, such as arousal, working memory, and response inhibition, all of which are typically affected in ADHD. Furthermore, the norepinephrine transporter (NET) is an important target for frequently prescribed medication in ADHD. Therefore, the NET is suggested to play a critical role in ADHD. OBJECTIVE To explore the differences in NET nondisplaceable binding potential (NET BPND) using positron emission tomography and the highly selective radioligand (S,S)-[18F]FMeNER-D2 [(S,S)-2-(α-(2-[18F]fluoro[2H2]methoxyphenoxy)benzyl)morpholine] between adults with ADHD and healthy volunteers serving as controls. DESIGN, SETTING, AND PARTICIPANTS Twenty-two medication-free patients with ADHD (mean [SD] age, 30.7 [10.4] years; 15 [68%] men) without psychiatric comorbidities and 22 age- and sex-matched healthy controls (30.9 [10.6] years; 15 [68%] men) underwent positron emission tomography once. A linear mixed model was used to compare NET BPND between groups. MAIN OUTCOMES AND MEASURES The NET BPND in selected regions of interest relevant for ADHD, including the hippocampus, putamen, pallidum, thalamus, midbrain with pons (comprising a region of interest that includes the locus coeruleus), and cerebellum. In addition, the NET BPND was evaluated in thalamic subnuclei (13 atlas-based regions of interest). RESULTS We found no significant differences in NET availability or regional distribution between patients with ADHD and healthy controls in all investigated brain regions (F1,41<0.01; P=.96). Furthermore, we identified no significant association between ADHD symptom severity and regional NET availability. Neither sex nor smoking status influenced NET availability. We determined a significant negative correlation between age and NET availability in the thalamus (R2=0.29; P<.01 corrected) and midbrain with pons, including the locus coeruleus (R2=0.18; P<.01 corrected), which corroborates prior findings of a decrease in NET availability with aging in the human brain. CONCLUSIONS AND RELEVANCE Our results do not indicate involvement of changes in brain NET availability or distribution in the pathogenesis of ADHD. However, the noradrenergic transmitter system may be affected on a different level, such as in cortical regions, which cannot be reliably quantified with this positron emission tomography ligand. Alternatively, different key proteins of noradrenergic neurotransmission might be affected.


Covid-19: give NHS staff rest spaces and free parking not thank yous, says doctor.


Public health in the age of ebola in West Africa.


title: Radiofrequency ablation to treat loco-regional recurrence of well-differentiated thyroid carcinoma.

text: OBJECTIVE To evaluate the efficacy of radiofrequency ablation (RFA) in the treatment of loco-regional, recurrent, and well-differentiated thyroid carcinoma. MATERIALS AND METHODS Thirty-five recurrent well-differentiated thyroid carcinomas (RTC) in 32 patients were treated with RFA, between March 2008 and October 2011. RTCs were detected by regular follow-up ultrasound and confirmed by biopsy. All patients had fewer than 3 RTCs in the neck and were at high surgical risk or refused to undergo repeated surgery. Average number of RFA sessions were 1.3 (range 1-3). Post-RFA biopsy and ultrasound were performed. The mean follow-up period was 30 months. Pre- and post-RFA serum thyroglobulin values were evaluated. RESULTS Thirty-one patients with 33 RTCs were treated with RFA only, whereas 1 patient with 2 RTCs was treated with RFA followed by surgery. At the last follow-up ultrasound, 31 (94%) of the 33 RTCs treated with RFA alone completely disappeared and the remaining 2 (6%) RTCs showed decreased volume. The largest diameter and volume of the 33 RTCs were markedly decreased by 93.2% (from 8.1 ± 3.4 mm to 0.6 ± 1.8 mm, p < 0.001) and 96.4% (from 173.9 ± 198.7 mm(3) to 6.2 ± 27.9 mm(3), p < 0.001), respectively. Twenty of the 21 RTCs evaluated with post-RFA biopsies (95%) were negative for malignancy. One (5%) showed remaining tumor that was removed surgically. The serum thyroglobulin was decreased in 19 of 26 patients (73%). Voice change developed immediately after RFA in 6 patients (19%) and was spontaneously recovered in 5 patients (83%). CONCLUSION Radiofrequency ablation can be effective in treating loco-regional, recurrent, and well-differentiated thyroid carcinoma in patients at high surgical risk.


title: ACUTE-PHASE RESPONSES IN HEALTHY, MALNOURISHED, AND OTOSTRONGYLUS-INFECTED JUVENILE NORTHERN ELEPHANT SEALS (MIROUNGA ANGUSTIROSTRIS).

text: Acute-phase proteins (APPs) are utilized to detect early inflammation in many domestic and nondomestic species, but variability exists between species and inflammatory diseases as to which APPs are most useful. Stranded juvenile northern elephant seals (NESs; Mirounga angustirostris) undergoing rehabilitation at the Marine Mammal Center experience high mortality rates due to severe arteritis caused by the lungworm, Otostrongylus circumlitis (OC), and there are currently no effective antemortem diagnostic tools for this disease. To characterize patterns of the acute-phase response in the NES, two APPs-serum amyloid A (SAA) and C-reactive protein (CRP)-were measured, and serum protein electrophoresis was performed to measure albumin and globulin fractions in 81 serum samples from 58 NESs in four different health states: healthy, malnourished, preclinical for OC infection, or clinical for OC infection. Compared to healthy NESs (median, 11.2 mg/L), SAA concentrations were significantly increased in malnourished (33.9 mg/L), preclinical (247 mg/L), and clinical OC-infected NESs (328 mg/L) (P < 0.05). CRP concentrations were increased only in clinical OC-infected NESs (median, 53.9 mg/L) and were below detectable limits in the other three groups (<0.01 mg/L). These results show that SAA and CRP are positive APPs in NESs with OC infection, and that SAA may serve as the major APP for this species. Albumin : globulin ratios were significantly increased in malnourished NESs (median, 1.26) and decreased in clinical OC-infected NESs (0.53). As a result, albumin is a negative APP in the NES, similar to other mammalian species. APP monitoring can be helpful in detecting and monitoring inflammation in rehabilitating juvenile NESs.


title: Efficacy and safety of sacubitril/valsartan in the treatment of heart failure: protocol for a systematic review incorporating unpublished clinical study reports.

text: Background: Sacubitril/valsartan is a first-in-class angiotensin-receptor neprilysin inhibitor used to treat heart failure with reduced ejection fraction. The evidence base for this novel medication is largely based on one pivotal phase III trial which was stopped early due to significant clinical benefits being shown. However potential limitations in the trial design have been highlighted in recent medical literature, necessitating a thorough review of the evidence base for sacubitril/valsartan. Methods: This review will be conducted using the PRISMA reporting guidelines. Relevant randomised controlled trials (RCTs) for sacubitril/valsartan will be systematically searched for in Medline (PubMed), Embase, Cochrane library, Google Scholar, Web of Science, Toxline and Scopus. Clinical trials registries will be searched, as will eight grey literature databases. In addition, unpublished clinical study reports (CSRs) of relevant trials will be requested from the European Medicines Agency (EMA) and the Clinical Study Data Request database. Studies will be included if they involve randomising adult patients with heart failure to either sacubitril/valsartan or usual care with either an active comparator or placebo as a control. All relevant clinical and safety outcomes will be reviewed, particularly hospitalisation due to heart failure and cardiovascular mortality. Two reviewers will assess eligibility of selected trials for inclusion. Data extraction will be performed separately for trial publications, clinical trial registries and for CSRs using a piloted form. Methodological quality of included trials from published sources will be assessed separately using the recently updated Cochrane Risk of Bias tool version 2. Narrative synthesis of included studies will be conducted and, if appropriate, meta-analysis for clinical efficacy and safety outcomes. Discussion: This review will collate all available RCT data on sacubitril/valsartan including published and unpublished sources in order to obtain a more complete picture of the evidence base for sacubitril/valsartan. Registration: This protocol has been submitted for registration on PROSPERO.


title: Barriers to and facilitators for use of augmentative and alternative communication and voice restorative devices in the adult intensive care unit: a scoping review protocol.

text: BACKGROUND Mechanically ventilated patients in the intensive care unit (ICU) experience profound communication impairment, placing them at risk for poor physical and psychological outcomes. Patient communication strategies such as augmentative and alternative communication (AAC) and voice restorative devices are recommended to facilitate communication. These strategies, however, are inconsistently adopted in ICU practice signaling utilization barriers. Our objective is to map and synthesize the current evidence-base for stakeholder-reported barriers and facilitators to patient communication strategy utilization for adults with an advanced airway in the ICU. METHODS AND ANALYSIS We will use Arskey and O'Malley's recommended methods to conduct a scoping review using a rapid review framework to streamline the process. A single reviewer will conduct a search and an initial screen of titles and abstracts from five electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and PsychInfo) from 1990 to present to identify English language peer-reviewed studies. Subsequently, two reviewers will independently screen a shorter list of studies for inclusion. We will also search the reference lists of eligible studies. Two reviewers will independently extract study characteristics, communication strategy, and stakeholder reported barriers and facilitators. We will code and categorize the extracted barriers and facilitators according to the Theoretical Domains Framework (TDF), an integrative framework of behavior change. DISCUSSION To our knowledge, this will be the first scoping review to map and synthesize reported barriers and facilitators to communication strategy utilization in the adult ICU using a theoretical framework. The results of this scoping review will help to identify trends and gaps in the current evidence-base and support recommendations for improving patient-centered practice, policy, and research related to successfully establishing ICU patient communication.


title: Bronchoscopic pursuit of the peripheral pulmonary lesion: navigational bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy.

text: PURPOSE OF REVIEW Peripheral pulmonary lesions (PPL) are being diagnosed with increasing frequency, especially with the increased use of chest computed tomography (CT). Depending on the location and size, these lesions often present a diagnostic challenge in terms of the low yield of traditional bronchoscopic biopsy techniques or the risks of a percutaneous biopsy approach. RECENT FINDINGS Over the last several years, several different image-guided bronchoscopy techniques have emerged, including virtual bronchoscopic navigation, electromagnetic navigation bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy. These technologies seek to improve both access and the diagnostic yield of PPL compared with traditional bronchoscopy and to perform with a lower complication rate than percutaneous techniques such as CT-guided trans-thoracic needle aspiration. SUMMARY These advanced bronchoscopic techniques play an increasingly common role in the evaluation and biopsy of PPL. Electromagnetic navigation bronchoscopy and radial endobronchial ultrasound are the most commonly used guided techniques either in isolation or in combination and have the most published data regarding clinical experience and diagnostic yield; however, none of the techniques have consistently matched the yield of CT-guided trans-thoracic needle biopsy for PPL. Overall the complication rate of image-guided bronchoscopy techniques is low with pneumothorax being the most common adverse event.


title: [Expert recommendations on the management of patients with advanced non-small cell lung cancer during epidemic of COVID-19 (Trial version)].

text: The outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency of major international concern. Given the systemic immunosuppressive state caused by malignancy and anticancer treatments, patients with advanced lung cancer may be at a higher risk of COVID-19 infection. During epidemic of COVID-19, a guideline for the optimal management of patients with advanced lung cancer urgently needs to be proposed to distinguish the symptoms of COVID-19 and the side effects of antitumor drugs. This network questionnaire survey was conducted on the lung cancer group of the Chinese Thoracic Society, Chinese Medical Association; the lung cancer group of the Chinese Society of Clinical Oncology Youth Committee; and the Chinese Respiratory Oncology Collaboration. 321 valid questionnaires were received. Based on the guidelines on lung cancer and the results of the questionnaires, a consensus was reached. During the epidemic of COVID-19, We recommended that patients with advanced NSCLC should be treated as outpatients as possible at the nearest medical center; Patients who need to be hospitalized for antitumor treatment should be excluded from COVID-19 infection; More intensive attention should be paid to identification of COVID-19-related symptoms and adverse reactions caused by the malignancy or antitumor treatments. Stronger personal protection should be made for advanced NSCLC patients; An intentional postponing of antitumor treatment should be considered according to patient performance status. Treatment strategies should be made according to different types of advanced NSCLC patients and efficacy and toxicity of drugs.


title: Clinical outcomes of laparoscopic radiofrequency ablation of single primary or recurrent hepatocellular carcinoma (≤3 cm).

text: PURPOSE Percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) has some limitations such as poor sonic window and injury to adjacent organs. The laparoscopic approach has been suggested as an alternative option. The aim of this study was to show the safety and efficacy of laparoscopic RFA for single, small (≤3 cm), and primary or recurrent HCC that is not suitable for percutaneous RFA or surgical resection. METHODS We reviewed the cases of 37 patients (32 men and 5 women, mean age 61 ± 8.1 years) who underwent laparoscopic RFA for single, small HCC (≤3 cm) that was unsuitable for percutaneous RFA or surgical resection. RESULTS The technical success rate was 94.6% and 34 patients (95%) had no complications. There were no conversions to open RFA and no operative mortality. The primary effectiveness rate 1 month after the procedure was 100%. The overall recurrence rates at 3, 6, 12, and 24 months after the laparoscopic RFA were 8.1%, 14.4%, 25%, and 35.7%, respectively. The local tumor progression rate was 4.2% at 6 months and 8.7% at 9 months. CONCLUSION Laparoscopic RFA is a safe and effective treatment for HCC cases that are unsuitable for percutaneous RFA.


Prioritizing Frontline Workers during the COVID-19 Pandemic.


title: Occurrence, Loading, and Exposure of Atmospheric Particle-Bound POPs at the African and European Edges of the Western Mediterranean Sea.

text: A comparative study for 62 toxic chemicals based on the simultaneous monthly collection of aerosol samples during 2015-2016 in two coastal cities at both the African (Bizerte, Tunisia) and European (Marseille, France) edges of the Western Mediterranean basin is presented. Legacy polychlorinated biphenyls (∑18PCBs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (∑17PCDD/Fs) show generally higher median levels at the African edge (2.1 and 0.2 pg m-3, respectively) compared to the European coastal site (1.0 and 0.08 pg m-3, respectively). Contrarily, the "emerging" polybrominated diphenyl ethers' (∑27PBDEs) median concentrations were higher in Marseille (∼9.0 pg m-3) compared to Bizerte (∼6.0 pg m-3). Different past usages and current emission patterns were found at both edges of the Western Mediterranean, most probably linked to the respective different regulatory frameworks for toxic chemicals. Our results indicate that the total organic carbon (TOC) and/or the elemental carbon (EC) contents in the atmospheric aerosol may have a stronger effect than the total suspended particle (TSP) content as a whole on the spatial-temporal variability and the long-range atmospheric transport potential of the studied POPs. A "jumping" of the PBDE local atmospheric stocks from the Northwestern European Mediterranean edge to the Northwestern African coast seems to be possible under favorable conditions at present. While a higher PBDE median loading is estimated for the Marseille area (∼550 ng m-2 y-1) compared to Bizerte (∼400 ng m-2 y-1), the median PCB and PCDD/F dry deposition fluxes were higher at the African site, resulting in a 3-fold higher toxic equivalent (TEQ) loading of dioxin-like pollutants (400 pg TEQ m-2 y-1) compared to Marseille (∼140 pg TEQ m-2 y-1), with potential implications for aquatic organisms. However, the inhalation exposure assessment points to a minimum risk for human health at both sites.


title: Alcohol Use in Australia during the Early Days of the COVID-19 Pandemic: Initial results from the COLLATE project.

text: AIMS The effect of social isolation measures used to control the spread of COVID-19 are negatively impacting the mental health of many. One of the consequences of exposure to disasters/pandemics is an increase in alcohol use. The current study aimed to examine what predisposing (distal) and pandemic-related (proximal) factors were associated with increased drinking in the wake of the COVID-19 pandemic. METHODS On the 1st of April 2020, 5,158 Australians completed a survey from the COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project, a nationwide study aimed at tracking key mental health concerns. Using logistic regression, distal (demographics and previous drinking behaviours) and proximal factors (employment, lifestyle factors and mood) were assessed for their association with increased drinking since the onset of the COVID-19 pandemic. RESULTS Distal factors including heavier drinking pre-pandemic, middle age, average or higher income; and proximal factors including job loss, eating more, changes to sleep as well as stress and depression, were all associated with increased drinking in the COVID-19 pandemic environment. Female sex and self-reported history of mental illness became non-significant after proximal measures were added to the model. Living alone, exercise, anxiety or status as an essential or health care worker were not associated with increased drinking. CONCLUSIONS These results provide guidance as to who might be targeted to receive support based on predisposing demographic factors and pre-pandemic drinking behaviour. Second, they indicate what behaviours/factors accompany increased alcohol use and provide targets for psychosocial and psychoeducational supports to address these proximal factors. This article is protected by copyright. All rights reserved.


title: Reference Data for Standardized Quality of Life Questionnaires in Indian Patients with Brain Metastases from Non-small Cell Lung Cancer: Results from a Prospective Study.

text: INTRODUCTION Reference data for European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires do not include studies from the Indian subcontinent. The objective of the current study was to establish a reference dataset for Indian patients of non-small cell lung cancer (NSCLC) presenting with brain metastases (BM). MATERIAL AND METHODS One hundred forty patients with NSCLC with BM treated between 2012-2015 were registered in a prospective cohort study (CTRI/2013/01/003299). The baseline quality of life was evaluated using the EORTC general quality of life questionnaire QLQ-C30 and lung cancer specific module LC13. Minimum important difference (MID) scores for individual domains of the EORTC QLQ-C30 and LC13 questionnaires were derived (MID = 0.2 x standard deviation) from the reference data for patients with recurrent/metastatic lung cancers. In addition, a systematic review was conducted to identify studies reporting baseline quality of life scores for recurrent/metastatic NSCLC. RESULTS Scores of several functional as well as symptom scales in the current NSCLC population differed by more than the MID from the baseline mean scores in the reference EORTC population as well as that reported from other studies. Differences in mean score from the EORTC reference data ranged from 6.2 and 9.4 points for the role functioning and cognitive functioning domains. In the symptom scales, the largest differences were observed for the financial difficulties (23.9) scores for the QLQ-C30 and peripheral neuropathy (21.7) for LC13 questionnaires. CONCLUSION The current study demonstrates that baseline reference scores need to be established for patients from the Indian subcontinent. The findings from the current study have important implications for studies employing quality of life (QOL) assessment in the Indian NSCLC patient population.


title: Thrombectomy in acute ischemic stroke: estimations of increasing demands.

text: BACKGROUND New recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy. METHODS The new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (2009-2011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity according to the National Institutes of Health Stroke Scale score (0-5, 6-11, 12-19, and 20-35). We then estimated the total number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry. RESULTS The number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry). CONCLUSIONS When the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.


title: Immunopathology and immunotherapeutic strategies in severe acute respiratory syndrome coronavirus 2 infection.

text: The outbreak of coronavirus disease 2019 (COVID-19) and pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a major concern globally. As of 14 April 2020, more than 1.9 million COVID-19 cases have been reported in 185 countries. Some patients with COVID-19 develop severe clinical manifestations, while others show mild symptoms, suggesting that dysregulation of the host immune response contributes to disease progression and severity. In this review, we have summarized and discussed recent immunological studies focusing on the response of the host immune system and the immunopathology of SARS-CoV-2 infection as well as immunotherapeutic strategies for COVID-19. Immune evasion by SARS-CoV-2, functional exhaustion of lymphocytes, and cytokine storm have been discussed as part of immunopathology mechanisms in SARS-CoV-2 infection. Some potential immunotherapeutic strategies to control the progression of COVID-19, such as passive antibody therapy and use of interferon αβ and IL-6 receptor (IL-6R) inhibitor, have also been discussed. This may help us to understand the immune status of patients with COVID-19, particularly those with severe clinical presentation, and form a basis for further immunotherapeutic investigations.


title: Changes in body weight, physical activity and lifestyle during the semi-lockdown period after the outbreak of COVID-19 in China: an online survey.

text: Background: The outbreak of novel coronavirus (COVID-19) provided an opportunity to undertake an online survey to study the relationships between body weight changes with changes in physical activity and lifestyle during an unusual event of forced isolation or quarantine.Methods: We distributed an electronic questionnaire using the popular social application WeChat to adults from any province of China except Hubei Province, the epicenter of the outbreak. The questionnaire asked for demographic information, body weight, physical activity and lifestyle factors before, during the quarantine.Results: Of 376 questionnaires returned, 339 were valid (90.2%). During the period of semi-lockdown, both females and males with BMI < 24 gained weight, while males with BMI ≥ 24 lost weight while females with BMI≥24 gained weight. The average steps per day and the average moderate or vigorous-intensity exercise declined significantly for both males and females during the semi-lockdown. Changes in body weight inversely correlated with changes in steps per day and moderate or vigorous-intensity exercise during the quarantine.Conclusions: Normal weight individuals, who are not normally troubled by overweight or obesity had less awareness of weight gain than people with a BMI≥24. Under the conditions of the semi-lockdown, they tended to gain weight.


title: Endocrinology in the time of COVID-19: Management of calcium disorders and osteoporosis.

text: Endocrinologists have had to make rapid changes to services so that resources can be focused on the COVID-19 response to help prevent spread of the virus. Herein we provide pragmatic advice on the management of commonly encountered calcium problems and osteoporosis. Non-urgent elective appointments should be postponed, and remote consultations and digital health solutions promoted. Patients should be empowered to self-manage their conditions safely. Patients, their caregivers and healthcare providers should be directed to online resources e.g. Society for Endocrinology, Royal Osteoporosis Society, International Osteoporosis Foundation, specific patient groups and the European Reference Networks (ERNs) for Rare Endocrine and Rare Bone disorders. For patients in acute hospital settings, existing emergency guidance on the management of hyper- and hypo-calcaemia should be followed. A pragmatic, symptom-based approach should be implemented in patients at the end of life. An approach to osteoporosis management is outlined. IV zoledronic acid infusions can be delayed for 6-9 months during the pandemic. Patients established on denosumab and teriparatide should continue planned therapy. The challenge of this pandemic will act as a catalyst to innovate within our management of metabolic bone and mineral disorders to ensure best use of resources and resilience of healthcare systems in its aftermath.


title: Concurrence of Intraoperative Hypotension, Low Minimum Alveolar Concentration, and Low Bispectral Index Is Associated with Postoperative Death.

text: BACKGROUND An intraoperative concurrence of mean arterial pressure less than 75 mmHg, minimum alveolar concentration less than 0.8, and bispectral index less than 45 has been termed a "triple low" state. An association between triple low and postoperative mortality has been reported but was not replicated in a subsequent study. The authors pooled existing data from clinical trials to further evaluate the purported association in an observational study. METHODS This retrospective observational study included 13,198 patients from three clinical trials: B-Unaware, BAG-RECALL, and Michigan Awareness Control Study. Patients with greater than 15 not necessarily consecutive minutes of triple low were propensity matched to controls with similar characteristics and comorbidities. A multivariable Cox proportional hazards model was used to evaluate the association between triple low duration and postoperative mortality. RESULTS Thirty-day mortality was 0.8% overall, 1.9% in the triple low cohort, and 0.4% in the nontriple low cohort (odds ratio, 5.16; 95% CI, 4.21 to 6.34). After matching and adjusting for comorbidities, cumulative duration of triple low was significantly associated with an increased risk of mortality at 30 days (hazard ratio, 1.09; 95% CI, 1.07 to 1.11, per 15 min) and 90 days (hazard ratio, 1.09; 95% CI, 1.08 to 1.11, per 15 min). CONCLUSION There is a weak independent association between the triple low state and postoperative mortality, and the propensity-matched analysis does not suggest that this is an epiphenomenon.


Estimating the risk of COVID-19 in multiple sclerosis patients in Buenos Aires, Argentina.


Nonpharmaceutical interventions for tackling the COVID-19 epidemic in Brazil.


title: The effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease.

text: The study objective was to assess the effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. This is a retrospective cohort study. It is a Canadian Task Force classification II-2 study conducted at the University Hospital, Sweden. The patients were 949 women planned for robotic hysterectomy for malignant (75 %) and benign (25 %) gynecological disease between October 2005 and December 2013. They were continuously evaluated for the rate of intraoperative and postoperative complications up to 1-year post-surgery, the latter according to Clavien-Dindo classification following the introduction of robotic surgery with special awareness of complications possibly related to robot-specific risk factors, the description of refinement of practice and assessment of the effect of these measures. The rate of intraoperative complications, the overall rate of complications and the rate of ≥grade 3 complications decreased from the first to the last time period (4.8 vs 2.6 %, p = 0.037, 34 vs 19 %, p = 0.003 and 13.5 vs 3.2 %, p = 0.0003, respectively). The rate of intraoperative complications and the rate of postoperative complications possibly related to robot-specific risk factors was reduced from the first to the last time period (3.8 vs 0.6 %, p = 0.028 and 7.7 vs 1.5 %, p = 0.003, respectively). In patients undergoing robotic hysterectomy for malignant and benign gynecological disease intraoperative and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice.


title: Subjective and objective assessments of sleep problems in children with attention deficit/hyperactivity disorder and the effects of methylphenidate treatment.

text: BACKGROUND to investigate the sleep problems in children with different ADHD presentations and effects of methylphenidate (MPH) on the sleep problems of children with ADHD by both subjective and objective measurements. METHODS 71 children with ADHD and 30 controls were included. 35 had ADHD with predominantly inattentive presentation (ADHD-I) and 36 with predominantly hyperactive/impulsive or combined presentation (ADHD-C). We used the pediatric sleep questionnaire (PSQ) and a nocturnal polysomnography (PSG) to assess the sleep problems in children with ADHD before and 6 months after being treated with methylphenidate (0.3-0.7 mg/kg/dose). RESULTS PSG showed significantly higher apnea-hypopnea index and hypopnea counts, and lower slow-wave sleep percentage in children with ADHD. The results of PSQ reported by parents showed significantly higher rates of delay initiation of sleep, sleep onset latency, sleep fragment, daytime sleepiness, enuresis, bruxism, nightmares, periodic limb movement disorder (PLMD), and snoring in children with ADHD compared to normal controls. Comparisons of ADHD presentations revealed no significant difference between ADHD-I and ADHD-C by either PSG or PSQ measurements. After 6-month MPH treatment, the PSG showed significantly increased total sleep time and reduced periodic limb movement index (PLMI). The PSQ indicated significant reduction in bruxism and snoring in ADHD-I, as well as nightmares in ADHD-C, and both subgroups showed significant reduction in PLMD. CONCLUSION subjective and objective approaches produced inconsistent findings regarding the sleep problems in children with ADHD. Besides, MPH didn't worsen the sleep problems in children with ADHD.


title: Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis.

text: BACKGROUND The effect of alternative spontaneous breathing trial (SBT) techniques on extubation success and other clinically important outcomes is uncertain. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, Evidence-Based Medicine Reviews, Ovid Health Star, proceedings of five conferences (1990-2016), and reference lists for randomized trials comparing SBT techniques in intubated adults or children. Primary outcomes were initial SBT success, extubation success, or reintubation. Two reviewers independently screened citations, assessed trial quality, and abstracted data. RESULTS We identified 31 trials (n = 3541 patients). Moderate-quality evidence showed that patients undergoing pressure support (PS) compared with T-piece SBTs (nine trials, n = 1901) were as likely to pass an initial SBT (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.89-1.11; I 2 = 77%) but more likely to be ultimately extubated successfully (RR 1.06, 95% CI 1.02-1.10; 11 trials, n = 1904; I 2 = 0%). Exclusion of one trial with inconsistent results for SBT and extubation outcomes suggested that PS (vs T-piece) SBTs also improved initial SBT success (RR 1.06, 95% CI 1.01-1.12; I 2 = 0%). Limited data suggest that automatic tube compensation plus continuous positive airway pressure (CPAP) vs CPAP alone or PS increase SBT but not extubation success. CONCLUSIONS Patients undergoing PS (vs T-piece) SBTs appear to be 6% (95% CI 2-10%) more likely to be extubated successfully and, if the results of an outlier trial are excluded, 6% (95% CI 1-12%) more likely to pass an SBT. Future trials should investigate patients for whom SBT and extubation outcomes are uncertain and compare techniques that maximize differences in support.


title: Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy.

text: OBJECTIVES Our aim was to determine if there was a correlation between the preoperative prolapse stage and postoperative recurrence of prolapse 1 year after sacrocolpopexy. Our null hypothesis is that the preoperative stage of prolapse does not increase the risk of recurrence. METHODS This is a multicenter cohort study from 3 centers. We included subjects who underwent robotic-assisted sacrocolpopexy and completed a standardized 1-year follow-up from 2009-2014. All subjects underwent a complete preoperative evaluation and completed 12 months of follow-up with the pelvic organ prolapse quantification examination. We compared those subjects who met the definition of recurrence with those who did not, analyzing the following covariates: stage of prolapse using International Continence Society (ICS) definitions, individual pelvic organ prolapse quantification points, age, body mass index, race, exogenous estrogen use, menopause, smoking, vaginal parity, cesarean section, and performance of concomitant procedures. We defined recurrence as any prolapse beyond the hymen. RESULTS We had 125 women from 3 centers who met our criteria, with 23.2% of them having recurrence at 1 year. We found that recurrence increased as the preoperative ICS stage of prolapse increased (P = <0.001 in the univariate model). In the multivariate model, using logistic regression, we found that the risk of recurrence of pelvic organ prolapse increased as the presurgery clinical stage increased with an odds ratio of 3.8 (95% confidence interval, 1.5-9) when controlling for age, menopausal status, and genital hiatus (P = 0.004). CONCLUSIONS Much like a higher stage of disease in oncology, we found that increasing stage of prolapse preoperatively increased the risk of recurrence at 1 year after sacrocolpopexy.


Oculoplastic, Orbital, and Lacrimal Care in the Coronavirus Disease 2019 Pandemic: A Shared Experience From Melbourne.


title: The effect of convective heating on evaporative heat loss in anesthetized children.

text: BACKGROUND Convective warming is effective in maintaining core temperature under anesthesia. It may increase evaporative water loss (EWL). If significant, further investigation of warming modifications to minimize this impact would be warranted. OBJECTIVES To quantify EWL in two groups of children (warmed and nonwarmed) having surgical procedures under anesthesia. METHODS We performed an observational study of well children having general anesthesia for elective surgical procedures lasting ≥60 min. They were recruited sequentially to each of three age groups: 1-12 months, 13 months-5 years, and 5-12 years--with each age group divided into convectively warmed (43°C) and nonwarmed (21°C) subgroups. Evaporative heat loss (EHL) was calculated from accurate measurement of net EWL during the surgical period. RESULTS Sixty children were studied. As a percentage of body mass, mean EWLs were 0.29 (warmed) and 0.09 (nonwarmed). Using an ancova model, only procedure duration had a significant impact and explained why the extended procedural time in some convectively warmed children led to higher mean EWLs for that group. For the nonwarmed group, the mean Tcore drop was 1.27°C with a contribution from EWL of 0.6°C over ~70 min. CONCLUSIONS Within the age range 1 month-12 years, EHL is not significantly influenced by convective heating under anesthesia. There is no thermal advantage in exploring technique modifications such as humidifying the warming air. Previous estimates of the contribution of EHL to total heat loss in anesthetized children may require revision.


title: Global interim guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium from FIGO and allied partners: Information for healthcare professionals.

text: In response to the World Health Organization (WHO) statements and international concerns regarding the coronavirus disease 2019 (COVID-19) outbreak, FIGO has issued the following guidance for the management of pregnant women at the four main settings of pregnancy: (1) ambulatory antenatal care in the outpatient clinics; (2) management in the setting of the obstetrical triage; (3) intrapartum management; and (4) postpartum management and neonatal care. We also provide guidance on the medical treatment of pregnant women with COVID-19 infection.


title: Tailored One Anastomosis Gastric Bypass: 3-Year Outcomes of 94 Patients.

text: BACKGROUND One anastomosis gastric bypass (OAGB) claims its place among bariatric operations, proving itself a safe and effective procedure. METHODS This is a retrospective analysis of prospectively collected data regarding 94 patients who underwent surgery in a single surgical unit. Tailoring of the biliopancreatic limb length decided upon preoperative BMI was applied. Patients' excess weight loss and resolution of comorbidities were evaluated. Data on patients' nutritional status is also presented. RESULTS Mean BMI reduction at 36 months postoperatively was 21.7 ± 6.3 kg/m2. Mean excess weight loss (%EWL) was 83.6%, 91.8%, and 92.5% at 12, 24, and 36 months postoperatively, respectively. When controlling for preoperative BMI, a 36-month %EWL of 89.1% for the 2-m subgroup, a 95.3% for the 2.5-m subgroup, and a 104.7% for the 3-m subgroup were found. Operation's success, defined as %EWL greater than 50%, was 97.9% 36 months postoperatively. All patients suffering from hypertension, diabetes, and dyslipidemia achieved full remission. Furthermore, the percentage of patients with obstructive sleep apnea and gastroesophageal reflux disease, achieving full remission was 91.7% and 86.7%, respectively. An incidence of 5.3% new onset regurgitation was noted. Iron deficiency presented in 26 (27.7%) patients postoperatively, vitamin B12 deficiency in 13 (13.8%), folic acid deficiency in 18 (19.1%), and mild hypoalbuminemia in 7 (7.4%). Major early postoperative complications (Clavien-Dindo grade ≥ 3) were reported in 1.7% of our patients. One (1.1%) patient developed marginal ulcer and two (2.2) patients had late dumping. CONCLUSIONS OAGB is a safe and efficient technique; however, careful selection of patients and postoperative surveillance with respect to weight regain and nutritional deficiencies are mandatory for optimal results.


title: Examining raphe-amygdala structural connectivity as a biological predictor of SSRI response.

text: BACKGROUND Our lab has previously found that structural integrity in tracts from the raphe nucleus (RN) to the amygdala, measured by fractional anisotropy (FA), predicts remission to selective serotonin reuptake inhibitors (SSRIs) in major depressive disorder (MDD). This could potentially serve as a biomarker for remission that can guide clinical decision-making. To enhance repeatability and reproducibility, we replicated our study in a larger, more representative multi-site sample. METHODS 64 direction DTI was collected in 144 medication-free patients with MDD from the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) study. We performed probabilistic tractography between the RN and bilateral amygdala and hippocampus and calculated weighted FA in these tracts. Patients were treated with either sertraline or placebo, and their change in Hamilton Depression Rating Scale (HDRS) score reported. Pretreatment weighted FA was compared between remitters and nonremitters, and correlation between FA and percent change in HDRS score was assessed. Exploratory moderator and voxel analyses were also performed. RESULTS Contrary to our hypotheses, FA was greater in nonremitters than in remitters in RN-left and right amygdala tracts (p = 0.02 and 0.01, respectively). Pretreatment FA between the raphe and left amygdala correlated with greater, not reduced, HDRS (r = 0.18, p = 0.04). This finding was found to be greater in the placebo group. Moderator and voxel analyses yielded no significant findings. CONCLUSIONS We found greater FA in nonremitters between the RN and amygdala than in remitters, and a correlation between FA and symptom worsening, particularly with placebo. These findings may help reveal more about the nature of MDD, as well as guide research methods involving placebo response.


title: Treatment of acute inferior vena cava and iliac vein thrombosis with pharmacomechanical thrombectomy using simultaneously operating "kissing" Trellis-8 thrombolysis catheters.

text: PURPOSE To present a new endovascular technique for treating acute large thrombus burden in the iliocaval venous system. TECHNIQUE This method is demonstrated in a 62-year-old man with end-stage renal disease on hemodialysis who had a nonfunctioning right femoral dialysis catheter that was placed 3 month earlier. After catheter removal, venography demonstrated significant thrombus in the inferior vena cava (IVC) and both iliac veins. The patient was treated successfully using two simultaneously operating Trellis-8 thrombolysis catheters placed side-by-side in the IVC and both iliac veins in a "kissing" configuration. CONCLUSION This technique was able to effectively debulk acute large thrombus burden in the iliocaval system in a single session and preserve the patient's available hemodialysis access. The technique has the potential to minimize morbidity, duration of hospital stay, and overall cost of treatment.


title: A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: the effects on symptoms of depression and anxiety.

text: Obesity is a rising problem, especially among women of reproductive age. Overweight and obesity reduce both physical and mental health. Lifestyle interventions could have beneficial effects on both, but an overview of the effects on mental health, especially in women of reproductive age, is currently lacking. Therefore, the aim of this review was to assess the effect of lifestyle interventions on symptoms of depression and anxiety in women of reproductive age with overweight or obesity. The databases MEDLINE, EMBASE and PsycINFO were searched from inception to June 2018 for published randomized controlled trials (RCTs). We included lifestyle intervention RCTs in women of reproductive age with overweight or obesity that assessed effects on symptoms of depression and/or anxiety. The difference between baseline and post-intervention scores on symptoms of depression and anxiety for the intervention and control group was analysed. Meta-analysis was performed with a random effects model. The search resulted in 5,316 citations, and after screening five RCTs were included, in which 571 women were randomized. The effect of lifestyle interventions on depression scores was investigated among 224 women from five RCTs. The pooled estimate for the mean difference was -1.35 (95% CI, -2.36 to -0.35, p = 0.008). The effect of lifestyle interventions on anxiety levels was studied among 148 women from four RCTs, resulting in a pooled estimate of -1.74 (-2.62 to -0.87, p < 0.001). Based on five RCTs, meta-analyses showed that lifestyle interventions in women of reproductive age with overweight or obesity consistently reduce symptoms of depression and anxiety.


title: Hepatitis C virus NS5A protein is a substrate for the peptidyl-prolyl cis/trans isomerase activity of cyclophilins A and B.

text: We report here a biochemical and structural characterization of domain 2 of the nonstructural 5A protein (NS5A) from the JFH1 Hepatitis C virus strain and its interactions with cyclophilins A and B (CypA and CypB). Gel filtration chromatography, circular dichroism spectroscopy, and finally NMR spectroscopy all indicate the natively unfolded nature of this NS5A-D2 domain. Because mutations in this domain have been linked to cyclosporin A resistance, we used NMR spectroscopy to investigate potential interactions between NS5A-D2 and cellular CypA and CypB. We observed a direct molecular interaction between NS5A-D2 and both cyclophilins. The interaction surface on the cyclophilins corresponds to their active site, whereas on NS5A-D2, it proved to be distributed over the many proline residues of the domain. NMR heteronuclear exchange spectroscopy yielded direct evidence that many proline residues in NS5A-D2 form a valid substrate for the enzymatic peptidyl-prolyl cis/trans isomerase (PPIase) activity of CypA and CypB.


title: Self-gripping versus sutured mesh for inguinal hernia repair: a systematic review and meta-analysis of current literature.

text: BACKGROUND Lichtenstein tension-free mesh repair is the most commonly used technique for open inguinal hernia. However, mesh fixation with sutures to avoid dislocation has been considered as a cause of chronic pain and discomfort. A new self-gripping mesh (Parietene Progrip; Coviden) has been developed, which is making the use of sutureless for inguinal hernia repair. The aim of this systematic review was to compare the outcomes of open Lichtenstein inguinal hernia repair using new self-gripping mesh or sutured mesh. METHODS PubMed/MEDLINE, CENTRAL, and reference lists were searched for controlled trials of self-gripping mesh versus sutured mesh for open inguinal hernia repair from January 2005 to February 2013. The primary outcomes were chronic pain and recurrence. Secondary outcomes were duration of operation, wound infection, hematoma, seroma formation, postoperative pain, hospital stay, and time to return to work. The methodology was in accordance with the Cochrane Handbook for interventional systematic reviews and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS A total of seven studies, representing 1353 patients were included. There was no effect on chronic pain (risk difference -0.02 [95% confidence interval -0.07 to 0.03], P = 0.40) or recurrence (risk difference -0.00 [95% confidence interval -0.01 to 0.01], P = 0.57). No significant differences were noted in terms of secondary outcomes, such as wound infection, hematoma, and seroma formation, between self-gripping and sutured mesh repair. But the mean operative duration was shorter in the self-gripping mesh group than sutured mesh group. CONCLUSIONS Based on the results, both meshes appear to result in similar postoperation outcomes. Further long-term analysis may guide surgeon selection of adapted mesh for inguinal hernia repair.


title: Aspects of pulse oximetry screening for critical congenital heart defects: when, how and why?

text: Pulse oximetry (PO) screening for critical congenital heart defects (CCHD) has been studied extensively and is being increasingly implemented worldwide. This review provides an overview of all aspects of PO screening that need to be considered when introducing this methodology. PO screening for CCHD is effective, simple, quick, reliable, cost-effective and does not lead to extra burden for parents and caregivers. Test accuracy can be influenced by targets definition, gestational age, timing of screening and antenatal detection of CCHD. Early screening can lead to more false positive screenings, but has the potential to detect significant pathology earlier. There is no apparent difference in accuracy between screening with post-ductal measurements only, compared with screening using pre-ductal and post-ductal measurements. However, adding pre-ductal measurements identifies cases of CCHD which would have been missed by post-ductal screening. Screening at higher altitudes leads to more false positives. Important non-cardiac pathology is found in 35-74% of false positives in large studies. Screening is feasible in neonatal intensive care units and out-of-hospital births. Training caregivers, simplifying the algorithm and using computer-based interpretation tools can improve the quality of the screening. Caregivers need to consider all aspects of screening to enable them to choose an optimal protocol for implementation of CCHD screening in their specific setting.


title: Management of the compromised airway and role of tracheotomy in anaplastic thyroid carcinoma.

text: BACKGROUND Anaplastic thyroid carcinoma (ATC) is an uncommon thyroid malignancy with a poor prognosis. American Thyroid Association (ATA) guidelines acknowledge the complexity of airway management in these patients. We studied our local experience with the aim of providing guidance in airway management in ATC. METHODS Patients with histologically confirmed ATC from January 2004 to December 2011 were identified from our institutional database. The data were retrospectively analyzed using hospital case notes. RESULTS Twenty-six patients were identified with ATC, 25 of who died from the disease. Five of 26 patients (19%) had stridor at presentation. A further 6 of 26 patients (23%) developed stridor during or soon after radiotherapy. Nine patients (36%) died of airway obstruction. CONCLUSION Tracheotomy can facilitate completion of palliative treatment in those patients with ATC and stridor. Given the short life expectancy of these patients, a balanced decision must be made regarding the role and timing of tracheotomy.


title: Percutaneous radiofrequency ablation of lung cancer presenting as ground-glass opacity.

text: PURPOSE We retrospectively evaluated the outcomes of lung cancer patients presenting with ground-glass opacity (GGO) who received radiofrequency ablation (RFA). METHODS Sixteen patients (5 men and 11 women; mean age, 72.6 years) with 17 lung cancer lesions showing GGO (mean long axis diameter, 1.6 cm) underwent a total of 20 percutaneous computed tomography (CT) fluoroscopy-guided RFA sessions, including three repeated sessions for local progression. Lung cancer with GGO was defined as a histologically confirmed malignant pulmonary lesion with a GGO component accounting for >50 % of the lesion on high-resolution CT. Procedure outcomes were evaluated. RESULTS There were no major complications. Pneumothorax occurred in 15 of 20 treatment sessions: 14 were asymptomatic, and 1 required chest tube placement but resolved satisfactorily within 48 h. Minor pulmonary hemorrhage occurred in two and mild pneumonitis in one. The median tumor follow-up period was 61.5 (range 6.1-96.6) months. The effectiveness rates of the primary and secondary techniques were 100 and 100 % at 1 year, 93.3 and 100 % at 2 years, and 78.3 and 92.3 % at 3 years, respectively. The median patient follow-up period was 65.6 (range 6.1-96.6) months. One patient died owing to recurrent other cancer 11.7 months after RFA, whereas the other 15 remained alive. Overall survival and disease-specific survival rates were 93.3 and 100 % at 1 year and 93.3 and 100 % at 5 years, respectively. CONCLUSIONS RFA for lung cancer with GGO was safe and effective, and resulted in promising survival rates.


Three-dimensionally navigated image-guided radiofrequency ablation in the head and neck.


title: Comparison of Blumgart versus conventional duct-to-mucosa anastomosis for pancreaticojejunostomy after pancreaticoduodenectomy.

text: Backgrounds/Aims Pancreatic leakage is a major cause of postoperative death and morbidity after pancreaticoduodenectomy (PD). A recent study introduced Blumgart anastomosis (BA), which minimizes severe complications after PD. This study compares BA with conventional anastomosis (CA) for pancreaticojejunostomy (PJ) after PD at a single institution. Methods A total of 87 patients who underwent PD at our hospital between January 2003 and October 2015 were enrolled in this study. The patients were divided into two groups according to the anastomosis type. Of them, 44 patients underwent anastomosis using CA (group A, conventional duct-to-mucosa anastomosis) and 43 underwent anastomosis using BA (group B, Blumgart anastomosis). Results There was a significant difference in duration of the operation between groups A and B (473.1±102.0 versus 386.4±58.5 min, p<0.001) and intraoperative transfusion (2.2±2.7 versus 0.7±1.5 units, p<0.001). There was no significant difference between groups A and B in incidence of postoperative pancreatic fistula (POPF) (43.2% versus 27.9%, p=0.137) ,postoperative hemorrhage (PPH) (13.7% versus 7.0%, p=0.209), delayed gastric emptying (DGE) (29.5% versus 9.3%, p=0.063), surgical and non-surgical complications (60.5% versus 59.1%, p=0.896), length of ICU stay (9.0±6.3 versus 7.4±7.2 days, p=0.099), or length of postoperative hospital stay (37.7±16.7 versus 41.6±15.1 days, p=0.118). Conclusions The results of this study suggest that BA-type PJ is not inferior to CA-type PJ in terms of postoperative complications.


title: Evaluation of an Extended-Release, Abuse-Deterrent, Microsphere-in-Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD).

text: BACKGROUND Patients who have chronic pain with dysphagia (difficulty swallowing) (CPD) often have difficulty taking oral medication and, as such, alter their medications by crushing or chewing in an attempt to make it easier to swallow. Such manipulation of currently marketed, extended-release (ER) opioid analgesics can significantly alter the pharmacokinetic (PK) properties of the formulations, resulting in poor treatment outcome or serious adverse events. There is an unmet medical need for oral ER opioid formulations suitable for patients with CPD. OBJECTIVE The primary objectives of this study were to conduct in vitro studies to evaluate alternate means of administration of a new, extended-release (ER), abuse-deterrent, microsphere-in-capsule formulation of oxycodone for patients with CPD. Specifically, these studies investigated the in vitro equivalence of drug release rates from Oxycodone DETERx® ER intact capsules (control condition) and administration via alternate modes-opening the capsule and sprinkling the microspheres onto soft foods or administration through enteral tubes. Secondary objectives were to compare alternate modes of administration of Oxycodone DETERx® to a commercially available ER-morphine product. METHODS Soft food study: Oxycodone DETERx® microspheres were sprinkled onto and mixed with several soft foods (ie, applesauce, vanilla pudding, strawberry jam, yogurt, and vanilla ice cream); the effect of drug contact time (0, 30, and 60 minutes) on drug release was studied. Enteral tube study: Oxycodone DETERx® microspheres were administered through varying sizes of nasogastric (10 and 12 Fr.) tubes and a 16 Fr. gastrostomy tube using 5 different delivery vehicles (ie, water, liquid nutritional feeds [Jevity®, Ensure®], and milk [whole milk and 2% milk]). Drug release rate was characterized using a standard in vitro dissolution methodology; dissolution of intact Oxycodone DETERx® capsules served as the control for both the soft food and enteral tube studies. Oxycodone concentration was measured using a standardized high-performance liquid chromatography (HPLC) assay. Similarity factor (f2) analysis was used to compare similarity of the dissolution profiles of test and control conditions. RESULTS The mean dissolution profile of Oxycodone DETERx® microspheres sprinkled onto and mixed with each of the soft foods were similar (f2 > 50) to that of the control. Study drug-food contact time did not impact dissolution profiles. The dissolution data obtained from Oxycodone DETERx® microspheres passed through enteral feeding tubes of varying sizes were similar (f2 > 50) to that of the control. Unlike a marketed morphine sulfate ER pellet formulation, Oxycodone DETERx® did not clog any of the studied enteral tubes. CONCLUSION A new ER, abuse-deterrent, microsphere-in-capsule formulation of oxycodone can be administered by sprinkling onto soft food without affecting the drug release profile of the formulation. The formulation can also be administered directly via enteral tubes without affecting drug release and without clogging enteral tubes. Oxycodone DETERx® may offer physicians and patients with CPD an alternate treatment option, especially in those patients who have dysphagia or an aversion to swallowing monolithic tablet/capsule formulations and for whom analgesic patches or other opioid formulations are not a viable therapeutic option.


title: Status and Suggestions on Postmortem Examination during the Outbreak of COVID-19.

text: Abstract


title: Preparing an obstetric unit in the heart of the epidemic strike of COVID-19: quick reorganization tips.

text: COVID-19 is placing considerable strain on healthcare systems. Disaster and military medicine specialists were involved in the outbreak in Italy, after many units were overwhelmed.Health providers were caught off guard and personnel was unprepared to face this unprecedented threat. Local decisions accelerated the rate of the spread. Many countries declared a state of emergency and lockdown to contain the exponential transmission of the disease.The purpose of this review is to suggest quick key points of strategies to implement in obstetric units without delay to respond to the oncoming wave, based on experience and feedback from the field.It is essential in an emergency situation to understand what is at stake and prepare maternity wards in the best possible way.


Role of von Willebrand Factor and ADAMTS-13 in the Pathogenesis of Thrombi in SARS-CoV-2 Infection: Time to Rethink.


Innovation in Cancer Care Delivery in the Era of COVID-19.


title: Singapore COVID-19 Pandemic Response as a Successful Model Framework for Low-Resource Health Care Settings in Africa?

text: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus continues to spread and evolve across the planet. The crosscutting impacts of the virus, individual country responses to the virus, and the state of preparedness of local public health systems greatly vary across the world. The ostensibly late arrival of the virus in Africa has allowed learning, innovation, and adaptation of methods that have been successful in the early-hit countries. This article analyzes how Singapore has responded to the COVID-19 pandemic and proposes that adaptations of the Singapore pandemic response model would bode well for Africa's response to the COVID-19 pandemic in ways that also take into account regional differences in health care infrastructures, socioeconomic resilience, poverty, and the vast population diversity in the African continent. As the pandemic evolves, the lessons learned in Asia, in particular, and the emerging new experiences in African countries should inform, ideally in real time, how best to steer the world populations into safety, including those in low-resource health care settings. Finally, we note that the current COVID-19 pandemic is also a test for our collective ability to scale and surge public health in response to future and likely equally challenging zoonosis infections that jump from animals to humans, not to mention climate change-related planetary health calamities in the 21st century. Hence, what we learn effectively from the current COVID-19 pandemic shall have broad, enduring, and intergenerational relevance for the future of planetary heath and society.