title: Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders.

text: BACKGROUND Chronic alveolar hypoventilation is a common complication of many neuromuscular and chest wall disorders. Long-term nocturnal mechanical ventilation is commonly used to treat it. This is a 2014 update of a review first published in 2000 and previously updated in 2007. OBJECTIVES To examine the effects on mortality of nocturnal mechanical ventilation in people with neuromuscular or chest wall disorders. Subsidiary endpoints were to examine the effects of respiratory assistance on improvement of chronic hypoventilation, sleep quality, hospital admissions and quality of life. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE on 10 June 2014. We contacted authors of identified trials and other experts in the field. SELECTION CRITERIA We searched for quasi-randomised or randomised controlled trials of participants of all ages with neuromuscular or chest wall disorder-related stable chronic hypoventilation of all degrees of severity, receiving any type and any mode of long-term nocturnal mechanical ventilation. The primary outcome measure was one-year mortality and secondary outcomes were unplanned hospital admission, short-term and long-term reversal of hypoventilation-related clinical symptoms and daytime hypercapnia, improvement of lung function and sleep breathing disorders. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology to select studies, extract data and assess the risk of bias in included studies. MAIN RESULTS The 10 eligible trials included a total of 173 participants. Roughly half of the trials were at low risk of selection, attrition or reporting bias, and almost all were at high risk of performance and detection bias. Four trials reported mortality data in the long term. The pooled risk ratio (RR) of dying was 0.62 (95% confidence interval (CI) 0.42 to 0.91, P value = 0.01) in favour of nocturnal mechanical ventilation compared to spontaneous breathing. There was considerable and significant heterogeneity between the trials, possibly related to differences between the study populations. Information on unplanned hospitalisation was available from two studies. The corresponding pooled RR was 0.25 (95% CI 0.08 to 0.82, P value = 0.02) in favour of nocturnal mechanical ventilation. For most of the outcome measures there was no significant long-term difference between nocturnal mechanical ventilation and no ventilation. Most of the secondary outcomes were not assessed in the eligible trials. Three out of the 10 trials, accounting for 39 participants, two with a cross-over design and one with two parallel groups, compared volume- and pressure-cycled non-invasive mechanical ventilation in the short term. From the only trial (16 participants) on parallel groups, there was no difference in mortality (one death in each arm) between volume- and pressure-cycled mechanical ventilation. Data from the two cross-over trials suggested that compared with pressure-cycled ventilation, volume-cycled ventilation was associated with less sleep time spent with an arterial oxygen saturation below 90% (mean difference (MD) 6.83 minutes, 95% CI 4.68 to 8.98, P value = 0.00001) and a lower apnoea-hypopnoea (per sleep hour) index (MD -0.65, 95% CI -0.84 to -0.46, P value = 0.00001). We found no study that compared invasive and non-invasive mechanical ventilation or intermittent positive pressure versus negative pressure ventilation. AUTHORS' CONCLUSIONS Current evidence about the therapeutic benefit of mechanical ventilation is of very low quality, but is consistent, suggesting alleviation of the symptoms of chronic hypoventilation in the short term. In four small studies, survival was prolonged and unplanned hospitalisation was reduced, mainly in participants with motor neuron diseases. With the exception of motor neuron disease and Duchenne muscular dystrophy, for which the natural history supports the survival benefit of mechanical ventilation against no ventilation, further larger randomised trials should assess the long-term benefit of different types and modes of nocturnal mechanical ventilation on quality of life, morbidity and mortality, and its cost-benefit ratio in neuromuscular and chest wall diseases.


title: Identification of influencing municipal characteristics regarding household waste generation and their forecasting ability in Biscay.

text: The planning of waste management strategies needs tools to support decisions at all stages of the process. Accurate quantification of the waste to be generated is essential for both the daily management (short-term) and proper design of facilities (long-term). Designing without rigorous knowledge may have serious economic and environmental consequences. The present works aims at identifying relevant socio-economic features of municipalities regarding Household Waste (HW) generation by means of factor models. Factor models face two main drawbacks, data collection and identifying relevant explanatory variables within a heterogeneous group. Grouping similar characteristics observations within a group may favour the deduction of more robust models. The methodology followed has been tested with Biscay Province because it stands out for having very different municipalities ranging from very rural to urban ones. Two main models are developed, one for the overall province and a second one after clustering the municipalities. The results prove that relating municipalities with specific characteristics, improves the results in a very heterogeneous situation. The methodology has identified urban morphology, tourism activity, level of education and economic situation as the most influencing characteristics in HW generation.


title: Empirical derivation of cut-off values for the sleep health metric and its relationship to cardiometabolic morbidity: Results from the Midlife in the United States (MIDUS) study.

text: STUDY OBJECTIVES Emerging evidence supports a multidimensional perspective of sleep in the context of health. The sleep health model, and composite sleep health score, are increasingly used in research. However, specific cut-off values that differentiate "good" from "poor" sleep, have not been empirically-derived and its relationship to cardiometabolic health is less-well understood. We empirically-derived cut-off values for sleep health dimensions and examined the relationship between sleep health and cardiometabolic morbidity. METHODS Participants from two independent Biomarker Studies in the MIDUS II (N = 432, 39.8% male, age = 56.92±11.45) and MIDUS Refresher (N = 268, 43.7% male, age = 51.68±12.70) cohorts completed a 1-week study where sleep was assessed with daily diaries and wrist actigraphy. Self-reported physician diagnoses, medication use, and blood values were used to calculate total cardiometabolic morbidity. Receiver operating characteristic (ROC) curves were generated in the MIDUS II cohort for each sleep health dimension to determine cut-off values. Using derived cut-off values, logistic regression was used to examine the relationship between sleep health scores and cardiometabolic morbidity in the MIDUS Refresher cohort, controlling for traditional risk factors. RESULTS Empirically-derived sleep health cut-off values aligned reasonably well to cut-off values previously published in the sleep health literature and remained robust across physical and mental health outcomes. Better sleep health was significantly associated with a lower odds of cardiometabolic morbidity [OR(95%CI) =0.901(0.814-0.997), p = .044]. CONCLUSIONS These results contribute to the ongoing development of the sleep health model and add to the emerging research supporting a multidimensional perspective of sleep and health.


title: Robotic cross-folded U-configuration intracorporeal ileal neobladder for muscle-invasive bladder cancer: Initial experience and functional outcomes.

text: BACKGROUND This study compared the surgical and urinary functional outcomes in patients with muscle-invasive bladder cancer (MIBC) who underwent robot-assisted radical cystectomy (RARC) followed by intracorporeal ileal neobladder reconstruction (ICNB) to those in patients who underwent minimum incision endoscopic radical cystectomy (MIE-RC) followed by extracorporeal ileal neobladder reconstruction (ECNB). MATERIALS AND METHODS This study reviewed the clinical records of 153 consecutive MIBC patients who underwent neoadjuvant chemotherapy followed by radical cystectomy and ileal neobladder reconstruction. RESULTS The operative time in the ICNB group was significantly longer than that in the ECNB group. The median estimated blood loss was significantly less in the ICNB group than in the ECNB group. The neobladder capacity gradually increased in both groups. The maximum neobladder pressure and urethral closure pressure gradually improved in both groups. CONCLUSION Our initial experience with ICNB was favourable, with acceptable surgical and urinary functional outcomes.


title: Successful treatment of mediastinitis in a young child by omental translocation following extracardiac Fontan graft placement.

text: Mediastinitis after a midline sternotomy can become a serious complication, especially after implantation of prosthetic vascular grafts. We present a case of a three-year-old boy with hypoplastic left heart syndrome who developed mediastinitis following his third-stage palliation (Fontan operation). Rather than following the "traditional" surgical therapy of graft explantation, debridement, and replacement, we chose to preserve the graft and protect it by omental translocation. The relative merits of this therapeutic approach, which is rarely utilized and underappreciated in children, are outlined and discussed.


title: Thoracoscopic traction technique in long gap esophageal atresia: entering a new era.

text: OBJECTIVE To describe the evolution from delayed management of long gap esophageal atresia to thoracoscopic treatment directly after birth without the placement of a gastrostomy. BACKGROUND Long gap esophageal atresia remains a challenge for pediatric surgeons. Over the years, several techniques have been described to deal with the problem of the distance between the proximal and distal esophagus. More recently, a traction technique has been advocated. With the advent of minimal invasive surgery, the thoracoscopic elongation technique has been developed. METHODS Retrospective description of a single-center experience with the thoracoscopic treatment of patients with long gap esophageal atresia over a 7-year period. RESULTS Between 2007 and May 2014, 10 children with long gap esophageal atresia were treated by thoracoscopic elongation technique. In two children, the procedure failed. Eight children successfully underwent thoracoscopic traction with delayed primary anastomosis. Initially, all patients had a gastrostomy. During the course, the technique evolved into delayed primary anastomosis directly after birth without the use of a gastrostomy. CONCLUSION Thoracoscopic elongation technique in long gap esophageal atresia not only is feasible, but can nowadays also be performed directly after birth without the use of a gastrostomy. With this development, we have entered a new era in the management of long gap esophageal atresia.


Olfactory and gustatory dysfunctions in COVID-19. First reports of Latin-American ethnic patients.


title: The Hang Up.

text: Over the past year, our ethics service has had numerous consultations involving patients who use the emergency department for regular dialysis. Sometimes, they have access to outpatient hemodialysis that they forgo; other times, they've been "fired" from this kind of outpatient facility, and so the ED is their last option. In most of these cases, we're called because the patient is disruptive once admitted to the ICU and behavior plans haven't helped. But the call from a resident this March 2020 morning was different, the patient had end-stage renal disease and often missed hemodialysis, but he wasn't disruptive. "It's just that he comes in after using cocaine, and given scarcity with the coronavirus and ICU beds…." I have come to think that this is one of the more insidious effects of the pandemic: that there will be a resurgence of the view that some patients deserve health care by virtue of their compliant behavior and that those who are nonadherent don't.


title: Pure laparoscopic pancreatoduodenectomy with initial approach to the superior mesenteric artery.

text: INTRODUCTION The "artery-first approach" (AFA) to the superior mesenteric artery allows an early assessment of resectability of pancreatic tumours and could improve the benefits of laparoscopy, reducing invasiveness, especially for unresectable tumours. AIM To describe our technique of pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA, and to report the surgical outcomes of this procedure in a small series of 12 patients through a retrospective analysis of a prospectively collected database. MATERIAL AND METHODS Twelve selected patients underwent elective full laparoscopic pancreatoduodenectomy with the AFA. The technical aspects of the procedure are described in detail and the included images facilitate the understanding of the procedure. RESULTS The mean operative time was 300 min (range: 250-540 min). No intraoperative complications were observed. No conversion to laparotomy was necessary. The mean postoperative hospital stay was 18 days (range: 8-42). Mortality was null. There were 3 major complications at the 3rd post-operative month follow-up: 2 patients reporting a grade A pancreatic fistula and one biliary fistula. CONCLUSIONS Our work shows that pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA is feasible, in selected patients. The AFA could improve on the advantages of laparoscopy in the identification of unresectable patients, and it also allows early control of vascular structures.


title: Greek Traditional Dance as a Practice for Managing Stress and Anxiety in Cancer Patients.

text: Stress and anxiety levels in cancer patients tend to decrease by performing bodily-kinesthetic and musical activities. The hypothesis of the present study is that attending lessons in Greek traditional dance is an effective method for managing anxiety and stress in patients diagnosed with cancer of any type both during and after treatment. The study was conducted on 300 cancer patients (150 experimental subjects, 150 controls) selected by Attica hospitals and nonprofit cancer patients' organizations. Each patient in the experimental group attended an 8-week Greek traditional dance lesson program. Lessons were held twice per week, lasting 60 min each. A similar group of cancer patients not participating in any organized physical activity during the same time period served as a control group. Data were collected using the Depression Anxiety Stress Scale 21 (Dass-21) questionnaire and subjected to reliability analysis (Cronbach's alpha) and deviation-dependent analysis (one-way repeated). Both stress and anxiety values decreased significantly in the experimental group (stress value: initial mean = 16.27, second mean = 2.58, final mean = 6.77, p < 0.001; anxiety value: initial mean = 15.59, second mean = 2.81, final mean = 5.35, p < 0.001). In contrast, no significant fluctuation was observed in the control group. Thus, there was a significant decrease in stress and anxiety values in cancer patients who attended Greek traditional dances lessons with important psychotherapeutic significance.


title: Suppression of a pro-apoptotic K+ channel as a mechanism for hepatitis C virus persistence.

text: An estimated 3% of the global population are infected with hepatitis C virus (HCV), and the majority of these individuals will develop chronic liver disease. As with other chronic viruses, establishment of persistent infection requires that HCV-infected cells must be refractory to a range of pro-apoptotic stimuli. In response to oxidative stress, amplification of an outward K(+) current mediated by the Kv2.1 channel, precedes the onset of apoptosis. We show here that in human hepatoma cells either infected with HCV or harboring an HCV subgenomic replicon, oxidative stress failed to initiate apoptosis via Kv2.1. The HCV NS5A protein mediated this effect by inhibiting oxidative stress-induced p38 MAPK phosphorylation of Kv2.1. The inhibition of a host cell K(+) channel by a viral protein is a hitherto undescribed viral anti-apoptotic mechanism and represents a potential target for antiviral therapy.


title: CANINE DISTEMPER VIRUS IN THE SEA OTTER (ENHYDRA LUTRIS) POPULATION IN WASHINGTON STATE, USA.

text: Before 2001, all serosurveys for morbilliviruses in sea otters (Enhydra lutris) in California, Washington, and Alaska, USA, documented a 0% seroprevalence. The first published serologic detections of morbillivirus in sea otters occurred in 2001-02 in live-captured Washington sea otters, with a documented 80% seroprevalence. We conducted a retrospective study of sea otter cases from 1989 to 2010 compiled at the US Geological Survey, National Wildlife Health Center to identify cases of morbilliviral disease in Washington sea otters and to characterize the disease using immunohistochemistry, reverse transcription (RT)-PCR, genetic sequencing, virus isolation, and serology. We identified six cases of morbilliviral disease and 12 cases of morbilliviral infection in this population of sea otters during 2000-10. Significant histologic findings included inflammation in the white and gray matter of the brain characterized by lymphoplasmacytic perivascular cuffing, neuronal necrosis, and satellitosis in gray matter and by spongiosis, myelin degeneration, spheroids, and gemistocytes in white matter. Intranuclear and intracytoplasmic viral inclusion bodies were found in neurons, Purkinje cells, and glia. Immunohistochemistry for canine distemper virus (CDV) showed positive staining in neurons, glial cells, and cell processes. A pan-morbillivirus RT-PCR with subsequent restriction endonuclease digestion or sequencing identified CDV. Virus isolation was not successful. Two sea otters with morbilliviral encephalitis showed greater antibody titers to CDV than phocine distemper virus. Histologic changes were confined to the central nervous system and resembled neurologic canine distemper in domestic dogs. Cases of sea otters with morbilliviral infection without histologic changes could represent early infections or incompletely cleared sublethal infections. We found that morbillivirus was present in the Washington sea otter population as early as 2000, and we provide a description of the pathology of canine distemper in sea otters.


COVID-19: community CPAP and NIV should be stopped unless medically necessary to support life.


title: Effects and Results of Omentopexy During Laparoscopic Sleeve Gastrectomy.

text: PURPOSE The aim of this study was to demonstrate that gastric volvulus can be prevented by omentopexy and sleeve gastrectomy without increasing other complication rates. MATERIALS AND METHODS A total of 1385 patients who underwent omentopexy and sleeve gastrectomy between April 2013 and September 2017 were included this study. Body mass index, age, sex, comorbidities, and postoperative complications of the patients were recorded as data. RESULTS A total of 1385 patients underwent sleeve gastrectomy and omentopexy. There were 999 female and 386 male patients. The mean age of the patients was 36 years (14 to 71 y). The mean body mass index was 42.74 kg/m (35 to 73 kg/m). Twenty-one patients had previously undergone gastric banding and the other 80 patients had previous abdominal operation. The number of patients undergoing simultaneous cholecystectomy was 98. Three patients had hemorrhage due to hypertension and anticoagulant treatment in the postoperative period and the patients were treated medically. One staple-line leakage was observed. Twist, and stricture were not observed and no mortalities were noted. CONCLUSIONS Sleeve gastrectomy and omentopexy can prevent the gastric twist, which is a functional cause of gastric stenosis, by stabilizing the posterior stomach wall.


title: Favorable Bridging Therapy Based on DWI-FLAIR Mismatch in Patients with Unclear-Onset Stroke.

text: BACKGROUND AND PURPOSE Standard selection criteria for revascularization therapy usually exclude patients with unclear-onset stroke. Our aim was to evaluate the efficacy and safety of revascularization therapy in patients with unclear-onset stroke in the anterior circulation and to identify the predictive factors for favorable clinical outcome. MATERIALS AND METHODS We retrospectively analyzed 41 consecutive patients presenting with acute stroke with unknown time of onset treated by intravenous thrombolysis and/or mechanical thrombectomy. Only patients without well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions on MR imaging were enrolled. Twenty-one patients were treated by intravenous thrombolysis; 19 received, simultaneously, intravenous thrombolysis and mechanical thrombectomy (as a bridging therapy); and 1 patient, endovascular therapy alone. Clinical outcome was evaluated at 90 days by using the mRS. Mortality and symptomatic intracranial hemorrhage were also reported. RESULTS Median patient age was 72 years (range, 17-89 years). Mean initial NIHSS score was 14.5 ± 5.7. Successful recanalization (TICI 2b-3) was assessed in 61% of patients presenting with an arterial occlusion, symptomatic intracranial hemorrhage occurred in 2 patients (4.9%), and 3 (7.3%) patients died. After 90 days, favorable outcome (mRS 0-2) was observed in 25 (61%) patients. Following multivariate analysis, initial NIHSS score (OR, 1.43; 95% CI, 1.13-1.82; P = .003) and bridging therapy (OR, 37.92; 95% CI, 2.43-591.35; P = .009) were independently associated with a favorable outcome at 3 months. CONCLUSIONS The study demonstrates the safety and good clinical outcome of acute recanalization therapy in patients with acute stroke in the anterior circulation and an unknown time of onset and a DWI/FLAIR mismatch on imaging. Moreover, bridging therapy versus intravenous thrombolysis alone was independently associated with favorable outcome at 3 months.


title: Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study.

text: BACKGROUND Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. METHODS A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories. RESULTS From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals' expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself. CONCLUSIONS Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.


title: Development of a non-contact screening system for rapid medical inspection at a quarantine depot using a laser Doppler blood-flow meter, microwave radar and infrared thermography.

text: In order to conduct fast screening of passengers with infections such as severe acute respiratory syndrome (SARS) or pandemic influenza at a quarantine depot, we developed a non-contact screening system with a self-produced program to conduct a human screening within five seconds, via a linear discriminant function from non-contact derived variables, i.e. palmer pulse derived from a laser Doppler blood-flow meter, respiration rate determined by a 10-GHz microwave radar, and facial temperature measured by a thermography. The system evaluation was conducted on seven healthy male subjects (23+1 years). In order to achieve a pseudo-infection condition, the subjects maintained an ergo-meter exercise load (100 W, 10 minutes). Before (normal condition) and after (pseudo-infection condition) exercise, a significant linear discriminant function (p50.001) was determined to distinguish the pseudo-infection condition from the normal condition (Mahalanobis D-square 1/4 20.3, classification error rate55%). The proposed system appears promising for future application in fast screening of infection at a quarantine depot.


title: Long-Term Clinical and Angiographic Outcomes Following Pipeline Embolization Device Treatment of Complex Internal Carotid Artery Aneurysms: Five-Year Results of the Pipeline for Uncoilable or Failed Aneurysms Trial.

text: BACKGROUND Early and mid-term safety and efficacy of aneurysm treatment with the Pipeline Embolization Device (PED) has been well demonstrated in prior studies. OBJECTIVE To present 5-yr follow-up for patients treated in the Pipeline for Uncoilable or Failed Aneurysms clinical trial. METHODS In our prospective, multicenter trial, 109 complex internal carotid artery (ICA) aneurysms in 107 subjects were treated with the PED. Patients were followed per a standardized protocol at 180 d and 1, 3, and 5 yr. Aneurysm occlusion, in-stent stenosis, modified Rankin Scale scores, and complications were recorded. RESULTS The primary endpoint of complete aneurysm occlusion at 180 d (73.6%) was previously reported. Aneurysm occlusion for those patients with angiographic follow-up progressively increased over time to 86.8% (79/91), 93.4% (71/76), and 95.2% (60/63) at 1, 3, and 5 yr, respectively. Six aneurysms (5.7%) were retreated. New serious device-related events at 1, 3, and 5 yr were noted in 1% (1/96), 3.5% (3/85), and 0% (0/81) of subjects. There were 4 (3.7%) reported deaths in our trial. Seventy-eight (96.3%) of 81 patients with 5-yr clinical follow-up had modified Rankin Scale scores ≤2. No delayed neurological deaths or hemorrhagic or ischemic cerebrovascular events were reported beyond 6 mo. No recanalization of a previously occluded aneurysm was observed. CONCLUSION Our 5-yr findings demonstrate that PED is a safe and effective treatment for large and giant wide-necked aneurysms of the intracranial ICA, with high rates of complete occlusion and low rates of delayed adverse events.


Daniel S. Greenberg (1931-2020).


title: Endoscopically Assisted Transumbilical Single-Incision Laparoscopic Gastric Resection for GIST Treatment.

text: PURPOSE Complete surgical resection with negative margins without lymphadenectomy is the treatment of choice for nonmetastatic Gastrointestinal Stromal Tumors (GISTs). Laparoscopic resection of gastric GISTs <5 cm is an acceptable and oncologically feasible, safe, and effective treatment. We present our experience of an endoscopically assisted minimally invasive transumbilical single-incision laparoscopic (SILS) technique for gastric GISTs resection. METHODS Four patients with small gastric GISTs ≤5 cm located on the greater curvature or the anterior wall were resected with SILS by using a lesion-lifting technique under the guidance of flexible gastroscopy. RESULTS The technique was feasible and safe and offered significant advantages in locating the tumor and controlling the resection margins. There were no major intraoperative or postoperative complications, conversions, or tumor ruptures. Pathology showed low-risk GISTs resected with disease-free margins without tumor rupture. No recurrences have been observed. CONCLUSION The endoscopically assisted SILS wedge gastrectomy is a feasible, safe, and advantageous technique for the treatment of the greater curvature or anterior wall gastric GISTs.


title: [Supporting the battle against COVID-19 in E'zhou, Hubei Province: the experience of Guizhou medical team].

text: To suppress the rapid spread of coronavirus disease 2019 (COVID-19) in Hubei province, a medical rescue team consisting of 860 members was sent to E'zhou, one of the hard-hit cities in east Hubei. A total of 414 of the team members, whose core members were from Guizhou Medical University and its Affiliated Hospital, took over the full operation of Leishan hospital of E'zhou, a makeshift hospital built for treating COVID-19 patients. Under the instructions by the E'zhou Medical Team Front Command, the staff made quick responses to the surging number of patients with COVID-19 and rapidly formulated treatment plans based on the local conditions. The medical team efficiently carried out the operations and successfully completed the rescue mission. Herein the authors, as members of Guizhou Medical Team supporting COVID-19 containment in E'zhou, analyze and summarize the experiences of Guizhou Medical Team with the organization, implementation and logistic support of medical rescue operations, which may provide reference for future rescue missions in a similar scenario.


title: Autographa californica multiple nucleopolyhedrovirus GP64 protein: roles of histidine residues in triggering membrane fusion and fusion pore expansion.

text: The Autographa californica multiple nucleopolyhedrovirus (AcMNPV) GP64 protein mediates membrane fusion during entry. Fusion results from a low-pH-triggered conformational change in GP64 and subsequent interactions with the membrane bilayers. The low-pH sensor and trigger of the conformational change are not known, but histidine residues are implicated because the pK(a) of histidine is near the threshold for triggering fusion by GP64. We used alanine substitutions to examine the roles of all individual and selected clusters of GP64 histidine residues in triggering and mediating fusion by GP64. Three histidine residues (H152, H155, and H156), located in fusion loop 2, were identified as important for membrane fusion. These three histidine residues were important for efficient pore expansion but were not required for the pH-triggered conformational change. In contrast, a cluster of three histidine residues (H245, H304, and H430) located near the base of the central coiled coil was identified as a putative sensor for low pH. Three alanine substitutions in cluster H245/H304/H430 resulted in dramatically reduced membrane fusion and the apparent loss of the prefusion conformation at neutral pH. Thus, the H245/H304/H430 cluster of histidines may function or participate as a pH sensor by stabilizing the prefusion structure of GP64.


title: Assessing the Impact of Lockdown: Fresh Challenges for the Care of Haematology Patients in the COVID-19 Pandemic.

text: Worldwide cases of confirmed COVID-19 are approaching three million, and citizens around the world are experiencing unprecedented changes to their lifestyles due to the measures implemented to slow the spread of the disease.


title: The Influence of 3D in Single-port Laparoscopy Surgery: An Experimental Study.

text: The aim of this experimental study was to analyze the effect of 3-dimensional (3D) imaging in laparoendoscopic single-site surgery. End points were time, errors, and preference. Twenty-six participants were enrolled in the study, and these were divided into Beginners and Experts, in exercises either with a 2-dimensional or a 3D system. The 4 phantom exercises were chosen from the E-BLUS-European Training in Basic Laparoscopic Urological Skills from the American Fundamentals of Laparoscopic Surgery (FLS) system. A postexercise questionnaire was delivered. Statistical analyses using SPSS 22.0 for Windows yielded a 1-way analysis of variance. There was a significant positive impact of 3D imaging on experts' performance: faster exercise completion with fewer errors. The majority reported improved performance with the 3D system (86%, Beginners; 100%, Experts). 3D systems for laparoscopy would likely increase experts' performance for laparoendoscopic single-site surgery and improve comfort during difficult procedures.


title: Evaluation of a new index of mechanical ventilation weaning: the timed inspiratory effort.

text: PURPOSE The performance of most indices used to predict ventilator weaning outcomes remains below expectation. The purpose of this study was to evaluate a new weaning index, the timed inspiratory effort (TIE) index, which is based on the maximal inspiratory pressure and the occlusion time required to reach it. METHODS This observational prospective study included patients undergoing mechanical ventilation. Patients ready to be weaned had their TIE index and 6 previously reported indices recorded. The primary end point was the overall predictive performance of the studied weaning indices (area under the receiver operating characteristic curves [AUCs]). The secondary end points were sensitivity, specificity, positive predictive value, and negative predictive value. P values <.05 were considered significant. RESULTS From the 128 initially screened patients, the 103 patients selected for the study included 45 women and 58 men (mean age 60.8 ± 19.8 years). In all, 60 patients were weaned, 43 were not weaned, and 32 died during the study period. Tracheotomy was necessary in 61 patients. The mean duration of mechanical ventilation was 17.5 ± 17.3 days. The AUC of 3 weaning predictors (the TIE index, the integrative weaning index, and the frequency-to-tidal volume [f/Vt] ratio index) was higher than the other indices. The TIE index had the largest AUC. CONCLUSION The TIE index performed better than the best weaning indices used in clinical practice.


title: Parasitic bronchitis causes problems in cattle.

text: Parasitic bronchitis (lungworm, husk) in cattle Lead poisoning in cattle associated with bonfire ash Deaths of ewes associated with faulty administration of boluses Streptococcus suis associated with respiratory and nervous disease in pigs Blackhead and mycoplasmosis causing losses in turkeys These are among matters discussed in the Veterinary Laboratories Agency's (VLA's) disease surveillance report for October.


title: Management of Challenging Urethro-ileal Anastomosis During Robotic Assisted Radical Cystectomy with Intracorporeal Neobladder Formation.

text: BACKGROUND Robotic assisted radical cystectomy (RARC) is increasingly being adopted, but intracorporeal neobladder formation remains a challenging procedure limited to selected centers. Common challenges with intracorporeal neobladder formation relate to fashioning a tension-free urethro-ileal anastomosis. In this paper, we describe a series of maneuvers to overcome these challenges that we believe will be of great utility to surgeons performing intracorporeal neobladder. OBJECTIVE To describe maneuvers to overcome challenges during intracorporeal urethro-ileal anastomosis formation and to report postoperative outcomes for patients in whom these maneuvers were used. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of medical records of patients who underwent RARC with intracorporeal neobladder performed by one surgeon (G.-P.H.) at our tertiary center from January 2012 to February 2015 in which at least one additional maneuver was required beyond preservation of urethral length, removal of the sigmoid colon from the pelvis, and careful ileal loop selection. The primary end point was 90-d complications. Follow-up ranged from 6 to 36 mo, and 16 patients had at least 1-yr follow-up. SURGICAL PROCEDURE RARC with intracorporeal neobladder formation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Clinical and operative data collected from a prospectively maintained, institutional review board-approved database. Maneuvers used during intracorporeal urethro-ileal anastomosis were recorded. Descriptive statistics were used to evaluate postoperative outcomes. RESULTS AND LIMITATIONS Nineteen patients met the inclusion criteria. Mean operative time was 486 min (standard deviation: 112 min) with median hospitalization of 7 d (interquartile range: 7-9 d). Seven patients (36.8%) experienced a complication, with one (5.3%) major complication thought to be unrelated to surgery. No open conversions were required. There was no 90-d mortality. CONCLUSIONS Our stepwise approach can help overcome challenges of urethro-ileal anastomosis during intracorporeal neobladder formation. PATIENT SUMMARY When performing intracorporeal neobladder formation, challenges are often encountered in fashioning the urethro-ileal anastomosis. We describe a series of maneuvers that, when used in a stepwise manner, help overcome these challenges.


COVID-19: Stay Cool toward Corticosteroids.


title: Gal power: the diverse roles of galectins in regulating viral infections.

text: Viruses, as a class of pathogenic microbe, remain a significant health burden globally. Viral infections result in significant morbidity and mortality annually and many remain in need of novel vaccine and anti-viral strategies. The development of effective novel anti-viral therapeutics, in particular, requires detailed understanding of the mechanism of viral infection, and the host response, including the innate and adaptive arms of the immune system. In recent years, the role of glycans and lectins in pathogen-host interactions has become an increasingly relevant issue. This review focuses on the interactions between a specific lectin family, galectins, and the broad range of viral infections in which they play a role. Discussed are the diverse activities that galectins play in interacting directly with virions or the cells they infect, to promote or inhibit viral infection. In addition we describe how galectin expression is regulated both transcriptionally and post-transcriptionally by viral infections. We also compare the contribution of known galectin-mediated immune modulation, across a range of innate and adaptive immune anti-viral responses, to the outcome of viral infections.


title: Transabdominal robotic repair of a congenital right diaphragmatic hernia containing an intrathoracic kidney: a case report.

text: Bochdalek diaphragmatic hernia is a rare condition and is typically diagnosed prior to adulthood. Furthermore, right-sided defects are also uncommon due to the location of the liver, but can contain colon, omentum, small bowel, or rarely the kidney. Minimally invasive laparoscopic and thoracoscopic diaphragmatic hernia repairs are associated with improved outcomes when compared to open approaches-recently, robotic-assisted repairs have been performed in children with no morbidity and minimal complications. We report a case of an 80-year-old female who presented with an enlarging right-sided Bochdalek hernia containing an acquired intrathoracic kidney that was repaired using a robotic-assisted laparoscopic transabdominal approach with mesh placement. In this case, the robotic platform's advantages included excellent visualization of the posterolateral defect and efficient suturing during mesh placement. This approach is a viable option for skilled minimally invasive surgeons; however, further studies are warranted to investigate its utility in the management of diaphragmatic hernia repair.


title: Systematic review of strategies to manage and allocate scarce resources during mass casualty events.

text: STUDY OBJECTIVE Efficient management and allocation of scarce medical resources can improve outcomes for victims of mass casualty events. However, the effectiveness of specific strategies has never been systematically reviewed. We analyze published evidence on strategies to optimize the management and allocation of scarce resources across a wide range of mass casualty event contexts and study designs. METHODS Our literature search included MEDLINE, Scopus, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Database of Systematic Reviews, from 1990 through late 2011. We also searched the gray literature, using the New York Academy of Medicine's Grey Literature Report and key Web sites. We included both English- and foreign-language articles. We included studies that evaluated strategies used in actual mass casualty events or tested through drills, exercises, or computer simulations. We excluded studies that lacked a comparison group or did not report quantitative outcomes. Data extraction, quality assessment, and strength of evidence ratings were conducted by a single researcher and reviewed by a second; discrepancies were reconciled by the 2 reviewers. Because of heterogeneity in outcome measures, we qualitatively synthesized findings within categories of strategies. RESULTS From 5,716 potentially relevant citations, 74 studies met inclusion criteria. Strategies included reducing demand for health care services (18 studies), optimizing use of existing resources (50), augmenting existing resources (5), implementing crisis standards of care (5), and multiple categories (4). The evidence was sufficient to form conclusions on 2 strategies, although the strength of evidence was rated as low. First, as a strategy to reduce demand for health care services, points of dispensing can be used to efficiently distribute biological countermeasures after a bioterrorism attack or influenza pandemic, and their organization influences speed of distribution. Second, as a strategy to optimize use of existing resources, commonly used field triage systems do not perform consistently during actual mass casualty events. The number of high-quality studies addressing other strategies was insufficient to support conclusions about their effectiveness because of differences in study context, comparison groups, and outcome measures. Our literature search may have missed key resource management and allocation strategies because of their extreme heterogeneity. Interrater reliability was not assessed for quality assessments or strength of evidence ratings. Publication bias is likely, given the large number of studies reporting positive findings. CONCLUSION The current evidence base is inadequate to inform providers and policymakers about the most effective strategies for managing or allocating scarce resources during mass casualty events. Consensus on methodological standards that encompass a range of study designs is needed to guide future research and strengthen the evidence base. Evidentiary standards should be developed to promote consensus interpretations of the evidence supporting individual strategies.


title: Computational flow dynamics and preclinical assessment of a novel hemodialysis catheter.

text: We examined flow characteristics and recirculation of a novel dialysis catheter with helically contoured lumens, which optimize the vectors of blood entering and leaving the device. Computational flow dynamics were used to measure shear stress, residence time (RT), Platelet Lysis Index (PLI), and recirculation of the study catheter, termed the VectorFlow catheter, compared with the Palindrome catheter. Bench and animal models were used to measure recirculation compared with other dialysis catheter designs. The VectorFlow catheter was associated with an 18% reduction in mean shear stress compared with the Palindrome catheter, at 13.6 and 16.6 Pa, respectively. Low PLI was seen with the VectorFlow (PLI = 0.019) and Palindrome (PLI = 0.015) catheters. The VectorFlow catheter was associated with a % RT >0.030 seconds of 1.2%, compared to 0.9% for the Palindrome. Calculated recirculation of the VectorFlow, Palindrome, and step-tip catheter designs in reversed position were 1.2 × 10(-4) %, 0.039%, and 13.6%, respectively. In vitro, the VectorFlow catheter had no detectable recirculation (0%) compared to 7.3-9.5% with the Palindrome at flow rates of 400-600 ml/minute. In vivo, the VectorFlow catheter had no detectable recirculation, compared to 6.7-12% for the Palindrome. The VectorFlow catheter was associated with an absence of detectable recirculation with favorable flow dynamics.


title: The burden of infections by parainfluenza virus in hospitalized children in Spain.

text: We designed a prospective study to describe the clinical impact of the parainfluenza viruse (PIV) types detected in hospitalized children with respiratory tract infections from September 2008 to August 2010 in Spain. PIV infections were a significant proportion of viral respiratory detections (11.8% of cases). PIV types 3 and 4 were most commonly detected. There were clinical differences between PIV and respiratory syncytial virus infections.


title: Lymphovenous Anastomosis Bypass Surgery.

text: The field of lymphedema surgery has witnessed tremendous advancements over the years and has been coupled to the rapid growth of supermicrosurgical techniques. A lymphovenous bypass or lymphaticovenular anastomosis is a new technique that requires identification of patent, residual lymphatic channels and performing an anastomosis to a recipient venule, thereby allowing outflow of lymphatic fluid and improvement in a patient's lymphedema. This article provides a summary of the maturation of the technique, as well as the technical aspects of the approach and the current outcomes in the treatment of postmastectomy lymphedema.


title: [Dynamic basic reproduction number based evaluation for current prevention and control of COVID-19 outbreak in China].

text: Objective: To evaluate the current status of the prevention and control of coronavirus disease (COVID-19) outbreak in China, establish a predictive model to evaluate the effects of the current prevention and control strategies, and provide scientific information for decision- making departments. Methods: Based on the epidemic data of COVID-19 openly accessed from national health authorities, we estimated the dynamic basic reproduction number R(0)(t) to evaluate the effects of the current COVID-19 prevention and control strategies in all the provinces (municipalities and autonomous regions) as well as in Wuhan and the changes in infectivity of COVID-19 over time. Results: For the stability of the results, 24 provinces (municipality) with more than 100 confirmed COVID-19 cases were included in the analysis. At the beginning of the outbreak, the R(0)(t) showed unstable trend with big variances. As the strengthening of the prevention and control strategies, R(0)(t) began to show a downward trend in late January, and became stable in February. By the time of data analysis, 18 provinces (municipality) (75%) had the R(0)(t)s less than 1. The results could be used for the decision making to free population floating conditionally. Conclusions: Dynamic R(0)(t) is useful in the evaluation of the change in infectivity of COVID-19, the prevention and control strategies for the COVID-19 outbreak have shown preliminary effects, if continues, it is expected to control the COVID-19 outbreak in China in near future.


title: Assessment of the Spatial Heterogeneity of Breast Cancers: Associations Between Computed Tomography and Immunohistochemistry.

text: Background Tumour heterogeneity is considered an important mechanism of treatment failure. Imaging-based assessment of tumour heterogeneity is showing promise but the relationship between these mathematically derived measures and accepted 'gold standards' of tumour biology such as immunohistochemical measures is not established. Methods A total of 20 women with primary breast cancer underwent a research dynamic contrast-enhanced computed tomography prior to treatment with data being available for 15 of these. Texture analysis was performed of the primary tumours to extract 13 locoregional and global parameters. Immunohistochemical analysis associations were assessed by the Spearman rank correlation. Results Hypoxia-inducible factor-1α was correlated with first-order kurtosis (r = -0.533, P = .041) and higher order neighbourhood grey-tone difference matrix coarseness (r = 0.54, P = .038). Vascular maturity-related smooth muscle actin was correlated with higher order grey-level run-length long-run emphasis (r = -0.52, P = .047), fractal dimension (r = 0.613, P = .015), and lacunarity (r = -0.634, P = .011). Micro-vessel density, reflecting angiogenesis, was also associated with lacunarity (r = 0.547, P = .035). Conclusions The associations suggest a biological basis for these image-based heterogeneity features and support the use of imaging, already part of standard care, for assessing intratumoural heterogeneity.


title: The COVID-19 Pandemic: A View From Vietnam.

text: Vietnam can be considered a success story in its handling of the COVID-19 pandemic. As of April 27, 2020, the country has had 270 cases (225 recovered), no deaths, and no new cases for the past 10 days (since April 18). On Friday, April 24, two new cases were identified at the airport, but both cases were quarantined at arrival. We provide a few take-home lessons from the Vietnam experience. (Am J Public Health. Published online ahead of print May 28, 2020: e1-e2. doi:10.2105/AJPH.2020.305751).


title: Endoscopic Thyroidectomy Using the Unilateral Axillo-breast Approach Versus the Modified Anterior Chest Wall Approach: A Prospective Comparative Study.

text: INTRODUCTION Endoscopic thyroidectomy (ET) has become a well-established surgical technique that is mainly performed for benign thyroid lesions. Several endoscopic approaches are available, such as transaxillary, unilateral axillo-breast approach (UABA), modified anterior chest wall approach (MACWA), bilateral axillo-breast approach, and most recently the transoral approach and the robotic-assisted techniques. There is no recommended approach, because each approach has its own positive and negative attributes. We, herein, compare between UABA and MACWA in terms of surgical and cosmetic outcomes. METHODS This prospective study was conducted from April 2016 to August 2017. Forty patients with unilateral benign thyroid lesions were selected. Of them, 20 patients underwent ET using UABA, and 20 patients underwent ET using MACWA. Gas insufflation was implemented for all patients. Clinicopathologic data, surgical outcomes, and cosmetic outcomes in both groups were analyzed. RESULTS There was no significant difference between both groups in the clinicopathologic characteristics. The mean surgical time was significantly longer in the UABA group compared with the chest wall group (147.3 vs. 124.3 min). The postoperative pain scores were relatively lower in the UABA group compared with the MACWA group. We reported a higher rate of persistent paresthesia, neck contracture with swallowing discomfort, and hypertrophic scars in the MACWA group. Cosmetic satisfaction scores for patients who underwent UABA were higher than for those who underwent MACWA. CONCLUSIONS Both approaches were similar in terms of safety, feasibility, and operative complications. Even though the surgical time was longer, patients who underwent the UABA reported relatively less postoperative pain, superior cosmetic results, scar perception, and patient satisfaction compared with MACWA.


title: Effective chemokine secretion by dendritic cells and expansion of cross-presenting CD4-/CD8+ dendritic cells define a protective phenotype in the mouse model of coxsackievirus myocarditis.

text: Enteroviruses such as coxsackievirus B3 (CVB3) are able to induce lethal acute and chronic myocarditis. In resistant C57BL/6 mice, CVB3 myocarditis is abrogated by T-cell-dependent mechanisms, whereas major histocompatibility complex (MHC)-matched permissive A.BY/SnJ mice develop chronic myocarditis based on virus persistence. To define the role of T-cell-priming dendritic cells (DCs) in the outcome of CVB3 myocarditis, DCs were analyzed in this animal model in the course of CVB3 infection. In both mouse strains, DCs were found to be infectible with CVB3; however, formation of infectious virions was impaired. In DCs derived from C57BL/6 mice, significantly higher quantities of interleukin-10 (IL-10) and the proinflammatory cytokines IL-6 and tumor necrosis factor alpha were measured compared to those from A.BY/SnJ mice. Additionally, the chemokines interferon-inducible protein 10 (IP-10) and RANTES were secreted by DCs from resistant C57BL/6 mice earlier in infection and at significantly higher levels. The protective role of IP-10 in CVB3 myocarditis was confirmed in IP-10(-/-) mice, which had increased myocardial injury compared to the immunocompetent control animals. Also, major differences in resistant and permissive mice were found in DC subsets, with C57BL/6 mice harboring more cross-priming CD4(-) CD8(+) DCs. As CD4(-) CD8(+) DCs are known to express 10 times more Toll-like receptor 3 (TLR3) than other DC subsets, we followed the course of CVB3 infection in TLR3(-/-) mice. These mice developed a fulminant acute myocarditis and secreted sustained low amounts of type I interferons; secretion of IP-10 and RANTES was nearly abrogated in DCs. We conclude that MHC-independent genetic factors involving DC-related IP-10 secretion and TLR3 expression are beneficial in the prevention of chronic coxsackievirus myocarditis.


title: Improving the measurement of TMS-assessed voluntary activation in the knee extensors.

text: PURPOSE To test the accuracy, validity, reliability and sensitivity of an alternative method for the measure of TMS-assessed voluntary activation (VATMS) in the knee extensors. METHODS Ten healthy males (24 ± 5 years) completed a neuromuscular assessment protocol before and after a fatiguing isometric exercise: two sets of five contractions (50%, 62.5%, 75%, 87.5%, 100% Maximal Voluntary Contraction; MVC) with superimposed TMS-evoked twitches for calculation of VATMS using either the first 5 stimulations (1x5C) or all 10 (2x5C). This was performed on two separate occasions (between-day reliability). Accuracy and validity were compared with a routinely used protocol [i.e. 50%, 75%, and 100% of MVC (1x3C) performed three times (3x3C)]. RESULTS 95% confidence interval for estimated resting twitch, a key determinant of VATMS, was similar between 1x5C, 2x5C, and 3x3C but improved by six-fold when compared to 1x3C (P<0.05). In a fresh state, potentiated twitch force was unchanged following 1x5C but decreased following 2x5C (P<0.05). A recovery was found post-exercise but was smaller for 1x5C compared to 2x5C (P<0.05), with no difference between the latter two (P>0.05). Absolute reliability was strong enough for both 1x5C and 2x5C to depict a true detectable change in the sample's VATMS following the fatiguing exercise (TEM < 3% at rest, <9% post-exercise) but 2x5C was marginally more sensitive to individual's changes from baseline. CONCLUSION Both 1x5C and 2x5C provide reliable measures of VATMS. However, 1x5C may hold stronger internal validity. Both protocols allow detection of 'true' changes in sample's means but not individual scores following a fatiguing isometric exercise.


title: Persistently elevated parathyroid hormone after successful parathyroid surgery.

text: OBJECTIVES/HYPOTHESIS Explore potential causes of persistently elevated parathyroid hormone levels after curative parathyroidectomy in patients with primary hyperparathyroidism due to single gland disease. STUDY DESIGN Case series with planned data collection. METHODS An analysis was undertaken of 314 patients with primary hyperparathyroidism undergoing parathyroid surgery in a tertiary academic practice between January 2009 and April 2013. There were 187 patients with single-gland disease; 68 failed to meet inclusion criteria, resulting in a study population of 119 patients. Preoperative parathyroid hormone, calcium, ionized calcium, 25-OH-vitamin D, creatinine, and glomerular filtration rate values were determined, along with postoperative calcium, ionized calcium, and parathyroid hormone levels. Patients were divided into two groups based on their postoperative parathyroid hormone values: elevated parathyroid hormone and normal parathyroid hormone. RESULTS Thirty (25.2%) patients achieved postoperative normocalcemia but had elevated parathyroid hormone levels. This group had significantly higher preoperative levels of parathyroid hormone (P =.002) and creatinine (P =.007), and a lower glomerular filtration rate (P =.002) than patients with normal postoperative parathyroid hormone levels. The preoperative 25-OH-vitamin D level was not significantly associated with an elevated parathyroid hormone (odds ratio [OR]: 1.56). Preoperative impaired renal function, specifically an abnormal glomerular filtration rate (OR: 12.8), was significantly associated with an elevated parathyroid hormone. CONCLUSIONS Parathyroid hormone remains elevated in 25% of patients who are cured (eucalcemic) after surgery for primary hyperparathyroidism. This phenomenon was associated with higher preoperative parathyroid hormone levels and impaired renal function rather than low 25-OH-vitamin D levels. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1720-1723, 2017.


title: Induced tolerance to abiotic and biotic stresses of broccoli and Arabidopsis after treatment with elicitor molecules.

text: The plant hormones salicylic acid (SA) and jasmonic acid (JA) regulate defense mechanisms capable of overcoming different plant stress conditions and constitute distinct but interconnected signaling pathways. Interestingly, several other molecules are reported to trigger stress-specific defense responses to biotic and abiotic stresses. In this study, we investigated the effect of 14 elicitors against diverse but pivotal types of abiotic (drought) and biotic (the chewing insect Ascia monuste, the hemibiotrophic bacterium Pseudomonas syringae DC 3000 and the necrotrophic fungus Alternaria alternata) stresses on broccoli and Arabidopsis. Among the main findings, broccoli pre-treated with SA and chitosan showed the highest drought stress recovery in a dose-dependent manner. Several molecules led to increased drought tolerance over a period of three weeks. The enhanced drought tolerance after triggering the SA pathway was associated with stomata control. Moreover, methyl jasmonate (MeJA) reduced A. monuste insect development and plant damage, but unexpectedly, other elicitors increased both parameters. GUS reporter assays indicated expression of the SA-dependent PR1 gene in plants treated with nine elicitors, whereas the JA-dependent LOX2 gene was only expressed upon MeJA treatment. Overall, elicitors capable of tackling drought and biotrophic pathogens mainly triggered the SA pathway, but adversely also induced systemic susceptibility to chewing insects. These findings provide directions for potential future in-depth characterization and utilization of elicitors and induced resistance in plant protection.


title: A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases.

text: BACKGROUND Microwave (MWA) and radiofrequency ablation (RFA) are the most commonly used techniques for ablating colorectal-liver metastases (CRLM). The technical and oncologic differences between these modalities are unclear. METHODS We conducted a matched-cohort analysis of patients undergoing open MWA or RFA for CRLM at a tertiary-care center between 2008 and 2011; the primary endpoint was ablation-site recurrence. Tumors were matched by size, clinical-risk score, and arterial-intrahepatic or systemic chemotherapy use. Outcomes were compared using conditional logistic regression and stratified log-rank test. RESULTS We matched 254 tumors (127 per group) from 134 patients. MWA and RFA groups were comparable by age, gender, median number of tumors treated, proximity to major vessels, and postoperative complication rates. Patients in the MWA group had lower ablation-site recurrence rates (6% vs. 20%; P < 0.01). Median follow-up, however, was significantly shorter in the MWA group (18 months [95% confidence interval 17-20] vs. 31 months [95% confidence interval 28-35]; P < 0.001). Kaplan-Meier estimates of ablation-site recurrence at 2 years were significantly lower for the lesions treated with MWA (7% vs. 18%, P: 0.01). CONCLUSIONS Ablation-site recurrences of CRLM were lower with MWA compared with RFA in this matched cohort analysis. Longer follow-up time in the MWA may increase the recurrence rate; however, actuarial local failure estimations demonstrated better local control with MWA.


Assessing the severity of the novel influenza A/H1N1 pandemic.


title: Changes in helper lymphocyte chemokine receptor expression and elevation of IP-10 during acute respiratory syncytial virus infection in infants.

text: It is known that lymphopenia caused by apoptosis may occur during severe respiratory syncytial virus (RSV) infection. However, further evidence about how T-cell subsets may be affected in infants during severe RSV bronchiolitis is needed to understand the mechanisms through which immunological memory may be altered. There is increasingly convincing evidence that RSV may be associated with the development of atopy and asthma. Surrogates of Th1, Th2 and regulatory T-lymphocyte populations were measured in blood from children with acute RSV bronchiolitis and in convalescence using the cell surface receptors CXCR3, CCR4 and CD25, respectively. Samples were also obtained from healthy age-matched controls. Plasma levels of the chemokines interferon-γ inducible protein-10 (IP-10) and thymus and activation-regulated chemokine (TARC), which are known ligands for CXCR3 and CCR4, were also measured. Free plasma DNA was measured using quantitative PCR. CXCR3-positive cells were significantly decreased during acute infection (p = 0.013), while CCR4 and CD25 T-cell populations were unchanged. Plasma levels of IP-10 were markedly elevated in acute infection (p = 0.001). Convalescent samples were not significantly different to control samples for lymphocyte phenotypes or plasma chemokines. Elevated free plasma DNA was detected during acute infection compared with convalescence and controls. A profound reduction in the Th1, but not Th2, and CD25-positive lymphocyte populations associated with exaggerated IP-10 production occurs in severe RSV bronchiolitis. Free DNA is detectable in plasma. This may allow significant alterations in the generation of T-cell memory.


title: Reoperation for postoperative bleeding following pulmonary resection: a report of a single-center experience.

text: OBJECTIVE The variety and incidence of postoperative complications seem to have changed with recent progress in thoracic surgery. This study attempted to improve our recognition of postoperative bleeding. METHODS Among 1143 patients undergoing pulmonary resection for pulmonary nodules, ten underwent surgical treatment for postoperative bleeding. Clinical and pathologic data were analyzed. Additionally, the relationship between the bleeding point and an increased amount of drained bloody effusion before the second operation was analyzed. RESULTS The bleeding point was recognized in eight cases: the intercostal artery (n = 4), the lung (n = 2), aberrant vessel of the apex of the lung (n = 1) and the bronchial artery (n = 1). The bleeding points were unknown in two cases in whom the decision to perform a second operation was delayed. Potential reasons or influential factors for bleeding were stapling complications (n = 4), low coagulation ability (n = 2) and intraoperative injury (n = 1). We experienced two cases in which intercostal arterial bleeding was induced by scratching the thoracic wall or the vertebra with the edge of the reinforced stapling line or the sharp edge of a broken staple at the first operation. We divided patients into three groups based on the interval between operations. Bleeding from the arteries seemed to show a higher rate of bleeding per hour than that from the lung parenchyma. CONCLUSION The bleeding points and speculated reasons for bleeding varied among patients. We were able to cure all ten cases. It might be dependent on the rapid decision of reoperation in cases with arterial bleeding was suspected.


title: Biomechanical evaluation of finger trap suture variants for securing catheters.

text: OBJECTIVE To biomechanically evaluate various finger trap patterns and suture materials for securing 5F polyvinylchloride and polypropylene catheters. DESIGN In vitro prospective study. SAMPLE 132 finger trap constructs. PROCEDURES Each group of constructs comprised 6 to 10 replicates each of 3 finger trap patterns tied with 2-0 glycolide-lactide copolymer (GLC), braided nylon, and monofilament polypropylene suture on 5F polypropylene and polyvinylchloride catheters. The 3 finger trap variants were of similar lengths but differed in the number of surgeon's throws included in the pattern. Constructs were tested with a universal materials testing machine to the point of failure or a maximum of 100 mm of distraction. Force and distraction data were evaluated for significance with a competing risks model. RESULTS There was no difference in performance (as measured by the proportion of test failures, median distraction distance, or median force at failure or end of testing) attributable to the finger trap pattern variants. Sixteen of 66 constructs with polyvinylchloride catheter material failed at ≤ 100 mm distraction, whereas all polypropylene constructs failed during testing. For polypropylene catheters, braided nylon or GLC suture withstood greater distraction distance and force, respectively. For polyvinylchloride catheters, differences among suture types were nonsignificant. CONCLUSIONS AND CLINICAL RELEVANCE Data suggested that, for the material combinations evaluated, a finger trap suture pattern with fewer knots may provide catheter security similar to that for patterns tied with a more traditional pattern. These results should not be extrapolated to catheters of different diameters or materials, patterns tied with different suture sizes, or clinical performance in vivo without further testing.


The role of endoscopy in the management of suspected small-bowel bleeding.


title: Responsiveness of the Intermittent and Constant Osteoarthritis Pain (ICOAP) scale in a trial of duloxetine for treatment of osteoarthritis knee pain.

text: OBJECTIVE To assess the change in the Intermittent and Constant Osteoarthritis Pain (ICOAP)-scale scores in patients taking duloxetine or placebo and to characterize the responsiveness of the ICOAP by comparing the effect size associated with its scales to effect sizes seen with other pain scales used in this study. METHODS This was a secondary analysis of data from a 10-week, double-blind, randomized, flexible-dose, placebo-controlled trial that enrolled patients who had persistent moderate pain due to osteoarthritis (OA) of the knee, despite having received nonsteroidal anti-inflammatory drug (NSAID) therapy. The pain measures used in this study (focusing on the drug-placebo difference at week 8) were patient-rated pain severity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Brief Pain Inventory (BPI), and the ICOAP. RESULTS The mean difference between duloxetine and placebo at week 8 for patient-rated pain severity, the BPI average pain, WOMAC pain, and each ICOAP scale was statistically significant (P < 0.001 for each). The ICOAP total showed a moderate effect size of 0.53, whereas the constant and intermittent scores showed effect sizes of 0.47 and 0.49, respectively. The patient-rated pain severity and the BPI average pain showed similar moderate effect sizes of 0.59 and 0.53, respectively. CONCLUSION The study demonstrated efficacy of duloxetine compared with placebo when using the ICOAP scale in a placebo-controlled trial. The observed treatment effect size for the ICOAP scores was similar to that for other reliable, valid and responsive pain assessments. CLINICAL TRIALS REGISTRATION ClinicalTrial.gov Identifier: NCT01018680.


title: [Chest CT findings and their dynamic changes in patients with COVID-19].

text: ObjectiveTo define chest CT findings and their dynamic changes in patients with coronavirus disease 2019 (COVID-19) from disease onset to the cure.MethodWe analyzed the clinical and chest CT data of 6 patients with RT-PCR-confirmed COVID-19. According to the time from the disease onset to the cure or from the onset to each CT scan, the total of 30 chest CT scans were divided into 4 stages, namely stage 1 (0-4 days), stage 2 (5-9 days), stage 3 (10-14 days), and stage 4 (over 14 days). A semi-quantitative scoring system was used to quantitatively assess the pulmonary involvement on the basis of the involved area. The differences in chest CT signs and the lung injury scores based on CT findings were compared among the 4 stages.ResultsIn stage 1, ground-glass opacities (GGO) was found frequently in the subpleura, and the CT score was the lowest at 4.00±0.40. Stage 2 was characterized by an increased and mixed density (crazy-paving pattern) with mild consolidation of the lungs, and the CT score reached its peak level of 7.38±3.34 (P < 0.05). In stage 3, an expanded range of consolidation and linear lesions were found in the lungs, and the total CT score averaged 6.86±2.91. In stage 4, a gradual resolution of the consolidation occurred with more linear lesions in the lungs, and the total CT score was 6.21±1.56. The CT scores of the lower lobes were significantly higher compared with those of the middle/upper lobes (P < 0.05) in stage 3 and stage 4.ConclusionChest CT scans allows dynamic monitoring of the changes in the distribution, density and extent of the pulmonary lesions in the 4 stages, which are closely correlated with the evolution of the disease course of COVID-19.


title: Air pollution exposures during adulthood and risk of endometriosis in the Nurses' Health Study II.

text: BACKGROUND Particulate matter and proximity to large roadways may promote disease mechanisms, including systemic inflammation, hormonal alteration, and vascular proliferation, that may contribute to the development and severity of endometriosis. OBJECTIVE Our goal was to determine the association of air pollution exposures during adulthood, including distance to road, particulate matter<2.5 μm, between 2.5 and 10 μm, and <10 μm, (PM2.5, PM10-2.5, PM10), and timing of exposure with risk of endometriosis in the Nurses' Health Study II. METHODS Proximity to major roadways and outdoor levels of PM2.5, PM10-2.5, and PM10 were determined for all residential addresses from 1993 to 2007. Multivariable-adjusted time-varying Cox proportional hazard models were used to estimate the relation between these air pollution exposures and endometriosis risk. RESULTS Among 84,060 women, 2,486 incident cases of surgically confirmed endometriosis were identified over 710,230 person-years of follow-up. There was no evidence of an association between endometriosis risk and distance to road or exposure to PM2.5, PM10-2.5, or PM10 averaged over follow-up or during the previous 2- or 4-year period. CONCLUSIONS Traffic and air pollution exposures during adulthood were not associated with incident endometriosis in this cohort of women.


title: Near-infrared spectroscopy: applications in neonates.

text: Near-infrared spectroscopy (NIRS) offers non-invasive, in-vivo, real-time monitoring of tissue oxygenation. Changes in regional tissue oxygenation as detected by NIRS may reflect the delicate balance between oxygen delivery and consumption. Originally used predominantly to assess cerebral oxygenation and perfusion perioperatively during cardiac and neurosurgery, and following head trauma, NIRS has gained widespread popularity in many clinical settings in all age groups including neonates. However, more studies are required to establish the ability of NIRS monitoring to improve patient outcomes, especially in neonates. This review provides a comprehensive description of the use of NIRS in neonates.


title: Technical Feasibility and Short-Term Outcome of Intracorporeal Hand-Sewn Esophagojejunostomy After Laparoscopic Total Gastrectomy: Our Experience.

text: The purpose of this study was to demonstrate the safety and technical feasibility of intracorporeal hand-sewn esophagojejunostomy after laparoscopic total gastrectomy. Laparoscopic total gastrectomy (LTG) is a technically challenging procedure, especially for esophagojejunal anastomosis (EJA). Various techniques have been described to overcome these difficulties using staplers with variable results. We report successfully performed complete intracorporeal hand-sewn EJA after LTG. The perioperative clinical data and short-term outcomes for 30 patients who underwent LTG using hand-sewn EJA for gastric cancer between 2013 and 2015 have been retrospectively reviewed. The mean age was 49.9 years; 64 % of patients were male and 36 % were female. The mean body mass index (kg/m2) was 22.4, and the mean American Society of Anesthesiologists (ASA) score was 1.4. Eleven patients had co-morbidities, and six patients had previous abdominal operations. The mean operative time, time for EJA, and blood loss was 136.9 min, 13.25 min, and 166 ml, respectively. The conversion rate was nil. The mean time for the first oral feeding and mean hospital stay was 8.3 and 9.8 days respectively. The postoperative complications were found in 16 % of patients with one case of 30-day mortality because of lobar pneumonia. There were three cases of anastomotic stenosis; however, no leakage was identified both clinically and radiologically. Complete intracorporeal hand-sewn EJA is a safe and feasible technique in the hands of experienced surgeons that can be considered as an alternative cost-effective method when performing LTG.


title: Occupational burnout and its overlapping effect with depression and anxiety.

text: OBJECTIVES The problem of defining burnout concerns its overlapping effect with other syndromes and disorders, such as depression and anxiety. Additionally, some individual characteristics influence susceptibility to burnout (e.g., neuroticism). Therefore, the question arises whether burnout is or is not a distinct syndrome. The aim of the study is to compare 2 distinct burnout measures by analyzing their connections with organizational and individual variables. MATERIAL AND METHODS The study was conducted in the Institute of Applied Psychology at the Jagiellonian University, Kraków, Poland on a group of employees (N = 100; 40 men; mean age 36.03 years). All participants completed 2 burnout scales: the Maslach Burnout Inventory - General Survey (MBI-GS) and the Link Burnout Questionnaire (LBQ). Organizational and individual factors were controlled with Areas of Worklife Survey, State-Trait Anxiety Inventory, NEO Five-Factor Inventory and Beck's Depression Inventory scales. A structural equation path model was created to quantify the relations between organizational factors and burnout, as well as to control the individual factors of anxiety, neuroticism and depression. RESULTS The results indicate high compatibility between MBI-GS and LBQ on burnout diagnosis. The MBI-GS and LBQ revealed stronger connections with organizational context and individual characteristics, respectively. Depression explains dimensions of exhaustion (MBI-GS, LBQ), sense of disillusion (LBQ), neuroticism-exhaustion (MBI-GS); anxiety explains sense of professional inefficacy (LBQ). CONCLUSIONS Besides organizational variables, individual characteristics also play an important role in explaining burnout syndrome. Exploring the 2 burnout models has revealed that depression is an important determinant of exhaustion. Cynicism and relationship deterioration have consistently been explained only by organizational context. Int J Occup Med Environ Health. 2019;32(2):229-44.


What every intensivist should know about using high-flow nasal oxygen for critically ill patients.


title: Women with dysmenorrhoea are hypersensitive to experimentally induced forearm ischaemia during painful menstruation and during the pain-free follicular phase.

text: BACKGROUND Monthly primary dysmenorrhoeic pain is associated with increased sensitivity to painful stimuli, particularly in deep tissue. We investigated whether women with dysmenorrhoea, compared with controls, have increased sensitivity to experimentally induced deep-tissue muscle ischaemia in a body area distant from that of referred menstrual pain. METHODS The sub-maximal effort tourniquet test was used to induce forearm ischaemia in 11 women with severe dysmenorrhoea and in nine control women both during menstruation and in the follicular phase of the menstrual cycle. Von Frey hair assessments confirmed the presence of experimental ischaemia. Women rated the intensity of menstrual and ischaemic pain on a 100-mm visual analogue scale. RESULTS Women with dysmenorrhoea [mean (SD): 68 (20) mm] reported significantly greater menstrual pain compared with controls [mean (SD): 2 (6) mm; p = 0.0001] during the menstruation phase. They also rated their forearm ischaemic pain as significantly greater than the controls during the menstruation [dysmenorrhoeics vs. controls mean (SD): 58 (19) mm vs. 31 (21) mm, p < 0.01] and follicular [dysmenorrhoeics vs. controls mean (SD): 60 (18) mm vs. 40 (14) mm, p < 0.01] phases of the menstrual cycle. CONCLUSIONS These data show that compared with controls, women who experience severe recurrent dysmenorrhoea have deep-tissue hyperalgesia to ischaemic pain in muscles outside of the referred area of menstrual pain both during the painful menstruation phase and pain-free follicular phase. These findings suggest the presence of long-lasting changes in muscle pain sensitivity in women with dysmenorrhoea. Our findings that dysmenorrhoeic women are hyperalgesic to a clinically relevant, deep-muscle ischaemic pain in areas outside of referred menstrual pain confirm other studies showing long-lasting changes in pain sensitivity outside of the painful period during menstruation.


title: Value and limitations of transpulmonary pressure calculations during intra-abdominal hypertension.

text: OBJECTIVE To clarify the effect of progressively increasing intra-abdominal pressure on esophageal pressure, transpulmonary pressure, and functional residual capacity. DESIGN Controlled application of increased intra-abdominal pressure at two positive end-expiratory pressure levels (1 and 10 cm H2O) in an anesthetized porcine model of controlled ventilation. SETTING Large animal laboratory of a university-affiliated hospital. SUBJECTS Eleven deeply anesthetized swine (weight 46.2 ± 6.2 kg). INTERVENTIONS Air-regulated intra-abdominal hypertension (0-25 mm Hg). MEASUREMENTS Esophageal pressure, tidal compliance, bladder pressure, and end-expiratory lung aeration by gas dilution. MAIN RESULTS Functional residual capacity was significantly reduced by increasing intra-abdominal pressure at both positive end-expiratory pressure levels (p ≤ 0.0001) without corresponding changes of end-expiratory esophageal pressure. Above intra-abdominal pressure 5 mm Hg, plateau airway pressure increased linearly by ~ 50% of the applied intra-abdominal pressure value, associated with commensurate changes of esophageal pressure. With tidal volume held constant, negligible changes occurred in transpulmonary pressure due to intra-abdominal pressure. Driving pressures calculated from airway pressures alone (plateau airway pressure--positive end-expiratory pressure) did not equate to those computed from transpulmonary pressure (tidal changes in transpulmonary pressure). Increasing positive end-expiratory pressure shifted the predominantly negative end-expiratory transpulmonary pressure at positive end-expiratory pressure 1 cm H2O (mean -3.5 ± 0.4 cm H2O) into the positive range at positive end-expiratory pressure 10 cm H2O (mean 0.58 ± 1.2 cm H2O). CONCLUSIONS Despite its insensitivity to changes in functional residual capacity, measuring transpulmonary pressure may be helpful in explaining how different levels of positive end-expiratory pressure influence recruitment and collapse during tidal ventilation in the presence of increased intra-abdominal pressure and in calculating true transpulmonary driving pressure (tidal changes of transpulmonary pressure). Traditional interpretations of respiratory mechanics based on unmodified airway pressure were misleading regarding lung behavior in this setting.


Early Diagnosis of Gastroesophageal Cancers and the Cytosponge: A Work in Progress.


title: COVID-19 presenting with ophthalmoparesis from cranial nerve palsy.

text: Neurological complications of COVID-19 are not well described. We report two patients who were diagnosed with COVID-19 after presenting with diplopia and ophthalmoparesis.


title: Beak and feather disease virus (BFDV) prevalence, load and excretion in seven species of wild caught common Australian parrots.

text: Pathogens pose a major risk to wild host populations, especially in the face of ongoing biodiversity declines. Beak and feather disease virus (BFDV) can affect most if not all members of one of the largest and most threatened bird orders world-wide, the Psittaciformes. Signs of disease can be severe and mortality rates high. Its broad host range makes it a risk to threatened species in particular, because infection can occur via spill-over from abundant hosts. Despite these risks, surveillance of BFDV in locally abundant wild host species has been lacking. We used qPCR and haemagglutination assays to investigate BFDV prevalence, load and shedding in seven abundant host species in the wild in south-east Australia: Crimson Rosellas (Platycercus elegans), Eastern Rosellas (Platycercus eximius), Galahs (Eolophus roseicapillus), Sulphur-crested Cockatoos (Cacatua galerita), Blue-winged Parrots (Neophema chrysostoma), Rainbow Lorikeets (Trichoglossus moluccanus) and Red-rumped Parrots (Psephotus haematonotus). We found BFDV infection in clinically normal birds in six of the seven species sampled. We focused our analysis on the four most commonly caught species, namely Crimson Rosellas (BFDV prevalence in blood samples: 41.8%), Sulphur-crested Cockatoos (20.0%), Blue-winged Parrots (11.8%) and Galahs (8.8%). Species, but not sex, was a significant predictor for BFDV prevalence and load. 56.1% of BFDV positive individuals were excreting BFDV antigen into their feathers, indicative of active viral replication with shedding. Being BFDV positive in blood samples predicted shedding in Crimson Rosellas. Our study confirms that BFDV is endemic in our study region, and can inform targeted disease management by providing comparative data on interspecies variation in virus prevalence, load and shedding.


title: Using the internet to assist smoking prevention and cessation in schools: a randomized, controlled trial.

text: OBJECTIVE To evaluate the impact of a classroom-based, Web-assisted tobacco intervention addressing smoking prevention and cessation with adolescents. DESIGN A two-group randomized control trial with 1,402 male and female students in grades 9 through 11 from 14 secondary schools in Toronto, Canada. Participants were randomly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up. The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine (http://www.smokingzine.org) integrated into a program that included a paper-based journal, a small group form of motivational interviewing, and tailored e-mails. MAIN OUTCOME MEASURE Resistance to smoking, behavioral intentions to smoke, and cigarette use were assessed at baseline, postintervention, and three- and six-month follow-up. Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time. RESULTS The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months. The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period. CONCLUSION The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months. By providing an accessible and attractive method of engaging young people in smoking prevention and cessation, this interactive and integrated program provides a novel vehicle for school- and population-level health promotion.


title: Comparison between orogastric tube/bougie and a suction calibration system for effects on operative duration, staple-line corkscrewing, and esophageal perforation during laparoscopic sleeve gastrectomy.

text: INTRODUCTION Placement of a bougie for sleeve sizing during laparoscopic sleeve gastrectomy (LSG) is recommended. We compared this standard with a suction calibration system (SCS) that performs all functions with one insertion, and measured each step's duration. METHODS Primary LSG was performed using a bougie and SCS in alternating order. Number of tube movements to achieve optimal placement, durations of decompression, leak testing, and overall operative time, and remnant linear measurements were obtained. RESULTS LSG was performed in 26 patients (15 women, 11 men; mean age 36.8 years; mean BMI 45.3 kg/m(2)). The mean number of tube movements was significantly greater for the bougie than for the SCS (8.13 vs. 3.58; p < 0.0001). Percent reductions achieved using the SCS were: time to full decompression of the stomach, 62% (21 vs. 8 s; p < 0.138); tube placement, 51% (101 vs. 49 s; p < 0.0001); leak testing, 78% (119 vs. 26 s; p < 0.0003); and mean operative duration (from tube insertion to end of stapling), 21% (875 vs. 697 s; p < 0.019). Variance of the staple-line distance, measured from the greater curvature to the staple line, was 1.64 and 0.92 for the bougie and SCS, respectively, indicating a reduction in corkscrewing, for a 43.9% straighter sleeve. CONCLUSION SCS maintained the gastric wall in place, thereby preventing corkscrewing, and reducing total operating time. Reducing the number of tube insertions may prevent esophageal damage and accidental tube stapling.


title: Quantification of Chronic Lymphedema in a Revised Mouse Model.

text: BACKGROUND Lymphedema is a common and debilitating complication following cancer treatment with surgical lymph node excision and radiotherapy. Currently there are no curative treatments for lymphedema. Animal models that intended to replicate the disease have been inadequate, making a troublesome transition from experimental therapeutic studies into the clinic. It is therefore imperative to establish an experimental animal model that can reliably replicate clinical lymphedema. METHODS To discover the optimal method of lymphedema induction, surgical lymph ablation and irradiation or silicone splint emplacement were combined in 8 experimental groups (n = 4). In total, 32 mice served in this study and were followed for 8 weeks after surgery. Outcomes included micro-computed tomography hind limb volumetry, lymphatic clearance measured with technetium Tc 99m (Tc) human serum albumin lymphoscintigraphy and lymph vessel ectasia quantified with LYVE-1 immunohistochemistry. RESULTS All trialed models but one resulted in only transient lymphedema or lasting lymphedema with adverse morbidity. Combined surgical lymph obstruction with 2 fractions of 10-Gy irradiation successfully induced lasting lymphedema without adverse events. Over the 8 weeks' follow-up, limb volumes were significantly increased at all time points (P < 0.001), lymph drainage was impaired (P < 0.001), and lymph vessels were ectatic (P < 0.001), when compared with the unoperated limbs. CONCLUSIONS The presented model of acquired lymphedema is a reduction and refinement of previous works and can transpose to future observational and interventional studies. In addition, it is shown how Tc-HSA lymphoscintigraphy can quantify lymphatic clearance, which can prove insightful in therapeutic studies aiming to enhance lymphatic drainage.


APIC's Strategic Partner Program: Elevating the profession and working toward a shared vision.


Imported malaria in the UK.


Professional commitment to ethical discussions needed from epidemiologists in the COVID-19 pandemic.


title: Fear, xenophobia and collectivism as predictors of well-being during Coronavirus disease 2019: An empirical study from India.

text: BACKGROUND The Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. Biological disasters like this can generate immense prejudice, xenophobia, stigma and othering, all of which have adverse consequences on health and well-being. In a country as diverse and populous in India, such crisis can trigger communalism and mutual blame. Keeping this in context, this study explored the relationship between well-being and xenophobic attitudes towards Muslims, collectivism and fear of COVID-19 in India. METHODS The study was carried out on 600 non-Islamic Indians (231 males, 366 females and 3 others; mean age: 38.76 years), using convenience sampling. An online survey containing Fear of Coronavirus scale, Warwick-Edinburgh Mental Well-Being Scale and Collectivism Scale was used. Xenophobia was assessed using two scales: generalized prejudice towards Muslims and specific xenophobic tendencies towards Muslims during COVID-19. The data were analysed using correlational methods and multiple regression. RESULTS The findings showed that positively significant relationship exists between well-being and age as well as with collectivism, while an inversely significant relationship between well-being and fear of COVID-19 was found. The results of the multiple regression analysis shows that fear of COVID-19, age, collectivism and generalized xenophobia, in the order of their importance, together contributed to nearly 20% of variance in well-being. CONCLUSION The findings are reflective of the importance of collectivism in enhancing well-being in these times of uncertainty. Xenophobia, one of the common offshoots of pandemics, can also harm the overall well-being. Implications are discussed in the light of India's diverse socio-religious background and global context.


title: Infectious disease transmission as a forensic problem: who infected whom?

text: Observations on infectious diseases often consist of a sample of cases, distinguished by symptoms, and other characteristics, such as onset dates, spatial locations, genetic sequence of the pathogen and/or physiological and clinical data. Cases are often clustered, in space and time, suggesting that they are connected. By defining kernel functions for pairwise analysis of cases, a matrix of transmission probabilities can be estimated. We set up a Bayesian framework to integrate various sources of information to estimate the transmission network. The method is illustrated by analysing data from a multi-year study (2002-2007) of nosocomial outbreaks of norovirus in a large university hospital in the Netherlands. The study included 264 cases, the norovirus genotype was known in approximately 60 per cent of the patients. Combining all the available data allowed likely identification of individual transmission links between most of the cases (72%). This illustrates that the proposed method can be used to accurately reconstruct transmission networks, enhancing our understanding of outbreak dynamics and possibly leading to new insights into how to prevent outbreaks.


title: Single-incision laparoscopic surgery in urology.

text: INTRODUCTION To assess the feasibility of single-incision laparoscopic surgery (SILS) in some urological surgeries. MATERIAL AND METHODS This prospective study was conducted on 40 patients (27 males and 13 females) from January 2010 to June 2011. Six procedures were done, SILS renal cyst decortication (n = 10), SILS varicocelectomy (n = 10), SILS orchiopexy (n = 10), SILS nephrectomy (n = 3), SILS pyelolithtomy (n = 6) and SILS adrenalectomy (n = 1). RESULTS Postoperative complications included ileus (10%) and fever (10%) in SILS renal cyst ablation. SILS varicocelectomy had postoperative sequalae as persistent varicocele (10%) and hydrocele (10%). SILS orchiopexy was also done with a success rate 100% in this series. SILS pyelolithotomy was successfully done in 5 out of 6 patients and only 1 patient was converted to conventional laparoscopy. In SILS nephrectomy 1 patient out of 3 was converted to conventional laparoscopy. CONCLUSION SILS in urology has proven to be safe and feasible in the hands of experienced laparoscopic surgeons, using specially designed ports and instruments in selected patients.


Human Vaccines & Immunotherapeutics: News.


title: Phase III HEAT Study Adding Lyso-Thermosensitive Liposomal Doxorubicin to Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Lesions.

text: Purpose: Lyso-thermosensitive liposomal doxorubicin (LTLD) consists of doxorubicin contained within a heat-sensitive liposome. When heated to ≥40°C, LTLD locally releases a high concentration of doxorubicin. We aimed to determine whether adding LTLD improves the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) lesions with a maximum diameter (dmax) of 3 to 7 cm.Experimental Design: The HEAT Study was a randomized, double-blind, dummy-controlled trial of RFA ± LTLD. The 701 enrolled patients had to have ≤4 unresectable HCC lesions, at least one of which had a dmax of 3 to 7 cm. The primary endpoint was progression-free survival (PFS) and a key secondary endpoint was overall survival (OS). Post hoc subset analyses investigated whether RFA duration was associated with efficacy.Results: The primary endpoint was not met; in intention-to-treat analysis, the PFS HR of RFA + LTLD versus RFA alone was 0.96 [95% confidence interval (CI), 0.79-1.18; P = 0.71], and the OS HR ratio was 0.95 (95% CI, 0.76-1.20; P = 0.67). Among 285 patients with a solitary HCC lesion who received ≥45 minutes RFA dwell time, the OS HR was 0.63 (95% CI, 0.41-0.96; P < 0.05) in favor of combination therapy. RFA + LTLD had reversible myelosuppression similar to free doxorubicin.Conclusions: Adding LTLD to RFA was safe but did not increase PFS or OS in the overall study population. However, consistent with LTLD's heat-based mechanism of action, subgroup analysis suggested that RFA + LTLD efficacy is improved when RFA dwell time for a solitary lesion ≥45 minutes. Clin Cancer Res; 24(1); 73-83. ©2017 AACR.


title: Endovascular treatment of anterior communicating artery aneurysms: a systematic review and meta-analysis.

text: BACKGROUND AND PURPOSE Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms. MATERIALS AND METHODS A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification. RESULTS Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81-93%) and 85% (95% CI = 78-90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3-6%). The re-bleeding rate was 2% (95% CI = 1-4%) and the retreatment rate was 7% (95% CI = 5-12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2-6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4-8%) and 3% (95% CI = 2-4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered. CONCLUSIONS Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.


title: A noncoding RNA produced by arthropod-borne flaviviruses inhibits the cellular exoribonuclease XRN1 and alters host mRNA stability.

text: All arthropod-borne flaviviruses generate a short noncoding RNA (sfRNA) from the viral 3' untranslated region during infection due to stalling of the cellular 5'-to-3' exonuclease XRN1. We show here that formation of sfRNA also inhibits XRN1 activity. Cells infected with Dengue or Kunjin viruses accumulate uncapped mRNAs, decay intermediates normally targeted by XRN1. XRN1 repression also resulted in the increased overall stability of cellular mRNAs in flavivirus-infected cells. Importantly, a mutant Kunjin virus that cannot form sfRNA but replicates to normal levels failed to affect host mRNA stability or XRN1 activity. Expression of sfRNA in the absence of viral infection demonstrated that sfRNA formation was directly responsible for the stabilization of cellular mRNAs. Finally, numerous cellular mRNAs were differentially expressed in an sfRNA-dependent fashion in a Kunjin virus infection. We conclude that flaviviruses incapacitate XRN1 during infection and dysregulate host mRNA stability as a result of sfRNA formation.