title: Infection control in mass respiratory failure: preparing to respond to H1N1.

text: The first hints of a global public health crisis emerged with the identification of a new strain of H1N1 influenza A in March and April 2009 in Mexico City. By June 11, the World Health Organization had declared the outbreak of 2009 H1N1 a global pandemic. Now, with the continued growing presence of 2009 H1N1 on the global scene, much attention has been focused on the key role of personal protective equipment in healthcare infection control. Much less emphasis has been placed on specific interventions that may minimize the increased infectious risk commonly associated with critical care delivery. Given the frequency of high-risk respiratory procedures such as intubation and delivery of aerosolized medications in the intensive care unit, the delivery of critical care presents unique infection control challenges and unique opportunities to augment usual infection control practice with specific source-control efforts. Here, we summarize data regarding risks to critical care healthcare workers from previous respiratory virus outbreaks, discuss findings from the early 2009 H1N1 experience that suggest reasons for increased concern for those delivering critical care, and review best available evidence regarding strategies for source control in respiratory and critical care delivery.


title: Automating Biomedical Evidence Synthesis: RobotReviewer.

text: We present RobotReviewer, an open-source web-based system that uses machine learning and NLP to semi-automate biomedical evidence synthesis, to aid the practice of Evidence-Based Medicine. RobotReviewer processes full-text journal articles (PDFs) describing randomized controlled trials (RCTs). It appraises the reliability of RCTs and extracts text describing key trial characteristics (e.g., descriptions of the population) using novel NLP methods. RobotReviewer then automatically generates a report synthesising this information. Our goal is for RobotReviewer to automatically extract and synthesise the full-range of structured data needed to inform evidence-based practice.


title: Robotic Pancreaticoduodenectomy: Single-Surgeon Initial Experience.

text: Minimally invasive surgery has gained increasing acceptance over the last few years, which has expanded to pancreaticoduodenectomy. Laparoscopic pancreaticoduodenectomy has been determined to be a feasible, safe, and effective procedure in an experienced surgeon's hands, but the adaptations to the clumsy instruments are needed. The improved dexterity of the Da Vinci robotic system provides a good opportunity to perform this challenging procedure in the minimally invasive context. The aim of this study was to share our preliminary experience of totally robotic pancreaticoduodenectomy. From April 2015 to August 2015, four patients were selected to undergo totally robotic pancreaticoduodenectomy in the Department of Pancreatic Surgery, West China Hospital, Sichuan University, China. The demographic characteristics, perioperative details, and pathological results were retrospectively reviewed. One female and two male patients underwent totally robotic pancreaticoduodenectomy, while another male patient underwent robotic total pancreatectomy due to the severe atrophy of pancreatic body and tail. The mean age of the four patients was 56.8 years. The average operation time and intraoperative blood loss were 563 min and 228 mL, respectively. No one needed blood transfusion, conversion to open pancreaticoduodenectomy, or postoperative analgesia. The postoperative courses of these patients were uneventful. The mean postoperative hospital stay was 10 days. No one required to be readmitted, and there was no death within 30 days following the surgery. Final pathologic examinations revealed one malignant pancreatic ductal adenocarcinoma, and three benign lesions. Based on this initial study, robotic pancreaticoduodenectomy is safe and feasible, with acceptable oncological outcomes for highly selected patients in experienced surgeons' hands. However, concerns such as long-term outcomes, cost-effectiveness analysis, and learning curve analysis should be fully demonstrated before the popularization of this challenging procedure.


title: Mechanical ventilation and Streptococcus pneumoniae pneumonia alter mitochondrial homeostasis.

text: Required mechanical ventilation (MV) may contribute to bacterial dissemination in patients with Streptococcus pneumoniae pneumonia. Significant variations in plasma mitochondrial DNA (mtDNA) have been reported in sepsis according to the outcome. The impact of lung stretch during MV was addressed in a model of pneumonia. Healthy or S. pneumoniae infected rabbits were submitted to MV or kept spontaneously breathing (SB). Bacterial burden, cytokines release, mitochondrial DNA levels, integrity and transcription were assessed along with 48-hour mortality. Compared with infected SB rabbits, MV rabbits developed more severe pneumonia with greater concentrations of bacteria in the lungs, higher rates of systemic dissemination, higher levels of circulating inflammatory mediators and decreased survival. Pulmonary mtDNA levels were significantly lower in infected animals as compared to non-infected ones, whenever they were SB or MV. After a significant early drop, circulating mtDNA levels returned to baseline values in the infected SB rabbits, but remained low until death in the MV ones. Whole blood ex-vivo stimulation with Streptococcus pneumoniae resulted in a reduction of polymorphonuclear leukocytes mitochondrial density and plasma mtDNA concentrations. Thus, persistent mitochondrial depletion and dysfunction in the infected animals submitted to MV could account for their less efficient immune response against S. pneumoniae.


β-Arrestin-Biased Angiotensin II Receptor Agonists for COVID-19.


[Proctology in dermatology-quo vadis?]


title: Interventions to improve participation in health-care decisions in non-Western countries: A systematic review and narrative synthesis.

text: BACKGROUND Patients' participation in medical decision making is an important aspect of patient-centred care. However, there is often uncertainty about its applicability and feasibility in non-Western countries. OBJECTIVE To provide an overview and assessment of interventions that aimed to improve patients' participation in decision making in non-Western countries. METHOD Ovid Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Ovid MEDLINE(R) Epub Ahead of Print, In-Process, Other Non-Indexed Citations, without Revisions and Daily Update and Database of Abstracts of Reviews of Effects, were searched from respective inception to February 2018. Studies were included if they (a) were randomized controlled trials, before-and-after studies and interrupted time series studies; (b) were conducted in non-Western countries; (c) aimed to improve patients' participation in dyadic decision making; and (d) reported outcomes relevant to patient participation in decision making. Studies were excluded if they included children, were about triadic decision making or solely focused on information provision without reporting outcomes related to patient participation. Narrative synthesis method was used for data analysis and presentation. RESULTS A total of 17 studies, 6 RCTs and 11 non-RCTs, were included across ten countries. Intervention strategies included patient and/or provider communication skills training, decision aids and a question prompt material. Whilst most of the studies reported increased patient participation, those interventions which had provider or patient training in communication skills were found to be more effective. CONCLUSION Interventions to improve patient participation, within the context of dyadic decision making, in non-Western countries can be feasible and effective if communication skills training is provided for health-care providers and/or patients.


title: Alteration in tumoural PD-L1 expression and stromal CD8-positive tumour-infiltrating lymphocytes after concurrent chemo-radiotherapy for non-small cell lung cancer.

text: BACKGROUND Consolidation treatment with an anti-PD-L1 antibody, durvalumab, following concurrent chemo-radiotherapy (cCRT) has become a new standard of care for locally advanced non-small cell lung cancer (NSCLC). The rationale of PD-L1 blockade after cCRT is based on preclinical evidence suggesting that chemotherapy and radiotherapy up-regulate tumoural PD-L1 expression, which has not been shown in clinical studies. METHODS To examine alteration in tumoural PD-L1 expression (tumour proportion score, TPS) and density of stromal CD8-positive tumour-infiltrating lymphocytes (CD8 + TILs) after cCRT, paired NSCLC samples obtained before and after cCRT were reviewed in comparison with those obtained before and after drug therapy. RESULTS PD-L1 expression was significantly up-regulated after cCRT (median TPS, 1.0 at baseline versus 48.0 after cCRT; P < 0.001), but not after drug therapy. There was no significant correlation between baseline TPS and post-cCRT TPS. CD8 + TIL density was significantly increased after cCRT (median, 10.6 versus 39.1; P < 0.001), and higher post-cCRT CD8 + TIL density was associated with a higher pathologic response and with a favourable survival (P = 0.019). CONCLUSION Tumoural PD-L1 expression was up-regulated after cCRT, which provides pathologic rationale for PD-L1 blockade following cCRT to improve prognosis. Stromal CD8 + TIL density was also increased after cCRT, and higher post-cCRT CD8 + TIL density was a favourable prognostic indicator.


title: Evaluation of an infrared thermal detection system for fever recognition during the H1N1 influenza pandemic.

text: Infrared thermal detection systems (ITDSs) have been utilized in several countries to screen for fever in travelers. Since fever screening with an ITDS is rapid and noninvasive, this technology may be useful as an infection control measure in clinical settings during a pandemic.


Response to: Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic.


title: Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar.

text: Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.


title: Central Venous Catheter-Related Infection in Severe Trauma Patients.

text: AIM To evaluate the CVC-related infection rate according to catheter insertion site and to analyze the risk factors for catheter-related local infections (CRLI) and bloodstream infections (CRBSI) among severe trauma patients. METHODS We reviewed the medical records of 736 severe trauma patients with an Injury Severity Score of >15. Poisson regression was used to compare the infection rates according to the catheter insertion sites. Univariate analysis of the groups with and without CVC-related infection was used to identify confounding variables for inclusion in multivariate models that were used to identify the risk factors for CRLI and CRBSI. RESULTS We evaluated 1646 catheter insertions and their duration of insertion and found 1241 subclavian (18,461 days), 251 internal jugular (3454 days), and 154 femoral catheters (1526 days). The CRLI infection rate per 1000 catheter days was significantly lower for subclavian, compared to that for internal jugular (4.83 vs. 9.55, respectively; P < 0.001) and femoral catheters (4.83 vs. 7.93, respectively; P = 0.013). Multivariate logistic regression analysis revealed that catheter insertion duration [odds ratio (95 % confidence interval): 1.035 (1.021-1.050), P < 0.001] and subclavian access [0.532 (0.366-0.775), P < 0.001] were significantly associated with CRLI, while catheter insertion duration [1.024 (1.002-1.046), P = 0.032] was significantly associated with CRBSI. CONCLUSIONS To reduce the rate of CVC-related infections in severe trauma patients, we suggest that catheters be shifted from the internal jugular or femoral veins to the subclavian vein as soon as possible and that the duration of catheter insertion should be minimized.


title: Insights into cellular factors that regulate HIV-1 replication in human cells.

text: Retroviruses integrate into the host cell's chromosome. Accordingly, many aspects of the life cycle of retroviruses like HIV-1 are intimately linked to the functions of cellular proteins and RNAs. In this review, we discuss in brief recent genomewide screens for the identification of cellular proteins that assist HIV-1 replication in human cells. We also review findings for other cellular moieties that help or restrict the viral life cycle.


title: Feed-related Splanchnic Oxygenation in Preterm Infants With Abnormal Antenatal Doppler Developing Gut Complications.

text: Preterm infants with antenatal absent or reversed end diastolic flow (AREDF) in umbilical arteries are at major risk for gastrointestinal (GI) complications, such as necrotizing enterocolitis, intestinal perforation and feeding intolerance. Near-infrared spectroscopy provides continuous monitoring of splanchnic oxygenation (SrSO2) and may represent a useful tool to predict GI outcomes in this high-risk population. This observational, pilot study assessed feed-related SrSO2 patterns at enteral feeding introduction and full enteral feeding (FEF) achievement in twenty AREDF infants with gestational age ≤34 weeks. Enrolled infants were divided into 2 groups according to the development versus lack of GI complications. Infants developing GI complications showed significantly lower SrSO2 and increased splanchnic oxygen extraction in response to enteral feeds at both enteral feeding introduction and FEF. The potential role of these findings in predicting GI complications in AREDF preterm infants seems promising and deserves further evaluation.


title: Optimal CT scanning parameters for commonly used tumor ablation applicators.

text: PURPOSE CT-beam hardening artifact can make tumor margin visualization and its relationship to the ablation applicator tip challenging. To determine optimal scanning parameters for commonly-used applicators. MATERIALS AND METHODS Applicators were placed in ex-vivo cow livers with implanted mock tumors, surrounded by bolus gel. Various CT scans were performed at 440mA with 5mm thickness changing kVp, scan time, ASiR, scan type, pitch, and reconstruction algorithm. Four radiologists blindly scored the images for image quality and artifact quantitatively. RESULTS A significant relationship between probe, kVp level, ASiR level, and reconstruction algorithm was observed concerning both image artifact and image quality (both p=<0.0001). Specifically, there are certain combinations of kVp, ASiR, and reconstruction algorithm that yield better images than other combinations. In particular, one probe performed equivalently or better than any competing probe considered here, regardless of kVp, ASiR, and reconstruction algorithm combination. CONCLUSION The findings illustrate the overall interaction of the effects of kVp, ASiR, and reconstruction algorithm within and between probes, so that radiologists may easily reference optimal imaging performance for a certain combinations of kVp, ASiR, reconstruction algorithm and probes at their disposal. Optimum combinations for each probe are provided.


title: Structural barriers to adhering to health behaviours in the context of the COVID-19 crisis: Considerations for low- and middle-income countries.

text: ABSTRACT In seeking to limit the number of new infections of COVID-19, governments around the world have implemented national lockdowns and guidelines about safe behaviours. Lockdown requires people to stay home and only leave when essential such as to purchase groceries and medication. In low- and middle-income countries, many of which have large proportions of the population living in precarity, lockdown forces millions of people to spend prolonged periods of time together in close proximity to one another and with limited resources. In many ways, efforts to contain the spread of COVID-19 in densely populated communities with limited access to food, water and sanitation may seem counter-intuitive and even impossible under conditions of precarity. In this paper, we explore the barriers to implementation of lockdown rules in conditions of precarity. We conceptualise the structural barriers by drawing on the Theoretical Domains Framework to explain how these barriers influence adherence to lockdown rules. We argue that without sufficient support or intervention to help poor communities mitigate these structural barriers, adhering to lockdown rules is difficult, resulting in continued COVID-19 infections.


title: Comparison of gastrojejunal anastomosis techniques in laparoscopic Roux-en-Y gastric bypass: gastrojejunal stricture rate and effect on subsequent weight loss.

text: BACKGROUND Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss. METHODS A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals. RESULTS Included in the data were 426 patients, divided between HSA (n = 174, 40.8%), CSA (n = 110, 25.8%) and LSA (n = 142, 33.3%). There was no significant difference in the stricture rates (HSA n = 17, 9.72%; CSA n = 9, 8.18%; LSA n = 8, 5.63%; p = 0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6% ± 16.2% vs 35.92% ± 21.42% vs 48.21 % ± 14.79%; p = 0.0821), 6 months (61.48% ± 23.94% vs 58.16 % ± 27.31% vs 60.18% ± 22.26%; p = 0.2296), 12 months (72.94% ± 19.93% vs 69.72 ± 21.42% vs 66.05% ± 17.75%; p = 0.0617) and 24 months (73.29% ± 22.31% vs 68.75 % ± 24.71% vs 69.40% ± 23.10%; p = 0.7242), respectively. The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39% ± 16.82 % vs 39.22 % ± 21.93%; p = 0.0340); however, this difference had resolved at 6 months (61.29% ± 18.50 % vs 59.79% ± 23.03%; p = 0.8802) and 12 months (71.59 % ± 18.67 % vs 68.69 % ± 22.19 %; p = 0.5970). CONCLUSIONS There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different.


title: Hemodialysis with Cohort Isolation to Prevent Secondary Transmission during a COVID-19 Outbreak in Korea.

text: BACKGROUND Health care-associated infections during previous coronavirus epidemics involving severe acute respiratory syndrome and Middle East respiratory syndrome resulted from human-to-human transmission in hemodialysis (HD) facilities. The effect of a strategy of HD with cohort isolation-separate dialysis sessions for close contacts of patients with confirmed coronavirus disease 2019 (COVID-19)-on the prevention of secondary transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in HD units is unknown. METHODS Our multicenter cohort study of an HD with cohort isolation strategy enrolled close contacts of patients with confirmed COVID-19, including patients on HD and health care workers in HD units. Close contacts had been identified by epidemiologic investigation and tested negative on an immediate screening test for SARS-CoV-2. RESULTS As of March 14, 11 patients on HD and 7 health care workers from 11 HD centers were diagnosed as having COVID-19. The immediate screening test was performed in 306 people, and among them, 302 close contacts with negative test results were enrolled. HD with cohort isolation was performed among all close contacts for a median of 14 days in seven centers. During cohort isolation, nine patients showed symptoms but tested negative for SARS-CoV-2. Two health care workers in the HD units (0.66% of the total group) were diagnosed at the termination test for SARS-CoV-2. CONCLUSIONS The transmission of COVID-19 can be controlled without closure of HD centers by implementing preemptive activities, including early detection with rapid testing, cohort isolation, collaboration between institutions, and continuous monitoring of infection. Our strategy and experience may provide helpful guidance for circumstances involving the rapid spread of infectious diseases such as COVID-19.


title: A laparoscopic approach for removal of ovarian remnant tissue in 32 dogs.

text: BACKGROUND Surgical treatment of ovarian remnant syndrome (ORS) in dogs usually necessitates large celiotomies and considerable manipulation of organs because of the relatively deep position of ovarian remnant tissue, large patient size, and often encountered adhesions. In women, laparoscopic treatment of ORS is successful and has significant advantages over laparotomy. Since laparoscopic ovariectomy has significant advantages over open ovariectomy in dogs, including reduced surgical stress and postoperative pain and shorter convalescence period, the rationale for a laparoscopic approach of canine ORS is evident. Feasibility and efficacy of a laparoscopic approach for treatment of ORS in dogs was prospectively evaluated using a standardized protocol for diagnosis, treatment, and follow-up. Treatment success was evaluated by histology of removed tissues, postoperative hormone testing, and long-term clinical follow-up. RESULTS Thirty-two client-owned predominantly medium and large breed dogs diagnosed with ORS underwent abdominal ultrasound for ovarian remnant localization prior to laparoscopic surgery for removal of ovarian remnants. Tissue dissection and excision was performed using a vessel sealing forceps. Laparoscopy subjectively enabled detailed visibility and facilitated detection and removal of suspected ovarian tissue in all cases. Histology confirmed ovarian origin of removed tissue in all dogs. Additionally, a GnRH stimulation test was performed in fourteen dogs after a median follow-up of 10.5 months, which verified absence of residual functional ovarian remnant tissue in all dogs. Median surgery duration was 97.5 min and mean total convalescence duration, subjectively scored by owners, was 1.5 ± 0.7 days. No major complications occurred. Adhesions were observed in 79% of the dogs, complicated the surgical approach, and significantly affected surgery duration (85 versus 109 min; p = 0.03). Minor hemorrhage occurred in 12% and significantly increased surgery duration (95.5 versus 128 min; p = 0.02). Trendelenburg position and lateral tilting of the patient were essential for proper access to ovarian remnants. GnRH stimulation test results and/or absence of clinical signs indicative of ORS after a median follow-up period of 22.5 months confirmed treatment efficacy in all dogs. CONCLUSION Laparoscopic surgery for ORS in dogs is effective with minimal complications and short convalescence and can successfully replace the conventional, more invasive open surgical procedure.


title: Norovirus non-structural protein p20 leads to impaired restitution of epithelial defects by inhibition of actin cytoskeleton remodelling.

text: OBJECTIVE Norovirus is the most common cause of acute gastroenteritis in humans worldwide. Typical symptoms are vomiting, nausea and severe watery diarrhea. Because of the lack of cell lines susceptible to human norovirus infection, pathomechanisms and replication cycle are largely unknown. Here, we address the issue of how norovirus infection could lead to epithelial barrier dysfunction. MATERIAL AND METHODS Expression of the non-structural norovirus protein p20 in the epithelial cell line HT-29/B6 was activated through a tetracycline sensitive promoter. Tight junction proteins were studied by Western blot and confocal laser scanning microscopy. Apoptoses were detected in TUNEL stainings. Epithelial restitution was monitored by conductance scanning after induction of single cell lesions. RESULTS Changes in the expression or localization of the tight junction proteins occludin and/or claudin-1, -2,- 3, -4, -5, -7 and -8 could be ruled out to mediate epithelial barrier modulation. Cell motility was also unaltered by p20. Investigation of epithelial apoptosis revealed an accumulation of apoptic cells in epithelial monolayers after induction of p20 expression. In epithelial cell restitution assays, an arrest was identified in p20 expressing cells. Fluorescence microscopy revealed an inability for condensation and redistribution of cellular actin, which led to a reduced transepithelial electrical resistance. CONCLUSIONS Functional data for norovirus protein p20 suggest a role in modulation of the actin cytoskeleton leading to barrier dysfunction through impairment of restitution of epithelial defects.


Simulation-based skills training in non-performing orthopedic surgeons: skills acquisition, motivation, and flow during the COVID-19 pandemic.


title: Cognitive-Linguistic Performance and Quality of Life in Healthy Aging.

text: BACKGROUND/AIMS This study investigated quality of life (QoL) in relation to cognitive-linguistic performance and demographic characteristics (age, education and gender) in a large cohort of cognitively healthy older adults. METHOD A total of 578 Greek-Cypriots aged 60-91 years were recruited from the Neurocognitive Study on Aging. Of those, 395 healthy participants (171 males and 224 females) who met all study criteria were retained. They completed measures of executive functioning, working memory, receptive vocabulary and confrontational naming in addition to the WHOQOL-BREF (brief version of the WHO QoL questionnaire). RESULTS There were modest but significant relationships between executive functioning, working memory, vocabulary measures and the WHOQOL-BREF (p < 0.01). MANOVA yielded significant gender and education effects on QoL. Sequential stepwise regression confirmed that gender, depression scores and years of education made significant contributions to predicting the total score on WHOQOL-BREF and accounted for 31% of the variance (R² = 0.310). CONCLUSION Self-reports of QoL remain stable in older adulthood. Demographic variables such as gender and years of education affected several domains of QoL, and, along with depression symptomatology, accounted for a significant part of the WHOQOL-BREF variance. Cognitive-linguistic measures correlated on the physical and psychological health domains of the WHOQOL-BREF in healthy older adults.


title: Right heart catheterization using metallic guidewires and low SAR cardiovascular magnetic resonance fluoroscopy at 1.5 Tesla: first in human experience.

text: BACKGROUND Cardiovascular magnetic resonance (CMR) fluoroscopy allows for simultaneous measurement of cardiac function, flow and chamber pressure during diagnostic heart catheterization. To date, commercial metallic guidewires were considered contraindicated during CMR fluoroscopy due to concerns over radiofrequency (RF)-induced heating. The inability to use metallic guidewires hampers catheter navigation in patients with challenging anatomy. Here we use low specific absorption rate (SAR) imaging from gradient echo spiral acquisitions and a commercial nitinol guidewire for CMR fluoroscopy right heart catheterization in patients. METHODS The low-SAR imaging protocol used a reduced flip angle gradient echo acquisition (10° vs 45°) and a longer repetition time (TR) spiral readout (10 ms vs 2.98 ms). Temperature was measured in vitro in the ASTM 2182 gel phantom and post-mortem animal experiments to ensure freedom from heating with the selected guidewire (150 cm × 0.035″ angled-tip nitinol Terumo Glidewire). Seven patients underwent CMR fluoroscopy catheterization. Time to enter each chamber (superior vena cava, main pulmonary artery, and each branch pulmonary artery) was recorded and device visibility and confidence in catheter and guidewire position were scored on a Likert-type scale. RESULTS Negligible heating (< 0.07°C) was observed under all in vitro conditions using this guidewire and imaging approach. In patients, chamber entry was successful in 100% of attempts with a guidewire compared to 94% without a guidewire, with failures to reach the branch pulmonary arteries. Time-to-enter each chamber was similar (p=NS) for the two approaches. The guidewire imparted useful catheter shaft conspicuity and enabled interactive modification of catheter shaft stiffness, however, the guidewire tip visibility was poor. CONCLUSIONS Under specific conditions, trained operators can apply low-SAR imaging and using a specific fully-insulated metallic nitinol guidewire (150 cm × 0.035" Terumo Glidewire) to augment clinical CMR fluoroscopy right heart catheterization. TRIAL REGISTRATION Clinicaltrials.gov NCT03152773 , registered May 15, 2017.


title: Treatment of severe human metapneumovirus (hMPV) pneumonia in an immunocompromised child with oral ribavirin and IVIG.

text: BACKGROUND The clinical manifestations of human metapneumovirus (hMPV) infection resemble those of respiratory syncytial virus with the most severe disease occurring in infants, the elderly, chronically ill, and immunocompromised hosts. OBSERVATION We present a case of a 2-year-old girl undergoing intensive chemotherapy for Burkitt lymphoma who developed severe hMPV pneumonia. Rapid and complete recovery was observed after treatment with oral ribavirin and intravenous immunoglobulin. CONCLUSION As hMPV can cause severe pneumonia in immunocompromised patients and due to the reports of effective treatment with ribavirin, clinical studies to elucidate the role of ribavirin in treatment of hMPV pneumonia may be needed.


title: The sample of choice for detecting Middle East respiratory syndrome coronavirus in asymptomatic dromedary camels using real-time reversetranscription polymerase chain reaction.

text: The newly identified Middle East respiratory syndrome coronavirus (MERS-CoV), which causes severe respiratory disease, particularly in people with comorbidities, requires further investigation. Studies in Qatar and elsewhere have provided evidence that dromedary camels are a reservoir for the virus, but the exact modes of transmission of MERS-CoV to humans remain unclear. In February 2014, an assessment was made of the suitability and sensitivity of different types of sample for the detection of MERSCoV by real-time reverse-transcription polymerase chain reaction (RT-PCR) for three gene targets: UpE (upstream of the E gene), the N (nucleocapsid) gene and open reading frame (ORF) 1a. Fifty-three animals presented for slaughter were sampled. A high percentage of the sampled camels (79% [95% confidence interval 66.9-91.5%, standard error 0.0625]; 42 out of 53) were shown to be shedding MERS-CoV at the time of slaughter, yet all the animals were apparently healthy. Among the virus-positive animals, nasal swabs were most often positive (97.6%). Oral swabs were the second most frequently positive (35.7%), followed by rectal swabs (28.5%). In addition, the highest viral load, expressed as a cycle threshold (Ct) value of 11.27, was obtained from a nasal swab. These findings lead to the conclusion that nasal swabs are the candidate sample of choice for detecting MERS-CoV using RT-PCR technology in apparently healthy camels.


title: Teaching the surgical airway using fresh cadavers and confirming placement nonsurgically.

text: STUDY OBJECTIVE To determine if teaching cricothyrotomy with fresh cadavers improves confidence with neck anatomy, patient positioning, procedural steps, and familiarity with a cricothyrotomy kit. DESIGN Prospective pre- and post-educational. SETTING University medical center. SUBJECTS 16 anesthesiology residents, one certified registered nurse-anesthetist (CRNA), and 8 medical students. MEASUREMENTS Subjects received workshop training with a PowerPoint presentation followed by an instructional video. Subjects then performed cricothyrotomy during supervision on cadavers. The comfort levels of 25 subjects before (pre) and after (post) the workshop were assessed using a 7-point Likert scale. Correct placement of the cricothyrotome was confirmed with visualization of the carina fiberoptically. MAIN RESULTS There was a significant increase (P < 0.001) between pre- and post-training comfort levels in identification of neck anatomy, surgical landmarks, and patient positioning (pre, 2.60 ± 1.56; post, 5.64 ± 1.22; mean ± SD); use of cricothyrotomy kit (pre, 1.72 ± 1.22; post, 5.52 ± 1.26), and surgical steps (pre, 1.76 ± 1.17; post, 5.52 ± 1.26). In 24 of 25 attempts (96% success rate), correct placement of the cricothyrotome was confirmed by visualization of the carina fiberoptically. CONCLUSIONS A didactic workshop followed by performance of cricothyrotomy on fresh human cadavers may improve both physician and non-physician anesthesiology care providers' confidence in performing cricothyrotomy.


Internet-Related Behaviors and Psychological Distress Among Schoolchildren During COVID-19 School Suspension.


title: Anti-vascular endothelial growth factor receptor (VEGFR) 2 autoantibody identification in glioblastoma patient using single B cell-based antibody gene cloning.

text: Antibody direct cloning from single B cells is simple and efficient and has been successful in antibody identification of infectious diseases. However, although a recent whole-exome sequencing revealed abundant heterogeneic mutation accumulation in cancers, identification and synthesis of autoantibodies against specific cancer-associated antigens is still difficult in cancer patients owing to the very small number of B cells producing autoantibodies. In the present study, to identify autoantibodies targeting tumor antigens, we measured the titer of autoantibodies in high-grade glioma patients' plasma and identified two patients with elevated autoantibodies to a few transmembrane proteins. Specific B cells producing autoantibody against vascular endothelial growth factor receptor (VEGFR) 2 were immunostained with labeled protein and anti-human IgG antibody, and then collected by a single cell sorter. Finally, 22 antibody genes were successfully identified using direct IgG cloning from single B cell mRNA, and two antibody clones were found to have significant VEGFR2-specific binding affinity. The current direct human IgG gene cloning technique for identifying human antibodies derived from IgG-memory B cells avoids time-consuming procedures such as phage display-based antibody-library screening, and therefore may be applicable to identifying human autoantibodies in a variety of disorders including cancers even when antibody elevation is not detected because of a very small number of memory B cells.


title: Impact on the endoplasmic reticulum and Golgi apparatus of turnip mosaic virus infection.

text: The impact of turnip mosaic virus (TuMV) infection on the endomembranes of the host early secretory pathway was investigated using an infectious clone that has been engineered for tagging viral membrane structures with a fluorescent protein fused to the viral protein 6K(2). TuMV infection led to the amalgamation of the endoplasmic reticulum (ER), Golgi apparatus, COPII coatamers, and chloroplasts into a perinuclear globular structure that also contained viral proteins. One consequence of TuMV infection was that protein secretion was blocked at the ER-Golgi interface. Fluorescence recovery after photobleaching (FRAP) experiments indicated that the perinuclear structure cannot be restocked in viral components but was dynamically connected to the bulk of the Golgi apparatus and the ER. Experiments with 6K(2) fused to photoactivable green fluorescent protein (GFP) showed that production of motile peripheral 6K(2) vesicles was functionally linked to the perinuclear structure. Disruption of the early secretory pathway did not prevent the formation of the perinuclear globular structure, enhanced the clustering of peripheral 6K(2) vesicles with COPII coatamers, and led to inhibition of cell-to-cell virus movement. This suggests that a functional secretory pathway is not required for the formation of the TuMV perinuclear globular structure and peripheral vesicles but is needed for successful viral intercellular propagation.


title: Effect of surgical wound classification on biologic graft performance in complex hernia repair: an experimental study.

text: BACKGROUND Despite relatively sparse data regarding their outcomes in the setting of infection, biologic grafts have gained rapid acceptance by the surgical community for complex hernia repair. These materials are heterogeneous in their procurement and processing techniques, which may ultimately have an impact in their ability to withstand infection. The objective of this study is to evaluate the impact of varying levels of contamination on biologic graft performance in a chronic ventral hernia animal model. METHODS Four commonly applied biologic grafts were used in the repair of a chronic ventral hernia rat model (n = 218). Each material was repaired in the setting of 1 of 4 surgical wound classifications (clean, clean contaminated, contaminated, dirty infected) with Staphylococcus aureus as our inoculum agent. After a 30-day survival, repairs underwent quantitative cultures, histological, and biomechanical testing. RESULTS Marked differences were observed in biologic graft bacterial burden, biomechanical and histological responses at 30 days. Persistent bacterial burden varied among the biologic grafts and increased with increasing wound contamination (P < .05). Delays in wound healing were observed in the contaminated and dirty infected setting (P < .05). Increasing infection weakened the biomechanical strength of repairs (P < .05). CONCLUSION The degree of bacterial contamination at the time of repair affected the rates of bacterial clearance, wound-healing ability, and subsequent repair strength. Material source and processing techniques might alter graft durability, biocompatibility, and ability to clear bacteria in a contaminated field. Clinical trials are warranted in contaminated settings.


title: Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre.

text: BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.


title: Three-Port Laparoscopic Right Colectomy Versus Conventional Five-Port Laparoscopy for Right-Sided Colon Cancer.

text: BACKGROUND The purpose of the study was to evaluate the safety and effectiveness of three-port laparoscopic right colectomy (3-LRC) for right-sided colon cancer compared with conventional five-port laparoscopic right colectomy (5-LRC). MATERIALS AND METHODS One hundred sixty-three patients diagnosed with right-sided colon adenocarcinoma underwent laparoscopic right colectomy (LRC) between April 2011 and December 2017. Seventy-four of these patients underwent 3-LRC procedure and 89 patients underwent 5-LRC. Clinical characteristics, perioperative short-term outcomes, and pathologic data were analyzed. RESULTS There were no differences in TNM stage, tumor location, estimated blood loss, complications, and open conversion rates. The operation time was shorter in the 3-LRC group than in 5-LRC group (140.9 ± 27.5 minutes versus 178.2 ± 38.2 minutes; P = .001). The number of harvested lymph nodes (28.5 ± 13.9 versus 22.6 ± 11.7; P = .004) was also higher in the 3-LRC group. The first passage of flatus and first oral diet were significantly faster in the 3-LRC group than in the 5-LRC group (2.8 ± 1.0 days versus 4.0 ± 1.2 days; P = .001, 3.6 ± 2.9 days versus 5.0 ± 1.5 days; P = .001). The number of patients who required analgesics is less in the 3-LRC group (32.4% versus 43.8%; P = .583). CONCLUSION 3-LRC for right-sided colon cancer is technically feasible and is associated with a short operation time. We believe that 3-LRC effectively reduces the costs associated with equipment and manpower and represents a standard procedure.


title: Role of 0.4% glyceryl trinitrate ointment after haemorrhoidectomy: results of a prospective randomised study.

text: INTRODUCTION Conventional haemorrhoidectomy (CH) is well known to cause significant post-operative pain and delayed return to daily activities. Both surgical wounds and sphincterial apparatus spasms are likely responsible for the pain. In this study, we evaluated the role of glyceryl trinitrate ointment (GTN) in reducing post-operative pain, ameliorating wound healing and recovery after CH. PATIENTS AND METHODS Between 01/08 and 12/11, 203 patients with symptomatic haemorrhoids were enrolled in the study and received (103 patients) or not (100 patients) 0.4 % GTN ointment for 6 weeks after surgery. Pain was assessed using a 10-cm linear visual analogue scale (VAS). Data on post-operative pain, wound secretion and bleeding, return to normal activities and complications were recorded. Data were analysed using Fisher's exact and Mann-Whitney tests. RESULTS GTN-treated group experienced significantly less pain during the first week after surgery (p < 0.0001). This difference was more evident starting from post-operative day 4 (p < 0.0001). A significant higher percentage of untreated patients experienced severe pain (mean VAS score > 7) (10 % vs 31 %). There were significant differences in terms of secretion time (p = 0.0052) and bleeding time (p = 0.02) in favor of GTN. In addition, the duration of itching was less in the GTN group (p = 0.0145). Patients treated with GTN were able to an early return to daily activities compared to untreated (p < 0.0001). Fifteen GTN-treated patients (14.6 %) discontinued the application because of local discomfort and headache. CONCLUSIONS GTN ointment enhances significantly post-operative recovery, reducing pain in terms of duration and intensity. This effect might be secondary to a faster wound healing expressed by reduced secretion, bleeding and itching time.


title: Surgical resection in Crohn's disease: is immunosuppressive medication associated with higher postoperative infection rates?

text: AIM The aim of this study was to analyse postoperative infection in patients undergoing surgery for Crohn's disease (CD) according to the use of preoperative immunosuppressants, including infliximab. METHOD With IRB approval, the records of all patients with CD who underwent abdominal surgery between 2001 and 2008 were reviewed for comorbidity, preoperative medication, type of surgery, stoma construction and postoperative complications. Patients were divided into three categories according to the preoperative medication within 90 days of surgery as follows: infliximab (IFX), other drugs including steroids and/or immunosuppressive agents (OD) and no drugs (ND). RESULTS Two hundred and twenty-five patients were identified. Preoperative comorbidity, surgical indication and type of surgery were not significantly different among the three groups. Ileocolic resection was the most common procedure [50.8%, IFX group; 61.2%, OD group; 41.3%, ND group (P = 0.09)]. Other procedures included total colectomy (16%), protectomy (15%) and others (18%). Laparoscopic surgery was performed in 47.7%, 45.9% and 29.3% of patients in the IFX, OD and ND groups, respectively (P = 0.04). There were no differences in postoperative rates of infection [pneumonia (P = 0.14), wound infection (P = 0.35), abscess (P = 0.34) or anastomotic leakage (P = 0.44)]. Reoperation was needed in 3.0%, 8.2% and 2.6% of patients in the IFX, OD and ND groups, respectively. Multiple logistic regression found no relationship between infliximab use and infection. CONCLUSION There was no difference in the rate of postoperative complications among the groups of patients undergoing surgery for CD pretreated with IFX or other immunosuppressive drugs.


title: Comparison of two multiplex methods for detection of respiratory viruses: FilmArray RP and xTAG RVP.

text: We compared the FilmArray RP (Idaho Technology, Inc., Salt Lake City, UT) and the xTAG RVP (Luminex Corporation, Toronto, Canada) multiplex respiratory virus PCR methods for the detection of respiratory viruses in a set of 200 patient specimens frozen at -70 °C after standard viral culture and antigen detection methods were done. Both systems detected between 40 to 50% more viruses than traditional methods, primarily rhinoviruses and human metapneumovirus. The FilmArray RP detected significantly more total viruses either alone or as part of mixed infections than the xTAG RVP, as well as an additional 21.6% more respiratory syncytial viruses. The xTAG RVP requires 5 to 6 h with 2.5 to 3 h of hands-on time, while the FilmArray RP takes about an hour with 3 to 5 min of hands-on time, making it much easier to perform.


title: Conditional Cell Reprogramming for Modeling Host-Virus Interactions and Human Viral Diseases.

text: Conventional cancer and transformed cell lines are widely used in cancer biology and other fields within biology. These cells usually have abnormalities from the original tumor itself, but may also develop abnormalities due to genetic manipulation, or genetic and epigenetic changes during long term passages. Primary cultures may maintain lineage functions as the original tissue types, yet they have a very limited life span or population doubling time because of the nature of cellular senescence. Primary cultures usually have very low yields, and the high variability from any original tissue specimens, largely limiting their applications in research. Animal models are often used for studies of virus infections, disease modeling, development of antiviral drugs and vaccines. Human viruses often need a series of passages in vivo in order to adapt to the host environment because of variable receptors on the cell surface and may have intracellular restrictions from the cell types or host species. Here we describe a long term cell culture system, conditionally reprogrammed cells (CRCs), and its applications in modeling human viral diseases and drug discovery. Using feeder layer co-culture in presence of Y-27632 (conditional reprogramming, CR), CRCs can be obtained and rapidly propagated from surgical specimens, core or needle biopsies, and other minimally invasive or non-invasive specimens, for example, nasal cavity brushing. CRCs preserve their lineage functions, and provide biologically relevant and physiological conditions, which are suitable for studies of viral entry and replication, innate immune responses of host cells, and discovery of antiviral drugs. In this review, we summarize applications of CR technology in modeling host-virus interactions and human viral diseases, including SARS-CoV-2 and COVID-19, and anti-viral discovery. This article is protected by copyright. All rights reserved.


title: Pneumatic compression devices during hemodialysis: a randomized crossover trial.

text: BACKGROUND Maintenance of central blood volume (CBV) is essential for hemodynamic stability during hemodialysis (HD), though preservation of CBV is poorly understood. Pneumatic compression devices (PCDs) during HD may help maintain CBV. METHODS We performed a randomized, crossover trial to determine the effect of PCDs on CBV during HD. Patients underwent two consecutive mid-week HD sessions, randomized to begin the first session either with or without PCDs [stratified by intradialytic hypotension (IDH)-prone status]. The primary outcome was change in CBV during HD. The secondary outcomes were change in other hemodynamic and volume status parameters. RESULTS Fifty-one patients (median age 65 years, 75% male, 22% IDH-prone) were randomized; forty-six completed the study. During HD, the median change in CBV for PCD and control sessions was -0.08 versus -0.05 L (P = 0.62). There was no difference in the change in cardiac output (CO) (-0.63 versus -0.49 L/min, P = 0.78) or systemic vascular resistance (SVR) (+1.30 versus +1.55 mmHg/L/min, P = 0.67) for PCDs versus control. Based on the bioimpedance measurements, patients were not volume overloaded pre-dialysis. There was a greater reduction in total body water (TBW) (-2.6 versus -2.3 L, P = 0.05) and intracellular fluid (ICF) volume (-1.3 versus -1.1 L, P = 0.03), and no difference in change in the extracellular fluid (ECF) volume (1.3 versus 1.2 L, P = 0.09) with PCDs versus control. Similar results were observed in IDH-prone patients. CONCLUSIONS Compared with standard of care, PCDs have no effect on intradialytic hemodynamic parameters, including CBV, although they may allow greater capacity for fluid removal. Further studies are required to better understand physiological and hemodynamic changes in patients during HD.


title: Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19.

text: Imaging modalities play a crucial role in the management of suspected COVID-19-infected patients. Before reverse transcription polymerase chain reaction (RT-PCR) test results are positive, 60-93% of patients have positive chest computed tomographic (CT) findings consistent with COVID-19 infection. We report a case of positive lung ultrasound findings consistent with COVID-19 in a woman with an initial negative RT-PCR result. The lung ultrasound-imaging findings were present between the negative and subsequent positive RT-PCR tests and correlated with CT findings. The point-of-care lung-ultrasound examination was easy to perform and, as such, could play an important role in the triage of women with suspected COVID-19. The neonatal swabs, cord blood, and placental swab RT-PCR tests were negative for SARS-CoV-2, a finding consistent with the published literature suggesting no vertical transmission of SARS-CoV-2 in pregnant women. This article is protected by copyright. All rights reserved.


title: From bariatric to metabolic surgery: definition of a new discipline and implications for clinical practice.

text: Bariatric surgery indicates a variety of gastrointestinal (GI) surgical procedures originally designed to induce weight reduction in morbidly obese patients. Benefits of bariatric surgery, however, extend well beyond weight loss and include dramatic improvement of type 2 diabetes, hypertension, dyslipidemia, and reduction of overall mortality. Furthermore, studies in rodents and humans show that the anti-diabetes effect of certain bariatric procedures results from a variety of neuroendocrine and metabolic mechanisms secondary to changes in GI anatomy. The recognition that benefits and mechanisms of GI operations are not limited to weight reduction provided a rationale for the emergence of metabolic surgery intended as a surgical approach primarily aimed to the treatment of diabetes and metabolic disease. Consistent with the goals of improving glycemic and metabolic control, in contrast to mere weight loss, metabolic surgery implies the development of a new model of care distinct from traditional bariatric surgery. This paper discusses the definition of metabolic surgery and its clinical practice.


title: An efficacy and safety comparison between different stentriever designs in acute ischaemic stroke: a systematic review and meta-analysis.

text: AIM To assess the recanalisation rates and long-term functional outcomes of the Solitaire and Trevo devices; to compare these results to those from the Solitaire With the Intention For Thrombectomy (SWIFT) trial and TREVO 2 studies; and to assess for statistical differences in the outcomes between the two devices. MATERIALS AND METHODS A systematic review and meta-analysis of studies that utilised stentrievers in the treatment of acute ischaemic stroke was conducted. The results were compared to those of the SWIFT and TREVO 2 trials and outcome differences between Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire (ev3/Covidien, Irvine, California, USA) were analysed statistically. RESULTS Solitaire had a lower mortality rate compared to Trevo (16.2% [95% confidence interval {CI}: 13.1%, 19.8%] versus 22.2% [95% CI: 10.8%, 40.2%]) and achieved a higher rate of functional independence (52.1% [95% CI: 46.3%, 57.8%] versus 47.6% [95% CI: 36.7%, 58.8%]). Statistical tests, however, failed to demonstrate significant differences in either functional outcomes or 3-month mortality rates. No significant differences were noted in weighted mean recanalisation rates between the Solitaire and Trevo groups. CONCLUSION Stentrievers achieve a high rate of recanalisation and functional independence in acute ischaemic stroke and have a relatively good safety profile. No significant differences in functional outcomes, mortality, and symptomatic intra-cranial haemorrhage could be demonstrated between two popular stentrievers designs, namely Trevo and Solitaire.


title: TWIRLS, a knowledge-mining technology, suggests a possible mechanism for the pathological changes in the human host after coronavirus infection via ACE2.

text: Faced with the current large-scale public health emergency, collecting, sorting, and analyzing biomedical information related to the "SARS-CoV-2" should be done as quickly as possible to gain a global perspective, which is a basic requirement for strengthening epidemic control capacity. However, for human researchers studying viruses and hosts, the vast amount of information available cannot be processed effectively and in a timely manner, particularly if our scientific understanding is also limited, which further lowers the information processing efficiency. We present TWIRLS (Topic-wise inference engine of massive biomedical literatures), a method that can deal with various scientific problems, such as liver cancer, acute myeloid leukemia, and so forth, which can automatically acquire, organize, and classify information. Additionally, this information can be combined with independent functional data sources to build an inference system via a machine-based approach, which can provide relevant knowledge to help human researchers quickly establish subject cognition and to make more effective decisions. Using TWIRLS, we automatically analyzed more than three million words in more than 14,000 literature articles in only 4 hr. We found that an important regulatory factor angiotensin-converting enzyme 2 (ACE2) may be involved in host pathological changes on binding to the coronavirus after infection. On triggering functional changes in ACE2/AT2R, the cytokine homeostasis regulation axis becomes imbalanced via the Renin-Angiotensin System and IP-10, leading to a cytokine storm. Through a preliminary analysis of blood indices of COVID-19 patients with a history of hypertension, we found that non-ARB (Angiotensin II receptor blockers) users had more symptoms of severe illness than ARB users. This suggests ARBs could potentially be used to treat acute lung injury caused by coronavirus infection.


title: Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA.

text: BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) for the treatment of acute ischemic stroke has been growing in popularity while the therapeutic benefit of MT has been increasingly debated. Our objective was to examine national trends in mortality following MT. METHODS We analyzed the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2008-2011) for patients with a primary diagnosis of acute ischemic stroke that received MT. Temporal trends in mortality were examined using Spearman's rank correlation. To account for confounding factors, mortality was further analyzed in binary logistic regression. RESULTS Hospitals performing MT comprised 8% of all hospitals treating ischemic stroke. The percentage of stroke cases treated with MT increased from 0.6% of cases in 2008 to 1.1% in 2012, totaling 16 307 MT cases in a 5 year period. Inhospital mortality decreased over the study period from 25.4% in 2008 to 16.1% in 2012 (r=-0.081, p<0.001). This finding was supported by regression analysis as each incremental year reduced the odds of mortality by 20% (OR=0.832, p<0.001). Administration of recombinant tissue plasminogen activator was associated with a decrease in the odds of mortality (OR=0.805, p<0.001). CONCLUSIONS Utilization of MT represents a small percentage of stroke cases, although the trend is increasing. Mortality following MT has been showing a steady decline over the past 5 years. This may be a result of a learning curve, improved patient selection, and/or device improvements. Randomized trials remain essential to evaluate the potential benefit of endovascular devices and identify the most appropriate patients.


title: Immune Responses to SARS-CoV, MERS-CoV and SARS-CoV-2.

text: The world has given an outbreak alarm in the last two decades, with different members of the coronavirus family infecting people at different times. The spread of the SARS-CoV-2 virus, which last appeared in December 2019 in China and spread rapidly to all over the world, has led the scientific world to studies on these viruses. While scientists are trying to develop vaccines or drugs against the virus, the body's immune response to the virus is emerged the biggest guide. In this review, we aimed to provide a good view on immune strategies by comparing immunological responses to SARS-CoV-2 disease among other members of the family, SARS-CoV and MERS-CoV. In the near future, it may contribute to vaccine or drug studies to be developed on immune intervention.


title: Viral infections in solid organ transplant recipients: novel updates and a review of the classics.

text: PURPOSE OF REVIEW To summarize new discoveries in viral pathogenesis and novel therapeutic and prophylactic strategies in organ transplant recipients. RECENT FINDINGS For decades, prophylaxis of cytomegalovirus (CMV) has been the standard preventive strategy, but new clinical trials are expected to determine the advantages of preemptive therapy over prophylaxis. Novel anti-CMV agents, such as maribavir and letermovir, are being studied for the treatment of resistant/refractory CMV as alternatives to foscarnet and cidofovir. CMV immune monitoring may offer individualized management plans. Epstein-Barr virus infections in transplant recipients are difficult to prevent and treat, though recent data suggest possible merit to pretransplant rituximab among high-risk transplant recipients. We review the groundbreaking HIV-to-HIV organ transplant trials, which are expected to revolutionize the care of HIV-infected individuals. Finally, we review topical developments in human herpesvirus 8, Zika virus, RNA respiratory viruses, adenovirus, norovirus, and polyoma viruses in organ transplantation. SUMMARY Ongoing trials to optimize CMV prophylaxis and treatment, and outcomes of HIV-to-HIV organ transplantation in the United States, have significant implications to optimize management of these viruses in transplant recipients. Assessment of new antivirals and antiviral strategies, such as adoptive immunotherapy, is warranted for refractory viral infections.


title: Historical and methodological highlights of quarantine measures: from ancient plague epidemics to current coronavirus disease (COVID-19) pandemic.

text: The ongoing 2020 coronavirus disease (COVID-19) pandemic is an enormous challenge for the health systems and the entire societies of the countries involved. Since at present the outbreak continues to evolve (April 2020), the World Health Organization (WHO) has declared it a public health emergency of international concern, specifying that public health interventions aimed at the prevention of the further spread of this disease include quarantine. Quarantine, that may be defined as a restraint on the activities of people or on the traffic of goods, targeted to the prevention of the diffusion of communicable pathologies, is a health concept profoundly rooted in the history of mankind. The lessons of the past are always pertinent for the present and for the future, in particular from a public health standpoint. One of the most relevant of them is connected with previous influenza pandemics, similar to the current COVID-19 2019/2020 pandemic, and it indicates that it is practically impossible, even in recent times, to contain the infection in the geographic area where it has risen and to prevent its trans-national disseminated spread. With specific reference to the COVID-19 pandemic, therefore, health authorities still adopt "classical" preventive interventions, namely workplace social distancing measures and quarantine, to reduce the transmission of the disease. Only the future will testify the precise overall effectiveness of preventive public health measures in containing the impact of the present coronavirus pandemic. However, what in this epidemiological scenario is already known, is that the multi-century international health value of quarantine remains essential and unavoidable.


title: Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: Suture line reinforcement of the weak point of the anastomosis.

text: BACKGROUND Few studies have been designed regarding optimal reinforcement of the crotch of a side-to-side anastomosis. The purpose of this study was to clarify the weak point of the side-to-side anastomosis and to evaluate the effect of bioabsorbable reinforcement material. METHODS Fresh pig small bowel was used for all experiments. A side-to-side anastomosis was performed using a linear stapler, and the burst pressure of the anastomosis was measured. Three separate experiments were done. In experiment 1, the weak point and the burst pressure of that point were defined. In experiment 2, the burst pressure of the side of the anastomosis was measured. In experiment 3, we evaluated the effect of Neoveil(®) to strengthen the weak point of the anastomosis. RESULTS The weak point of the side-to side anastomosis was the crotch and the burst pressure was 39.8 ± 5.7 mmHg. The burst pressure of the side of the anastomosis was 109.9 ± 7.9 mmHg. This was significantly higher than the burst pressure of the crotch (P = 0.008). The burst pressure of the crotch in the group with Neoveil(®) was 83.3 ± 14.9 mmHg. This pressure was significantly higher than the group with no Neoveil(®) reinforcement (P = 0.001). CONCLUSION These findings suggest that the use of Neoveil(®) as a buttressing material is associated with reinforced staple lines and increased crotch burst pressures compared to non-buttressed staple lines. Neoveil(®) was found to perform comparably to clinically available buttress materials in this ex vivo model. Reinforcement of the weak point of the side-to-side anastomosis with Neoveil(®)may lead to fewer anastomotic leaks.


title: Embolization with ethylene vinyl alcohol copolymer (Onyx®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study.

text: Background Onyx® is a liquid embolic agent, which is approved for the treatment of cerebral vascular lesions but still rarely used in peripheral interventional radiology. The goal of this study is to report the feasibility and safety of embolization with Onyx® for peripheral hemostatic and non-hemostatic endovascular procedures. Methods Retrospective study of all consecutive patients who underwent visceral or peripheral embolization with Onyx® for hemostatic or non-hemostatic purpose in our department between May 2014 and November 2016. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular procedure, pain during embolization, outcomes, and follow-up data were collected. Results Fifty patients (males, 34; females, 16; mean age, 56±18 years; range, 15-89 years) were included. Twenty-nine (58%) of patients underwent hemostatic embolization for arterial (n=22, 44%) or venous (n=7, 14%) bleeding lesions, whereas 21 (42%) of patients underwent non-hemostatic embolization for arterial aneurysms (n=8, 16%), preoperative portal vein deprivation (n=6, 12%) or other indications (n=7, 14%). Onyx-18 was used in 37 (74%) patients, Onyx-34 in 9 (18%) patients, and a combination of both in 4 (8%) patients. Onyx was used alone in 25 (50%) patients and in combination with other agent in 25 (50%) patients. Mean number of Onyx® vials used was 3.7 (range, 1-17). Immediate technical success rate was 100%. Primary clinical success was achieved in all patients. Recurrent bleeding occurred in two patients. Significant pain (pain score ≥3) was noted during injection in 10 (20%) patients. No major complication or side effects were noted within 1 month. Conclusions Transcatheter embolization with Onyx® is feasible and safe in the peripheral arterial or venous vasculature for both bleeding and non-bleeding patients whatever the anatomic site.


title: Magnetic Resonance Imaging With Cochlear Implant Magnet in Place: Safety and Imaging Quality.

text: OBJECTIVE To evaluate the safety and image quality of 1.5-T MRI in patients with cochlear implants and retained internal magnets. STUDY DESIGN Retrospective case series from 2012 to 2014. SETTING Single tertiary academic referral center. PATIENTS All cochlear implant recipients undergoing 1.5-T MRI without internal magnet removal. INTERVENTION(S) MRI after tight headwrap application. MAIN OUTCOME MEASURES Patient tolerance, complications, and characteristics of imaging artifact. RESULTS Nineteen ears underwent a total of 34 MRI scans. Two patients did not tolerate imaging with the headwrap in place and required magnet removal before rescanning. One subject experienced two separate episodes of polarity reversal in the same device from physical realignment (i.e., flipping) of the internal magnet requiring surgical repositioning. Three patients were discovered to have canting of the internal magnet after imaging. In all three cases, the magnet could be reseated by applying gentle firm pressure to the scalp until the magnet "popped" back into place. These patients continue to use their device without difficulty and have not required surgical replacement. In patients receiving head MRI, the ipsilateral internal auditory canal and cerebellopontine angle could be visualized without difficulty in 94% of cases. There were no episodes of cochlear implant device failure or soft tissue complications. CONCLUSION Under controlled conditions, 1.5-T MRI can be successfully performed in most patients without the need for cochlear implant magnet removal. In nearly all cases, imaging artifact does not impede evaluation of the ipsilateral skull base. Patients should be counseled regarding the risk of internal magnet movement that may occur in up to 15% of cases, even with tight headwrap application. If internal magnet polarity reversal occurs, a trial of reversing the external magnet can be considered. If canting or mild displacement of the internal magnet occurs, an attempt at reseating can be made by applying gentle firm pressure to the scalp over the internal magnet. If conservative measures fail, the magnet should be surgically repositioned to minimize interruption of device use and to prevent scalp complications.


Steroid injections for pain management in the COVID-19 era.


title: ASGE EndoVators Summit: simulators and the future of endoscopic training.

text: Interest in the use of simulation for acquiring, maintaining, and assessing skills in GI endoscopy has grown over the past decade, as evidenced by recent American Society for Gastrointestinal Endoscopy (ASGE) guidelines encouraging the use of endoscopy simulation training and its incorporation into training standards by a key accreditation organization. An EndoVators Summit, partially supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, (NIH) was held at the ASGE Institute for Training and Technology from November 19 to 20, 2017. The summit brought together over 70 thought leaders in simulation research and simulator development and key decision makers from industry. Proceedings opened with a historical review of the role of simulation in medicine and an outline of priority areas related to the emerging role of simulation training within medicine broadly. Subsequent sessions addressed the summit's purposes: to review the current state of endoscopy simulation and the role it could play in endoscopic training, to define the role and value of simulators in the future of endoscopic training and to reach consensus regarding priority areas for simulation-related education and research and simulator development. This white paper provides an overview of the central points raised by presenters, synthesizes the discussions on the key issues under consideration, and outlines actionable items and/or areas of consensus reached by summit participants and society leadership pertinent to each session. The goal was to provide a working roadmap for the developers of simulators, the investigators who strive to define the optimal use of endoscopy-related simulation and assess its impact on educational outcomes and health care quality, and the educators who seek to enhance integration of simulation into training and practice.


title: Relation of Baseline Hemoglobin Levels and Adverse Events in Patients With Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage strategY and Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction Trials).

text: The association between anemia at admission and adverse outcomes in patients with acute coronary syndrome (ACS) has been incompletely studied. Anemia was defined as serum hemoglobin <12 g/dl in women or <13 g/dl in men in 2 large trials of patients with ACS. We plotted hazard functions for major bleeding at 30 days and all-cause mortality, myocardial infarction, and stent thrombosis at 1 year according to baseline hemoglobin. Among 16,318 patients, 3070 (18.8%) had anemia at baseline. All-cause death at 1 year (2.9% vs 1.5%), major bleeding (7.6% vs 3.6%, p <0.001), and transfusions (6.7% vs 1.5%, p <0.001) were more common in patients with baseline anemia. Spline transformations of the hazard for adverse events as a function of hemoglobin level on admission showed that adverse outcomes increased in a nonlinear fashion with lower levels of baseline hemoglobin; the lowest rates were observed at a level of ∼14 g/dl. Baseline hemoglobin and anemia were independent predictors of major bleeding and death. In conclusion, in patients with ACS, baseline hemoglobin carries important independent prognostic information and demonstrates a nonlinear association with major bleeding and mortality.


Compassionate Use of Remdesivir in Covid-19.


title: Proteogenomics analysis unveils a TFG-RET gene fusion and druggable targets in papillary thyroid carcinomas.

text: Papillary thyroid cancer (PTC) is the most common type of endocrine malignancy. By RNA-seq analysis, we identify a RET rearrangement in the tumour material of a patient who does not harbour any known RAS or BRAF mutations. This new gene fusion involves exons 1-4 from the 5' end of the Trk fused Gene (TFG) fused to the 3' end of RET tyrosine kinase leading to a TFG-RET fusion which transforms immortalized human thyroid cells in a kinase-dependent manner. TFG-RET oligomerises in a PB1 domain-dependent manner and oligomerisation of TFG-RET is required for oncogenic transformation. Quantitative proteomic analysis reveals the upregulation of E3 Ubiquitin ligase HUWE1 and DUBs like USP9X and UBP7 in both tumor and metastatic lesions, which is further confirmed in additional patients. Expression of TFG-RET leads to the upregulation of HUWE1 and inhibition of HUWE1 significantly reduces RET-mediated oncogenesis.


title: Simultaneous Suppression of Multiple Programmed Cell Death Pathways by miRNA-105 in Cardiac Ischemic Injury.

text: Recent studies have shown that several upstream signaling elements of apoptosis and necroptosis are closely associated with acute injury in the heart. In our study, we observed that miR-105 was notably dysregulated in rat hearts with myocardial infarction (MI). Thus, the purpose of this study was to test the hypothesis that miR-105 participates in the regulation of RIP3/p-MLKL- and BNIP3-dependent necroptosis/apoptosis in H9c2 cells and MI rat hearts. Our results show that the RIP3/p-MLKL necroptotic pathway and BNIP3-dependent apoptosis signaling are enhanced in H9c2 cells under hypoxic conditions, whereas, compared with these pathways in the controls, those in miR-105-treated H9c2 cells are suppressed. Mechanistically, we identified miR-105 as the miRNA directly suppressing the expression of RIP3 and BNIP3, two important mediators involved in cell necroptosis and apoptosis. Furthermore, MI rat hearts injected with miR-105 had decreased infarct sizes, indicating that miR-105 is among three miRNAs that function simultaneously to suppress necroptotic/apoptotic cell death pathways and to inhibit MI-induced cardiomyocyte cell death at multiple levels. Taken together, miR-105 may constitute a new therapeutic strategy for cardioprotection in ischemic heart disease.


title: Cross-regulation of cytokine signalling: pro-inflammatory cytokines restrict IL-6 signalling through receptor internalisation and degradation.

text: The inflammatory response involves a complex interplay of different cytokines which act in an auto- or paracrine manner to induce the so-called acute phase response. Cytokines are known to crosstalk on multiple levels, for instance by regulating the mRNA stability of targeted cytokines through activation of the p38-MAPK pathway. In our study we discovered a new mechanism that answers the long-standing question how pro-inflammatory cytokines and environmental stress restrict immediate signalling of interleukin (IL)-6-type cytokines. We show that p38, activated by IL-1beta, TNFalpha or environmental stress, impairs IL-6-induced JAK/STAT signalling through phosphorylation of the common cytokine receptor subunit gp130 and its subsequent internalisation and degradation. We identify MK2 as the kinase that phosphorylates serine 782 in the cytoplasmic part of gp130. Consequently, inhibition of p38 or MK2, deletion of MK2 or mutation of crucial amino acids within the MK2 target site or the di-leucine internalisation motif blocks receptor depletion and restores IL-6-dependent STAT activation as well as gene induction. Hence, a novel negative crosstalk mechanism for cytokine signalling is described, where cytokine receptor turnover is regulated in trans by pro-inflammatory cytokines and stress stimuli to coordinate the inflammatory response.


title: Mechanical properties of commercially available nylon sutures in the United States.

text: Surgeons can choose from a wide selection of commercially available suture brands, which come at a range of prices. There is currently limited evidence in the literature to guide this selection process. This investigation examined the breaking force, stress, and elongation of a variety of commercially available nylon sutures compared to their relative prices. Seven 5-0, nonabsorbable, nylon suture brands were tensile tested in straight, knotted and knot-security configurations according to the procedures outlined by the United States Pharmacopeia for the tensile testing of sutures. Covidien, the cheapest brand tested, had the highest failure load of straight and knot-security tests. Dafilon was found to have the highest breaking force and percent elongation of knot-pull tests. J&J Ethicon and Supramid had the highest percent elongation to failure for straight-pull and knot-security tests, respectively. This study was limited to specific in vitro tensile properties of nylon suture. Other factors affecting suture quality and price, such as needle properties, were not investigated. The data presented in the study provide information for guiding the selection and purchase of sutures according to tensile properties. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 815-819, 2017.


title: The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

text: The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.


title: Time-of-day effects of exposure to solar radiation on thermoregulation during outdoor exercise in the heat.

text: High solar radiation has been recognised as a contributing factor to exertional heat-related illness in individuals exercising outdoors in the heat. Although solar radiation intensity has been known to have similar time-of-day variation as body temperature, the relationship between fluctuations in solar radiation associated with diurnal change in the angle of sunlight and thermoregulatory responses in individuals exercising outdoors in a hot environment remains largely unknown. The present study therefore investigated the time-of-day effects of variations in solar radiation associated with changing solar elevation angle on thermoregulatory responses during moderate-intensity outdoor exercise in the heat of summer. Eight healthy, high school baseball players, heat-acclimatised male volunteers completed a 3-h outdoor baseball trainings under the clear sky in the heat. The trainings were commenced at 0900 h in AM trial and at 1600 h in PM trial each on a separate day. Solar radiation and solar elevation angle during exercise continued to increase in AM (672-1107 W/m2 and 44-69°) and decrease in PM (717-0 W/m2 and 34-0°) and were higher on AM than on PM (both P < 0.001). Although ambient temperature (AM 32-36°C, PM 36-30°C) and wet-bulb globe temperature (AM 31-33°C, PM 34-27°C) also continued to increase in AM and decrease in PM, there were no differences between trials in these (both P > 0.05). Tympanic temperature measured by an infrared tympanic thermometer and mean skin temperature were higher in AM than PM at 120 and 180 min (P < 0.05). Skin temperature was higher in AM than PM at the upper arm and thigh at 120 min (P < 0.05) and at the calf at 120 and 180 min (both P < 0.05). Body heat gain from the sun was greater during exercise in AM than PM (P < 0.0001), at 0-60 min in PM than AM (P < 0.0001) and at 120-180 min in AM than PM (P < 0.0001). Dry heat loss during exercise was greater at 0-60 min (P < 0.0001), and lower at 60-120 min (P < 0.05) and 120-180 min (P < 0.0001) in AM than PM. Evaporative heat loss during exercise was greater in PM than AM at 120-180 min (P < 0.0001). Total (dry + evaporation) heat loss at the skin was greater during exercise in PM than AM (P < 0.0001), at 0-60 min in AM than PM (P < 0.0001) and at 60-120 and 120-180 min in PM than AM (P < 0.05 and 0.0001). Heart rate at 120-150 min was also higher in AM than PM (P < 0.05). Neither perceived thermal sensation nor rating of perceived exertion was different between trials (both P > 0.05). The current study demonstrates a greater thermoregulatory strain in the morning than in the afternoon resulting from a higher body temperature and heart rate in relation to an increase in environmental heat stress with rising solar radiation and solar elevation angle during moderate-intensity outdoor exercise in the heat. This response is associated with a lesser net heat loss at the skin and a greater body heat gain from the sun in the morning compared with the afternoon.


title: Recommendations for multimodal noninvasive and invasive screening for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency: a position statement of the International Society for Neurovascular Disease.

text: Under the auspices of the International Society for Neurovascular Disease (ISNVD), four expert panel committees were created from the ISNVD membership between 2011 and 2012 to determine and standardize noninvasive and invasive imaging protocols for detection of extracranial venous abnormalities indicative of chronic cerebrospinal venous insufficiency (CCSVI). The committees created working groups on color Doppler ultrasound (US), magnetic resonance (MR) imaging, catheter venography (CV), and intravascular US. Each group organized a workshop focused on its assigned imaging modality. Non-ISNVD members from other societies were invited to contribute to the various workshops. More than 60 neurology, radiology, vascular surgery, and interventional radiology experts participated in these workshops and contributed to the development of standardized noninvasive and invasive imaging protocols for the detection of extracranial venous abnormalities indicative of CCSVI. This ISNVD position statement presents the MR imaging and intravascular US protocols for the first time and describes refined color Doppler US and CV protocols. It also emphasizes the need for the use of for noninvasive and invasive multimodal imaging to diagnose adequately and monitor extracranial venous abnormalities indicative of CCSVI for open-label or double-blinded, randomized, controlled studies.


title: Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.

text: OBJECTIVES This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery. BACKGROUND Untreated severe aortic stenosis is a progressive disease with a poor prognosis. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy. METHODS We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG). RESULTS A total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p < 0.0001). Individual 30-day and 12-month events included all-cause mortality (8.4% and 24.3%, respectively) and major stroke (2.3% and 4.3%, respectively). Procedural events at 30 days included life-threatening/disabling bleeding (12.7%), major vascular complications (8.2%), and need for permanent pacemaker placement (21.6%). The frequency of moderate or severe paravalvular aortic regurgitation was lower 12 months after self-expanding TAVR (4.2%) than at discharge (10.7%; p = 0.004 for paired analysis). CONCLUSIONS TAVR with a self-expanding bioprosthesis was safe and effective in patients with symptomatic severe aortic stenosis at prohibitive risk for surgical valve replacement. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).


title: Endocrinology in the time of COVID-19: Management of Hyponatraemia and Diabetes Insipidus.

text: • COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatremia. • The principles of management outlined in international guidelines still form the basis of management during COVID-19. • The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. • Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Endocrinologists must supervise the fluid replacement and dosing of desmopressin. • Patients after pituitary surgery should only drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. • Hyponatraemia is common in patients with pneumonia, but it is unclear if it is only a marker of disease severity or if its correction improves outcomes. Its prevalence in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. • In contrast, hypernatraemia may develop in COVID-19 patients in ICU most probably due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high rate of acute kidney injury in COVID-19. • IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


title: CT and MR imaging findings of periorbital lipogranuloma developing after endoscopic sinus surgery.

text: SUMMARY Periorbital lipogranuloma is a rare complication after ESS and presently lacks specific imaging reports. The purpose of this study was to describe the CT and MR imaging features of periorbital lipogranuloma. We retrospectively reviewed 9 patients with histology-confirmed periorbital lipogranuloma. All 9 patients underwent CT and MR imaging. Five lipogranulomas were located in the right eyelid and 4 in the left eyelid, which extended into the extraconal space to some degree. The lesions displayed an irregular shape and had an ill-defined margin. Multiple, specked, or nodular foci containing fat were scattered within these lesions. The lesions demonstrated moderate heterogeneous contrast enhancement on contrast-enhanced MR imaging. The TICs showed a persistent pattern (type I) in 6 patients undergoing DCE MR imaging. Thus, an ill-defined, irregular-shaped periorbital mass with multiple foci containing fat, combined with an ESS history, can help to accurately diagnose this entity.


title: Clinical course of three postoperative symptomatic Covid-19 cases in patients after lung lobectomy.

text: Covid-19 is a highly contagious viral infection caused by the SARS-CoV-2 virus. Its rapid spread and severe clinical presentation influences patient management in all specialties including thoracic surgery. We report three cases of Covid-19 occurring in patients shortly after thoracotomy and thoracoscopy procedures, illustrating the imminent threat of SARS-CoV-2 infection for thoracic surgery patients.


title: Workplace justice and intention to leave the nursing profession.

text: BACKGROUND: Poor psychosocial work environments are considered critical factors of nurses' intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses' intention to leave their profession and the population attributable risk among nurses. OBJECTIVE: This study identified factors associated with workplace justice and nurses' intention to leave the profession. METHOD: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses' intention to leave the nursing profession. ETHICAL CONSIDERATIONS: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. RESULT: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02-1.77). "Employees' opinions are influential in hospital's decision making" and "employees' performance is evaluated fairly" were the most influential factors of the participants' intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. CONCLUSION: This study has identified that workplace justice is a protective factor of nurses' leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.


Covid-19: pandemic healthcare centres should have already existed.


title: Molecular pathways differentiate hepatitis C virus (HCV) recurrence from acute cellular rejection in HCV liver recipients.

text: Acute cellular rejection (ACR) and hepatitis C virus (HCV) recurrence (HCVrec) are common complications after liver transplantation (LT) in HCV patients, who share common clinical and histological features, making a differential diagnosis difficult. Fifty-three liver allograft samples from unique HCV LT recipients were studied using microarrays, including a training set (n = 32) and a validation set (n = 19). Two no-HCV-ACR samples from LT recipients were also included. Probe set intensity values were obtained using the robust multiarray average method (RMA) method. Analysis of variance identified statistically differentially expressed genes (P ≤ 0.005). The limma package was used to fit the mixed-effects models using a restricted maximum likelihood procedure. The last absolute shrinkage and selection operator (LASSO) model was fit with HCVrec versus ACR as the dependent variable predicted. N-fold cross-validation was performed to provide an unbiased estimate of generalization error. A total of 179 probe sets were differentially expressed among groups, with 71 exclusive genes between HCVrec and HCV-ACR. No differences were found within ACR group (HCV-ACR vs. no-HCV-ACR). Supervised clustering analysis displayed two clearly independent groups, and no-HCV-ACR clustered within HCV-ACR. HCVrec-related genes were associated with a cytotoxic T-cell profile, and HCV-ACR-related genes were associated with the inflammatory response. The best-fitting LASSO model classifier accuracy, including 15 genes, has an accuracy of 100% in the training set. N-fold cross-validation accuracy was 78.1%, and sensitivity, specificity and positive and negative predictive values were 50.0%, 90.9%, 71.4% and 80.0%, respectively. Arginase type II (ARG2), ethylmalonic encephalopathy 1 (ETHE1), transmembrane protein 176A (TMEM176A) and TMEM176B genes were significantly confirmed in the validation set. A molecular signature capable of distinguishing HCVrec and ACR in HCV LT recipients was identified and validated.


Challenges of the COVID-19 pandemic: for a Brazilian research agenda in global health and sustainability.


title: Aneurysm pressure measurement before and after placement of a Pipeline stent: feasibility study using a 0.014 inch pressure wire for coronary intervention.

text: Flow-diverting stents have provided a new endovascular capacity to reconstruct an intracranial aneurysm with its diseased parent artery. The results of first-generation flow diversion stents have been encouraging, with even large or giant treated aneurysms achieving complete angiographic occlusion at 12-month follow-up. Numerous clinical reports have described a slow progressive thrombosis pattern and gradual increase in rate of complete aneurysm obliteration over time. Despite promising early results, some complications specific to flow-diverting stents have been encountered. Chief among them is delayed aneurysm rupture. This complication did not emerge with stent-assisted coil embolization of intracranial aneurysms, and the underlying cause has not been established. However, new evidence suggests that persistent, or even increased, aneurysm pressure after stent placement may play a role in some delayed ruptures. We sought to evaluate this phenomenon by measuring intrasaccular pressure before and after stent placement using two different 0.014 inch coronary pressure measurement wires. Two patients with giant internal carotid artery aneurysms treated with flow-diverting stents were evaluated. Before and after stent deployment, intrasaccular aneurysm and systemic arterial pressures were recorded for 60 s and compared. In both cases, intrasaccular pressure measurement with the use of 0.014 inch pressure wire system was feasible; the pressure wires could be pushed out of the microcatheter placed in the aneurysms without friction or unexpected microcatheter motion. Despite successful flow-diverting stent deployment and angiographic flow diversion effects with excellent wall opposition across the aneurysm necks, there was no significant difference between intrasaccular and systemic pressures.


title: Endovascular embolization is applicable for large and giant intracranial aneurysms: experience in one center with long-term angiographic follow-up.

text: BACKGROUND Endovascular treatment of large and giant intracranial aneurysms and long-term results of angiographic follow-up of these aneurysms treated endovascularly are not known currently. PURPOSE To investigate the outcome of endovascular treatment of large and giant aneurysms and the long-term angiographic follow-up results. MATERIAL AND METHODS A retrospective analysis of all patients with endovascular treatment of large and giant aneurysms between 1998 and 2009 was performed. There were 90 large or giant aneurysms treated with coiling alone, stent-assisted coiling, covered-stent deployment, or parent artery occlusion (PAO) in 88 patients (female/male, 54/34; age range, 23-92 years; mean age, 56 years). RESULTS Immediately after the initial endovascular embolization procedure, complete occlusion was achieved in 56.7%, near complete occlusion in 37.8%, and incomplete occlusion in 5.5%. The total periprocedural complication rate excluding subarachnoid hemorrhage (SAH)-induced vasospasm was 10.2% with a mortality rate of 2.3%. Follow-up angiography was performed in all of the aneurysms with the longest follow-up duration of 131 months. Among 38 aneurysms initially treated with coiling alone and 17 initially treated with stent-assisted coiling, 22 (57.9%) and four (23.5%) recurred, respectively, during follow-up. No recurrence occurred in aneurysms initially treated with covered-stent deployment or PAO. Aneurysm recurrence was predominantly seen in older and female patients, in larger aneurysms, and in aneurysms treated with coiling alone. Twenty-three aneurysms were successfully retreated endovascularly. CONCLUSION Endovascular intervention with coiling alone or stent-assisted coiling for large and giant cerebral aneurysms is not very effective, while covered stents are more promising. Better endovascular devices are needed to obtain more secure closure.