title: Management and Treatment of Concussions via Tele-concussion in a Pediatric Setting: A Methodological Approach and Descriptive Analysis.

text: BACKGROUND Approximately 2.0 million children in the United States sustain a concussion annually, resulting in an economic impact as high as $20 billion. Patients who receive treatment at concussion specialty clinics, versus primary care, experience faster recovery, thereby reducing patient burden and subsequent medical related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the SARS-CoV2 pandemic and subsequent guidance to eliminate all non-medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established. OBJECTIVE The purpose of this paper is two-fold: to describe a pediatric concussion specialty clinic's experiences in delivering telehealth concussion services, and to provide preliminary descriptive data on a sample of pediatric telehealth concussion patients. METHODS The specialty pediatric concussion clinic described herein began providing telehealth services in 2019, and is part of the largest and fastest growing telehealth hospital network in the United States. The clinical care process will be described including accessing the telehealth platform, assessment during initial appointment, injury management including communication with relevant patient stakeholders (e.g., parent/guardians, athletic trainers, etc.), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include patient demographics, radius of care, time between date of injury and initial visit, average number of follow-up visits, and days until medically cleared from return-to-learn and return-to-play. RESULTS The analytic sample included 18 concussion patients who were seen for all of their visits via telehealth August 2019-April 2020. The mean (standard deviation [sd]) age of the sample was 14.5 (2.5) years. Radius of care was a median (interquartile range [IQR]) 17 (11.0-31.0) miles from the clinic, with median (IQR) time between injury and the first visit of 21 (6.0-41.5) days. Mean (sd) number of visits was 2.2 (0.8) with a median (IQR) days between visits of 5.4 (3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (10/18) were medically cleared the return to learn/play process in a median (IQR) 15.5 (11.0-29.0) days. CONCLUSIONS Limited access to health care is a well understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in a pediatric. CLINICALTRIAL


title: Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique.

text: Current available evidence regarding transanal total mesorectal excision (TATME) was analyzed including perioperative and immediate oncologic outcomes. A literature search of PubMed, Embase and Cochrane was performed. Thirty-two studies were identified, reporting on 721 patients who underwent TATME. TATME represents a feasible and reproducible technique. Nevertheless, the results of the present review are limited by the design of the included studies, which are mostly case reports and case series. Little is known about long-term oncologic outcomes, intestinal, sexual, urinary function and quality of life after TATME. Multicenter large sample randomized controlled trials are required for further investigation of these issues.


COVID-19 infection: Is the outcome time-dependent?


title: Perioperative considerations for COVID-19 patients: lessons learnt from the pandemic.

text: Background As the coronavirus (COVID-19) pandemic spreads globally, hospitals are rushing to adapt their facilities which may not have been designed to deal with infections adequately. We present the management of a patient with suspected COVID-19 pneumonia. Case A 66-years-old man presented to the hospital and his recent travel history, infective symptoms and CXR made him a possible COVID-19 suspect. Emergency surgery was decided considering the septic condition. The patient was transported to operating theatre with supplemental oxygen over a face mask and plastic covering over the trolley. Rapid sequence intubation was performed by an experienced anesthetist using a videolaryngoscope. After surgery, the patient remained intubated to avoid re-intubation due to initial presentation of respiratory distress. Droplet, contact and airborne infection precautions were instituted. Conclusions Our objective was to facilitate surgical management of patients with known or suspected COVID-19 while minimising risk of nosocomial transmission to healthcare workers and other patients.


title: Clinical trials in molecular imaging: the importance of following the protocol.

text: Nuclear medicine technologists and investigators who perform imaging procedures in clinical trials often have not received training on clinical research regulations, such as Title 21, part 312, of the Code of Federal Regulations or Good Clinical Practices. These regulations directly affect implementation of the therapeutic or imaging protocol. Lack of understanding of the regulatory expectations in clinical research can lead to unintended errors or omissions in critical data that are needed for development of a new drug. One common error is not following the protocol exactly as written, or modifying the imaging parameters in some way as to make the data nonstandard from site to site. These errors and omissions are a source of delay in the development of new imaging and therapeutic products. Although not following the protocol does not result in criminal penalties per se, errors and omissions can lead to regulatory consequences such as warning letters to the investigator or sponsor, which if not resolved can lead to barring a site or investigator from participation in any future research trials. Pharmaceutical sponsors, device sponsors, and federal granting agencies such as the National Cancer Institute enter into contracts with imaging sites under the expectation that the investigator and all research staff know and understand clinical research regulations. This article is intended to teach imaging personnel what any sponsor (pharmaceutical, device, or federal agency) is expecting from research imaging and how lack of understanding of Good Clinical Practices and federal regulations can impede the optimal success of a research study. After reading this article, nuclear medicine technologists should be able to understand the importance of following the clinical trial protocol to exact specifications, create a list of questions that should be answered by the sponsor or trial organizers before patient enrollment, describe Form FDA 1572, and describe the terms protocol, protocol deviation, protocol violation, and protocol exception.


title: Understanding global health governance as a complex adaptive system.

text: The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.


Management of Inflammatory Bowel Diseases in the Wake of COVID-19 Pandemic.


title: IFN-induced TPR protein IFIT3 potentiates antiviral signaling by bridging MAVS and TBK1.

text: Intracellular RNA viruses are sensed by receptors retinoic acid-inducible gene I/MDA5, which trigger formation of the mitochondrial antiviral signaling (MAVS) complex on mitochondria. Consequently, this leads to the activation of TNFR-associated factor family member-associated NF-κB activator-binding kinase 1 (TBK1) and phosphorylation of IFN regulatory factor 3 (IRF3). It remains to be elucidated how MAVS activates TBK1/IRF3. In this study, we report that IFN-induced protein with tetratricopeptide repeats 3 (IFIT3) is significantly induced upon RNA virus infection. Ectopic expression or knockdown of IFIT3 could, respectively, enhance or impair IRF3-mediated gene expression. Mechanistically, the tetratrico-peptide repeat motif (E164/E165) of IFIT3 interacts with the N terminus (K38) of TBK1, thus bridging TBK1 to MAVS on the mitochondrion. Disruption of this interaction markedly attenuates the activation of TBK1 and IRF3. Furthermore, host antiviral responses are significantly boosted or crippled in the presence or absence of IFIT3. Collectively, our study characterizes IFIT3 as an important modulator in innate immunity, revealing a new function of the IFIT family proteins (IFN-induced protein with tetratricopeptide repeats).


title: Hepatitis B virus (HBV) subgenotypes C2 and B2 differ in lamivudine- and adefovir-resistance-associated mutational patterns in HBV-infected Chinese patients.

text: We aimed to study the prevalence and clinical implications of hepatitis B virus (HBV) subgenotypes in Chinese patients. A total of 4,300 patients, mainly from northern China, were enrolled, including 182 patients with acute hepatitis B and 4,118 patients with chronic HBV infection who had been exposed to nucleoside or nucleotide analogs. HBV genotypes/subgenotypes were determined by direct sequencing of the HBV S/Pol region. The prevalence rates were 0.40% for HBV/B1, 14.30% for HBV/B2, 0.25% for HBV/B3, 0.35% for HBV/B4, 1.05% for HBV/C1, 81.72% for HBV/C2, 0.93% for HBV/C3, 0.16% for HBV/C4, and 0.84% for HBV/D. In chronic HBV infection, patients with HBV/B2 were younger and had lower ΗBeAg positive rates than patients with HBV/C2. The incidence of lamivudine-resistant mutations was significantly higher in HBV/C2 compared to HBV/B2 (27.9% versus 19.8%; P<0.01), and the significant difference was observed only for rtM204I and not rtM204V. In addition, compensatory mutations were more frequently detected in HBV/C2. The incidence of adefovir-resistant mutations was similar between the two subsets, but HBV/C2 inclined to show rtA181V (3.6% for C2 versus 0.9% for B2; P<0.01), while HBV/B2 inclined to show rtN236T (4.5% for versus 2.5% for C2; P<0.01). The ratios of HBV/B2 to HBV/C2 infection were 1.7 (110/65), 5.7 (2,653/463), 7.5 (520/69), 8.0 (48/6), and 15.3 (183/12) for acute hepatitis B, chronic hepatitis B, liver cirrhosis, acute-on-chronic liver failure, and hepatocellular carcinoma, respectively. In conclusion, HBV/C2 and HBV/B2, two prevalent subgenotypes, differ in lamivudine- and adefovir-resistance-associated mutational patterns. HBV/C2-infected patients are more likely to have disease progression than HBV/B2-infected ones.


title: Feasibility of Reduced-Port Robotic Surgery for Myomectomy with the da Vinci Surgical System.

text: STUDY OBJECTIVE To present our initial experience with reduced-port robotic surgery (RPRS) for myomectomy using the Octo-Port system (DalimSurgNet, Seoul, Korea). DESIGN Prospective and noncomparative study (Canadian Task Force classification II-3). SETTING University hospital. PATIENTS Nineteen consecutive patients with symptomatic uterine myomas desiring conservative minimally invasive robotic surgery from October 2015 to December 2016. INTERVENTIONS An 8.5-mm or 12-mm robotic camera cannula was inserted through 1 of the Octo-Port channels and an 8-mm conventional robotic port was inserted into a 10-mm channel of the Octo-Port through a 3-cm transumbilical incision. An additional 8-mm conventional robotic port was inserted into a typical robotic port site in the patient's right abdomen. MEASUREMENTS AND MAIN RESULTS Feasibility and operative outcomes of RPRS myomectomy. The median docking time and console time were 10 minutes (range, 4-22) and 90 minutes (range, 29-198). The largest myoma was located on the anterior uterine wall in 11 patients (57.9%). The median myoma size and weight were 7.2 cm (range, 4.1-10.5) and 141 g (range, 42-590), respectively. Median operative blood loss and change in hemoglobin were 100 mL (range, 30-700) and 2.6 mg/dL (range, .1-3.8), respectively. The procedure was successfully performed via RPRS in 89.5% of patients; 2 patients required placement of 1 to 2 additional robotic ports, resulting in a return to traditional multiport robotic surgery. There were no major postoperative complications or postoperative hernias. CONCLUSION Our experience demonstrated the feasibility of RPRS for myomectomy using the Octo-Port system in selected patients.


title: Novel respiratory viruses: what should the clinician be alert for?

text: Since 1990, several novel respiratory viruses affecting humans have been described. In this review, we focus on three pathogens that have caused significant human mortality and raise important public health concerns: severe acute respiratory syndrome (SARS)-coronavirus, Middle East respiratory syndrome (MERS)-coronavirus and avian influenza A viruses (H5N1 and H7N9). Novel respiratory viruses have the potential to instil fear in the public and physicians alike if they are associated with a high case fatality rate. Those viruses with a significant potential for onward human-to-human transmission (including in healthcare settings) might present significant challenges for national public health services and local hospital infection control.


UK launches subscription style model for antibiotics to encourage new development.


Forgetting Bias in Radiology Oral Boards?


title: Evaluation of acute fixation strength for mechanical tacking devices and fibrin sealant versus polypropylene suture for laparoscopic ventral hernia repair.

text: BACKGROUND The purpose of this comparative study is to evaluate the acute fixation strength of mechanical tacking devices and fibrin sealant against polypropylene suture for laparoscopic ventral hernia repair. METHODS Three metallic mechanical tacking devices (ProTack, Salute, EndoANCHOR), 4 absorbable tacking devices (AbsorbaTack, PermaSorb, I-Clip, and SorbaFix), and 2 types of fibrin sealant (Tisseel, Artiss) were compared with 0-polypropylene suture. Three constructs from each device or an amount of sealant sufficient to cover a 3 × 3 cm(2) area were used to affix a 4 × 3 cm piece of absorbable barrier-coated mesh (Proceed, Ethicon, Inc) to the peritoneal surface of porcine abdominal wall. Ten samples were completed for each fixation modality. Acute fixation strength was measured via a lap shear test on an Instron tensiometer. RESULTS Acute fixation strength was significantly greater for suture (59.7 7.2 N) compared with all laparoscopic tacking devices and to fibrin sealant (P < .001 for all comparisons). Protack (29.5 ± 2.8 N) was stronger than Absorbatack (13.2 ± 3.7 N; P = .029). Protack, Permasorb, SorbaFix, and I-clip were stronger than fibrin sealant (P < .05 for all comparisons). CONCLUSIONS The acute fixation strengths of metallic or absorbable tacks as well as fibrin sealant are all significantly less than that achieved with polypropylene suture. These factors should be considered in selecting the type of mechanical fixation for patients undergoing laparoscopic ventral hernia repair.


title: Cerebral aneurysms treated with flow-diverting stents: computational models with intravascular blood flow measurements.

text: BACKGROUND AND PURPOSE Computational fluid dynamics modeling is useful in the study of the hemodynamic environment of cerebral aneurysms, but patient-specific measurements of boundary conditions, such as blood flow velocity and pressure, have not been previously applied to the study of flow-diverting stents. We integrated patient-specific intravascular blood flow velocity and pressure measurements into computational models of aneurysms before and after treatment with flow-diverting stents to determine stent effects on aneurysm hemodynamics. MATERIALS AND METHODS Blood flow velocity and pressure were measured in peri-aneurysmal locations by use of an intravascular dual-sensor pressure and Doppler velocity guidewire before and after flow-diverting stent treatment of 4 unruptured cerebral aneurysms. These measurements defined inflow and outflow boundary conditions for computational models. Intra-aneurysmal flow rates, wall shear stress, and wall shear stress gradient were calculated. RESULTS Measurements of inflow velocity and outflow pressure were successful in all 4 patients. Computational models incorporating these measurements demonstrated significant reductions in intra-aneurysmal wall shear stress and wall shear stress gradient and a trend in reduced intra-aneurysmal blood flow. CONCLUSIONS Integration of intravascular dual-sensor guidewire measurements of blood flow velocity and blood pressure provided patient-specific computational models of cerebral aneurysms. Aneurysm treatment with flow-diverting stents reduces blood flow and hemodynamic shear stress in the aneurysm dome.


title: Isoflurane in contrast to propofol promotes fluid extravasation during cardiopulmonary bypass in pigs.

text: BACKGROUND A highly positive intraoperative fluid balance should be prevented as it negatively impacts patient outcome. Analysis of volume-kinetics has identified an increase in interstitial fluid volume after crystalloid fluid loading during isoflurane anesthesia. Isoflurane has also been associated with postoperative hypoxemia and may be associated with an increase in alveolar epithelial permeability, edema formation, and hindered oxygen exchange. In this article, the authors compare fluid extravasation rates before and during cardiopulmonary bypass (CPB) with isoflurane- versus propofol-based anesthesia. METHODS Fourteen pigs underwent 2 h of tepid CPB with propofol (P-group; n = 7) or isoflurane anesthesia (I-group; n = 7). Fluid requirements, plasma volume, colloid osmotic pressures in plasma and interstitial fluid, hematocrit levels, and total tissue water content were recorded, and fluid extravasation rates calculated. RESULTS Fluid extravasation rates increased in the I-group from the pre-CPB level of 0.27 (0.13) to 0.92 (0.36) ml·kg·min, but remained essentially unchanged in the P-group with significant between-group differences during CPB (pb = 0.002). The results are supported by corresponding changes in interstitial colloid osmotic pressure and total tissue water content. CONCLUSIONS During CPB, isoflurane, in contrast to propofol, significantly contributes to a general increase in fluid shifts from the intravascular to the interstitial space with edema formation and a possible negative impact on postoperative organ function.


title: Persistently positive severe acute respiratory syndrome coronavirus 2 (SARS-COV2) nasopharyngeal PCR in a kidney transplant recipient.

text: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2 ) infection is usually diagnosed by a positive PCR test in respiratory samples. While the respiratory PCR may remain positive for 2-3 weeks in the general population there have been occasional reports of persistent and recurrent positive SARS-COV2 PCR beyond 4 weeks despite clinical resolution 1-6 .


title: Reproductive health and burn-out among female physicians: nationwide, representative study from Hungary.

text: BACKGROUND There is a worldwide rising tendency of women deciding to become physicians; hence, one of the most remarkable fields of investigation is the wellbeing of female doctors. The aim of this study was to describe female physicians' reproductive health in Hungary and to explore the potential correlation between their reproductive disorders and burnout symptoms. Up to our present knowledge, there have not been any studies investigating the correlation between reproductive disorders and burnout of female physicians; therefore, our study represents a unique approach. METHODS Data in this representative cross-sectional epidemiological study were obtained from online questionnaires completed by 3039 female physicians. Participants in a representative nationwide survey (Hungarostudy, 2013) served as controls (n = 1069). Differences between physicians and the control group were disclosed by chi-square test. Correlations between certain factors of reproductive health and the three dimensions of burnout were detected by Pearson correlations and X2 test. Binary logistic regression analysis was used to determine the association between burnout and reproductive health. RESULTS Female physicians were more often characterised by time-to-pregnancy interval longer than one year (18.4% vs. 9.8%), were bearing more high-risk pregnancies (26.3% vs.16.3%), and were more likely to be undergoing infertility therapy (8.5% vs. 3.4%) and experiencing miscarriage (20.8% vs. 14.6%) during their reproductive years, compared with the general female population. With the exception of miscarriages, the difference remained significant in all comparisons with the professional control group. Both high-risk pregnancies and miscarriages of doctors were associated with depersonalisation (p = 0.028 and p = 0.012 respectively) and personal accomplishment (p = 0.016 and p = 0.008 respectively) dimensions of burnout. Results of the multivariate analysis showed that, beside traditional risk factors, depersonalisation acted as an important explanatory factor in case of high-risk pregnancies (OR = 1.086). CONCLUSIONS There is a circulatory causality between burnout and the development of reproductive disorders. Burnout is an important risk factor for high-risk pregnancies and miscarriages, and it has a negative effect on the outcome of pregnancies. At the same time, women suffering from reproductive disorders are more likely to develop burnout syndrome. Improvement of working conditions and prevention of burnout in female doctors are equally important tasks.


title: Basilar Perforator Aneurysms: Presentation of 4 Cases and Review of the Literature.

text: OBJECTIVE Basilar perforator aneurysms (BPAs) are rare lesions that present a therapeutic challenge. We present 4 cases of ruptured BPAs treated either conservatively or by flow diverter deployment and review the literature. METHODS Patients (age 78, 59, 53, and 62 years) presented with World Federation of Neurological Societies grade I-IV and Fisher grade 3-4 subarachnoid hemorrhage. Initial angiography results were normal in 3 patients and necessitated a second angiography. BPA diameter was 0.5-3 mm; BPAs were located in the mid-third of the basilar artery in 2 patients and the upper third in 2 patients. RESULTS All patients were managed conservatively. One patient experienced rebleeding 10 days after initial ictus, which required the deployment of a flow diverter in the basilar artery. One patient developed a severe spontaneous pontine ischemic stroke with severe quadriparesis and refused further imaging. He was clinically stable at 1-year clinical follow-up. The other 3 patients showed complete resolution of BPAs on control follow-up imaging. CONCLUSIONS Ruptured BPAs are rare lesions that may heal spontaneously or be associated with spontaneous ischemic brainstem stroke or rerupture. These lesions can be managed conservatively initially with flow diverter deployment the most suitable therapeutic alternative in selected cases. Larger studies are needed to fully understand the natural history and refine the therapeutic strategy for these lesions.


SARS-CoV-2 pneumonia and pulmonary embolism in a 66-year-old female.


title: A comparative study on bioactive constituents in different parts of Lonicera japonica determined by HPLC-ESI-MS(n).

text: Lonicera japonica Thunb. is a well-known traditional herbal medicine in most East Asian countries. In China, the flower bud and stem of this plant are used for various clinical therapies, while the leaf is not officially recognized as an active part. Due to the similarities in their chemical constituents but great differences in their commercial values, the flower bud has been found to be adulterated with leaf and/or stem during the production of formulations by some drug manufactures. In order to identify adulteration in products and enable quality control, it is necessary to chemically discriminate these three parts of L. japonica. In the current study, an HPLC-ESI-MS(n) method was developed and validated for the quantitative analysis of 18 bioactive compounds: 7 organic acids, 6 iridoids, and 5 flavonoids, in batches of flower bud, stem, and leaf samples. Subsequently, chemometric analyses, such as one-way analysis of variance, principal component analysis, and hierarchical clustering analysis, were performed based on the quantitative data. The results indicated that there were remarkable differences in the distribution of the investigated compounds among the three parts of L. japonica, and that they could be straightforwardly and reliably distinguished according to their chemical profiles. Twelve compounds were selected as potential differential metabolites, which would be useful for quality control of L. japonica. As the content of caffeic acid was low in the flower bud but much higher in the stem and leaf, it could be used as a chemical marker to identify adulteration.


title: Impact of acoustic airflow on intrasinus drug deposition: New insights into the vibrating mode and the optimal acoustic frequency to enhance the delivery of nebulized antibiotic.

text: AIM We investigated the impact of vibrating acoustic airflow, the high frequency (f≥100 Hz) and the low frequency (f≤45 Hz) sound waves, on the enhancement of intrasinus drug deposition. METHODS (81m)Kr-gas ventilation study was performed in a plastinated human cast with and without the addition of vibrating acoustic airflow. Similarly, intrasinus drug deposition in a nasal replica using gentamicin as a marker was studied with and without the superposition of different modes of acoustic airflow. RESULTS Ventilation experiments demonstrate that no sinus ventilation was observed without acoustic airflow although sinus ventilation occurred whatever the modes of acoustic airflow applied. Intrasinus drug deposition experiments showed that the high frequency acoustic airflow led to 4-fold increase in gentamicin deposition into the left maxillary sinus and to 2-fold deposition increase into the right maxillary sinus. Besides, the low frequency acoustic airflow demonstrated a significant increase of 4-fold and 2-fold in the right and left maxillary sinuses, respectively. CONCLUSION We demonstrated the benefit of different modes of vibrating acoustic airflow for maxillary sinus ventilation and intrasinus drug deposition. The degree of gentamicin deposition varies as a function of frequency of the vibrating acoustic airflow and the geometry of the ostia.


title: Randomized, crossover questionnaire survey of acceptabilities of controlled-release mesalazine tablets and granules in ulcerative colitis patients.

text: BACKGROUND/AIMS Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.


title: Green Machine: A Card Game Introducing Students to Systems Thinking in Green Chemistry by Strategizing the Creation of a Recycling Plant.

text: Green Machine is a competitive strategy card game facilitating a systems thinking approach to learning recycling processes and green chemistry in accordance with the United Nations Sustainable Development Goals. Players compete to be the first to be able to launch their recycling plant by collecting a series of playing cards. Players must use interpersonal skills to consider the interconnected systems while showing an appreciation for commercial awareness and versatility, as dynamic problem solving (reflecting real-world scenarios) is required to play the game successfully. The card game was implemented with 19 U.K. graduate students and 29 U.S. second-year undergraduate students. Survey feedback showed that Green Machine was an innovative resource that was enjoyable to play and engaged students in learning recycling processes through systems thinking. On the basis of pre- and post-test questions to evaluate learning gain, Green Machine is a helpful resource to introduce students not only to green chemistry and sustainability but also to taking a systems thinking approach to learning.


title: Health Professionals' and Postpartum Women's Perspectives on Digital Health Interventions for Lifestyle Management in the Postpartum Period: A Systematic Review of Qualitative Studies.

text: Objective: To explore postpartum women and health professionals' perspectives of digital health interventions (DHIs) for lifestyle management in postpartum women. Design: A systematic review and thematic synthesis of peer-reviewed qualitative studies. Relevant databases were searched from 1990 to 2019. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist. Setting and participants: Studies describing postpartum women's or health professionals' views regarding DHIs for lifestyle management in postpartum women. Findings: Nine studies with postpartum women were included in the thematic synthesis. Four common themes emerged: "personal facilitators and barriers to lifestyle modification," "intervention-related strategies for lifestyle modification," "user experience of the technology," "suggestions for improvement." The review indicated that DHIs are highly acceptable among postpartum women. Postpartum women valued behavior change strategies that were delivered through DHIs including goal-setting and self-monitoring, however personal barriers such as lack of motivation or childcare priorities were cited. Key conclusions and implications for practice: DHIs should be considered for lifestyle management in postpartum women. The development of DHIs should focus on delivering behavior change strategies and addressing practical barriers faced by postpartum women.


High-resolution computed tomography in a patient with COVID-19 with non-diagnostic serial radiographs.


title: Genetic manipulation of porcine epidemic diarrhoea virus recovered from a full-length infectious cDNA clone.

text: Porcine epidemic diarrhoea virus (PEDV) causes acute diarrhoea and dehydration in swine of all ages, with significant mortality in neonatal pigs. The recent rise of PEDV outbreaks in Asia and North America warrants an urgent search for effective vaccines. However, PEDV vaccine research has been hampered by difficulties in isolating and propagating the virus in mammalian cells, thereby complicating the recovery of infectious PEDV using a full-length infectious clone. Here, we engineered VeroE6 cells to stably express porcine aminopeptidase N (pAPN) and used them as a platform to obtain a high-growth variant of PEDV, termed PEDVAVCT12. Subsequently, the full-length cDNA clone was constructed by assembling contiguous cDNA fragments encompassing the complete genome of PEDVAVCT12 in a bacterial artificial chromosome. Infectious PEDV could be recovered, and the rescued virus displayed phenotypic properties identical to the parental virus. Interestingly, we found that PEDVAVCT12 contained a C-terminal deletion of the spike gene, resulting in disruption of the ORF3 start codon. When a functional ORF3 gene was restored, the recombinant virus could not be rescued, suggesting that ORF3 could suppress PEDV replication in vitro. In addition, a high-growth and genetically stable recombinant PEDV expressing a foreign protein could be rescued by replacing the ORF3 gene with the mCherry gene. Together, the results of this study provide a means to generate genetically defined PEDV as a promising vaccine candidate.


title: Prototype development of an electrical impedance based simultaneous respiratory and cardiac monitoring system for gated radiotherapy.

text: BACKGROUND In radiotherapy, temporary translocations of the internal organs and tumor induced by respiratory and cardiac activities can undesirably lead to significantly lower radiation dose on the targeted tumor but more harmful radiation on surrounding healthy tissues. Respiratory and cardiac gated radiotherapy offers a potential solution for the treatment of tumors located in the upper thorax. The present study focuses on the design and development of simultaneous acquisition of respiratory and cardiac signal using electrical impedance technology for use in dual gated radiotherapy. METHODS An electronic circuitry was developed for monitoring the bio-impedance change due to respiratory and cardiac motions and extracting the cardiogenic ECG signal. The system was analyzed in terms of reliability of signal acquisition, time delay, and functionality in a high energy radiation environment. The resulting signal of the system developed was also compared with the output of the commercially available Real-time Position Management™ (RPM) system in both time and frequency domains. RESULTS The results demonstrate that the bioimpedance-based method can potentially provide reliable tracking of respiratory and cardiac motion in humans, alternative to currently available methods. When compared with the RPM system, the impedance-based system developed in the present study shows similar output pattern but different sensitivities in monitoring different respiratory rates. The tracking of cardiac motion was more susceptible to interference from other sources than respiratory motion but also provided synchronous output compared with the ECG signal extracted. The proposed hardware-based implementation was observed to have a worst-case time delay of approximately 33 ms for respiratory monitoring and 45 ms for cardiac monitoring. No significant effect on the functionality of the system was observed when it was tested in a radiation environment with the electrode lead wires directly exposed to high-energy X-Rays. CONCLUSION The developed system capable of rendering quality signals for tracking both respiratory and cardiac motions can potentially provide a solution for simultaneous dual-gated radiotherapy.


title: Impact of the COVID-19 pandemic on the gastrointestinal endoscopic activity in France.

text: BACKGROUND AND STUDY AIMS The SARS-CoV-2 pandemic has strongly affected medical activity around the world. We sought to measure the impact of the COVID-19 pandemic on the gastrointestinal endoscopic activity in France. METHODS We performed a web-based survey, including 35 questions on the responders and their endoscopic practice, from March 23rd to March 27th 2020, sent to the 3300 French gastroenterologists practicing endoscopy. RESULTS 694 (21%) gastrointestinal endoscopists provided analyzable data. 29.4% (204/694) were involved in the management of COVID-19 patients outside the endoscopy departments, and 98.7% (685/694) of the endoscopic procedures were canceled. 12.8% (89/694) of the gastroenterologists reported symptoms compatible with COVID-19 infection, and a positive PCR was recorded in 12/197 (6.1%) vs. 3/497 (0.6%) patients in the high vs. low prevalence areas, p<0.0001. CONCLUSIONS The COVID-19 pandemic led to a major reduction in the volume of gastrointestinal endoscopies performed in France in March 2020. The prolonged limited access to gastrointestinal endoscopy could lead to a delay in the management of patients with gastrointestinal cancers.


title: Seven challenges for metapopulation models of epidemics, including households models.

text: This paper considers metapopulation models in the general sense, i.e. where the population is partitioned into sub-populations (groups, patches,...), irrespective of the biological interpretation they have, e.g. spatially segregated large sub-populations, small households or hosts themselves modelled as populations of pathogens. This framework has traditionally provided an attractive approach to incorporating more realistic contact structure into epidemic models, since it often preserves analytic tractability (in stochastic as well as deterministic models) but also captures the most salient structural inhomogeneity in contact patterns in many applied contexts. Despite the progress that has been made in both the theory and application of such metapopulation models, we present here several major challenges that remain for future work, focusing on models that, in contrast to agent-based ones, are amenable to mathematical analysis. The challenges range from clarifying the usefulness of systems of weakly-coupled large sub-populations in modelling the spread of specific diseases to developing a theory for endemic models with household structure. They include also developing inferential methods for data on the emerging phase of epidemics, extending metapopulation models to more complex forms of human social structure, developing metapopulation models to reflect spatial population structure, developing computationally efficient methods for calculating key epidemiological model quantities, and integrating within- and between-host dynamics in models.


title: Prognosis of patients with primary malignant brain tumors admitted to the intensive care unit: a two-decade experience.

text: The purpose of this study is to describe the reasons for ICU admission and to evaluate the outcome and prognostic factors of patients with primary malignant brain tumors (PMBT) admitted to the intensive care unit (ICU). This is a retrospective observational cohort study of 196 PMBT patients admitted to two ICUs over a 19-year period. Acute respiratory failure was the main reason for ICU admission (45%) followed by seizures (25%) and non-epileptic coma (14%). Seizures were more common in patients with glial lesions (84 vs. 67%), whereas patients with primary brain lymphoma were more frequently admitted for shock (42 vs. 18%). Overall ICU and 90-day mortality rates were 23 and 50%, respectively. Admission for seizures was independently associated with lower ICU mortality [odds ratio (OR) 0.06], whereas the need for mechanical ventilation (OR 6.85), cancer progression (OR 7.84), respiratory rate (OR 1.11) and Glasgow coma scale (OR 0.85) were associated with higher ICU mortality. Among the 95 patients who received invasive mechanical ventilation, ICU mortality was 37% (n = 35). For these patients, admission for seizures was associated with lower ICU mortality (OR 0.050) whereas cancer progression (OR 7.49) and respiratory rate (OR 1.08) were associated with higher ICU mortality. The prognosis of PMBT patients admitted to the ICU appears relatively favorable compared to that of hematologic malignancies or solid tumors, especially when the patient is admitted for seizures. The presence of a PMBT, therefore, does not appear to be sufficient for refusal of ICU admission. Predictive factors of mortality may help clinicians make optimal triage decisions.


title: The Danger of Neglecting Melanoma during the COVID-19 Pandemic.

text: Due to the COVID-19 pandemic, planned medical and surgical activities are being postponed. For the dermatology community, this interruption to the healthcare system can lead to delays in the diagnosis and treatment of melanoma. Neglecting melanoma during this crisis can result in increased mortality, morbidity and healthcare costs. With the COVID-19 pandemic evolving and no clear solutions in sight, it is time for the prospective evaluation of teledermatology. However, dermatologists should be cautious and continue seeing patients with pigmented lesions in person due to the necessity of early surgical intervention.


Re: Reflections on the COVID-19 Pandemic.


title: Comparison of symmetric hemodialysis catheters using computational fluid dynamics.

text: PURPOSE Symmetric-tip dialysis catheters have become alternative devices because of low access recirculation and ease of tip positioning. Flow characteristics of three symmetric catheters were compared based on computational fluid dynamics (CFD) as they relate to catheter function. MATERIALS AND METHODS In Palindrome, GlidePath, and VectorFlow catheters, a computational fluid dynamics-based approach was used to assess (i) regions of flow separation, which are prone to thrombus development; (ii) shear-induced platelet activation potency; (iii) recirculation; and (iv) venous outflow deflection. A steady-state, laminar flow model simulated catheter tip position within the superior vena cava. Catheter performance was investigated at high hemodialysis flow rate (400 mL/min). Blood was assumed as a Newtonian fluid. RESULTS Wide regions of flow separation downstream of the Palindrome side slot and close to the distal tip were observed in forward and reversed line configurations. Geometric asymmetry of the distal guide wire aperture of the GlidePath catheter produced the highest levels of inverted velocity flow when run in reversed configuration. The lowest mean shear-induced platelet activation was exhibited by GlidePath and VectorFlow catheters; the Palindrome catheter exhibited 152% higher overall platelet activation potency. All catheters were associated with a recirculation close to zero; the helically contoured lumens of the VectorFlow catheter produced the greatest amount of deflection of venous flow away from the arterial lumen. CONCLUSIONS The VectorFlow catheter produced less shear-induced platelet activation than the Palindrome catheter and less flow separation than the Palindrome and GlidePath catheters irrespective of line configuration. These findings have potential implications for differences in thrombogenic risk during clinical performance of these catheters.


title: Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study.

text: Background Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. Objective To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. Design Prospective cohort study. Setting 16 hospitals in 9 countries. Patients 10 402 patients aged 45 years or older having inpatient noncardiac surgery. Measurements All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery. Results In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]). Limitation External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. Conclusion Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI. Primary Funding Source Canadian Institutes of Health Research.


title: Acetaminophen (paracetamol) for the common cold in adults.

text: BACKGROUND Acetaminophen is frequently prescribed for treating patients with the common cold, but there is little evidence as to whether it is effective. OBJECTIVES To determine the efficacy and safety of acetaminophen in the treatment of the common cold in adults. SEARCH METHODS We searched CENTRAL 2013, Issue 1, Ovid MEDLINE (1950 to January week 5, 2013), EMBASE (1980 to February 2013), CINAHL (1982 to February 2013) and LILACS (1985 to February 2013). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing acetaminophen to placebo or no treatment in adults with the common cold. Studies were included if the trials used acetaminophen as one ingredient of a combination therapy. We excluded studies in which the participants had complications. Primary outcomes included subjective symptom score and duration of common cold symptoms. Secondary outcomes were overall well being, adverse events and financial costs. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, assessed risk of bias and extracted data. We performed standard statistical analyses. MAIN RESULTS We included four RCTs involving 758 participants. We did not pool data because of heterogeneity in study designs, outcomes and time points. The studies provided sparse information about effects longer than a few hours, as three of four included studies were short trials of only four to six hours. Participants treated with acetaminophen had significant improvements in nasal obstruction in two of the four studies. One study showed that acetaminophen was superior to placebo in decreasing rhinorrhoea severity, but was not superior for treating sneezing and coughing. Acetaminophen did not improve sore throat or malaise in two of the four studies. Results were inconsistent for some symptoms. Two studies showed that headache and achiness improved more in the acetaminophen group than in the placebo group, while one study showed no difference between the acetaminophen and placebo group. None of the included studies reported the duration of common cold symptoms. Minor side effects (including gastrointestinal adverse events, dizziness, dry mouth, somnolence and increased sweating) in the acetaminophen group were reported in two of the four studies. One of them used a combination of pseudoephedrine and acetaminophen. AUTHORS' CONCLUSIONS Acetaminophen may help relieve nasal obstruction and rhinorrhoea but does not appear to improve some other cold symptoms (including sore throat, malaise, sneezing and cough). However, two of the four included studies in this review were small and allocation concealment was unclear in all four studies. The data in this review do not provide sufficient evidence to inform practice regarding the use of acetaminophen for the common cold in adults. Further large-scale, well-designed trials are needed to determine whether this intervention is beneficial in the treatment of adults with the common cold.


The COVID-19 Pandemic: A Global Natural Experiment.


title: DOACs and 'newer' haemophilia therapies in COVID-19.

text: We would like to thank the authors for their insightful thoughts on the consideration of anticoagulants and treatment for haemophilia A and B during the COVID-19 pandemic. They highlight some important practical points which certainly should be adopted by the thrombosis and haemostasis community in the current situation of restricted mobility, which reduces the possibility for patients to access general practitioners and hospitals.


title: Severe acute respiratory syndrome vaccine efficacy in ferrets: whole killed virus and adenovirus-vectored vaccines.

text: Although the 2003 severe acute respiratory syndrome (SARS) outbreak was controlled, repeated transmission of SARS coronavirus (CoV) over several years makes the development of a SARS vaccine desirable. We performed a comparative evaluation of two SARS vaccines for their ability to protect against live SARS-CoV intranasal challenge in ferrets. Both the whole killed SARS-CoV vaccine (with and without alum) and adenovirus-based vectors encoding the nucleocapsid (N) and spike (S) protein induced neutralizing antibody responses and reduced viral replication and shedding in the upper respiratory tract and progression of virus to the lower respiratory tract. The vaccines also diminished haemorrhage in the thymus and reduced the severity and extent of pneumonia and damage to lung epithelium. However, despite high neutralizing antibody titres, protection was incomplete for all vaccine preparations and administration routes. Our data suggest that a combination of vaccine strategies may be required for effective protection from this pathogen. The ferret may be a good model for SARS-CoV infection because it is the only model that replicates the fever seen in human patients, as well as replicating other SARS disease features including infection by the respiratory route, clinical signs, viral replication in upper and lower respiratory tract and lung damage.


title: The cellular RNA helicase DDX1 interacts with coronavirus nonstructural protein 14 and enhances viral replication.

text: The involvement of host proteins in the replication and transcription of viral RNA is a poorly understood area for many RNA viruses. For coronaviruses, it was long speculated that replication of the giant RNA genome and transcription of multiple subgenomic mRNA species by a unique discontinuous transcription mechanism may require host cofactors. To search for such cellular proteins, yeast two-hybrid screening was carried out by using the nonstructural protein 14 (nsp14) from the coronavirus infectious bronchitis virus (IBV) as a bait protein, leading to the identification of DDX1, a cellular RNA helicase in the DExD/H helicase family, as a potential interacting partner. This interaction was subsequently confirmed by coimmunoprecipitation assays with cells coexpressing the two proteins and with IBV-infected cells. Furthermore, the endogenous DDX1 protein was found to be relocated from the nucleus to the cytoplasm in IBV-infected cells. In addition to its interaction with IBV nsp14, DDX1 could also interact with the nsp14 protein from severe acute respiratory syndrome coronavirus (SARS-CoV), suggesting that interaction with DDX1 may be a general feature of coronavirus nsp14. The interacting domains were mapped to the C-terminal region of DDX1 containing motifs V and VI and to the N-terminal portion of nsp14. Manipulation of DDX1 expression, either by small interfering RNA-induced knockdown or by overexpression of a mutant DDX1 protein, confirmed that this interaction may enhance IBV replication. This study reveals that DDX1 contributes to efficient coronavirus replication in cell culture.


title: Respiratory Virus Epidemiology Among US Infants With Severe Bronchiolitis: Analysis of 2 Multicenter, Multiyear Cohort Studies.

text: In 2 multicenter cohort studies of 2912 infants hospitalized for bronchiolitis during 2007-2014, the 5 most common pathogens were RSV (76.5%), rhinovirus (23.8%), coronavirus (6.9%), adenovirus (6.4%) and human metapneumovirus (6.0%). Hospitalization months significantly differed for these common pathogens (P ≤ 0.01), except for coronavirus (P = 0.30). There was a significant heterogeneity in temporal patterns by region in RSV-A and -B (both P < 0.001).


title: Comparative Effectiveness of Carotid Artery Stenting Versus Carotid Endarterectomy Among Medicare Beneficiaries.

text: BACKGROUND Effectiveness of carotid artery stenting (CAS) relative to carotid endarterectomy (CEA) among Medicare patients has not been established. We compared effectiveness of CAS versus CEA among Medicare beneficiaries. METHODS AND RESULTS We linked Medicare data (2000-2009) to the Society for Vascular Surgery's Vascular Registry (2005-2008) and the National Cardiovascular Data Registry's (NCDR) Carotid Artery Revascularization and Endarterectomy Registry (2006-2008/2009). Medicare patients were followed up from procedure date until death, stroke/transient ischemic attack, periprocedural myocardial infarction, or a composite end point for these outcomes. We derived high-dimensional propensity scores using registry and Medicare data to control for patient factors and adjusted for provider factors in a Cox regression model comparing CAS with CEA. Among 5254 Society for Vascular Surgery's Vascular Registry (1999 CAS; 3255 CEA) and 4055 Carotid Artery Revascularization and Endarterectomy Registry (2824 CAS; 1231 CEA) Medicare patients, CAS patients had a higher comorbidity burden and were more likely to be at high surgical risk (Society for Vascular Surgery's Vascular Registry: 96.7% versus 44.5%; Carotid Artery Revascularization and Endarterectomy Registry: 71.3% versus 44.7%). Unadjusted outcome risks were higher for CAS. Mortality risks remained elevated for CAS after adjusting for patient-level factors (hazard ratio, 1.24; 95% confidence interval, 1.06-1.46). After further adjustment for provider factors, differences between CAS and CEA were attenuated or no longer present (hazard ratio for mortality, 1.13; 95% confidence interval, 0.94-1.37). Performance was comparable across subgroups defined by sex and degree of carotid stenosis, but there was a nonsignificant trend suggesting a higher risk of adverse outcomes in older (>80) and symptomatic patients undergoing CAS. CONCLUSIONS Outcomes after CAS and CEA among Medicare beneficiaries were comparable after adjusting for both patient- and provider-level factors.


The starry heaven and the crowded shelters: public health risks.


title: Cerebellar Theta Frequency Transcranial Pulsed Stimulation Increases Frontal Theta Oscillations in Patients with Schizophrenia.

text: Cognitive dysfunction is a pervasive and disabling aspect of schizophrenia without adequate treatments. A recognized correlate to cognitive dysfunction in schizophrenia is attenuated frontal theta oscillations. Neuromodulation to normalize these frontal rhythms represents a potential novel therapeutic strategy. Here, we evaluate whether noninvasive neuromodulation of the cerebellum in patients with schizophrenia can enhance frontal theta oscillations, with the future goal of targeting the cerebellum as a possible therapy for cognitive dysfunction in schizophrenia. We stimulated the midline cerebellum using transcranial pulsed current stimulation (tPCS), a noninvasive transcranial direct current that can be delivered in a frequency-specific manner. A single 20-min session of theta frequency stimulation was delivered in nine patients with schizophrenia (cathode on right shoulder). Delta frequency tPCS was also delivered as a control to evaluate for frequency-specific effects. EEG signals from midfrontal electrode Cz were analyzed before and after cerebellar tPCS while patients estimated the passage of 3- and 12-s intervals. Theta oscillations were significantly larger following theta frequency cerebellar tPCS in the midfrontal region, which was not seen with delta frequency stimulation. As previously reported, patients with schizophrenia showed a baseline reduction in accuracy estimating 3- and 12-s intervals relative to control subjects, which did not significantly improve following a single-session theta or delta frequency cerebellar tPCS. These preliminary results suggest that single-session theta frequency cerebellar tPCS may modulate task-related oscillatory activity in the frontal cortex in a frequency-specific manner. These preliminary findings warrant further investigation to evaluate whether multiple sessions delivered daily may have an impact on cognitive performance and have therapeutic implications for schizophrenia.


title: Global distributions and strain diversity of avian infectious bronchitis virus: a review.

text: The poultry industry faces challenge amidst global food security crisis. Infectious bronchitis is one of the most important viral infections that cause huge economic loss to the poultry industry worldwide. The causative agent, infectious bronchitis virus (IBV) is an RNA virus with great ability for mutation and recombination; thus, capable of generating new virus strains that are difficult to control. There are many IBV strains found worldwide, including the Massachusetts, 4/91, D274, and QX-like strains that can be grouped under the classic or variant serotypes. Currently, information on the epidemiology, strain diversity, and global distribution of IBV has not been comprehensively reported. This review is an update of current knowledge on the distribution, genetic relationship, and diversity of the IBV strains found worldwide.


title: Systematic Review and Meta-analysis on the Effect of Soy on Thyroid Function.

text: Soy foods have had an important dietary role in Asian countries for centuries, and in recent years they have become increasingly popular in Western countries as a result of their suggested health benefits. Nevertheless, there are some concerns that soy can have a negative effect on thyroid function and can alter the levels of thyroid hormones. The aim of this systematic review was to investigate the link between soy or soy product consumption and thyroid function via the measurement of thyroid hormone levels. A systematic review and meta-analysis was undertaken on all randomised controlled trials of studies including soy as an intervention and where free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone (TSH) was measured. The search included PubMed, MEDLINE, EMBASE, Cochrane and sources for the grey literature. Quantitative data synthesis was performed using a random-effects model, with standardized mean difference (SMD) and 95% confidence interval as summary statistics. A total of 18 articles were suitable for review. The meta-analysis showed no significant changes in fT3 (WMD: 0.027 pmol/L, 95% CI: -0.052, 0.107, p = 0.499; I2: 55.58%), fT4 (WMD: -0.003 pmol/L, 95% CI: -0.018, 0.011, p = 0.656; I2: 87.58%) while an elevation in TSH levels was observed (WMD: 0.248 mIU/L, 95% CI: 0.001, 0.494, p = 0.049; I2: 80.31%) levels with soy supplementation. There was no evidence of publication bias. Soy supplementation has no effect on the thyroid hormones and only very modestly raises TSH levels, the clinical significance, if any, of the rise in TSH is unclear.


title: Performance of using multiple stepwise algorithms for variable selection.

text: Some research studies in the medical literature use multiple stepwise variable selection (SVS) algorithms to build multivariable models. The purpose of this study is to determine whether the use of multiple SVS algorithms in tandem (stepwise agreement) is a valid variable selection procedure. Computer simulations were developed to address stepwise agreement. Three popular SVS algorithms were tested (backward elimination, forward selection, and stepwise) on three statistical methods (linear, logistic, and Cox proportional hazards regression). Other simulation parameters explored were the sample size, number of predictors considered, degree of correlation between pairs of predictors, p-value-based entrance and exit criteria, predictor type (normally distributed or binary), and differences between stepwise agreement between any two or all three algorithms. Among stepwise methods, the rate of agreement, agreement on a model including only those predictors truly associated with the outcome, and agreement on a model containing the predictors truly associated with the outcome were measured. These rates were dependent on all simulation parameters. Mostly, the SVS algorithms agreed on a final model, but rarely on a model with only the true predictors. Sample size and candidate predictor pool size are the most influential simulation conditions. To conclude, stepwise agreement is often a poor strategy that gives misleading results and researchers should avoid using multiple SVS algorithms to build multivariable models. More research on the relationship between sample size and variable selection is needed.


title: Why Do People With Diabetes Have a High Risk for Severe COVID-19 Disease?-A Dental Hypothesis and Possible Prevention Strategy.

text: The SARS-CoV-2 virus causes symptoms in infected individuals ranging from mild flu symptoms via severe COVID-19 pneumonia requiring ventilation to death. Risk factors for severe courses are age, diabetes, hypertension and other serious diseases. The main entry portal for the virus into the body is probably the oral mucosa, as it is a known location of virus accumulation. The suspected main receptor is highly expressed in this tissue. Such a route of penetration of the virus into the body provides plausible explanations for severe COVID-19 courses seen particularly in older diabetes patients. The immune system of people with diabetes is considered to be generally impaired. Diabetes induces a chronic systemic inflammation, which regularly manifests as periodontitis. Furthermore, frequent hyperglycaemia is known to lead to additional weakening of the oral mucosa barrier. It is therefore recommended that preventive measures in diabetes patients should also include the bucchal area. Knowledge of the inflammatory status in the mouth and throat may be helpful for identification of patients at particular risk. An established biomarker for measuring the degree of orall inflammation is activated matrix metalloproteinase 8 (aMMP8), for which saliva tests are available. From our point of view, the current recommendations for the prevention of SARS-CoV-2 associated COVID-19 disease should therefore be extended to include the aspects of measurement and sanitation of mouth and throat and regular disinfection of this area.


Covid-19: Testing times for the government-but not for NHS staff.


title: Long-Term Follow-Up of Lateral Canthal Resuspension.

text: PURPOSE To evaluate the long-term results of lateral canthal resuspension over time. DESIGN A cohort study of adults (n = 25, 45 eyelids) undergoing lateral canthal resuspension. METHODS Marginal reflex distance 2 (MRD2), inferior scleral show, lateral canthal height, lateral canthal angle, horizontal palpebral aperture, and lateral scleral triangle area were measured preoperatively and at postoperative week 1, month 3, and the final follow-up visit. RESULTS Minimum follow-up time was 6 months (mean, 15.1 months). At the final follow-up visit, MRD2 decreased by 0.41 ± 0.14 mm, inferior scleral show decreased by 0.27 ± 0.05 mm, and lateral canthal height increased by 0.81 ± 0.15 mm. The overall function of time was found to be significant for change in MRD2 (P < 0.01). In multiple comparisons, all time point values were significantly different from one another (Bonferroni corrected, P < 0.05), except for 3 months and the final position, which were not. Similarly, the overall effect of time on lateral canthus position was also significant (P < 0.01). All time points were significantly different from one another (Bonferroni corrected, P < 0.05). The overall effect of time on inferior scleral show was also significant (P < 0.01). Differences were significant from preoperative to final postoperative position, although the other time points were not significant (Bonferroni corrected, P < 0.05). No complications were noted. CONCLUSIONS Minimally invasive lateral canthal resuspension provides durable, albeit modest, improvements in MRD2, inferior scleral show, and lateral canthal height without significantly changing lateral canthal angle, horizontal palpebral aperture, or lateral scleral triangle area.


title: Vertebral endplate defects: nomenclature, classification and measurement methods: a scoping review.

text: PURPOSE To summarize the scope of nomenclature and measurement methods used to document endplate defects in the health sciences literature. METHODS The scoping review followed the York framework and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The databases of PubMed, Scopus, Embase and CINAHL were searched using key terms. Screening and selection were conducted by two independent reviewers. A standardized, pilot-tested form was used for extracting data, which were analyzed descriptively. RESULTS The review included 211 studies, originating from 29 countries, with the USA (18.8%) and China (12.26%) as leading contributors. Thirty-four different terms for structural endplate defects were reported, but were never defined in most studies (65%). Of the 34 different terms used, some appeared to represent the same phenomenon, while the same terms were occasionally defined differently between studies. Schmorl's nodes were most commonly investigated (n = 99 studies) and defined similarly across studies, with the main difference relating to whether the indentation (node) was required to have a sclerotic margin. There were also similarities in definitions for endplate sclerosis. However, there was great variability in the definitions of other terms, such as lesions, irregularities, abnormalities, erosions and changes. CONCLUSION With the possible exception of Schmorl's nodes, we lack a common language for effectively communicating structural endplate findings. This review provides a foundation and impetus for standardizing terminology and core measures to improve communication and synthesis of the growing body of endplate research to advance related knowledge. These slides can be retrieved under Electronic Supplementary Material (paragraph). Then process the ppt slide as graphical image.


title: QKI-mediated alternative splicing of the histone variant MacroH2A1 regulates cancer cell proliferation.

text: The histone variant macroH2A1 contains a carboxyl-terminal ∼30-kDa domain called a macro domain. MacroH2A1 is produced as one of two alternatively spliced forms, macroH2A1.1 and macroH2A1.2. While the macro domain of macroH2A1.1 can interact with NAD(+)-derived small molecules, such as poly(ADP-ribose), macroH2A1.2's macro domain cannot. Here, we show that changes in the alternative splicing of macroH2A1 pre-mRNA, which lead to a decrease in macroH2A1.1 expression, occur in a variety of cancers, including testicular, lung, bladder, cervical, breast, colon, ovarian, and endometrial. Furthermore, reintroduction of macroH2A1.1 suppresses the proliferation of lung and cervical cancer cells in a manner that requires the ability of macroH2A1.1 to bind NAD(+)-derived metabolites. MacroH2A1.1-mediated suppression of proliferation occurs, at least in part, through the reduction of poly(ADP-ribose) polymerase 1 (PARP-1) protein levels. By analyzing publically available expression and splicing microarray data, we identified splicing factors that correlate with alterations in macroH2A1 splicing. Using RNA interference, we demonstrate that one of these factors, QKI, regulates the alternative splicing of macroH2A1 pre-mRNA, resulting in increased levels of macroH2A1.1. Finally, we demonstrate that QKI expression is significantly reduced in many of the same cancer types that demonstrate a reduction in macroH2A1.1 splicing.


title: A balsam pear-shaped CuO SERS substrate with highly chemical enhancement for pesticide residue detection.

text: Simple and traditional hydrothermal fabrication of a novel balsam pear-shaped CuO with high SERS enhancement is presented. XRD (X-ray diffraction), SEM (scanning electronic microscopy), TEM (transmission electron microscope), HRTEM (high-resolution transmission electron microscope), UV-Vis, and Raman are adopted to ensure that this balsam pear-shaped CuO with dense nanoparticle protuberance is successfully prepared. The LOD of this CuO SERS substrate is 4.79 μg L-1 with R6G as molecular probe. By using DFT (density functional theory) calculation and FDTD (finite difference time domainmethod) simulation, both EM (electromagnetic enhancement) and CM (chemical enhancement) mechanisms are investigated, and the results show that these two-enhancement mechanisms can coexist in this balsam pear-shaped CuO. Finally, the prepared substrate has been applied for the determination of trace levels of paraquat in solution , and results show that its LOD for paraquat is 275 μg L-1 (optimum Raman band: 1646 cm-1 Raman shift), which is better than the government standard in China. A dexterous and facile way for fabrication of CuO SERS-active substrates with low cost and high performance, quite promising in detection of chemically hazardous substances and pesticide residue is provided. Graphical abstract.


title: Pneumonia in pregnancy.

text: Recent attention to H1N1 influenza has increased awareness in the lay community of the seriousness of respiratory complications in the gravid patient. Historically, pneumonia during pregnancy has been associated with increased maternal morbidity and mortality. Similarly, the increased number of pregnant patients with chronic medical illnesses, including diabetes, HIV, cardiac disease, and obesity may further complicate the clinical outcome in this population. Although data suggest that infants born to mother whose pregnancies have been complicated by pneumonia are more likely to be born preterm and to have a lower birth weight, care must be taken to balance treatment to serve both the mother and the fetus.


title: Oncostatin M-induced upregulation of SDF-1 improves Bone marrow stromal cell migration in a rat middle cerebral artery occlusion stroke model.

text: Bone marrow-derived mesenchymal stem cells (BMSCs) exhibit potential regenerative effects on the injured brain. However, these effects are constrained by their limited ability to migrate to the injured site. Oncostatin M (OSM) has been shown to affect the proliferation and migration of mesenchymal stem cells. Therefore, in the present study, we explored whether OSM improves BMSC migration and secretion of growth factors and cytokines in a rat middle cerebral artery occlusion (MCAO) stroke model. The effect of OSM on the proliferation and apoptosis of rat BMSCs was first assessed in vitro, and the gene and secretion levels of factors related to cell nutrition and migration, such as SDF-1 and VEGF, were detected. To further explore underlying pathways triggered by OSM, BMSCs were treated with OSM in the presence or absence of inhibitors of the STAT3 and ERK pathways. Effects of OSM on SDF-1 expression in astrocytes and BMSC migration were also evaluated. In the rat MCAO model, OSM secretion levels were detected in the brain for up to 72 h after model establishment. Ventricle injection of OSM alone or OSM combined with caudal vein graft of BMSCs was then performed in MCAO stroke rats. After 72 h, production of SDF-1 and grafted BMSCs was detected in the lesion areas of the brain, and the nerve function score was evaluated. We found that the production of OSM continually increased in the brains of MCAO rats from 12 h to 72 h. OSM significantly upregulated SDF-1 in BMSCs via the STAT3 and ERK pathways and significantly promoted the expression of VEGF and MMP-2. OSM also promoted the secretion of SDF-1 in astrocytes through the STAT3 and ERK pathways to in turn enhance BMSC migration. Combination treatment with OSM and BMSCs in MCAO rats increased the migration efficiency of BMSCs in the brain, which significantly improved neurofunctional recovery while reducing the expression of inflammatory mediators and promoting the secretion of nutrition factors. Overall, these results show that OSM is highly expressed in the brains of MCAO stroke rats and can upregulate SDF-1 to promote BMSC migration. Thus, combination treatment with OSM and BMSCs improves the graft efficiency of BMSCs and neurofunctional recovery.


title: Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials.

text: Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0-1) at 3-6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0-1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21-1.68 and 1.43, 1.23-1.65, respectively), but not in those outside the age-revised label (1.06, 0.90-1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76-1.25 and 1.01, 0.86-1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99-1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19-2.01 and 1.37, 1.17-1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97-1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77-1.26 and 1.02, 0.87-1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98-1.41). Conclusions An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality.


title: Three-Year Follow-Up of Laparoscopic Reduced Port Sleeve Gastrectomy in 808 Consecutive Patients.

text: BACKGROUND Sleeve gastrectomy (SG) is a very popular technique for the treatment of morbid obesity. Less and less invasive laparoscopic approaches to SG have been proposed and shown to be safe and feasible. OBJECTIVES We developed a reduced port laparoscopic approach to sleeve gastrectomy (RLSG) with the aim to further optimize the advantages of laparoscopy. Preliminary and safety profile of RLSG as well as 3 years weight loss outcome are hereby discussed. SETTING University Hospital, Kuwait. MATERIALS AND METHODS All patients had morbid obesity with history of failure of conservative treatment. The RLSG procedure was performed using only two skin incisions. RESULTS The analyzed population comprised 808 patients, including 642 women and 166 men. Mean age and BMI were 28.34 ± 8.37 and 41.09 ± 6.34, respectively. Mean operative time was 43 ± 20 min (range, 31-185). Mortality was nil. Overall morbidity rate was (4.5%). Three patients had postoperative leak (0.4%). Median duration of hospital stay was 2 days (range, 1-5). Mean percentage of excess weight loss (% EWL) was 23.18 ± 17.3% at 1 month, 55.08 ± 22.9% at 6 months, 82.6 ± 22.6% at 1 year, and 84.3 ± 22.4% at 3 years. Mean percentage total weight loss (%TWL) was 9.34% at 1 month, 22.42% at 6 months, and 34.57% at 1 year. CONCLUSION RLSG is a safe and effective surgical option in patients with morbid obesity. Moreover, 3-year follow-up assessment confirmed adequate % EWL.


title: Review of the effects of soft robotic gloves for activity-based rehabilitation in individuals with reduced hand function and manual dexterity following a neurological event.

text: Despite limited scientific evidence, there is an increasing interest in soft robotic gloves to optimize hand- and finger-related functional abilities following a neurological event. This review maps evidence on the effects and effectiveness of soft robotic gloves for hand rehabilitation and, whenever possible, patients' satisfaction. A systematized search of the literature was conducted using keywords structured around three areas: technology attributes, anatomy, and rehabilitation. A total of 272 titles, abstracts, and keywords were initially retrieved, and data were extracted out of 13 articles. Six articles investigated the effects of wearing a soft robotic glove and eight studied the effect or effectiveness of an intervention with it. Some statistically significant and meaningful beneficial effects were confirmed with the 29 outcome measures used. Finally, 11 articles also confirmed users' satisfaction with regard to the soft robotic glove, while some articles also noticed an increased engagement in the rehabilitation program with this technology. Despite the heterogeneity across studies, soft robotic gloves stand out as a safe and promising technology to improve hand- and finger-related dexterity and functional performance. However, strengthened evidence of the effects or effectiveness of such devices is needed before their transition from laboratory to clinical practice.


title: Total transvaginal endoscopic abdominal wall hernia repair: a NOTES survival study.

text: HYPOTHESIS Natural orifice transluminal endoscopic surgery (NOTES) has gained widespread interest as a potentially less invasive alternative to laparoscopic surgery or, else, an evolution as the next-generation surgery. The main objective of this study was to assess the safety of transluminal abdominal wall hernia repair for potential human application by specifically investigating the feasibility and challenges of using a transvaginal approach. DESIGN NOTES ventral hernia repair via a transvaginal approach. SETTING University Hospital (National University Health System, Singapore). PARTICIPANTS The study utilized five female pigs (30-40 kg) between 5 and 7 months of age, which underwent abdominal wall hernia repair using a transvaginal approach. INTERVENTION The procedures were performed using a double-channel endoscope under general endotracheal anesthesia. A mesh was placed and fixed to the abdominal wall using standard laparoscopic and endoscopic equipment. The animals survived for 2 weeks and were then euthanized and a necropsy performed. MAIN OUTCOME MEASURES To assess the safety and feasibility of NOTES ventral hernia repair in a survival experimental model. RESULTS All of the procedures could be safely performed using the standard equipment. At the necropsy, all meshes were well in place and mild adhesions were recorded in one animal with a small abscess in the subcutaneous area. CONCLUSION This novel approach seems technically challenging but feasible using equipment and accessories currently available for conventional laparoscopic and interventional endoscopy with low intra-abdominal contamination and sepsis. New procedure-specific instruments and equipment need to be developed to allow the surgeon safer access and more degrees of instrument freedom.


title: Rapid Conversion of an Outpatient Psychiatric Clinic to a 100% Virtual Telepsychiatry Clinic in Response to COVID-19.

text: In anticipation of a surge of COVID-19 cases in Northern California, the outpatient psychiatric clinic at UC Davis Health, in which 98% of visits initially occurred in person, was converted to a telepsychiatry clinic, with all visits changed to virtual appointments within 3 business days. The clinic had 73 virtual appointments on its first day after full conversion. This column describes the process, challenges, and lessons learned from this rapid conversion. Patients were generally grateful, providers learned rapidly how to work from home, and the clinic remained financially viable with no immediate losses.


title: Systems science methods in public health: dynamics, networks, and agents.

text: Complex systems abound in public health. Complex systems are made up of heterogeneous elements that interact with one another, have emergent properties that are not explained by understanding the individual elements of the system, persist over time, and adapt to changing circumstances. Public health is starting to use results from systems science studies to shape practice and policy, for example in preparing for global pandemics. However, systems science study designs and analytic methods remain underutilized and are not widely featured in public health curricula or training. In this review we present an argument for the utility of systems science methods in public health, introduce three important systems science methods (system dynamics, network analysis, and agent-based modeling), and provide three case studies in which these methods have been used to answer important public health science questions in the areas of infectious disease, tobacco control, and obesity.


title: Impact of Collateral Status Evaluated by Dynamic Computed Tomographic Angiography on Clinical Outcome in Patients With Ischemic Stroke.

text: BACKGROUND AND PURPOSE Status of collateral circulation is a strong predictor of outcome after acute ischemic stroke. Our aim was to compare the predictive value of strategies for collateral blood flow assessment with dynamic computed tomographic angiography (CTA) and conventional single-phase CT angiography. METHODS Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT, single-phase CTA and whole brain CT perfusion/dynamic CTA within 9 hours after stroke onset. We defined poor outcome as a score on the modified Rankin Scale score of ≥3. The association between collateral score and clinical outcome at 3 months was analyzed with Poisson regression. The prognostic value of collateral scoring with dynamic CTA and single-phase CTA in addition to age, stroke severity, and noncontrast CT was assessed with logistic regression and summarized with the area under the curve. RESULTS Seventy patients were included, with a mean age of 68 years. We observed an increased risk of poor outcome in patients with poor collaterals on single-phase CTA (risk ratio, 1.8; 95% confidence interval, 1.0-3.1) and on dynamic CTA (risk ratio, 2.0; 95% confidence interval, 1.5-2.7). The prediction of poor clinical outcome by means of collateral adjustment was better with dynamic CTA (area under the curve, 0.84; likelihood ratio test P<0.01) than by single-phase CTA (area under the curve, 0.80; likelihood ratio test P=0.33). CONCLUSIONS Collateral assessment with dynamic CTA better predicts clinical outcome at 3 months than single-phase conventional CTA. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl/trialreg. Unique identifier: NTR1804. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00880113.


title: Single-port laparoscopic cholecystectomy in situs inversus totalis using the E.K. glove port.

text: Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). In an effort to reduce morbidity and improve the cosmesis single-port laparoscopic cholecystectomy has recently emerged, where the surgery is done through a single port, typically the patient's navel. This improves the cosmesis, lessens post-operative pain and ensures virtually a "scar less" surgery. We report a case of successful single-port laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages and review of literature.


title: Changes in cuff pressure and position of cylindrical-cuff and tapered-cuff tracheal tubes during laparoscopic abdominal surgery.

text: OBJECTIVES To evaluate changes in cuff pressure and position of tapered-cuff and cylindrical-cuff tracheal tubes (TTs) during laparoscopic cholecystectomy; to compare the frequency of endobronchial intubation and airway complaints with the two types of TT. METHODS Patients were randomly assigned to intubation with a TT with a cylindrical cuff (group C) or a tapered cuff (group T). Anaesthesia was maintained with sevoflurane, O(2) and N(2)O after intubation. TT cuffs were inflated to 20 cm H(2)O; changes in cuff pressure and volume were measured up to 30 min after the start of N(2)O use. Distance between the TT tip and the carina was measured before and after pneumoperitoneum and position change. Frequency of sore throat, dysphagia and hoarseness in the two groups was recorded. RESULTS Cuff volume and pressure were significantly lower in group T than in group C (n = 32 per group). Cuff pressure and volume significantly increased 30 min after start of N(2)O use in both groups. Distance from the TT tip to the carina decreased during surgery in both groups. There were no cases of endobronchial intubation, and there were no between-group differences in the frequency of airway complaints. CONCLUSIONS The tapered cuff was associated with a smaller change in cuff pressure during laparoscopic cholecystectomy than the cylindrical cuff, and therefore may be associated with increased preservation of tracheal mucosal perfusion.


title: AYUSH for COVID-19: Science or Superstition?

text: There is a lot of discussion on COVID-19 control strategies from the mainstream approaches, but it is also necessary to examine the contributions of the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy (AYUSH) sector, which is now being brought into public health interventions nationally. Although the AYUSH sector had previously joined the management of dengue and chikungunya outbreaks in some Indian states, its participation has remained contentious and there is reluctance in mainstream public health discourses to seriously examine their interventions. This is a commentary on the efforts made by the Ministry of AYUSH, state AYUSH directorates, AYUSH research institutions, and public hospitals, based on official documents as well as official statements reported in the media, with the aim of bringing out concerns in the process of adapting traditional textual knowledge and practices to public health requirements of the current age.


title: Foraging through multiple nest holes: An impediment to collective decision-making in ants.

text: In social insects, collective choices between food sources are based on self-organized mechanisms where information about resources are locally processed by the foragers. Such a collective decision emerges from the competition between pheromone trails leading to different resources but also between the recruiting stimuli emitted by successful foragers at nest entrances. In this study, we investigated how an additional nest entrance influences the ability of Myrmica rubra ant colonies to exploit two food sources of different quality (1M and 0.1M sucrose solution) and to select the most rewarding one. We found that the mobilisation of workers doubled in two-entrance nests compared to one-entrance nests but that ants were less likely to reach a food source once they exited the nest. Moreover, the collective selection of the most rewarding food source was less marked in two-entrance nests, with foragers distributing themselves evenly between the two feeders. Ultimately, multiple nest entrances reduced the foraging efficiency of ant colonies that consumed significantly less sugar out of the two available resources. Our results highlight that the nest structure, more specifically the number of nest entrances, can impede the ant's ability to process information about environmental opportunities and to select the most rewarding resource. This study opens new insights on how the physical interface between the nest interior and the outside environment can act upon collective decision-making and foraging efficiency in self-organized insect societies.


title: Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation.

text: BACKGROUND The functional status and outcomes in patients with prolonged mechanical ventilation (PMV) are often limited by poor endurance and pulmonary mechanics, which result from the primary diseases or prolonged time bedridden. We evaluate the impact of exercise training on pulmonary mechanics, physical functional status, and hospitalization outcomes in PMV patients. METHODS Twenty-seven subjects with PMV in our respiratory care center (RCC) were divided randomly into an exercise training group (n = 12) and a control group (n = 15). The exercise program comprised 10 sessions of exercise training. The measurement of pulmonary mechanics and physical functional status (Functional Independence Measurement and Barthel index) were performed pre-study and post-study. The hospitalization outcomes included: days of mechanical ventilation, hospitalization days, and weaning and mortality rates during RCC stay. RESULTS The training group had significant improvement in tidal volume (143.6 mL vs 192.5 mL, P = .02) and rapid shallow breathing index after training (162.2 vs 110.6, P = .009). No significant change was found in the control group except respiratory rate. Both groups had significant improvement in functional status during the study. However, the training group had greater changes in FIM score than the control group (44.6 vs 34.2, P = .024). The training group also had shorter RCC stay and higher weaning and survival rates than the control group, although no statistical difference was found. CONCLUSIONS Subjects with PMV in our RCC demonstrated significant improvement in pulmonary mechanics and functional status after exercise training. The application of exercise training may be helpful for PMV patients to improve hospitalization outcomes.


title: Mesenchymal Stem Cell-based Therapy for COVID-19: Possibility and Potential.

text: A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged in Wuhan, China since the end of December 2019 and has quickly spread all over the world in a matter of two months. To date, no specific treatment has been proven to be effective for coronavirus disease 2019 (COVID-19). With the rapid increase of infected patients and deaths, it is urgent to explore an effective treatment for COVID-19. Current studies suggest that there exists cytokine storm in SARS-CoV-2-infected patient, some of the patients will develop to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction, even death. Mesenchymal stem cells (MSCs) possess the property of immunomodulation. Given the previous preclinical and clinical studies, MSCs therapy has been shown safety and efficacy in the treatment of respiratory failure or ARDS. Based on similar principles, MSCs therapy may also be an effective therapy in the treatment of COVID-19. In this study, we summarized the clinical outcomes of MSCs for ARDS patients in some preclinical and clinical studies, and discussed the application of MSCs for patients with COVID-19 in China and the related important issues with MSCs use during the outbreak.


Breast unit Efficacy with the relocation of the surgical breast team during the COVID-19 pandemic.


title: Comparison of the effects of isoflurane versus propofol-remifentanil anesthesia on oxygen delivery during thoracoscopic lung lobectomy with one-lung ventilation in dogs.

text: This study compared effects of isoflurane inhalation (ISO) and propofol-remifentanil combined total intravenous anesthesia (TIVA) on oxygenation during thoracoscopic lung lobectomy with 30-min one-lung ventilation (1LV). Thoracoscopic right middle lung lobectomy was performed in ten dogs divided into ISO and TIVA groups, and cardiopulmonary parameters were measured with blood gas analysis. Throughout the study, isoflurane was inhaled up to 1.5%, and the infusion rates of propofol and remifentanil were 0.2 to 0.4 mg/kg/min and 6 to 11 µg/kg/h, respectively. Cardiac index was not affected in the ISO group, but it increased during 1LV in the TIVA group. There were significant alterations in arterial oxygen pressure, arterial oxygen saturation, oxygen content, and shunt fraction associated with 1LV in each group. However, oxygen delivery did not decrease significantly due to open chest condition, 1LV, or surgical maneuver in either group, rather it increased during 1LV in the TIVA group. All parameters showed no significant difference between groups. Pulmonary vascular resistant index was unaffected in both groups, and there was no difference between groups except in re-ventilation phase. Accordingly, the effect of both anesthetic regimens on oxygenation was not different between groups and can be used with short-term 1LV for thoracoscopic lung lobectomy in dogs.


title: Disadvantageous decision-making in borderline personality disorder: Partial support from a meta-analytic review.

text: To achieve long-term goals, organisms evaluate outcomes and expected consequences of their behaviors. Unfavorable decisions maintain many symptoms of borderline personality disorder (BPD); therefore, a better understanding of the mechanisms underlying decision-making in BPD is needed. In this review, the current literature comparing decision-making in patients with BPD versus healthy controls is analyzed. Twenty-eight empirical studies were identified through a structured literature search. The effect sizes from studies applying comparable experimental tasks were analyzed. It was found that (1) BPD patients discounted delayed rewards more strongly; (2) reversal learning was not significantly altered in BPD; and (3) BPD patients achieved lower net gains in the Iowa Gambling Task (IGT). Current psychotropic medication, sex and differences in age between the patient and control group moderated the IGT outcome. Altered decision-making in a variety of other tasks was supported by a qualitative review. In summary, current evidence supports the altered valuation of outcomes in BPD. A multifaceted influence on decision-making and adaptive learning is reflected in this literature.


Aminosalicylates and COVID-19: Facts or Coincidences?


title: Mapping communicable disease control in the European union.

text: Understanding both the current performance of communicable disease control in Europe and the scale of the differences among systems is crucial to understanding its present performance and possible Europeanization. We attempt to identify the structure of authority in communicable disease control in each European Union (EU) member state. The primary sources of information were the competent bodies list posted on the European Centre for Disease Prevention and Control website and the Health in Transition reports produced by the European Observatory on Health Systems and Policies. Three key patterns emerge to answer the question of who does what. First, the landscape is full and crowded, with many actors involved. Second, the landscape is highly fragmented, with many organizations performing overlapping functions in each country. Third, regional patterns describe which types of organizations are assigned which functions. These full, fragmented, and regionally disparate systems show no signs of constituting a shared model. As a result, if there is an EU model of communicable disease control today, it is at most an aspiration.