title: Long-Term Management for Ventilator-Assisted Children in Hong Kong: 2 Decades' Experience.

text: BACKGROUND The population of children receiving long-term mechanical ventilation is growing worldwide, but only limited data exist in Asian regions. The objective of the study was to review the management of these children in Hong Kong over the past 2 decades. METHODS This was a retrospective cohort study. Hospital records from subjects receiving mechanical ventilation for >3 months were retrieved. Demographic characteristics and medical information of subjects (≤21 y old) under the care of the ventilator program at the Duchess of Kent Children's Hospital between 1997 and 2015 were reviewed. RESULTS There were a total of 96 subjects, with male predominance (75%). Twenty-five subjects (26%) required invasive mechanical ventilation via tracheostomy, and the median age of starting ventilation was much lower than for subjects receiving noninvasive ventilation (1.6 vs 11.2 y, P .003). Underlying causes included neuromuscular diseases (50%); abnormal ventilatory control related to neurological, metabolic, or genetic conditions (25%); airway problems (18%); and chronic lung diseases (6%). Comorbidities were frequent, with significantly more subjects receiving invasive mechanical ventilation who required gastrostomy or nasogastric tube feeding and had intellectual impairment. Despite their medical complexities, most of our subjects (87.5%) could be discharged and resided in the community. Social reasons were the obstacles for discharge in 12 subjects receiving invasive mechanical ventilation. Seventeen subjects who died were receiving noninvasive ventilation, and most had progressive neuromuscular diseases. Only 8% subjects could be weaned off of ventilator support. At the time of the report, about one third of the subjects have reached adult age. CONCLUSIONS Our study showed a steady growth in the number of children receiving long-term mechanical ventilation, similar to that in western countries, yet these children have distinct demographic characteristics, underlying diseases, comorbidities, and outcomes. Home care is feasible in the majority of these children despite a lack of in-home nursing care provision. Prolonged survival of these subjects necessitates the enhancement of transitional care to adult service.


title: Osseointegration of multiphase anodic spark deposition treated porous titanium implants in an ovine model.

text: Modification of titanium oxide by multiphase anodic spark deposition (ASD) has the potential to increase bioactivity and hasten osseointegration and biological fixation in uncemented arthroplasty. This study assessed the in vivo performance of control (Ti), plasma-sprayed HA-coated (TiHA) and ASD (Biospark) treated (TiAn) porous titanium implants with a solid core using a standard uncemented implant fixation sheep model. Cortical interfacial shear-strength and bone ingrowth in cortical and cancellous sites were quantified following 12 weeks in situ. Ultimate shear-strength for the Ti, TiHA and TiAn coatings was 33±9.5, 35.4±8.4 and 33.8±7.8 MPa, respectively, which was limited by coating delamination. ASD treatment was associated with significantly higher mean bone ingrowth at both sites. These results support the osteoconductive potential of the BioSpark treatment of porous titanium.


title: Affibody molecules for epidermal growth factor receptor targeting in vivo: aspects of dimerization and labeling chemistry.

text: UNLABELLED Noninvasive detection of epidermal growth factor receptor (EGFR) expression in malignant tumors by radionuclide molecular imaging may provide diagnostic information influencing patient management. The aim of this study was to evaluate a novel EGFR-targeting protein, the ZEGFR:1907 Affibody molecule, for radionuclide imaging of EGFR expression, to determine a suitable tracer format (dimer or monomer) and optimal label. METHODS An EGFR-specific Affibody molecule, ZEGFR:1907, and its dimeric form, (ZEGFR:1907)2, were labeled with 111In using benzyl-diethylenetriaminepentaacetic acid and with 125I using p-iodobenzoate. Affinity and cellular retention of conjugates were evaluated in vitro. Biodistribution of radiolabeled Affibody molecules was compared in mice bearing EGFR-expressing A431 xenografts. Specificity of EGFR targeting was confirmed by comparison with biodistribution of non-EGFR-specific counterparts. RESULTS Head-to-tail dimerization of the Affibody molecule improved the dissociation rate. In vitro, dimeric forms demonstrated superior cellular retention of radioactivity. For both molecular set-ups, retention was better for the 111In-labeled tracer than for the radioiodinated counterpart. In vivo, all conjugates accumulated specifically in xenografts and in EGFR-expressing tissues. The retention of radioactivity in tumors was better in vivo for dimeric forms; however, the absolute uptake values were higher for monomeric tracers. The best tracer, 111In-labeled ZEGFR:1907, provided a tumor-to-blood ratio of 100 (24 h after injection). CONCLUSION The radiometal-labeled monomeric Affibody molecule ZEGFR:1907 has a potential for radionuclide molecular imaging of EGFR expression in malignant tumors.


title: Pooled Testing for Expanding COVID-19 Mass Surveillance.

text: Diagnostic testing to identify patients infected with SARS-CoV-2 plays a key role to control the COVID-19 pandemic. While several countries, have implemented the use of diagnostic testing in a massive scale as a cornerstone for infection control and surveillance, other countries affected by the pandemic are hampered by its limited testing capacity. Pooled testing was first introduced in the 1940s and is now used for screening in blood banks. Testing is done by pooling multiple individual samples together. Only in the case of a positive pool test would individual samples of the pool be tested, thus substantially reducing the number of tests needed. Several studies regarding its use for SARS CoV-2 have been done in the US, Israel and, Germany. Studies have shown that an individual positive sample can still be detected in pools of up to 32 samples, and possibly even 64 samples provided additional PCR amplification cycles are conducted with sensitivity of 96%. Simulation studies to determine optimal pool size and pooling techniques have also been conducted. Based on these studies, pooled testing is shown to be able to detect positive samples with sufficient accuracy and can easily be utilised with existing equipment and personnel for population-wide screening.


title: Endovascular retrieval of an irrigation cannula from the thoracic aorta following cardiac surgery: A case report.

text: INTRODUCTION Endovascular techniques to retrieve intravascular foreign bodies are a necessary component of the Vascular surgeon's skill set. We report the successful retrieval of an embolized irrigation cannula from the thoracic aorta following aortic valve replacement. PRESENTATION OF CASE The patient is an 81 year old male who underwent coronary artery bypass grafting and aortic valve replacement. Prior to closure, the aortotomy was irrigated with heparinized saline using a syringe with an olive tip irrigation cannula. When the syringe was handed back to the nursing staff, the tip was noted to be missing but could not be found. Prior to closure of the sternum, the field was searched again for the tip and thus the chest was closed. The missing instrument then prompted an intraoperative chest radiograph that demonstrated a metal irrigation cannula superimposed on the cardiac silhouette. Additionally, a transesophageal echocardiogram was performed, which demonstrated the irrigation cannula within the descending thoracic aorta. Right common femoral artery was accessed and a thoracic aortogram was performed demonstrating the cannula to be lodged in the descending thoracic aorta. Intravascular ultrasound (IVUS) was performed to exclude an aortic abnormality preventing the caudad migration of the cannula. No aortic pathology was identified. A tri-lobed snare was used to grasp the cannula at its tip and withdrawn into the right external iliac artery. The cannula was successfully removed through a transverse arteriotomy in the distal right external iliac artery. The patient's postoperative course was uneventful. CONCLUSION Endovascular retrieval of intravascular foreign bodies is minimally invasive, relatively simple, and carries minimal morbidity compared to conventional open surgical techniques. This unusual case demonstrates the importance of a working knowledge of techniques and instruments requisite for retrieval of intravascular foreign bodies.


title: AAV1.NT-3 gene therapy attenuates spontaneous autoimmune peripheral polyneuropathy.

text: The spontaneous autoimmune peripheral polyneuropathy (SAPP) model in B7-2 knockout non-obese diabetic mice shares clinical and histological features with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Secondary axonal loss is prominent in the progressive phase of this neuropathy. Neurotrophin 3 (NT-3) is an important autocrine factor supporting Schwann cell survival and differentiation and stimulates neurite outgrowth and myelination. The anti-inflammatory and immunomodulatory effects of NT-3 raised considerations of potential efficacy in the SAPP model that could be applicable to CIDP. For this study, scAAV1.tMCK.NT-3 was delivered to the gastrocnemius muscle of 25-week-old SAPP mice. Measurable NT-3 levels were found in the serum at 7-week postgene delivery. The outcome measures included functional, electrophysiological and histological assessments. At week 32, NT-3-treated mice showed increased hind limb grip strength that correlated with improved compound muscle action potential amplitude. Myelinated fiber density was 1.9 times higher in the NT-3-treated group compared with controls and the number of demyelinated axons was significantly lower. The remyelinated nerve fiber population was significantly increased. These improved histopathological parameters from scAAV1.tMCK.NT-3 treatment occurred in the setting of reduced sciatic nerve inflammation. Collectively, these findings suggest a translational application to CIDP.


title: What older adults do with the results of dementia screening programs.

text: INTRODUCTION Alzheimer's disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful. METHODS A community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models. RESULTS Participants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19-2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09-6.83), and mobility issues (OR = 2.43;95%CI: 1.93-5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06-0.59) and better physical function (OR = 0.38; 95%CI: 0.17-0.81). DISCUSSION MCI/ADRD screening was well-received by a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did not always act on screening results, 25% ordered further testing and evaluation. Efforts need to be directed toward (1) increasing self-efficacy of older adults to discuss screening results with their HCPs, and (2) educating HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making.


People.


Covid-19's impact on US medical research-shifting money, easing rules.


SGLT2 inhibition during the COVID-19 epidemic: friend or foe?


title: Risk of major bleeding during extended oral anticoagulation in patients with first unprovoked venous thromboembolism: a systematic review and meta-analysis protocol.

text: BACKGROUND The optimal duration of anticoagulation after a first unprovoked venous thromboembolism (VTE) remains controversial. Deciding to stop or continue anticoagulant therapy indefinitely after completing 3 to 6 months of initial treatment requires balancing the long-term risk of recurrent VTE if anticoagulation is stopped against the long-term risk of major bleeding if anticoagulation is continued. However, knowledge of the long-term risk for major bleeding events during extended anticoagulation in this patient population is limited. We plan to conduct a systematic review and meta-analysis to quantify the risk for major bleeding events during extended oral anticoagulation in patients with first unprovoked VTE. METHODS Electronic databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials will be systematically searched with the assistance of an information specialist (from inception to March 1, 2019) to identify randomized controlled trials and prospective cohort studies reporting major bleeding during extended oral anticoagulation in patients with first unprovoked VTE, who have completed at least 3 months of initial anticoagulant therapy. Study selection, risk of bias assessment, and data extraction will be performed independently by at least two investigators. The number of major bleeding events and person-years of follow-up will be used to calculate the rate (events per 100 person-years) with its 95% confidence interval for each study cohort, during clinically relevant time periods of extended anticoagulant therapy. Results will be pooled using random effect meta-analysis. DISCUSSION The planned systematic review and meta-analysis will provide reliable estimates of the risk for major bleeding events during extended anticoagulation. This information will help inform patient prognosis and assist clinicians with balancing the risks and benefits of treatment to guide management of unprovoked VTE. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019128597 .


title: Persistent left superior vena cava and partially left inferior vena cava: a case report of a dangerous central venous catheterization.

text: BACKGROUND The coexistence of a double superior vena cava (SVC) and a partially left inferior vena cava (PLIVC) with a circumaortic collar, associated with other congenital malformations, was not described previously. CASE DESCRIPTION We present a 33-year-old woman in hemodialysis with complete exhaustion of the brachial routes for vascular access, admitted to our Nephrology Unit for a long-term central venous catheter (CVC) implant, usually by us performed under EchoScopic Technique (EST), an echographic venipuncture followed by continuous radioscopic control of guidewire and catheter in all the steps of implant. An intraoperative venography showed a complete stop of right internal jugular vein, a right SVC, a persistent left SVC, a left inferior vena cava in the iliac and subrenal tracts, a circumaortic venous collar in the renal tract, and normal right suprarenal and hepatic tracts. CONCLUSIONS The double SVC was related to the persistence of the caudal part of the anterior cardinal veins. As to the PLIVC, the iliac and subrenal parts of the inferior vena cava can be related to the persistent left supracardinal vein, while the circumaortic venous collar to the persistent intersupracardinal and left subsupracardinal anastomoses. All invasive procedures, and particularly those potentially complicated, must be performed under EST, now considered a mandatory tool for CVC implants, owing to the hypothesis of possible venous congenital anomalies.


title: The Magnitude of Antral Resection in Laparoscopic Sleeve Gastrectomy and its Relationship to Excess Weight Loss.

text: BACKGROUND The objective of this study was to evaluate the effect of antral resection on weight loss and complications after laparoscopic sleeve gastrectomy (LSG). METHODS This was a retrospective study of the prospectively collected data of patients who underwent LSG at Jordan University Hospital from February 2011 to February 2012. Patients were divided into two groups based on antral resection: group A underwent a 6-cm antral resection, and group B underwent a 2-cm antral resection. The percentage of excess weight loss (%EWL) was calculated at 3, 6, 12, and 24 months postoperatively. RESULTS One hundred and ten patients were included in the study, all of whom completed at least 24 months of follow-up (mean follow-up, 33 months). Their mean body mass index was 46.1 ± 7.9 kg/m(2). In group A, the mean %EWL was 38.1 ± 14.1, 54.9 ± 19.9, 65.6 ± 22.8, and 66.8 ± 28.4% at 3, 6, 12, and 24 months, respectively. However, in group B, the mean %EWL was 42.1 ± 13.4, 63.8 ± 19.8, 80.0 ± 22.1, and 81.5 ± 22.9% at 3, 6, 12, and 24 months, respectively. Patients in group B experienced statistically significant greater weight loss than patients in group A. Statistically significant greater weight regain was seen in group A. Group A had a higher incidence of reflux symptoms (six patients; 11%) than group B (four patients; 7.1%). CONCLUSIONS Radical antral resection in association with LSG safely potentiates the restrictive effect achieved and may result in greater and better maintained weight loss.


Low levels of total and ionized calcium in blood of COVID-19 patients.


title: Pneumocystis jirovecii pneumonia associated with gemcitabine chemotherapy: experience at an Australian center and recommendations for targeted prophylaxis.

text: Pneumocystis jirovecii pneumonia (PJP) is seen increasingly in non-human immunodeficiency virus (HIV) infected immunocompromised populations, but few cases have previously been reported in association with gemcitabine therapy. We identified all patients administered gemcitabine between March 2009 and December 2012 at the Peter MacCallum Cancer Centre. Cases of PJP were identified using accepted definitions. Overall, 288 gemcitabine-treated patients were identified. Nine cases of PJP were detected, corresponding to an overall rate of 3.1% (95% confidence interval [CI] 1.5-5.7%). PJP was diagnosed during gemcitabine therapy in seven patients, a median of 67 (range 31-109) days from commencement. Among patients with lymphoma, 4/22 developed PJP, corresponding to a rate of 18.2% (95% CI 6.1-38.2%). Fewer infections were associated with breast, lung and gastrointestinal malignancies (1/24 [4.2%], 3/118 [2.5%] and 1/61 [1.6%], respectively). A risk-based tool incorporating concomitant steroid therapy can be applied to target high-risk populations who would benefit from PJP prophylaxis during gemcitabine therapy.


title: Relationship between respiratory viral load and lung lesion severity: a study in 24 cases of pandemic H1N1 2009 influenza A pneumonia.

text: OBJECTIVE To investigate the relationship between respiratory viral load and lung lesion severity of patients with pandemic H1N1 2009 influenza A pneumonia. STUDY DESIGN Cross-sectional observation study. METHODS 24 consecutive H1N1 influenza patients with viral pneumonia (13 males, 11 females, mean age: 17.5 years) during their presentation to hospital were retrospectively analysed. Viral load were first measured on average 5.2 days after the onset of symptoms. The initial CT and viral load measurement was carried on the same day in 13 patients. The rest were carried out with a mean interval time of 1.5 days. All patients had viral load follow-up till turned negative. Thirteen patients had radiological follow-up. RESULTS There was no significant correlation between the initial lung lesion severity and viral load (P=0.4). Both viral load and lung lesion severity decreased over time, being highest value at initial presentation. The patients had higher initial viral load or higher initial lung lesion severity tended to be slower in resolving. The lung lesion decreased at a slower rate than viral load. CONCLUSIONS While there was no correlation between the initial viral load and lung lesion severity, these two indices provide valuable information for epidemiological control.


Escaping Pandora's Box - Another Novel Coronavirus.


title: Malignant middle cerebral artery infarction.

text: PURPOSE OF REVIEW This review will report on the new aspects of management of 'malignant' middle cerebral artery (MCA) infarctions. RECENT FINDINGS Large MCA infarctions have been associated with high death rates for years. The most reliable predictors of a 'malignant' course are hypodensity in more than 50% of the MCA territory on computed tomography as well as stroke volume greater than 145 ml on diffusion-weighted imaging. Real-time neuromonitoring may be helpful in the detection of development of cerebral edema. The attempt of recanalization of the affected artery utilizing a combination of intravenous and intra-arterial thrombolysis and mechanical thrombectomy is crucial. Monitoring of intracranial pressure has not been proven helpful. Decompressive surgery within 48 h after symptom onset in patients less than 60 years old reduces mortality and severe disability. The quality of life perceived by the survivors is variable and deserves further study. The neuroprotective effect of hypothermia requires additional investigation. SUMMARY The era of decompressive hemicraniectomy has changed the prospects of patients with large infarctions in the MCA or internal carotid artery territory who are at risk of development of 'malignant' cerebral edema. Timing of surgery and appropriate patient selection based on age and other criteria need to be refined.


One world, one pandemic, many guidelines: management of liver diseases during COVID-19.


title: Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study).

text: BACKGROUND Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) without resection of the distal stomach is largely performed over the world for morbid obesity. Potential risk of gastric remnant carcinoma development has been suggested. PURPOSE To present the results obtained after LRYGB with resection of distal stomach. METHOD This prospective study includes 400 consecutive patients. The mean body weight was 105.9 ± 16.8 Kg (range 83-145 kg), and body mass index (BMI) was 38.5 ± 4.4 kg/m2 (32.9-50.3). Postoperative morbid-mortality and follow-up were analyzed. RESULTS Operative time was 128.5 ± 18.7 min, hospital discharge occurred at 3rd postoperative day, postoperative complications occurred in 9.25%, early surgical complications were observed in 3% and medical complications 4%, late surgical complications occurred 2.25%, no mortality was observed. At 1 year follow-up, BMI was 25.3 ± 2.7 kg/m2 with % of weight loss (%WL) of 84.6 + 19.1%. At five years follow-up very similar values were observed. CONCLUSION The results obtained after LRYGB with resection of distal stomach are similar to results published after non resection LRYGB regarding early and late results and can be indicated in high risk areas of gastric carcinoma.


title: Preload dependency determines the effects of phenylephrine on cardiac output in anaesthetised patients: A prospective observational study.

text: BACKGROUND Although phenylephrine is widely used in the operating room to control arterial pressure, its haemodynamic effects remain controversial. OBJECTIVE We hypothesised that the effect of phenylephrine on cardiac output is affected by preload dependency. DESIGN A prospective observational study. SETTING Single-centre, University Hospital of Caen, France. PATIENTS Fifty ventilated patients undergoing surgery were studied during hypotension before and after administration of phenylephrine. MAIN OUTCOME MEASURES Cardiac index (CI), stroke volume (SV), corrected flow time, mean arterial pressure, pulse pressure variations (PPV) and systemic vascular resistance index were used to assess effects of changes in preload dependency. RESULTS Twenty seven (54%) patients were included in the preload-dependent group (PPV ≥ 13%) and 23 (46%) in the preload-independent group (PPV < 13%) before administration of phenylephrine. For the whole cohort, phenylephrine increased mean arterial pressure [58 (±8) mmHg vs. 79 (±13) mmHg; P < 0.0001] and calculated systemic vascular resistance index [2010 (1338; 2481) dyn s cm m vs. 2989 (2155; 3870) dyn s cm m; P < 0.0001]. However, CI and SV decreased in the preload-independent group [2.3 (1.9; 3.7) l min m vs. 1.8 (1.5; 2.7) l min m; P < 0.0001 and 65 (44; 81) ml vs. 56 (39; 66) ml; P < 0.0001 for both] but not in the preload-dependent group [respectively 2.1 (1.8; 3.5) l min m vs. 2.1 (1.8; 3.3) l min m; P = 0.168 and 49 (41; 67) ml vs. 53 (41; 69) ml; P = 0.191]. Corrected flow time increased [294 (47) ms vs. 306 (56) ms; P = 0.031], and PPV decreased [17 (15; 19) % vs.12 (14; 16) %; P < 0.0003] only in the PPV at least 13% group. CONCLUSION The effects of phenylephrine on CI and SV depend on preload. CI and SV decreased in preload-independent patients through increase in afterload, but were unchanged in those preload-dependent through increased venous return.


title: Time window for recanalization in basilar artery occlusion: Speculative synthesis.

text: Basilar artery occlusion (BAO) is one of the most devastating forms of stroke and few patients have good outcomes without recanalization. Most centers apply recanalization therapies for BAO up to 12-24 hours after symptom onset, which is a substantially longer time window than the 4.5 hours used in anterior circulation stroke. In this speculative synthesis, we discuss recent advances in BAO treatment in order to understand why and under which circumstances longer symptom duration might not necrotize the brainstem and turn therapeutic attempts futile. We raise the possibility that distinct features of the posterior circulation, e.g., highly developed, persistent collateral arterial network, reverse filling of the distal basilar artery, and delicate plasma flow siding the clot, might sustain brittle patency of brainstem perforators in the face of stepwise growth of the thrombus. Meanwhile, the tissue clock characterizing the rapid necrosis of a typical anterior circulation penumbra will not start. During this perilous time period, recanalization at any point would salvage the brainstem from eventual necrosis caused by imminent reinforcement and further building up of the clot.


Health care practitioners' responsibility to address intimate partner violence related to the COVID-19 pandemic.


title: Prognostic value of new-onset right bundle-branch block in acute myocardial infarction patients: a systematic review and meta-analysis.

text: Background Patients with acute myocardial infarction (AMI) and bundle-branch block have poor prognoses. The new European Society of Cardiology guideline suggests a primary percutaneous coronary intervention strategy when persistent ischemic symptoms occur in patients with persistent ischemic symptoms and right bundle-branch block (RBBB), but the level of evidence is not high. In fact, the presence of RBBB may lead to the misdiagnosis of transmural ischemia and mask the early diagnosis of ST-elevation myocardial infarction. Moreover, new-onset RBBB is occasionally caused by AMI. Our study aims to investigate the prognostic value of new-onset RBBB in AMI. Methods and Results We conducted a meta-analysis of studies to evaluate the prognostic value of RBBB in AMI patients. Of 914 primary records, five studies and 874 MI patients were included for meta-analysis. Compared with previous RBBB, AMI patients with new-onset RBBB had a higher risk of long-term mortality (RR, 1.66, 95% CI [1.31-2.09], I2 = 0.0%, p = 0.000, n = 2), ventricular arrhythmia (RR, 4.86, 95% CI [2.10-11.27], I2 = 0.0%, p = 0.000, n = 3), and cardiogenic shock (RR, 2.76, 95% CI [1.66-4.59], I2 = 0.0%, p = 0.000, n = 3), but a lower risk of heart failure (RR, 0.66, 95% CI [0.52-0.85], I2 = 2.50%, p = 0.001, n = 4). Compared with AMI patients with new-onset permanent RBBB, patients with new-onset transient RBBB had a lower risk of short-term mortality (RR, 0.20, 95% CI [0.11-0.37], I2 = 44.1%, p = 0.000, n = 4). Conclusion New-onset RBBB is likely to increase long-term mortality, ventricular arrhythmia, and cardiogenic shock, but not heart failure in AMI patients. AMI patients with new-onset transient RBBB have a lower risk of short-term mortality than those with new-onset permanent RBBB. Revascularization therapies should be considered when persistent ischemic symptoms occur in patients with RBBB, especially new-onset RBBB.


title: Office workers' sick building syndrome and indoor carbon dioxide concentrations.

text: This study attempted to determine whether any association exists between sick building syndrome (SBS) and indoor carbon dioxide (CO(2)) concentrations. We evaluated SBS among 111 office workers in August and November 2003. The environmental conditions in the office, including CO(2) concentrations, temperature, relative humidity, and fine particulate matter (PM(2.5)), were continuously monitored. The most prevalent symptoms of the five SBS groups were eye irritation and nonspecific and upper respiratory symptoms. The generalized estimating equation (GEE) models show that workers exposed to indoor CO(2) levels greater than 800 ppm were likely to report more eye irritation or upper respiratory symptoms.


title: Covering the staple line with polyglycolic acid sheet versus oxidized regenerated cellulose mesh after thoracoscopic bullectomy for primary spontaneous pneumothorax.

text: OBJECTIVE The aim of this study was to compare coverage with oxidized regenerated cellulose mesh and that with polyglycolic acid sheet to decrease the incidence of postoperative recurrent pneumothorax. METHODS From August 2010 to August 2014, a total of 112 patients with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled. We compared the clinicopathological characteristics between recurrent and non-recurrent cases and examined their association with the material used for visceral pleural coverage: polyglycolic acid sheet versus oxidized regenerated cellulose mesh. RESULTS 57 patients underwent thoracoscopic bullectomy plus coverage using oxidized regenerated cellulose mesh and 55 underwent thoracoscopic bullectomy plus coverage using polyglycolic acid sheet. The recurrence rate among all patients was 13.3%. No severe postoperative complications were observed in either group. There were no significant differences in the perioperative outcomes. However, the postoperative recurrence rate was significantly higher in the oxidized regenerated cellulose mesh group than in the polyglycolic acid sheet group (22.8 vs 3.6%). CONCLUSIONS Our results suggest that coverage with oxidized regerated cellulose mesh was not superior to coverage with polyglycolic acid sheet for postoperative recurrent pneumothorax.


title: Mortality, hepatopathy and liver copper concentrations in artificially reared Jersey calves before and after reductions in copper supplementation.

text: High winter mortality (28 per cent) in female Jersey calves (<one month) characterised by mild hepatopathy and enteropathy was investigated. Liver copper (Cu) was very high in casualties, but also high in culled, newborn males (19.2 ± 1.54 and 12.0 ± 2.74 sd mmol/kg dry matter (DM) respectively). Serum glutamate dehydrogenase (GLDH) was >80 IU/l in healthy females aged 3-24 weeks, and correlated with serum aspartate transaminase (AST). Copper supplementation of total mixed rations during lactation was excessive (40-60 mg added Cu/kg DM) and reduced to 16-28 mg Cu/kg, but supplementation of milk replacer and creep feed (10 and 35 mg added Cu/kg DM, respectively) continued. The syndrome recurred two years later, and liver Cu remained high in casualties (13.6 ± 2.6) and culled cows (6.38 ± 2.38 mmol/kg DM) prompting withdrawal of all Cu supplements. Mortality remained low (6-9 per cent) thereafter. Three years after removal of all Cu supplements, six culled newborn were examined postmortem; five had normal liver Cu (4.5 ± 1.73), but a sixth had 11.65 mmol/kg DM. In live, healthy calves (1-6 months old) sampled at the same time, GLDH and AST increased with age to levels found five years earlier, indicating possible subclinical hepatopathy. Causative links between Cu supplementation, high calf mortality and hepatopathy are plausible, and reductions in Cu supplementation may prove beneficial in other dairy herds.


title: Historical and contemporary aspects of maternal immunity in swine.

text: Maternal immunity plays a pivotal role in swine health and production because piglets are born agammaglobulinemic and with limited cell-mediated immunity, i.e. few peripheral lymphoid cells, immature lymphoid tissues, and no effector and memory T-lymphocytes. Swine do not become fully immunologically competent until about 4 weeks of age, which means that their compromised ability to respond to infectious agents during the first month of life must be supplemented by maternal immune components: (1) circulating antibodies derived from colostrum; (2) mucosal antibodies from colostrum and milk; and (3) immune cells provided in mammary secretions. Because maternal immunity is highly effective at protecting piglets against specific pathogens, strengthening sow herd immunity against certain diseases through exposure or vaccination is a useful management tool for ameliorating clinical effects in piglets and delaying infection until the piglets' immune system is better prepared to respond. In this review, we discuss the anatomy and physiology of lactation, the immune functions of components provided to neonatal swine in mammary secretion, the importance of maternal immunity in the prevention and control of significant pathogens.


title: A survey of intracranial aneurysm treatment practices among United States physicians.

text: BACKGROUND Recent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians. OBJECTIVE To survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences. METHODS A 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section. RESULTS 211 physicians completed the survey. Most respondents recommend endovascular treatment as the first-line management strategy for most ruptured (78%) and unruptured (71%) aneurysms. Thirty-eight per cent of respondents indicate that they routinely treat all patients with subarachnoid hemorrhage regardless of grade. Most physicians use the International Study of Unruptured Intracranial Aneurysms data for counseling patients on natural history risk (80%); a small minority (11%) always or usually recommend treatment of anterior circulation aneurysms of <5 mm. Two-thirds of respondents continue to recommend clipping for most middle cerebral artery aneurysms, while most (51%) recommend flow diversion for wide-necked internal carotid artery aneurysms. Follow-up imaging schedules are highly variable. Neurosurgeons at academic institutions and those practicing longer were more likely to recommend clipping surgery for aneurysms (p<0.05). CONCLUSIONS This survey demonstrates considerable variability in patient selection for intracranial aneurysm treatment, preferred treatment strategies, and follow-up imaging schedules among US physicians.


title: Effects of automatic cluster removal and feeding during milking on milking efficiency, milk yield and milk fat quality.

text: In order to increase milking efficiency, the effects of two different cluster take-off levels (200 and 800 g/min) and feeding vs. not feeding during milking were tested in a Latin square design study including 32 cows. Milk yield, milking time, milk flow and milking interval were measured and milk samples were analysed for gross composition, sodium and potassium concentration, free fatty acid (FFA) content, milk fat globule (MFG) size, MFG membrane (MFGM) material and fatty acid composition. Residual milk was harvested to evaluate udder emptying. Increasing the take-off level from 200 to 800 g/min at the whole udder level decreased milking time and increased harvest flow. Udder emptying decreased slightly, but there were no effects on milk yield, FFA content or MFGM. There were interactive effects of take-off level and feeding during milking on content of fatty acids C4:0, C6:0, C16:0, C18:3(n-3) and C20:0. Feeding during milking increased milk yield per day and decreased milking interval. Sodium and potassium concentrations in milk were unaffected by treatments, indicating no loss of tight junction integrity. From these results, it is clear that feeding during milking should be used to increase milk yield and improve milking efficiency, regardless of take-off level used, and that the effect of feeding is more pronounced when a low take-off level is used. Feeding seemed to counteract the effects of the low take-off level on milking time and milking interval. Low take-off levels can therefore be used in combination with feeding.


title: Sanitizer aerosol-driven ocular surface disease (SADOSD)-A COVID-19 repercussion?

text: Since the onset of the COVID-19 pandemic, there has been an advisory for regular and thorough cleaning of hands besides other measures such as social distancing and self-isolation. The rationale for the same is to prevent the transfer of the virus from hands that have come in contact with fomites. While both alcohol-based hand rubs (ABHR) or washing with soap and water are claimed to have been effective, hand sanitizers have gained more popularity due to the ease of use. The increased frequency of ABHR use and the aerosols generated pose a potential threat to the skin and exposed mucosal surfaces, especially that of the eye due to the proximity of use. The adverse effects of alcohol in these sanitizers can be manifold. An allergic or inflammatory response can occur depending on the predisposing or preexisting conditions. This article describes the risks, underlying mechanisms, and preventive measures for sanitizer aerosol-driven ocular surface disease.


title: Single-incision laparoscopic surgery as an option for the laparoscopic resection of an urachal fistula: first description of the surgical technique.

text: BACKGROUND Persistent urachal sinuses or fistulas are rare but may potentially cause various symptoms and lead to repeated operations. Both laparoscopic and open surgery have been used for the resection of the urachus. METHODS This report describes the first case of an external urachal fistula with recurrent infections and discharge of the umbilicus treated by complete resection using single-incision laparoscopic surgery (SILS). This involved a laparoscopic single-incision three-trocar-technique, leaving the infected site of the umbilicus untouched. RESULTS Healing of the umbilicus was uneventful and complete. To date, the authors have not seen any recurrence of the fistula or its symptoms. CONCLUSIONS Remnants of the urachus should be considered in cases of recurrent infections or discharge of the umbilicus. The SILS procedure is an excellent option for the radical resection of the remnant urachus. Compared with the standard laparoscopic approach, it requires only one incision, decreasing the risks compared with those of several trocars. At the same time, the patient benefits from the better cosmetic result.


title: Management of von Hippel-Lindau disease-associated CNS lesions.

text: Patients with von Hippel-Lindau disease (VHL) often harbor significant disease burden within the CNS, specifically craniospinal-axis hemangioblastomas and endolymphatic sac tumors (ELSTs). The majority (60-80%) of patients with VHL harbor hemangioblastomas, and 10-15% will develop ELSTs. Advances in the understanding of the natural history and outcomes associated with the surgical management of VHL-associated tumors have led to improved management of patients with VHL. Optimizing indications for surgical intervention and refining of surgical techniques for these lesions can reduce patient morbidity associated with the management of this syndrome. In this article, we review the various aspects of perioperative management of patients with VHL, surgical indications and general operative principles for the management of hemangioblastomas and ELSTs, and outcomes associated with the surgical treatment of these tumors.


title: Optimal platelet function test for in-stent tissue protrusion following carotid artery stenting.

text: Purpose To determine the best platelet function test for in-stent tissue protrusion following carotid artery stenting (CAS). Methods Patients who underwent CAS were recruited prospectively in this observational study. Combination of aspirin 100 mg/day and clopidogrel 75 mg/day was administered for a minimum of 7 days prior to procedure. Platelet aggregation was measured by light transmittance aggregometry (LTA) following stimulation by adenosine diphosphate (ADP), collagen, and thrombin receptor activating peptide (TRAP) and by the point of care assay, VerifyNow which measures aspirin and thienopyridine reaction units. Results In-stent tissue protrusion with maximum projection area of ≥1 mm2 was detected by optical coherence tomography (OCT) in 10/28 (36%) patients. Baseline characteristics were not significantly different between the two in-stent size groups (i.e., ≥1 mm2 vs. <1 mm2) but after stimulation by collagen at 10 and 20 μg/ml, platelet reactivity as measured by LTA was significantly higher in the ≥1 mm2 group compared with the <1 mm2 group. No other differences in platelet function were detected. Conclusions Collagen-induced platelet reactivity was related to in-stent tissue protrusion size following CAS.


Science in the time of coronavirus.


title: Ultra-shortwave diathermy - a new purported treatment for management of patients with COVID-19.

text: The pandemic spread of coronavirus disease 2019 (COVID-19) has driven efforts to address the global threat to public health and there is increasing pressure to exploit interventions to manage the pneumonic inflammation manifested in this disease. Ultra-shortwave diathermy (USWD) is proposed by some rehabilitation professions in China, purportedly to minimise pneumonic inflammation. However, treatment of any symptomatic pneumonia should be evidence-based. There is no valid evidence, published in English, which establishes any benefit of USWD in pulmonary conditions, let alone COVID-19. The need for rigorous research and evidence-based practice is discussed in this article. Novel interventions require a solid physiological basis and must undergo rigorous testing prior to clinical adoption even during a pandemic. We are of the view that deployment of USWD in patients with COVID-19 must be prudent and supported by a logical scientific basis.


title: Lymphatic territories (lymphosomes) in a canine: an animal model for investigation of postoperative lymphatic alterations.

text: BACKGROUND Lymph node dissection is often performed as a part of surgical treatment for breast cancer and malignant melanoma to prevent malignant cells from traveling via the lymphatic system. Currently little is known about postoperative lymphatic drainage pattern alterations. This knowledge may be useful for management of recurrent cancer and prevention of breast cancer related lymphedema. We mapped the complete superficial lymphatic system of a dog and used this canine model to perform preliminary studies of lymphatic architectural changes in postoperative condition. METHODS Lymphatic territories (lymphosomes) were mapped with 4 female mongrel carcasses using an indocyanine green (ICG) fluorescent lymphography and a radiographic microinjection technique. Two live dogs were then subjected to unilateral lymph node dissection of lymph basins of the forelimb, and ICG lymphography and lymphangiogram were performed 6 months after the surgery to investigate lymphatic changes. Lymphatic patterns in the carcass were then compared with postoperative lymphatic patterns in the live dogs. RESULTS Ten lymphosomes were identified, corresponding with ten lymphatic basins. Postoperative fluorescent lymphographic images and lymphangiograms in the live dogs revealed small caliber lymphatic network fulfilling gaps in the surgical area and collateral lymphatic vessels arising from the network connecting to lymph nodes in the contralateral and ipsilateral neck in one dog and the ipsilateral subclavicular vein in another dog. CONCLUSION Our canine lymphosome map allowed us to observe lymphatic collateral formations after lymph node dissection in live dogs. This canine model may help clarify our understanding of postoperative lymphatic changes in humans in future studies.


title: SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis.

text: BACKGROUND The flow diverting stent is a new and expansive tool in the endovascular therapy of complex intracranial aneurysms. We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. METHODS Between September 2010 and May 2012, 19 consecutive patients with 29 complex intracranial aneurysms were treated with SFD without the adjunctive use of coils. We retrospectively evaluated the technical aspects, thromboembolic events, adjunctive therapies, and short term results in patients with complex intracranial aneurysms treated with SFD. A cost analysis of patients who were treated with SFD was performed and compared with similar sized aneurysms coiled with stent assisted coiling. RESULTS The primary technical success rate was 100%. An adjunctive device was required in two of our patients. The technique related complication rate and the 30 day mortality and morbidity rates were 5% (1/20) and 10% (2/20), respectively. We had a total of 263 patient months of clinical and 166 patient months of imaging follow-up. Follow-up imaging revealed two asymptomatic occlusions of the parent artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 59% of patients where follow-up images were available. The cost analysis showed that the mean cost of treatment with SFD was significantly cheaper compared with the presumed cost of stent assisted coiling (p<0.001). CONCLUSIONS The SFD provides a very feasible, efficient, relatively safe, and cost effective method to treat complex intracranial aneurysms without the use of adjunct coiling.


Selenium toxicity causes paralysis in Scottish pigs.


title: The viral, epidemiologic, clinical characteristics and potential therapy options for COVID-19: a review.

text: Coronavirus Disease-2019 (COVID-19) caused by SARS-CoV-2 infection has rapidly spread all over the world, in just two months. As of 27 March, globally, 509,164 cases confirmed included 23,335 deaths in approximately 150 countries. Recently, WHO has defined COVID-19 as a global pandemic, and considerable researches have focused on the identification and prevention of SARS-CoV-2. As a result, accumulated publications successively reported their early findings, leading to the constant updating of information, which might make confusion for readers. Therefore, this review summarized the current researches about the genomic evolution, variation of SARS-CoV-2, and demonstrated its viral structure for pathogenesis. Meanwhile, we analyzed the epidemiologic and clinical characteristics of COVID-19, in order to provide recommendations for present clinical treatments and inspirations for potential therapy options.


title: Spatial Analysis of COVID-19 cases and intensive care beds in the State of Ceará, Brazil.

text: The geographical distribution of COVID-19 through Geographic Information Systems resources is hardly explored. We aimed to analyze the distribution of COVID-19 cases and the exclusive intensive care beds in the state of Ceará, Brazil. This is an ecological study with the geographic distribution of the case detection coefficient in 184 municipalities. Maps of crude and estimated values (global and local Bayesian method) were developed, calculating the Moran index and using BoxMap and MoranMap. Intensive care beds were distributed through geolocalized points. In total, 3,000 cases and 459 beds were studied. The highest rates were found in the capital Fortaleza, the Metropolitan Region (MR), and the south of this region. A positive spatial autocorrelation has been identified in the local Bayesian rate (I = 0.66). The distribution of beds superimposed on the BoxMap shows clusters with a High-High pattern of number of beds (capital, MR, northwestern part). However, a similar pattern is found in the far east or transition areas with insufficient beds. The MoranMap shows clusters statistically significant in the state. COVID-19 interiorization in Ceará requires contingency measures geared to the distribution of specific intensive care beds for COVID-19 cases in order to meet the demand.


title: Borna disease virus infection in cats: ABCD guidelines on prevention and management.

text: OVERVIEW Borna disease virus (BDV) has a broad host range, affecting primarily horses and sheep, but also cattle, ostriches, cats and dogs. In cats, BDV may cause a non-suppurative meningoencephalomyelitis ('staggering disease'). INFECTION The mode of transmission is not completely elucidated. Direct and indirect virus transmission is postulated, but BDV is not readily transmitted between cats. Vectors such as ticks may play a role and shrews have been identified as a potential reservoir host. Access to forested areas has been reported to be an important risk factor for staggering disease. DISEASE SIGNS It is postulated that BDV may infect nerve endings in the oropharynx and spread via olfactory nerve cells to the central nervous system. A strong T-cell response may contribute to the development of clinical disease. Affected cats develop gait disturbances, ataxia, pain in the lower back and behavioural changes. DIAGNOSIS For diagnostic purposes, detection of viral RNA by reverse transcription PCR in samples collected from cats with clinical signs of Borna disease can be considered diagnostic. Serology is of little value; cats without signs of Borna disease may be seropositive and yet not every cat with BDV infection has detectable levels of antibodies. HUMAN INFECTION A hypothesis that BDV infection may be involved in the development of selected neurological disorders in man could not be confirmed. A research group within the German Robert Koch Institute studied the potential health threat of BDV to humans and concluded that BDV was not involved in the aetiology of human psychiatric diseases.


How I Do It: Robotic Pancreaticoduodenectomy.


title: Cauda equina syndrome after a TLIF resulting from postoperative expansion of a hydrogel dural sealant.

text: BACKGROUND DuraSeal(™) (Coviden, Waltham, MA, USA), a hydrogel sealant, is primarily used as an adjunct to a dural repair. Its use has also been described to seal off an annulotomy after a transforaminal lumbar interbody fusion when recombinant human bone morphogenetic protein-2 (rhBMP-2) is used. This aids in the reduction of postoperative radiculitis caused by rhBMP-2. However, as a result of its hydrophilic properties, DuraSeal(™) has the potential to swell, which could lead to compression of the thecal sac. CASE DESCRIPTION We report a 57-year-old woman who developed cauda equina after a transforaminal lumbar 47 interbody fusion (TLIF) procedure in which the expansion of the DuraSeal(™) was believed to be the causative factor. The patient developed urinary retention, bowel incontinence, and paresthesias in the saddle region on postoperative Day 3. She underwent emergent exploration and decompression of the thecal sac. The gel-like DuraSeal™ material was causing significant compression of the thecal sac. LITERATURE REVIEW Multiple reports have documented that DuraSeal(™), used as an adjunct to dural repair, can swell leading to compression of the spinal cord and/or neural elements. Our case demonstrates the use of DuraSeal(™) both over a site of a dural repair and over an annulotomy site, through which a TLIF was performed, is associated with the risk of developing postoperative cauda equina syndrome as a result of swelling of the DuraSeal(™). CLINICAL RELEVANCE Those using DuraSeal™ to seal off the annulotomy after a TLIF procedure performed with rhBMP-2 should use the product with an understanding of the potential postoperative swelling of the product and resulting neurologic sequela, particularly if DuraSeal(™) is used concomitantly at the site of dural repair.


title: Team-based model for non-operating room airway management: validation using a simulation-based study.

text: BACKGROUND Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. METHODS Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). RESULTS Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. CONCLUSIONS Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method.


title: A pseudotype baculovirus-mediated vaccine confers protective immunity against lethal challenge with H5N1 avian influenza virus in mice and chickens.

text: Baculovirus has emerged recently as a novel and attractive gene delivery vehicle for mammalian cells. In this study, baculovirus pseudotyped with vesicular stomatitis virus glycoprotein was used as a vector to express the hemagglutinin (HA) protein of highly pathogenic H5N1 avian influenza virus, A/Chicken/Hubei/327/2004 (HB/327). The resultant recombinant baculovirus (BV-G-HA) mediated gene delivery and HA expression efficiently in mammalian cells. Mice immunized with 1 x 10(9)PFU of BV-G-HA developed significantly higher levels of H5-specific antibodies and cellular immunity than those that received 100 microg of DNA vaccines expressing HA, and were completely protected from lethal challenge with HB/327. Different vaccination doses were further tested in chickens, and these experiments demonstrated that 1 x 10(8)PFU of BV-G-HA offered complete protection from challenge with 100 LD(50) of HB/327. These data indicate that the pseudotype baculovirus-mediated vaccine could be utilized as an alternative strategy against the pandemic spread of H5N1 influenza virus.


The Impact of COVID-19 on the State of Clinical and Laboratory Research Globally in Transplantation in May 2020.


title: Properties of collagen-based hemostatic patch compared to oxidized cellulose-based patch.

text: Two self-adhering hemostatic patches, based on either PEG-coated collagen (PCC) or PEG-coated oxidized cellulose (PCOC), are compared regarding to maximum burst pressure, mechanical stability, and swelling. In addition, the induction of tissue adhesions by the materials was assessed in a rabbit liver abrasion model. Both materials showed comparable sealing efficacy in a burst pressure test (37 ± 16 vs. 35 ± 8 mmHg, P = 0.730). After incubation in human plasma, PCC retained its mechanical properties over the test period of 8 h, while PCOC showed faster degradation after the 2 h time-point. The degradation led to a significantly decreased force at break (minimum force at break 0.55 N during 8 h for PCC, 0.27 N for PCOC; p < 0.001). Further, PCC allowed significantly higher deformation before break (52% after 4 h and 50% after 8 h for PCC, 18% after 4 h and 23% after 8 h for PCOC; p = 0.003 and p < 0.001 for 4 h and 8 h, respectively) and showed less swelling in human plasma (maximum increase in thickness: ~20% PCC, ~100% PCOC). Faster degradation of PCOC was visible macroscopically and histologically in vivo after 14 days. PCC showed visible structural residues with little cellular infiltration while strong infiltration with no remaining structural material was seen with PCOC. In vivo, a higher incidence of adhesion formation after PCOC application was detected. In conclusion, PCC has more reliable mechanical properties, reduced swelling, and less adhesion formation than PCOC. PCC may offer greater clinical benefit for surgeons in procedures that have potential risk for body fluid leakage or that require prolonged mechanical stability.


title: Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19).

text: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory disease, which can evolve into multi-organ failure (MOF), leading to death. Several biochemical alterations have been described in COVID-19 patients. To date, many biomarkers reflecting the main pathophysiological characteristics of the disease have been identified and associated with the risk of developing severe disease. Lymphopenia represents the hallmark of the disease, and it can be detected since the early stage of infection. Increased levels of several inflammatory biomarkers, including c-reactive protein, have been found in COVID-19 patients and associated with an increased risk of severe disease, which is characterised by the so-called "cytokine storm". Also, the increase of cardiac and liver dysfunction biomarkers has been associated with poor outcome. In this review, we provide an overview of the main biochemical characteristics of COVID-19 and the associated biomarkers alterations.


title: Potential Antiviral Drugs for SARS-Cov-2 Treatment: Preclinical Findings and Ongoing Clinical Research.

text: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), initially termed 2019-new CoV (2019-nCoV), is a novel coronavirus responsible for the severe respiratory illness currently ongoing worldwide from the beginning of December 2019. This beta gene virus, very close to bat coronaviruses (bat-CoV-RaTG13) and bat-SL-CoVZC45, causes a severe disease, similar to those caused by Middle East respiratory syndrome (MERS)-CoV and SARS-CoV viruses, featured by low to moderate mortality rate. Unfortunately, the antiviral drugs commonly used in clinical practice to treat viral infections, are not applicable to SARS-Cov-2 and no vaccine is available. Thus, it is extremely necessary to identify new drugs suitable for the treatment of the 2019-nCoV outbreak. Different preclinical studies conducted on other coronaviruses suggested that promising clinical outcomes for 2019-nCoV should be obtained by using alpha-interferon, chloroquine phosphate, arabinol, remdesivir, lopinavir/ritonavir, and anti-inflammatory drugs. Moreover, clinical trials with these suitable drugs should be performed on patients affected by SARS-Cov-2 to prove their efficacy and safety. Finally, a very promising therapeutic drug, tocilizumab, is discussed; it is currently used to treat patients presenting COVID-19 pneumonia. Herein, we recapitulate these experimental studies to highlight the use of antiviral drugs for the treatment of SARS-Cov-2 disease.


title: In vitro characterization and immunogenicity of chitosan nanoparticles loaded with native and inactivated extracellular proteins from a field strain of Clostridium perfringens associated with necrotic enteritis.

text: There are currently no licensed vaccines against Clostridium perfringens which causes necrotic enteritis in poultry. Chitosan nanoparticles were formulated with native (CN) or toxoids (CT) of extracellular proteins (ECP) of C. perfringens, both surface-tagged with Salmonella flagellar proteins. In a pH stability assay, CN and CT nanoparticles released 6% and 0% of their protein at 8.0 pH. In a protein release assay, CN and CT nanoparticles released 16% and 10% of their protein respectively at 7.4 pH after 24 h. CN and CT nanoparticles incubated at 100 μg/mL PBS with Chicken RBCs released 1% and 0% hemoglobin respectively. Ninety broilers were randomly assigned to treatments; sham-vaccinated (Control), CN-vaccinated (CN), and CT-vaccinated (CT). Each bird was orally gavaged with 50 μg vaccine in 0.5 mL PBS or 0.5 mL PBS only on d 0, 3, 7 and 14 of age. At 21 d of age, the CN group had higher anti-ECP IgA than control (P < 0.05). At 21 d of age, the CN and CT group had higher anti-ECP IgA than control (P < 0.05). At 17 d of age, the CN group had higher anti-flagellar IgG than control (P < 0.05). At 10 d of age, the CN group had higher anti-flagellar IgA than control (P < 0.05). Splenic T cells from chickens in the CN and CT group ex-vivo stimulated with 0.05 mg/mL ECP, had higher proliferation control (P < 0.05, P < 0.01 respectively). Splenic T cells from chickens in the CN and CT groups ex-vivo stimulated with 0.1 mg/mL ECP had proliferation than control (P < 0.05). Pooled serum from 17 d of age CN and CT-vaccinated birds partially neutralized toxins in 50 μg of ECP (P < 0.05). Pooled serum from 28 d of age CN-vaccinated birds also partially neutralized toxins in 50 μg of ECP. The result from this study indicates the potential for chitosan loaded with Clostridium perfringens extracellular proteins to be applied to necrotic enteritis challenge studies.


title: When staplers misfire: endoscopic rescue of low pelvic anastomoses.

text: The end-to-end stapler has made it possible for colorectal surgeons to construct deeper anastomoses. Although complications associated with the device are mainly postoperative, very serious intraoperative complications, such as stapler misfire, can occur. The authors report their experience with two cases of stapler misfire, describing their method for the extraction of the device and the entrapped tissue using a flexible sigmoidoscope and a hot biopsy forceps. There were no immediate or long-term problems. The technique appears to be safe and effective.


title: Infection of calves with bovine norovirus GIII.1 strain Jena virus: an experimental model to study the pathogenesis of norovirus infection.

text: The experimental infection of newborn calves with bovine norovirus was used as a homologous large animal model to study the pathogenesis of norovirus infection and to determine target cells for viral replication. Six newborn calves were inoculated orally with Jena virus (JV), a bovine norovirus GIII.1 strain, and six calves served as mock-inoculated controls. Following infection, calves were euthanized before the onset of diarrhea (12 h postinoculation [hpi]), shortly after the onset of diarrhea (18 to 21 hpi), and postconvalescence (4 days pi [dpi]). Calves inoculated with JV developed severe watery diarrhea at 14 to 16 hpi, and this symptom lasted for 53.5 to 67.0 h. Intestinal lesions were characterized by severe villus atrophy together with loss and attenuation of villus epithelium. Viral capsid antigen (JV antigen) was detected by immunohistochemistry in the cytoplasm of epithelial cells on villi. In addition, granular material positive for JV antigen was detected in the lamina propria of villi. Lesions first appeared at 12 hpi and were most extensive at 18 to 19 hpi, extending from midjejunum to ileum. The intestinal mucosa had completely recovered at 4 dpi. There was no indication of systemic infection as described for norovirus infection in mice. JV was found in intestinal contents by reverse transcription-PCR (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) as early as 12 hpi. Fecal shedding of the virus started at 13 hpi and stopped at 23 hpi or at necropsy (4 dpi), respectively. Throughout the trial, none of the control calves tested positive for JV by ELISA or RT-PCR.


title: Bariatric aftercare and outcomes in the Medicaid population following sleeve gastrectomy.

text: BACKGROUND Medicaid patients tend to have poor access to care and suffer from more obesity and obesity-related co-morbidities compared to their privately insured counterparts. The impact of Medicaid status on outcomes after laparoscopic sleeve gastrectomy (LSG) is unknown. The aim of this study was to identify factors that influence outcomes following LSG in the adult Medicaid population of Louisiana with particular focus on adherence to bariatric aftercare attendance and access to care. METHODS A retrospective review of 63 Medicaid patients undergoing LSG was performed. Demographic data, access to care, weight, co-morbidities morbidity, and mortality were analyzed. Changes in weight and obesity-related co-morbidities were analyzed for patients with ≥12 months of follow-up. Regression analyses were used for estimating the relationships among variables. RESULTS The majority of patients were female and non-Caucasian. The mean age was 38.6 years. Morbidity was 16% and mortality was 0%. The average distance traveled to clinic was 71.9 miles. Within the first year only 10% of the patients attended all post-operative clinic visits. A multiple logistic model showed that the only predictor of clinic attendance was increased age. At a mean follow-up of 17.7 months, the mean percent excess body weight loss was 47.2%. Greater pre-surgical weight was the only variable associated with suboptimal weight loss. Improvement or resolution of all major co-morbidities was seen in 65% of patients. CONCLUSION Medicaid patients had a poor attendance at bariatric surgery follow up appointments. Since long-term follow-up is critical, we needed to develop strategies that will optimize follow-up in this patient population.


title: Estimation of Reproduction Number (Ro) and Early Prediction of 2019 Novel Coronavirus Disease (COVID-19) Outbreak in India Using Statistical Computing Approach.

text: The novel coronavirus disease (COVID-19) is a pandemic and causes respiratory infection. The World Health Organization (WHO) announced it as a public health crisis of international concern. We developed susceptible-exposed-infected-removed (SEIR) model for COVID-19 to show the importance of estimation of reproduction number (R0). This work is focused on predicting the COVID-19 outbreak at the early stage in India based on estimation of reproduction number (R0). The developed model will help to take active measures prior to the spread of 2019-nCoV disease. The data of daily newly infective cases in India from 2nd March 2020 to 2nd April 2020 has been used as samples to obtain the reproduction number. The 'earlyR' package has been utilized for the estimation of R0. The Maximum-Likelihood approach has been carried out to the distribution of R0 and applied bootstrap strategy for resampling to maximize likely R0 values. We estimated the median value of Ro value as 1.471 (1.351-1.592) with 95% confidence interval (CI) and predicted that the new cases count may reach 39382 (34300-47351) in 30 days.


title: Mechanical ventilatory support in potential lung donor patients.

text: Lung transplantation reduces mortality in patients with end-stage lung disease; however, only approximately 21% of lungs from potential donor patients undergo transplantation. A large number of donor lungs become categorized as unsuitable for lung transplantation as a result of lung injury around the time of brain death. Limiting this injury is key to increasing the number of successful lung procurements and subsequent transplants. This narrative review by a working group of pulmonologists, respiratory therapists, and lung transplant specialists elucidates principles of mechanical ventilatory support that can be used to limit lung injury in potential lung donor patients and examines the implementation of protocolized strategies in enhancing the procurement of donor lungs for transplantation.


title: Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients.

text: BACKGROUND Excellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU). METHODS Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6-12-year FU. Mean age was 43 years (12-74) and body mass index (BMI) 46 kg/m2 (33-86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. RESULTS Mean operating time (min) was as follows: (a) primary procedure, 86 (45-180); (b) with other operations, 112 (95-230); and (c) revisions, 180 (130-240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m2) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards. CONCLUSIONS Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.


Covid-19: Researchers launch app to track spread of symptoms in the UK.


title: Unruptured giant intracavernous aneurysms untolerate internal carotid artery occlusion test: Untreated and treated with flow-diversion.

text: BACKGROUND AND OBJECTIVE Giant intracavernous aneurysms (GICAs) are located in extradural space; their clinical manifestation and treatment are different from other intradural aneurysms. This study reports clinical outcomes of GICAs untolerate internal carotid artery occlusion tests. METHODS Between January 2012 and September 2017, 14 consecutive cases of GICAs untolerated internal carotid artery occlusion test were retrospectively reviewed. A total of nine patients were not treated and five patients were treated using a Pipeline Embolization Device. RESULTS Of the 14 patients, 12 had compression symptoms and 2 were incidental. In nine untreated patients, during 34 months' (range, 7-64 months) follow-up, four worsened to headaches or ablepsia (more than 34 months). One patient, who presented with ophthalmoplegia and diplopia, showed spontaneous resolution of symptoms at 32-month follow-up. Symptoms in four patients remained unchanged during less than 36-month follow-up period. In five (100%, 95% confidence interval 57% to 100%) treated patients, symptoms recovered completely during 11 months' follow-up after transient worsening of mass compression. CONCLUSIONS GICAs frequently result in intractable cranial neuropathy requiring treatment. The Pipeline Embolization Device is an effective option for these complex aneurysms in selective cases.


title: Needs of individuals recovering from a first episode of mental illness: A scoping review.

text: Central to the role of mental health clinicians is the assessment of needs. A number of assessment tools have been used to evaluate the needs of individuals diagnosed with a mental illness. These tools have largely been developed for people with a severe and persistent mental illness and may not be suitable for individuals who are recovering from a first episode of mental illness. The aims of this review were therefore to identify the needs experienced by individuals recovering from a first episode of mental illness; determine what tools have been used to evaluate these needs; and explore whether existing tools adequately reflect the needs described in the literature. Twenty-one articles were included, comprising articles which identified needs (n = 10), needs assessment tools (n = 1), or articles which identified both needs and a needs assessment tool (n = 10). Results indicate that individuals who have been admitted to a specialized mental health unit and are recovering from a first episode of mental illness may experience an extensive range of needs, spanning emotional, psychological, social, informational, functional, practical, and relationship needs. Four established needs assessment tools were found to have been used to evaluate these needs; however, these do not appear to represent all needs discovered in this review, were mostly developed for populations with a long-term mental illness, and may not be suitable for assessing the needs of individuals recovering from a first episode of mental illness following a presentation to a specialized mental health unit.


title: Older multimorbid patients' experiences on integration of services: a systematic review.

text: BACKGROUND Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. METHODS A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. INCLUSION CRITERIA studies exploring patients' point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. RESULTS Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. CONCLUSIONS Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.


title: Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Second IFSO Global Registry Report 2013-2015.

text: BACKGROUND Five International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) surveys since 1998 have estimated the volume and type of bariatric surgery being done in constituent member countries. These reports did not include baseline demographic descriptions. METHODS An IFSO Global Registry pilot project in 2014 demonstrated that it was possible to amalgamate large numbers of individual patient data from different local and national database systems. Here we describe demographic data from the second report for 54,490 patients from 31 countries operated in the 3 calendar years 2013-2015 and follow up data from 66,560 of 112,544 patients in 2009-2015. RESULTS Most procedures (97.8%) were performed laparoscopically and 73.3% (95% CI: 73.0-73.7%, range 54.2 to 80.3%) were female. The average age was 42.0 years (95% CI 41.9-42.1, inter-quartile range 33.0-51.0 years) and the median body mass index was 43.3 kg/m2 (inter-quartile range 39.4-48.8 kg/m2). Before surgery, 22.0% patients had type 2 diabetes (inter-country variation 7.4-63.2%); 31.9% were hypertensive (15.8-92.7%); 17.6% had depression (0.0-46.3%); 27.8% took medication for musculoskeletal pain (0.0-58.9%); 18.9% had sleep apnea (0.0-63.2%); and 29.6% of patients had gastro-esophageal reflux disease (9.1-90.9%). Gastric bypass was the most prevalent operation (49.4%), followed by sleeve gastrectomy (40.7%) and gastric banding (5.5%). The 1-year total weight loss for patients with available data was 30.53% (95% CI: 30.22-30.84%) and in the cohort 2009-15 was 30.4% with a follow-up rate of 59.14%. In the 2009-2015 cohort, 64.7% of patients on treatment for diabetes preoperatively were not on treatment postoperatively. CONCLUSIONS There is widespread variation in access to surgery and in baseline patient characteristics in the countries submitting data to the IFSO Global Registry.


title: Endoscopic Bariatric and Metabolic Therapies: New and Emerging Technologies.

text: Endoscopic bariatric and metabolic therapies (EBMT) are a new addition to the treatment arsenal for obesity. These include devices that are placed or removed via flexible endoscopy, and procedures that utilize instruments that require flexible endoscopy for the indications of weight loss or treatment of glucose intolerance (from pre-diabetes to diabetes). The EBMTs are generally divided into gastric and small bowel categories, and although individual EBMTs may have unique mechanisms of action, similar themes in proposed mechanism of action are seen in the gastric and small bowel EBMTs, respectively. In this review we will describe the therapies approved for use in the United States or currently in the process of obtaining approval for use in the United States. We will discuss potential mechanisms of action and examine safety and efficacy data.


title: Percutaneous radiofrequency ablation for early hepatocellular carcinoma: risk factors for survival.

text: AIM To evaluate outcomes of radiofrequency ablation (RFA) therapy for early hepatocellular carcinoma (HCC) and identify survival- and recurrence-related factors. METHODS Consecutive patients diagnosed with early HCC by computed tomography (CT) or magnetic resonance imaging (MRI) (single nodule of ≤ 5 cm, or multi- (up to 3) nodules of ≤ 3 cm each) and who underwent RFA treatment with curative intent between January 2010 and August 2011 at the Instituto do Câncer do Estado de São Paulo, Brazil were enrolled in the study. RFA of the liver tumors (with 1.0 cm ablative margin) was carried out under CT-fluoro scan and ultrasonic image guidance of the percutaneous ablation probes. Procedure-related complications were recorded. At 1-mo post-RFA and 3-mo intervals thereafter, CT and MRI were performed to assess outcomes of complete response (absence of enhancing tissue at the tumor site) or incomplete response (enhancing tissue remaining at the tumor site). Overall survival and disease-free survival rates were estimated by the Kaplan-Meier method and compared by the log rank test or simple Cox regression. The effect of risk factors on survival was assessed by the Cox proportional hazard model. RESULTS A total of 38 RFA sessions were performed during the study period on 34 patients (age in years: mean, 63 and range, 49-84). The mean follow-up time was 22 mo (range, 1-33). The study population showed predominance of male sex (76%), less severe liver disease (Child-Pugh A, n = 26; Child-Pugh B, n = 8), and single tumor (65%). The maximum tumor diameters ranged from 10 to 50 mm (median, 26 mm). The initial (immediately post-procedure) rate of RFA-induced complete tumor necrosis was 90%. The probability of achieving complete response was significantly greater in patients with a single nodule (vs patients with multi-nodules, P = 0.04). Two patients experienced major complications, including acute pulmonary edema (resolved with intervention) and intestinal perforation (led to death). The 1- and 2-year overall survival rates were 82% and 71%, respectively. Sex, tumor size, initial response, and recurrence status influenced survival, but did not reach the threshold of statistical significance. Child-Pugh class and the model for end-stage liver disease score were identified as predictors of survival by simple Cox regression, but only Child-Pugh class showed a statistically significant association to survival in multiple Cox regression analysis (HR = 15; 95%CI: 3-76 mo; P = 0.001). The 1- and 2-year cumulative disease-free survival rates were 65% and 36%, respectively. CONCLUSION RFA is an effective therapy for local tumor control of early HCC, and patients with preserved liver function are the best candidates.


title: Single-port hysterectomy: robotic versus laparoscopic.

text: This study evaluated the feasibility and safety of robotic single port hysterectomy and laparoscopic single port hysterectomy, and to compare the perioperative parameters of the two systems. Twenty patients underwent robotic single port hysterectomy and 25 patients underwent laparoscopic single port hysterectomy. All hysterectomies were successfully performed via a single port and there were no conversions to conventional multi-port laparoscopy, multi-port robotic, open surgery, or vaginal surgery. The median operative time and hysterectomy time in robotic and laparoscopic groups were 90 vs. 90 min (P 0.74), 57.5 vs. 60 min (P 0.17), respectively. The median estimated blood loss was 40 ml in the robotic group and 50 ml in the laparoscopic group (P 0.77). No operative and post-operative complications were observed in the two groups. The median time to discharge from the hospital was one day for both techniques (P 0.17). Robotic and laparoscopic single port systems are feasible and safe for hysterectomy operation in terms of operative time, conversion to laparotomy or multiport laparoscopy/robotic rates, complication rates, and postoperative results in the hands of experienced surgeons. The possible benefits of robotic single port surgery compared with conventional laparoscopy should be evaluated in further randomized controlled studies.


Covid-19: local implementation of tracing and testing programmes could enable some schools to reopen.


title: Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases.

text: BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is a common bariatric procedure associated with a high rate of weight loss failure and/or complications in the long term. The objective of this study was to test the hypothesis that the conversion of failed LAGB into laparoscopic sleeve gastrectomy (LSG) is not associated with an increased risk of postoperative complications and leads to weight loss results that are comparable to those obtained with a primary LSG. METHODS We retrospectively analyzed the results of a prospective series of 1360 LSG regarding patient demographics, the indication for revision morbidity, the percentage of excess weight loss, and the rate of postoperative complications. RESULTS The primary LSG group contained 1060 patients and the LAGB to LSG group contained 300 patients. The rate of postoperative complications was 4.5% in the primary LSG group and 2% in the LAGB to LSG group. Two patients died in the LSG group (1 pulmonary embolus, 1 myocardial infarction). There was no significant difference with respect to the rate of leak, which was 1% in the LAGB to LSG group and 1.6% in the primary LSG group. There was a greater weight loss after primary LSG, mean % excess weight loss of 75.9%±21.4 at a mean interval of 29±19.8 months, versus 62.6%±22.2 at a mean interval of 35±24 months after LAGB to LSG (P = .008). There were 72.1% and 59.2% of patients available for follow-up after primary LSG at 24 and 60 months respectively, versus 69.3% and 55.4% after LAGB to LSG. CONCLUSION This study indicates that the risk of leak after LSG was not increased after conversion failed LAGB into LSG when performed as a 2-step procedure.


title: Single-port laparoscopic nissen fundoplication: a new method for retraction of the left lobe of the liver.

text: Retraction of the left lobe of the liver without inserting an additional trocar poses a major problem in single-incision laparoscopic Nissen fundoplication. The adequate visibility of the crural area can be achieved by liberalizing the fibrous appendix. The main principle of this new technique is to make the crural window visible by folding the left lobe of the liver upon itself. Single-incision Nissen fundoplication may be easily performed with this new liver retraction technique.


title: Dependence liability of lormetazepam: are all benzodiazepines equal? The case of the new i.v. lormetazepam for anesthetic procedures.

text: There are contradictory publications and reports regarding the dependence liability of the 3-hydroxy-benzo-1,4-diazepine derivative lormetazepam, one of the most often prescribed hypnotic benzodiazepines which is now also available as an intravenous (i.v.) product for anesthetists. The author was involved in the preclinical and subsequently in the clinical development and post-marketing surveillance of lormetazepam. Here, he reviews the published and unpublished data about lormetazepam dependence and proposes explanations for contradictory views from other authors. On this basis and in contrast to class labeling from regulatory bodies and WHO, the author comes to the conclusion that use of lormetazepam definitely carries a lower risk of inducing dependence and causing abuse than most other benzodiazepines. This applies as well to Sedalam®, the new i.v. application form of lormetazepam, which is much better tolerated than propofol. Because of its pharmacokinetic properties and because all its effects can be fully antagonized with the benzodiazepine antagonist flumazenil, this innovative intravenous application form of lormetazepam provides an excellent method for premedication, symptomatic treatment of excitation and anxiety in the context of surgical or diagnostic procedures including outpatient interventions and for basic sedation during anesthesia.


title: [Screening and management of asymptomatic infection of 2019-novel coronavirus].

text: At present, the prevention and control of COVID-19 in China has entered a critical period. Recently, various areas outside Hubei Province have gradually begun to resume work and production, but the development of the epidemic situation is still uncertain and complex. A few days ago, researchers gradually began to pay attention to asymptomatic infection of 2019-novel coronavirus and described the disease process of asymptomatic infection and the possibility of being a source of infection. This provided a scientific basis for further optimizing and improving epidemic prevention and control measures. Paying attention to the screening and self-protection of high-risk groups and strengthening the level of detection should be helpful to the detection and management of asymptomatic infection.


title: Middle East respiratory syndrome coronavirus infection mediated by the transmembrane serine protease TMPRSS2.

text: The Middle East respiratory syndrome coronavirus (MERS-CoV) utilizes host proteases for virus entry into lung cells. In the current study, Vero cells constitutively expressing type II transmembrane serine protease (Vero-TMPRSS2 cells) showed larger syncytia at 18 h after infection with MERS-CoV than after infection with other coronaviruses. Furthermore, the susceptibility of Vero-TMPRSS2 cells to MERS-CoV was 100-fold higher than that of non-TMPRSS2-expressing parental Vero cells. The serine protease inhibitor camostat, which inhibits TMPRSS2 activity, completely blocked syncytium formation but only partially blocked virus entry into Vero-TMPRSS2 cells. Importantly, the coronavirus is thought to enter cells via two distinct pathways, one mediated by TMPRSS2 at the cell surface and the other mediated by cathepsin L in the endosome. Simultaneous treatment with inhibitors of cathepsin L and TMPRSS2 completely blocked virus entry into Vero-TMPRSS2 cells, indicating that MERS-CoV employs both the cell surface and the endosomal pathway to infect Vero-TMPRSS2 cells. In contrast, a single camostat treatment suppressed MERS-CoV entry into human bronchial submucosal gland-derived Calu-3 cells by 10-fold and virus growth by 270-fold, although treatment with both camostat and (23,25)-trans-epoxysuccinyl-L-leucylamindo-3-methylbutane ethyl ester, a cathepsin inhibitor, or treatment with leupeptin, an inhibitor of cysteine, serine, and threonine peptidases, was no more efficacious than treatment with camostat alone. Further, these inhibitors were not efficacious against MERS-CoV infection of MRC-5 and WI-38 cells, which were derived from lung, but these characters differed from those of mature pneumocytes. These results suggest that a single treatment with camostat is sufficient to block MERS-CoV entry into a well-differentiated lung-derived cell line.


Is the COVID-19 lockdown nudging people to be more active: a big data analysis.


The Perioperative Services Response at a Major Children's Hospital During the Peak of the COVID-19 Pandemic in New York City.


RE: RE: COVID-19 Coagulopathy: Considerations for Urologists.


Involving patients in research during a pandemic.


title: Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis.

text: OBJECTIVE We compared long-term follow-up from surgical versus non-surgical treatment of ACL rupture regarding radiographic knee osteoarthritis (OA), secondary surgery, laxity and patient-reported outcome measures (PROMs). DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE, CINAHL and the Cochrane Library databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies directly comparing the minimally invasive surgical (arthroscopy or miniarthrotomy) and non-surgical treatment of ACL rupture with at least 10 years of follow-up in adult patients were included. RESULTS Five studies met the eligibility criteria. A meta-analysis revealed a higher risk of radiographic knee OA and a lower risk of secondary meniscal surgery for patients in the surgical group. The risk of graft rupture/secondary ACL revision and secondary ACL reconstruction was equal in the surgical and non-surgical groups. Knee laxity was lower among patients in the surgical group in four studies. No difference was found in the PROMs (ie, International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores). CONCLUSION The risk of radiographic knee OA was higher, but the risk of secondary meniscal injury was lower 10 years after surgical treatment of ACL rupture. The risk of graft rupture/secondary ACL revision or secondary reconstruction was unrelated to treatment type. The degree of knee laxity was reduced after surgical treatment in comparison with non-surgical treatment, while PROMs were similar. However, due to the methodological challenges highlighted in this systematic review, these findings must be interpreted with caution. PROSPERO REGISTRATION NUMBER CRD42019119468.


title: Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures.

text: Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan-coated Vicryl Plus. In our study, sutures were cultivated on color-change agar with Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Escherichia coli, and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p < 0.001), but 1.4 times larger than on Ethilon II (p < 0.001) regarding S. aureus. Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925-933, 2017.


title: Initial application of reduced port surgery using the single port access technique for laparoscopic canine ovariectomy.

text: OBJECTIVE To describe the Single port access (SPA) laparoscopic entry technique for canine ovariectomy (OVE), report complications, and outcomes. STUDY DESIGN Pilot study. ANIMALS Intact female dogs (n = 6). METHODS With owner consent, 6 intact female dogs had SPA laparoscopic OVE. Data, including signalment, surgical time (from incision to completion of closure), size and location of port placement, need for conversion (both to standard multiport laparoscopy and laparotomy), as well as any intraoperative complications including blood loss or tissue injury were recorded. RESULTS Mean surgical time was 52.5 minutes (range, 45-60 minutes) and mean incision length, 1.8 cm (range, 1.5-2.0 cm). In an 18-kg mix breed dog (dog 3), a "single port rescue" was required and located on midline 2-cm caudal to the umbilicus. Close positioning of the trocars caused instrument interference, limited viewing, and prevented safe ligation of the ovarian vessels vein with a vessel-sealing device. OVE was successfully completed laparoscopically in all dogs. CONCLUSION The SPA laparoscopic entry technique can be used in dogs, although instrument and camera interference can occur if trocar placement is too consolidated within the initial skin incision.


title: [Cerebral venous thrombosis and SARS-CoV-2 infection].

text: Trombosis venosa cerebral e infección por SARS-CoV-2.


title: Electrically and Ultrasonically Enhanced Transdermal Delivery of Methotrexate.

text: In this study, we used sonophoresis and iontophoresis to enhance the in vitro delivery of methotrexate through human cadaver skin. Iontophoresis was applied for 60 min at a 0.4 mA/sq·cm current density, while low-frequency sonophoresis was applied at a 20 kHz frequency (2 min application, and 6.9 W/sq·cm intensity). The treated skin was characterized by dye binding, transepidermal water loss, skin electrical resistance, and skin temperature measurement. Both sonophoresis and iontophoresis resulted in a significant reduction in skin electrical resistance as well as a marked increase in transepidermal water loss value (p < 0.05). Furthermore, the ultrasonic waves resulted in a significant increase in skin temperature (p < 0.05). In permeation studies, the use of iontophoresis led to a significantly higher drug permeability than the untreated group (n = 4, p < 0.05). The skin became markedly more permeable to methotrexate after the treatment by sonophoresis than by iontophoresis (p < 0.01). A synergistic effect for the combined application of sonophoresis and iontophoresis was also observed. Drug distribution in the skin layers revealed a significantly higher level of methotrexate in the sonicated skin than that in iontophoresis and untreated groups. Iontophoresis and low-frequency sonophoresis were found to enhance the transdermal and intradermal delivery of methotrexate in vitro.


Appraisal of the endotracheal tube as an alternative to the intercostal catheter.