title: An examination of the predictors of blood donors' intentions to donate during two phases of an avian influenza outbreak.

text: BACKGROUND Data from prior health scares suggest that an avian influenza outbreak will impact on people's intention to donate blood; however, research exploring this is scarce. Using an augmented theory of planned behavior (TPB), incorporating threat perceptions alongside the rational decision-making components of the TPB, the current study sought to identify predictors of blood donors' intentions to donate during two phases of an avian influenza outbreak. STUDY DESIGN AND METHODS Blood donors (n = 172) completed an on-line survey assessing the standard TPB predictors as well as measures of threat perceptions from the health belief model (i.e., perceived susceptibility and severity). Path analyses examined the utility of the augmented TPB to predict donors' intentions to donate during a low- and high-risk phase of an avian influenza outbreak. RESULTS In both phases, the model provided a good fit to the data explaining 69% (low risk) and 72% (high risk) of the variance in intentions. Attitude, subjective norm, and perceived susceptibility significantly predicted donor intentions in both phases. Within the low-risk phase, sex was an additional significant predictor of intention, while in the high-risk phase, perceived behavioral control was significantly related to intentions. CONCLUSIONS An augmented TPB model can be used to predict donors' intentions to donate blood in a low-risk and a high-risk phase of an outbreak of avian influenza. As such, the results provide important insights into donors' decision-making that can be used by blood agencies to maintain the blood supply in the context of an avian influenza outbreak.


title: The Role of Stress Granules and the Nonsense-mediated mRNA Decay Pathway in Antiviral Defence.

text: Eukaryotic cells have evolved a number of survival tactics and quality control pathways that are able to counter intrinsic error-prone mechanisms and allow for maintenance of cellular homeostasis in the face of external stresses. This review will discuss the role of two cellular eukaryotic processes that are vital for maintenance of cellular homeostasis - 1) the nonsense-mediated mRNA decay (NMD) pathway and 2) the transient formation of stress granules (SG) - and explore the current literature on their roles in antiviral defence. Within the NCCR RNA & Disease, the laboratories of Proffs. O. Mühlemann and Volker Thiel teamed up to unravel the roles of NMD and SGs, and their interconnections in defending cells from alphavirus and coronavirus infections.


title: Nurses' Mental Health and Well-Being: COVID-19 Impacts.

text: The editorial will introduce a special section on nurses' mental health and well-being that will showcase results from a groundbreaking pan-Canadian study of nurses' occupational stress. The article series highlights research efforts toward better supporting nurses' mental health. In this editorial, we discuss the importance of this research in light of the COVID-19 pandemic. We review the current stressors faced by nurses and anticipate how nurses' mental health and well-being will be impacted by COVID-19.


EXPRESS: COVID-19 and Acute Ischemic Stroke- A Case Series from Dubai, UAE.


title: Mechanical removal of a refluxed Onyx piece from the middle cerebral artery using the Solitaire Stent: Technical report.

text: Onyx reflux into the parent artery is a rare and sometimes significant complication in the treatment of cerebral arteriovenous malformations (AVMs). We report a patient who presented with Onyx reflux into the M1 segment of the middle cerebral artery (MCA) during embolization of a right temporal AVM. The refluxed Onyx cast was successfully removed by a mechanical thrombectomy device using a self-expandable and fully retrievable Solitaire AB stent.


title: Consideration of prevention and management of long-term consequences of post-acute respiratory distress syndrome in patients with COVID-19.

text: This manuscript provides support for physical therapists to focus on the long-term, as well as the short-term, consequences of acute respiratory distress syndrome (ARDS) associated with COVID-19. Since late November 2019, COVID-19 has become a global health pandemic and threat. Although most people have no or mild symptoms, COVID-19 spreads aggressively and can lead to ARDS rapidly in a proportion of individuals. The evidence supports that gas exchange and countering the negative effects of bed rest and immobility are priorities in severely affected patients admitted to the intensive care unit (ICU). However, in recent years, research has focused on poor long-term functional outcomes in patients with ARDS, often associated with ICU-acquired weakness, deconditioning, and myopathies and neuropathies. In addition to physical therapists providing respiratory support in the ICU, the literature unequivocally supports the view that early intervention for ICU management of patients with ARDS secondary to COVID-19 needs to focus on reducing contributors to impaired long-term function, with direct attention paid to preventing or managing ICU-acquired weakness, deconditioning, and myopathies and neuropathies, in conjunction with respiratory care.


CPR in the Covid-19 Era - An Ethical Framework.


title: Patent Ductus Arteriosus and Brain Volume.

text: BACKGROUND AND OBJECTIVES A hemodynamically significant patent ductus arteriosus (PDA) can compromise perfusion and oxygenation of the preterm brain. Reports suggest that PDA is associated with increased mortality and morbidity. We hypothesize that long-standing low cerebral oxygenation due to PDA might affect brain volume at term equivalent age. METHODS Observational study in 140 infants investigating the relationship between near-infrared spectroscopy-monitored cerebral oxygen saturation (rSco2) and MRI-assessed regional brain volume and maturation of the posterior limb of the internal capsule at term-equivalent age in 3 groups: those whose PDA closed with indomethacin, those who needed additional surgical closure, and matched controls. RESULTS The surgery group had the lowest rSco2 values before closure (n = 35), 48% ± 9.7% (mean ± SD) as compared with the indomethacin (n = 35), 59% ± 10.4 (P < .001), and control groups (n = 70), 66% ± 6.9 (P < .001); the highest postnatal age before effective treatment; and the lowest volumes of most brain regions at term-equivalent age. Multiple linear regression analysis showed a significant effect of preductal closure rSco2 on cerebellar volume in this group. No differences were found in maturation of the posterior limb of the internal capsule. CONCLUSIONS Long-standing suboptimal cerebral oxygenation due to a PDA may negatively influence brain growth, affecting neurodevelopmental outcome.


title: Abdominal Imaging Findings in COVID-19: Preliminary Observations.

text: Background Angiotensin converting enzyme 2 (ACE2), a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019 (COVID-19). Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from 3/27/2020 to 4/10/2020 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included. Abdominal imaging studies performed in these patients were reviewed and salient findings recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results 412 patients (average age 57 years; range 18->90 years; 241 men, 171 women) were evaluated. 224 abdominal imaging studies were performed (radiographs, n=137; ultrasound, n=44; CT, n=42; MRI, n=1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR] 1.03 per year increase, p=0.001) and ICU admission (OR 17.3, p<0.001). Bowel wall abnormalities were seen on 31% of CT scans (13 of 42) and were associated with ICU admission (OR 15.5, p=0.01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT scans in ICU patients (4 of 20). Surgical correlation (n=4) revealed unusual yellow discoloration of bowel (n=3) and bowel infarction (n=2). Pathology demonstrated ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n=2). Of right upper quadrant ultrasounds, 87% (32 of 37) were performed for liver laboratory findings, and 54% (20 of 37) demonstrated a dilated sludge-filled gallbladder suggestive of cholestasis. Patients with a cholecystostomy tube placed (n=4) had negative bacterial cultures. Conclusion Bowel abnormalities and cholestasis were common findings on abdominal imaging of inpatients with COVID-19. Patients who went to laparotomy often had ischemia, possibly due to small vessel thrombosis.


Declaration of conflicts of interest: a 'crooked' line towards scientific integrity.


title: Interleukin-6 as a marker of inflammation secondary to endotracheal intubation in pediatric patients.

text: Ιnterleukin-6 (IL-6) has been identified as an early biochemical marker of inflammation both in animal and human studies. With this study, we sought to examine the development of local inflammation of the glottic tissues in correlation with the duration of intubation in anesthetized pediatric patients. We measured IL-6 levels in the organic material isolated from the tip of the tube post-extubation in 48 children aged 7 months to 14 years old who were submitted to a total of 72 surgical procedures. A statistically significant positive correlation (ρ = 0.28, p = 0.05) was detected among duration of anesthesia and IL-6 concentration. The odds of having detectable IL-6 levels rose by 36.7 % for every 10 min of anesthetic duration (p = 0.045). In conclusion, the increase of IL-6 in relation to the duration of the intubation indicates an increased risk of inflammation.


title: Mental Health and Related Factors of Hospital Nurses.

text: The mental health of hospital nurses is a key health issue in public health promotion during the recovery phase following the Fukushima disaster. In this study, conducted 4 years after the disaster, we analyzed the overall mental health, knowledge, risk perception of radiation, and work and daily life burdens of nurses working at medical institutions in the Fukushima Prefecture (collection rate = 89.6%; response number = 730). Overall mental health status was estimated using the 12-item version of the General Health Questionnaire, and 333 respondents (45.6%) scored above the 12-item General Health Questionnaire threshold point (≥4), indicating probable emotional distress compared with the general population under normal circumstances. Multivariate logistic analysis suggested that the ability to cope with daily life and work-related stressors were more important than risk perception and acquisition of knowledge regarding radiation and its control methods for supporting the mental health of nurses following the Fukushima disaster.


title: Clinical next-generation sequencing in patients with non-small cell lung cancer.

text: BACKGROUND A clinical assay was implemented to perform next-generation sequencing (NGS) of genes commonly mutated in multiple cancer types. This report describes the feasibility and diagnostic yield of this assay in 381 consecutive patients with non-small cell lung cancer (NSCLC). METHODS Clinical targeted sequencing of 23 genes was performed with DNA from formalin-fixed, paraffin-embedded (FFPE) tumor tissue. The assay used Agilent SureSelect hybrid capture followed by Illumina HiSeq 2000, MiSeq, or HiSeq 2500 sequencing in a College of American Pathologists-accredited, Clinical Laboratory Improvement Amendments-certified laboratory. Single-nucleotide variants and insertion/deletion events were reported. This assay was performed before methods were developed to detect rearrangements by NGS. RESULTS Two hundred nine of all requisitioned samples (55%) were successfully sequenced. The most common reason for not performing the sequencing was an insufficient quantity of tissue available in the blocks (29%). Excisional, endoscopic, and core biopsy specimens were sufficient for testing in 95%, 66%, and 40% of the cases, respectively. The median turnaround time (TAT) in the pathology laboratory was 21 days, and there was a trend of an improved TAT with more rapid sequencing platforms. Sequencing yielded a mean coverage of 1318×. Potentially actionable mutations (ie, predictive or prognostic) were identified in 46% of 209 samples and were most commonly found in KRAS (28%), epidermal growth factor receptor (14%), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (4%), phosphatase and tensin homolog (1%), and BRAF (1%). Five percent of the samples had multiple actionable mutations. A targeted therapy was instituted on the basis of NGS in 11% of the sequenced patients or in 6% of all patients. CONCLUSIONS NGS-based diagnostics are feasible in NSCLC and provide clinically relevant information from readily available FFPE tissue. The sample type is associated with the probability of successful testing.


title: Components reuse in the building sector - A systematic review.

text: Widespread reuse of building components can promote the circularity of materials in the building sector. However, the reuse of building components is not yet a mainstream practise. Although there have been several studies on the factors affecting the reuse of building components, there is no single study that has tried to harmonize the circumstances affecting this intervention. Through a systematic literature review targeting peer-reviewed journal articles, this study intends to identify and stratify factors affecting the reuse of components of the superstructure of a building and eventually delineate correlations between these factors. Factors identified throughout this study are classified into six major categories and 23 sub-categories. Then the inter-dependencies between the barriers are studied by developing the correlation indices between the sub-categories. Results indicate that addressing the economic, social and regulatory barriers should be prioritized. Although the impact of barriers under perception, risk, compliance and market sub-categories are very pronounced, the highest inter-dependency among the sub-categories is found between perception and risk. It suggests that the perception of the stakeholders about building components reuse is affected by the potential risks associated with this intervention.


title: An inexpensive and portable microchip-based platform for integrated RT-PCR and capillary electrophoresis.

text: We present an inexpensive, portable and integrated microfluidic instrument that is optimized to perform genetic amplification and analysis on a single sample. Biochemical reactions and analytical separations for genetic analysis are performed within tri-layered glass-PDMS microchips. The microchip itself consists of integrated pneumatically-actuated valves and pumps for fluid handling, a thin-film resistive element that acts simultaneously as a heater and a temperature sensor, and channels for capillary electrophoresis (CE). The platform is comprised of high voltage circuitry, an optical assembly consisting of a laser diode and a charged coupled device (CCD) camera, circuitry for thermal control, and mini-pumps to generate vacuum/pressure to operate the on-chip diaphragm-based pumps and valves. Using this microchip and instrument, we demonstrate an integration of reverse transcription (RT), polymerase chain reaction (PCR), and capillary electrophoresis (CE). The novelty of this system lies in the cost-effective integration of microfluidics, optics, and electronics to realize a fully portable and inexpensive system (on the order of $1000 in component costs) for performing both genetic amplification and analysis - the basis of many medical diagnostics. We believe that this combination of portability, cost-effectiveness and performance will enable more accessible healthcare.


In focus in HCB.


Covid-19: European drugs agency to review safety of ibuprofen.


title: Whole-Brain Computed Tomographic Perfusion Imaging in Acute Cerebral Venous Sinus Thrombosis.

text: BACKGROUND Acute cerebral venous sinus thrombosis (VST) can be difficult to diagnose because of its diverse clinical presentation. The utility of perfusion imaging for diagnosing VST is not well understood. SUMMARY We retrospectively reviewed cases of acute VST in patients who underwent whole-brain (320-detector-row) computed tomographic (CT) perfusion imaging in combination with craniocervical CT venography. Perfusion maps that were analyzed included cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time, and time to peak. Among the 10 patients with acute VST included in this study, 9 had perfusion abnormalities. All perfusion abnormalities were localized in areas adjacent to the occluded sinus and did not match typical anterior or posterior circulation arterial territories. Bilateral perfusion deficits were seen in 4 cases. In 2 cases, parenchymal hemorrhage was diagnosed on noncontrast CT imaging; in those cases, focal CBV and CBF were reduced. KEY MESSAGES Whole-brain CT perfusion imaging with 320-detector-row scanners can further assist in establishing the diagnosis of VST by detecting perfusion abnormalities corresponding to venous and not arterial territories. CT perfusion could assist in the differentiation between focal reversible changes, such as those caused by vasogenic edema, and irreversible changes due to infarction.


title: Robot-assisted Laparoscopic Repair of Vesicovaginal Fistula: A Single-center Experience.

text: OBJECTIVE To describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients. METHODS From November 2010 to April 2014, a total of 10 patients with VVF underwent robot-assisted laparoscopic VVF repair. The principles of VVF repair were followed. The fistula tract was excised. The vagina defect and the cystotomy were closed with a flap of epiploica of sigmoid colon, a peritoneal inlay, or a bladder adventitia layer interposed between the bladder and vaginal suture lines. Perioperative patient characteristics, complications, operative data, and follow-up results were retrospectively reviewed with institutional review board approval. RESULTS All 10 patients developed VVF as a result of previous elective hysterectomies for benign indications. Mean operative time was 214 minutes (range, 120-457 minutes). Longer operative times were caused by concomitant surgeries (3 ureteral reimplantations and 1 planned sigmoid colectomy). Median length of stay was 1 day (range, 1-5 days). There were no intraoperative complications. Perioperatively, there was 1 Clavien-Dindo grade 1 complication (ileus), and 2 grade 2 complications (readmission with Clostridium difficile infection and atelectasis). All patients were cured and were without VVF recurrence at a median follow-up close to 2 years. CONCLUSION Robot-assisted laparoscopic VVF repair is an effective approach to manage VVF even in complex medical scenarios. It is anticipated that an increasing number of VVF repairs will be undertaken with robot-assisted approach in the future, offering more patients who need VVF repair the advantages of minimally invasive surgery.


title: Factors affecting valrubicin response in patients with bacillus Calmette-Guérin-refractory bladder carcinoma in situ.

text: OBJECTIVE Patients with bacillus Calmette-Guérin (BCG)-refractory carcinoma in situ (CIS) of the bladder are candidates for intravesical (IVe) valrubicin. This post-hoc analysis of data from the pivotal phase 3, prospective, open-label study of valrubicin evaluated the effects of patient characteristics and past treatments on the response to valrubicin. METHODS Enrolled patients had non-muscle-invasive CIS with or without concurrent papillary disease stage Ta and/or T1 for which papillary tumors had been resected before treatment, and had previously received ≥ 2 courses of IVe therapy (≥ 1 BCG course). Patients received a course of valrubicin, which consisted of 6 weekly IVe treatments of valrubicin (800 mg). Complete response was defined as no evidence of disease by urine cytology, cystoscopy, and biopsy at 3 and 6 months posttreatment. Patient characteristics, baseline urinary symptoms, and number and type of previous treatment courses and instillations were compared for complete versus nonresponders (including partial responders) to valrubicin. RESULTS Ninety patients enrolled; 87 patients with positive biopsy at initiation completed a valrubicin course and underwent the 3-month assessment. Five had missing data at 6 months. Of the remaining 82 patients, 18 demonstrated a complete response; 64 demonstrated partial or no response. For complete responders versus partial or nonresponders, differences in patient characteristics, baseline urinary symptoms, and number of previous courses or instillations of BCG or other types of treatment were not significant (P > 0.05). More complete responders had evidence of inflammation before or during valrubicin treatment (P = 0.005 vs nonresponders). CONCLUSIONS In these patients with BCG-refractory CIS, complete responders to valrubicin did not differ significantly from partial or nonresponders in the number of prior courses or instillations. The results suggest that therapy with valrubicin may be considered in appropriate candidates who have not responded to prior therapies. Cystectomy should be reconsidered when valrubicin treatment fails.


title: Accuracy and Safety of the Cytosponge for Assessing Histologic Activity in Eosinophilic Esophagitis: A Two-Center Study.

text: OBJECTIVES Management of eosinophilic esophagitis (EoE) requires repeated endoscopic mucosal sampling to assess disease activity. A less invasive and expensive means of monitoring of EoE is required. The objective of this study was to assess the accuracy, safety, and tolerability of the cytosponge compared to endoscopy and biopsy for histologic assessment of EoE. METHODS In this prospective two-center cross-sectional study, patients with known EoE underwent cytosponge sampling followed by endoscopy and biopsy. Sample adequacy and eosinophil counts (eos/HPF) were determined for both cytosponge and endoscopic samples. The cytosponge was assessed for diagnostic accuracy, safety, and patient preference as compared to endoscopy. RESULTS Six patients (7%) failed to swallow the sponge. One hundred and five procedures were successfully performed in 80 patients (66% male, 100% white, 19% stricture). The cytosponge sample was adequate in 102 and the biopsy in 104; 101 procedures had adequate samples by both techniques. Fifty-seven biopsies were graded as active EoE with ≥15 eos/HPF as the gold standard. Eosinophil counts highly correlated between the biopsy and cytosponge (r=0.78, P<0.0001). Using a cutoff of ≤15 eos/HPF for inactive disease, the sensitivity and specificity of the cytosponge was 75% and 86%, respectively. Six patients had active EoE on cytosponge not found on biopsy. For biopsies with inactive EoE, the cytosponge identified 38/44. No complications occurred, and cytosponge endoscopic abrasion scores were low (0.34/4). Patients preferred cytosponge to endoscopy with higher rating scores (7.27 vs. 6.11, P=0.002). CONCLUSIONS Compared to endoscopy with biopsy, cytosponge provided a minimally invasive, safe, well tolerated, and accurate method to assess EoE histologic activity. (ClinicalTrial.gov number NCT01585103).


title: The pREset Stent Retriever for Endovascular Treatment of Stroke Caused by MCA Occlusion: Safety and Clinical Outcome.

text: PURPOSE The purpose of this study was to analyze the safety and efficacy of the pREset device, a stent retriever system, for endovascular mechanical thrombectomy (MT) in acute ischemic stroke (AIS) after middle cerebral artery (MCA) occlusion. METHODS Retrospectively, 48 consecutive patients (mean age ± standard deviation, 71.0 ± 11.9 years; 24 women) treated for acute MCA occlusion using pREset solely or in combination with other MT devices were identified. Recanalization success was evaluated using the modified thrombolysis in cerebral infarction score (TICI), and complications were detected by 24-h follow-up computed tomography or magnetic resonance imaging. MCA anatomy was assessed in angiograms. Clinical outcome was evaluated with National Institutes of Health Stroke Scale (NIHSS) score at admission and discharge, and modified Rankin scale (mRS) score at discharge and follow-up. RESULTS Successful recanalization (TICI 2b/3) was achieved in 39 patients (81.3 %). Rate of procedure-related complications was 8.3 %. In four patients, a subarachnoid hemorrhage occurred (8.3 %), and parenchymal hematoma was detected in four patients (8.3 %). None of those events was associated with clinical deterioration. MCA curvature significantly influenced recanalization success (P < 0.005). Successful recanalization correlated significantly with lower NIHSS scores and favorable clinical outcome (mRS score 0-2) at discharge (P < 0.05). Mortality within 90 days was significantly lower in patients with TICI 2b/3 (P < 0.005). CONCLUSIONS High recanalization rates, low complication rates, and a significantly improved outcome after successful recanalization strongly suggest that MT with pREset is an adequate therapy for AIS after MCA occlusion. Vessel curvature is a significant determining factor for recanalization success.


title: COVID-19 pandemic and impact on cancer clinical trials: An academic medical center perspective.

text: The COVID-19 pandemic changed health-care operations around the world and has interrupted standard clinical practices as well as created clinical research challenges for cancer patients. Cancer patients are uniquely susceptible to COVID-19 infection and have some of the worst outcomes. Importantly, cancer therapeutics could potentially render cancer patients more susceptible to demise from COVID-19 yet the poor survival outcome of many cancer diagnoses outweighs this risk. In addition, the pandemic has resulted in risks to health-care workers and research staff driving important change in clinical research operations and procedures. Remote telephone and video visits, remote monitoring, electronic capture of signatures and data, and limiting sample collections have allowed the leadership in our institution to ensure the safety of our staff and patients while continuing critical clinical research operations. Here we discuss some of these unique challenges and our response to change that was necessary to continue cancer clinical research; and, the impacts the pandemic has caused including increases in efficiency for our cancer research office.


title: Molecular methods in detection and epidemiologic studies of rabbit and hare viruses: a review.

text: Various PCR-based assays for rabbit viruses have gradually replaced traditional virologic assays, such as virus isolation, because they offer high-throughput analysis, better test sensitivity and specificity, and allow vaccine and wild-type virus strains to be fully typed and differentiated. In addition, PCR is irreplaceable in the detection of uncultivable or fastidious rabbit pathogens or those occurring in low quantity in a tested sample. We provide herein an overview of the current state of the art in the molecular detection of lagomorph viral pathogens along with details of their targeted gene or nucleic acid sequence and recommendations for their application. Apart from the nucleic acids-based methods used for identification and comprehensive typing of rabbit viruses, novel methods such as microarray, next-generation sequencing, and mass spectrometry (MALDI-TOF MS) could also be employed given that they offer greater throughput in sample screening for viral pathogens. Molecular methods should be provided with an appropriate set of controls, including an internal amplification control, to confirm the validity of the results obtained.


Providing assisted reproduction treatment during the COVID-19 pandemic in Singapore.


title: Antiviral Substances in Raw Bovine Milk Active Against Bovine Rotavirus and Coronavirus.

text: After experimental contamination of bovine raw and heat-treated milks with bovine rotavirus and coronavirus strains, we observed a strong viral inhibition only with raw milks, from which virus recovery was 5 × 10-4%. Between 30% and 80% of the virus was recovered from the heat-treated milks, depending on the level of inoculation. The antiviral substance is heat-labile (destroyed within 30 min at 100°C), precipitated by ammonium sulfate and filtrable (0.45 μm Millipore membrane). It also has neutralizing activity on tissue culture.


Endoscopic treatment of internal hemorrhoids by use of a bipolar system.


title: Using social and behavioural science to support COVID-19 pandemic response.

text: The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.


title: Mucosal Lactobacillus vectored vaccines.

text: Traditional non-gastrointestinal vaccines can prevent effectively the invasion of pathogens; however, these vaccines are less effective against mucosal infections because there is not a sufficient immune response at the mucosa. Most pathogens invade via a mucosal pathway (oral, intranasal, or vaginal). It is widely accepted that Lactobacillus species play a critical role as commensals in the gastrointestinal (GI) tract. Their ability to survive in the digestive tract, their close association with the intestinal epithelium, their immunomodulatory properties and their safety even when consumed in large amounts make lactobacilli attractive candidates for live vehicles for the delivery of immunogens to the intestinal mucosa. The oral or intranasal administration of Lactobacillus-based vaccines is a promising method to control mucosal infection because these vaccines could induce strong humoral and cellular immune responses both in the blood and at mucosal sites.


title: Recombinant Newcastle disease virus-vectored vaccines against human and animal infectious diseases.

text: Recent advances in recombinant genetic engineering techniques have brought forward a leap in designing new vaccines in modern medicine. One attractive strategy is the application of reverse genetics technology to make recombinant Newcastle disease virus (rNDV) deliver protective antigens of pathogens. In recent years, numerous studies have demonstrated that rNDV-vectored vaccines can induce quicker and better humoral and mucosal immune responses than conventional vaccines and are protective against pathogen challenges. With deeper understanding of NDV molecular biology, it is feasible to develop gene-modified rNDV vaccines accompanied by good safety, high efficacy, low toxicity and better immunogenicity. This review summarizes the development of reverse genetics technology in using NDV as a promising vaccine vector to design new vaccines for human and animal use.


title: Minimally invasive oesophagectomy: preliminary results after introduction of an intrathoracic anastomosis.

text: BACKGROUND Intrathoracic anastomosis after oesophagectomy has recently been associated with reduced functional morbidity compared to a cervical anastomosis. METHODS From January 2011 until August 2012, all operable patients were scheduled to undergo minimally invasive oesophagectomy (MIE) with intrathoracic anastomosis. Patient characteristics, complications, morbidity and mortality were prospectively registered and analysed. RESULTS Forty-five patients underwent MIE with intrathoracic stapled end-to-side anastomosis. Major changes in operative technique were made 2 times due to non-satisfactory results, dividing the patients into 3 groups. One patient in group 1 died. The anastomotic leakage rate decreased from 44% in group 1 to 0% in groups 2 and 3 (p = 0.007). The pulmonary complication rate decreased from 67% in group 1 to 44% in group 2 (not significant, NS) and 22% in group 3 (p = 0.04). The median hospital stay decreased from 17 days in group 1 to 14 days in group 2 (NS) and 8 days in group 3 (p < 0.001). There were no stenoses, no dilatations and no patients with recurrent laryngeal nerve palsy. CONCLUSIONS The introduction of the intrathoracic anastomosis led to favourable functional results but was initially associated with considerable morbidity. RESULTS improved after changing operative techniques, but the learning curve may also be responsible.


Letter to the editor: A comparative study of three-year weight loss and outcomes after laparoscopic gastric bypass in patients with "yellow light" psychological clearance.


title: Preclinical efficacy in therapeutic area guidelines from the U.S. Food and Drug Administration and the European Medicines Agency: a cross-sectional study.

text: BACKGROUND AND PURPOSE Therapeutic area guidelines (TAGs) published by the EMA and the FDA offer guidance in planning the launch of a trial in a certain indication. We assessed and compared the guidance on preclinical efficacy of all available TAGs from EMA and FDA. EXPERIMENTAL APPROACH EMA and FDA websites and databases were searched for all TAGs. A mixed deductive and inductive approach was applied to analyse and cluster content for preclinical efficacy. KEY RESULTS A total of 114 EMA and 120 FDA TAGs were identified, covering 126 indications. Our core finding is that 75% of EMA TAGs and 58% from the FDA TAGs do not offer any guidance on preclinical efficacy. TAGs varied widely on the extent, nature and detail of guidance. CONCLUSIONS AND IMPLICATIONS Guidance on preclinical efficacy in a consistent, comprehensive and explicit way that still allows for justified deviations is an important but neglected aspect of transparency for drug development. This transparency would help sponsors in designing preclinical studies and in negotiating more efficiently with regulators.


Prevention is better than cure for emerging infectious diseases.


title: Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.

text: PURPOSE To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. METHODS In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. RESULTS The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. CONCLUSION In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint.


title: Two years after pandemic influenza A/2009/H1N1: what have we learned?

text: The world had been anticipating another influenza pandemic since the last one in 1968. The pandemic influenza A H1N1 2009 virus (A/2009/H1N1) finally arrived, causing the first pandemic influenza of the new millennium, which has affected over 214 countries and caused over 18,449 deaths. Because of the persistent threat from the A/H5N1 virus since 1997 and the outbreak of the severe acute respiratory syndrome (SARS) coronavirus in 2003, medical and scientific communities have been more prepared in mindset and infrastructure. This preparedness has allowed for rapid and effective research on the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the disease, with impacts on its control. A PubMed search using the keywords "pandemic influenza virus H1N1 2009" yielded over 2,500 publications, which markedly exceeded the number published on previous pandemics. Only representative works with relevance to clinical microbiology and infectious diseases are reviewed in this article. A significant increase in the understanding of this virus and the disease within such a short amount of time has allowed for the timely development of diagnostic tests, treatments, and preventive measures. These findings could prove useful for future randomized controlled clinical trials and the epidemiological control of future pandemics.


title: Molecular detection and phylogenetic analysis of Kenyan human bocavirus isolates.

text: INTRODUCTION The commonly expected causative agents associated with flu-like symptoms in Kenya are the classical viral pathogens identifiable as influenza virus, adenovirus, parainfluenza virus, enteroviruses, respiratory syncytial virus (RSV) and rhinovirus. However, newer agents have been identified globally that present with illnesses clinically indistinguishable from those caused by the classical pathogens; one of them is human bocavirus. METHODOLOGY A total of 384 specimens were analyzed, primarily to determine if the emerging human bocavirus (HBoV) infections exist in Kenya as coinfections with other respiratory viruses and to describe the genotype of the virus in circulation. In brief, viral nucleic acids were extracted from culture supernatants, amplified by PCR, and sequenced. RESULTS HBoV DNA was amplified from 1.8% of screened specimens. Coinfection with parainfluenza virus, adenovirus, and enterovirus was 2.5%, 2%, and 1.4%, respectively. Multiple coinfections consisting of HBoV plus two other viruses were found in 3% of specimens. Isolation occurred in the months of January, March, April, August, and November. Retrospective review of clinical parameters indicated that all the individuals complained of non-specific symptoms, mainly fever, coughs, nasal stuffiness, runny noses, and vomiting. Phylogenetically, the GenBank deposited sequences of this study's isolates cluster closely to the reference strain NC_07455 (HBoV1). CONCLUSION Coinfections with human bocavirus (HBoV1) occur in Kenya, and high incidence might primarily be during the early stages of children's lives.


title: Possible association between successful intubation via the right nostril and anatomical variations of the nasopharynx during nasotracheal intubation: a multiplanar imaging study.

text: PURPOSE Most reported cases of nasopharyngeal laceration following impingement during nasotracheal intubation involved tube insertion via the right nostril. We postulated that recesses on the posterior wall of the nasopharynx might be associated with tube impingement. Using multiplanar imaging and clinical statistics, we evaluated whether anatomical variations in the recesses are related to successful intubation via the right nostril. METHODS Using multiplanar computed tomography (CT) images of 97 patients, we investigated the locations of recesses relative to the mid-sagittal plane, nasal floor plane and posterior end of the nasal septum, and their shapes. Incidents of impingement of the tube during nasotracheal intubation and the shapes of the fossa of Rosenmüller on CT images were retrospectively evaluated in 170 patients. RESULTS Eustachian tube orifices were located approximately 10 mm laterally from the sagittal plane, and approximately 10 mm above the nasal floor plane. The fossa of Rosenmüller was vertically elongated and located 7 mm laterally from the mid-sagittal plane. Pharyngeal bursae were found in 15 % of the subjects. Patients with failed insertion via the right nostril due to impingement frequently had a wide opening of the fossa of Rosenmüller. CONCLUSIONS Successful intubation via the right nostril is related to the anatomy of structures on the posterior nasopharyngeal wall, particularly recesses located close to the path of nasotracheal tube insertion. Nasopharyngeal anatomical variations should be considered when one notices any resistance to advancement of the tube into the nasopharynx during nasotracheal intubation.


title: Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results.

text: OBJECT Neuroophthalmological morbidity is commonly associated with large and giant cavernous and supraclinoid internal carotid artery (ICA) aneurysms. The authors sought to evaluate the neuroophthalmological outcomes after treatment of these aneurysms with the Pipeline Embolization Device (PED). METHODS The Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial was an international, multicenter prospective trial evaluating the safety and efficacy of the PED. All patients underwent complete neuroophthalmological examinations both before the PED procedure and at a 6-month follow-up. All examinations were performed for the purpose of this study and according to study criteria. RESULTS In total, 108 patients were treated in the PUFS trial, 98 of whom had complete neuroophthalmological follow-up. Of the patients with complete follow-up, 39 (40%) presented with a neuroophthalmological baseline deficit that was presumed to be attributable to the aneurysm, and patients with these baseline deficits had significantly larger aneurysms. In 25 of these patients (64%), the baseline deficit showed at least some improvement 6 months after PED treatment, whereas in 1 patient (2.6%), the deficits only worsened. In 5 patients (5%), new deficits had developed at the 6-month follow-up, while in another 6 patients (6%), deficits that were not originally assumed to be related to the aneurysm had improved by that time. A history of diabetes was associated with failure of the baseline deficits to improve after the treatment. The aneurysm maximum diameter was significantly larger in patients with a new deficit or a worse baseline deficit at 6 months postprocedure. CONCLUSIONS Patients treated with the PED for large and giant ICA aneurysms had excellent neuroophthalmological outcomes 6 months after the procedure, with deficits improving in most of the patients, very few deficits worsening, and few new deficits developing.


title: Treatment of pulmonary colorectal metastases by radiofrequency ablation.

text: UNLABELLED We evaluated the local tumor control and the survival benefit achieved with radiofrequency ablation (RFA) for nonoperable lung metastases in 45 patients with colorectal cancer. Median survival from the time of RFA was 46 months. One-, 2- and 3-year local tumor progression (LTP)-free survival rates were 92%, 77%, and 77%, respectively. RFA offers very good local control in patients with pulmonary metastases from colorectal cancer. BACKGROUND Radiofrequency ablation has emerged as a potential, lung function-preserving treatment of colorectal lung metastases. PATIENTS AND METHODS Forty-five patients with colorectal pulmonary metastases underwent computed tomography-guided RFA from December 2004 to June 2010. A baseline posttreatment scan was obtained 4-6 weeks after RFA and follow-up imaging studies every 3 months thereafter were obtained and compared to evaluate the tumor progression at site of ablation or elsewhere. The primary end points were LTP-free survival and overall survival from RFA procedure. The Kaplan-Meier method was used to analyze the end points. A Cox proportional hazard model with robust inference was used to estimate the associations between baseline factors and survival end points. RESULTS Sixty-nine metastases were ablated in 45 patients. Tumor size ranged from 0.4 to 3.5 cm. The median number of metastases ablated per patient was 1 (range, 1-3). Median follow-up after RFA was 18 months. Median survival from the time of RFA was 46 months (95% confidence interval [CI], 27.8-47.3). One-, 2- and 3-year overall survival rates from the time of RFA were 95% (95% CI, 82%-99%), 72% (95% CI, 52%-85%), and 50% (95% CI, 26%-71%), respectively. Nine of 69 lesions (13%) progressed and 4 were retreated with no progression after second RFA. Median time to progression was not reached. LTP-free survival from RFA was 92% (95% CI, 82%-97%) at 1 year, 77% (95% CI, 58%-88%) at 2 years, and 77% (95% CI, 58%-88%) at 3 years. CONCLUSION Radiofrequency ablation of lung metastases is an effective minimally invasive, parenchymal-sparing technique that has very good local control rates in patients with pulmonary metastases from colorectal cancer, with LTP-free survival of 77% at 3 years.


title: Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report.

text: Acute exacerbation of idiopathic pulmonary fibrosis has been defined as an acute, clinically significant, respiratory deterioration of unidentifiable cause. The objective of this international working group report on acute exacerbation of idiopathic pulmonary fibrosis was to provide a comprehensive update on the topic. A literature review was conducted to identify all relevant English text publications and abstracts. Evidence-based updates on the epidemiology, etiology, risk factors, prognosis, and management of acute exacerbations of idiopathic pulmonary fibrosis are provided. Finally, to better reflect the current state of knowledge and improve the feasibility of future research into its etiology and treatment, the working group proposes a new conceptual framework for acute respiratory deterioration in idiopathic pulmonary fibrosis and a revised definition and diagnostic criteria for acute exacerbation of idiopathic pulmonary fibrosis.


title: Therapeutic and Surgical Indications for Patients with Penile Cancer in the COVID-19 era.

text: PURPOSE The aim of this work is to review and synthesize the existing evidence and recommendations regarding to the therapeutic and surgical indications as well as monitoring of patients with Penile Cancer in COVID-19 era and to propose an action protocol to facilitate decision-making. MATERIAL AND METHODS A non-systematic review of the literature regarding the management of penile cancer during the COVID-19 pandemic was performed until April 30, 2020. We propose our recommendations based on this evidence. RESULTS Penile cancer is an uncommon but aggressive disease. Prognosis is determined by several characteristics, being the most important the presence of lymph nodes, in which case, treatment should not be delayed. For these reasons, an initial evaluation is mandatory. Priority classifications, based on the oncological outcomes when treatment is delayed, have been made in order to separate deferrable disease from the one that needs high priority treatment. In penile cancer with low risk of progression, surgical treatment can be delayed, but other options must be considered, like topical treatment or laser therapy. In cases with intermediate risk of progression, surgical treatment may be delayed up to three months, but we must consider radiation therapy and brachytherapy as effective options. When feasible, follow-up should by telemonitoring. CONCLUSIONS In the COVID-19 era, initial evaluation of the patient is mandatory. Histological diagnosis with local staging is necessary before offering any therapeutic option. In case of superficial non-invasive disease, topical treatment is effective in absence of lymph node involvement. In selected patients, radiotherapy is an organ-preserving approach with good results. Non-deferrable surgical treatment must be performed by an experienced surgeon and as an outpatient procedure when possible. When indicated, iLND should not be delayed since it is decisive for patient survival. Follow-up should be by telemonitoring.


title: ADAPT technique in ischemic stroke treatment of M2 middle cerebral artery occlusions in comparison to M1 occlusions: Post hoc analysis of the PROMISE study.

text: BACKGROUND/PURPOSE The benefit of endovascular thrombectomy in acute ischemic stroke (AIS) therapy of proximal large vessel occlusions (LVO) is established. However, there are few prospective studies evaluating the use of a direct aspiration first pass technique in distal vessel occlusions. This post hoc analysis of the PROMISE study examines the safety and effectiveness of the Penumbra System with the ACE68 and ACE64 Reperfusion Catheters for aspiration thrombectomy in the M1 and M2 segments of the middle cerebral artery. METHODS PROMISE is a prospective, multicenter study that enrolled 204 patients with anterior circulation LVO AIS-treated frontline with ACE68/ACE64 catheters. We compared clinical and angiographic outcomes, complications, and mortality in patients with M1 and M2 occlusions. The association of M1 and M2 location and functional independence or mTICI 2b-3 reperfusion was described in univariable and multivariable analyses. RESULTS One hundred sixty-one patients (124 M1 and 37 M2 locations) met the study criteria. Post procedure mTICI 2b-3 reperfusion (93% vs. 92%, p = 1.00), functional independence (57% vs. 70%, p = 0.18), symptomatic intracranial hemorrhage (1.6% vs. 2.7%, p = 0.55), device- or procedure-related serious adverse events at 30 days (4.0% vs. 8.1%, p = 0.39), and mortality at 90 days (6.6% vs. 2.7%, p = 0.69) were comparable between M1 and M2 occlusions. In multivariable analysis, lower age, lower baseline NIHSS, and shorter time from onset to admission were independent predictors of functional independence. CONCLUSIONS For frontline aspiration thrombectomy of stroke, use of large-bore ACE68/ACE64 catheters for treatment of M2 occlusions appeared as safe and effective as for M1 occlusions.


title: The use of acellular dermal matrix in release of burn contracture scars in the hand.

text: BACKGROUND Contracture deformities of the upper extremity are encountered frequently in burn victims. Surgical repair of this problem is challenged by a paucity of soft tissue, poor functional outcome, and a high rate of recurrence. Acellular dermal matrix has become increasingly popular in reconstructive surgery--at times--as an alternative to local and free tissue transfer in different parts of the body. However, its applicability in contracture release, particularly in hand surgery, has not been widely explored. METHODS Nine patients with burn contracture scars involving different locations in the hand and the wrist underwent two-stage reconstruction consisting of contracture release and use of acellular dermal matrix followed by definitive coverage with skin graft at the second stage. Patients were followed up for a period of at least 10 months (range, 10 to 25 months), during which time the passive range of motion of the hand was used as a quantitative measure of surgical outcome. RESULTS All nine patients retained at least 83 percent of the corrected range of motion involving the affected joints by 1 year and at least 89 percent of correction at each webspace. No patient required a revision procedure. CONCLUSION Acellular dermal matrix can be an effective tool in surgical treatment of difficult burn contracture deformity in the hand, with lasting results.


title: A new suture material for hypospadias surgery: a comparative study.

text: PURPOSE We compared the results of hypospadias repair using polyglytone versus polydioxanone to evaluate the potential benefit of using a suture with a rapid absorption time. MATERIALS AND METHODS A total of 100 patients 8 to 24 months old affected by distal isolated penile hypospadias were considered for this study. Patients were randomized and assigned to 2 different groups according to the suture material used during the surgical procedure (tubularized incised plate repair with or without preputial reconstruction). Polyglytone was used in group A and polydioxanone was used in group B. All patients were evaluated at 4 intervals (1 week, 1 month, 6 months and 2 years postoperatively). Persistence of sutures on penile skin, urethral fistulas, skin dehiscence, infection and skin tracks were recorded. Statistical analysis was performed using chi-square test. RESULTS Followup data documented the absence of significant differences in terms of urethral fistula rate, skin dehiscence and acute skin infection. Persistence of sutures and multiple skin tracks at long-term followup were significantly greater in patients in group B. CONCLUSIONS Both sutures are adequate for hypospadias surgery in small children. The use of a rapid absorption monofilament may allow much more rapid disappearance of the skin sutures. In the long term this outcome means almost complete absence of suture tracks. No statistically significant difference in terms of urethrocutaneous fistula was observed, suggesting that the tensile strength of polyglytone is adequate.


title: Ventriculoperitoneal shunt in a patient with ruptured blister aneurysm treated with pipeline embolization device.

text: Cerebral spinal fluid (CSF) diversion is frequently required in patients with aneurysmal subarachnoid hemorrhage who develop subsequent hydrocephalus. Procedures such as external ventricular drain (EVD) and ventriculoperitoneal shunt (VPS) usually carry a very low rate of complications. However, as flow diverting stents such as Pipeline Embolization Device (PED) become more widely available, flow diverters are being used in treatment of some ruptured complex aneurysms. EVD and VPS placement in the setting of dual antiplatelet therapy (DAT) in these patients are associated with a significant risk of intracranial hemorrhage. We describe a management strategy and surgical technique that can minimize hemorrhagic complications associated with VPS in patients on DAT after treatment with flow diverting stents.


title: Bilateral totally extraperitoneal (TEP) repair of the ultrasound-diagnosed asymptomatic contralateral inguinal hernia.

text: BACKGROUND The aim of this series is to determine the clinical utility of routine ultrasound (US) of the contralateral, clinically normal groin when a unilateral inguinal hernia is referred for hernia repair-specifically assessing the morbidity and short-term change in quality-of-life (QoL) due to repair of this occult contralateral hernia when also repairing the symptomatic side. TEP inguinal hernia repair affords the opportunity to repair any groin hernia through the same small incisions. US detects 96.6% of groin hernias with 84.4% specificity. METHODS 234 consecutive male patients with clinically unilateral and clinically bilateral hernia were enrolled; those with a clinically unilateral hernia were sent for groin US and if positive, a bilateral TEP groin hernia repair was performed (USBH). If negative, a unilateral TEP groin hernia repair was performed (UNIH). Carolina's comfort scales (CCS) and visual analogue scores (VAS) were recorded at 2 and 6 weeks postoperatively, while a modified CCS (MCCS) was recorded for all patients preoperatively. RESULTS Bilateral TEP repair resulted in higher VAS scores than unilateral repair at 2 weeks but not 6 weeks. CCS were worse in the USBH group than UNIH group at 2 weeks but were similar by 6 weeks. Complications' rates were similar amongst all 3 groups. Factors contributing to worse scores were: smaller hernia, complications, worse preoperative MCCS results, recurrent hernia and bilateral rather than unilateral repair. CONCLUSION Bilateral TEP for the clinically unilateral groin hernia with an occult contralateral groin hernia can be performed without increased morbidity, accepting a minor and very temporary impairment of QoL.


title: Hypoglycemia After Gastric Bypass Surgery: Current Concepts and Controversies.

text: Context Hypoglycemia, occurring after bariatric and other forms of upper gastrointestinal surgery, is increasingly encountered by clinical endocrinologists. The true frequency of this condition remains uncertain, due, in part, to differences in the diagnostic criteria and in the affected populations, as well as relative lack of patient and physician awareness and understanding of this condition. Postbariatric hypoglycemia can be severe and disabling for some patients, with neuroglycopenia (altered cognition, seizures, and loss of consciousness) leading to falls, motor vehicle accidents, and job and income loss. Moreover, repeated episodes of hypoglycemia can result in hypoglycemia unawareness, further impairing safety and requiring the assistance of others to treat hypoglycemia. Objective In this review, we summarize and integrate data from studies of patients affected by hypoglycemia after Roux-en-Y gastric bypass (RYGB) surgery, obtained from PubMed searches (1990 to 2017) and reference searches of relevant retrieved articles. Whereas hypoglycemia can also be observed after sleeve gastrectomy and fundoplication, this review is focused on post-RYGB, given the greater body of published clinical studies at present. Outcome Measures Data addressing specific aspects of diagnosis, pathophysiology, and treatment were reviewed by the authors; when not available, the authors have provided opinions based on clinical experience with this challenging condition. Conclusions Hypoglycemia, occurring after gastric bypass surgery, is challenging for patients and physicians alike. This review provides a systematic approach to diagnosis and treatment based on the underlying pathophysiology.


title: Complete genome sequence and pathogenicity of two swine parainfluenzavirus 3 isolates from pigs in the United States.

text: Two novel paramyxoviruses, 81-19252 (Texas81) and 92-7783 (ISU92), isolated from the brains of pigs in the United States in the 1980s and 1990s, were characterized. The complete genome of Texas81 virus was 15,456 nucleotides (nt) in length, that of ISU92 was 15,480 nt, and both genomes consisted of six nonoverlapping genes, predicted to encode nine proteins, with conserved and complementary 3' leader and 5' trailer regions and conserved gene starts, gene stops, and trinucleotide intergenic sequences similar to those in paramyxoviruses. The corresponding genes from these two viruses were similar in length, except for the F genes, of which the ISU92 form had an additional 24-nt U-rich 3' untranslated region. The P genes of swine viruses were predicted to produce V and D mRNAs by RNA editing (one to four G insertions in Texas81 and one to nine G insertions in ISU92) or C mRNA by alternative translation initiation. Sequence-specific features related to virus replication and host-specific amino acid signatures indicated that these viruses originated from bovine parainfluenzavirus 3 (bPIV3). Phylogenetic analysis of individual genes suggested that these viruses are novel members of the genus Respirovirus of the Paramyxovirinae subfamily and may be grouped into two subgenotypes of genotype A of bPIV3. Our comprehensive studies revealed that these swine PIV3 are variants of bPIV3 and were possibly transferred from cattle to pigs but failed to establish an active enzootic state. These two viruses were mildly pathogenic to conventionally reared pigs, and results from a limited enzyme-linked immunosorbent assay-based serosurvey of swine farms in Minnesota and Iowa in 2007 and 2008 were negative.


Sedation vs Intubation for Patients With Acute Stroke Undergoing Thrombectomy-Reply.


From mice to monkeys, animals studied for coronavirus answers.


title: Measles virus.

text: Measles was an inevitable infection during the human development with substantial degree of morbidity and mortality. The severity of measles virus (MV) infection was largely contained by the development of a live attenuated vaccine that was introduced into the vaccination programs. However, all efforts to eradicate the disease failed and continued to annually result in significant deaths. The development of molecular biology techniques allowed the rescue of MV from cDNA that enabled important insights into a variety of aspects of the biology of the virus and its pathogenesis. Subsequently these technologies facilitated the development of novel vaccine candidates that induce immunity against measles and other pathogens. Based on the promising prospective, the use of MV as a recombinant vaccine and a therapeutic vector is addressed.


title: Single-port gynecologic surgery with a novel surgical platform.

text: BACKGROUND Laparoendoscopic single-site surgery (LESS) allows better cosmesis and decreased pain when compared with traditional laparoscopy (TL). Instrument crowding and diminished triangulation are limitations. This study evaluates a novel single-port surgical platform (NSP) designed to facilitate the transition from TL to LESS (TransEnterix SPIDER, Durham, NC). METHODS NSP and TL were compared using standardized dry lab tasks. Feasibility of NSP in gynecology was assessed using the porcine model. RESULTS Completion times with NSP were longer for ring transfer (P = .025) and trended longer for disc cutting (P = .074). Disc cutting accuracy was lower with NSP versus TL (P = .008). NSP operative times for hysterectomy, pelvic and para-aortic node dissection were 22.3, 13.3, and 26 minutes, respectively, without complications. Fatigue and lack of integrated bipolar cautery were limitations of NSP. CONCLUSION While application of NSP to gynecology appears feasible, lower performance when compared with TL underscores the need for caution when applying NSP to humans.


title: Endoscopic closure of gastric access in perspective NOTES: an update on techniques and technologies.

text: BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is currently of major research interest as it may offer significant clinical potential for endoscopic procedures in the future. Nevertheless, many issues are still unresolved. The aim of this study is a systematic review of the literature to evaluate techniques and technologies to address the issue of achieving a secure gastric wall defect closure. METHODS Studies were identified by searching MEDLINE, EMBASE, Current Contents, Cochrane Library, Entrez PubMed and Clinical Trials Database until December 2008. We divided the different technologies into four groups: clipping, stitching, stapling and occluding systems. We analysed the different technologies in terms of (1) simplicity of manoeuvring for port closure, (2) security of introduction, (3) permanent implantation of the device into the organ, (4) effectiveness of port closure and (5) availability on the market. RESULTS Twenty-eight published studies were identified, while nine clinical trials are ongoing. Among proposed technologies, staplers and occluders have greater effectiveness but lack of security, and in the case of staplers also lack of simplicity of use. None of the stitching technologies can really be considered effective except for the Flexible Endostitch, which on the other side is difficult to handle in the current fashion. Standard clips, although easy to handle, have never been proved to be reliable, as only mucosal layer closure has been demonstrated to date. On the other side, the over-the-scope clip is likely to be effective, secure to introduce and simple to handle within the hollow organ. CONCLUSIONS Achieving reliable closure of the hollow organ defect represents the first step towards implementation of clinical NOTES. The current data do not yet allow definitive and clear advantages or disadvantages of the different options to be determined. The introduction of the EURONOTES registry will help us to understand in which direction to proceed.


title: Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas.

text: OBJECTIVE Many small series and technical reports chronicle the evolution of endovascular techniques for cranial dural arteriovenous fistulas (dAVFs) over the past 3 decades, but reports of large patient series are lacking. The authors provide a thorough analysis of clinical and angiographic outcomes across a large patient cohort. METHODS The authors reviewed their endovascular database from January 1996 to September 2015 to identify patients harboring cranial dAVFs who were treated initially with endovascular approaches. They extracted demographic, presentation, angiographic, detailed treatment, and long-term follow-up data, and they evaluated natural history, initial angiographic occlusion, complications, recurrence, and symptomatic resolution rates. RESULTS Across a cohort of 251 patients with 260 distinct dAVFs, the overall initial angiographic occlusion rate was 70%; recurrence or occult residual lesions were seen on subsequent angiography in 3% of cases. The overall complication rate was 8%, with permanent neurological complications occurring in 3% of cases. Among 102 patients with dAVFs without cortical venous reflux, rates of resolution/improvement of pulsatile tinnitus and ocular symptoms were 79% and 78%, respectively. Following the introduction of Onyx during the latter half of the study period, the number of treated dAVFs doubled; the initial angiographic occlusion rate increased significantly from 60% before the use of Onyx to 76% after (p = 0.01). In addition, during the latter period compared with the pre-Onyx period, the rate of dAVFs obliterated via a transarterial-only approach was significantly greater (43% vs 23%, p = 0.002), as was the number of dAVFs obliterated via a single arterial pedicle (29% vs 11%, p = 0.002). CONCLUSIONS Overall, in the Onyx era, the rate of initial angiographic occlusion was approximately 80%, as was the rate of meaningful clinical improvement in tinnitus and/or ocular symptoms after initial endovascular treatment of cranial dAVFs.


title: Niclosamide suppresses acute myeloid leukemia cell proliferation through inhibition of CREB-dependent signaling pathways.

text: CREB (cAMP Response Element Binding protein) is a transcription factor that is overexpressed in primary acute myeloid leukemia (AML) cells and associated with a decreased event-free survival and increased risk of relapse. We recently reported a small molecule inhibitor of CREB, XX-650-23, which inhibits CREB activity in AML cells. Structure-activity relationship analysis for chemical compounds with structures similar to XX-650-23 led to the identification of the anthelminthic drug niclosamide as a potent anti-leukemic agent that suppresses cell viability of AML cell lines and primary AML cells without a significant decrease in colony forming activity of normal bone marrow cells. Niclosamide significantly inhibited CREB function and CREB-mediated gene expression in cells, leading to apoptosis and G1/S cell cycle arrest with reduced phosphorylated CREB levels. CREB knockdown protected cells from niclosamide treatment-mediated cytotoxic effects. Furthermore, treatment with a combination of niclosamide and CREB inhibitor XX-650-23 showed an additive anti-proliferative effect, consistent with the hypothesis that niclosamide and XX-650-23 regulate the same targets or pathways to inhibit proliferation and survival of AML cells. Niclosamide significantly inhibited the progression of disease in AML patient-derived xenograft (PDX) mice, and prolonged survival of PDX mice. Niclosamide also showed synergistic effects with chemotherapy drugs to inhibit AML cell proliferation. While chemotherapy antagonized the cytotoxic potential of niclosamide, pretreatment with niclosamide sensitized cells to chemotherapeutic drugs, cytarabine, daunorubicin, and vincristine. Therefore, our results demonstrate niclosamide as a potential drug to treat AML by inducing apoptosis and cell cycle arrest through inhibition of CREB-dependent pathways in AML cells.


title: The TRIP database showed most acute respiratory infections questions were already addressed by Cochrane reviews.

text: OBJECTIVES Cochrane systematic reviews require more methodological support from Cochrane Review Groups (CRGs) than is customarily received by authors from journals; CRGs must therefore prioritize reviews to conserve resources. The TRIP database provided a data set of questions to guide prioritization for the acute respiratory infections (ARIs) CRG. STUDY DESIGN AND SETTING We extracted the ARI searches from the TRIP database (2010 to 2017) that contained at least one disease and one clinical management term, (defined as a "search"), and tabulated these by frequency. RESULTS There were 314,346 ARI searches from which we inferred 45,497 clinical questions, covering 365 topics. Two-thirds (30,541) of these addressed 20 clinical questions, of which treatment were the most frequent, followed by diagnosis, mortality, and prognosis. The five most frequent clinical questions were "Influenza + Vaccination" 4,989 (12.1%), "acute otitis media + antibiotics" 3,578 (8.7%), "common cold + vitamin C" 3,528 (8.6%), "meningitis + corticosteroids" 1,910 (4.6%), and "pneumonia + general treatment" 1,765 (4.3%). The 20 most frequent clinical questions were addressed by Cochrane reviews or protocols. CONCLUSION ARI questions are common and repeated often. Most may have been addressed by Cochrane reviews. The remainder form the basis of a priority list to assign resources for future Cochrane topics.


title: Laparoscopic gastric pouch and remnant resection: a novel approach to refractory anastomotic ulcers after Roux-en-Y gastric bypass: case report.

text: BACKGROUND Anastomotic or marginal ulcers occur in 0.6 to 16% of patients after laparoscopic Roux-en-Y-Gastric Bypass. Initial therapy aims at eliminating known risk factors including smoking, Helicobacter pylori infection, use of non-steroidal anti-inflammatory drugs and inhibition of gastric acid secretion. While this approach is successful in 68 to 88% of the cases, up to one third of patients need a subsequent surgical revision. However, marginal ulcers still recur in up to 10% of cases after revisional surgery, thus constituting a serious challenge for bariatric surgeons. CASE PRESENTATION We herein report a case of an insidious marginal ulcer refractory to both medical therapy with high-dosed proton pump inhibitors and sucralfate as well as surgical therapy consisting of the lengthening of a short alimentary limb and later resection of the gastroenterostomy and construction of a new tension-free anastomosis. Only after gastrectomy by laparoscopic en-bloc resection of the gastrojejunostomy, the gastric pouch and resection of the gastric remnant with reconstruction by esophagojejunostomy the patient remained free of symptoms. CONCLUSION By laparoscopic resection of the entire gastric pouch and the gastric remnant the risk to leave a suboptimally vascularised or even ischemic pouch in situ was avoided. The esophagojejunostomy was then created in healthy, good vascularised tissue. In our case this novel approach was effective in the management of a refractory anastomotic ulcer and might represent a rescue option when simple revision of the gastrojejunostomy fails.


title: Polygraphic findings of 47 cases with respiratory inhibition after crying.

text: OBJECTIVE To report the polygraphic findings of infants with respiratory inhibition after crying (RIAC). METHODS We screened for RIAC among infants with a gestational age ≥36 weeks using our established method with cranial ultrasonography, SpO(2) monitoring and polygraphy. RIAC is defined as central apnea that occurred immediately after crying with a decrease in SpO(2) to <60%, followed by repeated irregular respiration and apnea as the respiration gradually recovered. The subjects were infants with RIAC for whom we could study the polygraphic findings in detail. RESULTS Forty-seven RIAC cases were included in the present analysis. The frequency of RIAC was 2.1 (1.2-7.0) times per 24 h. The maximum duration of respiratory inhibition was 78.0 (52.6-109.0) s. The maximum duration of SpO(2) <60% during RIAC was 39.0 (9.8-93.2) s. The minimum SpO(2) value during RIAC was 53.0% (42.2-58.0%). The minimum heart rate during RIAC was 103.0 (79.1-127.1) bpm. CONCLUSIONS RIAC is observed among healthy infants, and they experience repeated prolonged hypoxemia.


title: Single incision vs. conventional multiport laparoscopic cholecystectomy: a comparison of two approaches.

text: BACKGROUND AND AIMS Laparoscopic techniques are rapidly evolving and trends towards a more minimally invasive approach have led to the introduction of single incision and natural orifice laparoscopic surgery. The aim of this study was to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) to conventional multiport laparoscopic cholecystectomy (MPLC). We compared intra-operative complications, operative time, postoperative complications, pain score, readmission rate and conversion to open amongst both groups. METHODS A retrospective review of data of patients who underwent laparoscopic cholecystectomy between May 2009 and November 2011 was performed. All procedures were performed by a single surgeon. RESULTS A total of 184 patients underwent laparoscopic cholecystectomy. 76 patients from MPLC were excluded from comparison based on exclusion criteria. The remaining 62 patients in MPLC and 45 patients in the SILC group were compared. The two groups were similar with respect to patients' demographics and American Society of Anaesthesiology grades. The median operative time for SILC was 75 min (range 42-120) compared to 60 min (range 26-117) in MPLC (p = 0.02). There was no conversion to open procedure. One patient in SILC group was converted to MPLC and two patients required a second port insertion. Postoperative pain-score and length of hospital stay were comparable in both groups. One patient in each group had minor bleeding from gall bladder bed controlled with diathermy. CONCLUSION SILC is a safe and feasible approach in selected patients. There was no difference in complication rate amongst the two approaches with a longer operative time in the SILC approach.


title: Cannabinoids for the Neuropsychiatric Symptoms of Dementia: A Systematic Review and Meta-Analysis.

text: BACKGROUND In 2016, the global number of individuals living with dementia was 43.8 million, representing a 117% increase from 1990-mainly due to increases in aging and population growth. Up to 90% of individuals with dementia experience neuropsychiatric symptoms (NPS). However, the limitations of current treatments for NPS have drivent he search for safer pharmacotherapies-including cannabinoids. AIM To assess the efficacy and acceptability of cannabinoids for the treatment of NPS in individuals with dementia. DESIGN Systematic review and meta-analysis of clinical trials. SETTING AND PARTICIPANTS Of 6,902 papers, 9 were eligible (n = 205, 44% female, 78 ± 7 years, 85% Alzheimer disease). Trials were in North America and Europe and explored tetrahydrocannabinol (n = 3), dronabinol (n = 5), or nabilone (n = 1). MEASUREMENT Titles/abstracts were independently screened by one reviewer and reviewed by a second. Full-text screening was by two reviewers with discrepancies resolved via a third reviewer. We extracted data on the standardized mean difference (SMD) for several NPS instruments, trial completion, and adverse events. Data were pooled using random-effects models. FINDINGS Cannabinoids led to significant improvements across NPS instruments, including the Cohen Mansfield Agitation Inventory (SMD = -0.80; 95% confidence interval [CI], -1.45 to -0.16), the Neuropsychiatric Inventory (SMD = -0.61; CI, -1.07 to -0.15), and nocturnal actigraphy (SMD = -1.05; CI, -1.56 to -0.54h). Cannabinoids were well-tolerated, with an overall trial completion rate of 93% (193/205) and no serious treatment-related adverse events. Treatment efficacy was associated with baseline dementia severity and dose, but not dementia subtype, age, or sex. The overall study quality was rated as low. CONCLUSIONS There is preliminary evidence for the efficacy and tolerability of cannabinoids as treatments for NPS. Population-based studies are needed to characterize their real-world effectiveness and acceptability.


title: Unphosphorylated ISGF3 drives constitutive expression of interferon-stimulated genes to protect against viral infections.

text: Interferon (IFN)-stimulated genes (ISGs) are antiviral effectors that are induced by IFNs through the formation of a tripartite transcription factor ISGF3, which is composed of IRF9 and phosphorylated forms of STAT1 and STAT2. However, we found that IFN-independent ISG expression was detectable in immortalized cell lines, primary intestinal and liver organoids, and liver tissues. The constitutive expression of ISGs was mediated by the unphosphorylated ISGF3 (U-ISGF3) complex, consisting of IRF9 together with unphosphorylated STAT1 and STAT2. Under homeostatic conditions, STAT1, STAT2, and IRF9 were found in the nucleus. Analysis of a chromatin immunoprecipitation sequencing data set revealed that STAT1 specifically bound to the promoters of ISGs even in the absence of IFNs. Knockdown of STAT1, STAT2, or IRF9 by RNA interference led to the decreased expression of various ISGs in Huh7.5 human liver cells, which was confirmed in mouse embryonic fibroblasts (MEFs) from STAT1-/-, STAT2-/-, or IRF9-/- mice. Furthermore, decreased ISG expression was accompanied by increased replication of hepatitis C virus and hepatitis E virus. Conversely, simultaneous overexpression of all ISGF3 components, but not any single factor, induced the expression of ISGs and inhibited viral replication; however, no phosphorylated STAT1 and STAT2 were detected. A phosphorylation-deficient STAT1 mutant was comparable to the wild-type protein in mediating the IFN-independent expression of ISGs and antiviral activity, suggesting that ISGF3 works in a phosphorylation-independent manner. These data suggest that the U-ISGF3 complex is both necessary and sufficient for constitutive ISG expression and antiviral immunity under homeostatic conditions.


title: Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost.

text: BACKGROUND Comparison studies of hand-assisted and laparoscopic-assisted colectomy have indicated that short-term outcomes are similar. Although a few of these studies have compared costs, none has reported on the costs of hand-assisted colectomy performed in the US. Our aim was to determine the short-term outcomes and direct costs associated with hand-assisted and laparoscopic-assisted colectomy performed in the US. STUDY DESIGN One hundred hand-assisted laparoscopic colectomies were matched to 100 laparoscopic-assisted colectomies performed concurrently. Matching criteria were age (+/- 10 years), gender, diagnosis, American Society of Anesthesiologists score, earlier abdominal operation, colectomy type, and conversion. Operative time, morbidity, length of stay, reoperation, and readmission were assessed. Direct costs for the operating room, nursing care, intensive care, anesthesia, laboratory, pharmacy, radiology, emergency services and consultations, and professional and ancillary services related to the initial hospitalization and readmissions were compared. RESULTS From June 2005 to August 2008, 176 hand-assisted and 845 laparoscopic-assisted segmental and total colectomies were performed. Of 100 matched hand-assisted and laparoscopic-assisted patients, there were no differences in body mass index (29 and 28, respectively), operating time (168 and 163 minutes, respectively), length of stay (4 days), readmission (6% and 11%, respectively), or reoperation rates (5% and 9%, respectively). Overall morbidity was 16% and 32% for hand-assisted and laparoscopic-assisted colectomy, respectively (p = 0.009). Major morbidity, including abscess, hemorrhage, and anastomotic leak, were similar. Operating room costs were increased for hand-assisted colectomy (3,476 versus 3,167 US dollars); total costs were similar (8,521 versus 8,373 US dollars). CONCLUSIONS Short-term outcomes and total costs of hand-assisted and laparoscopic-assisted colectomy are similar.


Quality indicators for EUS.


title: Characterization of a critical interaction between the coronavirus nucleocapsid protein and nonstructural protein 3 of the viral replicase-transcriptase complex.

text: The coronavirus nucleocapsid protein (N) plays an essential structural role in virions through a network of interactions with positive-strand viral genomic RNA, the envelope membrane protein (M), and other N molecules. Additionally, N protein participates in at least one stage of the complex mechanism of coronavirus RNA synthesis. We previously uncovered an unanticipated interaction between N and the largest subunit of the viral replicase-transcriptase complex, nonstructural protein 3 (nsp3). This was found through analysis of revertants of a severely defective mutant of murine hepatitis virus (MHV) in which the N gene was replaced with that of its close relative, bovine coronavirus (BCoV). In the work reported here, we constructed BCoV chimeras and other mutants of MHV nsp3 and obtained complementary genetic evidence for its association with N protein. We found that the N-nsp3 interaction maps to the amino-terminal ubiquitin-like domain of nsp3, which is essential for the virus. The interaction does not require the adjacent acidic domain of nsp3, which is dispensable. In addition, we demonstrated a complete correspondence between N-nsp3 genetic interactions and the ability of N protein to enhance the infectivity of transfected coronavirus genomic RNA. The latter function of N was shown to depend on both of the RNA-binding domains of N, as well as on the serine- and arginine-rich central region of N, which binds nsp3. Our results support a model in which the N-nsp3 interaction serves to tether the genome to the newly translated replicase-transcriptase complex at a very early stage of infection.


title: Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience.

text: BACKGROUND Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. Coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe. METHODS Freely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression was used for inferential estimates. RESULTS Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (p=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], p=0.004). CONCLUSIONS ECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.


Severe acute respiratory syndrome coronavirus-2 in post-laryngectomy patients: case series of four patients.


title: Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis.

text: A systematic review and meta-analysis was conducted in an attempt to systematically collect and evaluate the associations of epidemiological, comorbidity factors with the severity and prognosis of coronavirus disease 2019 (COVID-19). The systematic review and meta-analysis was conducted according to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Sixty nine publications met our study criteria, and 61 studies with more than 10,000 COVID-19 cases were eligible for the quantitative synthesis. We found that the males had significantly higher disease severity (RR: 1.20, 95% CI: 1.13-1.27, P <0.001) and more prognostic endpoints. Older age was found to be significantly associated with the disease severity and six prognostic endpoints. Chronic kidney disease contributed mostly for death (RR: 7.10, 95% CI: 3.14-16.02), chronic obstructive pulmonary disease (COPD) for disease severity (RR: 4.20, 95% CI: 2.82-6.25), admission to intensive care unit (ICU) (RR: 5.61, 95% CI: 2.68-11.76), the composite endpoint (RR: 8.52, 95% CI: 4.36-16.65,), invasive ventilation (RR: 6.53, 95% CI: 2.70-15.84), and disease progression (RR: 7.48, 95% CI: 1.60-35.05), cerebrovascular disease for acute respiratory distress syndrome (ARDS) (RR: 3.15, 95% CI: 1.23-8.04), coronary heart disease for cardiac abnormality (RR: 5.37, 95% CI: 1.74-16.54). Our study highlighted that the male gender, older age and comorbidities owned strong epidemiological evidence of associations with the severity and prognosis of COVID-19.


Culture of responsibility.


title: A VISTA on PD-1H.

text: Three years ago, two research groups independently identified a previously undescribed T cell cosignaling molecule; one referred to it as V-domain Ig suppressor of T cell activation (VISTA), and the other used the term programmed death-1 homolog (PD-1H). Recombinant and ectopically expressed PD-1H functions as a coinhibitory ligand for T cell responses. However, the function of endogenous PD-1H is not clear. In this issue of the JCI, Flies and colleagues demonstrate that endogenous PD-1H on both T cells and APCs serves as a coinhibitory molecule for T cell activation and provide further support for targeting PD-1H as a therapeutic strategy for transplantation and cancers.


title: Bite force and electromyographic activity of the masseter muscle in children with hemifacial microsomia.

text: Hemifacial microsomia (HFM) is a malformation characterized by asymmetric facial growth with mandibular and muscular involvement. There are no reports focused on the functional status of the masticatory system of patients with HFM. The objective of this work evaluate bite force and electrical activity of masseter muscle in children with HFM, and compare them to healthy controls. A cross-sectional study was performed to compare bite force and electrical activity of masseter muscle between subjects with HFM and healthy children. Mean bite force (MBF) and surface electromyography (EMG) on maximum intercuspation (MIC) and rest position (RP) from both sides of the face were recorded. Comparative statistics between HFM patients and controls were performed using the Mann-Whitney test, Wilcoxon's signed rank test was used to compare the microsomic and healthy hemifaces. Twenty children with HFM and 10 controls were included, average age was 7.2 years (range 3-14). MBF did not show statistical significance between both groups. Surface EMG signal at MIC was significantly diminished when compared to the healthy side (p = .003) and to the control group (p = .016), this significance was also present at RP when comparing the affected and non-affected sides of the face (p < .01) but not against the controls (p = .08). This study showed that patients with HFM had diminished EMG values of the masseter muscle on the affected side, compared to healthy individuals, but bite force did not show significant alterations.


title: Comparison of hemostatic properties between collagen and synthetic buttress materials used in staple line reinforcement in a swine splenic hemorrhage model.

text: INTRODUCTION The use of staplers in gastrointestinal surgery is widespread, especially in advanced laparoscopic procedures. Staple line reinforcement with a buttress reduces bleeding and associated complications through a combination of factors. The intrinsic hemostatic properties of buttress materials have not been examined. This study examined the intrinsic hemostatic properties of two different types of material used in buttressing in an accepted hemostasis model that does not involve stapling or its effects by compression. MATERIALS An acellular collagen buttress (Veritas) and a synthetic polymer buttress (Duet) were compared to two commonly used hemostatic agents, Syvek and Surgicel, with gauze as control. METHODS In a swine capsular stripping hemostasis model, a 1 × 1 cm section of spleen capsule was removed and used as a source of bleeding, with one patch of material tested per bleeding site. A total of 51 wounds were created in five pigs (each patch n = 10, control n = 11). Hemostatic efficacy was assessed by quantitating the number of applications and total time needed for bleeding to stop. RESULTS The mean time needed for hemostasis for Syvek and Veritas patches was significantly less than gauze, Duet and Surgicel (4.02, 4.51 vs. 8.97, 9.22, and 10.30 min respectively; p < 0.05). The Syvek and Veritas patches required significantly fewer applications than gauze, Duet™ and Surgicel (1.7, 2.2 vs. 4.1, 4.6, and 4.9 respectively; p < 0.01). CONCLUSIONS The intrinsic hemostatic properties of different buttressing materials vary widely. In this study, a collagen buttress was significantly better at promoting hemostasis than the synthetic buttress material in a nonstapling model. This could be another factor to consider when choosing a buttress for staple line reinforcement.


title: Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve.

text: BACKGROUND Transanal total mesorectal excision (TaTME) provides an excellent view of the resection margins for rectal cancer from below, but is challenging due to few anatomical landmarks. During implementation of this technique, patient safety and optimal outcomes need to be ensured. The aim of this study was to evaluate the learning curve of TaTME in patients with rectal cancer in order to optimize future training programs. METHODS All consecutive patients after TaTME for rectal cancer between February 2012 and January 2017 were included in a single-center database. Influence of surgical experience on major postoperative complications, leakage rate and operating time was evaluated using cumulative sum charts and the splitting model. Correction for potential case-mix differences was performed. RESULTS Over a period of 60 months, a total of 138 patients were included in this study. Adjusted for case-mix, improvement in postoperative outcomes was clearly seen after the first 40 patients, showing a decrease in major postoperative complications from 47.5 to 17.5% and leakage rate from 27.5 to 5%. Mean operating time (42 min) and conversion rate (from 10% to zero) was lower after transition to a two-team approach, but neither endpoint decreased with experience. Readmission and reoperation rates were not influenced by surgical experience. CONCLUSIONS The learning curve of TaTME affected major (surgical) postoperative complications for the first 40 patients. A two-team approach decreased operative time and conversion rate. When implementing this new technique, a thorough teaching and supervisory program is recommended to shorten the learning curve and improve the clinical outcomes of the first patients.


title: A Comparison of Diffusion-Weighted Imaging Abnormalities Following Balloon Remodeling for Aneurysm Coil Embolization in the Ruptured vs Unruptured Setting.

text: BACKGROUND The prothrombotic milieu seen in subarachnoid hemorrhage (SAH) poses a unique challenge to neurovascular surgeons with regard to device use and microcatheter practice. OBJECTIVE To determine how demographic factors and balloon practices impact diffusion-weighted imaging (DWI) abnormalities and outcomes in patients with SAH compared to those without (non-SAH). METHODS We retrospectively analyzed 77 patients with SAH treated by balloon-assisted coiling in a single institution compared with 81 consecutive patients with unruptured aneurysms treated by balloon-assisted coiling at the same institution. Data were collected with regard to demographic factors, procedural and anatomic considerations, and DWI abnormalities on postprocedural magnetic resonance imaging. RESULTS SAH patients were significantly more likely to have DWI abnormality (75% vs 21%, P < .0001) and had a higher number and volume of DWI (4.0 vs 3.0, P = .0421 and 1.3 vs 0.3 cc, P = .0041) despite similar balloon practices. SAH patients were not more likely to have DWI abnormality in vascular territory distal to the treated aneurysm but had a higher likelihood of DWI in a vascular territory unrelated to the aneurysm (81.5% vs 47.1%, P = .0235). Patients without DWI abnormality were significantly more likely to have a good outcome as defined by modified Rankin Score 0 to 2 (95.6% vs 81.6%, P = .0328). Patients with DWI abnormality more often underwent 4-vessel angiography (70.5% vs 48.0%, P = .0174), but this was not found to be significant on multivariate analysis. CONCLUSION Balloon-assisted coiling does not result in increased incidence of downstream ischemic events in SAH patients compared to non-SAH patients and is safe in this cohort of patients. Other factors, such as 4-vessel angiography of the SAH milieu itself, may predispose patients to a higher rate of ischemic events.


Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.


title: Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation.

text: INTRODUCTION Catheter ablation of longstanding (> 1 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block. METHODS AND RESULTS Bilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0 V/2 ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings. Twenty-five consecutive patients were included (58 ± 7 years, persistent AF duration 1.8 ± 0.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17 ± 7 months, 76 % of the patients (n = 19) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs. CONCLUSIONS Treatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.


title: Treatment of giant hiatal hernia by laparoscopic Roux-en-Y gastric bypass.

text: INTRODUCTION Obesity is a risk factor for hiatal hernia. In addition, much higher recurrence rates are reported after standard surgical treatment of hiatal hernia in morbidly obese patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective surgical treatment for morbid obesity and is known to effectively control symptoms of gastroesophageal reflux (GERD). CASE PRESENTATION Two patients suffering from giant hiatal hernias where a combined LRYGB and hiatal hernia repair (HHR) with mesh was performed are presented in this paper. There were no postoperative complications and at 1 year follow-up, there was no sign of recurrence of the hernia. DISCUSSION The gold standard for all symptomatic reflux patients is still surgical correction of the paraesophageal hernia, including complete reduction of the hernia sac, resection of the sac, hiatal closure and fundoplication. However, HHR outcome is adversely affected by higher BMI levels, leading to increased HH recurrence rates in the obese. CONCLUSION Concomitant giant hiatal hernia repair with LRYGB appears to be safe and feasible. Moreover, LRYGB plus HHR appears to be a good alternative for HH patients suffering from morbid obesity as well than antireflux surgery alone because of the additional benefit of significant weight loss and improvement of obesity related co-morbidity.


Gastrointestinal endoscopy and the COVID-19 pandemic: Urgent issues in endoscopic retrograde cholangio-pancreatography and endoscopic training.