title: Involvement of the open-source community in combating the worldwide COVID-19 pandemic: a review.

text: The ongoing COVID-19 pandemic is unprecedented in the modern age both due to its scale and its disruption to daily life throughout the world. Widespread social isolation and restrictions in the age of modern communicative technology, coupled with some early successes for makers, have united the open-source community towards a common goal in a way not previously seen. Local hospitals and care facilities are turning to makers to print essential consumable parts, such as simple visors, while in the hardest hit areas, critical pieces of medical technology are being fabricated. While important and effective innovations are appearing almost daily, there are also some worrying trends towards hobbyists attempting manufacture of complex medical devices with little understanding of the clinical or scientific rationale behind their design. The nature of the open-source community, an area of intensive innovation, fluidity, and experimentation, jars with the exacting standards of medical device regulation. Here, we review the involvement of rapid prototyping and the open-source community in the key areas of personal protective equipment (PPE), diagnostics, critical care technology, and information acquisition and sharing, highlighting where makers and hackers have clashed with medical device regulations, and areas where the system has worked well to facilitate change.


title: [Medical management and prevention instruction of chronic obstructive pulmonary disease during the coronavirus disease 2019 epidemic].

text: Currently, coronavirus disease 2019 (COVID-19) was of clustering onset in China and challenging to the Chinese healthcare system. Epidemiological data showed that the older patients with chronic commodities were at high risk of the involvement of the severe and critical type of COVID-19, especially patients with chronic obstructive pulmonary disease (COPD) resulting in high mortalities. There were nearly 100 million COPD patients in China, and most of them were the elderly. Once infected with COVID-19, it would be life-threatening for the COPD patients. Therefore, during the epidemic, it was of vital significance for us to attach great importance to optimize the management of COPD patients. Based on these considerations, the COPD Group of the Chinese Thoracic Society (CTS) and the COPD working Committee of the Chinese Association of Chest Physicians (CACP) altogether drafted the instruction for medical management and prevention of COPD during the COVID-19 epidemic period for the healthcare practitioner and patients.


title: Internal plug mesh without fixation in laparoscopic total extraperitoneal (TEP) repair of inguinal hernias: a pilot study.

text: PURPOSE Mesh fixation is essential in laparoscopic total extraperitoneal (TEP) repair of inguinal hernia; however, fixation sometimes causes post-operative pain. This study investigated a novel method of laparoscopic TEP repair without mesh fixation. METHODS This study reviewed data from about two-hundred and forty-one laparoscopic TEP repairs on 219 patients, which were performed between December 2004 and October 2005. RESULTS There were no statistically significant differences in the recurrence rate, seroma formation, and hospital stay. However, the mean operation time was shorter in the internal plug mesh group than the fixation group (p = 0.009), and post-operative pain only occurred in 4 cases in the internal plug mesh group in comparison to 29 cases in the mesh fixation group (p = 0.014). CONCLUSIONS An internal plug mesh without fixation might reduce post-operative pain after laparoscopic TEP repair of an inguinal hernia. Internal plug mesh without fixation may be an alternative method in laparoscopic TEP repair, especially for those involving indirect hernias.


title: Standardized DMEK Technique: Reducing Complications Using Prestripped Tissue, Novel Glass Injector, and Sulfur Hexafluoride (SF6) Gas.

text: PURPOSE To report low complication rates in Descemet membrane endothelial keratoplasty (DMEK) using sulfur hexafluoride (SF6) gas, a novel glass injector, and donor tissue prestripped by an eye bank technician. METHODS A standardized technique of DMEK was performed in 80 consecutive Fuchs corneal dystrophy cases using technician-prestripped tissue, a novel glass injector, a modified Yoeruek tap technique, and an SF6 gas (20% concentration) bubble for prolonged tissue support. Twenty-five donors were premarked with an "S" stamp for intraoperative orientation. Surgery was performed by 2 experienced DMEK surgeons and 2 inexperienced cornea fellows. Complications were recorded, and the percent endothelial cell loss was calculated at 6 months postoperatively. RESULTS There were 5 cases that received an air bubble injection postoperatively (6% rebubble rate). There were 6 grafts that immediately failed, 2 because of excessive surgical trauma, and 4 because of upside-down graft placement documented by optical coherence tomography. None of the 25 cases with an S stamp failed. Recipient corneas cleared quickly with no clinical evidence of toxicity from the SF6 gas bubble, and the grafts experienced a mean endothelial cell loss of 27% at 6 months. CONCLUSIONS Tissue prestripped by an eye bank technician can be safely used for DMEK surgery. SF6 gas for prolonged tissue support may reduce the rebubble rate in DMEK, with no apparent acute toxic effect. An unrecognized upside-down graft was the primary cause of graft failure in this series. Upside-down grafts may be eliminated by the use of donor tissue premarked by the eye bank with an S orientation stamp.


title: Could attitudes toward COVID-19 in Spain render men more vulnerable than women?

text: The COVID-19 pandemic affects the whole world. Spain is 5th in the world and 3rd in Europe with the largest number of diagnosed cases. Spanish citizens' attitudes are important in controlling the pandemic. This research assessed attitudes of Spaniards toward COVID-19 in two studies. One (n = 64) was conducted in a shopping centre in Madrid and another (n = 640) online. The results of both studies suggest that women in Spain have a 'more responsible' attitude toward the COVID-19 than men. Young adults (18-25 years) scored lower on compliance with safety measures and perceived need to stay home than older adults. In Study 1, level of compliance, knowing someone at risk, and knowing someone infected predicted 31.2% of the variance in the perceived need to stay home. In Study 2, personal concern, level of compliance, keeping distance from others, and perceived social alarm predicted 28.5% of the variance in perceived need to stay home. Regardless of age and/or gender, Spanish people's personal concern about COVID-19 was less than their perceived social alarm about it. These results might help policy makers in considering public attitudes which could play an important role in controlling the current, and possibly a second, wave of COVID-19.


title: Physiological comparison of breathing patterns with neurally adjusted ventilatory assist (NAVA) and pressure-support ventilation to improve NAVA settings.

text: Neurally adjusted ventilator assist (NAVA) assists spontaneous breathing in proportion to diaphragmatic electrical activity (EAdi). Here, we evaluate the effects of various levels of NAVA and PSV on the breathing pattern and, thereby, on [Formula: see text] homeostasis in 10 healthy volunteers. For each ventilation mode, four levels of support (delivered pressure 0 i.e. baseline, 5, 8, and 10cmH2O) were tested in random order. EAdi, flow, and airway pressure were recorded. Optoelectronic plethysmography was used to study lung volume distribution. During both PSV and NAVA, EAdi decreased with the level of assistance (P<0.01). Tidal volume (VT) increased and [Formula: see text] decreased with increased levels of PSV (P=0.044 and P=0.0004; respectively) while no change was observed with NAVA. Subject-ventilator synchronization was better with NAVA than with PSV. NAVA and PSV similarly decreased the abdominal contribution to VT. No airflow profile similarities were observed between baseline and mechanical ventilation. Diaphragmatic activity can decrease during NAVA without any change in VT and [Formula: see text] . This suggests that NAVA adjustment cannot be based solely on VT and [Formula: see text] criteria. Registered by Frédéric Lofaso and Nicolas Terzi on ClinicalTrials.gov, #NCT01614873.


title: Hybrid single-port cholecystectomy in children.

text: BACKGROUND AND OBJECTIVES Multiple single-port or single-incision techniques have been successfully implemented for laparoscopic cholecystectomy in adults and children. These techniques require either a large multichannel port or a larger skin incision to accommodate multiple ports or instruments. Inspired by a first generation single-port instrument, we developed a safe and effective technique for a single-port laparoscopic cholecystectomy with virtually scarless results. METHODS Over a 14-mo period, 20 patients (19 females, 1 male) underwent the hybrid single-port cholecystectomy. A straight 10-mm Storz telescope with inbuilt 6-mm working channel in combination with 2 portless 2.3-mm percutaneous graspers was used. The dissection is carried out with 43-cm bariatric length instruments. The cystic artery and duct are sealed with WECK Hem-o-lok clips or the Harmonic scalpel. RESULTS Range (mean) age: 7.7 y to 19.5 y (15.5), BMI: 11.6kg/m(2) to 42.3kg/m(2) (27), operative duration 48 min to 120 min (79), postoperative length of stay: 5 h to 78 h (24). DIAGNOSIS 13 patients cholecystolithiasis, 7 patients biliary dyskinesia. Conversion to conventional 4-port cholecystectomy was required in 2 patients. No intra- or postoperative complications occurred. CONCLUSION The hybrid single-port technique is easy to master. It provides traditional anatomical exposure and allows application of conventional laparoscopic principles.


title: Efficient and Tumor Targeted siRNA Delivery by Polyethylenimine-graft-polycaprolactone-block-poly(ethylene glycol)-folate (PEI-PCL-PEG-Fol).

text: Efficient delivery of functional nucleic acids into specific cells or tissues is still a challenge for gene therapy and largely depends on targeted delivery strategies. The folate receptor (FR) is known to be overexpressed extracellularly on a variety of human cancers and is therefore an outstanding gate for tumor-targeted Trojan horse-like delivery of therapeutics. In this study, an amphiphilic and biodegradable ternary copolymer conjugated with folate as ligand, polyethylenimine-graft-polycaprolactone-block-poly(ethylene glycol)-folate (PEI-PCL-PEG-Fol) was synthesized and evaluated for targeted siRNA delivery via folate-FR recognition. The amphiphilic character of similar polymers was shown previously to support endosomal release of endocytosed nanocarriers and to promote formation of long circulating micelles. The obtained PEI-PCL-PEG-Fol exhibited less cytotoxicity in comparison with the corresponding ternary copolymer without folate (PEI-PCL-PEG) and with unmodified PEI25kDa. Stable micelle-like polyplexes with hydrodynamic diameters about 100 nm were found to have a zeta potential of +8.6 mV, which was lower than that of micelleplexes without folate-conjugation (+13-16 mV). Nonetheless, increased cellular uptake and in vitro gene knockdown of PEI-PCL-PEG-Fol/siRNA micelleplexes were observed in SKOV-3 cells, an FR overexpressing cell line, in comparison with the nonfolate-conjugated ones. Moreover, PEI-PCL-PEG-Fol/siRNA micelleplexes exhibited excellent stability in vivo during the analysis of 120 min and a longer circulation half life than hyPEI25kDa/siRNA polyplexes. Most interestingly, the targeted delivery system yielded 17% deposition of the i.v. injected siRNA per gram in the tumor after 24 h due to the effective folate targeting and the prolonged circulation.


title: Effects of the fusion design and immunization route on the immunogenicity of Ag85A-Mtb32 in adenoviral vectored tuberculosis vaccine.

text: Vaccines containing multiple antigens may induce broader immune responses and provide better protection against Mycobacterium tuberculosis (Mtb) infection as compared to a single antigen. However, strategies for incorporating multiple antigens into a single vector and the immunization routes may affect their immunogenicity. In this study, we utilized recombinant adenovirus type 5 (rAd5) as a model vaccine vector, and Ag85A (Rv3804c) and Mtb32 (Rv0125) as model antigens, to comparatively evaluate the influence of codon usage optimization, signal sequence, fusion linkers, and immunization routes on the immunogenicity of tuberculosis (TB) vaccine containing multiple antigens in C57BL/6 mice. We showed that codon-optimized Ag85A and Mtb32 fused with a GSG linker induced the strongest systemic and pulmonary cell-mediated immune (CMI) responses. Strong CMI responses were characterized by the generation of a robust IFN-γ ELISPOT response as well as antigen-specific CD4(+) T and CD8(+) T cells, which secreted mono-, dual-, or multiple cytokines. We also found that subcutaneous (SC) and intranasal (IN)/oral immunization with this candidate vaccine exhibited the strongest boosting effects for Mycobacterium bovis bacille Calmette-Guérin (BCG)-primed systemic and pulmonary CMI responses, respectively. Our results supported that codon optimized Ag85A and Mtb32 fused with a proper linker and immunized through SC and IN/oral routes can generate the strongest systemic and pulmonary CMI responses in BCG-primed mice, which may be particularly important for the design of TB vaccines containing multiple antigens.


title: How to reduce the impact of "low-risk patients" following a bioterrorist incident: lessons from SARS, anthrax, and pneumonic plague.

text: A bioterrorist attack may result in a large number of people who have not been exposed coming to medical facilities in search of treatment or reassurance. In this article, we review evidence from 3 previous biological incidents that are analogous to a bioterrorist attack in order to gauge the likely incidence of such "low-risk patients" and to identify possible strategies for coping with this phenomenon. Evidence from the anthrax attacks in the United States suggested that a surge of low-risk patients is by no means inevitable. Data from the SARS outbreak illustrated that if hospitals are seen as sources of contagion, many patients with non-bioterrorism-related healthcare needs may delay seeking help. Finally, the events surrounding the pneumonic plague outbreak of 1994 in Surat, India, highlighted the need for the public to be kept adequately informed about an incident. Although it is impossible to say what the likely incidence of low-risk patients will be during a future bioterrorist incident, several strategies may help to reduce it and to safeguard the well-being of the low-risk patients themselves. These strategies include providing clear information about who should and should not attend hospital; using telephone services to provide more detailed information and initial screening; employing rapid triage at hospital entrances, based, where possible, on exposure history and objective signs of illness; and following up by telephone those judged to be at low risk.


title: Overcoming the learning curve of single-port total laparoscopic hysterectomy with barbed suture: a single surgeon's initial experience.

text: INTRODUCTION Single-port total laparoscopic hysterectomy (TLH) has not been widely used because of its technical difficulty and steep learning curve, especially the laparoscopic suturing of the vaginal stump. Barbed suturing is a new technology that has the potential to greatly facilitate laparoscopic suturing. AIM To compare surgical outcomes and vaginal vault healing between barbed sutures and traditional sutures in the repair of the vaginal vault during single-port TLH. MATERIAL AND METHODS Between August 2013 and June 2015, we performed single-port TLH in 85 consecutive patients for benign or premalignant gynecological conditions. The first 48 patients underwent single-port TLH with traditional interrupted sutures, and the next 37 patients underwent single-port TLH with absorbable unidirectional knotless barbed sutures for repair of the vaginal vault. RESULTS The patient characteristics (age, body mass index), procedures performed, uterine weight, and uterine disease were similar between the groups. There were no differences in blood loss, hemoglobin change, length of hospital stay, or perioperative complications. Operative time and the time required for vaginal cuff suturing were significantly shorter in the barbed suture group than in the traditional suture group (57.8 ±13.5 vs. 80.1 ±18.7 min, p < 0.001; 5.5 ±1.7 vs. 12.9 ±3.5 min, p < 0.001). Moreover, the use of barbed sutures significantly reduced the incidence of vaginal granulation tissue formation (2.7% vs. 35.4%, p < 0.001). CONCLUSIONS Use of barbed sutures in single-port TLH reduced the operative time, suturing time of the vaginal vault, and formation of vaginal granulation tissue. Barbed suturing may help overcome surgical difficulties and vaginal cuff complications.


United we stand, divided we fall.


title: PHARMACOKINETICS OF MELOXICAM FOLLOWING A SINGLE ORAL DOSE IN MALAYAN FLYING FOXES ( PTEROPUS VAMPYRUS).

text: Meloxicam, a COX-2 selective nonsteroidal anti-inflammatory medication, has been used in many exotic animals at doses extrapolated from domestic animal pharmacokinetic and pharmacodynamic studies. Increasing evidence suggests that significant species differences exist in meloxicam metabolism. Because of this, dose extrapolation from domestic animals may not be appropriate for exotic species. The objective of this study was to investigate the pharmacokinetics of meloxicam in a population of male Malayan flying foxes, Pteropus vampyrus, following a single oral dose of 0.2 mg/kg. Using a sparse sampling method based on a pilot study, two blood samples from each of 10 bats were collected over an 8-hr time period. Analysis of meloxicam in plasma samples was conducted using reversed-phase high-performance liquid chromatography. The peak plasma concentration of 598 ± 157.5 ng/ml occurred at 1.0 hr post dosing. The terminal half-life was 1.1 ± 0.1 hr, which indicates that meloxicam is rapidly metabolized in this species. No adverse clinical effects were noted during the study period. A single oral dose of 0.2 mg/kg appears safe for use in male Malayan flying foxes, but due to rapid elimination, frequent dosing may be required to maintain plasma concentrations within a therapeutic range. Multidose studies are needed to determine if plasma accumulation of meloxicam occurs.


title: Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03.

text: BACKGROUND Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). METHODS The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. RESULTS There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). CONCLUSIONS The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.


title: [Prospective randomized trial of long-term results of inguinal hernia repair using autoadhesive mesh compared to classic Lichtenstein technique with sutures and polypropylene mesh].

text: INTRODUCTION The use of autoadhesive meshes with hooks that allow fixation without sutures is a therapeutic alternative to decrease recurrence and chronic pain after inguinal hernia repair. The aim of this study was to evaluate if this kind of mesh has any advantage in long term results in comparison with the classic Lichtenstein technique with sutures and polypropylene mesh. MATERIAL AND METHODS We report a prospective and randomized study of patients who have been operated on for inguinal hernia between march of 2009 to march 2010, divided into 2 groups of 45 patients. In AutoAdhesive (AA) group, we included patients operated on with an autoadhesive mesh and in Classic Lichtenstein (CL) group we included cases with an inguinal hernioplasty with sutured polypropylene mesh. We evaluated time of inactivity, complications, recurrences and grade of pain after one year. RESULTS The mean age was 60 years in AA group and 49 in LC group. There were more men than women and there were no differences in co-morbilities between groups. The mean size of hernia orifice was 3cm in both groups and 60% of the hernias were indirect. After one year, 77 patients were evaluated; 39 in LC group and 38 in AA group. 86,8% and 87,2% of them were asymptomatic. The mean time of recovery of daily activities was 15 days in both groups. There were neither recurrences nor severe chronic pain in the AA group. The mean of grade of pain was 0 (range:0-4) in AA group and 0 (range: 0-5) in LC group. In this group, there was one recurrence and one patient was taking analgesics for intense pain. No mortality nor other long term complications were found. CONCLUSION The use of autoadhesive and parcial reabsorbible meshes in inguinal hernia repair has no effect on recovery of daily activities, postoperative pain and long term complications compared with hernioplasty with polypropylene mesh fixed with monofilament suture.


title: Management of community-acquired pneumonia: a review and update.

text: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, affecting approximately 5.6 million patients annually in the USA, where the annual cost exceeds US$12 billion. Optimal management should be based on knowledge of the most likely etiologic pathogens for each patient, based on an assessment of specific risk factors. It is also essential to assess severity of illness, to determine the appropriate site of care, and to order appropriate diagnostic testing. New developments in CAP management have focused on recognizing newly identified pathogens, such as methicillin-resistant Staphylococcus aureus and novel H1N1 influenza, understanding when to utilize new microbiological diagnostic techniques, and how to use biomarkers to direct the appropriate utilization of antibiotics and to define the duration of therapy. This paper reviews recent advances in our knowledge about the diagnosis and optimal management of CAP.


title: Characteristics, comorbidities, 30-day outcome and in-hospital mortality of patients hospitalised with COVID-19 in a Swiss area - a retrospective cohort study.

text: BACKGROUND Since its first description in December 2019, coronavirus disease 19 (COVID-19) has spread worldwide. There is limited information about presenting characteristics and outcomes of Swiss patients requiring hospitalisation. Furthermore, outcomes 30 days after onset of symptoms and after hospital discharge have not been described. AIMS To describe the clinical characteristics, outcomes 30 days after onset of symptoms and in-hospital mortality of a cohort of patients hospitalised for COVID-19 in a Swiss area. METHODS In this retrospective cohort study, we included all inpatients hospitalised with microbiologically confirmed COVID-19 between 1 March and 12 April 2020 in the public hospital network of a Swiss area (Fribourg). Demographic data, comorbidities and outcomes were recorded. Rate of potential hospital-acquired infection, outcomes 30 days after onset of symptoms and in-hospital mortality are reported. RESULTS One hundred ninety-six patients were included in the study. In our population, 119 (61%) were male and the median age was 70 years. Forty-nine patients (25%) were admitted to the intensive care unit (ICU). The rate of potential hospital-acquired infection was 7%. Overall, 30 days after onset of symptoms 117 patients (60%) had returned home, 23 patients (12%) were in a rehabilitation facility, 18 patients (9%) in a medical ward, 6 patients (3%) in ICU and 32 (16%) patients had died. Among patients who returned home within 30 days, 73 patients (63%) reported persistent symptoms. The overall in-hospital mortality was 17%. CONCLUSION We report the first cohort of Swiss patients hospitalised with COVID-19. Thirty days after onset of the symptoms, 60% had returned home. Among them, 63% still presented symptoms. Studies with longer follow-up are needed to document long-term outcomes in patients hospitalised with COVID-19.


Telemedicine for Diabetes After the COVID-19 Pandemic: We Can't Put the Toothpaste Back in the Tube or Turn Back the Clock.


Update in mechanical ventilation 2010.


title: Risk factors and effect of selective removal on retroviral infections prevalence in Belgian stray cats.

text: The aim of this study was to evaluate the effect of several risk/protective factors and predictors on the prevalence of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) infections in 302 stray cats captured during a trap-neuter-release programme in a mixed urban-rural area from Belgium, from 2010 to 2012. The impact of selective removal of FIV-positive cats on the apparent prevalence in the remaining population over this three-year period was also assessed. The seroprevalences over three years were 18.8 per cent for FIV and 0.7 per cent for FeLV. For FIV, the seroprevalence decreased significantly from the first year of the programme (2010; 30.5 per cent) to the last (2012; 13.1 per cent). Sex (male) and age (adult and old cats) were risk factors, while the year of sampling (years 2011 and 2012) was a protective factor. Age, sex and location were the most relevant predictors of FIV status. The data presented in this study revealed a very high FIV seroprevalence in Belgian stray cats, while FeLV was almost absent. The selective removal of positive cats had a drastic effect on the FIV seroprevalence in the remaining cat population.


title: Prevalence and evaluation strategies for viral contamination in food products: Risk to human health-a review.

text: Nowadays, viruses of foodborne origin such as norovirus and hepatitis A are considered major causes of foodborne gastrointestinal illness with widespread distribution worldwide. A number of foodborne outbreaks associated with food products of animal and non-animal origins, which often involve multiple cases of variety of food streams, have been reported. Although several viruses, including rotavirus, adenovirus, astrovirus, parvovirus, and other enteroviruses, significantly contribute to incidence of gastrointestinal diseases, systematic information on the role of food in transmitting such viruses is limited. Most of the outbreak cases caused by infected food handlers were the source of 53% of total outbreaks. Therefore, prevention and hygiene measures to reduce the frequency of foodborne virus outbreaks should focus on food workers and production site of food products. Pivotal strategies, such as proper investigation, surveillance, and reports on foodborne viral illnesses, are needed in order to develop more accurate measures to detect the presence and pathogenesis of viral infection with detailed descriptions. Moreover, molecular epidemiology and surveillance of food samples may help analysis of public health hazards associated with exposure to foodborne viruses. In this present review, we discuss different aspects of foodborne viral contamination and its impact on human health. This review also aims to improve understanding of foodborne viral infections as major causes of human illness as well as provide descriptions of their control and prevention strategies and rapid detection by advanced molecular techniques. Further, a brief description of methods available for the detection of viruses in food and related matrices is provided.


title: Early chest tube removal after surgery for primary spontaneous pneumothorax.

text: OBJECTIVE The purpose of this study was to analyze the safety and validity of early chest tube removal after bullectomy for primary spontaneous pneumothorax (PSP). METHODS Between January 2005 and July 2018, 123 cases of thoracoscopic surgery for PSP were reviewed. The principle procedure was bullectomy accompanied by mechanical and chemical pleurodesis. Approximately 4 h after surgery, we confirmed patients' sufficient recovery from anesthesia and investigated the presence of air leak in a sitting position. Chest tubes were removed on the same day as the surgery if there was no air leak or bloody drainage observed. Postoperative complications and factors that prevented early chest tube removal were analyzed by comparing the early removal group and the remaining tube group. RESULTS Chest tubes could be removed on the day of the surgery in 105 cases (85.4%). There were 7 cases (5.7%) in which chest tubes could be removed because air leak was not detected after patients' recovery despite intraoperative detection of minor air leak from the resection stump. No patients required chest tube reinsertion during their hospital stay. The mean length of postoperative hospital stay was 1.1 ± 0.5 days. In a logistic regression analysis, surgical history of ipsilateral PSP was independently and significantly associated with the prevention of early chest tube removal. CONCLUSIONS Chest tube removal on the day of surgery for PSP appears to be safe when air leak examination can be performed after sufficient recovery from anesthesia.


title: DISSEMINATED PROTOTHECOSIS IN A RUWENZORI LONG-HAIRED FRUIT BAT ( ROUSETTUS LANOSUS).

text: An adult male Ruwenzori long-haired fruit bat ( Rousettus lanosus) presented for lethargy and unthriftiness. Physical examination revealed cranial alopecia, mandibular ulceration, and dehydration. Supportive care and antibiotic therapy were initiated. The bat was found dead 3 days after presentation. Necropsy revealed alopecia on the head and body, exposed dried bone on the rostral tip of the mandible, and excessive clear pleural fluid. Lungs were congested and contained miliary white foci disseminated randomly throughout the parenchyma. Subcutaneous, intra-thoracic, and intra-abdominal adipose depots were minimal. Histologic examination of skin and lung revealed the presence of algal-like organisms morphologically consistent with Prototheca spp. Polymerase chain reaction amplification revealed >99% sequence identity match with Prototheca zopfii. Protothecosis has been previously reported in a single bat, Lyle's flying fox ( Pteropus lylei), in Switzerland, but definitive protothecal speciation was not possible.


title: Isolation of a novel adenovirus from Rousettus leschenaultii bats from India.

text: Surveillance work was initiated to study the presence of highly infectious diseases like Ebola-Reston, Marburg, Nipah and other possible viruses that are known to be found in the bat species and responsible for causing diseases in humans. A novel adenovirus was isolated from a common species of fruit bat (Rousettus leschenaultii) captured in Maharashtra State, India. Partial sequence analysis of the DNA polymerase gene shows this isolate to be a newly recognized member of the genus Mastadenovirus (family Adenoviridae), approximately 20% divergent at the nucleotide level from Japanese BatAdV, its closest known relative.


Covid-19: UK holds off closing schools and restricts testing to people in hospital.


title: Introducing the New 3.5/28 Microstent Retriever for Recanalization of Distal Cerebral Arteries in Acute Stroke: Preliminary Results.

text: BACKGROUND AND PURPOSE To describe our first experience using a small stent retriever specifically designed for thrombectomy in cerebral arteries with a small caliber (Acandis APERIO® 3.5/28) in patients with acute ischemic stroke. MATERIALS AND METHODS All patients with an acute ischemic stroke, who underwent endovascular recanalization using the APERIO® thrombectomy device with a diameter of 3.5 mm, were identified in retrospect and included in the present analysis. Demographic and clinical data as well as data on the procedures performed were collected (patient sex, mean age, NIHSS, mRS, TICI score, and complications). RESULTS Stent retriever-based thrombectomy with the Aperio® 3.5/28 alone (n = 10 vessels) or in combination with other devices (n = 13 vessels) was performed in 22 acute stroke patients with embolic occlusions of distal branches of the anterior and posterior circulations (median NIHSS = 8.5). For vessels treated with the Aperio® 3.5/28, we achieved a TICI 2b/3 reperfusion rate of 73.9%. One patient suffered a symptomatic intracerebral hemorrhage after thrombectomy; otherwise, no procedure-related complications were seen. CONCLUSION Our data suggest that mechanical thrombectomy of distal cerebral artery occlusions with the Aperio® 3.5/28 is feasible and in general safe, thus offering a promising option for endovascular stroke therapy. However, multicentric studies with larger patient cohorts are necessary to evaluate the clinical benefit.


title: Initial experience of coiling cerebral aneurysms using the new Comaneci device.

text: We present our initial patient experience with an innovative temporary bridging device, the Comaneci (Rapid Medical, Israel), to assist in the coiling of cerebral aneurysms. The Comaneci device confers the same benefits as balloon remodeling but without the risks of parent artery occlusion. This alleviates time pressure on the clinician, and could reduce the risk of parent artery thrombosis. Three patients were treated with the Comaneci device. Two patients had acute ruptured posterior communicating aneurysms and one patient was treated electively for a carotico-ophthalmic aneurysm. Excellent occlusion of all three aneurysms was obtained. One patient developed a distal middle cerebral artery clot, that was treated with intravenous aspirin, with minor neurological consequences. These early results show that the Comaneci device can be used to achieve good cerebral aneurysm occlusion. Vessel patency is maintained throughout the procedure with potential advantages over conventional balloon assisted coiling.


title: Current status of robot-assisted laparoscopic partial nephrectomy.

text: With increased incidence of diagnosis of small renal masses, partial nephrectomy has been preferred over radical nephrectomy as the surgical treatment of choice. The transition from open to laparoscopic partial nephrectomy had been challenging for many urologists. Robotic-assisted laparoscopic partial nephrectomy(RLPN) is increasingly used to facilitate this transition . In this review, we examine the recent technical advances and clinical outcomes in RLPN. Many series had successfully reported the feasibility of using the da Vinci Surgical (Intuitive Surgical Inc, Sunnyvale, CA) System in laparoscopic partial nephrectomy. Recent advances had focused on reducing risk of renal damage by shortening the warm ischaemia time. These techniques included unclamped excision, selective arterial clamping and improved renorrhaphy methods. Operative times and warm ischaemia times have also improved once the learning curve are overcome, which is less steep than conventional laparoscopy. With longer follow-up and more widespread experience, the outcome of RLPN could be favourable compared to conventional laparoscopy. Improving techniques had made this surgery a safe and efficacious treatment option for small renal masses.


title: Treatment of Cerebral Vasospasm in an Infant Using a Modified Dotter Technique.

text: An 8-month old female presented with spontaneous subarachnoid hemorrhage and was treated successfully with endovascular coil embolization of the ruptured aneurysm. Transcranial Doppler ultrasound performed four days later demonstrated middle cerebral artery (MCA) velocities greater than 350 cm/sec on the right and greater than 200 cm/sec on the left, despite medical management. The patient demonstrated no focal neurological deficits, though examination was limited by our patient's sedation and intubation. Angiography revealed severe vasospasm of the supraclinoid internal carotid and MCA territories, bilaterally. The vasospasm was refractory to the administration of intra-arterial verapamil. Balloon angioplasty was attempted, but the device could not be advanced safely due to the small size of the patient's vessels and the stiffness of the device. A microcatheter (0.0165" diameter) was advanced over a J-shaped soft microwire (0.014" diameter) to perform mechanical angioplasty in the internal carotid artery and MCA vessels bilaterally. Dramatic improvement was seen angiographically and on transcranial Doppler, and no complications were seen.


title: Impact of area under the concentration-time curve to minimum inhibitory concentration ratio on vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus bacteraemia.

text: There have been few clinical studies on the association between the vancomycin 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio and vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections. To examine this association and to establish a suitable cut-off value for AUC24/MIC, a multicentre prospective observational study was conducted in patients with MRSA bacteraemia. Data were collected on all patients aged ≥18 years with MRSA bacteraemia treated with vancomycin for ≥72 h without dialysis. The MIC was determined by broth microdilution (BMD) and Etest. Treatment failure was defined as (i) 30-day mortality, (ii) persistent bacteraemia (≥7 days) and (iii) recurrence (≤30 days after completion of therapy). AUC24 was estimated by a Bayesian approach based on individual vancomycin concentrations. The AUC24/MIC cut-off value for differentiating treatment success and failure was calculated by Classification and Regression Tree (CART) analysis. In total, 117 patients were enrolled, among which vancomycin treatment failure occurred in 38 (32.5%). In univariate analysis, high vancomycin MIC and low trough levels were unrelated to treatment outcomes. In the CART analysis, low vancomycin AUC24/MIC [<392.7 (BMD) and <397.2 (Etest)] was associated with treatment failure. In multivariate analysis, low AUC24/MIC was a risk factor for treatment failure [adjusted odds ratio (aOR)=3.50, 95% confidence interval (CI) 1.39-8.82 by BMD; aOR=5.61, 95% CI 2.07-15.24 by Etest]. AUC24/MIC is associated with vancomycin treatment outcomes in MRSA bacteraemia, and seeking individualised AUC24/MIC ratios above target (>400) may improve treatment outcomes.


Coronavirus disease 2019 outbreak: liver disease a prognostic tool?


title: The evolution of One Health: a decade of progress and challenges for the future.

text: The One Health concept is gathering momentum and, over the next 12 months, Veterinary Record will be publishing a series of articles to help encourage that process. Written by specialists in a range of fields, the articles will consider the meaning of One Health, the interactions between animal and human health and how a collaborative and interdisciplinary approach could help to solve emerging global problems. To set the scene, Paul Gibbs outlines the recent history of One Health, discusses current challenges and muses on what the future might hold.


title: Results of radiofrequency kidney tumor ablation: renal function preservation and oncologic efficacy.

text: OBJECTIVES Radiofrequency ablation (RFA) is increasingly finding a place in the treatment of small renal masses (SRM). RFA may be able to provide better renal preservation, while achieving appropriate cancer control. This investigation takes a critical look at pertinent aspects of RFA principles and reviews oncological and renal function outcomes. METHODS A review of the most current English literature using a PubMed search was done. Oncological and renal function outcomes were reviewed from selected articles published between 2003 and 2009. Oncological outcome was determined by "single treatment" success rate at first follow-up and "After single treatment" success rate after first follow-up. Renal function outcome was determined by either change in creatinine, creatinine clearance, or GFR after RFA. RESULTS The mean tumor size was 2.5 cm for 16/17 studies. Average mean and median follow-up was 23.3 months in 13/17 studies and 19.8 months for 4/17 studies. "Single Treatment" success rates of 90-100% (average = 97.2%) were noted in 13 studies. Average increase in serum creatinine was +0.14 mg/dL in four studies. Serum creatinine and creatinine clearance change in one solitary kidney study was +11 mmol/L and -8 mL/min., respectively. CONCLUSIONS RFA is fast emerging as a safe and efficacious treatment for small renal masses. Compared to extirpative treatment options, RFA seems to provide the lowest rate of renal impairment, while providing acceptable rates of tumor ablation. As long-term results emerge, this may become one of the treatment modalities for renal tumors in patients with solitary kidneys and renal impairment.


title: Diaphragmatic Hernia After Totally Laparoscopic Total Gastrectomy for Gastric Cancer.

text: This study aimed to investigate the occurrence of diaphragmatic hernia (DH) after totally laparoscopic total gastrectomy (TLTG) for gastric cancer. We reviewed retrospectively collected data from 490 consecutive patients who underwent TLTG (functional method, 365; overlap method, 125) for upper body gastric cancer, between January 2011 and May 2017, performed by a single surgeon. The median follow-up period was 40.6 months. Of 490 patients, 8 (1.63%) developed DH at a mean interval after TLTG of 7.3 (range, 3.4 to 12.8) months. All 8 patients were from the functional group, and presented with abdominal pain or vomiting. They were managed with emergency surgery (5 laparoscopic hernia reduction, 3 open hernia reduction). The grade of complication according to Clavien-Dindo classification (CDC) was CDC-III in 7 cases and CDC-IV in 1 case. There was no death associated with DH complications. None of the patients in the overlap group developed DH. The incidence of DH after TLTG is negligible in the overlap method. Therefore, the overlap method may be a safe reconstruction technique that can reduce the occurrence of DC after TLTG for gastric cancer.


title: Not just little adults: preparing a children's emergency department for COVID-19.

text: COVID-19 presented unique challenges in preparing our stand-alone children's emergency department for the pandemic and has demonstrated well the paediatric adage, 'children aren't little adults'.


title: CD4 cell count criteria to determine when to initiate antiretroviral therapy in human immunodeficiency virus-infected children.

text: We evaluated the validity of CD4 count against CD4% criteria of 2008 World Health Organization guideline for initiating antiretroviral therapy using the data of 446 human immunodeficiency virus-infected Asian children aged 1 to 12 years who were screened to the Pediatric Randomized of Early versus Deferred Initiation in Cambodia and Thailand study. The overall sensitivity and specificity were 34% and 98%, respectively. Using the current CD4 count criteria would globally result in 66% missed opportunity to initiate treatment in a timely fashion. Raising CD4 count thresholds should be considered to increase its sensitivity and reduce missed opportunity.


title: Clinical and Anatomic Insights From a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute.

text: BACKGROUND Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. METHODS We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. RESULTS In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. CONCLUSIONS Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.


Alveolar Recruitment Strategies After Cardiac Surgery.


title: Revisional bariatric surgery for failed gastric banding in Asia: a review of choice of revisional procedure, surgical technique and postoperative complication rates.

text: INTRODUCTION In Asia, long-term weight loss results of gastric banding have been unsatisfactory. Bands are associated with higher complication rates, which result in a high reoperation rate. The aim of this paper is to discuss the choice of revisional procedure, operative technique and evaluate the postoperative complication rates. METHODS Between January 2007 and January 2010, we operated on 41 patients who were included retrospectively in this series. The most common reason for band removal was failure to lose adequate weight. Of those patients, 40 underwent band removal and conversion to a revisional bariatric surgery concomitantly; one patient's procedure was deferred to a later date. LSG was performed in 26 and LRYGB in 15. The highlights of the operative technique were meticulous dissection, complete removal of the pseudocapsule, choosing the right stapler cartridge, oversewing and inverting the entire staple line, and complete dissection of the left crus and pars flaccid. RESULT The median duration of surgery was 85 min (range, 55-180 min). There was no conversion to open surgery. The median stay in the hospital was 4 d (range, 2-7 d). There were no leaks or any other major complications in the postoperative period. CONCLUSION Concomitant revisional procedure after removal of gastric band is safe and feasible. The operative technique followed at our center has had an extremely low postoperative morbidity rate and a 0% leak rate.


title: Pseudogynecomastia after massive weight loss: detectability of technique, patient satisfaction, and classification.

text: BACKGROUND An increasing number of male patients are presenting for treatment of male chest deformity after massive weight loss. The authors prefer to preserve the nipple-areola complex on a dermoglandular pedicle. They sought to identify detectability of technique, assess patient satisfaction, and outline a treatment algorithm for this population. METHODS Ten male massive weight loss patients underwent chest-contouring procedures over a period of 6 years and were surveyed to identify satisfaction with reconstruction. Preoperative photographs were used to devise a classification system. Twenty-seven medical professionals evaluated and rated digital photographs of the patients. RESULTS Eight patients had pedicled reconstructions and two had free-nipple grafts. Mean age was 42.9 +/- 9.5 years, mean pre-weight loss body mass index was 54.1 +/- 10.6, post-weight loss body mass index was 29.4 +/- 4.5, and mean change in body mass index was 24.8 +/- 9.7. All patients would have surgery again, nine would recommend it to a friend, six would go shirtless in public, nine reported no loss of nipple sensation, and three reported dysesthesias of the nipple-areola complex. Medical professionals reproducibly associated poor wound healing with free-nipple grafting and rated poorly positioned nipple-areola complexes with low aesthetic scores. Medical professional scores for chest contour and nipple-areola complex aesthetics did not correlate with technique and were lower than scores provided by the patients. CONCLUSIONS Patient satisfaction for treatment of the male chest deformity after massive weight loss is high. In carefully selected patients, preservation of the nipple-areola complex on a dermoglandular pedicle can aid in achieving an optimal aesthetic result.


title: Single Anastomosis Gastric Bypass-Comparative Short-Term Outcome Study of Conversional and Primary Procedures.

text: BACKGROUND Single anastomosis gastric bypass (SAGB) has been established as a safe and effective bariatric procedure. SAGB has also been suggested as a conversion option from other procedures, but so far not extensively explored in that direction. METHODS The study retrospectively reviewed and analyzed 154 consecutive SAGB procedures, including 48 conversional SAGB (cSAGB) and 106 primary SAGB (pSAGB). Preoperative physical dimensions and perioperative complications were obtained. Patients were followed 1, 3, and 6 months postoperatively, with weight measurements compared between groups. RESULTS Operative times were longer in the cSAGB group but length of hospital stay was the same for both groups. Sixty-five percent of the cSAGB group had adjustable banding as a primary operation, and 94 % opted for conversion due to insufficient weight loss or regain thereof. Follow-up data availability was 98, 82, and 79 % for the three checkpoints. Three and 6 months postoperatively, cSAGB had inferior mean excess weight loss (EWL) compared to pSAGB, though both groups were successful after 6 months (mean EWL >50 %). Body mass index loss was significantly higher for pSAGB for the first postoperative 3 months. Low complication rates in both groups precluded statistical comparison in that respect. DISCUSSION Initial weight loss after conversional SAGB is inferior to primary SAGB after 6 months. The observed safety of cSAGB is comparable to previous evidence for this procedure in the conversional settings. CONCLUSION SAGB may be considered as a safe and effective conversional procedure, but not as effective as pSAGB for initial weight loss.


title: Author Correction: A novel quantitative PCR mediated by high-fidelity DNA polymerase.

text: A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.


title: Efficacy of antiviral chemotherapy for retrovirus-infected cats: What does the current literature tell us?

text: GLOBAL IMPORTANCE The two feline retroviruses, feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV), are global and widespread, but differ in their potential to cause disease. VIRAL INFECTION - FIV FIV, a lentivirus that shares many properties with human immunodeficiency virus (HIV), can cause an acquired immune deficiency syndrome, which predisposes cats to other infections, stomatitis, neurological disorders and tumours. Although secondary infections are common, specific opportunistic infections or acquired immunodeficiency virus-defining infections, such as those that occur with HIV, are not commonly reported in FIV-infected cats. In most naturally infected cats, FIV does not cause a severe clinical syndrome; with appropriate care, FIV-infected cats can live many years before succumbing to conditions unrelated to their FIV infection. Thus, overall survival time is not necessarily shorter than in uninfected cats, and quality of life is usually high over many years or lifelong. VIRAL INFECTION - FELV FeLV, an oncornavirus, is more pathogenic than FIV. Historically, it was considered to account for more disease-related deaths and clinical syndromes in cats than any other infectious agent. Recently, the prevalence and importance of FeLV have been decreasing, mainly because of testing and eradication programmes and the use of FeLV vaccines. Progressive FeLV infection can cause tumours, bone marrow suppression and immunosuppression, as well as neurological and other disorders, and leads to a decrease in life expectancy. However, with appropriate care, many FeLV-infected cats can also live several years with a good quality of life. PRACTICAL RELEVANCE A decision regarding treatment or euthanasia should never be based solely on the presence or absence of a retrovirus infection. Antiviral chemotherapy is of increasing interest in veterinary medicine, but is still not used commonly. EVIDENCE BASE This article reviews the current literature on antiviral chemotherapy in retrovirus-infected cats, focusing on drugs that are currently available on the market and, thus, could potentially be used in cats.


title: Risk Factors for Fatal Middle East Respiratory Syndrome Coronavirus Infections in Saudi Arabia: Analysis of the WHO Line List, 2013-2018.

text: Objectives. To explore complex associations among demographic factors, risk factors, health care, and fatality rates of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia. Methods. We based this study on analysis of a publicly accessible line listing of 1256 MERS-CoV cases (2013 to October 2018) available on the World Health Organization's Web site. For analyses of demographic factors (e.g., age, gender), access to health care, promptness of laboratory services, risk factors (comorbidity, exposure to camels and persons with MERS-CoV), occupation (health care), and outcome (fatality), we used descriptive statistics, risk ratio (RR), and the Pearson χ2 test. Results. Presence of comorbidity (RR = 3; 95% confidence interval [CI] = 2.2, 3.9), being male (RR = 1.6; 95% CI = 1.2, 2.1), exposure to dromedary camels (RR = 1.6; 95% CI = 1.3, 2.3), and consumption of camel milk (RR = 1.5; 95% CI = 0.9, 1.7) can significantly increase risk for fatality. Health care workers have significantly lower fatality (P < .001) than the rest of the persons with MERS-CoV. Conclusions. Policies that promote health awareness for the high-risk population and their prompt seeking of health care should be considered. Publicly accessible line lists of infectious diseases such as MERS-CoV can be valuable sources for epidemiological analysis. (Am J Public Health. Published online ahead of print July 18, 2019: e1-e6. doi:10.2105/AJPH.2019.305186).


title: Peristomal skin complications and management.

text: PURPOSE : To provide the wound care practitioner with an overview of practical approaches to prevent and treat common peristomal skin conditions. TARGET AUDIENCE : This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES : After participating in this educational activity, the participant should be better able to:


title: Prescription practice of antihistamines for acute upper respiratory tract infections in pediatric patients in a local emergency department in Hong Kong.

text: BACKGROUND Currently there is very limited data in the literature assessing the prevalence of antihistamine prescription, and there is no local prevalence data about the prescription of antihistamine agents among primary practitioner and emergency physicians. The objectives are 1) to report the prevalence of antihistamine prescription for children less than 6 years old with acute upper respiratory infection and 2) to explore the associated factors for the prescription practice. METHODS This is a cross-sectional study. All consecutive cases of paediatric patients aged 6 or below who presented to the emergency department during a study period of one week from April 1 to July 4, 2009 with diagnosis of acute upper respiratory infection were included. Totally 162 patients were included. RESULTS Among the 162 cases, 141 (87%) patients were prescribed one antihistamine of any group. Sixty (37%) patients were prescribed two or more antihistamines. In multivariate logistic regression model, age was found to be significantly (P<0.001) associated with multiple antihistamine prescription (OR=1.042, 95%CI=1.02 to 1.06). Years of graduation of attending physician for more than 5 years was also a strong predictor of multiple antihistamine prescription (OR=4.654, 95%CI=2.20 to 9.84, P<0.001). CONCLUSION In the local emergency department, patients' age and the years of graduation from medical school of the attending physician were predictors of multiple antihistamine prescription for acute upper respiratory infections for children aged less than 6.


title: Detection of SARS-CoV-2 in Human Retinal Biopsies of Deceased COVID-19 Patients.

text: PURPOSE To report the presence of viral ribonucleic acid (RNA) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in human retina in deceased patients with confirmed novel coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS Fourteen eyes of 14 deceased patients with confirmed COVID-19 disease were enucleated during autopsy. A sample of human retina was secured and fixed in RNAlater™. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect three different viral RNA sequences (RdRp-gene, E-gene and Orf1 gene) of SARS-CoV-2. RESULTS In three out of 14 eyes SARS-CoV-2 viral RNA was detected in the retina of deceased COVID-19 patients. As analysis for three different sequences (RdRp-gene, E-gene and Orf1 gene) revealed positive results in RT-PCR, the existence of SARS-CoV-2 viral RNA in human retina is proven according to the standards of the World-Health-Organization. CONCLUSION Viral RNA of SARS-CoV-2 is detectable in the retina of COVID-19 patients.


title: Modified hanging maneuver using the goldfinger dissector in laparoscopic right and left hepatectomy.

text: BACKGROUND The liver hanging maneuver is a useful technique to transect the liver parenchyma in an open approach while lifting it with a tape passed between the anterior surface of the inferior vena cava and the liver parenchyma. The hanging maneuver during laparoscopic liver resection is not routinely utilized. MATERIALS AND METHODS We describe the technique and results of a modified hanging maneuver using the Goldfinger dissector in 13 right and 5 left hepatectomies. This technique allowed us to dissect the space between right and middle hepatic veins; to create the infero-superior arcade through the space between the anterior surface of the vena cava and the posterior surface of the liver; to lift the cutting area of the liver from the posterior to the anterior direction; to indicate the parenchymal transection line. RESULTS The median resection time and blood loss were 96 min and 220 ml respectively. No conversion was recorded. Two complications (11%) occurred: a biliary fistula and a respiratory distress syndrome, spontaneously resolved. CONCLUSIONS The modified hanging maneuver for laparoscopic right and left hepatectomy based on the use of the Goldfinger dissector is safe, reproducible, and can facilitate liver dissection during major hepatectomy.


title: Evaluation of Ebola Virus Inhibitors for Drug Repurposing.

text: A systematic screen of FDA-approved drugs was performed to identify compounds with in vitro antiviral activities against Ebola virus (EBOV). Compounds active (>50% viral inhibition and <30% cellular toxicity) at a single concentration were tested in dose-response assays to quantitate the antiviral activities in replication and viral entry assays as well as cytotoxicity in the Vero cell line used to conduct these assays. On the basis of the approved human dosing, toxicity/tolerability, and pharmacokinetic data, seven of these in vitro hits from different pharmacological classes (chloroquine (CQ), amiodarone, prochlorperazine, benztropine, azithromycin, chlortetracycline, and clomiphene) were evaluated for their in vivo efficacy at a single dose and were administered via either intraperitoneal (ip) or oral route. Initially, azithromycin (100 mg/kg, twice daily, ip), CQ (90 mg/kg, twice daily, ip), and amiodarone (60 mg/kg, twice daily, ip) demonstrated significant increases in survival in the mouse model. After repeat evaluation, only CQ was found to reproducibly give significant efficacy in the mouse model with this dosing regimen. Azithromycin and CQ were also tested in a guinea pig model of EBOV infection over a range of doses, but none of the doses increased survival, and drug-related toxicity was observed at lower doses than in the mouse. These results show the benefits and specific challenges associated with drug repurposing and highlight the need for careful evaluation of approved drugs as rapidly deployable countermeasures against future pandemics.


title: Cost-effective critical care: cost containment and rationing.

text: Rationing occurs whenever the demand for a good or service exceeds its supply. Therefore rationing is an inevitable occurrence in medicine and in critical care where the potential demand for effective medical care will exceed supply. Although there are many strategies to allocate medical resources one that is often considered is based on cost-effectiveness. Cost-effectiveness analysis attempts to estimate the value of individual medical treatments in terms of dollars and outcomes. Allocation of medical treatments based on cost-effectiveness analysis requires valid estimates of both the costs and the effectiveness of treatments as well as some overarching body with the authority to enforce allocation based on these analyses. Limitations of allocation based on cost-effectiveness analysis in critical care include difficulties in estimating marginal costs of critical care treatments, limited evidence for any treatments with efficacy, and the ethical principle of rescuing identifiable lives in imminent risk of death. The prospect of a pandemic influenza-like infection has stimulated a lot of interest in hypothetical rationing strategies for the intensive care unit, none of which has been tested in actual pandemic scenarios. Given the burden of critical illness and the wide variation in resources a global approach to rationing is untenable. The article concludes with a vision of the future of allocation in critical care.


title: A novel technique to skin graft abdominal wall wounds surrounding enterocutaneous fistulas.

text: BACKGROUND Enterocutaneous fistulas often are associated with large abdominal wall wounds. Successful skin grafting of these sites is difficult, as the bed is constantly bathed by enteric contents. A method to graft these sites successfully would provide an important advance in their treatment. METHODS The medical records of patients undergoing skin grafting of a site around an enterocutaneous fistula were reviewed. The amount of fistula output at the time of grafting was recorded. The method of grafting, as well as the means of protecting the graft from enteric exposure, were noted. Skin grafts were evaluated for the extent of "take." RESULTS Seven patients met the inclusion criteria. After 1-2 weeks, the graft take was 90% in three patients, 80% in two patients, and 50% in two patients. After 1 month, there was complete epithelialization in 85% of patients, and the remaining patient had most of the site epithelialized. This healing allowed placement of an ostomy appliance in all patients. The fistula output was >400 mL per day in 70% of the patients. Multiple techniques were used to divert enteric flow away from the graft, but the most common was placement of a negative pressure dressing that concomitantly secured the graft and allowed enteric diversion. CONCLUSION The presence of a high-output enterocutaneous fistula does not preclude successful skin grafting. Such grafting can accelerate wound healing as well as improve skin and site hygiene by allowing the placement of an ostomy device.


title: Variability Assessment of California Infectious Bronchitis Virus Variants.

text: On the basis of the data from the California Animal Health and Food Safety Laboratory System, 1444 infectious bronchitis (IB) cases were diagnosed between 1997 and 2012. Epidemiologic analyses demonstrated two major IB virus (IBV) outbreak peaks, affecting mainly 35-to-49-day-old broiler chickens. California variant 1737 (CA1737) and California variant 1999 (Cal 99) IBV types were the most prevalent genotypes during the analyzed period. To further understand the increased prevalence of these genotypes, we assessed and compared the variability of the S1 gene hypervariable region of CA1737 and Cal 99 with the variability of IBV strains belonging to the Massachusetts 41 (M41) and Arkansas (Ark) types during serial passages in embryonated chicken eggs. On the basis of the S1 nonsynonymous changes, seven different subpopulations were detected in M41. However, the predominant population of the field strain M41 before passages continued to be predominant throughout the experiment. In contrast, Ark passaging resulted in the detection of 13 different subpopulations, and the field sequence became extinct after the first passage. In IBV Cal 99, eight different subpopulations were detected; one of these became predominant after the second passage. In CA1737, 10 different subpopulations were detected. The field strain major sequence was not detected after the first passage but reappeared after the second passage and remained at low levels throughout the experiment. Compared with M41 and Ark, Cal 99 and CA1737 showed intermediate variability.


Covid-19: Doctors face shortages of vital drugs, gases, and therapeutics, survey finds.


title: Cell cycle dependence of ACE-2 explains downregulation in idiopathic pulmonary fibrosis.

text: Alveolar epithelial type II cells, a major source of angiotensin-converting enzyme (ACE)-2 in the adult lung, are normally quiescent but actively proliferate in lung fibrosis and downregulate this protective enzyme. It was, therefore, hypothesised that ACE-2 expression might be related to cell cycle progression. To test this hypothesis, ACE-2 mRNA levels, protein levels and enzymatic activity were examined in fibrotic human lungs and in the alveolar epithelial cell lines A549 and MLE-12 studied at postconfluent (quiescent) versus subconfluent (proliferating) densities. ACE-2 mRNA, immunoreactive protein and enzymatic activity were all high in quiescent cells, but were severely downregulated or absent in actively proliferating cells. Upregulation of the enzyme in cells that were progressing to quiescence was completely inhibited by the transcription blocker actinomycin D or by SP600125, an inhibitor of c-Jun N-terminal kinase (JNK). In lung biopsy specimens obtained from patients with idiopathic pulmonary fibrosis, immunoreactive enzyme was absent in alveolar epithelia that were positive for proliferation markers, but was robustly expressed in alveolar epithelia devoid of proliferation markers. These data explain the loss of ACE-2 in lung fibrosis and demonstrate cell cycle-dependent regulation of this protective enzyme by a JNK-mediated transcriptional mechanism.


title: Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020.

text: This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.


title: [Technologies and requirements of protection and disinfection in key places during COVID-19 outbreak].

text: COVID-19 a new respiratory infectious disease, has become an important public health problem. Inappropriate protection and disinfection measures are potential risk factors of transmission and outbreak of COVID-19 in key places. This theme issue is concerned with the prevention and control of COVID-19. Comprehensive measures and suggestions for protection and disinfection are put forward from perspectives of functional areas in key places, such as hotels, mobile cabin hospitals, passenger transport stations and public transport facilities, environment and facilities, personal protection, operation management system, etc., so as to provide technical support for the prevention and control of new respiratory infectious diseases.


Hong Kong closes all primary schools in flu outbreak.


title: Radiofrequency ablation for treatment for osteoid osteoma of the scapula using a new three-dimensional fluoroscopic navigation system.

text: Osteoid osteoma is a relatively common benign skeletal tumor. The traditional standard treatment has been surgical resection of the nidus. Recently, computed tomography (CT)-guided radiofrequency ablation (RFA) has gained favor as a more precise alternative due to potentially less bone destruction. However, CT-guided RFA is limited in treatment for osteoid osteoma involving complex anatomic structures such as cervical spine, pelvis, or scapula because of difficulty in approach and proximity to neurovascular structures. To solve this problem, we investigated RFA using a new real-time three-dimensional fluoroscopic navigation system. We report its technical procedure and use in a rare case of osteoid osteoma of the scapula.


Research and statistics: case reports, anecdotal evidence, and descriptive epidemiologic studies in pediatric practice.


title: Computed Tomography-Assisted Thoracoscopic Surgery: A Novel, Innovative Approach in Patients With Deep Intrapulmonary Lesions of Unknown Malignant Status.

text: OBJECTIVES Minimally invasive resection of small, deep intrapulmonary lesions can be challenging due to the difficulty of localizing them during video-assisted thoracoscopic surgery (VATS). We report our preliminary results evaluating the feasibility of an image-guided, minimally invasive, 1-stop-shop approach for the resection of small, deep intrapulmonary lesions in a hybrid operating room (OR). MATERIALS AND METHODS Fifteen patients (5 men, 10 women; mean age, 63 years) with a total of 16 solitary, deep intrapulmonary nodules of unknown malignant status were identified for intraoperative wire marking. Patients were placed on the operating table for resection by VATS. A marking wire was placed within the lesion under 3D laser and fluoroscopic guidance using a cone beam computed tomography system. Then, wedge resection by VATS was performed in the same setting without repositioning the patient. RESULTS Complete resection with adequate safety margins was confirmed for all lesions. Marking wire placement facilitated resection in 15 of 16 lesions. Eleven lesions proved to be malignant, either primary or secondary; 5 were benign. Mean lesion size was 7.7 mm; mean distance to the pleural surface was 15.1 mm (mean lesion depth-diameter ratio, 2.2). Mean procedural time for marking wire placement was 35 minutes; mean VATS duration was 36 minutes. CONCLUSIONS Computed tomography-assisted thoracoscopic surgery is a new, safe, and effective procedure for minimally invasive resection of small, deeply localized intrapulmonary lesions. The benefits of computed tomography-assisted thoracoscopic surgery are 1. One-stop-shop procedure, 2. Lower risk for the patient (no patient relocation, no marking wire loss), and 3. No need to coordinate scheduling between the CT room and OR.


Hospital-associated Middle East respiratory syndrome coronavirus infections.


Modeling infectious epidemics.


title: Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile Infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals.

text: We sought to determine the burden of nosocomial Clostridium difficile infection in comparison to other healthcare-associated infections (HAIs) in community hospitals participating in an infection control network. Our data suggest that C. difficile has replaced MRSA as the most common etiology of HAI in community hospitals in the southeastern United States.


title: An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results.

text: BACKGROUND AND PURPOSE The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data. MATERIALS AND METHODS Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included. RESULTS Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3-11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0-2) was achieved in 90% of patients. CONCLUSIONS The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.


title: Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.

text: PURPOSE To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. METHODS Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. RESULTS Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). CONCLUSIONS Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.


title: Bmi1 inhibitor PTC-209 promotes Chemically-induced Direct Cardiac Reprogramming of cardiac fibroblasts into cardiomyocytes.

text: The development of therapeutic approaches based on direct cardiac reprogramming of fibroblasts into induced-cardiomyocytes (iCM) has emerged as an attractive strategy to repair the injured myocardium. The identification of the mechanisms driving lineage conversion represents a crucial step toward the development of new and more efficient regenerative strategies. To this aim, here we show that pre-treatment with the Bmi1 inhibitor PTC-209 is sufficient to increase the efficiency of Chemical-induced Direct Cardiac Reprogramming both in mouse embryonic fibroblasts and adult cardiac fibroblasts. PTC-209 induces an overall increase of spontaneously beating iCM at end-stage of reprogramming, expressing high levels of late cardiac markers Troponin T and myosin muscle light chain-2v. The inhibition of Bmi1 expression occurring upon PTC-209 pre-treatment was maintained throughout the reprogramming protocol, contributing to a significant gene expression de-regulation. RNA profiling revealed that, upon Bmi1 inhibition a significant down-regulation of genes associated with immune and inflammatory signalling pathways occurred, with repression of different genes involved in interleukin, cytokine and chemokine pathways. Accordingly, we observed the down-regulation of both JAK/STAT3 and MAPK/ERK1-2 pathway activation, highlighting the crucial role of these pathways as a barrier for cardiac reprogramming. These findings have significant implications for the development of new cardiac regenerative therapies.


title: Use of parallel grafts to save failed prior endovascular aortic aneurysm repair and type Ia endoleaks.

text: OBJECTIVE The aim of this study was the evaluation of the clinical and radiologic outcomes of parallel grafts in the treatment of patients with failed prior endovascular aneurysm repair and type Ia endoleak. METHODS Prospectively collected clinical and radiologic data of consecutive patients with prior endovascular aneurysm repair and evidence of type Ia endoleak were analyzed. All patients were treated between January 2009 and November 2014 by use of parallel grafts, ie, chimney/snorkel or periscope grafts and abdominal endovascular devices. Primary outcome of the study was the technical success. Secondary outcomes were patency of the chimney grafts and shrinkage of aneurysm morphology. RESULTS Technical success was 94.4% (17 of 18). One patient showed evidence of persistent type Ia endoleak after triple chimney graft placement and treated by Onyx embolization (Covidien, Plymouth, Minn) successfully. The mean preoperative and postoperative aneurysm diameters were 7.1 ± 1.7 and 7.0 ± 2 cm. Primary patency of the chimney grafts was 96.7% and assisted patency was 100% after successful retrograde recanalization of an acute occlusion of the superior mesenteric artery from the celiac trunk and the gastroduodenal artery. One patient who had undergone the sandwich technique with transfemoral placement of the flexible Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) due to impossible catheterization of the target vessel from the upper extremity presented with contained rupture caused by gutter-associated endoleak and underwent urgent embolization with Onyx successfully. No procedure-related death or open conversion was observed in the entire follow-up period. CONCLUSIONS Use of parallel grafts showed midterm safety and feasibility with low incidence of persistent endoleaks requiring intervention or progression of aneurysm diameter. Reproducible results from other vascular centers will establish the chimney technique in the treatment of type I endoleaks as a viable endovascular modality.


title: Preoperative quality of life questionnaires are an adequate tool to select women with genital prolapse for laparoscopic sacrocolpopexy.

text: INTRODUCTION AND HYPOTHESIS No clear consensus exists on the selection of patients with pelvic organ prolapse (POP) for surgery. There is a need to preoperatively identify candidates who will benefit from surgery as there is no strict correlation between POP anatomical abnormalities and changes in symptoms and quality of life (QOL) after surgical treatment. Therefore, our objectives were to evaluate the changes in QOL after laparoscopic sacrocolpopexy (LSC) for POP using validated questionnaires and to assess their relevance in selecting women for surgery. METHODS This was a prospective study of 48 women with advanced stages of POP treated by LSC from March 2005 to January 2015. We developed a recursive partitioning model from QOL PFDI-20 and PFIQ-7 questionnaire scores to determine a preoperative cut-off score for predicting improvement after surgery. The model was then validated in 84 consecutive women. RESULTS Optimal anatomical results were obtained in 129 of the 132 women (97.7%). Both questionnaires revealed a significant improvement after LSC (p < 0.01). The probability of improvement after surgery was 0% in women with a preoperative PFIQ-7 score of <45.25, and 84% in women with a PFIQ-7 score of ≥45.25. The probability of improvement after surgery was 0% in women with a preoperative PFDI-20 score of <52.15, 88.2% in those with a PFDI-20 score of ≥ 98.45, and 42.9% in those with a PFDI-20 score between 52.15 and 98.45. In the validation set, the discriminatory accuracies of the model were 0.96 (95% CI 0.925-0.998) and 0.75 (95% CI 0.64-0.85) for the PFIQ-7 and PFDI-20 questionnaires, respectively. The performance was accurate with a significant difference between observed outcome frequencies and predicted probabilities (p = 1). CONCLUSIONS Our results support the use QOL questionnaires to select women for LSC.


title: A single institution's experience with single incision cholecystectomy compared to standard laparoscopic cholecystectomy.

text: BACKGROUND The advent of single incision laparoscopic surgery has brought renewed attention to cholecystectomy due to the promise of improved cosmesis and less parietal trauma. Small series have demonstrated the feasibility of single incision laparoscopic cholecystectomy (LC). Our series adds to the literature by demonstrating a variety of ancillary techniques that may be employed to perform single incision LC safely, and compares our early experience with that of our standard LC. METHODS We performed a retrospective chart review of patients who underwent single incision LC between February 2008 and April 2009. These patients were compared with an equal number of randomly selected patients undergoing LC during the same period. We identified 25 attempted single incision LC, which were included in our analysis. RESULTS Single incision LC was successfully performed in 21 patients, with only 4 patients requiring conversion to LC. No patients in either group had acute cholecystitis. The critical view of safety was documented in 20 of 21 patients undergoing a successful single incision LC compared with all patients undergoing LC. Operative time was significantly longer in the single incision group. Complications were minor and comparable between the 2 groups. In 9 patients (43%), a suture passer helped to retract the gallbladder. In 8 patients (38%), 1 or 2 Prolene sutures placed by means of a Keith needle helped to retract the gallbladder over the liver and/or helped to retract the infundibulum. In 2 patients, ≥1 supplemental 5-mm port was utilized. In 5 patients (24%), no supplementary retraction was necessary. CONCLUSION Single incision LC is technically more challenging than LC, but can be performed safely by experienced laparoscopic surgeons with results comparable with LC.


Astrovirus VA1 identified by next-generation sequencing in a nasopharyngeal specimen of a febrile Tanzanian child with acute respiratory disease of unknown etiology.


title: What We Learned about COVID-19 So Far? Notes from Underground.

text: The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.


Covid-19: Antibody tests will not be rolled out in UK until at least May, MPs hear.


title: Why the ABCs Matter More than Ever in Medical Education.

text: Addressing social drivers of health in medical education-through community engagement experiences-is essential for health equity and the development of future physicians. While this was written before the COVID-19 pandemic, these practices will gain even more importance as we come together to better understand its health and community implications in North Carolina and the United States.


title: JC Virus Replication at the First Symptoms of Multiple Sclerosis: A Case Report.

text: Multiple sclerosis (MS) is an autoimmune, demyelinating disorder of unknown etiology, in which viruses have been suggested as etiological/triggering agents. The attention to the association between viruses and MS has been rekindled by the development of progressive multifocal leukoencephalopathy in natalizumab-treated MS patients. Here we report the case of a woman with JC virus (JCV) replication in the cerebrospinal fluid, blood and urine collected at the first symptoms of MS and during several follow-up visits. This observation shows that JCV can be associated with MS without a relation with natalizumab treatment, although the triggering role of JCV in some cases of MS will require further studies.


title: Characteristics of hemostasis during experimental Ehrlichia canis infection.

text: BACKGROUND Ehrlichia canis infection in dogs can cause thrombocytopenia and clinical evidence of bleeding. It is unknown why some dogs show signs of bleeding whereas others do not despite clinically relevant thrombocytopenia. HYPOTHESIS/OBJECTIVES Activated platelets, decreased fibrinolysis or both mitigate bleeding tendency. Assess standard hemostatic variables, platelet dynamics, and specialized coagulation testing in dogs experimentally infected with E. canis to evaluate this clinical discrepancy. ANIMALS Four healthy laboratory beagles. METHODS Dogs were given blood infected with E. canis IV. Platelet indices of activation, platelet aggregometry, antiplatelet antibodies (percent IgG), complete coagulation panel, and thromboelastography (TEG) were measured before inoculation and on weeks 1-8. Dogs were treated with doxycycline at approximately 5 mg/kg PO q12h between weeks 3 and 4 (day 24). For each variable, 1-way repeated measures analysis (1-way ANOVA) with post-hoc analysis was performed with statistical significance set at P < .05. RESULTS Dogs had significantly lower platelet counts, evidence of activated platelets, and antiplatelet antibodies during E. canis infection. Dogs also appeared hypercoagulable and hypofibrinolytic using TEG as compared with baseline, changes that persisted for variable amounts of time after doxycycline administration. No overt signs of bleeding were noted during the study. CONCLUSIONS AND CLINICAL IMPORTANCE Activated platelets and a hypercoagulable, hypofibrinolytic state could explain the lack of a bleeding phenotype in some dogs despite clinically relevant thrombocytopenia. Findings from our pilot study indicate that additional studies are warranted.


title: In-line pressure within a HOTLINE® Fluid Warmer, under various flow conditions.

text: Roller pump infusion devices are widely used for rapid infusion, and may be combined with separate warming devices. There may be instances however, where the pressures generated by the roller pump may not be compatible with the warming device. We assessed a commonly used roller pump in combination with a HOTLINE® Fluid Warmer, and found that it could generate pressures exceeding the HOTLINE® manufacturers specifications. This was of concern because the HOTLINE® manufacturer guideline states that not for use with pressure devices generating over 300 mmHg. Pressure greater than 300 mmHg may compromise the integrity of the HOTLINE® Fluid Warming Set. The aim of this study was to compare in-line pressure within a HOTLINE® Fluid Warmer at different infusion rates of a roller pump using various sizes of intravenous cannulae. The rapid infusion system comprised a 500 mL-normal saline bag, roller pump type infusion device, HOTLINE® Fluid Warmer (blood and fluid warmer system), and six different sizes of intravenous cannulae. In-line pressure was measured proximal to the HOTLINE® (pre-warmer) and proximal to the cannula (post-warmer), at flow rate of 50-160 mL/min. The in-line pressures increased significantly with increasing flow rate. The pre-warmer pressures exceeded 300 mmHg when the flow rate was ≥120 mL/min with 20-gauge, 48 mm length cannula, 130 with 20-gauge, 25 mm cannula, and 160 mL/min with 18-gauge, 48 mm cannula. However, they were <300 mmHg at any flow rates with 18-gauge, 30 mm cannula and 16-gauge cannulae. The post-warmer pressures exceeded 300 mmHg at the flow rate of 140 mL/min with 20-gauge, 48 mm cannula, and 160 mL/min with 20-gauge, 25 mm cannula, while they were <300 mmHg at any flow rates with 18 and 16-gauge cannulae. The in-line pressure within a HOTLINE® could exceed 300 mmHg, depending on the flow rate and size and length of cannula. It is important to pay attention to the size and length of cannulae and flow rate to keep the maximum in-line pressure<300 mmHg when a roller pump type infusion device is used.


title: Loss of mammal-specific tectorial membrane component carcinoembryonic antigen cell adhesion molecule 16 (CEACAM16) leads to hearing impairment at low and high frequencies.

text: The vertebrate-restricted carcinoembryonic antigen gene family evolves extremely rapidly. Among their widely expressed members, the mammal-specific, secreted CEACAM16 is exceptionally well conserved and specifically expressed in the inner ear. To elucidate a potential auditory function, we inactivated murine Ceacam16 by homologous recombination. In young Ceacam16(-/-) mice the hearing threshold for frequencies below 10 kHz and above 22 kHz was raised. This hearing impairment progressed with age. A similar phenotype is observed in hearing-impaired members of Family 1070 with non-syndromic autosomal dominant hearing loss (DFNA4) who carry a missense mutation in CEACAM16. CEACAM16 was found in interdental and Deiters cells and was deposited in the tectorial membrane of the cochlea between postnatal days 12 and 15, when hearing starts in mice. In cochlear sections of Ceacam16(-/-) mice tectorial membranes were significantly more often stretched out as compared with wild-type mice where they were mostly contracted and detached from the outer hair cells. Homotypic cell sorting observed after ectopic cell surface expression of the carboxyl-terminal immunoglobulin variable-like N2 domain of CEACAM16 indicated that CEACAM16 can interact in trans. Furthermore, Western blot analyses of CEACAM16 under reducing and non-reducing conditions demonstrated oligomerization via unpaired cysteines. Taken together, CEACAM16 can probably form higher order structures with other tectorial membrane proteins such as α-tectorin and β-tectorin and influences the physical properties of the tectorial membrane. Evolution of CEACAM16 might have been an important step for the specialization of the mammalian cochlea, allowing hearing over an extended frequency range.


title: Characterization of host response, resorption, and strength properties, and performance in the presence of bacteria for fully absorbable biomaterials for soft tissue repair.

text: PURPOSE The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models. METHODS In a rat model, one mesh (2 × 2 cm) was implanted subcutaneously in n = 60 rats. Animals were euthanized after 2, 4, 8, 12, 16, or 24 weeks (n = 5/mesh/time point), and implant sites were assessed for host inflammatory response and overall fibrotic repair thickness. In a rabbit model, meshes (3.8 cm diameter) were bilaterally implanted in subcutaneous pockets in n = 20 rabbits (n = 10 rabbits/mesh) and inoculated with 108 CFU clinically isolated methicillin-resistant Staphylococcus aureus (MRSA). One mesh type was implanted per animal. Animals were euthanized after 7 days, and implants were assessed for abscess formation, bacterial colonization, and mechanical strength. RESULTS In the rat study, Phasix™ and Bio-A® exhibited similar biocompatibility, although Bio-A® demonstrated a significantly greater inflammatory response at 4 weeks compared to Phasix™ (p < 0.01). Morphometric analysis demonstrated rapid resorption of Bio-A® implants with initially thicker repair sites at 2, 4, 8, and 12 weeks (p < 0.0001), which transitioned to significantly thinner sites compared to Phasix™ at 16 and 24 weeks (p < 0.0001). In the rabbit bacterial inoculation study, Phasix™ exhibited significantly lower abscess score (p < 0.001) and bacterial colonization (p < 0.01), with significantly greater mechanical strength than Bio-A® (p < 0.001). CONCLUSIONS Host response, resorption, repair thickness, strength, and bacterial colonization suggest a more stable and favorable outcome for monofilament, macroporous devices such as Phasix™ relative to multifilament, microporous devices such as Bio-A® over time.