title: Renal sympathetic nerve ablation for the management of resistant hypertension: an update.

text: PURPOSE OF REVIEW The aim is to provide clinicians with a concise update on renal sympathetic nerve ablation in the management of resistant hypertension. The review will specifically discuss the latest clinical trial findings, technological advancements in ablation modalities and expert guidelines for patient eligibility. Novel therapeutic applications beyond blood pressure (BP) control will also be discussed. RECENT FINDINGS Follow-up data from the Symplicity Clinical Trials Program provides further evidence for the safety of the procedure and substantiates a sustained reduction in BP in most patients with resistant hypertension. Recently published expert consensus statements recommend that only patients with resistant hypertension should undergo the procedure at this stage. Several alternative treatment modalities for renal denervation have been developed to improve efficacy, procedure time and safety. Initial findings suggest comparable BP reductions amongst technical approaches. Several pilot studies, although predominantly uncontrolled, indicate additional benefits of renal sympathetic nerve ablation on regression of hypertensive end-organ damage, heart failure, cardiac arrhythmias and other disturbances commonly associated with resistant hypertension. SUMMARY Catheter-based renal nerve ablation is emerging as a well tolerated, effective and cost-effective treatment to control BP in patients with resistant hypertension. Further studies are required to determine the long-term impact of this novel therapeutic option.


title: Fireworks-related injury surveillance in the Philippines: trends in 2010-2014.

text: Analysis of the annual fireworks-related injury surveillance data collected by the Philippines Department of Health (DOH) in 2010-2014 was conducted to describe the profile of such injuries in the Philippines. Surveillance data were collected from DOH's Online National Electronic Injury Surveillance System and analysed. A case was defined as any person who had sustained injury from fireworks in any form within the 16-day surveillance period (21 December to 5 January) and had presented to any of the 50 sentinel hospitals. Of the 4649 cases, there were 4706 fireworks-related injuries involving 5076 anatomic sites in 2010-2014. A significant decrease of cases in 2014 was observed when compared with the previous study years (P = 0.02). The number of cases peaked at public holidays. Males (80%) were more commonly injured, and children aged 5 to 14 years were primarily affected (47%). Ignition of illegal fireworks accounted for half (50%) of the injuries; most injuries (68%) occurred in street settings. The majority of injuries (57%) were sustained by fireworks igniters. The most common anatomic injury sites were hands (44%), legs (21%) and eyes (14%). Illegal fireworks were related to 100% (4/4) of the deaths and 49% (105/214) of the cases who needed amputations. Fireworks-related injuries declined significantly in 2014. Public awareness campaigns may have contributed to reducing the injury occurrences. As illegal fireworks accounted for all deaths and more than half of the amputations, law enforcement should be directed towards preventing importing, distributing and using illegal fireworks.


Israel in deadlock on Horizon 2020.


title: Novel in situ forming hydrogel microneedles for transdermal drug delivery.

text: Novel in situ forming hydrogel microneedles were evaluated for transdermal drug delivery using a biocompatible non-ionic triblock amphiphilic thermosensitive copolymer. The transition property of poloxamer from solution at room temperature to gel at skin temperature (32 °C) was utilized in preparation of in situ forming hydrogel microneedles. Methotrexate has been used to treat solid tumors, but because of its narrow safety margin, it requires sustained delivery within the therapeutic window. Formulations with and without poloxamer at different methotrexate concentrations were prepared and evaluated for drug permeation across skin using vertical Franz diffusion cell for 72 h. Sol-gel transition, skin resistance and thickness, microneedles geometry, microchannel depth, shape, formation and uniformity, viscoelasticity of skin, and in vitro drug permeation were characterized and tested. An average cumulative drug amount of 32.2 ± 15.76 and 114.54 ± 40.89 μg/cm2 for porcine ear skin and 3.89 ± 0.60 and 10.27 ± 6.98 μg/cm2 for dermatomed human skin from 0.2 % w/w and 0.4 % w/w methotrexate formulations was delivered by the in situ forming hydrogel microneedles. These in situ hydrogel microneedles embedded within the porated site of the skin provided a steady and sustained drug delivery.


title: Are there predictors of outcome following rectovaginal fistula repair?

text: BACKGROUND Rectovaginal fistula is a distressing condition for patients and for physicians who are continuously challenged in providing durable treatment options. The aim of this study is to assess the results of rectovaginal fistula repair and identify predictive factors for poor outcome. METHODS Retrospective analysis of patients who underwent rectovaginal fistula repair from 1988 to 2008 was performed. chi tests and logistical regression analysis were used to study treatment outcomes according to the following fistula characteristics: etiology, size, location, and number of prior attempts at fistula repair. In addition, patient factors such as age, body mass index, smoking history, comorbid condition of diabetes, use of steroid and immunosuppressive medications, number of prior vaginal deliveries, and presence of a diverting stoma were analyzed. RESULTS A total of 184 procedures were performed in 125 patients. Inflammatory bowel disease was the most common indication for surgery (45.6%), followed by obstetric injury (24%) and surgical trauma (16%). The mean duration of fistula presence was 31.2 months. The procedures performed included endorectal advancement flap (35.3%), gracilis muscle interposition (13.6%), seton placement (13.6%), and transperineal (8.7%) and transvaginal repair (8.1%). The overall success rate per procedure was 60%, with no difference in recurrence rates based on the type of repair. Patients with Crohn's disease had more recurrent fistulas (44.2% success per procedure; P < .01), although 78% eventually healed after an average of 1.8 procedures. Patients with obstetric injuries had an 89% success rate after an average of 1.3 procedures per patient, which is similar to the success rate for traumatic fistulas. Pouch vaginal fistulas had a 91% success rate after an average of 1.6 procedures per patient. The overall success rate per patient was 88% after multiple procedures with a mean follow-up of 16.3 months. Age, body mass index, diabetes, use of steroids and immunosuppressive agents, size and location of the fistula, number of vaginal deliveries, time interval between a recurrent episode and subsequent repair, and the presence of fecal diversion did not affect outcomes. The presence of Crohn's disease and a smoking history are strongly associated with rectovaginal fistula recurrence (P = .02). CONCLUSIONS Despite a relatively low initial success rate (60%), most rectovaginal fistulas can be successfully repaired with subsequent operations. Crohn's disease and smoking are associated with adverse outcomes.


title: Outcomes of Reoperation After Laparoscopic Gastric Plication Failure.

text: BACKGROUND Management of failed laparoscopic gastric plication (LGP), defined as weight regain or inadequate weight loss, is a challenging issue. METHODS This prospective investigation was conducted in individuals with morbid obesity who had undergone LGP from 2000 to 2016. Patients with weight loss failure, weight regain, and regain-prone cases were indicated for reoperation. Re-plication, laparoscopic one anastomosis gastric bypass (LOAGB), and modified jejunoileal bypass were done as revisional surgery. RESULTS Revisional surgery was performed in 102 of 124 patients who needed reoperation. Overall, 39 re-plication, 38 LOAGB, and 25 malabsorptive procedures were performed. Re-plication was the shortest surgery and had the shortest length of hospital stay. The percentage of TWL at 6, 12, and 24 months of follow-up was 20.5%, 25%, and 26.8% for re-plication; 20.2%, 27%, and 30.5% for LOAGB; and 22.9%, 28.9%, and 32.6% for the malabsorptive procedure, respectively. In addition, the percentage of EWL at 6, 12, and 24 months of follow-up was 62%, 74.6%, and 79.6% for re-plication; 51.6%, 68.2%, and 75.9% for LOAGB; and 55.4%, 70.1%, and 79.1% for malabsorptive procedure, respectively. In long-term follow-up, according to %TWL, LOAGB and malabsorptive procedure had better outcome compared to re-plication, whereas there was no statistically significant difference in %EWL among the three surgical approaches. CONCLUSIONS In terms of weight loss, reoperation on failed LGP was completely successful and no treatment failure was reported. All three revisional procedures, including re-plication, LOAGB, and malabsorptive procedure showed promising results and provided substantial weight loss. Since there is little information about the long-term efficacy and safety of revisional surgery on failed LGP, we highly recommend further investigations to confirm our results.


title: A minimal access far-lateral approach to foramen magnum lesions.

text: Objectives The far-lateral approach is widely used to treat pathology of the ventral foramen magnum. Numerous methods of exposure have been described, most of which utilize long skin incisions and myocutaneous flaps. Here we present our experience with gaining exposure through a small paramedian incision using a muscle-splitting technique. Design A cadaveric anatomical study was first performed to verify the feasibility of the approach. We then describe our experience with using the approach in 13 patients. A retrospective chart review was performed and data regarding pathology, imaging, and complications were collected. Results The cadaveric study confirmed that a small paramedian muscle-splitting approach allows sufficient exposure to approach many foramen magnum lesions. Our case series included 10 patients with meningioma, one brainstem glioblastoma, one posterior inferior cerebellar artery aneurysm, and one odontoid pannus. The exposure was adequate in all cases. For the meningioma patients, six had gross total resections and four had subtotal resection because of tumor adherence to neurovascular structures. Two patients experienced postoperative cardiovascular complications. There were no new neurologic deficits, cerebrospinal fluid leaks, or wound complications. Conclusions A small paramedian incision may be used to gain exposure and perform successful far-lateral approaches. The small exposure is likely to reduce the risk of local complications such as cerebrospinal fluid fistula and pseudomeningocele when compared with larger exposures.


title: Seasonality of Respiratory Viral Infections.

text: The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field. Expected final online publication date for the Annual Review of Virology, Volume 7 is September 29, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.


title: Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa®: an observational study.

text: BACKGROUND The anaesthetic conserving device, AnaConDa(®), allows use of inhaled anaesthetics for sedation in the intensive care unit. We prospectively measured cerebral and cardiopulmonary parameters in patients with acute stroke or subarachnoid haemorrhage during a switch from i.v. to inhalative sedation. METHODS 25 patients were switched from i.v. to an indefinite period of inhaled sedation with sevoflurane. Mean arterial (MAP), intracranial (ICP), and cerebral perfusion pressure (CPP), middle cerebral artery mean flow velocity (MFV) and fractional tissue oxygen extraction (FTOE), systemic cardiopulmonary parameters, and administered drugs were assessed before and after the change (-6 to +12 h). RESULTS In 8 patients, critically reduced MAP or ICP crisis led to premature termination of sevoflurane sedation. In the other 17 patients, after the first hour, mean ICP increased [2.4 (4.5) mm Hg; P=0.046], MAP decreased [7.8 (14.1) mm Hg; P=0.036] and thus CPP decreased also [-10.2 (15.1) mm Hg; P=0.014]. MFV and FTOE did not change. Over a 12 hour post switch observational period, [Formula: see text] increased slightly [0.3 (0.8) kPa; P=0.104], ICP did not change [0.2 (3.9) mm Hg; P=0.865], but MAP [-6 (6.9) mm Hg; P=0.002] and thus CPP decreased [-6 (8.5) mm Hg; P=0.010]. CONCLUSION Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.


title: omputer modelling of a potential agent against SARS-Cov-2 (COVID-19) protease.

text: We have modelled modifications of a known ligand to the SARS-CoV-2 (COVID-19) protease, that can form a covalent adduct, plus additional ligand-protein hydrogen bonds. This article is protected by copyright. All rights reserved.


title: Prediction Model for Hemorrhagic Complications after Laparoscopic Sleeve Gastrectomy: Development of SLEEVE BLEED Calculator.

text: INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures. Hemorrhagic complications (HC) after surgery are common and require surgical revision. Accurate estimation of the risk of postoperative HC can improve surgical decision-making process and minimize the risk of reoperation. The aim of the present study was to develop a predictive model for HC after LSG. MATERIAL AND METHODS The retrospective analysis of 522 patients after primary LSG was performed. Patients underwent surgery from January 2013 to February 2015. The primary outcome was defined as a surgical revision due to hemorrhagic complications. Multiple regression analysis was performed. RESULTS The rate of hemorrhagic complications was 4 %. The mean age of patients was 41.0 (±11.6) years and mean BMI was 47.3 (±7.3) kg/m2. Of the 12 examined variables, four were associated with risk of HC. Protective factors for HC were no history of obstructive sleep apnea (odds ratio [OR] 0.22; 95 % CI 0.05-0.94) and no history of hypertension (OR 0.38; 95 % CI 0.14-1.05). The low level of expertise in bariatric surgery (OR 2.85; 95 % CI 1.08-7.53) and no staple line reinforcement (OR 3.34; 95 % CI 1.21-9.21) were associated with higher risk of HC. CONCLUSIONS The result revealed the association between hemorrhagic complications and the following factors: obstructive sleep apnea, hypertension, level of expertise in bariatric surgery, and reinforcement of the staple line. The risk assessment model for hemorrhagic complications after LSG can contribute to surgical decision-making process.


title: The M, E, and N structural proteins of the severe acute respiratory syndrome coronavirus are required for efficient assembly, trafficking, and release of virus-like particles.

text: The production of virus-like particles (VLPs) constitutes a relevant and safe model to study molecular determinants of virion egress. The minimal requirement for the assembly of VLPs for the coronavirus responsible for severe acute respiratory syndrome in humans (SARS-CoV) is still controversial. Recent studies have shown that SARS-CoV VLP formation depends on either M and E proteins or M and N proteins. Here we show that both E and N proteins must be coexpressed with M protein for the efficient production and release of VLPs by transfected Vero E6 cells. This suggests that the mechanism of SARS-CoV assembly differs from that of other studied coronaviruses, which only require M and E proteins for VLP formation. When coexpressed, the native envelope trimeric S glycoprotein is incorporated onto VLPs. Interestingly, when a fluorescent protein tag is added to the C-terminal end of N or S protein, but not M protein, the chimeric viral proteins can be assembled within VLPs and allow visualization of VLP production and trafficking in living cells by state-of-the-art imaging technologies. Fluorescent VLPs will be used further to investigate the role of cellular machineries during SARS-CoV egress.


title: [Investigation of transmission chain of a cluster COVID-19 cases].

text: Objective: To analyze of the transmission characteristics of a cluster of COVID-19 cases in Chongqing and evaluate the infectivity of COVID-19 in the incubation period. Methods: A retrospective survey was conducted by using unified questionnaire through field and telephone interviews among 129 close contacts of COVID-19 cases. The relationship of transmission was indicated by transmission chain, and the infectivity was analyzed by the contact history. Results: This cluster of COVID-19 cases occurred after a classmate party involving members in three families and work fellows in a factory (R(0)=3.8). The infection rate during the incubation period was 17.57%. On average, it was infectious three days before onset. There was significant difference in infection rate among different contact modes (χ(2)=15.10, P<0.01),There was significant difference in infection rate among single exposureswith different time length ( χ(2)=25.08, P<0.01). Conclusions: COVID-19 is highly infectious in the incubation period. The more confined the space is, the higher the risk is,and the longer the single exposure is, the higher the risk of transmission is. Indirect contact transmission still exists.


title: Left Atrial Appendage Ligation in Nonvalvular Atrial Fibrillation Patients at High Risk for Embolic Events With Ineligibility for Oral Anticoagulation: Initial Report of Clinical Outcomes.

text: OBJECTIVES This study sought to assess long-term clinical outcomes in adults with nonvalvular atrial fibrillation (AF) who are ineligible for oral anticoagulation therapy and underwent left atrial appendage (LAA) ligation with the Lariat device. BACKGROUND LAA exclusion has been used to prevent thrombus formation within the LAA in AF patients and is believed to decrease the risk of cardioembolic events. METHODS LAA ligation with the Lariat device was performed in 139 patients with nonvalvular AF. LAA closure was verified during the procedure by LA angiography and transesophageal echocardiography. A follow-up transesophageal echocardiography was performed at 30 to 45 days post-procedure. After the procedure, patients received aspirin only, clopidogrel only, aspirin plus clopidogrel, or no antithrombotic drugs. Patients did not receive transition oral anticoagulation therapy post-LAA ligation. Patients were followed for LAA closure and adverse events, including stroke, systemic events, and death. RESULTS Acute closure was accomplished in 138 of 139 treated patients (99%). In 1 patient, a posterior lobe was partially closed. At the day-30 to day-45 transesophageal echocardiography (n = 127), 114 (90%) had complete LAA closure, and 13 (10%) had a 2- to 4-mm leak. There were no leaks ≥5 mm. The periprocedural adverse event rate was 11.5%, including 2 cardiac perforations and 1 death due to pulmonary embolus. Over a mean follow-up of 2.9 ± 1.1 years, the event rate for the composite endpoint of stroke and systemic embolism was 1.0% per year (n = 4). The combined stroke, embolism, and death of any cause event rate was 2.8% (n = 11) per year. CONCLUSIONS The findings from this analysis of post-procedure event rates suggest that LAA ligation with the Lariat device effectively closes the LAA and may be a beneficial approach to reduce the risk of embolic events in AF patients ineligible to oral anticoagulation therapy. However, future randomized clinical trials are needed to verify these results and to determine device and procedural safety.


title: Do replicable profiles of multimorbidity exist? Systematic review and synthesis.

text: This systematic review aimed to synthesise multimorbidity profiling literature to identify replicable and clinically meaningful groupings of multimorbidity. We searched six electronic databases (Medline, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science) for articles reporting multimorbidity profiles. The identified profiles were synthesised with multidimensional scaling, stratified by type of statistical analysis used in the derivation of profiles. The 51 studies that met inclusion criteria reported results of 98 separate analyses of multimorbidity profiling, with a total of 407 multimorbidity profiles identified. The statistical techniques used to identify multimorbidity profiles were exploratory factor analysis, cluster analysis of diseases, cluster analysis of people, and latent class analysis. Reporting of methodological details of statistical methods was often incomplete. The discernible groupings of multimorbidity took the form of both discrete categories and continuous dimensions. Mental health conditions and cardio-metabolic conditions grouped along identifiable continua in the synthesised results of all four methods. Discrete groupings of chronic obstructive pulmonary disease with asthma, falls and fractures with sensory deficits and of Parkinson's disease and cognitive decline where partially replicable (identifiable in the results of more than one method), while clustering of musculoskeletal conditions and clustering of reproductive systems were each observed only in one statistical approach. The two most replicable multimorbidity profiles were mental health conditions and cardio-metabolic conditions. Further studies are needed to understand aetiology and evolution of these multimorbidity groupings. Guidelines for strengthening the reporting of multimorbidity profiling studies are proposed.


title: Video-assisted thoracoscopic surgery extended thymectomy for myasthenia gravis using manual manipulators: the radius surgical system.

text: A 32-year-old woman with ocular-typed myasthenia gravis (MG) without thymoma was admitted to the hospital to undergo surgical treatment. Video-assisted thoracoscopic surgery (VATS) extended thymectomy was successfully performed with three small ports using manual manipulators, the Radius Surgical System (RSS). The device may facilitate many degrees of freedom to general thoracic surgery.


Underuse versus equipoise for low tidal volume ventilation in acute respiratory distress syndrome: is this the right question?*.


title: Glycoprotein B of equine herpesvirus type 1 has two recognition sites for subtilisin-like proteases that are cleaved by furin.

text: Glycoprotein B (gB) of equine herpesvirus type 1 (EHV-1) is predicted to be cleaved by furin in a fashion similar to that of related herpesviruses. To investigate the contribution of furin-mediated gB cleavage to EHV-1 growth, canonical furin cleavage sites were mutated. Western blot analysis of mutated EHV-1 gB showed that it was cleaved at two positions, 518RRRR521 and 544RLHK547, and that the 28 aa between the two sites were removed after cleavage. Treating infected cells with either convertase or furin inhibitors reduced gB cleavage efficiency. Further, removal of the first furin recognition motif did not affect in vitro growth of EHV-1, while mutation of the second motif greatly affected virus growth. In addition, a second possible signal peptide cleavage site was identified for EHV-1 gB between residues 98 and 99, which was 13 aa downstream of that previously identified.


Nebulized Treatments and the Possible Risk of Coronavirus Transmission: Where Is the Evidence?


Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists.


title: Physical activity monitors to enhance the daily amount of physical activity in elderly-a protocol for a systematic review and meta-analysis.

text: BACKGROUND To investigate the use of physical activity monitors (PAMs) for the elderly, the scientific literature should be systematically reviewed and the effect quantified, as the evidence seems inconclusive. METHODS AND DESIGN Randomized controlled trials and randomized crossover trials, with participants with a mean age above 65 years, comparing any PAM intervention with other control interventions or no intervention, will be included. This protocol is detailed according to the recommendations of the Cochrane Handbook, and it is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. RESULTS We will present results from the search in a flow diagram. The results from the analyses will include regular meta-analyses, stratified analyses, and meta-regressions. The results on each outcome of interest will be presented in a summary of findings table. DISCUSSION This paper will explore and analyze the heterogeneity of the results and try to identify variables that will enhance the effect of PAMs in elderly. The results will be useful to researchers working with elderly and/or PAMs, health care professionals working with elderly, and relatives together with the elderly themselves. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018083648 .


title: Catheter-directed thrombolysis through the operatively recanalized umbilical vein for acute extensive portal vein thrombosis: report of a case.

text: Acute portal vein thrombosis is a rare but severe complication of intra-abdominal infection. It can be life-threatening, given the risk of developing liver abscess and subsequent liver failure. Various types of hereditary thrombophilia are known risk factors for acute portal vein thrombosis. In addition to surgical treatment and potent antibiotic therapy, systemic administration of anticoagulants and locoregional trans-catheter delivery of thrombolytic agents are known to be effective. We present a case report of acute portal vein thrombosis with pylephlebitis caused by acute appendicitis, successfully treated with catheter-directed thrombolysis through the operatively recanalized umbilical vein. The umbilical vein is a promising access route to the portal vein. Therefore, this procedure is an effective and preferred treatment option for portal septic thrombosis, particularly because it does not require puncture of the liver parenchyma or catheterization through an infected peritoneal cavity.


title: Microwave ablation of lung tumours: single-centre preliminary experience.

text: PURPOSE This study was done to evaluate the feasibility, effectiveness and safety of microwave (MW) ablation of lung tumours. MATERIALS AND METHODS Twenty-four patients underwent percutaneous MW ablation of 26 intraparenchymal pulmonary masses. All patients were judged to be inoperable on the basis of tumour stage, comorbidities, advanced age and/or refusal to undergo surgery. Ablation was performed using a microwave generator (Evident Microwave Ablation System, Covidien Ltd., Dublin). Lesions with a diameter ≤ 3 cm were treated with a single antenna, lesions with a diameter >3 cm were treated by positioning two or more antennae, simultaneously. All patients underwent computed tomography (CT) follow-up with and without contrast administration at 1, 3 and 6 months and then yearly in combination with complete blood and metabolic tests. RESULTS Technical success was 100 %. No major complications were recorded. Asymptomatic grade-1 pneumothorax was recorded in 9 patients (37.5 %). One case of asymptomatic pleural effusion and one of haemoptysis, not requiring transfusion, were observed. No patients were diagnosed with a post-ablation syndrome. Complete necrosis was observed in 16 of 26 lesions (61.6 %). Partial necrosis was obtained in 30.8 % (8/26 lesions); in one case (3.8 %) a progression of the disease was recorded and in another case (3.8 %) a stability was observed. CONCLUSIONS Our preliminary experience may be considered in accordance with literature dates, in terms of efficacy and safety.


title: Incarceration And Its Disseminations: COVID-19 Pandemic Lessons From Chicago's Cook County Jail.

text: Jails and prisons are major sites of novel coronavirus (SARS-CoV-2) infection. Many jurisdictions in the United States have therefore accelerated release of low-risk offenders. Early release, however, does not address how arrest and pre-trial detention practices may be contributing to disease spread. Using data from Cook County Jail, in Chicago, Illinois, one of the largest known nodes of SARS-CoV-2 spread, we analyze the relationship between jailing practices and community infections at the zip-code level. We find that jail cycling is a significant predictor of SARS-CoV-2 infection, accounting for 55 percent of the variance in case rates across zip codes in Chicago and 37 percent in Illinois. By comparison, jail cycling far exceeds race, poverty, public transit utilization, and population density as a predictor of variance. The data suggest that cycling through Cook County Jail alone is associated with 15.7 percent of all documented novel coronavirus disease (COVID-19) cases in Illinois and 15.9 percent in Chicago as of April 19, 2020. Our findings support arguments for reduced reliance on incarceration and for related justice reforms both as emergency measures during the present pandemic and as sustained structural changes vital for future pandemic preparedness and public health. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].


New anticoagulants in ambulatory anaesthesia.


title: Evolving Management of Zenker's Diverticulum in the Endoscopic Era: A North American Experience.

text: BACKGROUND Open surgical cricopharyngeal myotomy(CM) is considered standard of care for Zenker's diverticulum(ZD). Trans-oral CM has been described using a rigid stapling device for two decades; however, this remains problematic for severely kyphotic patients. This problem can be overcome with flexible endoscopy utilizing an electrosurgical needle knife. We sought to compare clinical outcomes between these techniques to stratify patient selection. METHODS Patients undergoing ZD treatment from 1992 to 2015 were reviewed. Demographics, diverticulum size, post-operative complications, and length of stay (LOS) were compared between open cricopharyngeal myotomy (OpenCM), rigid trans-oral stapling myotomy (RigidCM), and flexible endoscopic myotomy (FlexCM). Dysphagia scores (DS, 0:best-4:worst) and pneumonia incidence were assessed pre-operatively and post-operatively. RESULTS 62 patients underwent OpenCM (39/62(63 %)) or endoscopic CM (23/62(37 %) (8 RigidCM/15 FlexCM)). CM significantly reduced dysphagia for all approaches [OpenCM:2(2-3)-0(0-0); RigidCM:2(2-2)-0(0-0); FlexCM:3(3-3)-0(0-0)]. FlexCM patients had significantly worse pre-operative DS. Endoscopic CM was attempted and completed in 23/35(66 %) patients. Reasons for OpenCM conversion included inability to position the diverticular retractor due to patient body habitus (RigidCM), and the inability to position the overtube due to small ZD (FlexCM). Major post-operative complications were rare and similar in all groups. Medium-to-long-term post-myotomy pneumonia was comparable between groups. LOS (days) was reduced for FlexCM (1(1-2)) versus RigidCM (3(2-6)) and OpenCM (4(3-7)). CONCLUSIONS CM is highly effective for treating ZD. Open and endoscopic approaches offer comparable outcomes and dysphagia resolution. FlexCM is efficacious for large ZD and can be performed in most patients irrespective of body habitus. FlexCM represents an excellent approach for large ZD, while OpenCM should be reserved for small ZD for which an overtube cannot be positioned.


title: Videothoracoscopic management of middle esophageal diverticulum with secondary bronchoesophageal fistula: report of a case.

text: Middle esophageal diverticulum is rare, but can result in bronchoesophageal fistula. Previous reports have described open surgical techniques to treat esophageal diverticula, but few have evaluated the effectiveness of a videothoracoscopy approach. We report a case of middle esophageal diverticulum associated with bronchoesophageal fistula, managed successfully with videothoracoscopy. We also review the relevant literature.


title: Quarantine protects Falkland Islands (Malvinas) cats from feline coronavirus infection.

text: Feline coronavirus (FCoV) causes feline infectious peritonitis (FIP). Since 2002, when 20 cats on the Falkland Islands were found to be FCoV seronegative, only seronegative cats could be imported. Between 2005-2007, 95 pet and 10 feral cats tested negative by indirect immunofluorescence antibody (IFA) analysis using two strains of type II FCoV, two transmissible gastroenteritis virus assays, an enzyme-linked immunosorbent assay and rapid immunomigration test. Twenty-four samples (23%) showed non-specific fluorescence, mostly attributable to anti-nuclear antibodies (ANA). The reason for ANA was unclear: reactive samples were negative for Erhlichia canis antibodies; seven were feline immunodeficiency virus positive, but 15 were negative. It was not possible to determine retrospectively whether the cats had autoimmune disease, hyperthyroidism treatment, or recent vaccination which may also cause ANA. The FCoV/ FIP-free status of the Falkland Islands cats should be maintained by FCoV testing incoming cats. However, ANA can complicate interpretation of IFA tests.


title: Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach.

text: BACKGROUND Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine. METHODOLOGY/PRINCIPAL FINDINGS We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider. CONCLUSIONS/SIGNIFICANCE These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.


title: Surgical Efficacy Among Laparoscopic Ultrasonic Dissectors: Are We Advancing Safely? A Review of Literature.

text: The specialty of laparoscopy has evolved with the advent of new technologies over the last few years. Energy-based devices and Ultrasonic dissectors are used with a lot of factors in play-including ergonomics and economics during surgery. Here an attempt is based to review the surgical efficacy and safety of these dissectors with importance to plume production and lateral thermal damage. The factors contributing to adversities to the dissectors are also to be noted. The strategy adopted was aimed at finding relevant studies from PubMed from 1995 to 2014. The basic principle of plume production and thermal damage are studied in this review. Factors contributing to the same that can lead to adversities during laparoscopic surgeries are identified. Summarizing key points that increase lateral thermal damage and plume production amongst different ultrasonic shears and suggesting a technique to identify the right balance between the existing dissectors was possible. The RF Device and USS are both useful and widely used and are more safer than monopolar devices. RF Device is considerably slower than USS, as it cannot achieve coagulation and cutting at the same time. Although USS definitely improvises dissection and has less thermal injury than RF Device, the clinical implications in balancing dissection efficacy with hemostasis need to be investigated further. The ideal haemostatic energy-based shear device would be one with excellent hemostatic results and visual acuity while allowing none or minimal thermal energy escape at the point of application. In our current setting, a combined use of both RF and USS device usage as applied in the particular situations has potential.


title: Detection and characterization of canine astroviruses.

text: Astroviruses (AstVs) have been identified only occasionally in dogs. A canine AstV, strain Bari/08/ITA, was detected from a pup with gastroenteric signs and the virus was isolated in cell culture and characterized molecularly. In the full-length capsid protein, the virus displayed genetic similarities (83.5 % aa identity) to another canine AstV strain, although a high rate of variation occurred in the hypervariable domain, which is related to AstV antigenic specificity. Specific antibodies were detected in the convalescent dog, indicating seroconversion, and in 59 % of a collection of dog serum samples. Using primers specific for canine AstV, designed to detect a conserved region of ORF1b, canine AstVs were detected in 24.5 % of young pups with gastroenteritis, either alone or in mixed infections with other canine pathogens. In contrast, AstVs were detected in only 9.3 % of asymptomatic pups. These findings indicate that canine AstVs are common in dogs and may suggest a possible role as canine enteric pathogens.


Geriatric emergency medicine: Research priorities to respond to "The Silver Boom".


title: Fast-track surgery of the colon in children.

text: INTRODUCTION The aim of this study is to present the "fast-track" experience in children who underwent colon resection. MATERIALS AND METHODS Forty-six children who underwent laparoscopic colon resection were prospectively included in the study. Anomalies of colon innervation and inflammatory bowel disease represented the main surgical indications. RESULTS Left colon/sigmoid resection was performed in 37, total colon resection was done in 5, and right colon resection in 4 children. Total colon resection was always associated to ileostomy. Anastomosis was performed in 41 cases. Patients were postoperatively monitored for pain, return to normal activity, feeding, bowel movements, and complications. Stool passage and oral feeding were started on postoperative day 1, and all patients were discharged before postoperative day 4. One child was readmitted the day after discharge because of an anastomotic leak. No other major complications were recorded. DISCUSSION Minimally invasive surgery is safe and effective in pediatric colonic surgery and allows a fast recovery time (fast-track).


title: [Online learning-related visual impairment and preventive measures during the 2019 novel coronvirus outbreak].

text: 目前我国对2019新型冠状病毒疫情的防治工作正处于关键时期，延迟开学是减少校园内交叉感染、保护儿童和青少年身体健康、共同抗击疫情的重要举措。与此同时，远程教学模式的大规模开展导致儿童和青少年的学习模式和用眼习惯发生巨大转变，其对儿童和青少年视觉健康的潜在影响不容忽视。本文对线上学习相关眼健康问题和眼科疾病进行总结，并提出针对性的预防措施，为儿童和青少年在线上学习期间的视功能保护提供有效指导。（中华眼科杂志，2020，56： ）.


Balancing Health and Economic Factors when Reopening Business in the Age of COVID-19.


title: Cytolytic activity of the human papillomavirus type 16 E711-20 epitope-specific cytotoxic T lymphocyte is enhanced by heat shock protein 110 in HLA-A*0201 transgenic mice.

text: Heat shock proteins (HSPs) have been successfully applied to a broad range of vaccines as biological adjuvants to enhance the immune response. The recently defined HSP110, in particular, exhibits strong protein binding affinity and is capable of enhancing the immunogenicity of protein antigens remarkably more than other HSP family members. In our previous study, we verified that murine HSP110 (mHSP110) significantly enhanced the immune response of a C57BL/6 mouse model to the H-2(d)-restricted human papillomavirus (HPV) E749-57 epitope (short peptide spanning the 49th to 57th amino acid residues in the E7 protein). To determine whether HSP110 similarly enhances the immunogenicity of human epitope peptides, we used the HLA-A2 transgenic mouse model to investigate the efficacy of the mHSP110 chaperone molecule as an immunoadjuvant of the human HLA-A2-restricted HPV16 E711-20 epitope vaccine. Results showed that mHSP110 efficiently formed a noncovalently bound complex with the E711-20 epitope. The mHSP110-E711-20 complex induced epitope-specific splenocyte proliferation and E711-20-specific gamma interferon (IFN-γ) secretion. Importantly, cytotoxic T lymphocytes primed by the mHSP110-E711-20 complex exerted strong cytolytic effects on target T2 cells pulsed with the E711-20 peptide or TC-1 cells transfected with the HLA-A2 gene. In addition, the mHSP110-E711-20 complex elicited stronger ex vivo and in vivo antitumor responses than either emulsified complete Freund's adjuvant or HSP70-chaperoned E711-20 peptide. These collective data suggest that HSP110 is a promising immunomodulator candidate for peptide-based human cancer vaccines, such as for the HLA-A2-restricted E711-20 epitope.


Covid-19: Death rate in England and Wales reaches record high because of covid-19.


title: Single chain MHC I trimer-based DNA vaccines for protection against Listeria monocytogenes infection.

text: To circumvent limitations of poor antigen presentation and immunogenicity of DNA vaccines that target induction of CD8(+) T cell immunity, we have generated single chain MHC I trimers (MHC I SCTs) composed of a single polypeptide chain with a linear composition of antigenic peptide, β2-microglobulin, and heavy chain of a MHC class I molecule connected by flexible linkers. Because of its pre-assembled nature, the SCT presents enhanced expression and presentation of the antigenic peptide/MHC complexes at the cell surface. Furthermore, DNA vaccination with a plasmid DNA encoding an SCT incorporating an immunodominant viral epitope elicited protective CD8(+) T cell responses against lethal virus infection. To extend these findings, here we tested the efficacy of SCT DNA vaccines against bacterial infections. In a mouse infection model of Listeria monocytogenes, the SCT DNA vaccine encoding H-2K(d) and the immunodominant peptide LLO 91-99 generated functional primary and memory peptide-specific CD8(+) T cells that confer partial protection against L. monocytogenes infection. DNA immunization of K(d)/LLO(91-99) SCTs generated functional memory CD8(+) T cells independently of CD4(+) T cells, although the expression of cognate or non-cognate CD4(+) helper T cell epitopes further enhanced the protective efficacy of SCTs. Our study further demonstrates that the SCT serves as a potent platform for DNA vaccines against various infectious diseases.


title: Effect of Grazing Behavior on Weight Regain Post-Bariatric Surgery: A Systematic Review.

text: Grazing, a type of maladaptive eating behavior, has been associated with poor weight outcomes in bariatric patients. The purpose of this study was to conduct a systematic review of the association between grazing behavior and weight regain post-bariatric surgery. Literature searches, study selection, design of the method, and quality appraisal were carried out by two independent authors. The search strategy was performed until October 2017 in Medline, Embase, Cochrane, Lilacs, Scopus, Web of Science, Google Scholar, ProQuest Dissertation & Theses, and Open Grey. Of a total of 3764 articles, five papers met the inclusion criteria (four original articles and one thesis), comprising 994 subjects, mostly women. The prevalence of grazing behavior ranged from 16.6 to 46.6%, and the highest prevalence of significant weight regain was 47%. The association between grazing and weight regain was observed in four of the five evaluated studies. Our findings support an association between grazing behavior and weight regain after bariatric surgery, regardless of surgery type and contextual concept of grazing. Further studies are needed to confirm the clarity of the real prevalence and interfering factors related to grazing behavior and weight outcomes.


title: Anterior versus posterolateral approach for total laparoscopic splenectomy: a comparative study.

text: OBJECTIVE Although the anterior approach is normally used for elective laparoscopic splenectomy (LS), the posterolateral approach may be superior. We have retrospectively compared the effectiveness and safety of these approaches in patients with non-severe splenomegaly scheduled for elective total LS. METHODS Patients with surgical spleen disorders scheduled for elective LS between March 2005 and June 2011 underwent laparoscopic splenic mobilization via the posterolateral or anterior approach. Main outcome measures included operation time, intraoperative blood loss, frequency of postoperative pancreatic leakage, and length of hospital stay. RESULTS During the study period, 203 patients underwent LS, 58 (28.6%) via the posterolateral and 145 (71.4%) via the anterior approach. Three patients (1.5%) required conversion to laparotomy due to extensive perisplenic adhesions. The posterolateral approach was associated with significantly shorter operation time (65.0 ± 12.3 min vs. 95.0 ± 21.3 min, P < 0.01), reduced intraoperative blood loss (200.0 ± 23.4 mL vs. 350.0 ± 45.2 mL, P < 0.01), and shorter hospital stay (5.0 ± 2.0 d vs. 9.0 ± 3.0 d, P < 0.01) than the anterior approach. The frequency of pancreatic leakage was slightly lower in patients undergoing LS via the posterolateral than the anterior approach (0.0% vs. 3.4%, P > 0.05). CONCLUSIONS The posterolateral approach is more effective and safer than the anterior approach in patients without severe splenomegaly (< 30 cm).


title: Gammaretrovirus-specific antibodies in free-ranging and captive Namibian cheetahs.

text: The cheetah population in Namibia is the largest free-ranging population in the world and a key population for research regarding the health status of this species. We used serological methods and quantitative real-time PCR to test free-ranging and captive Namibian cheetahs for the presence of feline leukemia virus (FeLV), a gammaretrovirus that can be highly aggressive in populations with low genetic diversity, such as cheetahs. We also assessed the presence of antibodies to other gammaretroviruses and the responses to a FeLV vaccine developed for domestic cats. Up to 19% of the free-ranging cheetahs, 27% of the captive nonvaccinated cheetahs, and 86% of the captive vaccinated cheetahs tested positive for FeLV antibodies. FeLV-antibody-positive free-ranging cheetahs also tested positive for Rauscher murine leukemia virus antibodies. Nevertheless, FeLV was not detectable by quantitative real-time PCR and no reverse transcriptase activity was detectable by product-enhanced reverse transcriptase assay in the plasma of cheetahs or the supernatants from cultures of peripheral blood mononuclear cells. The presence of antibodies to gammaretroviruses in clinically healthy specimens may be caused either by infection with a low-pathogenic retrovirus or by the expression of endogenous retroviral sequences. The strong humoral immune responses to FeLV vaccination demonstrate that cheetahs can respond to the vaccine and that vaccination against FeLV infection may be beneficial should FeLV infection ever become a threat, as was seen in Iberian lynx and Florida panthers.


title: Reduced port laparoscopic surgery for colon cancer in a patient with tuberculous kyphosis and dwarfism: a rare case and literature review.

text: With accumulated surgical experience, the contraindications to laparoscopic surgery have been decreasing. Reduced port laparoscopic surgery has been widely adopted for a variety of diseases. However, surgery in patients with anatomic deformities are still a challenge for surgeons, specifically abdominal surgery in patients with severe kyphosis. A 71-year-old man with a diagnosis of ascending colon cancer had severe kyphosis with extremely short stature, secondary to tuberculous spondylitis. Laparoscopic right hemicolectomy was successfully performed with a single umbilical incision plus one port. This is the first reported case involving laparoscopic surgery in a patient with tuberculous kyphosis. The purpose of this report is to describe the surgical skills of reduced port laparoscopic surgery in a patient with altered habitus. With proper planning and a meticulous operation, minimally invasive surgery could be safely achieved.


title: Endovascular treatment of pediatric intracranial aneurysms: a retrospective study of 35 aneurysms.

text: BACKGROUND Pediatric intracranial aneurysms are rare and not well characterized in comparison with those in adults. OBJECTIVE To analyze our institution's longitudinal experience of endovascular treatment for pediatric aneurysms to better understand this rare condition. METHODS A retrospective record review was performed of patients aged <20 years treated with endovascular methods for intracranial aneurysms between 1995 and 2012. There were 31 patients (average 14.4±4.2 years; 20 male, 11 female) with 35 intracranial aneurysms. RESULTS The rate of subarachnoid hemorrhage as the initial presentation was 48% and the rates of multiple and giant aneurysms were 13% and 31%, respectively; 28.5% of the cases were posterior circulation aneurysms. Fifteen saccular aneurysms occurred in 14 patients and 17 fusiform aneurysms were noted in 14 patients. Two infectious aneurysms were diagnosed in two patients and one traumatic aneurysm occurred in another patient. Thirty-four aneurysms were treated endovascularly and one had thrombosed spontaneously on a follow-up angiogram. Of the 15 saccular aneurysms, 11 were treated with conventional coiling, one was treated with stent-assisted coiling, one was treated with a flow-diverting stent and two were treated with parent vessel occlusion (PVO). Of the 17 fusiform aneurysms, 15 were treated with PVO with or without prior bypass surgery and one was treated with a flow-diverting stent. The rate of permanent complications and a favorable outcome were 2.9% and 87%, respectively. CONCLUSIONS Endovascular treatment of pediatric aneurysms is technically feasible with an acceptable complication rate despite the high incidence of fusiform aneurysms.


Does the newly observed inflammatory syndrome in children demonstrate a link between uncontrolled neutrophil extracellular traps formation and COVID-19?


title: The First Report of Laparoscopic Multivisceral Resection for a Gastrocolic Fistula Secondary to Colon Cancer.

text: BACKGROUND Colon cancer rarely presents with a gastrocolic fistula and resection, if feasible, is usually carried out by open surgery. The authors present the first literature case report of laparoscopic multivisceral resection for gastrocolic fistula secondary to locally advanced colon cancer. MATERIALS AND METHODS A 54-year-old man presented with feculant vomiting, cachexia, and severe iron deficiency anemia. Investigations confirmed a large nonmetastatic splenic flexure colon cancer with fistulation into the stomach. After 10 weeks of nutritional support and laparoscopic defunctioning proximal transverse loop colostomy, we proceeded to laparoscopic extended left hemicolectomy with en bloc sleeve gastrectomy and partial splenectomy. RESULT The procedure was completed laparoscopically (operating time, 400 min; blood loss, 150 mL). He was discharged on the 6th postoperative day after an uneventful recovery. Histology showed an R0 resection of a pT4N1a (1/45 lymph nodes involved) colon cancer with gastrocolic fistula. CONCLUSION Laparoscopic multivisceral en bloc R0 resection of locally advanced colon cancer with gastrocolic fistula can be accomplished safely in experienced hands.


title: Reoperative Parathyroidectomy: Overly Descended Superior Adenoma.

text: OBJECTIVES To identify the importance of the ectopic, overly descended superior parathyroid adenoma variant and its prevalence in primary and reoperative parathyroid surgery and the implications for successful initial parathyroidectomy. STUDY DESIGN Case series with planned data collection. SETTING Tertiary endocrine surgery practice in an academic medical center. SUBJECTS AND METHODS An analysis was undertaken of 561 consecutive patients undergoing parathyroid surgery in a tertiary endocrine surgery practice from March 2004 to April 2013. There were 270 patients who had curative primary or reoperative surgery for single-gland parathyroid adenomas during this time. Clinical records, imaging studies, operative reports, and pathology findings were evaluated, and cases from a subset of patients who had an ectopic, overly descended superior parathyroid adenoma were further analyzed. The prevalence of this entity in primary and revision surgeries was calculated. RESULTS Among the 270 patients with single-gland parathyroid adenomas, there were 251 primary operations and 19 reoperative procedures referred from outside institutions. An ectopic, overly descended superior parathyroid adenoma was present in 23 (9.2%) primary cases and 4 (21.1%) reoperative cases. CONCLUSION An overly descended superior parathyroid adenoma is frequently encountered during primary parathyroid surgery. It is more than twice as common in reoperative parathyroidectomy, reflecting the propensity to be missed at the first exploration. Recognition and proper treatment of this entity at the initial operation will reduce the need for revision surgery.


PPE: what now for the global supply chain?


title: The Percussive Effects of Pandemics and Disaster.

text: In this special issue, we note the percussive - immediate, disruptive and urgent - effects of the coronavirus pandemic, while anticipating its longer term repercussions. As social institutions, global and local economies, political relations, and everyday social lives are being remade, we highlight the implications of this microbial infection and its virulence. In doing so, we illustrate how medical anthropology both illuminates the present and warns of COVID-19's unequal unfolding.


title: Single-incision laparoscopic cholecystectomy in situs inversus totalis.

text: BACKGROUND AND OBJECTIVES Situs inversus totalis (SIT) is a rare congenital anomaly that can cause difficulties during standard laparoscopic cholecystectomy due to its mirror-image anatomy. These cases require more technically demanding procedures, and handedness of the surgeon may influence performance of these operations. Single-incision laparoscopic surgery (SILS) has been proposed as a less-invasive alternative to conventional laparoscopic surgery. We report the first case of successful SILS cholecystectomy in a patient with SIT and discuss technical aspects of the operation related to the handedness of the surgeon. CASE A 49-year-old man who was known to have situs inversus totalis presented with symptomatic cholelithiasis. This patient was operated on by a right-handed surgeon. The surgeon and camera assistant were positioned on the right and left side respectively with the video monitor above the patient's left shoulder. The SILS port (Covidien), which has 3 operating channels, was placed in the abdomen via a 2-cm intraumbilical incision. SILS cholecystectomy was performed successfully. Dissection of Calot's triangle and the gallbladder bed was performed using a dissector and hook in the right hand without any technical problems. CONCLUSION SIT may confer an advantage over the orthotopic position for right-handed surgeons. SILS cholecystectomy can be performed safely in SIT.


title: Opposing Roles of Double-Stranded RNA Effector Pathways and Viral Defense Proteins Revealed with CRISPR-Cas9 Knockout Cell Lines and Vaccinia Virus Mutants.

text: UNLABELLED Vaccinia virus (VACV) decapping enzymes and cellular exoribonuclease Xrn1 catalyze successive steps in mRNA degradation and prevent double-stranded RNA (dsRNA) accumulation, whereas the viral E3 protein can bind dsRNA. We showed that dsRNA and E3 colocalized within cytoplasmic viral factories in cells infected with a decapping enzyme mutant as well as with wild-type VACV and that they coprecipitated with antibody. An E3 deletion mutant induced protein kinase R (PKR) and eukaryotic translation initiation factor alpha (eIF2α) phosphorylation earlier and more strongly than a decapping enzyme mutant even though less dsRNA was made, leading to more profound effects on viral gene expression. Human HAP1 and A549 cells were genetically modified by clustered regularly interspaced short palindromic repeat-Cas9 (CRISPR-Cas9) to determine whether the same pathways restrict E3 and decapping mutants. The E3 mutant replicated in PKR knockout (KO) HAP1 cells in which RNase L is intrinsically inactive but only with a double knockout (DKO) of PKR and RNase L in A549 cells, indicating that both pathways decreased replication equivalently and that no additional dsRNA pathway was crucial. In contrast, replication of the decapping enzyme mutant increased significantly (though less than that of wild-type virus) in DKO A549 cells but not in DKO HAP1 cells where a smaller increase in viral protein synthesis occurred. Xrn1 KO A549 cells were viable but nonpermissive for VACV; however, wild-type and mutant viruses replicated in triple-KO cells in which RNase L and PKR were also inactivated. Since KO of PKR and RNase L was sufficient to enable VACV replication in the absence of E3 or Xrn1, the poor replication of the decapping mutant, particularly in HAP1 DKO, cells indicated additional translational defects. IMPORTANCE Viruses have evolved ways of preventing or counteracting the cascade of antiviral responses that double-stranded RNA (dsRNA) triggers in host cells. We showed that the dsRNA produced in excess in cells infected with a vaccinia virus (VACV) decapping enzyme mutant and by wild-type virus colocalized with the viral E3 protein in cytoplasmic viral factories. Novel human cell lines defective in either or both protein kinase R and RNase L dsRNA effector pathways and/or the cellular 5' exonuclease Xrn1 were prepared by CRISPR-Cas9 gene editing. Inactivation of both pathways was necessary and sufficient to allow full replication of the E3 mutant and reverse the defect cause by inactivation of Xrn1, whereas the decapping enzyme mutant still exhibited defects in gene expression. The study provided new insights into functions of the VACV proteins, and the well-characterized panel of CRISPR-Cas9-modified human cell lines should have broad applicability for studying innate dsRNA pathways.


COVID-19, Climate Change, and the American Thoracic Society: A Shared Responsibility.


title: Implementation of an evidence-based hand hygiene program in elementary schools in Ghana, as part of a City-to-City partnership between Ottawa public health and KEEA health directorate.

text: Ottawa Public Health in partnership with health staff from the municipality of KEEA (Komenda, Edina, Eguafo, Abrem) in Ghana engaged in a city-to-city partnership to adapt, implement, and evaluate an evidence-based hand hygiene public health initiative in elementary schools in Ghana. All 4 participating schools gained the necessary resources to carry out proper hand hygiene practice, and hand hygiene practice improved. Furthermore, pupils were more likely to wash hands after using the toilets and teachers were better equipped to be good role models. Providing resources to schools was key to the success of the implementation. This partnership gave health and education workers in Ghana the tools, knowledge, and confidence to implement a simple, evidence-based, hand hygiene program. One other remarkable outcome is that school children were the initiators of a behavior change in their community.


Novel Coronavirus: What Neuroradiologists as Citizens of the World Need to Know.


title: Methemoglobinemia should be suspected when oxygen saturation apparently decreases after prilocaine infiltration during intravenous sedation.

text: During intravenous sedation, a decrease in SpO2 is usually the result of respiratory failure. However, we experienced a case with SpO2 decrease that was caused by methemoglobinemia in prilocaine infiltration anesthesia during sedation. This indicates that methemoglobinemia should be considered if low SpO2 is sustained unrelated to sedation level.


title: Chromosome 14 transfer and functional studies identify a candidate tumor suppressor gene, mirror image polydactyly 1, in nasopharyngeal carcinoma.

text: Chromosome 14 allelic loss is common in nasopharyngeal carcinoma (NPC) and may reflect essential tumor suppressor gene loss in tumorigenesis. An intact chromosome 14 was transferred to an NPC cell line using a microcell-mediated chromosome transfer approach. Microcell hybrids (MCHs) containing intact exogenously transferred chromosome 14 were tumor suppressive in athymic mice, demonstrating that intact chromosome 14 NPC MCHs are able to suppress tumor growth in mice. Comparative analysis of these MCHs and their derived tumor segregants identified 4 commonly eliminated tumor-suppressive CRs. Here we provide functional evidence that a gene, Mirror-Image POLydactyly 1 (MIPOL1), which maps within a single 14q13.1-13.3 CR and that hitherto has been reported to be associated only with a developmental disorder, specifically suppresses in vivo tumor formation. MIPOL1 gene expression is down-regulated in all NPC cell lines and in approximately 63% of NPC tumors via promoter hypermethylation and allelic loss. SLC25A21 and FOXA1, 2 neighboring genes mapping to this region, did not show this frequent down-regulated gene expression or promoter hypermethylation, precluding possible global methylation effects and providing further evidence that MIPOL1 plays a unique role in NPC. The protein localizes mainly to the nucleus. Re-expression of MIPOL1 in the stable transfectants induces cell cycle arrest. MIPOL1 tumor suppression is related to up-regulation of the p21(WAF1/CIP1) and p27(KIP1) protein pathways. This study provides compelling evidence that chromosome 14 harbors tumor suppressor genes associated with NPC and that a candidate gene, MIPOL1, is associated with tumor development.


title: Correlation between antimicrobial consumption and resistance among Staphylococcus aureus and enterococci causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009.

text: This study investigated the correlation between antibiotic consumption and resistance among Staphylococcus aureus and enterococci causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009. Overall, the trend of total consumption (defined daily dose [DDD] per 1,000 patient-days) of glycopeptides, including vancomycin and teicoplanin, significantly increased during 2000 to 2003 and remained stable during 2004-2009. Vancomycin consumption significantly increased during 2003 and decreased after 2004. A significant decrease in the resistance rate with time was found for oxacillin- and gentamicin-resistant S. aureus. In contrast, the rates of vancomycin- and teicoplanin-resistant enterocci increased significantly. A significant correlation was found between the increased use of extended-spectrum cephalosporins, β-lactam-β-lactamase inhibitor combinations, carbapenems and the decreased prevalence of methicillin-resistant S. aureus (MRSA). In contrast, the increased use of teicoplanin, extended-spectrum cephalosporins, β-lactam-β-lactamase inhibitor combinations, and carbapenems was correlated with the increased prevalence of vancomycin-resistant enterococci (VRE). In conclusion, this 10-year study in a single institution identified different correlations between the prescription of antibiotics and the resistance rates of MRSA and VRE. Strict implementation of infection control policy based on these correlates would be helpful in decreasing the presence of these multidrug-resistant pathogens in hospitals.


title: Endovascular treatments for cerebral venous sinus thrombosis.

text: Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially fatal condition. CVST usually occurs young adults with a female predominance. The current mainstay for treating CVST is anticoagulation with heparin. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are non-responsive to heparin and other anticoagulants. Endovascular approaches include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy, all of which may rapidly recanalize the occluded venous sinus, restore the blood flow, reduce the increased intracranial pressure, and subsequently relieve the corresponding symptoms. However, as an invasive strategy, endovascular procedures per se may cause complications, such as intracranial hemorrhage, vessel dissection and pulmonary embolization, which may substantially decrease the benefit-risk ratio of the treatment. Due to the rareness of the condition and the limited indication of this invasive strategy, safety and efficacy of endovascular procedures in treating CVST are less feasible to be evaluated in large randomized clinical trails. Therefore, the evidences for justifying this treatment strategy are largely derived from case reports, cohort studies and clinical observations.


title: Molecular partners for interaction and cell internalization of cell-penetrating peptides: how identical are they?

text: Cell-penetrating peptides are short basic peptide sequences that might display amphipathic properties. These positively charged peptides internalize into all cell types, albeit with different efficiency. Cell-penetrating peptides use all routes of pinocytosis to internalize, in addition to direct membrane translocation that requires interaction with lipid membrane domains. These differences in internalization efficiency according to the peptide sequence and cell type suggest that the cell-penetrating peptides interact with different molecular partners at the cell surface. This review will first report on data that describe the molecular interaction of the most popular cell-penetrating peptides (penetratin, Tat and oligoarginine) with carbohydrates and lipids. The second part of the review will be dedicated to cell studies that have reported how cell surface composition influences cell internalization. Discussion will focus on the gap between in vitro and in cellulo studies, and more specifically to which extent the interaction with molecules found in membranes reflect the internalization efficiency of the peptides.


Audio Interview: New Data on Remdesivir in Covid-19.


title: N-Linked glycosylation is essential for the yellow head virus replication cycle.

text: Yellow head virus (YHV) particles contain a nucleocapsid protein (p20) and two envelope glycoproteins (gp116 and gp64). The glycans attached to the two glycoproteins are N-linked and are complex and high mannose types, respectively. Here, we show that treatment with the N-linked glycosylation inhibitor tunicamycin in YHV-infected black tiger shrimp (Penaeus monodon) resulted in less severe yellow head disease and reduced mortality when compared with untreated control shrimp. Quantitative real-time reverse transcription PCR analysis also revealed lower YHV copy numbers in the haemolymph of treated than control shrimp. This was concurrent with less intense immuno-reactions in tissues of treated versus untreated shrimp using mAbs against all three YHV structural proteins. In addition, transmission electron microscopy of lymphoid organ tissue of the treated and untreated shrimp [eight collected at 36 h and eight at 48 h post-infection (p.i.)] revealed only unenveloped nucleocapsids in all but one of the treated shrimp (collected at 48 h p.i.). By contrast, all the untreated shrimp showed a mixture of many unenveloped and enveloped virions. These results were supported by purification of YHV from the cell-free haemolymph of treated and untreated shrimp followed by YHV structural protein analysis by SDS-PAGE. It revealed three expected structural protein bands (116, 64 and 20 kDa) from the untreated shrimp but no structural protein bands from the tunicamycin-treated shrimp (confirmed by Western blot analysis). Overall, the results indicated that blocking glycosylation with tunicamycin inhibited the formation of mature YHV virions and their subsequent release into shrimp haemolymph, reducing the severity of disease.


title: Naso-esophageal extraluminal drainage for postoperative anastomotic leak after thoracic esophagectomy for patients with esophageal cancer.

text: Postoperative anastomotic leaks and subsequent mediastinal abscess are serious complications. The purpose of this study was to assess the efficacy of naso-esophageal extraluminal drainage after thoracic esophagectomy with gastric conduit reconstruction using a posterior mediastinal route. About 50 of 365 patients (13.7%) with esophageal cancer and postoperative anastomotic leak after curative esophagectomy was investigated. Beginning in June 2009, naso-esophageal extraluminal drainage by inserting a naso-esophageal aspiration tube into the abscess cavity when percutaneous abscess drainage was introduced which was ineffective or technically impossible. Twenty-five patients underwent naso-esophageal extraluminal drainage concomitantly with enteral nutrition. Twenty-one (84%) patients had major leaks, one (4%) minor leak and three (12%) had endoscopically proven conduit necrosis. None of the naso-esophageal extraluminal drainage cases (100%) required reintervention or reoperation and all experienced complete cure (100%) during hospitalization. Endoscopic balloon dilatation was performed for four patients after discharge because of anastomotic stricture. Patients with leaks were divided into two groups: current group (n = 32), treated after June 2009, and preceding group (n = 18), treated prior to the introduction of naso-esophageal extraluminal drainage. Significantly more patients in the preceding group suffered respiratory failure (28% vs. 61%, p = 0.024), and higher reoperation rate (0% vs. 17%, p = 0.042) and hospital mortality (0% vs. 22%, p = 0.013). In the current group, 31 (97%) patients experienced complete cure during hospitalization. Naso-esophageal extraluminal drainage and concomitant enteral nutritional support are less invasive, and effective and powerful methods to treat even major leakage after esophagectomy. These methods may be an alternative management to improve mortality for patients with esophageal cancer.


title: Possible involvement of coaxially stacked double pseudoknots in the regulation of -1 programmed ribosomal frameshifting in RNA viruses.

text: -1 programmed ribosomal frameshifting (PRF) in viruses is often stimulated by a pseudoknot downstream from the slippery sequence. At the PRF junction of HIV-1, transmissible gastroenteritis virus (TGEV), Barmah Forest virus (BFV), Fort Morgan virus (FMV), and Equine arteritis virus (EAV), we identified potential double pseudoknots in either a tandem mode or embedded mode. In viruses with tandem pseudoknots (5'PK & 3'PK), the slippery sequence is encompassed in the 5'PK. The ribosome needs to unwind the 5'PK to get to the slippery sequence. In HIV-1, the 3'PK and several alternative structures are mutually exclusive. Disruption of the tandem pseudoknots may enable one of the alternative structures to form as the effective frameshift stimulator. In TGEV/BFV/FMV, the 3'PK is a conventional frameshift stimulator. In all cases, the tandem pseudoknots may slow down the ribosome before it reaches the conventional PRF signals. In EAV, a compact pseudoknot is embedded within loop2 of the otherwise conventional frameshift-stimulating pseudoknot. All double pseudoknots have the potential to stack their stems coaxially. We built structural models of the HIV-1 and EAV double pseudoknots to show that both the tandem and embedded modes are feasible and reasonable. We hypothesize that the fundamental reason for the viruses to utilize coaxially stacked double pseudoknots is to increase the overall stability of the frameshift regulating structure, and avoid an ultra-stable single pseudoknot which may become a ribosomal roadblock. Our results significantly expand the repertoire of RNA structures and dynamics that may potentially involve in -1 PRF regulation.


title: Cultural differences in expectations of change and tolerance for contradiction: a decade of empirical research.

text: Since the publication of Peng and Nisbett's seminal paper on dialectical thinking, a substantial amount of empirical research has replicated and expanded on the core finding that people differ in the degree to which they view the world as inherently contradictory and in constant flux. Dialectical thinkers (who are more often members of East Asian than Western cultures) show greater expectation of change in tasks related to explanation and prediction and greater tolerance of contradiction in tasks involving the reconciliation of contradictory information. The authors show how these effects are manifested in the domains of the self, emotional experience, psychological well-being, attitudes and evaluations, social categorization and perception, and judgment and decision making. They note important topics in need of further investigation and offer predictions concerning possible cultural differences in unexplored domains as a function of the presence or absence of naïve dialecticism.


title: COVID in New York City, the epicenter: A New York University perspective and COVID in Duluth, the Bold North: A University of Minnesota perspective.

text: In the first part of this dual commentary, perspectives are gathered from students at New York University. COVID in New York City is compared with the trauma of the World Trade Center. Triggers, racism, concerns, acts of kindness, and the future are considered for both. The second part of the commentary is written in juxtaposition to the New York City perspective by sharing the Upper Midwest experiences of this COVID-19 pandemic period, particularly in the small city of Duluth. Perspectives are gathered over time from students at the University of Minnesota, Duluth. The Minnesota stories are presented chronologically, from the declaration of the global pandemic to the beginning of the summer semester. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups.

text: OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.


title: Single port laparoscopic liver resection for hepatocellular carcinoma: a preliminary report.

text: Single port laparoscopic surgery is an emerging technique, now commonly used in cholecystectomy. The experience of using this technique in liver resection for hepatocellular carcinoma is described in a series of 3 cases with single port laparoscopic liver resection performed during 2010. All patients were male aged 61 to 70 years, with several comorbidities. There were no complications in this early series. The length of hospital stay was 3-5 days. The blood loss was 200-450 mL, with operating time between 142 and 171 minutes. We conclude that this technique is feasible and safe to perform in experienced centers.


title: A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era.

text: The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.


title: Comparative long-term effectiveness and safety of primary bariatric surgeries in treating type 2 diabetes mellitus in adults: a protocol for systematic review and network meta-analysis of randomised controlled trials.

text: INTRODUCTION Bariatric surgeries are effective in treating obesity related comorbidities, including type 2 diabetes mellitus. More robust evidence is needed to facilitate choice of procedure. In this systemic review, we aim to investigate the comparative long-term effectiveness in inducing remission of type 2 diabetes, halting diabetic complications, reducing mortality and the safety of conventional and emerging bariatric surgeries. METHODS AND ANALYSIS Databases including Cochrane Central Register, EMBASE, MEDLINE and clinical trial registries will be searched for randomised controlled trials with at least 3 years of follow-up, including direct and/or indirect evidence regarding primary bariatric surgeries in overweight or obese adults with type 2 diabetes mellitus, from inception of each database to 2019, with no language or publication type limits imposed. Dual selection of studies, data extraction and risk of bias assessments will be performed. Primary outcomes include full diabetes remission, composite outcome of full or partial diabetes remission and adverse event profiles. Secondary outcomes include anthropometric measurements, cardiovascular risk factor burden, medication burden, diabetic complications and all-cause mortality. Given sufficient homogeneity, network meta-analyses will be performed in a random-effects model based on the Bayesian framework, while assessing for consistency between direct and indirect estimates. Heterogeneities of studies will be explored through meta-regression analysis, and robustness of findings will be checked by sensitivity analysis, and an alternative method under a frequentist framework. All statistical analysis and graphical presentations will be conducted by R software V.3.3.3 (The R Project for Statistical Computing). The overall quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation criteria for each outcome. ETHICS AND DISSEMINATION Ethics approval is not required as individual patient data will not be included. This review will be subject for publication in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018110775.


Novel Middle East respiratory syndrome and renal failure.


title: Transportation capacity for patients with highly infectious diseases in Europe: a survey in 16 nations

text: Abstract Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. In most European Union member states specialized isolation facilities are responsible for the management of such cases. Ground ambulances are often affiliated with those facilities because rapid relocation of patients is most desirable. To date, no pooled data on the accessibility, technical specifications and operational procedures for such transport capacities are available. During 2009, the ‘European Network for HIDs’ conducted a cross-sectional analysis of hospitals responsible for HID patients in Europe including an assessment of (a) legal aspects; (b) technical and infrastructure aspects; and (c) operational procedures for ground ambulances used for HID transport. Overall, 48 isolation facilities in 16 European countries were evaluated and feedback rates ranged from 78% to 100% (n = 37 to n = 48 centres). Only 46.8% (22/47) of all centres have both national and local guidelines regulating HID patient transport. If recommended, specific equipment is found in 90% of centres (9/10), but standard ambulances in only 6/13 centres (46%). Exclusive entrances (32/45; 71%) and pathways (30/44; 68.2%) for patient admission, as well as protocols for disinfection of ambulances (34/47; 72.3%) and equipment (30/43; 69.8%) exist in most centres. In conclusion, the availability and technical specifications of ambulances broadly differ, reflecting different preparedness levels within the European Union. Hence, regulations for technical specifications and operational procedures should be harmonized to promote patient and healthcare worker safety.


title: Shortened protocol for radiofrequency ablation of perforator veins.

text: BACKGROUND Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard treatment protocol at 85°C has a treatment time of 6 minutes. To make treatment time more efficient, we sought to determine the effect of a shortened protocol for radiofrequency stylet (RFS) ablation by comparing the early success using three different temperatures: 85°C, 90°C, and 95°C. METHODS A retrospective study examined 642 procedures of IPV closures in 255 patients with varying degrees of venous insufficiency treated with RFA from 2009 to 2015. The Covidien (Mansfield, Mass) RFA system allows the operator to regulate temperature and allows increments in temperature of the RFS to 85°C, 90°C, and 95°C. The RFS probe was angled at four 90-degree angles at the mentioned temperatures with a shorter treatment time at 6, 4, and 3 minutes, respectively. The three different treatment protocols were compared. All patients had comparative preoperative and postoperative duplex ultrasound scans. Postoperative duplex ultrasound scans were performed 3 to 7 days after the procedure. Successful obliteration was defined as lack of color flow on postoperative duplex ultrasound scanning. Clinical correlation with age, gender, laterality, presenting symptoms (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), location, and vein diameter was also performed. RESULTS Of the 255 patients who underwent RFS ablation, 138 were female, with a mean age of 65 years (standard deviation, ±14.6 years). These patients had CEAP presentations from C1 to C6 (0 C1, 1 C2, 57 C3, 118 C4, 4 C5, 75 C6). The location of the 642 IPVs was distributed as 472 in the calf and 170 in the ankle; 322 of these procedures were performed on the right leg. Use of a shortened protocol had no significant effect on the early obliteration rates with the 85°C, 90°C, and 95°C protocols, which were 66.1%, 61.8%, and 67.1%, respectively. Significant correlation was seen between location of targeted vein and successful obliteration (P < .001). There was a borderline inverse linear association between higher stylet temperature and successful obliteration in the proximal calf at 85°C. After accounting for within-patient correlation, the middle and distal calf continued to show higher nonobliteration compared with the ankle. No clinical correlation with age, gender, laterality, presenting symptoms of CEAP, or vein diameter was observed. CONCLUSIONS The study showed that shortening the protocol time for RFA of the perforator did not make a significant difference in the early success rate, regardless of the temperature. The overall early success rate is still low (65.1%). RFA of perforator veins has a higher successful closure rate in proximal calf and ankle areas compared with the middle and distal calf.


title: Effects of an Educational Glass Recycling Program against Environmental Pollution in Spain.

text: In this article, we analyzed the effects of an educational glass recycling program on primary schools and their students in Castilla-La Mancha (Spain). A sample of 89 schools, with 20,710 elementary students, was selected by simple random sampling. For the statistical analysis, descriptive techniques (frequencies and statistics), parametric (One Way ANOVA test), and non-parametric (Chi-Square test) inferential techniques were used, with a 5% significance level (p < 0.05). The program's results showed that 153,576.3 kg of glass (with a value of 17,064.03 €) were recycled. Significant determinants of glass recycling were: School category (p = 0.043), previous environmental/recycling education (p = 0.046), geographic location of school (p = 0.030), gender (p = 0.007), and academic year (p < 0.05). With the program, students learned the importance of glass recycling, obtained a greater knowledge of and habits related to the same, acquired favorable attitudes towards the environment, and promoted glass recycling in their social circles. We conclude that environmental education about glass recycling has positive effects on glass recycling attitudes and behaviors in elementary school students and may be used as a measure to combat the problem of environmental pollution.


title: Outcome after radiofrequency ablation of sarcoma lung metastases.

text: PURPOSE Resection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA). METHODS This is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded. RESULTS Twenty-two patients [15 women; median age 48 (range 10-78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5-2) cm, and 2.5 and 1 (1-7) respectively. Median CT and clinical follow-up were 12 (4-54) and 20 (8-63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival. CONCLUSION RFA is a safe and effective treatment for patients with small-volume sarcoma metastases.


COVID-19 and Cardiac Implantable Electronic Device Remote Monitoring: Crocodile Tears or New Opportunity?


Covid-19: UK starts social distancing after new model points to 260 000 potential deaths.


title: Cryoablation of sternal metastases for pain palliation and local tumor control.

text: PURPOSE To determine safety and effectiveness of cryoablation of sternal metastases for pain palliation and local tumor control. MATERIALS AND METHODS A tumor ablation database was retrospectively reviewed for sternal cryoablation procedures performed between January 2005 and June 2013, which yielded 15 procedures to treat 12 sternal metastases in 12 patients (five men). Median patient age was 57 years (range, 38-80 y). Metastases arose from five primary sites (breast, lung, kidney, ampulla, and thyroid), and median tumor size was 3.8 cm (range, 2.2-7.5 cm). Seven patients (58%) underwent cryoablation for pain palliation, and five (42%) underwent cryoablation for local tumor control of oligometastatic disease. Clinical outcomes (including complications, local tumor control, and pain response) were evaluated retrospectively. RESULTS Mean pain scores decreased from 7.0 ± 1.9 (median, 7; range, 4-10) at baseline to 1.8 ± 1.2 (median, 1.5; range, 0-4) following cryoablation (P = .00049). Two patients had durable pain palliation, and four had greater than 1 month of pain relief, with a median duration of 5.7 months (range, 1.5-14.7 mo). Two patients in whom recurrent pain developed underwent repeat cryoablation, with durable pain relief. Allowing for a single repeat treatment, local tumor control was achieved in four of five patients (80%) treated for this indication, with median follow-up of 8.4 months (range, 2.6-13.6 mo). In one patient (8%), an infectious complication developed that was successfully treated with antibiotics on an outpatient basis. CONCLUSIONS Cryoablation is a safe and potentially effective treatment for patients with painful sternal metastases and can achieve local tumor control in select patients.


title: The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study.

text: PURPOSE To assess whether the preoperative 1-h pad test could predict postoperative urinary incontinence and quality of life after robot-assisted radical prostatectomy. METHODS A total of 329 patients who underwent robot-assisted radical prostatectomy between 2013 and 2016 were prospectively enrolled in this study. These patients were divided into the preoperative urinary continence group and the preoperative urinary incontinence group according to the 1-h pad test. The time to achieve urinary continence, lower urinary tract function evaluated by uroflowmetry and post-voided residual urine volume, and quality of life evaluated by King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form were compared between these two groups. RESULTS There were 190 patients (58%) in the preoperative urinary continence group (1-h pad test ≤ 2 g) and 139 patients (42%) in the preoperative urinary incontinence group (1-h pad test > 2 g). In the preoperative urinary continence/incontinence groups, 83%/76% of patients achieved continence within 12 months, respectively, and urinary incontinence remained significantly longer in the preoperative incontinence group than in the preoperative continence group (P = 0.042). Although there were no significant differences in all quality of life items between the two groups before surgery, several items were significantly higher in the preoperative urinary continence group. CONCLUSION Achievement of urinary continence and improvement of urinary quality of life are delayed in patients with preoperative urinary incontinence assessed by the 1-h pad test. The preoperative 1-h pad test could be a useful predictor of prolonged urinary incontinence and poor quality of life after robot-assisted radical prostatectomy.


title: Discussing Goals of Care in a Pandemic: Precedent for an Unprecedented Situation.

text: The COVID-19 pandemic has precipitated the need for frequent end-of-life discussions. The circumstances surrounding these conversations are quite atypical. Here, I describe one such goals-of-care discussion during the pandemic and how I relied on the precedent of prior goals-of-care discussions to guide me through an unprecedented situation.


title: The accuracy of auditory spatial judgments in the visually impaired is dependent on sound source distance.

text: Blindness leads to substantial enhancements in many auditory abilities, and deficits in others. It is unknown how severe visual losses need to be before changes in auditory abilities occur, or whether the relationship between severity of visual loss and changes in auditory abilities is proportional and systematic. Here we show that greater severity of visual loss is associated with increased auditory judgments of distance and room size. On average participants with severe visual losses perceived sounds to be twice as far away, and rooms to be three times larger, than sighted controls. Distance estimates for sighted controls were most accurate for closer sounds and least accurate for farther sounds. As the severity of visual impairment increased, accuracy decreased for closer sounds and increased for farther sounds. However, it is for closer sounds that accurate judgments are needed to guide rapid motor responses to auditory events, e.g. planning a safe path through a busy street to avoid collisions with other people, and falls. Interestingly, greater visual impairment severity was associated with more accurate room size estimates. The results support a new hypothesis that crossmodal calibration of audition by vision depends on the severity of visual loss.


title: An Overview of Systematic Reviews and Meta- analyses on Acupuncture for Post-acute Stroke Dysphagia.

text: BACKGROUND Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. METHODS Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). RESULTS Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2-96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. CONCLUSION Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.