title: Information Overload: A Method to Share Updates among Frontline Staff during the COVID-19 Pandemic.

text: Since COVID-19 was classified as a pandemic, the stream of important information from multiple sources is constant and always changing. As the pandemic evolves, the need to report relevant information to frontline providers remains crucial. A 1-page centralized document termed a "quicksheet" was developed to include guidelines, policies, and practical information and to serve as a reference tool for our clinicians. It was updated and distributed frequently, up to once daily. It was initially embraced as an important resource for resident physicians and then quickly adopted by the entire department as a necessary reference and communication tool during the ongoing crisis. The quicksheet has been a beneficial tool to distill and organize the most important and relevant information for frontline staff, and we hope that it can serve as a template for departments and health care workers in other hospital systems to adopt.


Interference with BISTM values from a forced-air warming device.


title: Persistent vegetative state and minimally conscious state: a systematic review and meta-analysis of diagnostic procedures.

text: BACKGROUND Acute brain damage can cause major disturbances of consciousness, ranging all the way to the persistent vegetative state (PVS), which is also known as "unresponsive wakefulness syndrome". PVS can be hard to distinguish from a state of minimal preserved consciousness ("minimally conscious state," MCS); the rate of misdiagnosis is high and has been estimated at 37-43%. In contrast, PVS is easily distinguished from brain death. We discuss the various diagnostic techniques that can be used to determine whether a patient is minimally conscious or in a persistent vegetative state. METHODS This article is based on a systematic review of pertinent literature and on a quantitative meta-analysis of the sensitivity and specificity of new diagnostic methods for the minimally conscious state. RESULTS We identified and evaluated 20 clinical studies involving a total of 906 patients with either PVS or MCS. The reported sensitivities and specificities of the various techniques used to diagnose MCS vary widely. The sensitivity and specificity of functional MRI-based techniques are 44% and 67%, respectively (with corresponding 95% confidence intervals of 19%-72% and 55%-77%); those of quantitative EEG are 90% and 80%, respectively (95% CI, 69%-97% and 66%-90%). EEG, event-related potentials, and imaging studies can also aid in prognostication. Contrary to prior assumptions, 10% to 24% of patients in PVS can regain consciousness, sometimes years after the event, but only with marked functional impairment. CONCLUSION The basic diagnostic evaluation for differentiating PVS from MCS consists of a standardized clinical examination. In the future, modern diagnostic techniques may help identify patients who are in a subclinical minimally conscious state.


title: Synthesis and biochemical evaluation of thiochromanone thiosemicarbazone analogues as inhibitors of cathepsin L.

text: A series of 36 thiosemicarbazone analogues containing the thiochromanone molecular scaffold functionalized primarily at the C-6 position were prepared by chemical synthesis and evaluated as inhibitors of cathepsins L and B. The most promising inhibitors from this group are selective for cathepsin L and demonstrate IC50 values in the low nanomolar range. In nearly all cases, the thiochromanone sulfide analogues show superior inhibition of cathepsin L as compared to their corresponding thiochromanone sulfone derivatives. Without exception, the compounds evaluated were inactive (IC50 > 10000 nM) against cathepsin B. The most potent inhibitor (IC50 = 46 nM) of cathepsin L proved to be the 6,7-difluoro analogue 4. This small library of compounds significantly expands the structure-activity relationship known for small molecule, nonpeptidic inhibitors of cathepsin L.


title: Single-port cholecystectomy with the TransEnterix SPIDER: simple and safe.

text: INTRODUCTION Single-port or single-incision cholecystectomy with current rigid laparoscopic devices is limited by in-line visualization, restricting the ability to approach the surgical site with proper angles and instrumentation. A single-port access system with articulating arms and strong instrumentation should minimize these issues. The TransEnterix system may facilitate safe and straightforward single-port surgery. METHODS The TransEnterix single-port surgery system was used in both survival and nonsurvival porcine laparoscopic cholecystectomies under animal use committee approval. Nonsurvival procedures compared four standard laparoscopic with four single-port cholecystectomies from a histologic perspective. Five single-port swine laparoscopic cholecystectomy procedures were completed in sterile conditions, and all animals survived for 1 week postoperatively. Standard surgical clips were used for both cystic duct and artery ligation. At sacrifice, both gross and microscopic histology were obtained for assessment of surgical complications. RESULTS All cholecystectomies were successfully completed with the TransEnterix single-port system. Operative time for the survival procedures averaged 39.4 (range 18-66) min. Histology of the acute specimens showed less inflammation at the single-port site compared with the trocar sites from the standard cholecystectomy. At sacrifice, no complications were identified. CONCLUSIONS The TransEnterix system is safe and straightforward for completing single-port cholecystectomy in this limited porcine series. Port site inflammation is reduced compared with standard laparoscopic trocars.


Evaluation of current devices in single-incision laparoscopic colorectal surgery.


The physician as public health professional in the 21st century.


title: Adaptation of low-resolution methods for the study of yeast microsomal polytopic membrane proteins: a methodological review.

text: Most integral membrane proteins of yeast with two or more membrane-spanning sequences have not yet been crystallized and for many of them the side on which the active sites or ligand-binding domains reside is unknown. Also, bioinformatic topology predictions are not yet fully reliable. However, so-called low-resolution biochemical methods can be used to locate hydrophilic loops or individual residues of polytopic membrane proteins at one or the other side of the membrane. The advantages and limitations of several such methods for topological studies with yeast ER integral membrane proteins are discussed. We also describe new tools that allow us to better control and validate results obtained with SCAM (substituted cysteine accessibility method), an approach that determines the position of individual residues with respect to the membrane plane, whereby only minimal changes in the primary sequence have to be introduced into the protein of interest.


Are Powered Air Purifying Respirators a Solution for Protecting Healthcare Workers from Emerging Aerosol-Transmissible Diseases?


title: Characteristics of regional cerebral oxygen saturation levels in patients with out-of-hospital cardiac arrest with or without return of spontaneous circulation: A prospective observational multicentre study.

text: AIM Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. METHODS We enrolled 1921 OHCA patients from the Japan - Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. RESULTS After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15-20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39-65%] vs. 15% [15-17%], respectively; P<0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R=0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P<0.01). CONCLUSION Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA.


title: Acute respiratory tract infections: a potential trigger for the acute coronary syndrome.

text: Clinical studies suggest that acute respiratory tract infection (ARTI) may be a risk factor for the acute coronary syndrome (ACS). ARTI is associated with an increased risk for ACS up to 2 weeks prior to a cardiac event. The mechanism that may underlie this association is unclear. Infections are thought to play a role in the progression and instability of atherosclerotic plaques, resulting in plaque rupture, sudden constriction, and/or blockage of coronary arteries. Inflammation, endothelial dysfunction and thrombotic activation seem to play an important role in this. Influenza vaccination may reduce the risk of ACS in patients with coronary artery disease. Future studies will provide more information about the underlying mechanisms of infection-related ACS.


Donald Trump: a political determinant of covid-19.


title: A Randomized Controlled Trial Comparing Novel Triple-Cuffed Double-Lumen Endobronchial Tubes with Conventional Double-Lumen Endobronchial Tubes for Lung Isolation.

text: Placing a double-lumen endobronchial tube (DLT) in an appropriate position to facilitate lung isolation is essential for thoracic procedures. The novel ANKOR DLT is a DLT developed with three cuffs with a newly added carinal cuff designed to prevent further advancement by being blocked by the carina when the cuff is inflated. In this prospective study, the direction and depth of initial placement of ANKOR DLT were compared with those of conventional DLT. Patients undergoing thoracic surgery (n = 190) with one-lung ventilation (OLV) were randomly allocated into either left-sided conventional DLT group (n = 95) or left-sided ANKOR DLT group (n = 95). The direction and depth of DLT position were compared via fiberoptic bronchoscopy (FOB) after endobronchial intubation between the groups. There was no significant difference in the number of right mainstem endobronchial intubations between the two groups (p = 0.468). The difference between the initial depth of DLT placement and the target depth confirmed by FOB was significantly lower in the ANKOR DLT group than in the conventional DLT group (1.8 ± 1.8 vs. 12.9 ± 9.7 mm; p < 0.001). In conclusion, the ANKOR DLT facilitated its initial positioning at the optimal depth compared to the conventional DLT.


title: Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019.

text: To investigate the possibility of earlier cases of severe acute respiratory syndrome coronavirus 2 infection than previously recognized, we retrospectively tested pooled samples from 1,700 persons with respiratory signs/symptoms seen at Stanford Health Care, Palo Alto, California, USA, during the last 2 months of 2019. We found no evidence of earlier infection.


title: Short-term mesh exposure after robotic sacrocolpopexy with and without concomitant hysterectomy.

text: OBJECTIVES The primary objective of this study was to compare the short-term rate of mesh exposure after a robotic sacrocolpopexy (RSCP) compared with those after RSCP with a concomitant hysterectomy. Secondary objectives included a comparison of mesh exposure from total hysterectomies (TH) versus supracervical hysterectomies (SCH) and determination of risk factors for mesh exposure. METHODS This was a retrospective cohort study of women who underwent RSCP between January 2009 and December 2011 at one academic center. The primary outcome was mesh exposure at 6 weeks postoperation. Subjects were divided into two groups: those with concomitant hysterectomy and those with RSCP alone. The hysterectomy group was subdivided into TH versus SCH. Mesh exposures and mesh revision procedures were identified using International Classification of Diseases-9 and CPT codes, respectively, and confirmed by chart review. RESULTS There were 230 eligible women who underwent RSCP during the study period and were followed up at a 6-week postoperative visit; 118 (51.7%) had RSCP only and 112 (48.7%) had a concomitant hysterectomy. Of those who underwent hysterectomy, 79 patients (70.5%) had TH and 33 (29.5%) had SCH. There were nine (3.9%) mesh exposures attributed to RSCP. The difference between the RSCP + hysterectomy group and the RSCP-only group was 2.7% versus 5.1% (P = 0.50). The 2.7% of mesh exposures in the hysterectomy group were associated with TH and none with SCH, but this difference was not significant (P = 0.55). CONCLUSIONS Although mesh exposure with RSCP is low, serious morbidity can be associated with mesh use and appropriate preoperative counseling is critical.


title: Optimization and Standardization of the Immunodeficient Mouse Model for Assessing Fat Grafting Outcomes.

text: BACKGROUND Animal models are often used to assess interventions that might improve fat grafting outcomes; however, there is great variability in the models. The authors sought to determine the predictive value of the immunocompromised mouse model for fat grafting so that experiments could be standardized and optimized. METHODS Human lipoaspirate injections at different volumes and time points were assessed in a nude mouse model and compared with control injections of nonviable fat. Volume retention and explant histologic score were compared. In a separate study, interanimal reproducibility was determined by implanting a highly consistent hydrogel and measuring variability in volume retention. RESULTS Injection volume significantly affects adipose resorption kinetics at 6 and 12 weeks. Masson trichrome staining revealed that macrophages were unable to infiltrate large (1 ml) grafts, and oil cysts were not absorbed by 18 weeks, which interfered with interpretation of volume retention data. Nonviable tissue was resorbed when grafts were 0.3 ml, and quantification of graft histologic viability correlated well with graft retention at all study time points. Interanimal variability was measured to be 8.44 percent of the mean retention volume for small graft volumes. CONCLUSIONS Human fat graft retention in the immunodeficient mouse correlates with graft viability in small, 0.3-ml-volume grafts. However, centralized oil cysts in nonviable 1.0-ml grafts were not resorbed by 18 weeks and thus volume measurements were confounded and not significantly different from viable samples. In addition, tissue injury scores increased in initially healthy fat grafts at 18 weeks, possibly because of a delayed immune reaction.


title: Medical Education Adaptations During a Pandemic: Transitioning to Virtual Student Support.

text: Student pastoral support is crucial throughout medical training and is often conducted via face to face meetings with academic personal tutors or mentors. However, the sudden introduction of social distancing measures designed to stem the spread of the virus resulted in a national switch to online teaching and removed the ability to provide students with support in-person. This rapid and unexpected change of circumstances and loss of structure left many students socially isolated and struggling to cope with massive uncertainty.


title: Anti-TNF-α treatment for pelvic pain associated with endometriosis.

text: BACKGROUND Endometriosis is a chronic, recurring condition that can develop during the reproductive years. It is characterised by the development of endometrial tissue outside the uterine cavity. It is the most common cause of pelvic pain in women. This endometrial tissue development is dependent on oestrogen produced primarily by the ovaries and, therefore, traditional management has focused on suppression of ovarian function. Mounting evidence shows that altered immune function plays a crucial role in the genesis and development of endometriosis. In this review we considered modulation of the inflammation as an alternative approach. OBJECTIVES To determine the effectiveness and safety of anti-tumour necrosis factor-α (anti-TNF-α) treatment in the management of endometriosis in premenopausal women. SEARCH METHODS For the first publication of this review, we searched for trials in the following databases (from their inception to August 2009): Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, and PsycINFO. In addition, we searched all reference lists of included trials and contacted experts in the field in an attempt to locate trials. We reran this search to 3 September 2012 for this update. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing anti-TNF-α drugs with placebo, no treatment, medical treatment, or surgery for pelvic pain associated with endometriosis were included. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data using data extraction forms. The domains assessed for risk of bias were sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting. We used risk ratios (RR) for reporting dichotomous data with 95% confidence intervals (CI), whilst we expressed continuous data as mean differences (MD). We assessed statistical heterogeneity using the I(2) statistic. MAIN RESULTS Only one trial involving 21 participants was included. The results showed no evidence of an effect of infliximab, one of the known anti-TNF-α drugs, on pelvic pain reduction using the Biberoglu-Behrman (BB) score (0 to 3 scale) for participants (MD -0.14, 95% CI -0.43 to 0.15), the BB score for clinicians (MD -0.14, 95% CI -0.39 to 0.11), or a visual analogue pain score (VAS, 100 mm scale) (MD -5.60, 95% CI -16.10 to 4.90), or on the use of pain killers (ibuprofen, g/day) (MD -0.10, 95% CI -0.30 to 0.10). There was no evidence of an increase in adverse events in the infliximab group compared with placebo (RR 3.73, 95% CI 0.22 to 63.66). We found no evidence of clinical benefits of infliximab for endometriotic lesions, dysmenorrhoea, dyspareunia, or pelvic tenderness. To date, there is no trial that has reported a cost-effectiveness analysis of anti-TNF-α drugs, or the odds of recurrence. AUTHORS' CONCLUSIONS This review was updated in 2012. The results of the original review published in 2010 remain unchanged. There is still not enough evidence to support the use of anti-TNF-α drugs in the management of women with endometriosis for the relief of pelvic pain.


title: Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials.

text: BACKGROUND Recurrence of varicose veins after surgery (REVAS) for saphenous incompetence has been well described after ligation and stripping (L&S) but not after the now most frequently performed method of saphenous ablation, endovenous ablation (EVA). The purpose of this study was to define the overall incidence of REVAS as well as both the sites of reflux and the causes of REVAS through a systematic review and meta-analysis of randomized controlled trials (RCTs) for EVA. These studies have the advantage of prospectively collected data and a uniform duplex follow-up. METHODS We searched databases (January 1, 2000 through July 1, 2014) for published RCTs evaluating EVA treatment of great saphenous vein (GSV) incompetence that employed endovenous laser ablation or radiofrequency ablation. RCTs were eliminated that (1) did not have follow-up of at least 2 years, (2) did not obtain postoperative duplex scans, (3) did not clearly report the incidence of recurrent varicosities after GSV ablation, and (4) treated the small saphenous or anterior accessory saphenous veins. RESULTS Of the 68 studies screened, 20 RCTs that employed EVA of the GSV were identified. Eight had a follow-up of at least 2 years, but one was eliminated because of lack of information on both the site and cause of REVAS. The resultant seven RCTs provided eight comparisons (one study compared both types of EVA to a comparator arm): three used radiofrequency ablation, and five employed endovenous laser ablation. Overall recurrent varicose veins developed in 125 limbs after EVA (22%), with no difference in the incidence vs the L&S group (22%) based on the number of limbs available at the time of the development of recurrence for both groups, but this incidence is dependent on the length of follow-up after the initial treatment. The two studies with serial follow-up showed an approximate doubling of REVAS over time for both EVA and L&S. By contrast, the cause of REVAS was different between the two methods. Neovascularization occurred in only two limbs (2%) after EVA vs 18 (18%) in the L&S group. Recanalization was the most common cause of REVAS for EVA (32%; 40 of 125 limbs), followed by the development of anterior accessory saphenous vein incompetence (19%; 23 of 125 limbs). In contrast to other reports, incompetent calf perforating veins were an infrequent cause of REVAS (7%; eight of 125). CONCLUSIONS There is no difference in the incidence of REVAS for EVA vs L&S, but the causes of REVAS are different with L&S, which has important implications for treatment.


title: A descriptive analysis of occupational health exposures in an urban emergency medical services system: 2007-2009.

text: INTRODUCTION Prehospital providers are exposed to various infectious disease hazards. Examining specific infectious exposures would be useful in describing their current trends as well as guidance with appropriate protective measures an emergency medical services (EMS) system should consider. OBJECTIVE To describe the types of infectious occupational health exposures and associated outcomes reported at an urban EMS system. METHODS A retrospective review of all reported exposures was performed for a three-year period from January 1, 2007, to December 31, 2009. Descriptive analysis was performed on data such as provider demographics, types of exposures reported, confirmation of exposure based on patient follow-up information, and outcomes. RESULTS Three hundred ninety-seven exposure reports were filed with the designated infection control officer (ICO), resulting in an overall exposure rate of 1.2 per 1,000 EMS incidents. The most common exposure was to possible meningitis (n = 131, 32.9%), followed by tuberculosis (TB) (n = 68, 17.1%), viral respiratory infections (VRIs) such as influenza or H1N1 (n = 61, 15.4%), and body fluid splashes to skin or mucous membranes (n = 56, 14.1%). Body fluid splashes involving the eyes accounted for 41 cases (10.3%). Only six cases (1.5%) of needlestick injuries were reported. Three hundred thirty-two of all cases (83.6%) were considered true exposures to an infectious hazard, of which 177 (53.3%) were actually confirmed. Half of all exposures required only follow-up with the ICO (52.6%). One hundred twenty-seven cases (31.9%) required follow-up at a designated occupational health services or emergency department. Of these, only 23 cases (18.1%) required treatment. There was a significant trend of increasing incidence of VRI exposures from 2008 to 2009 (6.3% vs. 26.8%, p < 0.001), while a significant decrease in TB exposures was experienced during the same year (22.9% vs. 8.2%, p = 0.002). CONCLUSIONS Trends in our data suggest increasing exposures to viral respiratory illnesses, whereas exposures to needlestick injuries were relatively infrequent. Efforts should continue to focus on proper respiratory protection to include eye protection in order to mitigate these exposure risks.


title: Inferior Vena Cava Filters: Indications, Outcomes, and Evidence.

text: OPINION STATEMENT Filter technology seems relatively stable, although absorbable devices are an area of investigational interest. The indications for filter placement remain controversial, with wide variations in adherence to guidelines, and relatively poor quality of data about the specific prophylactic indications of trauma or bariatric surgery. The outcomes of filters are not well-defined despite widespread clinical use, and good data remains difficult to obtain. Several larger database and institutional retrospective studies support the notions that while filters prevent pulmonary embolism, they may be associated with venous thrombotic complications. Some subsets of cancer patients may be at increased risk of these complications, but whether the filter or the underlying hypercoagulable state is the cause is not clear. Lastly, although the benefits of filter retrieval are widely assumed (but not proven), filter retrieval rates remain lower than expected. The single most influential factor in improving filter retrieval rates is dedicated follow-up with intent to retrieve the filter.


title: End-of-Treatment Positron Emission Tomography After Uniform First-Line Therapy of B-Cell Posttransplant Lymphoproliferative Disorder Identifies Patients at Low Risk of Relapse in the Prospective German PTLD Registry.

text: BACKGROUND Fluorine-18 fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) is a recommended standard in the staging and response assessment of 18F-FDG-avid lymphoma. Posttransplant lymphoproliferative disorder (PTLD) can be detected by 18F-FDG-PET at diagnosis with high sensitivity and specificity. However, the role of response assessment by end-of-treatment (EOT) PET has only been addressed in small case series. METHODS We performed a retrospective, multicenter study of 37 patients with CD20-positive PTLD after solid organ transplantation treated with uniform, up-to-date, first-line protocols in the prospective German PTLD registry who had received EOT 18F-FDG-PET between 2006 and 2014. Median follow-up was 5.0 years. Any nonphysiological 18F-FDG uptake (Deauville score greater 2) was interpreted as PET-positive. RESULTS By computed tomography (CT) final staging, 18 of 37 patients had a complete response, 18 had a partial response and 1 patient had stable disease. EOT PET was negative in 24 of 37 patients and positive in 13 of 37 patients. The positive predictive value of EOT PET for PTLD relapse was 38%, and the negative predictive value was 92%. Time to progression (TTP) and progression-free-survival were significantly longer in the PET negative group (P = 0.019 and P = 0.013). In the 18 patients in a partial response by CT staging, we noted highly significant differences in overall survival (P = 0.001), time to progression (P = 0.007), and progression-free survival (P < 0.001) by EOT PET. CONCLUSIONS Even without baseline imaging, EOT PET in PTLD identifies patients at low risk of relapse and offers clinically relevant information, particularly in patients in a partial remission by CT staging.


South Korea scrambles to contain MERS virus.


title: Performance of CURB-65 in predicting mortality of patients with community-acquired pneumonia in Saudi Arabia.

text: INTRODUCTION Various objective scoring systems were developed to standardize the approach to the designation of severity of community-acquired pneumonia (CAP). There is limited data on the use of CURB-65 among admitted CAP patients in Saudi Arabia. METHODOLOGY: The retrospective study included CAP patients, admitted to a general hospital in Eastern Saudi Arabia. The CURB-65 was extracted from the available medical records. RESULTS During the study period, from 2013 to 2016, a total of 1786 adults were admitted with a mean age of 63.9 ± 21.7 (range 14-108 years). The majority of the patients (51.7%) had CURB-65 score 0 or 1 followed by the score 2, 3 and 4/5 (29%, 15.2%, and 4.1%, respectively). The mean CURB-65 was 1.4 ± 1.12 for those who survived and 2.27 ± 1.03 for those who died (p < 0.001). The mean age was 63.01± 21.9 years for survived patients and 75.1 ± 15.58 years for fatal cases (p < 0.001). The overall 30-day crude mortality rate was 7.6%. The mortality rates for CURB-65 scores 0, 1, 2, 3, and 4/5 were 1.8%, 4.3%, 10.2%, 14%, and 21.9%, respectively. CONCLUSIONS The mortality rates of admitted patients with CAP did not differ from those reported in the literature. However, the utilization of CURB-65 score was low and there is a need for wider implementation of pneumonia severity index for patients presenting with CAP.


title: Conventional blood tests in predicting influenza A (H1N1) rapidly.

text: PURPOSE Although real-time reverse transcriptase-polymerase chain reactions (rRT-PCR) are gold standard for the diagnosis of influenza A (H1N1), the results can be delayed up to several days, which is problematic during a pandemic. Because of this limitation of rRT-PCR, clinicians have often had to set a treatment plan that was solely based on clinical suspicion. We investigated the hematological and biochemical factors that are associated with rRT-PCR results, in order to help clinicians deal with acute febrile patients during influenza pandemics. METHODS We conducted a retrospective, cross-sectional study of 465 emergency department patients who underwent both rRT-PCR and blood tests at the same time. Hematological and biochemical findings were compared between the rRT-PCR-positive group and rRT-PCR-negative group. RESULTS Levels of leukocytes, hemoglobin, platelets, blood urea nitrogen (BUN), total bilirubin, lactate dehydrogenase, serum glucose, C-reactive protein (CRP), and procalcitonin were significantly different between the two groups in the univariate analyses. In the multivariate analyses, leukocyte counts ≤ 10.8 (× 10(9))/L [odd ratio (OR) = 8.2, sensitivity = 93.7%, NPV = 85.3%], BUN levels ≤ 7.1 μmol/L (OR = 3.0, sensitivity = 93.7%, NPV = 85.3%), and CRP levels ≤ 60 mg/L (OR = 2.4, sensitivity = 93.7%, NPV = 85.3%) were independently associated with positive rRT-PCR results. CONCLUSIONS Leukocyte counts, BUN levels and CRP levels were important predictors of rRT-PCR-positive results for 2009 influenza A (H1N1) in adults.


title: Diverse novel astroviruses identified in wild Himalayan marmots.

text: With advances in viral surveillance and next-generation sequencing, highly diverse novel astroviruses (AstVs) and different animal hosts had been discovered in recent years. However, the existence of AstVs in marmots had yet to be shown. Here, we identified two highly divergent strains of AstVs (tentatively named Qinghai Himalayanmarmot AstVs, HHMAstV1 and HHMAstV2), by viral metagenomic analysis in liver tissues isolated from wild Marmota himalayana in China. Overall, 12 of 99 (12.1 %) M. himalayana faecal samples were positive for the presence of genetically diverse AstVs, while only HHMAstV1 and HHMAstV2 were identified in 300 liver samples. The complete genomic sequences of HHMAstV1 and HHMAstV2 were 6681 and 6610 nt in length, respectively, with the typical genomic organization of AstVs. Analysis of the complete ORF 2 sequence showed that these novel AstVs are most closely related to the rabbit AstV, mamastrovirus 23 (with 31.0 and 48.0 % shared amino acid identity, respectively). Phylogenetic analysis of the amino acid sequences of ORF1a, ORF1b and ORF2 indicated that HHMAstV1 and HHMAstV2 form two distinct clusters among the mamastroviruses, and may share a common ancestor with the rabbit-specific mamastrovirus 23. These results suggest that HHMAstV1 and HHMAstV2 are two novel species of the genus Mamastrovirus in the Astroviridae. The remarkable diversity of these novel AstVs will contribute to a greater understanding of the evolution and ecology of AstVs, although additional studies will be needed to understand the clinical significance of these novel AstVs in marmots, as well as in humans.


title: Heparin-binding protein as a biomarker of gastrointestinal dysfunction in critically ill patients: a retrospective cross-sectional study in China.

text: OBJECTIVE To investigate the association of plasma heparin-binding protein (HBP) with the development of acute gastrointestinal injury (AGI) in critically ill patients. DESIGN Clinical retrospective cross-sectional study. SETTING A general teaching hospital in China. PARTICIPANTS Adult patients (age ≥18 years) admitted to our department with an intensive care unit (ICU) stay ≥5 days. MAIN OUTCOME MEASURES HBP levels were recorded twice or more within 5 days after admission. The initial AGI grades and the worst AGI grades within 5 days after admission, the number of patients receiving total enteral nutrition (TEN) and the number of patients with feeding intolerance (FI) and with sepsis were also recorded, along with some clinical severity and outcome variables. RESULTS From June 2018 to May 2019, 221 patients were enrolled in this study. We divided patients into four groups based on the HBP values: HBP ≤20 ng/mL, 20100 ng/mL. Significant differences were found in the ratios of AGI deterioration and TEN and the incidence rates of FI and sepsis among the four groups. Differences were also found among the groups regarding the worst AGI grades. The area under receiver operating characteristic curves for AGI deterioration, severe AGI (grades II or above), TEN and FI were 0.738 (p=0.001), 0.774 (p<0.001), 0.810 (p<0.001) and 0.729 (p=0.001), respectively. The optimal HBP cut-off values for AGI deterioration and severe AGI were 53.27 ng/mL and 41.26 ng/mL, respectively. However, no differences in ICU duration or 28-day mortality were found. CONCLUSIONS HBP levels were associated with gastrointestinal dysfunction in critically ill patients. Increased HBP was positively correlated with sepsis but it was not correlated with 28-day mortality.


title: Mapping the Specific Amino Acid Residues That Make Hamster DPP4 Functional as a Receptor for Middle East Respiratory Syndrome Coronavirus.

text: UNLABELLED The novel emerging coronavirus Middle East respiratory syndrome coronavirus (MERS-CoV) binds to its receptor, dipeptidyl peptidase 4 (DPP4), via 14 interacting amino acids. We previously showed that if the five interacting amino acids which differ between hamster and human DPP4 are changed to the residues found in human DPP4, hamster DPP4 does act as a receptor. Here, we show that the functionality of hamster DPP4 as a receptor is severely decreased if less than 4 out of 5 amino acids are changed. IMPORTANCE The novel emerging coronavirus MERS-CoV has infected >1,600 people worldwide, and the case fatality rate is ∼36%. In this study, we show that by changing 4 amino acids in hamster DPP4, this protein functions as a receptor for MERS-CoV. This work is vital in the development of new small-animal models, which will broaden our understanding of MERS-CoV and be instrumental in the development of countermeasures.


Mycoplasma bovis infection causing arthritis and pneumonia in cattle.


title: The safety and effectiveness of the retrievable option inferior vena cava filter: a United States prospective multicenter clinical study.

text: PURPOSE To evaluate the safety and effectiveness of the retrievable Option inferior vena cava (IVC) filter in patients at risk for pulmonary embolism (PE). MATERIALS AND METHODS This was a prospective, multicenter, single-arm clinical trial. Subjects (N = 100) underwent implantation of the IVC filter and were followed for 180 days; subjects whose filters were later removed were followed for 30 days thereafter. The primary objective was to determine whether the one-sided lower limit of the 95% CI for the observed clinical success rate was at least 80%. Clinical success was defined as technical success (deployment of the filter such that it was judged suitable for mechanical protection from PE) without subsequent PE, significant filter migration or embolization, symptomatic caval thrombosis, or other complications. RESULTS Technical success was achieved in 100% of subjects. There were eight cases of recurrent PE, two cases of filter migration (23 mm), and three cases of symptomatic caval occlusion/thrombosis (one in a subject who also experienced filter migration). No filter embolization or fracture occurred. Clinical success was achieved in 88% of subjects; the one-sided lower limit of the 95% CI was 81%. Retrieval was successful at a mean of 67.1 days after implantation (range, 1-175 d) for 36 of 39 subjects (92.3%). All deaths (n = 17) and deep vein thromboses (n = 18) were judged to have resulted from preexisting or intercurrent illnesses or interventions and unrelated to the filter device; all deaths were judged to be unrelated to PE. CONCLUSIONS Placement and retrieval of the Option IVC filter were performed safely and with high rates of clinical success.


title: Prediction of optimal endotracheal tube cuff volume from tracheal diameter and from patient height and age: a prospective cohort trial.

text: PURPOSE Endotracheal tube intra-cuff pressure should be maintained between 20 and 30 cmH(2)O to prevent damage to the tracheal wall. However, cuff pressure is rarely measured, and clinicians estimate cuff pressure poorly. The goal of the present study was to predict the cuff volume that produces optimal cuff pressure either from tracheal diameter or from patient height and age. METHODS In the development phase, initial cuff pressure and cuff volume were measured in 240 patients. Optimal cuff volume, defined as the volume halfway between the volumes required to produce cuff pressures of 20 and 30 cmH(2)O, was determined in each patient. Then, regression equations relating optimal cuff volume to tracheal diameter on chest X-ray, and between optimal cuff volume and a combination of height and age, were calculated. The primary outcome was the proportion of patients in a validation set (n = 104) who achieved a cuff pressure of 20-30 cmH(2)O when cuff volume was selected by each regression formula. RESULTS Only 28% of the cuffs were optimally inflated using clinical criteria during the development phase. There was good correlation between optimal cuff volume and tracheal diameter and moderate correlation between optimal cuff volume and both height and age. Predicted cuff volume was more likely to provide optimal cuff pressure when based on tracheal diameter (65% of patients) than when based on both height and age (45% of patients). CONCLUSIONS Optimal cuff volume was better estimated from tracheal diameter and patient height and age than from the manual palpation method.


title: Single-incision transperitoneal laparoscopic left adrenalectomy.

text: BACKGROUND Laparoscopic adrenalectomy via three or four trocars is a well-established procedure. This report describes the initial experience with single-incision laparoscopic surgery (SILS) using the transperitoneal approach for left adrenalectomy. METHODS Between April 2010 and August 2011, all consecutive patients with adrenal masses, including Conn's syndrome, Cushing's adenoma, and nonfunctional adrenal tumors, who agreed to undergo SILS adrenalectomy were included in a prospective study. The left 2.5-cm subcostal incision was the sole point of entry. Data of patients who underwent SILS adrenalectomy were compared with those from an uncontrolled group of patients who underwent conventional laparoscopic adrenalectomy during the same study period. RESULTS There were 20 patients in each study group (20 men, 20 women; mean age [SD] = 50 [6.5] years). SILS was successfully performed and none of the patients required conversion to an open procedure. In one case of SILS procedure, an additional lateral 5-mm port was needed for retraction of the kidney. The mean (SD) duration of the operation was 95 (20) min in the SILS group and 80 (8) min in the conventional laparoscopic adrenalectomy group (p = 0.052). There were no intraoperative or postoperative complications. There were no differences between the two study groups with respect to postoperative pain, number of patients who resumed oral intake within the first 24 h, final pathologic diagnosis, and length of hospital stay. CONCLUSION SILS left adrenalectomy is a technically feasible and safe procedure in carefully selected patients. The definitive clinical, aesthetic and functional advantages of this technique require further analysis.


title: Targeting obstetric providers in interventions for obesity and gestational weight gain: A systematic review.

text: BACKGROUND Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care. OBJECTIVE To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review. SEARCH STRATEGY A keyword search of databases was performed up to April 2017. SELECTION CRITERIA Obstetric providers who participated in an intervention with the aim to change a provider's clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921. DATA COLLECTION AND ANALYSIS Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness. MAIN RESULTS Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change. CONCLUSIONS Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.


title: The Hip Fracture Surgery in Elderly Patients (HIPELD) study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery.

text: BACKGROUND Strategies to protect the brain from postoperative delirium (POD) after hip fracture are urgently needed. The development of delirium often is associated with the loss of independence, poor functional recovery, and increased morbidity, as well as increases in length of hospital stay, discharges to nursing facilities, and healthcare costs. We hypothesize that xenon may reduce the burden of POD, (i) by avoiding the need to provide anesthesia with a drug that targets the γ-amino-butyric acid (GABA)A receptor and (ii) through beneficial anesthetic and organ-protective effects. METHODS AND DESIGN An international, multicenter, phase 2, prospective, randomized, blinded, parallel group and controlled trial to evaluate the incidence of POD, diagnosed with the Confusion Assessment Method (CAM), in older patients undergoing hip fracture surgery under general anesthesia with xenon or sevoflurane, for a period of 4 days post surgery (primary outcome) is planned. Secondary objectives are to compare the incidence of POD between xenon and sevoflurane, to evaluate the incidence of POD from day 5 post surgery until discharge from hospital, to determine the time to first POD diagnosis, to evaluate the duration of POD, to evaluate the evolution of the physiological status of the patients in the postoperative period, to evaluate the recovery parameters, to collect preliminary data to evaluate the economical impact of POD in the postoperative period and to collect safety data. Patients are eligible if they are older aged (≥ 75 years) and assigned to a planned hip fracture surgery within 48 h after the hip fracture. Furthermore, patients need to be willing and able to complete the requirements of this study including the signature of the written informed consent. A total of 256 randomized patients in the 10 participating centers will be recruited, that is, 128 randomized patients in each of the 2 study groups (receiving either xenon or sevoflurane). TRIAL REGISTRATION EudraCT Identifier: 2009-017153-35; ClinicalTrials.gov Identifier: NCT01199276.


title: Safety and immunogenicity of recombinant Rift Valley fever MP-12 vaccine candidates in sheep.

text: The safety and immunogenicity of two authentic recombinant (ar) Rift Valley fever (RVF) viruses, one with a deletion in the NSs region of the S RNA segment (arMP-12ΔNSs16/198) and the other with a large deletion of the NSm gene in the pre Gn region of the M RNA segment (arMP-12ΔNSm21/384) of the RVF MP-12 vaccine virus were tested in crossbred ewes at 30-50 days of gestation. First, we evaluated the neutralizing antibody response, measured by plaque reduction neutralization (PRNT(80)), and clinical response of the two viruses in groups of four ewes each. The virus dose was 1×10(5)plaque forming units (PFU). Control groups of four ewes each were also inoculated with a similar dose of RVF MP-12 or the parent recombinant virus (arMP-12). Neutralizing antibody was first detected in 3 of 4 animals inoculated with arMP-12ΔNSm21/384 on Day 5 post inoculation and all four animals had PRNT(80) titers of ≥1:20 on Day 6. Neutralizing antibody was first detected in 2 of 4 ewes inoculated with arMP-12ΔNSs16/198 on Day 7 and all had PRNT(80) titers of ≥1:20 on Day 10. We found the mean PRNT(80) response to arMP-12ΔNSs16/198 to be 16- to 25-fold lower than that of ewes inoculated with arMP-12ΔNSm21/384, arMP-12 or RVF MP-12. No abortions occurred though a single fetal death in each of the arMP-12 and RVF MP-12 groups was found at necropsy. The poor PRNT(80) response to arMP-12ΔNSs16/198 caused us to discontinue further testing of this candidate and focus on arMP-12ΔNSm21/384. A dose escalation study of arMP-12ΔNSm21/384 showed that 1×10(3)plaque forming units (PFU) stimulate a PRNT(80) response comparable to doses of up to 1×10(5)PFU of this virus. With further study, the arMP-12ΔNSm21/384 virus may prove to be a safe and efficacious candidate for a livestock vaccine. The large deletion in the NSm gene may also provide a negative marker that will allow serologic differentiation of naturally infected animals from vaccinated animals.


title: A Rabbit Corneal Endothelial Dysfunction Model Using Endothelial-Mesenchymal Transformed Cells.

text: Unlike humans, rabbit corneal endothelial wounds are known to spontaneously heal. The current study was aimed to develop a new rabbit bullous keratopathy model using corneal endothelial cells that were induced to undergo endothelial-mesenchymal transformation (EMT). EMT was induced in rabbit corneal endothelial cells (RCECs) by culturing with TGFβ and basic FGF Supplemented Medium. The corneal endothelia in recipient rabbits were mechanically scraped from the corneal endothelial surface inside an 8 mm mark. Then, a suspension of EMT-induced RCECs (EMT-RCECs) was injected into the anterior chamber. Eyes injected with freshly isolated RCECs (Fresh RCECs group) and eyes that were scraped without injection of cells (Scrape group) were used as controls. Immediately following operation, subepithelial and stromal edema was observed with increased central corneal thickness and corneal opacity in all groups. In the EMT-RCECs group, bullous keratopathy persisted for 42 days up to the end of the study. In the Fresh-RCECs and Scrape groups, corneal transparency and thickness recovered by 7 days after treatment and was maintained up to 42 days. The activated fibroblast marker, α-SMA, was observed spanning from corneal endothelium to corneal stroma in the EMT-RCECs group. Interestingly, α-SMA was upregulated in the Scrape-group as well. In all groups, there was no damage to other intraocular structures, and intraocular pressure was normal throughout the observation period. Transplanting a fresh donor cornea effectively treated corneal edema due to bullous keratopathy. This model is a promising tool for pre-clinical trials in the development of new therapies against corneal endothelial dysfunction.


The World Glaucoma Association during the COVID-19 Pandemic.


Cuff leakage caused by automatic cuff pressure monitor and water condensation in the inflation tube of Microcuff® endotracheal tube.


title: Clinical and computed tomographic (CT) images characteristics in the patients with COVID-19 infection: What should radiologists need to know?

text: OBJECTIVE To evaluate the clinical and computed tomographic (CT) features in the patients with COVID-19 pneumonia confirmed by the real-time reverse transcriptase polymerase chain reaction (rRT-PCR) amplification of the viral DNA from a sputum sample. MATERIAL AND METHODS Clinical information and CT findings of a total of 14 patients with COVID-19 infection (age range, 12-83 years; females 6) were analyzed retrospectively. The clinical information includes the history of exposure, laboratory results, and the symptoms (such as fever, cough, headache, etc.); CT findings of chest include the extension and distribution of lesion, the ground-glass opacity (GGO), consolidation, bronchovascular enlarged, irregular linear appearances, pleural effusion, and lymphadenopathy. RESULTS Eight patients had the exposure history for recent travel to Wuhan of Hubei province (8/14, 57%), 6 had the exposure to patients with COVID-19 infection. Significant statistical differences were observed in lymphocyte percentage decreased and C-reactive protein elevated (p = 0.015). Seven patients had fever, 7 had cough, 2 had headache, 3 had fatigue, 1 had body soreness, 3 had diarrhea, and 2 had no obvious symptoms. In chest CT examination, 10 patients were positive (10/14, 71.43%). Among these patients, 9 had lesions involving both lungs (9/10, 90%), 8 had lesions involving 4 to 5 lobes (8/10, 80%). Most of lesions were distributed peripherally and the most significant lesions were observed in the right lower lobe in 9 patients (9/10, 90%). Nodules were observed in 5 patients (5/10, 50%); GGO, consolidation, and bronchovascular enlarged were shown in 9 patients (9/10, 90%); irregular linear appearances were revealed in 7 patients (7/10, 70%); and pleural effusions were exhibited in 2 patients (2/10, 20%). Last, no patients showed lymphadenopathy. CONCLUSION There were some typical CT features for diagnosis of COVID-19 pneumonia. The radiologists should know these CT findings and clinical information, which could help for accurate analysis in the patients with 2019 novel coronavirus infection.


title: Discovering potent inhibitors against the beta-hydroxyacyl-acyl carrier protein dehydratase (FabZ) of Helicobacter pylori: structure-based design, synthesis, bioassay, and crystal structure determination.

text: The discovery of HpFabZ inhibitors is now of special interest in the treatment of various gastric diseases. In this work, three series of derivatives (compounds 3, 4, and 5) were designed, synthesized, and their biological activities were investigated as potential HpFabZ inhibitors in a two phased manner. First, we designed and synthesized two series of derivatives (3a-r and 4a-u) and evaluated the enzyme-based assay against HpFabZ. Five compounds (3i-k, 3m, and 3q) showed potential inhibitory activity, with IC(50) values less than 2 muM. Second, a focused combinatorial library containing 280 molecules was designed employing the LD1.0 program. Twelve compounds (5a-l) were selected and synthesized. The activity of the most potent compound 5h (IC(50) = 0.86 muM) was 46 times higher than that of the hit 1. The high hit rate and the potency of the new HpFabZ inhibitors demonstrated the efficiency of the strategy for the focused library design and virtual screening.


title: The management of chest tubes after pulmonary resection.

text: Most patients who undergo pulmonary resection can have one chest tube and have it removed by postoperative day 3. Air leaks are probably best treated with water seal (passive suction) for most patients with small leaks. If they develop a new or enlarging pneumothorax or subcutaneous emphysema, some suction (active suction) is needed and alternating suction at night with waters seal during the day may be best. Most patients with persistent air leaks can be discharged home safely on an outpatient device and have their tubes removed in 2 to 3 weeks even if they still have an air leak.


title: Deformable three-dimensional model architecture for interactive augmented reality in minimally invasive surgery.

text: BACKGROUND Surgical procedures have undergone considerable advancement during the last few decades. More recently, the availability of some imaging methods intraoperatively has added a new dimension to minimally invasive techniques. Augmented reality in surgery has been a topic of intense interest and research. METHODS Augmented reality involves usage of computer vision algorithms on video from endoscopic cameras or cameras mounted in the operating room to provide the surgeon additional information that he or she otherwise would have to recognize intuitively. One of the techniques combines a virtual preoperative model of the patient with the endoscope camera using natural or artificial landmarks to provide an augmented reality view in the operating room. The authors' approach is to provide this with the least number of changes to the operating room. Software architecture is presented to provide interactive adjustment in the registration of a three-dimensional (3D) model and endoscope video. RESULTS Augmented reality including adrenalectomy, ureteropelvic junction obstruction, and retrocaval ureter and pancreas was used to perform 12 surgeries. The general feedback from the surgeons has been very positive not only in terms of deciding the positions for inserting points but also in knowing the least change in anatomy. CONCLUSIONS The approach involves providing a deformable 3D model architecture and its application to the operating room. A 3D model with a deformable structure is needed to show the shape change of soft tissue during the surgery. The software architecture to provide interactive adjustment in registration of the 3D model and endoscope video with adjustability of every 3D model is presented.


title: Endovascular management of arteriovenous malformations of the brain.

text: Arteriovenous malformations (AVMs) of the brain are rare, complex, vascular lesions that can result in significant morbidity and mortality. Modern treatment of brain AVMs is a multimodality endeavor, requiring a multidisciplinary team with expertise in cerebrovascular neurosurgery, endovascular intervention, and radiation therapy in order to provide all therapeutic options and determine the most appropriate treatment regimen depending on patient characteristics and AVM morphology. Current therapeutic options include microsurgical resection, radiosurgery (focused radiation), and endovascular embolization. Endovascular embolization is primarily used as a preoperative adjuvant before microsurgery or radiosurgery. Palliative embolization has been used successfully to reduce the risk of hemorrhage, alleviate clinical symptoms, and preserve or improve neurological function in inoperable or nonradiosurgical AVMs. Less frequently, embolization is used as 'primary therapy' particularly for smaller, surgically difficult lesions. Current embolic agents used to treat brain AVMs include both solid and liquid agents. Liquid agents including N-butyl cyanoacrylate and Onyx are the most commonly used agents. As newer embolic agents become available and as microcatheter technology improves, the role of endovascular treatment for brain AVMs will likely expand.


title: Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta-analysis.

text: OBJECTIVE To establish maternal complication rates for fetoscopic or open fetal surgery. METHODS We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy. RESULTS One hundred sixty-six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22-27.13) for open fetal and 6.2% (95%CI, 4.93-7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien-Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24-5.98) for open fetal and 1.7% (95% CI, 1.19-2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications. CONCLUSIONS Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.


title: Anti-thrombotic therapy in patients with atrial fibrillation and intracranial hemorrhage.

text: Patients with atrial fibrillation have an increased risk of ischemic stroke that can be dramatically lowered by treatment with anticoagulants. The annual rate of major bleeds with warfarin averages about 2%. The rates of intracerebral and intracranial bleeds are significantly reduced with the use of the novel direct oral anticoagulants (DOACs) compared with warfarin. Treatment of anticoagulation-related intracerebral hemorrhage is based on the results of case series and small trials. Resumption of anticoagulation in patients with atrial fibrillation who had an intracerebral bleed depends on the etiology and location of the bleeding and the absolute rate of stroke in the absence of anticoagulation.


title: Endovascular management and treatment of acute ischemic stroke.

text: Endovascular intra-arterial therapy is reserved for strokes from large vessel occlusion. This article reviews the critical role of the location of the occlusion, extent and characteristics of the occlusive thrombus on noninvasive imaging, and identification of ischemic core and salvageable tissue on perfusion imaging for proper patient selection. The advantages of stentrievers over other mechanical thrombectomy approaches are discussed and the role of the aspiration thrombectomy approach in modern clinical practice is reviewed. Finally, the implications of the results of recent randomized trials of endovascular therapy on the future of intra-arterial revascularization therapies are discussed.


title: Efficacy of radiofrequency ablation for initial recurrent hepatocellular carcinoma after curative treatment: Comparison with primary cases.

text: OBJECTIVE To determine the efficacy of radiofrequency ablation (RFA) for initial recurrence of small hepatocellular carcinoma (HCC; ≤3 nodules, each nodule ≤3cm in diameter) after curative treatment and identify prognostic factors affecting therapeutic outcome, we compared clinical and outcome factors between patients with primary HCC and those with initial recurrent HCC who underwent RFA. METHODS In this retrospective cohort study, 211 HCC patients who underwent RFA were enrolled and comprised two groups: primary group (n=139) and initial recurrent group (n=72). We compared local tumor progression, overall survival (OS), disease-free survival (DFS), and RFA safety between the groups. RESULTS Median follow-up was 53 months. Local tumor progression rate was 5.8% in the primary group and 4.2% in the recurrent group. OS rates at 5 years and 10 years were 63.2% and 25.5% in the primary group and 54.5% and 33.4% in the recurrent group, respectively. Corresponding DFS rates were 30.7% and 14.6% and 19.2% and 11.0%. DFS was significantly shorter in the recurrent group (hazard ratio [HR]=1.81; 95% confidence interval [CI], 1.27-2.57; P=0.001). In the recurrent group, time from primary HCC development to recurrence was a determinant of OS (≤2 years; HR=3.42; 95% CI, 1.52-7.72; P=0.003). CONCLUSION Although local tumor control and OS were similar between the groups, the recurrent group had shorter DFS than the primary group. Time from primary HCC development to recurrence was a prognostic factor for recurrence of HCC.


title: Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results.

text: PURPOSE This study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee. MATERIALS AND METHODS A prospective study carried out in June and July 2014 included 12 women aged 21-48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success. RESULTS Successful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients-a decrease of 5.6 points-from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation-not clinically significant. CONCLUSIONS The use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.


Public health policies can reduce inequalities as we come out of lockdown.


Cardiovascular disease and COVID-19: implications for prevention, surveillance and treatment.


title: Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with turner syndrome: a systematic review and meta-analysis.

text: Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency. Hence, long-term estrogen replacement therapy is the cornerstone treatment. The estimates of its effect and optimal use, however, remain uncertain. We aimed to summarize the benefits and harms of estrogen replacement therapy on bone, cardiovascular, vasomotor and quality of life outcomes in patients with Turner syndrome. A comprehensive search of four databases was performed from inception through January 2016. Randomized clinical trials and observational cohort studies studying the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included. Independently and in duplicate reviewers selected studies, extracted data and assessed risk of bias. Subgroup analyses were based on route of administration and type of estrogen formulation. Twenty-five studies at moderate to high risk of bias (12 randomized trials, 13 cohort studies) with 771 patients were included. Using random-effects models, estrogen replacement therapy showed an increase in bone mineral density [weighted mean change from baseline 0.09 g/cm2 (0.04-0.14)] that differed by type of estrogen but not route of administration. Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [weighted mean difference 9.33 mg/dl (4.82-13.85)] with no significant effect on other lipid fractions. The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol. Whether this improvement translates into changes in patient important outcomes (cardiovascular events or fractures) remains uncertain. Larger randomized clinical trials with direct comparisons on patient important outcomes are necessary.


title: Pain and sensory detection threshold response to acupuncture is modulated by coping strategy and acupuncture sensation.

text: BACKGROUND Acupuncture has been shown to reduce pain, and acupuncture-induced sensation may be important for this analgesia. In addition, cognitive coping strategies can influence sensory perception. However, the role of coping strategy on acupuncture modulation of pain and sensory thresholds, and the association between acupuncture sensation and these modulatory effects, is currently unknown. METHODS Electroacupuncture (EA) was applied at acupoints ST36 and GB39 of 61 healthy adults. Different coping conditions were experimentally designed to form an active coping strategy group (AC group), who thought they could control EA stimulation intensity, and a passive coping strategy group (PC group), who did not think they had such control. Importantly, neither group was actually able to control EA stimulus intensity. Quantitative sensory testing was performed before and after EA, and consisted of vibration (VDT), mechanical (MDT), warm (WDT), and cold (CDT) detection thresholds, and pressure (PPT), mechanical (MPT), heat (HPT) and cold (CPT) pain thresholds. Autonomic measures (e.g. skin conductance response, SCR) were also acquired to quantify physiological response to EA under different coping conditions. Subjects also reported the intensity of any acupuncture-induced sensations. RESULTS Coping strategy was induced with successful blinding in 58% of AC subjects. Compared to PC, AC showed greater SCR to EA. Under AC, EA reduced PPT and CPT. In the AC group, improved pain and sensory thresholds were correlated with acupuncture sensation (VDTchange vs. MI: r=0.58, CDTchange vs. tingling: r=0.53, CPTchange vs. tingling; r=0.55, CPTchange vs. dull; r=0.55). However, in the PC group, improved sensory thresholds were negatively correlated with acupuncture sensation (CDTchange vs. intensity sensitization: r=-0.52, WDTchange vs. fullness: r=-0.57). CONCLUSIONS Our novel approach was able to successfully induce AC and PC strategies to EA stimulation. The interaction between psychological coping strategy and acupuncture sensation intensity can differentially modulate pain and sensory detection threshold response to EA. In a clinical context, our findings suggest that instructions given to the patient can significantly affect therapeutic outcomes and the relationship between acupuncture intensity and clinical response. Specifically, acupuncture analgesia can be enhanced by matching physical stimulation intensity with psychological coping strategy to acupuncture contexts. TRIAL REGISTRATION KCT0000905.


title: Hepatoblastoma state of the art: pre-treatment extent of disease, surgical resection guidelines and the role of liver transplantation.

text: PURPOSE OF REVIEW This is part two of a two-part state of the art--hepatoblastoma. International hepatoblastoma specialists were brought together to highlight advances, controversies, and future challenges in the treatment of this rare pediatric tumor. RECENT FINDINGS Pretreatment extent of disease (PRETEXT) is a grouping system introduced as part of the multicenter international childhood liver tumors strategy group, SIOPEL-1, study in 1990. The system has been refined over the ensuing years and has now come to be adopted for risk stratification by all of the major pediatric liver tumor multicenter trial groups. PRETEXT is being intensively studied in the current Children's Oncology Group (COG) AHEP-0731 trial in an attempt to validate interobserver reproducibility and ability to monitor response to neoadjuvant chemotherapy, and determine surgical resectability. PRETEXT is now used to identify those patients who are at risk for having an unresectable tumor and who should be referred to a liver specialty center with transplant capability early in their treatment schema. SUMMARY International collaborative efforts in hepatoblastoma have led to increased refinements in the use of the PRETEXT and post-treatment extent to define prognosis and surgical resectability. PRETEXT criteria which suggest a possible need for liver transplantation are discussed in detail.


title: Advances in interventional neuroradiology: novel use of mechanical thrombectomy in acute ischemic stroke.

text: Dr Sanjeev Nayak speaks to Sean Fitzpatrick, Commissioning Editor: Dr Sanjeev Nayak is a Consultant Neuroradiologist with special interest in Interventional Neuroradiology at the University Hospital of North Midlands, Stoke on Trent. He was responsible for the development of Interventional Stroke Service which he did immediately following his appointment in 2009 and was the lead neuroradiologist from 2010 to 2013. Dr Nayak and his team have pioneered in the field of mechanical thrombectomy and stenting in acute ischemic stroke and treated the largest number of such cases in the UK. His team has produced one of the best clinical outcomes for such patients with the lowest mortality rates in the UK. This work has been nominated for numerous national awards in various categories of BMJ, Patient Safety and Care integration awards. Dr Nayak was the finalist at the HSJ awards under the category of 'Clinical Leader of the Year 2012' and NHS Leadership awards 'NHS Inspirational Leader of the Year 2013. Dr Nayak is also involved in patents and designs involving new stroke interventional devices and is actively involved in stroke research which has led to numerous publications in peer reviewed journals. Dr Nayak has organized national conferences and lectured at various national and international conferences in his field of interest.


title: Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for patients with peritoneal carcinomatosis from colorectal cancer: a phase II study from a Chinese center.

text: BACKGROUND Peritoneal carcinomatosis (PC) is a difficult clinical challenge in colorectal cancer (CRC) because conventional treatment modalities could not produce significant survival benefit, which highlights the acute need for new treatment strategies. Our previous case-control study demonstrated the potential survival advantage of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) over CRS alone. This phase II study was to further investigate the efficacy and adverse events of CRS+HIPEC for Chinese patients with CRC PC. METHODS A total of 60 consecutive CRC PC patients underwent 63 procedures consisting of CRS+HIPEC and postoperative chemotherapy, all by a designated team focusing on this combined treatment modality. All the clinico-pathological information was systematically integrated into a prospective database. The primary end point was disease-specific overall survival (OS), and the secondary end points were perioperative safety profiles. RESULTS By the most recent database update, the median follow-up was 29.9 (range 3.5-108.9) months. The peritoneal cancer index (PCI) ≤20 was in 47.0% of patients, complete cytoreductive surgery (CC0-1) was performed in 53.0% of patients. The median OS was 16.0 (95% confidence interval [CI] 12.2-19.8) months, and the 1-, 2-, 3-, and 5-year survival rates were 70.5%, 34.2%, 22.0% and 22.0%, respectively. Mortality and grades 3 to 5 morbidity rates in postoperative 30 days were 0.0% and 30.2%, respectively. Univariate analysis identified 3 parameters with significant effects on OS: PCI ≤20, CC0-1 and adjuvant chemotherapy over 6 cycles. On multivariate analysis, however, only CC0-1 and adjuvant chemotherapy ≥6 cycles were found to be independent factors for OS benefit. DISCUSSION CRS+HIPEC at a specialized treatment center could improve OS for selected CRC PC patients from China, with acceptable perioperative safety.


title: [Diagnostic criteria: OCT angiography for retinal angiomatous proliferation (RAP lesions, type 3 neovascularization)].

text: BACKGROUND Multimodal imaging of retinal angiomatous proliferation (RAP) lesions (type 3 neovascularization) and the diagnostic significance of optical coherence tomography angiography (OCT-A). MATERIAL AND METHODS Confirmation of the diagnosis in six case reports with fundus photography, optical coherence tomography (OCT), fluorescein angiography (FLA), indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCT‑A). RESULTS AND CONCLUSION The use of OCT‑A is helpful for the diagnosis and follow-up examinations of RAP lesions (type 3 neovascularization). It enables the detailed visualization of intraretinal and choroidal microcirculation. Furthermore, it is possible to evaluate the progression, classify the stages and comprehend the treatment strategy.


title: Obligations to report outbreaks of foodborne disease under the International Health Regulations (2005).

text: Every year, Australia identifies 2-3 outbreaks associated with imported foods. To examine national authorities' obligations under the International Health Regulations (2005), we reviewed outbreaks in 2001-2007 that implicated internationally distributed foods. Under these regulations, 6 (43%) [corrected] of 14 outbreaks would have required notification to the World Health Organization.


title: A Single Point Mutation Creating a Furin Cleavage Site in the Spike Protein Renders Porcine Epidemic Diarrhea Coronavirus Trypsin Independent for Cell Entry and Fusion.

text: The emerging porcine epidemic diarrhea virus (PEDV) requires trypsin supplementation to activate its S protein for membrane fusion and virus propagation in cell culture. By substitution of a single amino acid in the S protein, we created a recombinant PEDV with an artificial furin protease cleavage site N terminal of the putative fusion peptide (PEDV-SFCS). PEDV-SFCS exhibited trypsin-independent cell-cell fusion and was able to replicate in culture cells independently of trypsin, though to low titer.


title: An Italian Experience of Spirituality from the Coronavirus Pandemic.

text: In this letter to the editor, the authors tell their personal experience in the fight against Coronavirus pandemic and call for more spirituality needed to battle in the COVID-19 emergency. They commemorate the story of many Italian priests who have died in this tragedy and claim that spiritual skills for healthcare workers are especially important in a disaster scenario like this COVID 19 pandemic, to relieve stress and psychic sufferance of the same healthcare professionals as well as of patients and their families.


title: Functional Evolution of Influenza Virus NS1 Protein in Currently Circulating Human 2009 Pandemic H1N1 Viruses.

text: In 2009, a novel H1N1 influenza virus emerged in humans, causing a global pandemic. It was previously shown that the NS1 protein from this human 2009 pandemic H1N1 (pH1N1) virus was an effective interferon (IFN) antagonist but could not inhibit general host gene expression, unlike other NS1 proteins from seasonal human H1N1 and H3N2 viruses. Here we show that the NS1 protein from currently circulating pH1N1 viruses has evolved to encode 6 amino acid changes (E55K, L90I, I123V, E125D, K131E, and N205S) with respect to the original protein. Notably, these 6 residue changes restore the ability of pH1N1 NS1 to inhibit general host gene expression, mainly by their ability to restore binding to the cellular factor CPSF30. This is the first report describing the ability of the pH1N1 NS1 protein to naturally acquire mutations that restore this function. Importantly, a recombinant pH1N1 virus containing these 6 amino acid changes in the NS1 protein (pH1N1/NSs-6mut) inhibited host IFN and proinflammatory responses to a greater extent than that with the parental virus (pH1N1/NS1-wt), yet virus titers were not significantly increased in cell cultures or in mouse lungs, and the disease was partially attenuated. The pH1N1/NSs-6mut virus grew similarly to pH1N1/NSs-wt in mouse lungs, but infection with pH1N1/NSs-6mut induced lower levels of proinflammatory cytokines, likely due to a general inhibition of gene expression mediated by the mutated NS1 protein. This lower level of inflammation induced by the pH1N1/NSs-6mut virus likely accounts for the attenuated disease phenotype and may represent a host-virus adaptation affecting influenza virus pathogenesis.IMPORTANCE Seasonal influenza A viruses (IAVs) are among the most common causes of respiratory infections in humans. In addition, occasional pandemics are caused when IAVs circulating in other species emerge in the human population. In 2009, a swine-origin H1N1 IAV (pH1N1) was transmitted to humans, infecting people then and up to the present. It was previously shown that the NS1 protein from the 2009 pandemic H1N1 (pH1N1) virus is not able to inhibit general gene expression. However, currently circulating pH1N1 viruses have evolved to encode 6 amino acid changes (E55K, L90I, I123V, E125D, K131E, and N205S) that allow the NS1 protein of contemporary pH1N1 strains to inhibit host gene expression, which correlates with its ability to interact with CPSF30. Infection with a recombinant pH1N1 virus encoding these 6 amino acid changes (pH1N1/NSs-6mut) induced lower levels of proinflammatory cytokines, resulting in viral attenuation in vivo This might represent an adaptation of pH1N1 virus to humans.


title: Robotic vs. laparoscopic colorectal surgery: an institutional experience.

text: BACKGROUND Robotic colorectal surgery is gaining interest in general and colorectal surgery. The use of the da Vinci(®) Robotic system has been postulated to improve outcomes, primarily by increasing the dexterity and facility with which complex dissections can be performed. We report a large, single institution, comparative study of laparoscopic and robotic colectomies, attempting to better elucidate the benefits of robotic surgery in patients with colorectal disease. METHODS We conducted a retrospective review of 171 patients who underwent robotic and laparoscopic colectomies (79 and 92, respectively) at our institution between November 2004 and November 2009. Patients in both groups had well-matched preoperative parameters. All cases were further subdivided by their anatomical location into right-sided and left-sided colectomy, and analysis was performed within these two subgroups. Perioperative outcomes reported include operative time, operative blood loss, time to return of bowel function, time to discontinuation of patient controlled analgesia, length of stay, and intraoperative or postoperative complications. RESULTS Our results indicate that there is no statistical difference in length of stay, time to return of bowel function, and time to discontinuation of patient-controlled analgesia between robotic and laparoscopic left and right colectomies. Interestingly, the total procedure time difference between the laparoscopic and robotic colectomies was much smaller than previously published accounts (mean 140 min vs. 135 min for right colectomy; mean 168 min vs. 203 min for left colectomy). CONCLUSIONS Our study is one of the largest reviews of robotic colorectal surgery to date. We believe that our results further demonstrate the equivalence of robotic surgery to laparoscopic surgery in colorectal procedures. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.


title: Histological Risk Factors to Predict Clinical Relapse in Ulcerative Colitis With Endoscopically Normal Mucosa.

text: Background and Aims The current goal of treatment for ulcerative colitis [UC] is endoscopic and ultimately histological mucosal healing. However, there is no consensus on the definition of histological mucosal healing. We evaluated histological risk factors for clinical relapse in UC patients with endoscopically normal mucosa to focus on the importance of histological evaluation. Methods Patients with UC who underwent colonoscopy confirming Mayo endoscopic subscore [MES] ≤ 1 with biopsies were enrolled into this retrospective cohort. Three expert pathologists evaluated the presence or absence of chronic inflammatory cell infiltrate, breaches in the surface epithelium, crypt abscesses, mucin depletion, crypt architectural irregularities and basal plasmacytosis. Clinical relapse was defined as partial Mayo score ≥ 3 or modification of induction treatment. Prediction models of clinical relapse were generated, especially in patients with MES 0. Results A total of 194 UC patients were enrolled. Histological abnormalities existed more frequently in patients with MES 1 than those with MES 0, while the vast majority of patients still possessed at least one abnormality. There was no significant difference in time to relapse between MES 0 and 1. Crypt architectural irregularities and mucin depletion were associated with time to relapse in patients with MES ≤ 1. In patients with MES 0, the presence of mucin depletion was the only factor significantly and independently associated with the risk of relapse (hazard ratio, 2.18 [1.16-5.82]; p = 0.03). Conclusions Mucin depletion was shown to be a histological risk factor for clinical relapse in UC patients with MES 0.


title: Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room.

text: Clinical assessment of an infant's heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by -9 (-15 to -2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by -5 (-12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10-18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.


title: Prevalence and predictors of self-reported sexual abuse in severely obese patients in a population-based bariatric program.

text: BACKGROUND Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. METHODS We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VAS). Multivariable logistic regression was performed to identify sexual abuse predictors. RESULTS The mean age was 43.7 y (SD 9.6), 441 (88.2%) were females, 458 (91.8%) were white, and the mean body mass index (BMI) was 47.9 kg/m(2) (SD 8.1). The self-reported prevalence of past abuse was 21.8% (95% CI 18.4-25.4%). Abused subjects had worse health status (VAS score 53.1 (SD 21.2) versus 58.0 (SD 20.1), P = 0.03). BMI was not associated with abuse (P > 0.5). Age, sex, BMI, and covariate-adjusted independent predictors of abuse included alcohol addiction (adjusted odds ratio 15.8; 95% CI 4.0-62.8), posttraumatic stress disorder (4.9; 2.5-9.5), borderline personality (3.8; 1.0-13.8), depression (2.4; 1.3-4.3), and lower household income (3.4; 1.6-7.0). CONCLUSIONS Abuse was common amongst obese patients managed in a population-based bariatric program; alcohol addiction, psychiatric comorbidities, and low-income status were highly associated with sexual abuse.


title: Effects of endurance training on neuromuscular fatigue in healthy active men. Part I: Strength loss and muscle fatigue.

text: PURPOSE The adaptations induced by endurance training on the neuromuscular function remain under investigation and, for methodological reasons, unclear. This study investigates the effects of cycling training on neuromuscular fatigue and its peripheral contribution measured during and immediately after cycling exercise. METHODS Fourteen healthy men performed a fatigue test before a 9-week cycling program (PRE) and two tests after training: at the same absolute power output as PRE (POSTABS) and based on the post-training maximal aerobic power (POSTREL). Throughout the tests and at exhaustion (EXH), maximal voluntary contraction (MVC) and peripheral fatigue were assessed in the quadriceps muscle by electrical nerve stimulation [single twitch (Pt); high-frequency doublet (Db100) and low-to-high-frequency ratio (Db10:100)]. RESULTS Time to EXH was longer in POSTABS than PRE (34 ± 5 vs. 27 ± 4 min, P < 0.001), and POSTREL tended to be longer than PRE (30 ± 6 min, P = 0.053). MVC and peripheral fatigue were overall less depressed in POSTABS than PRE at isotime. At EXH, MVC and Db10:100 were similarly reduced in all sessions (-37 to - 42% and - 30 to - 37%, respectively). Db100 tended to be less depressed in POSTABS than PRE (-40 ± 9 vs. - 48 ± 16%, P = 0.050) and in POSTREL than PRE (-39 ± 9%, P = 0.071). Pt decreased similarly in POSTABS and PRE (-52 ± 16 vs. - 54 ± 16%), but POSTREL tended to be less depressed than PRE (-48 ± 14%, P = 0.075). CONCLUSIONS This study confirms fatigue attenuation at isotime after training. Yet lower or similar fatigue at EXH indicates that, unlike previously suggested, fatigue tolerance may not be upregulated after 9 weeks of cycling training.


Evidence of Added Value of Chest CT in Coronavirus Disease (COVID-19) Pneumonia With Initial Negative RT-PCR Results.


"What Were You Before the War?" Repurposing Psychiatry During the COVID-19 Pandemic.


Is there a relationship between monthly rainfall and the isolation of Legionella in potable water systems in Spanish healthcare facilities?


title: Significance of Nissen fundoplication after endoscopic radiofrequency ablation of Barrett's esophagus.

text: OBJECTIVE HALO radiofrequency ablation (RFA) has been proven as safe and efficient in eradication of both non- and dysplastic Barrett's esophagus (BE). Definitive post-RFA treatment is yet to be determined. METHODS RFA was performed in 56 patients with BE, 38 with intestinal metaplasia (IM) and 18 with low-grade dysplasia (LGD), and repeated in case of residual BE. Length of the BE was classified according to C&M criteria. Follow-up included regular upper GI endoscopies with biopsies 6 months, 1 and 2 years after the complete resolution of BE. Patients were divided into two groups regarding post-RFA treatment: those maintaining proton pump inhibitors (PPI) daily and those submitted to laparoscopic Nissen fundoplication (LNF) at least 3 months after BE eradication or synchronous with RFA. RESULTS There were no perforations or strictures related to RFA. Complete endoscopic resolution of BE was observed in 83.92 % patients (86.84 % IM and 77.77 % LGD), in 25 that maintained PPI and 22 in whom LNF was done. In PPI group, 2-year follow-up revealed BE recurrence in biopsy samples in 20 % of patients, while in LNF group 9.1 % of patients had recurrent IM. In overall sample of patients, no difference was noted regarding the influence of post-RFA treatment (p < 0.423). LNF proved superiority over PPI treatment in patients with long-segment BE (cutoff C > 4 cm, p < 0.021). CONCLUSION HALO RFA is a safe procedure, with high rate of success in complete eradication of BE in symptomatic GERD patients. LNF provides good protection for neosquamous epithelium and in selected group of patients could be offered as a first line of treatment after HALO RFA.


title: Leveraging the power of mutual aid, coalitions, leadership, and advocacy during COVID-19.

text: The COVID-19 pandemic has shed light on the norms, patterns, and power structures in the United States that privilege certain groups of people over others. This article describes COVID-19 as an unprecedented catalyst for social transformation that underscores the need for multilevel and cross-sectoral solutions to address systemic changes to improve health equity for all. The authors propose that the American Psychological Association (APA) and its membership can initiate systemic change, in part, by (a) supporting mutual aid organizations that prioritize the needs of vulnerable communities; (b) leveraging the efforts and strides APA psychologists have already made within the association, in the profession, and in policymaking to attend to the health equity and the needs of marginalized communities; (c) building capacity for collaboration between a broad coalition of health associations, health experts, and policymakers to address the physio-psycho-socioeconomic needs of disadvantaged communities; and (d) increasing the APA's participation in the formulation and implementation of an advocacy agenda that prioritizes the physical and psychological health of the communities whose lives are most endangered by COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Surgical correction of labial fusion with vaginoplasty in a cat.

text: A spayed female domestic shorthair cat was first examined at the age of 16 months because of persistent licking of the perineal area. The cat had a grossly enlarged and oedematous vulva with pronounced superficial pyoderma of the perivulvar area, which responded favourably to systemic antibiotics, analgesics and local corticosteroids. A month after the initial examination, the cat was re-presented owing to pollakiuria, stranguria and dyschesia. The oedema of the vulva had disappeared and the vulvar labia were fused together; there was only a fistulous tract with a diameter of 1 mm present in the area of the vulva, and the cat strained to urinate through that opening. A contrast study revealed normal transit through the lower urinary tract, but labial adhesions resulted in the development of dilation cranially, where the vaginal vestibule was supposed to be. Vaginoplasty was subsequently performed, the cat recovered normally and, 10 months after the procedure, the lumen of the vaginostoma is preserved and the cat is urinating without difficulty.


title: Effects of supervised exercise compared to non-supervised exercise early after total hip replacement on patient-reported function, pain, health-related quality of life and performance-based function - a systematic review and meta-analysis of randomized controlled trials.

text: BACKGROUND: The rehabilitation after a total hip replacement varies in degree of supervision; however, it remains unknown whether supervised programmes are more effective than non-supervised. OBJECTIVE: This study compared the effectiveness of supervised exercise compared to non-supervised home-based exercise after total hip replacement on patient-reported function, hip-pain, health-related quality of life and performance-based function. METHODS: A systematic review and meta-analysis of randomized controlled trials investigating the effect of supervised exercise compared to non-supervised home-based exercise. An electronic search was performed in Medline, Embase and CINAHL on 14 March 2018. The methodological quality was assessed using the Cochrane Risk of Bias tool. RESULTS: Seven studies were included with a total of 389 participants. A small and non-significant difference in favour of the supervised groups was found in patient-reported function (standardized mean difference (SMD) -0.22 (95% confidence interval (CI) -0.46 to 0.02)), hip-related pain (SMD -0.03 (95% CI -0.27 to 0.21)), health-related quality of life (mean difference (MD) -3.08 (95% CI -6.29 to 0.14)) and performance-based function (SMD -0.26 (95% CI -0.68 to 0.17)) at end of treatment and in patient-reported function (MD -1.31 (95% CI -3.79 to 1.16)) at the 6- to 12-month follow-up. LIMITATIONS: The literature search was systematic, but limited to three databases. The overall quality of evidence was downgraded to moderate due to lack of blinding in included studies. CONCLUSION: Supervised exercise was not significantly effective compared to non-supervised home-based exercise on patient-reported function, pain, health-related quality of life and performance-based function after primary total hip replacement. OTHERS: PROSPERO registration number: CRD42017055604.


Global resource shortages during COVID-19: Bad news for low-income countries.


title: Radiofrequency ablation for stage I non-small cell lung cancer: management of locoregional recurrence.

text: BACKGROUND This study characterizes the management of locoregional recurrence (LRR) in patients with high-risk stage I non-small cell lung cancer (NSCLC) treated with lung radiofrequency ablation (RFA). METHODS Consecutive patients with biopsy-proven stage I NSCLC underwent computed tomography-guided lung RFA from December 2003 to 2010. All patients were deemed medically inoperable or refused an operation. RFA was performed with curative intent. RESULTS Fifty-five ablations were performed in 45 patients (age, 51 to 89 years) with stage I NSCLC. At a median follow-up of 32 months, LRR occurred in 21 (38%) within a mean of 12±10 (range, 1-44) months from RFA. Recurrence was observed locally in the tumor bed in 18 (33%), in regional nodes in 4 (7%), and distant in 2 (4%). The mean maximal tumor diameter was 2.3±1.3 (range, 0.7 to 4.5) cm. In tumors exceeding 3 cm, 10 (80%) were associated with LRR. Recurrent lesions were treated with repeat RFA (5), radiotherapy (8), chemoradiotherapy (5), and chemotherapy (2). Local control was achieved by repeat RFA in 2 of 5 (40%) or by radiotherapy in 8 lesions (100%), with 2 regional nodal failures (median follow-up, 40±13 months). Overall survival among patients who did or did not experience LRR was similar (32% to 35%). Repeat RFA was not associated with any significant complications or procedure-related 30-day mortality. CONCLUSIONS Lung RFA is associated with increased rates of local failure in tumors exceeding 3 cm and in contact with larger segmental vessels. Patients with local failure can be promptly salvaged with SBRT or repeat RFA, without detriment to overall survival.


title: Disproportionate Case Reduction After Ban of Elective Surgeries During the SARS-CoV-2 Pandemic.

text: STUDY DESIGN This is a retrospective case analysis. OBJECTIVE The objective of this study was to illustrate the numerical effects of regulatory restrictions of elective surgery at an orthopaedic university hospital. SUMMARY OF BACKGROUND DATA The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic all over the world places extraordinary demands on health care systems which are forced to ensure structural and personnel capacities. Consequently, hospitals may only perform urgent interventions. Spine patients, however, often need urgent surgery and, moreover, bear an above-average perioperative risk frequently requiring postoperative surveillance on intensive care units (ICUs). Facing this dilemma, we want to share our practice and its unexpected numerical effects. METHODS We compare case statistics during normal operation, directly before and after implementation of regulatory measures. We also analyzed the differences in ICU utilization, complexity and duration of interventions and the patient population. RESULTS Spine surgical interventions have been reduced by 42.7%. Regulatory restriction of "elective surgeries" in pandemic situations results in reduced ICU utilization, however in a disproportionate manner. Although other specialized surgeries can be reduced by 59%, surgical spine cases are only diminishable by 24%. The spine surgery-related ICU occupancy has been reduced by 35%. CONCLUSION The disproportionate effect of case reduction needs to be considered while calculating resources released by regulatory limitation of "elective surgeries" on a (inter-)national level.


Unleashing the Power of Laboratory Developed Tests: Closing Gaps in COVID Diagnosis and Beyond.