title: Endovascular treatment of sphenoid wing dural arteriovenous fistula with pure cortical venous drainage.

text: Curative endovascular treatment of sphenoid wing dural arteriovenous fistula (dAVF) with pure cortical venous drainage is challenging because of its rarity, lack of accessible dural sinus for transvenous embolization (TVE), and proximity of skull base vital regions. Direct surgery to disconnect venous reflux has been favored. We report the curative endovascular treatment of two sphenoid wing dAVFs with pure cortical venous drainage. One patient revealed complete obliteration of dAVF by a single session of transarterial embolization (TAE). As part of strategic TAE for this complex dAVF, we used a novel approach to create a complete flow-arrest condition in which coils and an occlusion balloon were combined. A liquid agent was then injected across the pathological fistula and into the parent venous apparatus, thereby occluding the lesion. The other patient was treated with percutaneous TVE after TAE was unsuccessful. With a specific strategy and appropriate devices, the microcatheter was successfully introduced through sigmoid sinus, transverse sinus, superior sagittal sinus, and refluxing cortical vein by puncture of the jugular vein. Coils were deployed at the venous side of the fistula, resulting in successful obliteration of the dAVF. Sphenoid wing dAVF with pure cortical venous drainage could be curable by endovascular treatment with proper strategy and instruments when anatomical condition permits.


title: Tacks, staples, or suture: method of peritoneal closure in laparoscopic transabdominal preperitoneal inguinal hernia repair effects early quality of life.

text: INTRODUCTION TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes. METHODS AND PROCEDURES A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale. RESULTS There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038). CONCLUSIONS Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.


title: Laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma accompanied by hypoplasia of the right hepatic lobe.

text: We report a case of laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma (HCC) accompanied by hypoplasia of the right hepatic lobe. An 80-year-old man was admitted with a suspicion of HCC diagnosed by computed tomography during follow-up for thyroid cancer. Dynamic computed tomography showed 40-mm HCC in segment 3 and hypoplasia of the right hepatic lobe with the Chilaiditi sign. We performed laparoscopic anatomical segment 3 segmentectomy. There were no postoperative complications, and the patient was discharged 6 days postoperatively. This procedure can be performed safely and is technically feasible, but special attention should be paid to anatomical alterations to avoid fatal surgical complications.


title: Building a Critical Limb Ischemia Program.

text: OPINION STATEMENT The need to develop highly qualified, multidisciplinary critical limb ischemia (CLI) programs has gained significant momentum. Due to the systemic nature of the disease, patients with CLI are inherently medically complex and often present with multiple comorbidities. Successful care for these patients depends on community screening, early referral, accurate diagnosis, risk stratification, risk factor modification, invasive and non-invasive treatment strategies, and appropriate surveillance. Patients with CLI are often treated by multiple subspecialists-often lacking a unified team which could lead to inefficiencies and redundancy. Establishing an effective critical limb ischemia program relies on the joint efforts of multiple physician specialists, nurses, technicians, wound care specialists, researchers, and administrators who together form an integrated network that is easily accessible to the patient. This article will focus on the various modalities needed to build an advanced critical limb ischemia program, while addressing the challenges facing the medical community in caring for this population.


Analysis of COVID-19 transmission: Low risk of presymptomatic spread?


title: Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy.

text: OBJECTIVE To compare analgesic and gastrointestinal effects of lidocaine and buprenorphine administered to rabbits undergoing ovariohysterectomy. ANIMALS Fourteen 12-month-old female New Zealand White rabbits. PROCEDURES Rabbits were assigned to 2 treatment groups (7 rabbits/group). One group received buprenorphine (0.06 mg/kg, IV, q 8 h for 2 days), and the other received lidocaine (continuous rate infusion [CRI] at 100 μg/kg/min for 2 days). Variables, including food and water consumption, fecal output, glucose and cortisol concentrations, and behaviors while in exercise pens, were recorded. RESULTS Rabbits receiving a lidocaine CRI had significantly higher gastrointestinal motility, food intake, and fecal output and significantly lower glucose concentrations, compared with results for rabbits receiving buprenorphine. Rabbits receiving lidocaine also had a higher number of normal behaviors (eg, sprawling, traveling, and frolicking) after surgery, compared with behaviors such as crouching and sitting that were seen more commonly in rabbits receiving buprenorphine. Both groups had significant weight loss after surgery. Pain scores did not differ significantly between treatment groups. Significant decreases in heart rate and respiratory rate were observed on the day of surgery, compared with values before and after surgery. Rabbits in the lidocaine group had significantly overall lower heart rates than did rabbits in the buprenorphine group. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of lidocaine to rabbits provided better postoperative outcomes with respect to fecal output, food intake, and glucose concentrations. Thus, lidocaine appeared to be a suitable alternative to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.


A case of limbic encephalitis associated with asymptomatic COVID-19 infection.


Are better drugs just a click away?


title: Analysis of cytokines in the peritoneal fluid of endometriosis patients as a function of the menstrual cycle stage using the Bio-Plex® platform.

text: OBJECTIVE Endometriosis is a painful disease affecting 10-15% of reproductive-age women. Concentrations of several cytokines and angiogenic factors in peritoneal fluid (PF) have been found to correlate with the severity of the disease. However, levels of some analytes vary across the menstrual cycle, and an ideal biomarker of endometriosis has not yet been identified. We have compared the PF concentrations of different cytokines in proliferative and secretory phases in women with and without the disease using the Bio-Plex platform. METHODS PF was aspirated during laparoscopy (N = 133) and the PF concentrations of 18 cytokines from Bio-Plex panels I and II determined with the serum protocol. RESULTS Increased PF concentrations of IL-6, IL-18, eotaxin, and MCP-1 were found in endometriosis with no changes with menstrual cycle. Levels of IL-12(p70), ICAM-1, and GRO-α were higher in the secretory phase, while eotaxin concentrations were lower. CONCLUSION Of the 18 cytokines tested, IL-6, IL-18 and MCP-1 were the best PF markers of endometriosis.


title: 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis.

text: To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse's role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.


title: Plant-derived virus-like particles as vaccines.

text: Virus-like particles (VLPs) are self-assembled structures derived from viral antigens that mimic the native architecture of viruses but lack the viral genome. VLPs have emerged as a premier vaccine platform due to their advantages in safety, immunogenicity, and manufacturing. The particulate nature and high-density presentation of viral structure proteins on their surface also render VLPs as attractive carriers for displaying foreign epitopes. Consequently, several VLP-based vaccines have been licensed for human use and achieved significant clinical and economical success. The major challenge, however, is to develop novel production platforms that can deliver VLP-based vaccines while significantly reducing production times and costs. Therefore, this review focuses on the essential role of plants as a novel, speedy and economical production platform for VLP-based vaccines. The advantages of plant expression systems are discussed in light of their distinctive posttranslational modifications, cost-effectiveness, production speed, and scalability. Recent achievements in the expression and assembly of VLPs and their chimeric derivatives in plant systems as well as their immunogenicity in animal models are presented. Results of human clinical trials demonstrating the safety and efficacy of plant-derived VLPs are also detailed. Moreover, the promising implications of the recent creation of "humanized" glycosylation plant lines as well as the very recent approval of the first plant-made biologics by the U. S. Food and Drug Administration (FDA) for plant production and commercialization of VLP-based vaccines are discussed. It is speculated that the combined potential of plant expression systems and VLP technology will lead to the emergence of successful vaccines and novel applications of VLPs in the near future.


title: Biopsychosocial Aspects of Functional Gastrointestinal Disorders.

text: In this paper, we provide a general framework for understanding the functional gastrointestinal disorders (FGID) from a biopsychosocial perspective. More specifically, we provide an overview of the recent research on how the complex interactions of environmental, psychological, and biological factors contribute to the development and maintenance of the FGID. We emphasize that considering and addressing all these factors is a conditio sine qua non for appropriate treatment of these conditions. First, we provide an overview of what is currently known about how each of these factors - the environment, including the influence of those in an individual's family, the individual's own psychological states and traits, and the individual's (neuro)physiological make-up - interact to ultimately result in the generation of FGID symptoms. Second, we provide an overview of commonly used assessment tools which can assist clinicians in obtaining a more comprehensive assessment of these factors in their patients. Finally, the broader perspective outlined earlier is applied to provide an overview of centrally acting treatment strategies, both psychological and pharmacological, which have been shown to be efficacious to treat FGID.


title: One to chelate them all: investigation of a versatile, bifunctional chelator for 64Cu, 99mTc, Re and Co.

text: We describe the synthesis of the dip (di-picolyl-carboxylate) bifunctional chelator system, capable of fast coordination of Cu(2+), (64)Cu(2+) and Co(2+), as well as the [M(CO)(3)](+)-core (M = (99m)Tc, Re); it displays a variety of binding modes--tridentate when protected, tetradentate when deprotected. Syntheses of both the benzyl-nitro derivative and the benzyl-amino derivatives are described. The latter was coupled to biotin to show the viability of the system for functionalization with biomolecules. Besides coordination chemistry with stable isotopes, we also present labelling data with (64)Cu and (99m)Tc, as well as in vitro stability studies.


title: Model-based estimation of pulmonary compliance and resistance parameters from time-based capnography.

text: We propose a highly-simplified single-alveolus mechanistic model of lung mechanics and gas mixing that leads to an analytical solution for carbon dioxide partial pressure in exhaled breath, as measured by time-based capnography. Using this solution, we estimate physiological parameters of the lungs on a continuous, breath-by-breath basis. We validate our model with capnograms from 15 subjects responding positively (>20% FEV1 drop from baseline) to methacholine challenge, and subsequently recovering with bronchodilator treatment. Our results suggest that parameter estimates from capnography may provide discriminatory value for lung function comparable to spirometry, thus warranting more detailed study.


title: Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor.

text: A novel and highly pathogenic coronavirus (SARS-CoV-2) has caused an outbreak in Wuhan city, Hubei province of China since December 2019, and soon spread nationwide and spilled over to other countries around the world1-3. To better understand the initial step of infection at an atomic level, we determined the crystal structure of the SARS-CoV-2 spike receptor-binding domain (RBD) bound to the cell receptor ACE2 at 2.45 Å resolution. The overall ACE2-binding mode of the SARS-CoV-2 RBD is nearly identical to that of the SARS-CoV RBD, which also utilizes ACE2 as the cell receptor4. Structural analysis identified residues in the SARS-CoV-2 RBD that are critical for ACE2 binding, the majority of which either are highly conserved or share similar side chain properties with those in the SARS-CoV RBD. Such similarity in structure and sequence strongly argue for convergent evolution between the SARS-CoV-2 and SARS-CoV RBDs for improved binding to ACE2, although SARS-CoV-2 does not cluster within SARS and SARS-related coronaviruses1-3,5. The epitopes of two SARS-CoV antibodies targeting the RBD are also analysed with the SARS-CoV-2 RBD, providing insights into the future identification of cross-reactive antibodies.


title: Extraumbilical single-incision laparoscopic cholecystectomy with standard laparoscopic instruments.

text: BACKGROUND AND AIM Single-incision laparoscopic surgery is a rapidly progressing field as it combines some advantages such as cosmesis and less incisional pain. However, it also has some disadvantages such as limitation of movement and clashing of the hand instruments, which increase the complexity and technical challenges of the operation. In this study, we describe a pilot trial of single-incision laparoscopic cholecystectomy through a paramedian access site. MATERIAL AND METHODS A total of 25 patients underwent single-incision laparoscopic cholecystectomy with this method. Acute cases with empyema and patients with history of previous abdominal surgery were excluded. Single-incision is established on the right upper quadrant, right latero-superior of the umbilicus, so that trocar sites and projection of the gallbladder on the abdominal wall are on the same vertical line. Standard laparoscopic instruments were placed into the abdominal cavity providing triangulation. Once the laparoscope, grasper, and dissector are in place, the overall procedures are similar to the standard laparoscopic cholecystectomy. RESULTS Single-incision laparoscopic cholecystectomy through an extraumbilical access site was successfully completed in all 25 patients without conversion to open surgery. Additional skin incisions and trocar access were required only in two patients. The mean operative time was 39.3 min (range: 20-75 min). The mean body mass index was 27.2. Postoperative course was uneventful in all patients. The mean postoperative hospital stay was shorter than 24 h, and all patients were discharged at first day postoperatively. No postoperative complications including seroma, wound infection, and trocar-site hernia were observed at 6-month follow-up. CONCLUSION We described a new access site for single-incision laparoscopic cholecystectomy using standard laparoscopic instruments. We believe that this type of access site overcomes the technical difficulties of performing single-incision laparoscopic cholecystectomy, and it is a promising alternative method for the treatment of patients with symptomatic gallstone disease as a minimal invasive abdominal surgery.


title: Robotic Endoscopic Off-Pump Total Pericardiectomy in Constrictive Pericarditis.

text: OBJECTIVE Although rare, constrictive pericarditis is a serious condition with debilitating symptoms and often severe heart failure. Total pericardiectomy is the most effective treatment and is traditionally performed via median sternotomy. With the increasing use of minimally invasive techniques, there have been reports of partial pericardiectomy via thoracoscopy but with suboptimal exposure and difficulty identifying both phrenic nerves. Robotic surgery offers both small incisions and enhanced visualization. We present four cases of robotic endoscopic off-pump total pericardiectomy for constrictive pericarditis. METHODS Four patients underwent off-pump total pericardiectomy with robotic assistance for constrictive pericarditis. All had constrictive physiology demonstrated by right heart catheterization and/or echocardiogram. One was also found to have coronary artery disease and underwent concurrent totally endoscopic coronary artery bypass grafting left internal mammary artery to left anterior descending artery. Ports were placed in the left second, fourth, and sixth intercostal spaces. The left lung was isolated and deflated with CO2 insufflation, aiding in exposure. With the use of electrocautery, the pericardium was removed first posterior to the left phrenic nerve, then anteriorly all the way to the right phrenic nerve, and caudally from the diaphragmatic reflection to the great vessel cephalad. A stabilizer in the subcostal fourth robotic arm was used to assist in the dissection. RESULTS Two of four patients were extubated within 6 hours after surgery and transferred to the floor on postoperative day 1. Both were discharged home by postoperative day 5. Two of four patients had preoperative sequelae from chronic constriction and necessitated longer hospital and intensive care unit stays but had improvement in symptoms and were discharged home within 3 weeks. CONCLUSIONS Total pericardiectomy for constrictive pericarditis can be performed using a robotic approach. In contrast to thoracoscopy, it offers better visualization of both phrenic nerves, avoids injury, and allows a thorough pericardial dissection. In our experience, the robotic left chest approach has proven more efficacious in removing the posterior pericardium than is allowed with median sternotomy.


title: Telemedicine during Covid-19 pandemic: Advantage or critical issue?

text: Telemedicine offers a support to traditional medicine, delivering clinical services when distance is a critical factor. Although this tool does not replace a medical examination, during Covid-19 pandemic, it reduces the spread of infection and avoids the need for a patient's visit. It is useful in the management of chronic disorders or for patients undergoing palliative treatment. The University Hospital of Palermo has applied this in cases of chronic illness caring for patients who cannot stop their treatment, such as Department of Onco-Haematology, Internal Medicine, Dermatology, etc. The Department of Legal Medicine of Palermo, in particular, is also using telemedicine to manage medico-legal sudden natural death investigations and dealing with the Public Prosecutor's office of Palermo. Even after the Covid-19 emergency, telemedicine will be essential to streamline outpatient visits, while at the same time limiting costs, with significant benefits for the Italian National Public Health Service budget. In conclusion, telemedicine can offer a valuable support to the doctor's activity by streamlining and facilitating their work. In this sense, the Covid-19 pandemic represents a positive input for the acceleration and enhancement of these tools.


Five ways that Trump is undermining environmental protections under the cover of coronavirus.


title: The novel zoonotic COVID-19 pandemic: An expected global health concern.

text: 18 years ago, in 2002, the world was astonished by the appearance of Severe Acute Respiratory Syndrome (SARS), supported by a zoonotic coronavirus, called SARS-CoV, from the Guangdong Province of southern China. After about 10 years, in 2012, another similar coronavirus triggered the Middle East Respiratory Syndrome (MERS-CoV) in Saudi Arabia. Both caused severe pneumonia killing 774 and 858 people with 8700 cases of confirmed infection for the former, and 2494 for the latter, causing significant economic losses. 8 years later, despite the MERS outbreak remaining in certain parts of the world, at the end of 2019, a new zoonotic coronavirus (SARS-CoV-2) and responsible of coronavirus Disease (COVID-19), arose from Wuhan, Hubei Province, China. It spread rapidly and to date has killed 3,242 persons with more than 81,000 cases of infection in China and causing over 126,000 global cases and 5,414 deaths in 166 other countries around the world, especially Italy. SARS-CoV-2 would seem to have come from a bat, but the intermediate reservoir continues to be unknown. Nonetheless, as for SARS-CoV and MERS CoV, the Spillover effect linked to animal-human promiscuity, human activities including deforestation, illegal bush-trafficking and bushmeat, cannot be excluded. Recently, however, evidence of inter-human only transmission of SARS-CoV-2 has been accumulated and thus, the outbreak seems to be spreading by human-to-human transmission throughout a large part of the world. Herein we will provide with an update on the main features of COVID-19 and suggest possible solutions how to halt the expansion of this novel pandemic.


title: Feeding the critically ill patient.

text: OBJECTIVE Critically ill patients are usually unable to maintain adequate volitional intake to meet their metabolic demands. As such, provision of nutrition is part of the medical care of these patients. This review provides detail and interpretation of current data on specialized nutrition therapy in critically ill patients, with focus on recently published studies. DATA SOURCES The authors used literature searches, personal contact with critical care nutrition experts, and knowledge of unpublished data for this review. STUDY SELECTION Published and unpublished nutrition studies, consisting of observational and randomized controlled trials, are reviewed. DATA EXTRACTION The authors used consensus to summarize the evidence behind specialized nutrition. DATA SYNTHESIS In addition, the authors provide recommendations for nutritional care of the critically ill patient. CONCLUSIONS Current evidence suggests that enteral nutrition, started as soon as possible after acute resuscitative efforts, may serve therapeutic roles beyond providing calories and protein. Although many new studies have further advanced our knowledge in this area, the appropriate level of standardization has not yet been achieved for nutrition therapy, as it has in other areas of critical care. Protocolized nutrition therapy should be modified for each institution based on available expertise, local barriers, and existing culture in the ICU to optimize evidence-based nutrition care for each critically ill patient.


title: Antibacterial evaluation of novel organoarsenic compounds by the microcalorimetric method.

text: Antibacterial activities of novel organoarsenic compounds As(III)-containing Schiff bases on Escherichia coli (CCTCCAB91112) were investigated by microcalorimetry in this study. The experimental result showed that the arsenic(III)-containing Schiff bases at micromolar concentration exhibit strong inhibition on the E. coli. Specifically, the growth rate constant k decreased, and the generation time t G and the inhibitory ratio I (percentage) increased with the increased dose of the arsenicals as inhibitors. All of the arsenicals display the feature of considerable lag phase inhibition on the cell growth. The compound 4-(4-bromobenzaliminyl)phenylarsenoxide makes the lag phase of E. coli cell growth cycles to reach 650 min at 5 μmol/L. The compounds with donating electron groups at aromatic ring B have lower IC50 to present higher antibacterial activity. The compound 4-(4-hydroxyl-3-methoxylbenzaliminyl)phenylarsenoxide has the lowest IC50 (1.82 μmol/L) to show the strongest antibacterial activity among them.


title: Are Visible Fractures Accurate Predictors of Flow and Mass Transport in Fractured Till?

text: Tracer experiments conducted in the laboratory on undisturbed core samples (<7.3-cm-diameter) have been a standard method for estimating hydraulic and transport properties of fractured till since the 1980s. This study assesses the relationship between visible fractures on the top and bottom of core samples and the resulting hydraulic and mass transport properties of the core. We hypothesized that more visible fractures would indicate the presence of a well-connected fracture network, leading to greater hydraulic conductivity (K) values and earlier chemical breakthrough times. To test this hypothesis, water flow and bromide (Br-) tracer experiments were performed on ten, 16-cm diameter, 16-cm-tall samples of fractured Dows Formation till from central Iowa. Visually identifiable fractures were present on the top and bottom of every sample. Results indicate that the visual identification of fractures does not predict a connected fracture network, as some samples produced breakthrough curves showing rapid first arrival times and shapes characteristic of solute transport in a fractured medium, while others appeared similar to an unfractured medium. No correlation was found between the number of visible fractures and K (Pearson's r = 0.25), or Br- first arrival time (r = -0.33), but a strong negative correlation between K and first arrival time (r = -0.92). Results indicate that the sample volume was not large enough to reliably contain a connected fracture network. Thus, testing large volumes of till at the field scale coupled with fracture-flow modeling likely represents the best approach for estimating hydraulic and mass transport properties for fractured till. This article is protected by copyright. All rights reserved.


title: Let Us Fight Together against COVID-19 Pandemic.

text: NA.


title: Discovery and bio-optimization of human antibody therapeutics using the XenoMouse® transgenic mouse platform.

text: Since the late 1990s, the use of transgenic animal platforms has transformed the discovery of fully human therapeutic monoclonal antibodies. The first approved therapy derived from a transgenic platform--the epidermal growth factor receptor antagonist panitumumab to treat advanced colorectal cancer--was developed using XenoMouse(®) technology. Since its approval in 2006, the science of discovering and developing therapeutic monoclonal antibodies derived from the XenoMouse(®) platform has advanced considerably. The emerging array of antibody therapeutics developed using transgenic technologies is expected to include antibodies and antibody fragments with novel mechanisms of action and extreme potencies. In addition to these impressive functional properties, these antibodies will be designed to have superior biophysical properties that enable highly efficient large-scale manufacturing methods. Achieving these new heights in antibody drug discovery will ultimately bring better medicines to patients. Here, we review best practices for the discovery and bio-optimization of monoclonal antibodies that fit functional design goals and meet high manufacturing standards.


title: Falls and fear of falling in older adults with total joint arthroplasty: a scoping review.

text: BACKGROUND Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. METHODS Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. RESULTS Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. CONCLUSIONS An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.


title: Laboratory test of a visual sputum suctioning system.

text: BACKGROUND Conventional sputum suctioning is a routine clinical practice, but complications may arise from the blind manipulation of the catheter. Recently, a visual sputum suctioning system (VSSS) was developed, and we tested this new system in a laboratory setting. METHODS We used coagulant concentrations of 1.5% and 3.0% to simulate mucus and sputum. Conventional single-lumen and triple-lumen catheters were inserted separately into a beaker for sputum suctioning (15 s, 200 mm Hg). A micro-imaging fiber was integrated into the triple-lumen catheter to create the VSSS. The single-lumen catheter and the VSSS were inserted separately into the mouth cavity, the nasal cavity, the tracheostomy tube, and the endotracheal tube of a human analog model for further comparisons. RESULTS As the suction channel of the triple-lumen catheter was reduced by 46.8%, the amount of simulant it suctioned was significantly less than that suctioned by the single-lumen catheter. However, under real-time guidance, the VSSS suctioned more simulant than the conventional single-lumen catheter in the human analog model. CONCLUSION Sputum suctioning with the VSSS was feasible. Because of its real-time imaging guidance, the efficiency of the VSSS procedure was greater than that of the conventional single-lumen catheter. Therefore, this system may provide a new platform for sputum suctioning.


title: White matter apoptosis is increased by delayed hypothermia and rewarming in a neonatal piglet model of hypoxic ischemic encephalopathy.

text: Therapeutic hypothermia is widely used to treat neonatal hypoxic ischemic (HI) brain injuries. However, potentially deleterious effects of delaying the induction of hypothermia and of rewarming on white matter injury remain unclear. We used a piglet model of HI to assess the effects of delayed hypothermia and rewarming on white matter apoptosis. Piglets underwent HI injury or sham surgery followed by normothermic or hypothermic recovery at 2h. Hypothermic groups were divided into those with no rewarming, slow rewarming at 0.5°C/h, or rapid rewarming at 4°C/h. Apoptotic cells in the subcortical white matter of the motor gyrus, corpus callosum, lateral olfactory tract, and internal capsule at 29h were identified morphologically and counted by hematoxylin & eosin staining. Cell death was verified by terminal deoxynucleotidyl transferase (TdT) dUTP nick end labeling (TUNEL) assay. White matter neurons were also counted, and apoptotic cells were immunophenotyped with the oligodendrocyte marker 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase). Hypothermia, slow rewarming, and rapid rewarming increased apoptosis in the subcortical white matter relative to normothermia (p<0.05). The number of white matter neurons was not lower in groups with more apoptosis after hypothermia or rapid rewarming, indicating that the apoptosis occurred among glial cells. Hypothermic piglets had more apoptosis in the lateral olfactory tract than those that were rewarmed (p<0.05). The promotion of apoptosis by hypothermia and rewarming in these regions was independent of HI. In the corpus callosum, HI piglets had more apoptosis than shams after normothermia, slow rewarming, and rapid rewarming (p<0.05). Many apoptotic cells were myelinating oligodendrocytes identified by CNPase positivity. Our results indicate that delaying the induction of hypothermia and rewarming are associated with white matter apoptosis in a piglet model of HI; in some regions these temperature effects are independent of HI. Vulnerable cells include myelinating oligodendrocytes. This study identifies a deleterious effect of therapeutic hypothermia in the developing brain.


Finding the Value in Personal Protective Equipment for Hospitalized Patients During a Pandemic and Beyond.


title: Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review.

text: PURPOSE The experience of endoscopic total extraperitoneal (TEP) repair of recurrent inguinal hernia in a major teaching hospital is reviewed. METHODS Between 2003 and 2008, 37 consecutive patients underwent 46 TEP repairs for recurrent inguinal hernia. Patient demographics, hernia characteristics, operating time, conversion rate, intraoperative, postoperative complications and recurrence were measured. Twenty-eight patients had unilateral hernia and nine patients had bilateral hernias. The mean age was 59 years old (range 22-88 years). RESULTS The mean operation duration was 88 min (range 60-120 min). Bilateral repairs took 38% longer than for unilateral repairs (108 vs 78 min). Three patients (8.1%) had conversion to open surgery. Seroma developed in two patients, which was subsequently resolved. Within 1 year of follow up evaluation, there was 1 recurrence (2.7%). The mean inpatient hospital stay was 1.6 days, and 24.3% of the operations were performed as outpatients. CONCLUSION Repair of recurrent hernia using the TEP approach can be achieved with minimum morbidity, good clinical outcomes and acceptable recurrence rates. Endoscopic repair has become the procedure of choice for the treatment of the majority of recurrent inguinal hernias at our institution.


title: Feasibility and safety of elective laparoscopic total extraperitoneal preperitoneal groin hernia repair in the elderly: a propensity score-matched comparison.

text: Background Several studies of hernia registries have revealed that elderly patients have higher perioperative complication rates compared with younger patients. However, the incidence of hernia increases with the aging process. To evaluate the feasibility and safety of laparoscopic hernia repair in elderly patients (≥75 years), we conducted a prospective case-matched control study to compare perioperative outcomes between patients older and younger than 75 years. Methods Between September 2008 and July 2015, 572 consecutive patients undergoing endoscopic hernia repair were included in this prospective study. This case-matched control study was matched based on sex, American Society of Anesthesiologists score, and body mass index between patients younger and ≥75 years. The propensity-score matching of two groups was carried out on a 1:1 basis. Perioperative data were prospectively recorded for all patients including demographic data, operation time, length of hospital stay, narcotic dose, and complications. Results In the final analysis, 54 patients who were <75 years were extracted to match the 54 patients ≥75 years. These two groups had similar baseline characteristics excluding age. They also had similar perioperative outcomes in hernia recurrence, metachronous contralateral hernia occurrence, complication rate and chronic pain. The patients ≥75 years of age had lower requirements for analgesics than those who were <75 years of age (p=0.047). Conclusion This is the first comparative cohort study investigating the impact of aging in an Asian hernia population. Laparoscopic inguinal hernia repair is feasible and safe for older patients, with comparable perioperative outcomes to patients <75 years.


title: Randomised study comparing heart rate measurement in newly born infants using a monitor incorporating electrocardiogram and pulse oximeter versus pulse oximeter alone.

text: AIM To determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone). METHODS Unmasked parallel group randomised (1:1) study. RESULTS We studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO2 (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer. CONCLUSIONS IntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high-risk infants is warranted.


title: The Impact of Community-Based Supports and Services on Quality of Life Among the Elderly in China: A Longitudinal Study.

text: Community-based supports and services (CBSS) have been developing rapidly in China as a new way of satisfying the needs of elderly people. However, it is not clear how pervasive these services are or whether the availability of CBSS impacts quality of life. This study examines trends in CBSS and the impact of the perceived CBSS availability on self-reported quality of life among the elderly in China. We found a significant increase in perceived CBSS availability from 2005 to 2011, but the perceived availability of CBSS varies by the type of CBSS. Multivariate analyses show that home medical visits (β = .181, p = .03), psychological support (β = .332, p = .02), social and recreation activities (β = .231, p = .02), and legal consulting services (β = .271, p = .02) were each significantly associated with a good quality of life. Results from this study provide insight that can inform CBSS strategies and the development of new services for the elderly in China.


title: Evidence for camel-to-human transmission of MERS coronavirus.

text: We describe the isolation and sequencing of Middle East respiratory syndrome coronavirus (MERS-CoV) obtained from a dromedary camel and from a patient who died of laboratory-confirmed MERS-CoV infection after close contact with camels that had rhinorrhea. Nasal swabs collected from the patient and from one of his nine camels were positive for MERS-CoV RNA. In addition, MERS-CoV was isolated from the patient and the camel. The full genome sequences of the two isolates were identical. Serologic data indicated that MERS-CoV was circulating in the camels but not in the patient before the human infection occurred. These data suggest that this fatal case of human MERS-CoV infection was transmitted through close contact with an infected camel.


title: On locating the obstruction in the upper airway via numerical simulation.

text: The fluid dynamical properties of the air flow in the upper airway (UA) are not fully understood at present due to the three-dimensional (3D) patient-specific complex geometry of the airway, flow transition from laminar to turbulent and flow-structure interaction during the breathing cycle. It is quite difficult at present to experimentally measure the instantaneous velocity and pressure at specific points in the human airway. On the other hand, direct numerical simulation (DNS) can predict all the flow properties and resolve all its relevant length- and time-scales. We developed a DNS solver with the state-of-the-art lattice Boltzmann method (LBM), and used it to investigate the flow in two patient-specific UAs reconstructed from CT scan data. Inspiration and expiration flows through these two airways are studied. The time-averaged first spatial derivative of pressure (pressure gradient), ∂p/∂z, is used to locate the region of the UA obstruction. But the time-averaged second spatial derivative, ∂(2)p/∂z(2), is used to pinpoint the exact location of the obstruction. The present results show that the DNS-LBM solver can be used to obtain accurate flow details in the UA and is a powerful tool to locate its obstruction.


COVID Experience.


title: A commentary on moral injury among health care providers during the COVID-19 pandemic.

text: Although little is known about moral injury in nonmilitary populations, the COVID-19 pandemic has made it clear that moral injury's relevance extends beyond the battlefield. Health care providers are experiencing potentially morally injurious events that may violate their moral code or values, yet almost no research has been conducted on moral injury among health care providers to date. The purpose of this commentary is to describe the relevance of moral injury to health care providers and to spark a dialogue that motivates future research, prevention, and intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Quantitative Volumetric Assessment of Ablative Margins in Hepatocellular Carcinoma: Predicting Local Tumor Progression Using Nonrigid Registration Software.

text: Purpose After radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), pre- and postinterventional contrast-enhanced CT (CECT) images are usually qualitatively interpreted to determine technical success, by eyeballing. The objective of this study was to evaluate the feasibility of quantitative assessment, using a nonrigid CT-CT coregistration algorithm. Materials and Methods 25 patients treated with RFA for HCC between 2009 and 2014 were retrospectively included. Semiautomated coregistration of pre- and posttreatment CECT was performed independently by two radiologists. In scans with a reliable registration, the tumor and ablation area were delineated to identify the side and size of narrowest RFA margin. In addition, qualitative assessment was performed independently by two other radiologists to determine technical success and the anatomical side and size of narrowest margin. Interobserver agreement rates were determined for both methods, and the outcomes were compared with occurrence of local tumor progression (LTP). Results CT-CT coregistration was technically feasible in 18/25 patients with almost perfect interobserver agreement for quantitative analysis (κ = 0.88). The interobserver agreement for qualitative RFA margin analysis was κ = 0.64. Using quantitative assessment, negative ablative margins were found in 12/18 patients, with LTP occurring in 8 of these patients. In the remaining 6 patients, quantitative analysis demonstrated complete tumor ablation and no LTP occurred. Conclusion Feasibility of quantitative RFA margin assessment using nonrigid coregistration of pre- and postablation CT is limited, but appears to be a valuable tool in predicting LTP in HCC patients (p=0.013).


title: Cost assessment of instruments for single-incision laparoscopic cholecystectomy.

text: BACKGROUND AND OBJECTIVES Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed as conventional laparoscopic 4-port cholecystectomy or as single-incision laparoscopic cholecystectomy. METHODS Two consecutive series of patients undergoing single-incision laparoscopic cholecystectomy were assessed: (1) single-incision cholecystectomy using a commercially available multichannel port (n=80) and (2) a modified single-incision cholecystectomy using 2 regular trocars inserted through the umbilicus (n=20) with transabdominal sutures for gallbladder mobilization (puppeteering technique). Patients who underwent conventional 4-port cholecystectomy during the same time period (n=100) were selected as controls. RESULTS The instrumental cost of the single-incision cholecystectomy using a commercial port was significantly higher (median, $1123) than the cost for conventional 4-port (median $441, P < .0005) and modified single-incision cholecystectomy (median $342, P < .0005). The cost of the modified single-incision procedure was significantly lower than that for the 4-port cholecystectomy (P < .0005). CONCLUSION The modified single-incision procedure using 2 regular ports inserted through the umbilicus can be performed at lower cost than conventional 4-port cholecystectomy.


title: Obstetrics and COVID-19.

text: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome corona virus 2 (SARS-Cov-2), an RNA virus which has caused pandemic in the whole world. It has put an unprecedented burden on healthcare system globally, and neither obstetricians nor labour rooms are spared as deliveries and caesarean sections cannot be postponed. There is a threat of collapse of healthcare system in maternity wards and labour rooms due to risk for transmission to healthy patients, obstetricians, midwives and other staff. It is not possible to screen all pregnant women especially in developing countries but due to asymptomatic cases, risk of infection looms large. Many countries including India have declared lockdown to stop the transmission but delivery services have to continue. Proper planning and division of the healthcare system into COVID-positive and negative areas with separate staff can help minimise the spread and preserve precious resources. Hospital staff must protect themselves by wearing personal protective equipment (PPE) in COVID-positive and suspected cases.


title: Long-term potency, sterility, and stability of vancomycin, ceftazidime, and moxifloxacin for treatment of bacterial endophthalmitis.

text: PURPOSE To determine the long-term potency, sterility, and stability of vancomycin, ceftazidime, and moxifloxacin prepared in single-use polypropylene syringes for intravitreal injection. METHODS Experimental study. Vancomycin 1 mg/0.1 mL, ceftazidime 2 mg/0.1 mL, and moxifloxacin 160 μg/0.1 mL were compounded and prepared in 1-mL polypropylene syringes and stored at 4 °C, -20 °C, and -80 °C. Antibiotic potency, sterility, pH, osmolality, and concentration were tested at baseline and at 1, 2, 4, 8, 12, and 24 weeks after preparation. RESULTS Potency, sterility, and stability were preserved for all 3 antibiotics at all temperatures out to 24 weeks, although there was a trend toward reduced potency at Week 24 for vancomycin and ceftazidime stored at 4°C. The largest zones of inhibition for Staphylococcus epidermidis and S. aureus were consistently demonstrated by moxifloxacin. CONCLUSION Vancomycin, ceftazidime, and moxifloxacin prepared in single-use polypropylene syringes retain potency, sterility, and stability out to 24 weeks when stored at -20 °C or -80 °C. The results of this study may have important implications for the current management of endophthalmitis.


title: Histological and prognostic data on surgically resected early-stage lung adenocarcinoma.

text: This article presents supplementary data for the research article by Yotsukura et al. entitled "Prognostic impact of cancer-associated active fibroblasts and invasive architectural patterns on early-stage lung adenocarcinoma" [1], which presented the postoperative prognosis for early-stage lung adenocarcinoma categorized according to histological findings. We included data of 1,032 resected cases of lung adenocarcinoma, which consisted of pathological stage IA invasive cancer and adenocarcinoma in situ resected at National Cancer Center Hospital, Tokyo, Japan, between 2007 and 2012. A pathological review was performed to assess total tumor size, size of invasion, histological subtype, lymphovascular invasion, and presence of cancer-associated active fibroblast (CAF). Tumor recurrence and overall survival were retrospectively recorded. Of the included cases, 166 (16.1%), and 866 (83.9%) were adenocarcinoma in situ and pathological stage IA, respectively. Pathological stage IA adenocarcinoma was further classified based on the histologial subtype and the presence of CAF. This data set may be useful for analyzing the postoperative prognosis of early-stage lung adenocarcinoma, in combination with detailed pathological findings including size of invasion, histological subtype, and presence of CAF.


title: Natura non facit saltus: a phase 2 proposal to manage brain tumors cases from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®).

text: The Coronavirus (COVID 19) pandemic has fast spread throughout the world in more than 200 countries, resulting in the need for a de-prioritization of elective medical care to face the demands of the global health crisis. Although the acute and catastrophic phase of the pandemic seems to have been left behind, it is also clear that the virus will not disappear soon, and we must live with it for a period of unpredictable length, the COVID-19 era. In this setting, a common coordinated approach to treat patients harboring brain tumors is urgently required to guarantee the best updated oncological care and to reduce the risk of viral infection during hospitalization. The study group on Neuro-oncology of Italian Society of Neurosurgery, SINCh gathered pieces of evidence and data and would like to suggest a practice protocol of care for neurosurgical oncologic procedures in the COVID-19 era. The present document is aimed at summarizing current evidence and expert opinions to help neurosurgeons in taking decisions on their patients harboring different brain tumors.


title: Diabetes Outcomes More than a Decade Following Sustained Weight Loss After Laparoscopic Adjustable Gastric Band Surgery.

text: BACKGROUND Long-term outcome data are needed to define the role of bariatric surgery in type 2 diabetes (T2D). To address this, we collated diabetes outcomes more than a decade after laparoscopic adjustable gastric band (LAGB) surgery. METHOD Clinical and biochemical measures from 113 obese T2D patients who underwent LAGB surgery in 2003 and 2004 were analyzed. Diabetes remission was defined as HbA1c < 6.2% (44 mmol/mol) and fasting glucose < 7.0 mmol/L. RESULTS Seventy-nine patients had weight data at 10 years and attained a median [Q1, Q3] weight loss of 16 [10, 21] percent. Sixty patients attended a follow-up assessment. Their baseline HbA1c of 7.8 [7.1, 9.3] percentage units (62 [54, 78] mmol/mol) had decreased to 6.6 [6.1, 8.4] (49 [43, 68] mmol/mol) despite no significant change in glucose-lowering therapy. Eleven patients (18%) were in diabetes remission and another 18 had HbA1c ≤ 6.5%. Significant improvements in physical measures of quality of life, blood pressure, and lipid profile were also observed but there was no change in the proportion of patients with albuminuria and a significant decline in estimated glomerular filtration rate. Twelve patients in the follow-up cohort (20%) required anti-reflux medication after surgery and 26 (43%) underwent gastric band revision surgery. CONCLUSION Weight loss for over 10 years after LAGB surgery delivers clinically meaningful improvements in HbA1c, blood pressure, lipids, and quality of life at the cost of a high rate of revision surgery and increased use of anti-reflux medication. These findings support the use of bariatric surgery as a long-term treatment for weight loss and wellbeing in patients with T2D. STUDY REGISTRATION Registered with the Australian Clinical trials registry as ACTRN12615000089538.


Pure red blood cell aplasia and isoniazid use.


title: Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients: The ADAPT-DES Study.

text: BACKGROUND Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuating P2Y12 receptor inhibition. Previous observational and randomized trials report conflicting results regarding the clinical significance of this pharmacological interaction. We examined the interaction between concomitant administration of PPI and clopidogrel on platelet reactivity and clinical outcomes in the large-scale, prospective Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents study. METHODS AND RESULTS On-treatment P2Y12 platelet reactivity testing was performed using the VerifyNow assay after clopidogrel loading and successful drug-eluting stent implantation at 11 sites in the United States and Germany. PPIs were prescribed at the discretion of treating physicians; patients were followed for 2 years. High platelet reactivity was defined as P2Y12 reactivity units >208. Of 8582 enrolled patients, 2697 (31.4%) were taking a PPI at the time of coronary intervention. After adjustment for differences in baseline characteristics, PPI use was independently associated with high platelet reactivity (odds ratio, 1.38: 95% confidence interval, 1.25-1.52, P=0.0001). A total of 2162 (25.2%) patients were prescribed a PPI at hospital discharge. In a propensity-adjusted multivariable analysis, discharge PPI use was independently associated with increased risk for postdischarge major adverse cardiac events (cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 2-year follow-up (hazard ratio, 1.21; 95% confidence interval, 1.04-1.42, P=0.02). CONCLUSIONS In patients treated with clopidogrel after successful drug-eluting stents implantation, the concomitant administration of PPI was associated with high platelet reactivity and a greater rate of adverse outcomes during long-term follow-up. Additional studies are warranted to determine the risk-benefit ratio of PPIs in patients with drug-eluting stents treated with clopidogrel. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.


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title: Rectocele repair by anterolateral rectopexy: long-term functional outcome.

text: INTRODUCTION Rectoceles are frequently associated with feelings of pelvic discomfort and symptoms of obstructed defaecation (OD). Repair by a transvaginal or transanal approach might result in de novo dyspareunia in up to approximately 40% of the cases. This study was designed to investigate whether anterolateral rectopexy provides an adequate rectocele repair without dyspareunia as a side effect. METHOD A consecutive series of 33 women (median age 55 years; range: 37-73) with a symptomatic rectocele (depth > 3 cm) underwent anterolateral rectopexy. Before the operation, all patients underwent evacuation proctography (EP), which was repeated 6 months after the repair in all but three patients. A standardized questionnaire concerning pelvic discomfort, OD and dyspareunia was used to assess the long-term effect of rectocele repair. The response rate was 91%. RESULTS Six months after the procedure, EP revealed a recurrent or persistent rectocele in six patients (20%). However, in four of these six patients, the depth of the rectocele was < 3 cm. The median duration of follow-up was 74 months (range: 2-96). Among the patients with an adequate repair, signs of OD persisted in 55%. None of the patients encountered de novo dyspareunia after the procedure. CONCLUSION Anterolateral rectopexy provides an effective tool for anatomical correction of rectoceles and does not result in dyspareunia as a side effect. However, despite adequate repair, OD persist in the majority of patients.


Challenges in COVID-19: is pulmonary thromboembolism related to overall severity?


title: A prospective single-center study of sentinel lymph node detection in cervical carcinoma: is there a place in clinical practice?

text: OBJECTIVE To establish the accuracy of sentinel lymph node (SLN) detection in early cervical cancer. MATERIALS AND METHODS Sentinel lymph node detection was performed prospectively over a 6-year period in 86 women undergoing surgery for cervical carcinoma by the combined method (Tc-99m and methylene blue dye). Further ultrastaging was performed on a subgroup of 26 patients who had benign SLNs on initial routine histological examination. RESULTS The SLN was detected in 84 (97.7%) of 86 women by the combined method. Blue dye uptake was not seen in 8 women (90.7%). Sentinel lymph nodes were detected bilaterally in 63 women (73.3%), and the external iliac region was the most common anatomic location (48.8%). The median SLN count was 3 nodes (range, 1-7). Of the 84 women with sentinel node detection, 65 also underwent bilateral pelvic lymph node dissection, and in none of these cases was a benign SLN associated with a malignant non-SLN (100% negative predictive value). The median non-SLN count for all patients was 19 nodes (range, 8-35). Eighteen patients underwent removal of the SLN without bilateral pelvic lymph node dissection. Nine women (10.5%) had positive lymph nodes on final histology. One patient had bulky pelvic nodes on preoperative imaging and underwent removal of the negative bulky malignant lymph nodes and a benign SLN on the contralateral side. This latter case confirms the unreliability of the SLN method with bulky nodes. The remaining 8 patients had positive SLNs with negative nonsentinel lymph nodes. Fifty-nine SLNs from 26 patients, which were benign on initial routine histology, underwent ultrastaging, but no further disease was identified. Four patients (5%) relapsed after a median follow-up of 28 months (range, 8-80 months). CONCLUSION Sentinel lymph node detection is an accurate and safe method in the assessment of nodal status in early cervical carcinoma.


title: Evaluation of a novel strain of infectious bronchitis virus emerged as a result of spike gene recombination between two highly diverged parent strains.

text: The emergence of new variant strains of the poultry pathogen infectious bronchitis virus (IBV) is continually reported worldwide, owing to the labile nature of the large single-stranded RNA IBV genome. High resolution melt curve analysis previously detected a variant strain, N1/08, and the present study confirmed that this strain had emerged as a result of recombination between Australian subgroup 2 and 3 strains in the spike gene region, in a similar manner reported for turkey coronaviruses. The S1 gene for N1/08 had highest nucleotide similarity with subgroup 2 strains, which is interesting considering subgroup 2 strains have not been detected since the early 1990s. SimPlot analysis of the 7.2-kb 3' end of the N1/08 genome with the same region for other Australian reference strains identified the sites of recombination as immediately upstream and downstream of the S1 gene. A pathogenicity study in 2-week-old chickens found that N1/08 had similar pathogenicity for chicken respiratory tissues to that reported for subgroup 2 strains rather than subgroup 3 strains. The results of this study demonstrate that recombination is a mechanism utilized for the emergence of new strains of IBV, with the ability to alter strain pathogenicity in a single generation.


title: Communications in public health emergency preparedness: a systematic review of the literature.

text: During a public health crisis, public health agencies engage in a variety of public communication efforts to inform the population, encourage the adoption of preventive behaviors, and limit the impact of adverse events. Given the importance of communication to the public in public health emergency preparedness, it is critical to examine the extent to which this field of study has received attention from the scientific community. We conducted a systematic literature review to describe current research in the area of communication to the public in public health emergency preparedness, focusing on the association between sociodemographic and behavioral factors and communication as well as preparedness outcomes. Articles were searched in PubMed and Embase and reviewed by 2 independent reviewers. A total of 131 articles were included for final review. Fifty-three percent of the articles were empirical, of which 74% were population-based studies, and 26% used information environment analysis techniques. None had an experimental study design. Population-based studies were rarely supported by theoretical models and mostly relied on a cross-sectional study design. Consistent results were reported on the association between population socioeconomic factors and public health emergency preparedness communication and preparedness outcomes. Our findings show the need for empirical research to determine what type of communication messages can be effective in achieving preparedness outcomes across various population groups. They suggest that a real-time analysis of the information environment is valuable in knowing what is being communicated to the public and could be used for course correction of public health messages during a crisis.


title: Influence of radiofrequency ablation of lung cancer on pulmonary function.

text: PURPOSE The purpose of this study was to evaluate altered pulmonary function retrospectively after RFA. METHODS This retrospective study comprised 41 ablation sessions for 39 patients (22 men and 17 women; mean age, 64.8 years). Vital capacity (VC) and forced expiratory volume in 1 s (FEV(1)) at 1 and 3 months after RFA were compared with the baseline (i.e., values before RFA). To evaluate the factors that influenced impaired pulmonary function, univariate analysis was performed by using multiple variables. If two or more variables were indicated as statistically significant by univariate analysis, these variables were subjected to multivariate analysis to identify independent factors. RESULTS The mean VC and FEV(1) before RFA and 1 and 3 months after RFA were 3.04 and 2.24 l, 2.79 and 2.11 l, and 2.85 and 2.13 l, respectively. The values at 1 and 3 months were significantly lower than the baseline. Severe pleuritis after RFA was identified as the independent factor influencing impaired VC at 1 month (P = 0.003). For impaired FEV(1) at 1 month, only severe pleuritis (P = 0.01) was statistically significant by univariate analysis. At 3 months, severe pleuritis (VC, P = 0.019; FEV(1), P = 0.003) and an ablated parenchymal volume ≥20 cm(3) (VC, P = 0.047; FEV(1), P = 0.038) were independent factors for impaired VC and FEV(1). CONCLUSIONS Pulmonary function decreased after RFA. RFA-induced severe pleuritis and ablation of a large volume of marginal parenchyma were associated with impaired pulmonary function.


title: Invited review: Relationship between cattle transport, immunity and respiratory disease.

text: The association between transportation and the occurrence of the bovine respiratory disease complex (BRDC) has long been recognised. Many hypotheses regarding this association have been declared through the past decades, and it is agreed upon by most researchers that the multiple stressors that calves experience during transportation result in an overall immunosuppression that allows the respiratory tract to be invaded by numerous opportunistic pathogens. Furthermore, the innate immune cells, neutrophils, may be trapped in a paradox whereby their crucial defence and pathogen-killing activities are counteracted by excessive inflammation and tissue damage that may exacerbate disease, including the BRDC. Neutrophilia in response to glucocorticoids has been attributed to an influx of immature neutrophils newly released from the bone marrow, a decrease in neutrophil margination along endothelial walls, and a decrease in neutrophil apoptosis. Several of these explanations have been confirmed by altered expression of genes and proteins important for neutrophil margination and apoptosis.


Risk of an Increase in Suicide Rates Associated With Economic Downturn due to COVID-19 Pandemic.


title: Laparoscopic partial splenectomy using a detachable clamp with and without partial splenic embolisation.

text: BACKGROUND In many centres, the laparoscopic total splenectomy is a well-established routine procedure. However, the crucial immunological role of the spleen in combating bacterial infections, in particular pneumonias, has led to a search for splenic-preserving techniques whenever possible. Yet, laparoscopic partial splenectomies are still rarely described possibly due to difficulties in controlling intra-operative parenchymal bleeding during splenic transection. METHODS Here, we present a case series of laparoscopic partial splenectomies using a new technique. The main splenic artery and vein were temporarily clamped using a detachable clip. Transection of the spleen was possible working with the LigaSure™ instrument. After transection, the margin was sealed with a collagen fleece. In one case of a haemangioma, the patient underwent a radiological coil embolisation of the feeding arteries of the splenic pole in question. This was done 4 weeks prior to surgery and included embolisation of the tumour. RESULTS Three patients (2 males, 1 female, mean age 58.3 years) have been successfully treated using a detachable clamp. The pre-surgical mean size of the spleen was 8.0 × 16.7 cm (range 6 × 14-11 × 22 cm). The removed specimens had a mean size of 4.2 × 5.5 cm (range 2.5 × 4.0-5.0 × 6.5 cm). The time of surgery averaged 144 min (range 110-187 min). Blood loss was minimal thereby avoiding the need for blood transfusions. The post-surgical course was uneventful; patients were discharged 5 days following surgery. Histopathology showed a benign splenic haemangioma, a benign splenic hamartoma and the presence of Hodgkin's disease stage III. CONCLUSIONS The technique of laparoscopic partial splenectomy and, in certain patients, pre-surgical partial splenic embolisation is safe and effective for patients with localised diseases of the spleen. This approach combines the benefits of the minimal surgical access with saving a significant amount of splenic tissue, thereby preserving the immune function of the spleen.


Oseltamivir resistance during treatment of H7N9 infection.


title: Ibogaine labeling with 99mTc-tricarbonyl: synthesis and transport at the mouse blood-brain barrier.

text: The (99m)Tc-tricarbonyl core may be used as an ideal tool for gamma-labeling ligands in noninvasive SPECT imaging. However, most (99m)Tc-tricarbonyl-labeled agents have difficulty crossing the blood-brain barrier (BBB). We radiolabeled the neuroactive indole ibogaine with (99m)Tc-tricarbonyl and measured its transport into the mouse brain by in situ brain perfusion. We measured the interactions of [(99m)Tc(CO)(3)-ibogaine](+) and (99m)Tc-tricarbonyl with the main BBB efflux transporters P-gp and BCRP in vitro and in vivo. Ibogaine was radiolabeled (yield: over 95%). [(99m)Tc(CO)(3)-ibogaine](+) entered the brain (K(in)) poorly (0.18 microL/g/s), at about the same rate as (99m)Tc-tricarbonyl (0.16 microL/g/s) and [(99m)Tc-sestamibi](+) (0.10 microL/g/s). The CNS tracer [(99m)Tc-HMPAO](0) entered the brain approximately 70-times higher than [(99m)Tc(CO)(3)-ibogaine](+). In vitro studies revealed that neither [(99m)Tc(CO)(3)-ibogaine](+) nor (99m)Tc-tricarbonyl ion were substrates for P-gp or BCRP. But lowering the membrane dipole potential barrier with phloretin enhanced the brain transport of [(99m)Tc(OH(2))(3)(CO)(3)](+) approximately 3-fold. Thus, ibogaine directly labeled with (99m)Tc-tricarbonyl is not suitable for CNS imaging because of its poor uptake. Brain transport is not restricted by efflux transporters but is reduced by its lipophilicity and interaction with the membrane-positive dipole potential.


title: Sleep and breathing disorders in myotonic dystrophy type 2.

text: OBJECTIVES In patients who exhibit myotonic dystrophy type 1 (DM1), sleep disorders and breathing impairments are common; however, in those with DM type 2 (DM2), limited studies on polysomnography (PSG) and none on phrenic compound motor action potential (CMAP) have been performed, which is the aim of this study. MATERIALS AND METHODS Sixteen patients with DM2 were questioned about respiratory symptoms. They underwent PSG with morning arterial gas analyses (AGA). Respiratory functions and phrenic CMAPs were studied. The data were compared to those of 16 healthy controls and 25 patients with DM1. RESULTS Daytime tiredness is the most common symptom, but orthopnea was reported in 13% of patients with DM2. A detailed sleep architecture analysis revealed a significantly greater proportion of time in stage 3 and REM sleep, and a shorter time in stage 2 in the DM2 than in controls. Lower respiratory volumes and pressures, abnormalities in AGA, night oxygen desaturation and higher EtCO2 are present in DM2, but are less pronounced than in the DM1 population. Small CMAP amplitudes were presented in 12% of patients with DM2, correlating with smaller respiratory functions and poorer sleep quality. AHI was abnormal in 38% of DM2, mainly due to obstructive apneas. PSG did not reveal hypoventilation. CONCLUSIONS Diaphragm weakness and sleep apneas might be present in patients with DM2; therefore, we suggest regular questioning about symptoms of respiratory insufficiency and monitoring of phrenic CMAP. PSG should be recorded, when patients have suggestive symptoms, abnormalities in AGA or higher BMI.


title: Congenital pigmented nevi of the auricle: clinical experience and approach to treatment.

text: BACKGROUND Congenital pigmented nevi of the auricle are uncommon. The authors' approach is to excise these nevi and perform reconstruction because of the risk of malignant transformation and the aesthetic and psychological effects these nevi can have on the child. This study presents the authors' experience in treating congenital nevi of the ear and suggests treatment principles and guidelines for the reconstructive surgeon. METHODS Fourteen patients with congenital nevus of the ear were treated from October of 1992 to September of 2008 by the senior surgeon (B.S.B.). Nevi involving the more stable areas such as the concha can be resected and grafted early; the antihelix, scapha, and triangular fossa area can be resected and grafted next; and the helical rim, having the most easily distorted cartilage, should be treated last. Lobule reconstruction requires combined flaps and a dermal fat graft or a postauricular fascial fat flap. RESULTS Successful reconstruction was achieved in 10 patients. Three patients require final revision procedures (lobule reconstruction). One patient, early in our series, developed a deformed helical rim resulting from skin grafting at age 16 months, before the cartilage was firm enough to withstand the contraction forces of the skin graft. All subsequent patients with helical rim involvement had treatment delayed until the ear was at or near completion of its growth. CONCLUSIONS Congenital nevi of the ear present a challenging reconstruction surgeon. The authors developed a treatment plan that breaks the ear down to aesthetic units and considers the location of the nevus, patient age, and the firmness of the cartilage.


title: Streptococcus suis: a re-emerging pathogen associated with occupational exposure to pigs or pork products. Part I - Epidemiology.

text: Streptococcus suis (ex Elliot 1966, Kilpper-Bälz & Schleifer 1987) is a facultatively anaerobic Gram-positive ovoid or coccal bacterium surrounded by a polysaccharide capsule. Based on the antigenic diversity of the capsule, S. suis strains are classified serologically into 35 serotypes. Streptococcus suis is a commensal of pigs, commonly colonizing their tonsils and nasal cavities, mostly in weaning piglets between 4-10 weeks of age. This species occurs also in cattle and other mammals, in birds and in humans. Some strains, mostly those belonging to serotype 2, are also pathogenic for pigs, as well as for other animals and humans. Meningitis is the primary disease syndrome caused by S. suis, both in pigs and in humans. It is estimated that meningitis accounted for 68.0% of all cases of human disease reported until the end of 2012, followed by septicaemia (including life-threatening condition described as 'streptococcal toxic shock-like syndrome' - STSLS), arthritis, endocarditis, and endophthalmitis. Hearing loss and/or ves tibular dysfunction are the most common sequelae after recovery from meningitis caused by S. suis, occurring in more than 50% of patients. In the last two decades, the number of reported human cases due to S. suis has dramatically increased, mostly due to epidemics recorded in China in 1998 and 2005, and the fulminant increase in morbidity in the countries of south-eastern Asia, mostly Vietnam and Thailand. Out of 1,642 cases of S. suis infections identified between 2002-2013 worldwide in humans, 90.2% occurred in Asia, 8.5% in Europe and 1.3% in other parts of the globe. The human disease has mostly a zoonotic and occupational origin and occurs in pig breeders, abattoir workers, butchers and workers of meat processing facilities, veterinarians and meat inspectors. Bacteria are transmitted to workers by close contact with pigs or pig products, usually through contamination of minor cuts or abrasions on skin of hands and/or arms, or by pig bite. A different epidemiologic situation occurs in the Southeast Asian countries where most people become infected by habitual consumption of raw or undercooked pork, blood and offal products in the form of traditional dishes. Prevention of S. suis infections in pigs includes vaccination, improvement in pig-raising conditions, disinfection and/or fumigation of animal houses, and isolation of sick animals at the outbreak of disease. Prevention of human infections comprises: protection of skin from pig bite or injury with sharp tools by people occupationally exposed to pigs and pig products, prompt disinfection and dressing of wounds and abrasions at work, protection of the respiratory tract by wearing appropriate masks or repirators, consulting a doctor in the case of febrile illness after exposure to pigs or pork meat, avoidance of occupations associated with exposure to pigs and pork by immunocompomised people, avoidance of consumption of raw pork or pig blood, adequate cooking of pork, and health education.


My lab is closed to me because of the coronavirus. Here's how I'm planning to stay productive.


title: Review: Delivering mental health support within schools and colleges - a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents.

text: BACKGROUND Increasing the role of schools and colleges in the provision of mental health services for young people has the potential to improve early intervention and access to treatment. We aimed to understand what factors influence the successful implementation of indicated psychological interventions within schools and colleges to help guide increased provision of mental health support within education settings. METHODS Systematic search for studies that have reported barriers or facilitators to the implementation of indicated interventions for adolescent emotional disorders delivered within schools and further education/sixth form colleges (CRD42018102830). Databases searched were EMBASE, MEDLINE, PsycINFO, CINAHL, British Nursing Index, ASSIA, ERIC and British Education Index. A thematic synthesis of factors reported to impact implementation was conducted. RESULTS Two thousand five hundred and sixty-nine records and 177 full texts were screened. Fifty studies were identified for inclusion, all of which were of school-based interventions. Eleven analytic themes were developed encompassing intervention characteristics, organisational capacity, training and technical assistance, provider characteristics and community-level factors. Findings indicate the need to select appropriate interventions, consider logistical challenges of the school context and provide training and supervision to enable staff to deliver interventions with fidelity. However, structural and environmental support is required for these facilitators to have the greatest impact on successful implementation. CONCLUSIONS Implementing indicated school-based mental health interventions is challenging. Those involved in planning school-based mental health initiatives must be alert to the impact of factors on multiple interacting levels. There is a lack of research on implementing mental health support within further education and sixth form colleges. KEY PRACTITIONER MESSAGE Increased utilisation of schools and colleges as a setting for early intervention has been proposed as a means of improving access to mental health treatment, but successful implementation of mental health interventions within educational settings is challenging. Based on a synthesis of current evidence, we recommend that young people and education professionals should be involved in the selection of school-based interventions to ensure they are acceptable and practical to deliver within the logistical constraints of the school environment. Those delivering interventions within schools, as well as staff involved in identifying young people who might benefit from these interventions, must receive high-quality ongoing training and support. Senior school leaders play an important role in championing mental health interventions and developing a school culture that prioritises mental well-being. Health and education policy should be designed to promote a cross-sector focus on the emotional health of young people. There is a lack of evidence on the implementation of indicated psychological interventions within sixth form and further education colleges.


Isopathic Remedy Prepared from Convalescent Plasma as a Therapeutic Option for COVID-19?


title: Can a NICO monitor substitute for thermodilution to measure cardiac output in patients with coexisting tricuspid regurgitation?

text: PURPOSE The validity of measuring cardiac output (CO) using thermodilution via pulmonary artery catheterization in the presence of tricuspid regurgitation (TR) remains controversial. METHODS We compared the accuracy and precision of a non-invasive cardiac output (NICO) monitor and of thermodilution with those of transesophageal echocardiography (TEE) to measure CO in 50 patients who underwent elective valvoplasty to treat TR (26 mild and 24 moderate-to-severe) and in 25 normal controls (without TR). We used TEE as a reference method to measure CO and to intraoperatively grade TR. RESULTS The differences between NICO monitor and TEE measurements in patients without TR and in those with mild and with moderate-to-severe TR were -0.17 +/- 0.88 (n = 150, r (2) = 0.75), -0.16 +/- 0.82 (n = 158, r (2) = 0.78), and 0.17 +/- 0.91 L/min (n = 155, r (2) = 0.78), respectively. The differences between bolus thermodilution cardiac output and TEE measurements in patients without TR and in those with mild and with moderate-to-severe TR were -0.08 +/- 0.55 (r (2) = 0.88), 0.05 +/- 0.61 (r (2) = 0.86), and 0.43 +/- 1.37 L/min (r (2) = 0.58), respectively. CONCLUSION These findings demonstrate that measuring CO using the thermodilution technique is less accurate in patients with moderate-to-severe TR and that the NICO monitor is more accurate for such patients. We postulate that the NICO monitor measures CO more accurately and reproducibly than thermodilution in patients with coexisting TR.


title: Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients.

text: PURPOSE The aim of our study was to evaluate the efficacy of microwave (MW) ablation of liver metastases guided by B-mode ultrasound (US) and contrast-enhanced US (CEUS). MATERIALS AND METHODS 39 patients (17 women and 22 men) with a total of 125 liver metastases were treated with percutaneous or intraoperative CEUS-guided MW ablation. The primary tumor was colorectal cancer (n = 31), breast cancer (n = 6), carcinoid tumor (n = 1), and gastrointestinal stromal tumor (GIST) (n = 1). The median number of metastases ablated in the 45 treatment sessions was 2 (range 1 - 11). The median size (maximum diameter) of the 125 metastases was 1.5 cm (range, 0.6 - 4.0 cm). Nineteen (15 %) of the 125 metastases were bigger than 2 cm. Metastases smaller than 2 cm were treated with a single needle, metastases bigger than 2 cm were treated with 2 or 3 parallel needles. RESULTS The 45 MW ablation sessions were performed percutaneously (n = 30), during laparotomy (n = 3), or during laparotomy combined with liver resection (n = 12). The 39 patients were followed up for at least 4 months with a median duration of 11 months (range, 4 - 20 months). The technical success rate was 100 %. The clinical effectiveness was 100 % with complete coverage of the metastasis by the avascular coagulation zone evaluated on immediate post-ablation CEUS. Local tumor progression (local recurrence) was seen in 12 (9.6 %) of the 125 treated metastases, and affected 10 (26 %) of the 39 patients. One major complication was observed in the form of a liver abscess that easily resolved after percutaneous drainage. Four minor complications were observed: Three cases of pain located at the puncture site and one case of ascites. CEUS was valuable in all phases of ablation including pre-ablation staging and procedure planning, placement of MW needles in the tumor, immediate post-ablation control of coagulation size, and finally in the long term follow-up regime. CONCLUSION CEUS-guided MW ablation of liver metastases is an efficient and safe ablation technique with several advantages compared to other ablation modalities.


title: The trajectory of loneliness in response to COVID-19.

text: Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread. A nationwide sample of American adults (N = 1,545; 45% women; ages 18 to 98, M = 53.68, SD = 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President's initial "15 Days to Slow the Spread" campaign), and in late April (during the "stay-at-home" policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d = .04, p > .05). In fact, respondents perceived increased support from others over the follow-up period (d = .19, p < .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d = .14, p < .05). Their loneliness, however, leveled off after the issuance of stay-at-home orders. Individuals living alone and those with at least one chronic condition reported feeling lonelier at baseline but did not increase in loneliness during the implementation of social distancing measures. Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease.

text: IMPORTANCE Atherosclerotic vertebrobasilar (VB) occlusive disease is a significant etiology of posterior circulation stroke, with regional hypoperfusion as an important potential contributor to stroke risk. OBJECTIVE To test the hypothesis that, among patients with symptomatic VB stenosis or occlusion, those with distal blood flow compromise as measured by large-vessel quantitative magnetic resonance angiography (QMRA) are at higher risk of subsequent posterior circulation stroke. DESIGN, SETTING, AND PARTICIPANTS A prospective, blinded, longitudinal cohort study was conducted at 5 academic hospital-based centers in the United States and Canada; 82 patients from inpatient and outpatient settings were enrolled. Participants with recent VB transient ischemic attack or stroke and 50% or more atherosclerotic stenosis or occlusion in vertebral and/or basilar arteries underwent large-vessel flow measurement in the VB territory using QMRA. Physicians performing follow-up assessments were blinded to QMRA flow status. Follow-up included monthly telephone calls for 12 months and biannual clinical visits (for a minimum of 12 months, and up to 24 months or the final visit). Enrollment took place from July 1, 2008, to July 31, 2013, with study completion on June 30, 2014; data analysis was performed from October 1, 2014, to April 10, 2015. EXPOSURE Standard medical management of stroke risk factors. MAIN OUTCOMES AND MEASURES The primary outcome was VB-territory stroke. RESULTS Of the 82 enrolled patients, 72 remained eligible after central review of their angiograms. Sixty-nine of 72 patients completed the minimum 12-month follow-up; median follow-up was 23 (interquartile range, 14-25) months. Distal flow status was low in 18 of the 72 participants (25%) included in the analysis and was significantly associated with risk for a subsequent VB stroke (P = .04), with 12- and 24-month event-free survival rates of 78% and 70%, respectively, in the low-flow group vs 96% and 87%, respectively, in the normal-flow group. The hazard ratio, adjusted for age and stroke risk factors, in the low distal flow status group was 11.55 (95% CI, 1.88-71.00; P = .008). Medical risk factor management at 6-month intervals was similar between patients with low and normal distal flow. Distal flow status remained significantly associated with risk even when controlling for the degree of stenosis and location. CONCLUSIONS AND RELEVANCE Distal flow status determined using a noninvasive and practical imaging tool is robustly associated with risk for subsequent stroke in patients with symptomatic atherosclerotic VB occlusive disease. Identification of high-risk patients has important implications for future investigation of more aggressive interventional or medical therapies.


title: Occult SARS-CoV-2 infection; a possible hypothesis for viral relapse.

text: Coronavirus disease 2019 (COVID-19) has emerged as a global public health emergency, which is characterized by high infection rate and fatal course. Recent data reported that the test for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) RNA might become positive again after one or two consecutively negative tests. Many researchers are currently evaluating the clinical characteristics of the SARS-CoV-2 reactivation. In this letter, we proposed a possible mechanism of SARS-CoV-2 reactivation or relapse after negative nasopharyngeal swabs PCR.


Prone Positioning in Awake, Nonintubated Patients With COVID-19: Necessity Is the Mother of Invention.


title: Poor Left Ventricular Performance in a Child With Coronary Sinus Stenosis: Successful Surgical Repair.

text: Atresia or stenosis of the coronary sinus is a rare congenital defect that can cause marked clinical manifestations, depending on the presence of concomitant anomalies securing adequate coronary venous outflow. We describe a 4.5-year-old boy admitted to the clinic with signs of congestive heart failure (left ventricular ejection fraction, 29%). His condition had deteriorated during the previous 4 months. The examination revealed stenosis of the coronary sinus ostium, coronary sinus-to-left atrium fistula, mitral regurgitation of the second grade, and moderate pulmonary hypertension. The surgical intervention consisted of enlargement and plastic reconstruction of the coronary sinus as well as closure of the coronary sinus-to-left atrium fistula. The hospital period was uneventful. The left ventricular ejection fraction at discharge increased up to 50%.


title: Problematic issues of air protection during thermal processes related to the energetic uses of sewage sludge and other waste. Case study: Co-combustion in peaking power plant.

text: Currently, it is necessary to deal with issues related to the emissions as there is a constantly increasing interest in combusting sludge from sewage treatment plants in the boilers for wood. An analysis of the energetic importance of the combustion of sewage sludge has already been carried out, but the effects of various treatments of the sludge are not always clear, e.g. composting and subsequent combustion to the air pollution. Investments in other thermal processes of energetic utilisation of sewage sludge and organic waste are not always successfully implemented. The objective of this paper is to point out some problematic cases for acceptance of thermal processes related to energetic use of waste in terms of the air protection. The other aim is to mention the experience with solutions of such issues in Slovakia. There are mentioned first results of the operational validation experiments during the energy generation in circulating fluidized bed boiler in peaking power plant (Power 110MW) with the addition of the so-called alternative fuel based on wood and sewage sludge to the main fuel - black coal (anthracite). And there has already been achieved the highest share of 12.4%w. (dry matter) of sewage sludge in form of compost in blend with black coal, which is technologically viable. Moreover analyzed the problems of the authorization and operation of the co-combustion of sewage sludge and of combustion of products of various kinds of pyrolysis waste - pyrolysis gas and pyrolysis oil are analyzed.


title: Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment.

text: INTRODUCTION Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature. METHODS PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017. RESULTS A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors "no pain" and "worst pain imaginable", with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used. DISCUSSION This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.


title: Demographics and clinical presentation of patients with ocular disorders during the COVID-19 lockdown in India: A report.

text: Purpose The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID-19) lockdown in India. Methods This cross-sectional hospital-based study included patients presenting between March 23, 2020 and April 19, 2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system. Results Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20-52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%), followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to 21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo-retinal procedures (32.86%) followed by trauma related (31.43%). Conclusion The enforcement of the nationwide lockdown due to COVID-19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo-retinal procedure.


title: Cerebrovascular events after a primary percutaneous coronary intervention strategy for acute ST-segment-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial.

text: BACKGROUND Patients with ST-segment-elevation myocardial infarction are at increased risk of cerebrovascular events. We assessed the incidence, predictors, and implications of cerebrovascular events in patients with ST-segment-elevation myocardial infarction managed with a primary percutaneous coronary intervention strategy. METHODS AND RESULTS In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, 72 of 3602 patients (2.0%) experienced at least 1 cerebrovascular event (stroke: 63 patients; transient ischemic attack: 12 patients) during the 3-year follow-up (40.3% within 30 days, 20.8% between 30 days and 1 year, and 38.9% between 1 and 3 years). Stroke was ischemic in 58 (92.1%) patients and hemorrhagic in 5 (7.9%) patients. More than half of all strokes (52.3%) were disabling. By principal management strategy, cerebrovascular events developed in 2.0%, 14.9%, and 1.9% of patients triaged to primary percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy, respectively (P<0.0001). Cerebrovascular events were independently predicted by older age, creatinine clearance <60 mL/min, treatment with coronary artery bypass grafting, anemia, and diabetes mellitus. Cerebrovascular events were associated with significantly increased rates of 3-year mortality (20.5% versus 6.5%; P<0.0001), as well as reinfarction (14.3% versus 3.8%; P=0.0007), ischemia-driven target vessel revascularization (22.8% versus 13.0%; P=0.006), and major bleeding (23.5% versus 8.4%; P<0.0001). CONCLUSIONS In HORIZONS-AMI, cerebrovascular events within 3 years after ST-segment-elevation myocardial infarction in patients undergoing a primary percutaneous coronary intervention management strategy occurred in 2.0% of patients and were most frequent after coronary artery bypass grafting. Cerebrovascular events were often disabling and were strongly associated with high rates of death, reinfarction, recurrent ischemia, and major bleeding. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00433966.