title: Renal artery sympathetic denervation: observations from the UK experience.

text: BACKGROUND Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN. METHODS We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres. RESULTS Results from 253 patients treated with five technologies are shown. Pre-procedural mean office BP (OBP) was 185/102 mmHg (SD 26/19; n = 253) and mean daytime ABP was 170/98 mmHg (SD 22/16; n = 186). Median number of antihypertensive drugs was 5.0: 96 % ACEi/ARB; 86 % thiazide/loop diuretic and 55 % aldosterone antagonist. OBP, available in 90 % at 11 months follow-up, was 163/93 mmHg (reduction of 22/9 mmHg). ABP, available in 70 % at 8.5 months follow-up, was 158/91 mmHg (fall of 12/7 mmHg). Mean drug changes post RDN were: 0.36 drugs added, 0.91 withdrawn. Dose changes appeared neutral. Quartile analysis by starting ABP showed mean reductions in systolic ABP after RDN of: 0.4; 6.5; 14.5 and 22.1 mmHg, respectively (p < 0.001 for trend). Use of aldosterone antagonist did not predict response (p > 0.2). CONCLUSION In 253 patients treated with RDN, office BP fell by 22/9 mmHg. Ambulatory BP fell by 12/7 mmHg, though little response was seen in the lowermost quartile of starting blood pressure. Fall in BP was not explained by medication changes and aldosterone antagonist use did not affect response.


title: Relationship between functional end-to-end anastomosis for colon cancer and surgical site infections.

text: PURPOSE Surgical site infections (SSI) are a common complication of gastrointestinal tract surgery. In this study, we explored the correlation between the anastomosis method and the incidence of SSI. METHODS A total of 110 patients underwent ileocecal resection or right hemicolectomy for the excision of colon cancer. Two methods (open and closed, 28 and 82 patients, respectively) of functional end-to-end anastomosis were adopted. RESULTS Increased perioperative blood loss (p = 0.029214), a longer hospital stay (p = 0.026668) and the development of SSI (p = 0.000181) were significantly correlated with the open method. There was no correlation between SSI and the body mass index, or between SSI and the length of the surgery or diabetes mellitus. However, patients that developed SSI tended to be obese. CONCLUSION The open method was associated with a higher incidence of SSI. Therefore, it is necessary to consider potential contamination of the surgical field at the time of anastomosis to reduce the incidence of SSI.


title: Human rhinovirus species and season of infection determine illness severity.

text: RATIONALE Human rhinoviruses (HRVs) consist of approximately 160 types that cause a wide range of clinical outcomes, including asymptomatic infections, common colds, and severe lower respiratory illnesses. OBJECTIVES To identify factors that influence the severity of HRV illnesses. METHODS HRV species and types were determined in 1,445 nasal lavages that were prospectively collected from 209 infants participating in a birth cohort who had at least one HRV infection. Questionnaires were used during each illness to identify moderate to severe illnesses (MSI). MEASUREMENTS AND MAIN RESULTS Altogether, 670 HRV infections were identified, and 519 of them were solitary infections (only one HRV type). These 519 viruses belonged to 93 different types of three species: 49 A, 9 B, and 35 C types. HRV-A (odds ratio, 8.2) and HRV-C (odds ratio, 7.6) were more likely to cause MSI compared with HRV-B. In addition, HRV infections were 5- to 10-fold more likely to cause MSI in the winter months (P < 0.0001) compared with summer, in contrast to peak seasonal prevalence in spring and fall. When significant differences in host susceptibility to MSI (P = 0.004) were considered, strain-specific rates of HRV MSI ranged from less than 1% to more than 20%. CONCLUSIONS Factors related to HRV species and type, season, and host susceptibility determine the risk of more severe HRV illness in infancy. These findings suggest that anti-HRV strategies should focus on HRV-A and -C species and identify the need for additional studies to determine mechanisms for seasonal increases of HRV severity, independent of viral prevalence, in cold weather months.


title: Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis.

text: BACKGROUND We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain. METHODS We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (€2017). RESULTS Over the 10-year horizon, BS led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and €300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss. CONCLUSIONS Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.


title: Three-dimensional imaging of the intracellular assembly of a functional viral RNA replicase complex.

text: Positive-strand RNA viruses, which can be devastating pathogens in humans, animals and plants, replicate their genomes on intracellular membranes. Here, we describe the three-dimensional ultrastructural organization of a tombusvirus replicase in yeast, a valuable model for exploring virus-host interactions. We visualized the intracellular distribution of a viral replicase protein using metal-tagging transmission electron microscopy, a highly sensitive nanotechnology whose full potential remains to be developed. These three-dimensional images show how viral replicase molecules are organized when they are incorporated into the active domains of the intracellular replication compartment. Our approach provides a means to study protein activation mechanisms in cells and to identify targets for new antiviral compounds.


title: How did the Macintosh laryngoscope become so popular?

text: The Macintosh laryngoscope has been described as 'the most numerously and widely made durable item in the history of anesthesia' (Sir Anthony Jephcott, February 6, 1983). This laryngoscope was originally designed to facilitate intubation in unparalyzed patients and became universally adopted by the anesthetic community. In spite of enormous subsequent changes in anesthetic practice, the Macintosh laryngoscope continues to dominate 50 years after its key indication has become obsolete. This study explores the development and success of this ubiquitous instrument.


title: Bispectral index as a predictor of unsalvageable traumatic brain injury.

text: PRIMARY OBJECTIVE We aimed to assess the utility of bispectral index (BIS) monitoring to diagnose brain death (BD) in patients with severe traumatic brain injury (TBI). RESEARCH DESIGN AND METHODS A prospective observational study was conducted for patients with severe TBI between 2012 and 2014. MAIN OUTCOMES AND RESULTS This study included 62 patients with a mean age of 32.5 ± 10.5 years. Nine patients had BD on admission with a sustainable BIS value of 0. Fifty-three patients were not initially diagnosed with BD with BIS values of 2-56. Forty-four patients deteriorated to BD, and their respective BIS values progressively decreased to 0. Nine patients with mean BIS of 39.2 ± 9.0 recovered and were transferred to a specialized high dependency unit. BIS values showed positive correlation with the Glasgow Coma Score (GCS) on admission (r = 0.43, p = 0.001). Survivors had higher BIS values than those who were initially declared BD or those who died during the hospitalization course (p = 0.001). CONCLUSION BIS values have a significant correlation with initial GCS and can assist in the early detection of BD in patients with severe acute TBI. Further larger studies are needed to support our findings.


title: Is an abnormal vascular response after renal sympathetic denervation predictive of permanent damage? An unusual case of late renal artery stenosis after energy delivery.

text: PURPOSE To describe the effect of renal sympathetic denervation (RDN) on renal arteries immediately after the procedure and at follow-up. CASE REPORT A 52-year-old woman with severe resistant hypertension underwent RDN. A transient spasm occurred in the left renal artery immediately after radiofrequency energy delivery, with subsequent complete resolution without any additional therapy. At 6-month follow-up, the blood pressure increased, and imaging revealed a tight stenosis in the left renal artery, which was successfully treated with a stent. In the next days, there was an immediate significant blood pressure reduction. CONCLUSION Renal denervation can be complicated by local tissue injury at the ablation sites that could be a possible trigger of late arterial disease.


Duane F. Alexander, M.D.: August 11, 1940-February 16, 2020.


title: Is near-infrared spectroscopy clinically useful in the preterm infant?

text: Near-infrared spectroscopy (NIRS) has been used to study cerebral haemodynamics and oxygenation in the preterm infant for many years, but its use as a clinical tool has remained elusive. This has partly been due to the challenges of providing a continuous quantitative measurement that is valid and reliable, as well as demonstrating that interventions based on NIRS measurements improve clinical outcome. Recent studies investigating cerebral oxygenation targeted treatment, and defining optimal blood pressure based on an assessment of cerebrovascular reactivity, suggest ways in which this technology may yet be clinically useful.


Americans are told to wear cloth masks.


title: WHO Declares COVID-19 a Pandemic.

text: The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic (1). At a news briefing , WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, noted that over the past 2 weeks, the number of cases outside China increased 13-fold and the number of countries with cases increased threefold. Further increases are expected. He said that the WHO is "deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction," and he called on countries to take action now to contain the virus. "We should double down," he said. "We should be more aggressive." [...].


title: Single-port laparoscopic sphincter-saving mesorectal excision for rectal cancer: report of the first 4 human cases.

text: HYPOTHESIS Single-port laparoscopic rectal surgery can be performed using the principles of oncologic surgery in institutes experienced in laparoscopy with the advantages of minimally invasive surgery. DESIGN Sphincter-saving mesorectal excision in 4 human cases via a single laparoscopic port. SETTINGS A university hospital and a private hospital. PATIENTS A series of 4 patients who underwent single-port laparoscopic sphincter-saving rectal resection for rectal cancer. Two of them were total and 2 were partial mesorectal excisions. INTERVENTIONS An umbilical incision was made to place the multichannel single port. The sigmoid colon was hung to the left lateral abdominal wall using an intracorporeal stitch passing through its appendices epiploicae to achieve medial dissection and vascular ligation. The mesorectum was sharply dissected down to the pelvic floor. Endoscopic linear roticulating staplers were used to divide the rectum and proximal colon. A specimen was retrieved using an extraction bag through the umbilicus. Anastomosis was performed using a circular stapler, or pull-through hand-sewn anastomosis was performed. MAIN OUTCOME MEASURES Duration of the operation, length of hospital stay, surgical complications, wound size, and histopathologic data. RESULTS There were no perioperative or postoperative complications. Mean operative time was 347 minutes (range, 240-480 minutes). Mean hospital stay was 4.25 days (range, 4-5 days). Mean wound size was 3.5 cm (range, 3-4 cm). Mean number of harvested lymph nodes was 15 (range, 8-28). CONCLUSIONS With the help of sophisticated surgical technology and techniques, single-port laparoscopic surgery for rectal cancer will be feasible while also maintaining oncologic principles and patient safety.


title: Public health intelligence and the detection of potential pandemics.

text: This article considers contemporary developments in public health intelligence (PHI), especially their focus on health events of pandemic potential. It argues that the sociological study of PHI can yield important insights for the sociology of pandemics. PHI aims to detect health events as (or even before) they unfold. Whilst its apparatuses envelope traditional public health activities, such as epidemiological surveillance, they increasingly extend to non-traditional public health activities such as data-mining in electronically mediated social networks. With a focus on non-traditional PHI activities, the article first situates the study of PHI in relation to the sociology of public health. It then discusses the conceptualisation and actualisation of pandemics, reflecting on how public health professionals and organisations must equip themselves with diverse allies in order to realise the claims they make about pandemic phenomena. Finally, using the analytic tools of actor-network theory, sites for future empirical research that can contribute to the sociology of pandemics are suggested.


title: Specific neutralizing response in plasma from convalescent patients of Ebola Virus Disease against the West Africa Makona variant of Ebola virus.

text: BACKGROUND The current outbreak of Ebola Virus Disease in West Africa is caused by a new variant of Ebola virus (EBOV) named Makona 2014, whose sequence differs 3% from isolates from Central Africa such as Mayinga 1976 EBOV. The specificity and kinetics of the neutralizing antibody response induced by the circulating Makona EBOV has not been thoroughly studied. METHODS We have used a lentiviral EBOV-glycoprotein (GP)-pseudotyped infection assay to measure Makona-GP and Mayinga-GP specific neutralizing activity of plasma from three convalescent Ebola Virus Disease patients from the current EBOV outbreak at 2, 3, 4 and 9 months post-infection. Total anti-EBOV GP IgG was measured by a commercial ELISA assay. FINDINGS In convalescent Ebola Virus Disease patients, Makona-GP-specific neutralizing titers increased from 2 months (mean IC50 1/59), 3 months (IC50 1/212), 4 months (IC50 1/239) and up to 9 months (IC50 1/268) post-infection. Neutralizing activity of plasma from the three convalescent Ebola Virus Disease patients was more vigorous against the current Makona-GP pseudotyped EBOV variant than against Mayinga-GP pseudotyped EBOV and this difference was observed at each time point tested: Mayinga vs Makona mean IC50 fold=4.92 at 2 months post-infection, 2.89 fold at 3 months post-infection, 2.23 at 4 months post-infection and 2.98 at 9 months post-infection (all differences p<0.01). Total level of IgG against EBOV-GP did not evolve significantly during the follow up. DISCUSSION In convalescent Ebola Virus Disease patients, EBOV-GP specific neutralizing activity increases over time, at least up to 9 months post-infection, which suggests that active affinity maturation of antibodies takes place long after clinical recovery. EBOV-GP specific neutralizing response is significantly higher against Makona EBOV circulating in West Africa than against the variants included in the currently approved vaccines. Correlates of protection for EBOV vaccines have not been completely established and the relevance of a lower neutralizing activity in convalescent plasma from the current outbreak against one of the EBOV-GPs contained in the vaccines in terms of its potential efficacy does not necessarily preclude its efficacy. However, this observation highlights the concern regarding the natural diversity of EBOV and its subsequent challenge for diagnosis, therapy and vaccine design. EBOV-GP neutralizing activity varies considerably over time in convalescent Ebola Virus Disease patients. Titering of convalescent blood products would be desirable to standardize and evaluate their potential therapeutic value.


title: Qualitative analysis of the viability of autogenous fat grafts grafted in different environments of interstitial pressure. Preliminary results and description of a new experimental model in mini-pigs.

text: PURPOSE To evaluate the feasibility of an experimental model of autologous fat graft (AFG) in different interstitial pressure (IP) environments. METHODS Three mini-pigs(Minipig-BR) with age of 8 months (weight: 25-30 kg) were used. AFG were collected from the bucal fat pad, and grafted in the intramuscular pocket (biceps femoralis muscle). IP model was based on a fusiform ressection followed by primary closure "under tension". A blood pressure catheter located in the intramuscular region connected to a pressure module was applied to quantify IP. RESULTS The mean operative time was 236 min (210 - 272 min). All the AFG and muscular segments were removed successfully. Average interstitial pressure CP and H were 3 and 10.6 mmHg respectively. The AFG were biopsied for histopathological analysis 30 days after graft. Hematoxylin-eosin staining and immunohistochemical analyzes (TNF-alpha, CD31 and Perilipine with monoclonal antibodies) were employed. CONCLUSION The data show that minipigs model could be used as a recipient site for autologous fat graft techniques and allow the development of studies to explore the AFG intake and pathophysiology response.


Three ways to turn the page after your first paper rejection.


title: Direct Cervical Carotid Stenting and Angioplasty of Right Internal Carotid Artery and Brachiocephalic Artery Ostial Stenoses With Flow Reversal: 2-Dimensional Operative Video.

text: We present a case of tandem stenosis of the great vessels (cervical internal carotid artery [ICA] and brachiocephalic trunk ostium [BTO]) treated with stenting and balloon angioplasty of both lesions under flow arrest. A 70-yr-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, and previous strokes presented with recurrent transient ischemic attacks of the left upper and lower extremities over the last 6 mo. She underwent right cervical endarterectomy (CEA) 16 yr prior. Neurological examination was unremarkable. Carotid Doppler ultrasonography revealed severely increased velocities of the right ICA. Cervical magnetic resonance angiography demonstrated 80% right ICA stenosis and 50% BTO stenosis. Digital subtraction cerebral angiography showed 80% right ICA stenosis and 70% BTO stenosis. The patient was not a candidate for standard carotid artery stenting because the BTO precluded endovascular access or for CEA because of the previous CEA; therefore, direct carotid access and flow reversal was an alternative. Under general anesthesia and systemic heparinization, the patient underwent right carotid artery surgical exposure. Under flow reversal using the Enroute System (Silk Road Medical, Sunnyvale, California), anterograde right ICA stenting angioplasty and retrograde BTO stenting and angioplasty were performed. Successful revascularization of the right ICA and BTO was obtained. No procedure-related complications occurred. The patient was discharged home 2 d postprocedure, neurologically intact. Direct carotid access with flow reversal is a safe and effective therapeutic alternative for patients with ICA (or common carotid artery) stenosis who cannot undergo CEA or when endovascular access from the aortic arch is not possible. Patient consent was obtained prior to performing the procedure. Institutional board approval is not required for the report of a single case.


title: Comparative bench study evaluation of different infant interfaces for non-invasive ventilation.

text: BACKGROUND To compare, in terms of patient-ventilator interaction and performance, a new nasal mask (Respireo, AirLiquide, FR) with the Endotracheal tube (ET) and a commonly used nasal mask (FPM, Fisher and Paykel, NZ) for delivering Pressure Support Ventilation (PSV) in an infant model of Acute Respiratory Failure (ARF). METHODS An active test lung (ASL 5000) connected to an infant mannequin through 3 different interfaces (Respireo, ET and FPM), was ventilated with a standard ICU ventilator set in PSV. The test lung was set to simulate a 5.5 kg infant with ARF, breathing at 50 and 60 breaths/min). Non-invasive ventilation (NIV) mode was not used and the leaks were nearly zero. RESULTS The ET showed the shortest inspiratory trigger delay and pressurization time compared to FPM and Respireo (p < 0.01). At each respiratory rate tested, the FPM showed the shortest Expiratory trigger delay compared to ET and Respireo (p < 0.01). The Respireo presented a lower value of Inspiratory pressure-time product and trigger pressure drop than ET (p < 0.01), while no significant difference was found in terms of pressure-time product at 300 and 500 ms. During all tests, compared with the FPM, ET showed a significantly higher tidal volume (VT) delivered (p < 0.01), while Respireo showed a trend toward an increase of tidal volume delivered compared with FPM. CONCLUSIONS The ET showed a better patient-ventilator interaction and performance compared to both the nasal masks. Despite the higher internal volume, Respireo showed a trend toward an increase of the delivered tidal volume; globally, its efficiency in terms of patient-ventilator interaction was comparable to the FPM, which is the infant NIV mask characterized by the smaller internal volume among the (few) models on the market.


title: Stability of SARS-CoV-2 in PBS for Molecular Detection.

text: RNA viruses often require "cold-chains" of transportation to prevent the breakdown of genetic material.….


title: Laparoscopic treatment for median arcuate ligament syndrome: the usefulness of intraoperative Doppler ultrasound to confirm the decompression of the celiac artery.

text: The median arcuate ligament syndrome is an unusual disease associated with postprandial epigastric pain, and the optimal treatment of this syndrome remains to be established. A 52-year-old woman manifested in our hospital postprandial epigastric pain, and extrinsic compression of the celiac trunk revealed by an abdominal computed tomography. After the induction of general anesthesia, the celiac artery origin was completely skeletonized using a laparoscopic dissector and vessel sealing system. Intraoperative Doppler ultrasound demonstrated that, after surgery, the stenosis of the celiac artery, and poststenotic dilatation observed before the release of the median arcuate ligament, had completely disappeared. In conclusion, the laparoscopic release of the median arcuate ligament is a minimally invasive treatment for median arcuate ligament syndrome. The intraoperative Doppler ultrasound is useful for confirming the decompression of the celiac artery, although long-term follow-up is mandatory.


title: Development of functional in vivo imaging of cerebral lenticulostriate artery using novel synchrotron radiation angiography.

text: The lenticulostriate artery plays a vital role in the onset and development of cerebral ischemia. However, current imaging techniques cannot assess the in vivo functioning of small arteries such as the lenticulostriate artery in the brain of rats. Here, we report a novel method to achieve a high resolution multi-functional imaging of the cerebrovascular system using synchrotron radiation angiography, which is based on spatio-temporal analysis of contrast density in the arterial cross section. This method provides a unique tool for studying the sub-cortical vascular elasticity after cerebral ischemia in rats. Using this technique, we demonstrated that the vascular elasticity of the lenticulostriate artery decreased from day 1 to day 7 after transient middle cerebral artery occlusion in rats and recovered from day 7 to day 28 compared to the controls (p < 0.001), which paralleled with brain edema formation and inversely correlated with blood flow velocity (p < 0.05). Our results demonstrated that the change of vascular elasticity was related to the levels of brain edema and the velocity of focal blood flow, suggesting that reducing brain edema is important for the improvement of the function of the lenticulostriate artery in the ischemic brain.


title: Thoracoscopic Thoracic Duct Ligation for Congenital and Acquired Disease.

text: PURPOSE Congenital and acquired chylothorax presents a unique management challenge in neonates and infants. A failure of conservative therapy requires surgical ligation to prevent continued fluid and protein losses. This article examines a 15-year experience with thoracoscopic ligation of the thoracic duct. PATIENTS AND METHODS From June 1999 to December 2013, 21 patients presented with chylothorax refractory to conservative management. Sixteen patients presented following cardiac procedures, 1 after tracheoesophageal fistula repair, 1 after extracorporeal membrane oxygenation cannulation, and 1 after trauma, and 2 had congenital chylothorax. Ages ranged from 3 weeks to 5 years, and weights ranged from 2.6 to 12.7 kg. All procedures were performed in the right chest with three ports. All cases consisted of sealing of the duct at the level of the diaphragm, a mechanical pleurodesis, and fibrin glue. RESULTS All cases were completed successfully thoracoscopically. Operative time ranged from 20 to 55 minutes. There were no intraoperative complications. One patient with congenital bilateral chylothorax required a left partial pleurectomy. The chest tube duration postoperatively ranged from 4 to 14 days. Ligation failed in 2 patients, requiring a subsequent thoracoscopic pleurectomy and chemical pleurodesis, respectively. CONCLUSIONS Thoracoscopic thoracic duct ligation is a safe and effective procedure even in post-cardiac surgery patients. The site of the leak can be identified in the majority of cases, and tissue-sealing technology appears to be effective. The minimally invasive nature of the procedure has led to more expedient operative repair to avoid the morbidity associated with chyle leak.


title: Raising awareness of disabled lives and health care rationing during the COVID-19 pandemic.

text: Discriminatory and ableist health care rationing policies have raised serious concern in the disability community during the novel coronavirus pandemic. These concerns reflect the long-standing devaluation of disabled lives and place considerable weight on the disability community during this already stressful time. Nondisabled psychologists should work to advocate for the rights of people with disabilities by amplifying the voices and concerns of disabled activists so that history does not repeat itself. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: A Pulmonary Trunk Banding Model of Pressure Overload Induced Right Ventricular Hypertrophy and Failure.

text: Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary disorders. Reliable and reproducible animal models of RV failure are therefore warranted in order to investigate disease mechanisms and effects of potential therapeutic strategies. Banding of the pulmonary trunk is a common method to induce isolated RV hypertrophy but in general, previously described models have not succeeded in creating a stable model of RV hypertrophy and failure. We present a rat model of pressure overload induced RV hypertrophy caused by pulmonary trunk banding (PTB) that enables different phenotypes of RV hypertrophy with and without RV failure. We use a modified ligating clip applier to compress a titanium clip around the pulmonary trunk to a pre-set inner diameter. We use different clip diameters to induce different stages of disease progression from mild RV hypertrophy to decompensated RV failure. RV hypertrophy develops consistently in rats subjected to the PTB procedure and depending on the diameter of the applied banding clip, we can accurately reproduce different disease severities ranging from compensated hypertrophy to severe decompensated RV failure with extra-cardiac manifestations. The presented PTB model is a valid and robust model of pressure overload induced RV hypertrophy and failure that has several advantages to other banding models including high reproducibility and the possibility of inducing severe and decompensated RV failure.


title: Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach.

text: There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.


Cholangioscopic appearance after radiofrequency ablation of cholangiocarcinoma.


Tracheal intubation in patients with COVID-19.


title: Coexisting with wildlife in transfrontier conservation areas in Zimbabwe: cattle owners' awareness of disease risks and perceptions of the role played by wildlife.

text: Diseases transmitted between wildlife and livestock may have significant impacts on local farmers' health, livestock health and productivity, overall national economies, and conservation initiatives, such as Transfrontier Conservation Areas in Southern Africa. However, little is known on local farmers' awareness of the potential risks, and how they perceive the role played by wildlife in the epidemiology of these diseases. We investigated the knowledge base regarding livestock diseases of local cattle owners living at the periphery of conservation areas within the Great Limpopo TFCA and the Kavango-Zambezi TFCA in Zimbabwe, using free-listing and semi-structured questionnaires during dipping sessions. The results suggest that information related to cattle diseases circulates widely between cattle farmers, including between different socio-cultural groups, using English and vernacular languages. Most respondents had an accurate perception of the epidemiology of diseases affecting their livestock, and their perception of the potential role played by wildlife species was usually in agreement with current state of veterinary knowledge. However, we found significant variations in the cultural importance of livestock diseases between sites, and owners' perceptions were not directly related with the local abundance of wildlife. As the establishment of TFCAs will potentially increase the risk of Transboundary Animal Diseases, we recommend an increased participation of communities at a local level in the prioritisation of livestock diseases control and surveillance, including zoonoses.


title: Host and viral ecology determine bat rabies seasonality and maintenance.

text: Rabies is an acute viral infection that is typically fatal. Most rabies modeling has focused on disease dynamics and control within terrestrial mammals (e.g., raccoons and foxes). As such, rabies in bats has been largely neglected until recently. Because bats have been implicated as natural reservoirs for several emerging zoonotic viruses, including SARS-like corona viruses, henipaviruses, and lyssaviruses, understanding how pathogens are maintained within a population becomes vital. Unfortunately, little is known about maintenance mechanisms for any pathogen in bat populations. We present a mathematical model parameterized with unique data from an extensive study of rabies in a Colorado population of big brown bats (Eptesicus fuscus) to elucidate general maintenance mechanisms. We propose that life history patterns of many species of temperate-zone bats, coupled with sufficiently long incubation periods, allows for rabies virus maintenance. Seasonal variability in bat mortality rates, specifically low mortality during hibernation, allows long-term bat population viability. Within viable bat populations, sufficiently long incubation periods allow enough infected individuals to enter hibernation and survive until the following year, and hence avoid an epizootic fadeout of rabies virus. We hypothesize that the slowing effects of hibernation on metabolic and viral activity maintains infected individuals and their pathogens until susceptibles from the annual birth pulse become infected and continue the cycle. This research provides a context to explore similar host ecology and viral dynamics that may explain seasonal patterns and maintenance of other bat-borne diseases.


title: Comparison of academic and nonacademic sites in multi-center clinical trials.

text: The selection of appropriate subjects is a critical element of successful clinical trials. Failure to properly identify, select, and retain subjects in clinical trials of antidepressant medications may affect the ability to show separation from placebo. Little is known about which type of site, academic or nonacademic, is superior in selecting and retaining appropriate subjects. In the present investigation, the authors conducted a retrospective analysis comparing the performance of academic and nonacademic sites in selecting and retaining appropriate subjects in a recently completed multi-site clinical study of aripiprazole augmentation. The authors used a set of operationalized criteria called the SAFER to identify appropriate study subjects. No significant differences were found in rates of SAFER interview passing, study completion, and clinical outcomes between academic and nonacademic sites. Our findings suggest that academic and nonacademic sites are equally effective in their ability to identify and retain appropriate study participants.


title: Continuous Normothermic Ex Vivo Kidney Perfusion Improves Graft Function in Donation After Circulatory Death Pig Kidney Transplantation.

text: BACKGROUND Donation after circulatory death (DCD) is current clinical practice to increase the donor pool. Deleterious effects on renal graft function are described for hypothermic preservation. Therefore, current research focuses on investigating alternative preservation techniques, such as normothermic perfusion. METHODS We compared continuous pressure-controlled normothermic ex vivo kidney perfusion (NEVKP) with static cold storage (SCS) in a porcine model of DCD autotransplantation. After 30 minutes of warm ischemia, right kidneys were removed from 30-kg Yorkshire pigs and preserved with 8-hour NEVKP or in 4°C histidine-tryptophan-ketoglutarate solution (SCS), followed by kidney autotransplantation. RESULTS Throughout NEVKP, electrolytes and pH values were maintained. Intrarenal resistance decreased over the course of perfusion (0 hour, 1.6 ± 0.51 mm per minute vs 7 hours, 0.34 ± 0.05 mm Hg/mL per minute, P = 0.005). Perfusate lactate concentration also decreased (0 hour, 10.5 ± 0.8 vs 7 hours, 1.4 ± 0.3 mmol/L, P < 0.001). Cellular injury markers lactate dehydrogenase and aspartate aminotransferase were persistently low (lactate dehydrogenase < 100 U/L, below analyzer range; aspartate aminotransferase 0 hour, 15.6 ± 9.3 U/L vs 7 hours, 24.8 ± 14.6 U/L, P = 0.298). After autotransplantation, renal grafts preserved with NEVKP demonstrated lower serum creatinine on days 1 to 7 (P < 0.05) and lower peak values (NEVKP, 5.5 ± 1.7 mg/dL vs SCS, 11.1 ± 2.1 mg/dL, P = 0.002). The creatinine clearance on day 4 was increased in NEVKP-preserved kidneys (NEVKP, 39 ± 6.4 vs SCS, 18 ± 10.6 mL/min; P = 0.012). Serum neutrophil gelatinase-associated lipocalin at day 3 was lower in the NEVKP group (1267 ± 372 vs 2697 ± 1145 ng/mL, P = 0.029). CONCLUSIONS Continuous pressure-controlled NEVKP improves renal function in DCD kidney transplantation. Normothermic ex vivo kidney perfusion might help to decrease posttransplant delayed graft function rates and to increase the donor pool.


title: Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System.

text: OBJECTIVE To describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures. MATERIALS AND METHODS Between May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications. RESULTS Mean FB size was 23 mm (range 8-74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications. CONCLUSION Percutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.


Point of care testing for malaria using LAMP, loop mediated isothermal amplification.


title: The neuro-critical care management of the endovascular stroke patient.

text: OPINION STATEMENT Acute ischemic stroke carries high morbidity and mortality. The advent of intravenous thrombolysis and endovascular reperfusion techniques have helped improve clinical outcomes for patients with large vessel acute ischemic stroke. The care of the post-endovascular stroke patient is complex and encompasses almost all aspects of medicine. Hemodynamics should be optimized post procedure to ensure adequate cerebral perfusion and strict hemodynamic parameters must be adhered to minimize reperfusion injury. Though no studies have specifically examined hemodynamic goals, our practice is to maintain a mean arterial pressure (MAP) > 70 and systolic blood pressure (SBP) < 140 for patients following successful recanalization. Early anti-thrombotic therapy is indicated in patients with stent placement. It remains less clear which patients may benefit from additional anticoagulation or therapy with IIb/IIIa inhibitors. Careful consideration must be paid to volume status to reduce risk of contrast nephropathy and maximize cerebral perfusion. Oral care and attention to dysphagia are key in preventing aspiration pneumonia. Glycemic control should be optimized to avoid excessive hyper and hypoglycemia. In the absence of data to guide treatment of anemia, our practice is to transfuse asymptomatic anemia when Hgb < 7 mg/dL, or if the patient is symptomatic or hemodynamically unstable. Neuro-protective strategies should be considered in the context of clinical trials until further studies are complete. At a minimum, fever should be treated aggressively. Young patients with good pre-morbid functional status who continue to have large volume infarcts may benefit from decompressive hemicraniectomy. When appropriate, aggressive and early mobilization is recommended to prepare patients for acute rehabilitation. Because randomized prospective data is lacking, patients should be encouraged to enroll in clinical trials to optimize care of this growing patient population.


title: Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy.

text: PURPOSE The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer. METHODS Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012. RESULTS In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes). CONCLUSION SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.


title: A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil.

text: The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.


title: Preventing staple-line leak in sleeve gastrectomy: reinforcement with bovine pericardium vs. oversewing.

text: One of the most serious, potentially life-threatening complications of laparoscopic sleeve gastrectomy (LSG) is staple-line leakage. Oversewing the LSG staple line vs buttressing it with bovine pericardial strips (BPS) to reduce perioperative bleeding and postoperative gastric leak was evaluated. From 2006 through 2011, 160 patients underwent LSG with suturing as the only staple-line reinforcement (Group A). From March 2010 through August 2012, 84 LSG patients had BPS incorporated into their last two stapler firings (Group B). Staple lines were evaluated perioperatively for bleeding, and patients were monitored for indications of staple-line leaks (peritonitis, abnormal output from the drain). In preoperative Group A and B, there were 117 (73.1%) vs. 56 (66.7%) females; mean age, 35.2 years (18.0-68.0) vs. 33.8 years (15.0-64.0); mean body mass index (BMI, kilograms per square meter), 42.5 (27.0-76.0) vs. 42.0 (30.0-58.0). Three months after surgery, mean BMI for Group A was 37.3 (-5.9); Group B, 35.2 (-7.3); at 6 months, 32.7 (-10.8) and 31.5 (-11.3; p < 0.001). Although there was no significant difference in perioperative blood loss, oversewn staple lines in Group A often required electrocautery to stanch bleeding; this was not required for Group B. In Group A, 15 patients (9.4%) developed complications; in Group B, five (6.0%; p = 0.46). Gastric fistula, verified by barium swallow, occurred in eight Group A patients (5.0%); in Group B, one (1.2%; p = 0.17). Relative to oversewing, staple-line buttressing with bovine pericardium was readily accomplished, safe, and associated with a lower staple-line leak rate.


title: A Role for Retinoids in The Treatment of Covid-19?

text: The 2020 global outbreak of the novel coronavirus (SARS-CoV-2 or Covid-19) is a serious threat to international health and thus there is an urgent need for discovery of novel therapies or use of repurposed drugs that can make a significant impact on slowing the spread of the virus. Type 1 interferons (IFN-I) are a family cytokines of the early innate immune response to viruses that are being tested against SARS-CoV-2. However coronaviruses similar to SARS-CoV-2 can suppress host IFN-I anti-viral responses. Retinoids are a family molecules related to vitamin A that possess robust immune modulating properties, including the ability to increase and potentiate the actions of IFN-I. Therefore adjuvants such as retinoids, capable of increasing IFN-I mediated anti-viral responses should be tested in combinations of IFN-I and anti-viral drugs in pre-clinical studies of SARS-CoV-2.


title: Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?

text: BACKGROUND Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. METHODS An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. RESULTS One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. CONCLUSION Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.


title: A running suture line for aortic valve replacement does not increase the rate of postoperative complete heart block.

text: BACKGROUND Surgical implantation of a prosthetic aortic valve is typically done with multiple interrupted sutures. We adapted a running suture line technique for prostheses implantation to decrease the rate of complete heart block necessitating permanent pacemaker. METHODS 374 patients undergoing isolated aortic valve replacements were identified between 2015 and 2017. Patients with preoperative heart block, patients undergoing concomitant MAZE procedure and those undergoing multivalve procedures were excluded. Interrupted technique was performed with multiple non-pledgeted sutures. Running technique was performed with three 2-0 polypropylene sutures. Propensity-score matching (caliper distance = 0.10) was used to match based on patient age, gender, BMI, diabetes mellitus, renal failure, heart failure, arrythmias, use of anti-arrhythmics, and STS PROM. RESULTS Propensity score matching yielded 103 pairs of running technique and interrupted technique patients for analysis. Within the propensity score-matched cohort, there were no differences in sustained complete heart block and need for pacemaker, 4 (3.8%) for running technique vs 3 (2.9%) for interrupted technique (p = 0.307). At 4 weeks, there was no difference in mean prosthetic aortic valve gradients calculated on transthoracic echocardiogram (6.39 ± 2.47 mmHg vs 6.46 ± 2.86, p = 0.850). There was no difference in paravalvular leak (0 (0%) vs 2 (1.9%), p = 0.070). CONCLUSIONS Surgical implantation of a prosthetic aortic valve may be performed with a running suture technique without any significant increase in risk of heart block, need for permanent pacemaker or paravalvular leak. Long-term data will be critical to evaluate any development of paravalvular leaks in the future.


title: Massive aspiration past the tracheal tube cuff caused by closed tracheal suction system.

text: BACKGROUND Aspiration past the tracheal tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed tracheal suctioning on aspiration of fluid past the tracheal tube cuff in an in vitro benchtop model. METHODS High-volume low pressure tube cuffs of 7.5 mm internal diameter (ID) were placed in a 22 mm ID artificial trachea connected to a test lung. Positive pressure ventilation (PPV) with 15 cm H₂O peak inspiratory pressure and 5 cm H₂O positive end-expiratory pressure (PEEP) was used. A closed tracheal suction system (CTSS) catheter (size 14Fr) was attached to the tracheal tube and suction was performed for 5, 10, 15, or 20 seconds under 200 or 300 cm H₂O suction pressures. Amount of fluid (mL) aspirated along the tube cuff and the airway pressure changes were recorded for each suction procedure. Fluid aspiration during different suction conditions was compared using Kruskal-Wallis and Mann-Whitney test (Bonferroni correction [α = .01]). RESULTS During 10, 15, and 20 seconds suction, airway pressure consistently dropped down to -8 to -13 cm H₂O (P < .001) from the preset level. Fluid aspiration was never observed under PPV + PEEP but occurred always during suctioning. Aspiration along the tube cuff was higher with -300 cm H₂O than with -200 cm H₂O suction pressure (P < .001) and was much more during 15 and 20 seconds suction time as compared to 5 seconds (P < .001). CONCLUSION Massive aspiration of fluid occurs along the tracheal tube cuff during suction with the closed tracheal suction system.


title: Single-port extraperitoneal transvesical adenomectomy: initial operative experience.

text: BACKGROUND Laparoscopic extraperitoneal adenomectomy is occasionally performed for symptomatic large-volume benign prostatic hyperplasia. Two different multichannel ports were used during operations. We describe the technique of single-port extraperitoneal transvesical adenomectomy and present the initial operative experience. METHODS Three patients in whom an open adenomectomy was indicated underwent single-port extraperitoneal transvesical adenomectomy. Following preparation of the extraperitoneal space via an umbilical incision, a multichannel port was inserted. A transverse cystotomy adjacent to the prostatovesical junction, incision of mucosa overlying the adenoma, subcapsular plane development, prostatic adenomectomy and cystotomy repair were performed as the standard steps of the laparoscopic procedure. RESULTS All cases were completed without conversion to standard laparoscopy. Mean operative time was 105 min. Mean blood loss was 190 ml. Hospital stay was 4 days and catheter duration was 6 days for all patients. No intraoperative or postoperative complication occurred. CONCLUSIONS Single-port extraperitoneal transvesical adenomectomy for large benign prostate hyperplasia is feasible with excellent cosmetic results and minimal morbidity.


title: First 200 consecutive transumbilical single-incision laparoscopic TEPs.

text: BACKGROUND Endoscopic pre-peritoneal mesh repair (TEP) through single-incision laparoscopy (SIL) permits placement of a large mesh through a final millimetric umbilical scar. This prospective study evaluates the first 200 consecutive SILTEPs performed by a single surgeon. PATIENTS AND METHODS Between November 2011 and September 2015, 200 consecutive SILTEPs were performed in 161 patients. The mean age was 49.8 ± 16.3 years and the mean BMI was 24.5 ± 3.4 kg/m2. The technique involved one 11-mm trocar, one 10-mm 0° scope and curved reusable instruments. A supplementary 1.8-mm straight trocarless grasping forceps was percutaneously inserted for perioperative complications or difficulties. RESULTS A unilateral hernia repair was performed in 122 patients, and a bilateral repair in 39 patients. The total operative time was 57.4 ± 22.3 min, and pure laparoscopic time was 46.6 ± 21.6 min. There was no need for insertion of a supplementary 5-mm trocar, and the need for insertion of 1.8-mm trocarless grasper was 32.9%. Perioperative complications occurred in 73 patients. The mean final scar length was 15.3 ± 2.6 mm. The mean hospital stay was 1.0 ± 0.3 days. Postoperative complications at the access site affected 15 patients and at the hernia site 31 patients. After a mean follow-up of 25.4 ± 12.3 months, there was one asymptomatic, small incisional hernia at the access site as well as one reoperation for recurrent inguinal hernia at 16 months. No other late complications were registered. CONCLUSION Transumbilical SILTEP permits placement of a large mesh through a final millimetric scar. Getting over the learning curve in conventional multitrocar TEP is mandatory. As per our institute's algorithm, the contraindications continue to be giant inguino-scrotal, incarcerated and recurrent inguinal hernias.


Coronavirus latest: global infections pass 100,000.


The primary care response to COVID-19 in England's National Health Service.


title: Composite fiber structures with antiproliferative agents exhibit advantageous drug delivery and cell growth inhibition in vitro.

text: Composite core/shell fiber structures loaded with the antiproliferative drugs paclitaxel or farnesylthiosalicylate (FTS) were developed and studied. The latter is a specific nontoxic Ras inhibitor with a mild hydrophobic nature, which can also be used for local cancer treatment and stent applications. The fibers were composed of a dense polyglyconate core and a porous drug-loaded poly(D,L-lactic-glycolic acid) shell, prepared using freeze drying of inverted emulsions. Our study focused on the release profile of the antiproliferative drugs from the fibers, the shell morphology and its degradation and erosion. The postfabrication antiproliferative effect of the drugs was tested in a cell culture. The process parameters were found to affect the drug-release profile via two routes: (1) direct, through water uptake and swelling of the structure leading to FTS release, or through degradation of the host polymer leading to paclitaxel release at a later stage; (2) indirect effect of the microstructure on the release profile. The fabrication process did not reduce the pharmacological activity of either paclitaxel or FTS. FTS-eluting composite fibers proved to effectively induce growth inhibition or cell death by a gradient effect and dose-dependent manner. The combined effect of the targeted mechanism of FTS as a Ras inhibitor together with the localized and controlled release characteristics of the fiber is an advantageous antiproliferative quality. It is therefore suggested that our drug-eluting fibers may be used in biomedical applications that require short release (restenosis) or prolonged release (cancer therapy).


title: Montelukast drug activity and potential against SARS-CoV-2.

text: COVID-19 presents a major worldwide public health emergency. Many research efforts are ongoing to find effective antiviral treatments via novel drug design or drug repurposing (Duarte et al., 2020). One drug, remdesivir, has been shown to have activity against the SARS-CoV-2 RNA dependent RNA polymerase (RdRp), and has been used clinically in severe COVID-19 disease, but more accessible and readily available treatments are needed for all stages of infection. This article is protected by copyright. All rights reserved.


title: Alignment-free prediction of a drug-target complex network based on parameters of drug connectivity and protein sequence of receptors.

text: There are many drugs described with very different affinity to a large number of receptors. In this work, we selected drug-receptor pairs (DRPs) of affinity/nonaffinity drugs to similar/dissimilar receptors and we represented them as a large network, which may be used to identify drugs that can act on a receptor. Computational chemistry prediction of the biological activity based on quantitative structure-activity relationships (QSAR) substantially increases the potentialities of this kind of networks avoiding time- and resource-consuming experiments. Unfortunately, most QSAR models are unspecific or predict activity against only one receptor. To solve this problem, we developed here a multitarget QSAR (mt-QSAR) classification model. Overall model classification accuracy was 72.25% (1390/1924 compounds) in training, 72.28% (459/635) in cross-validation. Outputs of this mt-QSAR model were used as inputs to construct a network. The observed network has 1735 nodes (DRPs), 1754 edges or pairs of DRPs with similar drug-target affinity (sPDRPs), and low coverage density d = 0.12%. The predicted network has 1735 DRPs, 1857 sPDRPs, and also low coverage density d = 0.12%. After an edge-to-edge comparison (chi-square = 9420.3; p < 0.005), we have demonstrated that the predicted network is significantly similar to the one observed and both have a distribution closer to exponential than to normal.


title: Prognostic Differences in ISUP Grade Group 4: a Systematic Review and Meta-Analysis.

text: The ISUP (Internal Society of Urologic Pathology) recently adopted a five-tiered prognostication system. There is evidence to suggest that the ISUP grade group 4 is a heterogeneous entity regarding prognosis. Our aim was to systematically examine the existing evidence to determine if outcome differences exist within the ISUP grade group 4. A systematic search of the literature for all studies examining the heterogeneity of the ISUP grade group 4 was conducted. Available studies were combined with meta-analysis to evaluate prognostic differences within the ISUP grade group 4 measured by all-cause mortality (ACM) and the prostate cancer-specific mortality (PCSM). Eight studies were identified and utilised a variety of outcome measures to answer the question of heterogeneity within the ISUP grade group 4. Four of these studies examined prognosis using both ACM and PCSM. These were combined into a meta-analysis. The combined group of 5 + 3/3 + 5 had statistically significant higher ACM (hazard ratio [HR] 1.23, 95% confidence internal [Cl] 1.08-1.41) when compared to the 4 + 4 group. There was no difference in the PCSM between the two groups (HR 1.34, 95% CI 0.89-2.01). However, heterogeneity was high for this analysis secondary to a range of methodological differences. Our meta-analysis showed that Gleason grade 3 + 5/5 + 3 had higher ACM than Gleason grade group 4 + 4. Measures of PCSM were statistically insignificant, although heterogeneity was high. Evidence suggests that heterogeneity is likely, although inconclusive. Further studies with consistent methodologies are required to answer this question.


title: Final results of a European, multi-centre, prospective, observational Study of Permacol™ collagen paste injection for the treatment of anal fistula.

text: AIM Permacol™ collagen paste (Permacol™ paste) is an acellular cross-linked porcine dermal collagen matrix suspension for use in soft tissue repair. The use of Permacol™ paste in the filling of anorectal fistula tract is a new sphincter-preserving method for fistula repair. The MASERATI100 study was a prospective, observational clinical study with the objective to assess the efficacy of Permacol™ collagen paste for anal fistula repair in 100 patients. METHOD Patients (N=100) with anal fistula were treated at ten European surgical sites with a sphincter-preserving technique using Permacol™ paste. Fistula healing was assessed at 1, 3, 6, and 12 months post-treatment, with the primary endpoint being healing at 6 months. Faecal continence and patient satisfaction were surveyed at each follow-up; adverse events (AEs) were monitored throughout the follow-up. RESULTS At 6 months post-surgery, 56.7% of patients were healed, and the percentage healed was largely maintained, with 53.5% healed at 12 months. 29.0% of patients had at least one AE, and 16.0% of patients had one or more procedure-related AE. Most AEs reported were minor and similar to those commonly observed after fistula treatment, and the incidence of serious adverse events was low (4.0% of patients). Regardless of treatment outcome, 73.0% of patients were satisfied or very satisfied with the procedure. CONCLUSION Permacol™ paste provides a promising sphincter-preserving treatment for anal fistulas with minimal adverse side-effects. This article is protected by copyright. All rights reserved.


title: Memory CD4+ T-cell-mediated protection from lethal coronavirus encephalomyelitis.

text: The antiviral role of CD4(+) T cells in virus-induced pathologies of the central nervous system (CNS) has not been explored extensively. Control of neurotropic mouse hepatitis virus (JHMV) requires the collaboration of CD4(+) and CD8(+) T cells, with CD8(+) T cells providing direct perforin and gamma interferon (IFN-gamma)-mediated antiviral activity. To distinguish bystander from direct antiviral contributions of CD4(+) T cells in virus clearance and pathology, memory CD4(+) T cells purified from wild type (wt), perforin-deficient (PKO), and IFN-gamma-deficient (GKO) immune donors were transferred to immunodeficient SCID mice prior to CNS challenge. All three donor CD4(+) T-cell populations controlled CNS virus replication at 8 days postinfection, indicating IFN-gamma- and perforin-independent antiviral function. Recipients of GKO CD4(+) T cells succumbed more rapidly to fatal disease than untreated control infected mice. In contrast, wt and PKO donor CD4(+) T cells cleared infectious virus to undetectable levels and protected from fatal disease. Recipients of all CD4(+) T-cell populations exhibited demyelination. However, it was more severe in wt CD4(+) T-cell recipients. These data support a role of CD4(+) T cells in virus clearance and demyelination. Despite substantial IFN-gamma-independent antiviral activity, IFN-gamma was crucial in providing protection from death. IFN-gamma reduced neutrophil accumulation and directed macrophages to white matter but did not ameliorate myelin loss.


title: Careers in virology: public health opportunities for early-career basic scientists.

text: Undergraduate, graduate, and postdoctoral scientists trained as virologists can play critical roles in public health, such as in health science policy, epidemiology, and national defense. Despite a need for basic science backgrounds within these fields, finding entry-level careers can be challenging. Volunteer opportunities are a great way for scientists to experience public health careers while still in school, and this article describes volunteering with the Medical Reserve Corps and outlines unique postgraduate opportunities for early-career virologists.


The IR Radlex Project: an interventional radiology lexicon--a collaborative project of the Radiological Society of North America and the Society of Interventional Radiology.


title: Safety and Feasibility of Using the Second-Generation Pillcam Colon Capsule to Assess Active Colonic Crohn's Disease.

text: BACKGROUND & AIMS The second-generation Pillcam Colon Capsule Endoscope (PCCE-2; Given Imaging Ltd, Yoqneam, Israel) is an ingestible capsule for visualization of the colon. We performed a multicenter pilot study to assess its safety and feasibility in evaluating the severity of Crohn's disease (CD). METHODS In a prospective study, 40 patients with active colonic CD underwent PCCE-2 and optical colonoscopy procedures. Using both techniques, we generated values for the Crohn's Disease Endoscopic Index of Severity (CDEIS), the Simple Endoscopic Score for CD, and global evaluation of lesion severity. In the first stage of the study, we calculated the correlation between PCCE-2 and optical colonoscopy scores. In the second stage, we performed interobserver agreement analysis for a random subset of 20 PCCE-2 recordings, graded in duplicate by 2 independent readers. RESULTS There was substantial agreement between PCCE-2 and optical colonoscopy in the measurement of the CDEIS (intraclass correlation coefficient [ICC], 0.65; 95% confidence interval [CI], 0.43-0.80). There was substantial interobserver agreement between 2 independent PCCE-2 readers for the CDEIS (ICC, 0.67; 95% CI, 0.35-0.86) and the Simple Endoscopic Score for CD (ICC, 0.66; 95% CI, 0.32-0.85). However, the PCCE-2 scoring systematically underestimated the severity of disease compared with optical colonoscopy; based on our results, PCCE-2 detected colonic ulcerations with 86% sensitivity and 40% specificity. No adverse events were observed and PCCE-2 was better tolerated than colonoscopy. CONCLUSIONS PCCE-2 is feasible, safe, and well tolerated for the assessment of mucosal CD activity in selected populations. Larger studies are needed to assess its operating characteristics further. European clinical trials database number: 2014-003854-15.


title: Management of acute tandem occlusions: Stent-retriever thrombectomy with emergency stenting or angioplasty.

text: Objective To compare outcomes following intracranial stent retriever-based intracranial thrombectomy (SRT) with emergency extracranial internal carotid artery (EICA) stenting or angioplasty alone in patients presenting with acute stroke due to tandem occlusions of the ICA. Methods Consecutive patients with acute anterior tandem occlusion who received an endovascular intervention within 6h of symptom onset between January 2013 and June 2016 were included in this prospective study. Demographic, radiological, procedural and clinical outcome data were compared between the stenting and the angioplasty alone groups. Results Of the 37 patients eligible for the study, 18 had angioplasty alone and 19 underwent stent placement. Successful recanalization rate was statistically significantly higher in the stenting group than in angioplasty alone group (74% vs. 39%) and although not statistically significant, more patients in the stenting group than in the angioplasty alone group had favourable outcomes (63% vs. 50%). There was no significant difference between groups in rates of symptomatic intracranial haemorrhage (SICH), cerebral herniation or mortality. Conclusion This study in a small sample size suggests that among patients with acute anterior tandem occlusion, SRT with EICA stenting tended to achieve higher recanalization and improved clinical outcomes at three months compared with SRT and angioplasty alone with a similar rate of SICH and mortality.


title: Primum non nocere. The SARS-CoV-2 pandemic course in oldest.

text: Dramatic outcomes of Covid-19 pandemia in Italy, in particular in the North, must be discussed. Maybe a bad strategy and lack of timely intervention togheter with concurrent social events, comorbidities of oldest persons, bed rest, inadequate nutritional support and drugs' side effects and infection of health professionals proved fatal for many.


title: (⁹⁹m)Tc-bisphosphonate-iron oxide nanoparticle conjugates for dual-modality biomedical imaging.

text: The combination of radionuclide-based imaging modalities such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) with magnetic resonance imaging (MRI) is likely to become the next generation of clinical scanners. Hence, there is a growing interest in the development of SPECT- and PET-MRI agents. To this end, we report a new class of dual-modality imaging agents based on the conjugation of radiolabeled bisphosphonates (BP) directly to the surface of superparamagnetic iron oxide (SPIO) nanoparticles. We demonstrate the high potential of BP-iron oxide conjugation using (⁹⁹m)Tc-dipicolylamine(DPA)-alendronate, a BP-SPECT agent, and Endorem/Feridex, a liver MRI contrast agent based on SPIO. The labeling of SPIOs with (⁹⁹m)Tc-DPA-alendronate can be performed in one step at room temperature if the SPIO is not coated with an organic polymer. Heating is needed if the nanoparticles are coated, as long as the coating is weakly bound as in the case of dextran in Endorem. The size of the radiolabeled Endorem (⁹⁹m)Tc-DPA-ale-Endorem) was characterized by TEM (5 nm, Fe₃O₄ core) and DLS (106 ± 60 nm, Fe₃O₄ core + dextran). EDX, Dittmer-Lester, and radiolabeling studies demonstrate that the BP is bound to the nanoparticles and that it binds to the Fe₃O₄ cores of Endorem, and not its dextran coating. The bimodal imaging capabilities and excellent stability of these nanoparticles were confirmed using MRI and nanoSPECT-CT imaging, showing that (⁹⁹m)Tc and Endorem co-localize in the liver and spleen In Vivo, as expected for particles of the composition and size of (⁹⁹m)Tc-DPA-ale-Endorem. To the best of our knowledge, this is the first example of radiolabeling SPIOs with BP conjugates and the first example of radiolabeling SPIO nanoparticles directly onto the surface of the iron oxide core, and not its coating. This work lays down the basis for a new generation of SPECT/PET-MR imaging agents in which the BP group could be used to attach functionality to provide targeting, stealth/stability, and radionuclides to Fe₃O₄ nanoparticles using very simple methodology readily amenable to GMP.


title: INFECTIONS IN PREGNANCY WITH COVID-19 AND OTHER RESPIRATORY RNA VIRUS DISEASES ARE RARELY, IF EVER, TRANSMITTED TO THE FETUS: EXPERIENCES WITH CORONAVIRUSES, HPIV, hMPV RSV, AND INFLUENZA.

text: SARS-CoV-2, the agent of COVID-19, is similar to two other coronaviruses, SARS-CoV and MERS-CoV, in causing life-threatening maternal respiratory infections and systemic complications. Because of global concern for potential intrauterine transmission of SARS-CoV-2 from pregnant women to their infants, this report analyzes the effects on pregnancy of infections caused by SARS-CoV-2 and other respiratory RNA viruses, and examines the frequency of maternal-fetal transmission with SARS-CoV-2, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, respiratory syncytial virus (RSV), parainfluenza (HPIV) and metapneumovirus (hMPV). There have been no confirmed cases of intrauterine transmission reported with COVID-19 or any other coronavirus infections. Influenza virus, despite causing approximately one billion annual infections globally, has only a few cases of confirmed or suspected intrauterine fetal infections reported. RSV is in an unusual cause of illness among pregnant women, and with the exception of one premature infant with congenital pneumonia, no other cases of maternal-fetal infection are described. Parainfluenza virus and human metapneumovirus can produce symptomatic maternal infections but do not cause intrauterine fetal infection. In summary, it appears that the absence thus far of maternal-fetal transmission of the SARS-CoV-2 virus during the COVID-19 pandemic is similar to other coronaviruses, and is also consistent with the extreme rarity of suggested or confirmed cases of intrauterine transmission of other respiratory RNA viruses. This observation has important consequences for pregnant women as it appears that if intrauterine transmission of SARSCoV-2 does eventually occur, it will be a rare event. Potential mechanisms of fetal protection from maternal viral infections are also discussed.


title: Utilities of Split-Thickness Skin Grafting for Male Genital Reconstruction.

text: OBJECTIVE To report our successful outcomes of genital split-thickness skin graft (STSG) in covering major skin loss and providing good functional and cosmetic outcomes. MATERIALS AND METHODS A retrospective chart review was performed for all adult urology patients who underwent STSG at our institution from 1998 to 2014. Patients had a wide range of disease etiologies, including tissue loss (eg post-Fournier's gangrene), lymphedema, buried penis, foreign body injection, and tumors. RESULTS A total of 54 patients were identified with the following breakdown of etiology: 13 patients with tissue loss (eg post-Fournier's gangrene), 13 with lymphedema, 12 with buried penis, 8 with foreign body injection, 4 with hidradenitis suppurativa, and 4 with tumors. Fifty-two out of 54 patients had more than 90% graft take, with maintained or improved erection, normal voiding, good cosmetic outcome as judged by the patient and the examining surgeon, and normal mobility. One patient died at 3 months due to cardiovascular cause, and 1 patient had a poor take of the graft. CONCLUSION We show the wide variety of indications for STSG use, the ease of the technique, and its successful outcomes. We believe this procedure should be offered to patients as a first-line treatment and also as a last resort when other more conservative approaches fail.


title: COVID-19 and telepsychiatry: an evidence-based guidance for clinicians.

text: BACKGROUND COVID-19 presents unique challenges in healthcare, including mental health care provision. Telepsychiatry can provide an alternative to face to face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. OBJECTIVE The aim was to produce an open access, easy-to-consult and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. METHODS We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre-COVID-19 guidelines and also other digital mental health topics where relevant. We summarised the data we extracted as answers to specific clinical questions. RESULTS Findings from this study are presented as both a short practical checklist for clinicians and a detailed table with a full summary of all the guidelines. The summary tables are also available on an open access webpage (https://oxfordhealthbrc.nihr.ac.uk/our-work/oxppl/table-5-digital-technologies-and-telepsychiatry/) which is regularly updated. These findings reflect the strong evidence base for the use of telepsychiatry and include guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focussed on practical implementation, and US guidelines more expansive and detailed. Guidelines on possible combination with other digital technologies such as apps, for example from the FDA, NHS Apps Library and NICE are less detailed. Several key areas were not represented. Whilst some special populations such as child and adolescent, older adult and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. CONCLUSIONS We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organisations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organisational change in the short and longer term. Providing easily accessible guidance is a first step, but will need cultural change to implement, as clinicians start to view telepsychiatry not just as a replacement, but as a parallel and complimentary form of delivering therapy, with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post-COVID-19 and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and also its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment. CLINICALTRIAL


title: [Consensus of Chinese experts on diagnosis and treatment processes of acute myocardial infarction in the context of prevention and control of COVID-19 (first edition)].

text: The SARS-CoV-2 epidemic starting in Wuhan in December, 2019 has spread rapidly throughout the nation. The control measures to contain the epidemic also produced influences on the transport and treatment process of patients with acute myocardial infarction (AMI), and adjustments in the management of the patients need to be made at this particular time. AMI is characterized by an acute onset with potentially fatal consequence, a short optimal treatment window, and frequent complications including respiratory infections and respiratory and circulatory failure, for which active on-site treatment is essential. To standardize the management and facilitate the diagnosis and treatment, we formulated the guidelines for the procedures and strategies for the diagnosis and treatment of AMI, which highlight 5 Key Principles, namely Nearby treatment, Safety protection, Priority of thrombolysis, Transport to designated hospitals, and Remote consultation. For AMI patients, different treatment strategies are selected based on the screening results of SARS-CoV-2, the time window of STEMI onset, and the vital signs of the patients. During this special period, the cardiologists, including the interventional physicians, should be fully aware of the indications and contraindications of thrombolysis. In the transport and treatment of AMI patients, the physicians should strictly observe the indications for patient transport with appropriate protective measurements of the medical staff.


US purchases world stocks of remdesivir: why the rest of the world should be glad to be at the back of the queue.


title: Cartilage repair of experimentally 11 induced osteochondral defects in New Zealand White rabbits.

text: Articular cartilage has a limited capacity for self-repair in adult humans, and methods used to stimulate regeneration often result in re-growth of fibrous cartilage, which has lower durability. No current treatment option can provide complete repair. The possibility of growth factor delivery into the joint for cartilage regeneration after injury would be an attractive treatment option. A full thickness osteochondral defect of 4 mm in diameter and 2 mm deep was created by mechanical drilling in the medial femoral condyle in 20 female adult New Zealand White rabbits. In an attempt to improve regeneration a hyaluronic hydrogel system, with or without bone morphogenetic protein-2 (BMP-2) was delivered intraarticularly. The contralateral joint defect was treated with saline as control. Throughout the study, rabbits were clinically examined and after 12 (n = 6) or 24 (n = 9) weeks, the rabbits were euthanized and the joints evaluated by histology. The defects healed with fibrocartilage like tissue, and the filling of the defects ranged from less than 25% to complete. The healing of the defects varied both inter- and intra-group wise. Treatment with hyaluronan gel with or without BMP-2 had no effect on cartilage regeneration compared with controls. Instead, severe ectopic bone formation was found in seven joints treated with BMP-2. In conclusion, the present study shows that neither treatment with hyaluronic gel alone, nor in combination with BMP-2, improves the healing of an induced cartilage defect in rabbits. It further shows that BMP-2 can induce ectopic bone formation, which severely affects the functionality of the joint.


Coronavirus shut-downs pose huge threat to Australian research jobs.


title: Image-guided microwave ablation of hepatic tumours: preliminary experience.

text: PURPOSE Microwave thermal ablation (MWA) opens up a new scenario in the field of image-guided tumour ablation thanks to its potential advantages over validated radiofrequency ablation (RFA). In this pilot study, we assessed the technical success, safety and efficacy of MWA in treating hepatic malignancies. MATERIALS AND METHODS After obtaining informed consent, we enrolled 15 inoperable patients, for a total of 19 lesions (ten metastases, nine hepatocellular carcinoma) with a mean diameter of 47 mm (range 14-78 mm). Mean follow-up was 8 (range 1-14) months. RESULTS Technical success reached 100%. Complications (one major and one minor) occurred in two cases. Complete ablation, obtained in 68.4% of cases, showed no significant correlation with either cancer histological type or with lesion diameter. At follow-up, treatment failures occurred in 60% of cases; lesion diameter was the only prognostic factor for maintaining complete ablation. CONCLUSIONS Our preliminary results should encourage further trials of this technique. MWA proved to be feasible and safe in treating advanced-stage liver tumours and represented an additional therapeutic attempt to be validated in further and larger efficacy studies.


title: Using Patient Portals to Improve Patient Outcomes: Systematic Review.

text: BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient's condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.


title: Understanding the knowledge, attitudes and practices of providing and receiving nutrition care for prediabetes: an integrative review.

text: To synthesise the literature on nutrition care for prediabetes from both the perspective of healthcare providers and patients, six databases (CINAHL, MEDLINE, Embase, PsycINFO, Scopus and ProQuest) were searched to identify qualitative or quantitative studies that focussed on nutrition care and prediabetes in primary care practice. Studies examining the perspectives of patients with prediabetes and healthcare providers were included. Outcomes of interest included knowledge of nutrition care for prediabetes, attitudes around providing or receiving nutrition care and actual nutrition care practices for prediabetes. Overall, 12851 studies were screened and 26 were included in the final review. Inductive analysis produced five themes: (i) nutrition care is preferable to pharmacological intervention; (ii) patients report taking action for behaviour change; (iii) healthcare providers experience barriers to nutrition care; (iv) healthcare providers tend not to refer patients for nutrition care; and (v) there are contradictory findings around provision and receipt of nutrition care. This review has revealed the contradictions between patients' and healthcare providers' knowledge, attitudes and practices around nutrition care for prediabetes. Further research is needed to shed light on how to resolve these disconnects in care and to improve nutrition care practices for people with prediabetes.


Hospital Admissions with Acute Coronary Syndromes During the COVID-19 Pandemic in German Cardiac Care Units.


title: Video-assisted thoracoscopic lobectomy in children: safety, efficacy, and risk factors for conversion to thoracotomy.

text: BACKGROUND Video-assisted thoracoscopic lobectomy in small children has not been widely performed because of difficulties in single-lung ventilation and surgical technique. This study assessed the feasibility, outcomes, and risk factors for conversion to thoracotomy of thoracoscopic lobectomy in children. METHODS From 2005 to 2011, thoracoscopic lobectomy was tried in 50 consecutive pediatric patients. The median age was 3.2 years and the median body weight was 16 kg. Congenital cystic adenomatoid malformation (CCAM) (78%) and pulmonary sequestration (18%) were the most common diagnoses. Prenatal diagnosis by ultrasonography was made in 34% of patients (17 of 50), and a previous history of pneumonia was present in 46% (23 of 50). The most commonly used single-lung ventilation modality was endobronchial blocking by balloon catheter through a single-lumen endotracheal tube. The use of a stapler was minimized, with endoscopic clipping devices and energy-based cutting instruments used instead. RESULTS Thoracoscopic lobectomy without conversion was accomplished in 82% of patients (41 of 50). There was no in-hospital mortality and 1 major morbidity (2%) with postoperative bleeding. Comparison with a group from an earlier period (∼2009) and a group from a later period (2010-2011) determined that thoracotomy conversion rates, mean operation times, and mean hospital days were 27% and 8%, 190±85 and 133±40 minutes, and 11.0±6.7 and 5.2±2.2 days, respectively. In univariate analysis, lower body weight (p=0.010), operations in the earlier period (p=0.040), single-lung ventilation failure (p=0.004), and a previous history of pneumonia (p<0.001) were related to conversion to thoracotomy. Multivariate analysis revealed a previous history of pneumonia to be the only independent risk factor for conversion to thoracotomy (p=0.0179). CONCLUSIONS Thoracoscopic lobectomy in small children is a safe and effective treatment modality. Close cooperation with the anesthesiologist, use of adequate instruments, and selection of proper patients are important for the success of thoracoscopic lobectomy in small children. A previous history of pneumonia was an independent risk factor for conversion to thoracotomy.


title: Adsorption of albumin on flax fibers increases endothelial cell adhesion and blood compatibility in vitro.

text: The physical and chemical properties of flax (linen) are attractive from the perspective of biomaterials science and engineering. Flax textiles uniquely combine hydrophilicity and strength, with the technical know-how to produce precisely engineered two- and three-dimensional knitted or woven structures. It is, however, extremely difficult to completely remove endotoxins from the flax, and this essentially precludes the use of linen for implant purposes. Herein, the potential utility of flax textiles for blood-contacting applications is investigated, using purified two-dimensional mesh specimens, with and without an albumin surface coating. It was hypothesized that the albumin coating will abolish the effect of adherent endotoxins at the flax's surface. In vitro cell viability assays showed that the flax mesh ± albumin is not cytotoxic. The albumin coating reduced (but not abolished) the effect of surface-exposed endotoxins (Limulus amebocyte lysate test). Under dynamic conditions, the albumin coating favors coverage with endothelial cells. Experiments with fresh human blood plasma (platelet-rich and platelet-free) showed that the albumin coating reduces the thrombogenicity in vitro. Platelets adhered to the albumin-coated flax mesh showed a less flattened structure. Although the results of this work cannot be extrapolated easily to in vivo situations, the data reveal that woven or knitted tubular structures produced from flax fibers may hold promise as implantable blood contacting devices like for instance vascular grafts.


title: An off-the-shelf plasma-based material to prevent pacemaker pocket infection.

text: Bacterial infection of subcutaneous "pockets" housing cardiovascular implantable electronic devices is a significant clinical complication. In this study, pacemakers encapsulated in a blood plasma-based material (PBM) composited with antibiotics were investigated for use as prophylactics against such infections. PBMs, which are made from pooled allogeneic plasma and platelets, are off-the-shelf biomaterials that can be manufactured in the form of complex 3D shapes, extrudable putties, or injectable pastes. In vitro studies with PBM pastes formulated with rifampicin and minocycline demonstrated antibiotic release over 6 days, activity against Escherichia coli, and reduced cytotoxic effects of the antibiotics on fibroblasts. The materials were also evaluated in vivo in a rabbit model in which pacemaker pockets were inoculated with methicillin-resistant Staphylococcus aureus (S. aureus) strain and examined 1 week later. The pockets containing the pacemaker plus S. aureus were grossly purulent and culture positive, whereas pockets into which PBM with antibiotics were injected around the pacemaker were free of purulence and culture negative (p < 0.001). None of the pockets into which PBM without antibiotics were placed demonstrated purulence, but 60% were culture positive. These results demonstrate the potential of PBMs to deliver antibiotics to diminish the incidence of pocket infections for pacemakers and other implantable devices.


title: Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993-2013).

text: OBJECTIVE To evaluate perioperative morbidity and outcome in dogs and cats undergoing esophageal surgery. DESIGN Retrospective case series. ANIMALS 63 client-owned dogs and 9 client-owned cats. PROCEDURES Medical records of dogs and cats that underwent esophageal surgery were reviewed for information on signalment, history, results of preoperative diagnostic testing, condition treated, details of surgery, intraoperative complications, and postoperative complications. Long-term follow-up data were obtained via veterinarian and client telephone conversations. The relationship between complications and survival to hospital discharge was evaluated by means of regression analysis. RESULTS The most common indication for surgical intervention was an esophageal foreign body in dogs (50/63 [79%]) and esophageal stricture in cats (3/9). Complications were documented in 54% (34/63) of dogs and 3 of 9 cats. The most common immediate postoperative complications were respiratory in nature (9 dogs, 1 cat). Partial esophagectomy and resection with anastomosis were significantly associated with the development of immediate postoperative complications in dogs. The most common delayed postoperative complications were persistent regurgitation (7 dogs) and esophageal stricture formation (3 dogs, 1 cat). For dogs, a mass lesion and increasing lesion size were significantly associated with the development of delayed postoperative complications. Six dogs (10%) and 1 cat died or were euthanized prior to discharge, and pneumomediastinum and leukopenia were negative prognostic factors for dogs being discharged from the hospital. CONCLUSIONS AND CLINICAL RELEVANCE Results of this study suggested that the short-term prognosis for dogs and cats that survive surgery for treatment of esophageal lesions is favorable, with 90% of patients discharged from the hospital (57/63 dogs; 8/9 cats). However, dogs treated for more extensive esophageal lesions as well as those undergoing esophagectomy or resection and anastomosis were more likely to develop postoperative complications.


title: Prevalence and molecular characterization of avian infectious bronchitis virus in poultry flocks in Morocco from 2010 to 2014 and first detection of Italy 02 in Africa.

text: The aim of this study was to investigate the prevalence and diversity of infectious bronchitis virus (IBV) genotypes in poultry flocks in 16 areas of Morocco between 2010 and 2014. A total of 360 chicken flocks suspected of being infected by IBV were screened for the IBV N gene using real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Flocks were classified into four groups according to their IBV vaccination programme. Group 1 contained unvaccinated birds. Group 2 received a single application of live H120 vaccine. Groups 3 and 4 birds received one or two booster vaccination(s), respectively, mostly using the H120 vaccine. The real-time RT-PCR results showed that 51.7% of the flocks were positive for the IBV genome with geographical disparities. Molecular characterization of IBV was performed on 50 RT-PCR positive samples by partially sequencing the S1 gene, including the hypervariable regions (nucleotides 705-1097). Two predominant genotypes were detected, with the Massachusetts type dominating (66%), among which 25% of the samples were identical to the H120 vaccine. The second most common genotype (present in 32% of the flocks) was surprisingly Italy 02, revealing the first detection of this genotype in Morocco and also in Africa. 793B, the predominant genotype in the late 1990s in Morocco, was only detected on one occasion and was identical to the 4/91 vaccine strain. This study highlights the high prevalence of IBV in poultry farms in Morocco and confirms its continuous dynamic changes and evolution.


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