title: Isolation and Characteristics of the Arkansas-Type Infectious Bronchitis Virus in China.

text: Two infectious bronchitis virus (IBV) strains, designated as γCoV/ck/China/I0712/11 (I0712/11) and γCoV/ck/China/I0108/17 (I0108/17), were isolated from diseased chicken flocks in different provinces in China and genotyped as Arkansas (Ark)-type viruses with three other Chinese Ark field strains, the Jilin vaccine strain, and the American Ark- and Ark DPI-like viruses. Complete genomic sequence analysis and pairwise comparison of nucleotide sequences encoding the S1 subunit of the spike protein and other structural and accessory proteins revealed that Chinese Ark field isolates were genetically closely related to the Jilin vaccine and American ArkDPI11 strains, although extensive nucleotide changes were found across the genomes of Chinese Ark field isolates. This suggests that Chinese Ark-type isolates are derived from the Jilin vaccine, and have diverged and evolved independently by point mutations since introduction into China. It is also possible that the Chinese Ark viruses have arisen as a result of different introductions of American ArkDPI11-like strains from the United States; this hypothesis requires further investigation. Pathogenicity testing showed that Chinese Ark viruses had comparable virulence to that of the Massachusetts-type M41 strain, although they had lower affinity for the kidneys of chickens than the M41 strain had. Although Ark-type viruses are not widespread in China, surveillance and updating the currently applied vaccination strategy for sound protection against IBV disease are important because this type of virus has caused heavy economic losses in the United States.


title: Neutrophils are needed for an effective immune response against pulmonary rat coronavirus infection, but also contribute to pathology.

text: Polymorphonuclear neutrophils (PMN) infiltrate the respiratory tract early after viral infection and can contribute to both host defence and pathology. Coronaviruses are important causes of respiratory tract infections, ranging from mild to severe depending on the viral strain. This study evaluated the role of PMN during a non-fatal pulmonary coronavirus infection in the natural host. Rat coronavirus (RCoV) causes respiratory disease in adult rats, characterized by an early PMN response, viral replication and inflammatory lesions in the lungs, mild weight loss and effective resolution of infection. To determine their role during RCoV infection, PMN were depleted and the effects on disease progression, viral replication, inflammatory response and lung pathology were analysed. Compared with RCoV infection in control animals, PMN-depleted rats had worsened disease with weight loss, clinical signs, mortality and prolonged pulmonary viral replication. PMN-depleted animals had fewer macrophages and lymphocytes in the respiratory tract, corresponding to lower chemokine levels. Combined with in vitro experiments showing that PMN express cytokines and chemokines in response to RCoV-infected alveolar epithelial cells, these findings support a role for PMN in eliciting an inflammatory response to RCoV infection. Despite their critical role in the protection from severe disease, the presence of PMN was correlated with haemorrhagic lesions, epithelial barrier permeability and cellular inflammation in the lungs. This study demonstrated that while PMN are required for an effective antiviral response, they also contribute to lung pathology during RCoV infection.


title: Quantification of fibrin in blood thrombi formed in hemodialysis central venous catheters: a pilot study on 43 CVCs.

text: PURPOSE Fibrin deposition and thrombotic occlusion represent a serious cause of access dysfunction in hemodialysis central venous catheters (CVCs). The aim of this work was to define and apply a method for imaging and quantifying fibrin in thrombi formed into the side holes of CVCs. METHODS Forty-three CVCs removed from a cohort of dialyzed patients were analyzed in this pilot study. Hematoxylin and eosin and a modified Carstair's staining were applied on permanent thrombus sections. Fluorescence microscopy and image analysis were performed to quantify the fibrin amount. RESULTS Highly fluorescent areas were invariably associated with fibrin by Carstair's method. The deposition of concentric layers of fibrin and erythrocytes was easily identified by fluorescence microscopy, showing growth features of the thrombus. Fibrin amount in diabetic patients was significantly higher than that in nondiabetic patients with median (interquartile range) values of 51% (47-68%) and 44% (30-54%), respectively (p=0.032). No significant difference in fibrin content was found by grouping data according to catheter type, permanence time, insertion site and dialysis vintage. Higher variability in fibrin values was found in thrombi from CVCs removed after 1-15 days compared with 16-60 days. A trend of an increase in fibrin amount in thrombi was noted according to blood platelet count at CVC insertion. CONCLUSIONS The analytical method presented here proved to be a rapid and effective way for quantifying fibrin content in thrombi formed on CVCs with potential application in future clinical studies.


title: Rapid reconstruction of SARS-CoV-2 using a synthetic genomics platform.

text: Reverse genetics has been an indispensable tool revolutionising insights into viral pathogenesis and vaccine development. Large RNA virus genomes, such as from Coronaviruses, are cumbersome to clone and manipulate in E. coli due to size and occasional instability1-3. Therefore, an alternative rapid and robust reverse genetics platform for RNA viruses would benefit the research community. Here we show the full functionality of a yeast-based synthetic genomics platform to genetically reconstruct diverse RNA viruses, including members of the Coronaviridae, Flaviviridae and Paramyxoviridae families. Viral subgenomic fragments were generated using viral isolates, cloned viral DNA, clinical samples, or synthetic DNA, and reassembled in one step in Saccharomyces cerevisiae using transformation associated recombination (TAR) cloning to maintain the genome as a yeast artificial chromosome (YAC). T7-RNA polymerase has been used to generate infectious RNA to rescue viable virus. Based on this platform we have been able to engineer and resurrect chemically-synthetized clones of the recent epidemic SARS-CoV-24 in only a week after receipt of the synthetic DNA fragments. The technical advance we describe here allows a rapidly response to emerging viruses as it enables the generation and functional characterization of evolving RNA virus variants-in real-time-during an outbreak.


title: The Role of Contrast-enhanced Ultrasound in Guiding Radiofrequency Ablation of Hepatocellular Carcinoma: A Retrospective Study.

text: PURPOSE The objective of the study was to determine the efficacy of contrast-enhanced ultrasound (CEUS) using ultrasound (US)-specific microbubbles in guiding radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS A retrospective analysis of 50 patients with HCC treated with CEUS guided RFA using perflutren at our institution was performed. CEUS images were first compared to B-mode US images performed at the same RFA session to determine the ability of CEUS to increase the conspicuity of lesions. A qualitative score (1 = poor, 2 = fair, 3 = excellent) was used to grade the ability to visualize the lesions. The preprocedure CEUS images were then evaluated using the most recent prior contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The efficacy of the treatment was evaluated with short-term follow-up imaging (median 1 month) for presence of residual or recurrent disease. RESULTS CEUS allows at least fair visualization (score ≥2) in 78% (reader 1) and 80% (reader 2) of the lesions not visualized by B-mode US, and 50% (reader 1) and 42% (reader 2) of the lesions poorly visualized by B-mode US. Lesion appearances on CEUS are largely concordant with those on CT or MRI: 88% for reader 1, 96% for reader 2. With CEUS-guided RFA, complete response was achieved in the vast majority of the lesions at short-term follow-up: 82% for reader 1, 94% for reader 2. CONCLUSIONS CEUS increases the conspicuity and provides better characterization of hypervascular HCC that are either not seen or poorly seen on B-mode US, and CEUS provides real-time guidance of RFA with good short-term treatment responses.


title: Improved access and visibility during stapling of the ultra-low rectum: a comparative human cadaver study between two curved staplers.

text: UNLABELLED BACKGROUND The purpose of this study was to compare in human cadavers the applicability of a commonly used stapling device, the CONTOUR® curved cutter (CC) (Ethicon Endo-Surgery, Cincinnati, OH) to a newly released, curved stapler, the Endo GIA™ Radial Reload with Tri-Staple™ Technology (RR) (Covidien, New Haven, CT) METHODS: Four experienced surgeons performed deep pelvic dissection with total mesorectal excision (TME) of the rectum in twelve randomized male cadavers. Both stapling devices were applied to the ultra-low rectum in coronal and sagittal configurations. Extensive measurements were recorded of anatomic landmarks for each cadaver pelvis along with various aspects of access, visibility, and ease of placement for each device. RESULTS The RR reached significantly lower into the pelvis in both the coronal and sagittal positions compared to the CC. The median distance from the pelvic floor was 1.0 cm compared to 2.0 cm in the coronal position, and 1.0 cm versus 3.3 cm placed sagitally, p < 0.0001. Surgeons gave a higher visibility rating with less visual impediment in the sagittal plane using the RR Stapler. Impediment of visibility occurred in only 10% (5/48) of RR applications in the coronal position, compared to a rate of 48% (23/48) using the CC, p = 0.0002. CONCLUSIONS The RR device performed significantly better when compared to the CC stapler in regards to placing the stapler further into the deep pelvis and closer to the pelvic floor, while causing less obstructing of visualization.


title: Incidence and clinical course of COVID-19 in patients with connective tissue diseases: a descriptive observational analysis.

text: The outbreak of COVID-19 in December 2019 in China has very quickly become a global health emergency with almost two million of infected patients worldwide.[1] Along with the spread of the pandemic, there has been a growing concern about the management of fragile rheumatic patients, for whom there is still very little data available. In particular, subjects affected by connective tissue diseases (CTD) are known to have an increased infectious risk compared to the healthy population due to a general impairment of the immune system intrinsic to the autoimmune disease itself, the iatrogenic effect linked to the use of immunosuppressive drugs, and the high number of comorbidities that often complicate the clinical picture.[2,3].


title: Modifying flow in the ICA bifurcation: Pipeline deployment from the supraclinoid ICA extending into the M1 segment-clinical and anatomic results.

text: BACKGROUND AND PURPOSE Utility of the Pipeline Embolization Device extending to the M1 and its clinical and flow consequences at the ICA bifurcation have not been characterized. We analyzed flow modification in cases where a single Pipeline Embolization Device was deployed from the M1 to the distal supraclinoid ICA, covering the A1, for aneurysm treatment. MATERIALS AND METHODS A1 flow modifications and size regression in postprocedure and follow-up angiography were analyzed. Vessel diameters and ratios of the proximal A1 and M1 segments and the distal ICA were assessed. Relationships between Pipeline Embolization Device nominal diameter and the vessel diameters at landing zones were obtained. Clinical assessments after flow modification were documented. RESULTS Six of 7 patients demonstrated no change of flow in the anterior cerebral artery/anterior communicating artery complex at immediate postembolization angiography. All patients who underwent follow-up angiography demonstrated size regression of the ipsilateral A1. Midterm follow-up angiography revealed complete reversal of flow in the ipsilateral A1 in 4 of 5 patients. One patient did not demonstrate flow modification. This patient had a dominant ipsilateral A1. Vessel ratios in this case demonstrated a unique configuration in favor of maintaining patency of the ipsilateral A1. There were no clinical or radiographic signs of ischemia. One patient experienced asymptomatic angiographic in-stent stenosis at the M1. CONCLUSIONS We found that deployment of a Pipeline Embolization Device from the distal supraclinoid ICA to the M1 may result in reversal of flow in the anterior cerebral artery/anterior communicating artery complex and regression of the ipsilateral A1. Preoperative anatomic quantitation and sizing of the Pipeline Embolization Device may predict flow modification results.


title: Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices.

text: BACKGROUND AND PURPOSE Treatment of patients with ischemic stroke after endovascular treatment requires in-depth knowledge of complications. The goal of this study was to make endovascular treatment for acute ischemic stroke safer through an in-depth review of the major periprocedural complications observed in the Solitaire FR With Intention for Thrombectomy (SWIFT) trial. MATERIALS AND METHODS The SWIFT data base was searched for major peri-procedural complications defined as symptomatic intracranial hemorrhage within 36 hours, SAH, air emboli, vessel dissection, major groin complications, and emboli to new vascular territories. RESULTS Major peri-procedural complications occurred in 18 of 144 patients (12.5%) as follows: symptomatic intracranial hemorrhage, 4.9%; air emboli, 1.4%; vessel dissection, 4.2%; major groin complications, 2.8%; and emboli to new vascular territories, 0.7%. Rates of symptomatic intracranial bleeding by subtype were PH1, 0.7%; PH2, 0.7% (PH1 indicates hematoma within ischemic field with some mild space-occupying effect but involving ≤ 30% of the infarcted area; PH2, hematoma within ischemic field with space-occupying effect involving >30% of the infarcted area); intracranial hemorrhage remote from ischemic zone, 0%; intraventricular hemorrhage, 0.7%; and SAH, 3.5%. We did not observe any statistically significant associations of peri-procedural complications with age; type of treatment center; duration of stroke symptoms; NIHSS score, IV thrombolytics, atrial fibrillation, site of vessel occlusion; rescue therapy administered after endovascular treatment; or device. Comparing the Merci with the Solitaire FR retrieval device, we observed symptomatic cerebral hemorrhage (10.9% versus 1.1%; P = .013); symptomatic SAH (7.3% versus 1.1%; P = .07), air emboli (1.8% versus 1.1%; P = 1.0), emboli to new vascular territories (1.8% versus 0%; P = .38), vessel dissection (1.8% versus 4.5%; P = .65), and major groin complications (3.6% versus 7.9%; P = .48). Angiographic vasospasm was common but without clinical sequelae. CONCLUSIONS Understanding of procedural complications is important for treatment of patients with stroke after endovascular treatment. We observed fewer endovascular complications with the Solitaire FR device treatment compared with Merci device treatment, particularly symptomatic cerebral hemorrhage.


Stroke: Part 2.


title: Controversies in the role of preoperative embolization in meningioma management.

text: The role of preoperative embolization in meningioma management remains controversial, even though 4 decades have passed since it was first described. It has been shown to offer benefits such as decreased blood loss and "softening of the tumor" during subsequent resection. However, the actual benefits remain unclear, and the potential harm of an additional procedure along with the cost of embolization have limited its use to a small proportion of the meningiomas treated. In this article the authors retrospectively reviewed their experience with preoperative embolization of meningiomas over the previous 6 years (March 2007-March 2013). In addition, they performed a MEDLINE search using a combination of the terms "meningioma," "preoperative," and "embolization" to analyze the indications, embolizing agents, timing, and complications reported during preoperative embolization of meningiomas. In this retrospective review, 18 cases (female/male ratio 12:6) were identified in which endovascular embolization was used prior to resection of an intracranial meningioma. Craniotomy for tumor resection was performed within 4 days after endovascular embolization in all cases, with an average time to surgery of 1.9 days. The average duration of surgery was 4 hours and 18 minutes, and the average blood loss was 574 ml, with a range of 300-1000 ml. Complications following endovascular therapy were identified in 3 (16.7%) of 18 cases, including one each of transient hemiparesis, permanent hemiparesis, and tumor swelling. The literature review returned 15 articles consisting of a study population greater than 25 patients. No randomized controlled study was found. The use of small polyvinyl alcohol particles (45-150 μm) is more effective in preoperative devascularization than larger particles (150-250 μm), but is criticized due to the higher risk of complications such as cranial nerve palsies and postprocedural hemorrhage. Time to surgery after embolization is inconsistently reported across the articles, and conclusions on the appropriate timing of surgery could not be drawn. The overall complication rate reported after treatment with preoperative meningioma embolization ranges from as high as 21% in some of the older literature to approximately 6% in recent literature describing treatment with newer embolization techniques. The evidence in the literature supporting the use of preoperative meningioma embolization is mainly from case series, and represents Level III evidence. Due to the lack of randomized controlled clinical trials, it is difficult to draw any significant conclusions on the overall usefulness of preoperative embolization during the management of meningiomas to consider it a standard practice.


title: Towards a real time release approach for manufacturing tablets using NIR spectroscopy.

text: The aim of this study was to use the near-infrared spectroscopy (NIRS) as a process analytical tool to evaluate the conformity of paracetamol tablets in terms of four Pharmacopoeia tests (content uniformity, hardness, disintegration time, friability) and to control in-line blend uniformity. Tablets were manufactured by direct compression. Three different active pharmaceutical ingredient (API) concentrations were manufactured and three different compaction pressures were used. Intact tablets were analysed by transmission mode with NIRS prior to European Pharmacopoeia tests that were used as reference methods. Partial least square (PLS) regression was selected to build the prediction NIR models for content uniformity, tablet hardness and disintegration time. The prediction of NIR content uniformity and tablet hardness methods were validated using the accuracy profile approach. The values of the root mean squared error of calibration (RMSEC) and the root mean squared error of prediction (RMSEP) for the disintegration time indicated the robustness and the global accuracy of the NIR model. Regarding the tablet friability test, the classification was based on K-nearest neighbours (KNN). Then tablet NIR analyses successfully allowed the prediction of their conformity. Compared to the time consuming Pharmacopoeia reference methods, the benefit of this nondestructive method is significant, especially for reducing batch release time.


title: A scoping literature review of studies assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions.

text: PURPOSE Approximately 1.5% of the world's population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development. METHODS Fourteen databases were searched from 1995-2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies. RESULTS The searches resulted in a total of 28,958 articles, a focus on studies with the words "randomized" OR "randomized" OR "cost" OR "economic" in their citation reduced this total to 2644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. A total of 346 randomized controlled trials were identified, with only four randomized controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures. CONCLUSIONS While various international organizations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments. Implications for rehabilitation Research into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations. Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research. This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.


Can Twitter predict disease outbreaks?


title: Ergonomics of disposable handles for minimally invasive surgery.

text: BACKGROUND The ergonomic deficiencies of currently available minimally invasive surgery (MIS) instrument handles have been addressed in many studies. In this study, a new ergonomic pistol handle concept, realized as a prototype, and two disposable ring handles were investigated according to ergonomic properties set by new European standards. METHODS In this study, 25 volunteers performed four practical tasks to evaluate the ergonomics of the handles used in standard operating procedures (e.g., measuring a suture and cutting to length, precise maneuvering and targeting, and dissection of a gallbladder). Moreover, 20 participants underwent electromyography (EMG) tests to measure the muscle strain they experienced while carrying out the basic functions (grasp, rotate, and maneuver) in the x, y, and z axes. The data measured included the number of errors, the time required for task completion, perception of pressure areas, and EMG data. The values for usability in the test were effectiveness, efficiency, and user satisfaction. Surveys relating to the subjective rating were completed after each task for each of the three handles tested. RESULTS Each handle except the new prototype caused pressure areas and pain. Extreme differences in muscle strain could not be observed for any of the three handles. Experienced surgeons worked more quickly with the prototype when measuring and cutting a suture (approximately 20%) and during precise maneuvering and targeting (approximately 20%). On the other hand, they completed the dissection task faster with the handle manufactured by Ethicon. Fewer errors were made with the prototype in dissection of the gallbladder. In contrast to the handles available on the market, the prototype was always rated as positive by the volunteers in the subjective surveys. CONCLUSIONS None of the handles could fulfil all of the requirements with top scores. Each handle had its advantages and disadvantages. In contrast to the ring handles, the volunteers could fulfil most of the tasks more efficiently using the prototype handle without any remarkable pressure areas, cramps, or pain.


Dual endolaparoscopic technique (DUET) for TAMIS proctectomy and concomitant parastomal hernia repair.


title: Lessons From the West Africa Ebola Epidemic: A Systematic Review of Epidemiological and Social and Behavioral Science Research Priorities.

text: This systematic literature review compared the epidemiological (EPI) research and the qualitative social and behavioral science (SBS) research published during the West Africa Ebola virus disease (EVD) epidemic. Beginning with an initial capture of over 2000 articles, we extracted 236 EPI and 171 SBS studies to examine how disciplinary priorities affected research conducted during the EVD response, with implications for epidemic response effectiveness. Building on this research, we set forth a roadmap for the closer integration of EPI and SBS research in all aspects of epidemic preparedness and response that incorporates the lessons of the West Africa EVD outbreak. Key priorities include the following: (1) developing the capacity to systematically quantify qualitative sociocultural variables; (2) establishing interdisciplinary collaborations to improve "risk segmentation" practices; (3) creating and prepositioning qualitative indicators and composite sociocultural indexes for rapid deployment in outbreaks; (4) integrating novel systems with community resources; (5) developing new techniques for modeling social mobilization and community engagement; (6) prioritizing good data and complex analyses early in emergencies; and (7) learning from past experiences. Our findings support a program of action that situates data collection and analysis in real-time, recursive, integrated efforts to move community attitudes, behaviors, and responses into epidemiological research. We offer recommendations to improve coordinated, multidisciplinary approaches to health emergencies.


title: Synthesis and immunological evaluation of a MUC1 glycopeptide incorporated into l-rhamnose displaying liposomes.

text: MUC1 variable number tandem repeats (VNTRs) conjugated to tumor-associated carbohydrate antigens (TACAs) have been shown to break self-tolerance in humanized MUC1 transgenic mice. Therefore, we hypothesize that a MUC1 VNTR TACA-conjugate can be successfully formulated into a liposome-based anticancer vaccine. The immunogenicity of the vaccine should be further augmented by incorporating surface-displayed l-rhamnose (Rha) epitopes onto the liposomes to take advantage of a natural antibody-dependent antigen uptake mechanism. To validate our hypothesis, we synthesized a 20-amino-acid MUC1 glycopeptide containing a GalNAc-O-Thr (Tn) TACA by SPPS and conjugated it to a functionalized Toll-like receptor ligand (TLRL). An l-Rha-cholesterol conjugate was prepared using tetra(ethylene glycol) (TEG) as a linker. The liposome-based anticancer vaccine was formulated by the extrusion method using TLRL-MUC1-Tn conjugate, Rha-TEG-cholesterol, and 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) in a total lipid concentration of 30 mM. The stability, homogeneity, and size characterization of the liposomes was evaluated by SEM and DLS measurements. The formulated liposomes demonstrated positive binding with both anti-Rha and mouse anti-human MUC1 antibodies. Groups of female BALB/c mice were immunized and boosted with a rhamnose-Ficoll (Rha-Ficoll) conjugate formulated with alum as adjuvant to generate the appropriate concentration of anti-Rha antibodies in the mice. Anti-Rha antibody titers were >25-fold higher in the groups of mice immunized with the Rha-Ficoll conjugate than the nonimmunized control groups. The mice were then immunized with the TLRL-MUC1-Tn liposomal vaccine formulated either with or without the surface displaying Rha epitopes. Sera collected from the groups of mice initially immunized with Rha-Ficoll and later vaccinated with the Rha-displaying TLRL-MUC1-Tn liposomes showed a >8-fold increase in both anti-MUC1-Tn and anti-Tn antibody titers in comparison to the groups of mice that did not receive Rha-Ficoll. T-cells from BALB/c mice primed with a MUC1-Tn peptide demonstrated increased proliferation to the Rha-liposomal vaccine in the presence of antibodies isolated from Rha-Ficoll immunized mice compared to nonimmune mice, supporting the proposed effect on antigen presentation. The anti-MUC1-Tn antibodies in the vaccinated mice serum recognized MUC1 on human leukemia U266 cells. Because this vaccine uses separate rhamnose and antigenic epitope components, the vaccine can easily be targeted to different antigens or epitopes by changing the peptide without having to change the other components.


title: Platelet Gene Expression and Function in COVID-19 Patients.

text: There is an urgent need to understand the pathogenesis of coronavirus disease 2019 (COVID-19). In particular, thrombotic complications in patients with COVID-19 are common and contribute to organ failure and mortality. Patients with severe COVID-19 present with hemostatic abnormalities that mimic disseminated intravascular coagulopathy associated with sepsis with the major difference being increased risk of thrombosis rather than bleeding. However, whether SARS-CoV-2 infection alters platelet function to contribute to the pathophysiology of COVID-19 remains unknown. In this study, we report altered platelet gene expression and functional responses in patients infected with SARS-CoV-2. RNA sequencing demonstrated distinct changes in the gene expression profile of circulating platelets of COVID-19 patients. Pathway analysis revealed differential gene expression changes in pathways associated with protein ubiquitination, antigen presentation and mitochondrial dysfunction. The receptor for SARS-CoV-2 binding, ACE2, was not detected by mRNA or protein in platelets. Surprisingly, mRNA from the SARS-CoV-2 N1 gene was detected in platelets from 2/25 COVID-19 patients, suggesting platelets may take-up SARS-COV-2 mRNA independent of ACE2. Resting platelets from COVID-19 patients had increased P-selectin expression basally and upon activation. Circulating platelet-neutrophil, -monocyte, and -T-cell aggregates were all significantly elevated in COVID-19 patients compared to healthy donors. Furthermore, platelets from COVID-19 patients aggregated faster and showed increased spreading on both fibrinogen and collagen. The increase in platelet activation and aggregation could partially be attributed to increased MAPK pathway activation and thromboxane generation. These findings demonstrate that SARS-CoV-2 infection is associated with platelet hyperreactivity which may contribute to COVID-19 pathophysiology.


Introducción. El virus sincicial respiratorio humano (hRSV) es la causa más frecuente de infección respiratoria aguda de las vías respiratorias inferiores en niños menores de cinco años. El desarrollo de técnicas moleculares para identificarlo es uno de los retos actuales en el campo de la investigación clínica. Objetivo. Evaluar un método de amplificación isotérmica para la detección rápida del hRSV en niños con infección respiratoria aguda. Materiales y métodos. Se extrajo el ARN viral de 304 muestras de hisopado nasal en niños con síntomas de infección respiratoria aguda atendidos en el servicio de urgencias del Hospital de la Universidad del Norte en Barranquilla entre abril del 2016 y julio del 2017. Se evaluó la prueba de amplificación isotérmica mediada por bucle mediante transcriptasa inversa de la proteína de la matriz (M) (Reverse Transcription Loop-Mediated Isothermal Amplification, RT-LAMP) comparada con técnicas moleculares como la reacción en cadena de la polimerasa mediante transcriptasa inversa múltiple anidada (Reverse Transcription-Polymerase Chain Reaction, RT-PCR), la cual se empleó como la prueba estándar, la PCR en tiempo real (quantitative PCR, qPCR) y la RT-LAMP de la proteína L (L) para la detección rápida del virus sincicial respiratorio (VSR), subtipo A y subtipo B. Resultados. La prueba de RT-LAMP (M) tuvo una sensibilidad de 93,59 %, una especificidad de 92,92 % y una concordancia de 0,83 ± 0,036 comparada con la prueba de RT-PCR anidada. El índice kappa del RT-LAMP (M) fue superior, y los valores del RTLAMP (L) y la qPCR concordaron (0,75 ± 0,043 y 0,71 ± 0,045, respectivamente).


title: [New respiratory viruses in children 2 months to 3 years old with recurrent wheeze].

text: INTRODUCTION Respiratory viruses are associated with respiratory exacerbations, more frequently Respiratory Syncytial Virus in infants and Rhinovirus in children. OBJECTIVE To evaluate the prevalence and epidemiological features of newer and traditional respiratory viruses in infants and young children with recurrent wheeze. MATERIAL AND METHODS Cross sectional, prospective and descriptive study. Patients with recurrent wheeze and risk factors for asthma, age 2 months to 3 years, hospitalized with bronchial obstruction were included. On admission a respiratory sample was obtained through a nasopharyngeal aspirate. Immunofluorescence was performed to detect Respiratory Syncytial Virus, Adenovirus, Parainfluenza 1, 2, 3 and Influenza A and B. Polymerase Chain Reaction was used to detect Rhinovirus, Enterovirus, Metapneumovirus, Bocavirus, Adenovirus and Coronavirus. RESULTS 119 patients (61 female), age (x E DS) 1.5 E 0.9 years were included. Days on admission and on oxygen requirement were, respectively (x E DS): 6.3 E 2.9 y 4.4 E 2.7. One hundred and two (86%) positive cases were diagnosed. Fifty five percent of the viruses were detected by Immunofluorescence and 45% by Polymerase Chain Reaction. A single virus was present in 75% of the samples, 22% had a double co-infection and 3% a triple virus co-infection. Overall, the prevalence of detected respiratory viruses was: Respiratory Syncytial Virus 55 (43%); Rhinovirus 30 (23%); Metapneumovirus 13 (10%); Influenza A 8 (6%); Enterovirus 6 (5%); Bocavirus 6 (5%); Adenovirus 4 (3%); Coronavirus 3 (2%); Parainfluenza 1: 2 (1%); Influenza B, 1 (1%) and Parainfluenza 3: 1 (1%). CONCLUSIONS Infants and young children with recurrent wheeze and risk factors for asthma hospitalized for bronchial obstruction present a high prevalence of respiratory viruses. Hospital admissions were more frequent during months of higher respiratory circulation.


title: Radiation therapy and the innate immune response: clinical implications for immunotherapy approaches.

text: Radiation therapy is an essential component of cancer care, contributing up to 40% of curative cancer treatment regimens. It creates DNA double-strand breaks causing cell death in highly replicating tumour cells. However, tumours can develop acquired resistance to therapy. The efficiency of radiation treatment has been increased by means of combining it with other approaches such as chemotherapy, molecule-targeted therapies and, in recent years, immunotherapy. Cancer-cell apoptosis after radiation treatment causes an immunological reaction that contributes to eradicate the tumour via antigen presentation and subsequent T-cell activation. On the other hand, radiotherapy also contributes to the formation of an immunosuppressive environment that hinders the efficacy of the therapy. Innate immune cells from myeloid and lymphoid origin show a very active role in both acquired resistance and anti-tumorigenic mechanisms. Therefore, many efforts are being made in order to reach a better understanding of the innate immunity reactions after radiation therapy and the design of new combinatorial immunotherapy strategies focused in these particular populations.


title: Surgical treatment of gallbladder carcinoma: a critical review.

text: Gallbladder carcinoma is a relatively uncommon cancer of gastrointestinal (GI) tract. Medical literature is full of nihilistic reports about the treatment of gallbladder carcinoma, especially due to its resistance to current radiotherapeutic or chemotherapeutic treatment modalities and difficult surgical approach for complete resection of these tumors. Herein, we review current diagnostic and therapeutic approaches to this rare GI cancer.


title: Development of a pragmatic framework to help food and drink manufacturers select the most sustainable food waste valorisation strategy.

text: Food waste is a significant contemporary issue in the UK, with substantial environmental, social and economic costs to the nation. Whilst efforts to reduce food waste are laudable, a significant proportion of food and drink manufacturer waste is unavoidable. On the one hand, there is a drive from industry to reclaim as much value from this waste as possible, for example, by conversion to valuable products in what is known as "valorisation". At the same time, growing social and legislative pressures mean that any attempts to valorise food waste must be performed in a sustainable manner. However, for every company and its specific food wastes, there will be multiple valorisation possibilities and few tools exist that allow food and drink manufacturers to identify which is most profitable and sustainable for them. Such a decision would need to not only consider environmental, social and economic performance, but also how ready the technology is and how well it aligns with that company's strategy. In response, this paper develops and presents a hybrid framework that guides a company in modelling the volumes/seasonality of its wastes, identifying potential valorisation options and selecting appropriate indicators for environmental, social and economic performance as well as technological maturity and alignment with company goals. The framework guides users in analyzing economic and environmental performance using Cost-Benefit Analysis and Life Cycle Assessment respectively. The results can then be ranked alongside those for social performance, technological maturity and alignment with company goals using a weighted sum model variant of Multi-Criteria Decision Analysis to facilitate easy visual comparison. This framework is demonstrated in the form of a case study with a major UK fruit consolidator to identify the optimal strategy for managing their citrus waste. Possibilities identified included sale of imperfect but still edible waste via wholesale at a significantly reduced profit and the investment in facilities to extract higher value pectin from the same waste stream using a microwave assisted pectin extraction process. Results suggest that continued sale of waste to wholesale markets is currently the most beneficial in terms of economic viability and environmental performance, but that in the medium to long term, the projected growth in the market for pectin suggests this could become the most viable strategy.


title: Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis.

text: Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.


title: Attention to the principles of exercise training in exercise studies on prostate cancer survivors: a systematic review.

text: BACKGROUND The purpose of this review is to update previously published reviews on exercise programming in exercise trials in prostate cancer survivors. We evaluated: 1) the application of the principles of exercise training in prescribed programs; 2) the reporting of the components of the exercise prescription; and 3) the reporting of adherence of participants to the prescribed programs. METHODS Building upon a previous review, a systematic review was conducted searching OVID Medline, Embase, CINAHL, and SPORTDiscus databases from 2012-2017. Randomized controlled trials of at least four weeks of aerobic and/or resistance exercise in men diagnosed with prostate cancer that reported physical fitness outcomes, including body composition were eligible for inclusion. RESULTS Specificity was appropriately applied by 93%, progression by 55%, overload by 48%, initial values by 55%, and diminishing returns by 28% of eligible studies. No study adequately applied the principle of reversibility. Most (79%) studies reported all components of the exercise prescription in the study methods, but no study reported all components of adherence to the prescribed intervention in the study results. CONCLUSIONS Application of standard exercise training principles is inadequate in exercise trials in men with prostate cancer and could possibly lead to an inadequate exercise stimulus. While many studies report the basic components of the exercise prescription in their study methods, full reporting of actual exercise completed is needed to advance our understanding of the optimal exercise dose for men with prostate cancer and promote translation of controlled trials to practice.


The first veterinary telemedicine study group.


Presenting prevalence, characteristics and outcome of asthmatic patients with T2 diseases in hospitalized subjects with COVID-19 in Madrid, Spain.


title: The dengue virus non-structural protein 1 (NS1) is secreted from infected mosquito cells via a non-classical caveolin-1-dependent pathway.

text: Dengue virus NS1 is a glycoprotein of 46-50 kDa that is conserved among flaviviruses, associates as a dimer to cell membranes and is secreted as a hexamer to the extracellular milieu. Recent evidence showed that NS1 is secreted efficiently from infected mosquito cells. To explore the secretory route of NS1 in mosquito cells, infected cells were treated with brefeldin A (BFA) and methyl-beta-cyclodextrin (MβCD). The results showed that MβCD, but not BFA, significantly reduced the release of NS1. Moreover, silencing the expression of caveolin-1 (CAV1; a key component of the caveolar system that transports cholesterol inside the cell), but not SAR1 (a GTPase that participates in the classical secretory pathway), also results in a significant reduction of the secretion of NS1. These results indicate that NS1 is released from mosquito cells via an unconventional secretory route that bypasses the Golgi complex, with the participation of CAV1. In agreement with this notion, differences were observed in the glycosylation status between secreted NS1 and E proteins. Classical mechanics and docking simulations suggested highly favoured interactions between the caveolin-binding domain present in NS1 and the scaffolding domain of CAV1. Finally, proximity ligation assays showed direct interaction between NS1 and CAV1 in infected mosquito cells. These findings are in line with the lipoprotein nature of secreted NS1 and provide new insights into the biology of NS1.


title: Inter-Day Reliability and Changes of Surface Electromyography on Two Postural Muscles Throughout 12 Weeks of Hippotherapy on Patients with Cerebral Palsy: A Pilot Study.

text: Cerebral palsy (CP) is an umbrella term covering a group of permanent developmental disorders of movement and posture characterized by highly variable clinical features. The aim of this study was to assess the short-term and mid-term effects of neurorehabilitation via hippotherapy on the contractile properties of two key postural muscles during functional sitting in such patients. Thirty-minute hippotherapy sessions were conducted biweekly for 12 weeks in 18 patients (18.1 ± 5.7 years old). Surface electromyography (EMG) was implemented bilaterally in rectus abdominis and adductor magnus. We quantitatively analyzed the amplitude of EMG signals in the time domain and its spectral characteristics in the frequency domain. EMGs were recorded at the beginning and end of each session on day one and at week six and week twelve. Statistical analysis revealed a substantial inter-day reliability of the EMG signals for both muscles, validating the methodological approach. To a lesser extent, while beyond the scope of the current study, quantitative changes suggested a more selective recruitment/contractile properties' shift of the examined muscles. Exploring postural control during functional activities would contribute to understanding the relationship between structural impairment, activity performance and patient capabilities, allowing the design of neurorehabilitation programs aimed at improving postural and functional skills according to each individual's needs. The present study provides basic quantitative data supporting the body of scientific evidence making hippotherapy an approach of choice for CP neurorehabilitation.


title: Pancreatitis and Systemic Coronavirus Infection in a Ferret (Mustela putorius furo).

text: A 1-y-old spayed female ferret (Mustela putorius furo) was referred for additional diagnostic evaluation after physical examination by the referring veterinarian revealed a cranial abdominal mass. The ferret had a 2-wk history of inappetence, weight loss, and lethargy. On presentation, the ferret was thin, and an approximately 3-cm mass was palpable in the cranial abdomen. No other abnormalities were noted. Abdominal ultrasonography confirmed the presence of a soft-tissue structure, with a moderate blood supply and mesenteric lymphadenopathy. Fine-needle aspirates of the mass were nondiagnostic. Exploratory laparotomy revealed multiple nodules and thickened tissues throughout the mesentery, a thickened and nodular pancreas, and a small amount of free abdominal fluid. Histopathology of mesenteric, lymphatic, and pancreatic biopsies revealed suppurative pancreatitis and necrotizing and pyogranulomatous mesenteric steatitis. Positive immunohistochemistry for feline coronavirus confirmed a diagnosis of ferret systemic coronavirus disease (FSCD). The ferret was treated medically with oral prednisolone, improved dramatically, and was still doing well 22 mo after diagnosis. Although FSCD has been reported extensively, this case is noteworthy for the presence of suppurative pancreatitis and the positive long-term outcome after corticosteroid therapy.


title: Agreement between lower esophageal and nasopharyngeal temperatures in children ventilated with an endotracheal tube with leak.

text: BACKGROUND A temperature probe placed in the lower third of the esophagus accurately reflects core temperature in anesthetized children. Temperature probes are commonly placed in the nasopharynx in children, but when utilizing an uncuffed endotracheal tube (ETT) with a softly audible leak, ventilated gases from the trachea can escape upwards toward the nasopharynx, thereby potentially causing a cooling effect in the nasopharynx. OBJECTIVES We sought to establish if nasopharyngeal and lower esophageal temperatures are in agreement in children undergoing general anesthesia, both in scenarios of ventilation with a cuffed ETT that has minimal or no leak (cuff up), as well as an ETT with leak (cuff down). METHODS A prospective, crossover agreement study was performed on anesthetized children. Children were intubated with a MicroCuff(®) ETT and had temperature probes inserted into both the nasopharynx and lower esophagus. Under standardized ventilator and gas flow settings, temperatures were recorded with the ETT cuff inflated, and with the cuff deflated. Bland-Altman plots were utilized to assess agreement of temperatures. RESULTS Fifty patients successfully completed this study. The mean difference between esophageal and nasopharyngeal temperature was found to be -0.03°C in the presence of minimal or no leak around the ETT (cuff up), with 95% limits of agreement (LOA) of -0.22 to 0.15°C. The mean difference between esophageal and nasopharyngeal temperature was found to be 0.1°C when a larger leak existed around the ETT (cuff down), with LOA of -0.31 to 0.51°C. CONCLUSIONS Nasopharyngeal temperature accurately reflects lower esophageal temperature when there is minimal or no ETT leak. When a larger ETT leak is present, nasopharyngeal temperature is on average 0.1°C cooler than lower esophageal temperature. As the nasopharyngeal temperature probe site confers the advantage of simplicity of accurate placement compared to its esophageal counterpart, our findings support the use of nasopharyngeal temperature probes in children ventilated with both cuffed and uncuffed ETTs.


Treatment considerations for coronavirus (COVID-19).


title: Oral Sucrose for Pain Relief During Clubfoot Casting: A Double-Blinded Randomized Controlled Trial.

text: BACKGROUND Idiopathic clubfoot treatment is treated by manipulation and casting utilizing the Ponseti technique which can make the infant fussy and irritable. The goal of this study was to determine which intervention could decrease this pain response in infants undergoing Ponseti casting for idiopathic clubfeet. Our hypothesis was that the administration of oral sucrose solution or milk would be the most effective in accomplishing that goal. METHODS We conducted a double-blinded randomized controlled trial at a tertiary pediatric orthopaedic center on 33 children (average age=17.94 d; SD=20.51 d) undergoing clubfoot manipulation and casting and their guardians. Each cast was considered a new event and was randomized to an oral 20% sucrose solution (S), water (W), or milk (M) in a bottle (breast or nonbreast). We assessed the Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation before, during, and after the casting. RESULTS A total of 131 casts were randomized and 118 analyzed (37 M, 42 S, 39 W). Each child underwent an average of 3.97 casts (SD=1.74). There were no significant differences seen between the groups before casting in their mean NIPS score (M=2.2; SD=2.38, S=1.84, SD=2.18, W=1.61, SD=2.12). However during casting, mean NIPS score for both milk, 0.91 (SD=1.26, P=0.0005) and sucrose, 0.64 (SD=1.27, P<0.0001) were significantly less than water, 2.27 (SD=2.03) but not different from each other (P=0.33). Postcasting, the sucrose NIPS score, 0.69 (SD=1.53) continued to be significantly less than milk, 2.11 (SD=2.37, P=0.0065. There was no correlation between heart rate or oxygen saturation and NIPS. CONCLUSIONS Sucrose solution and milk during Ponseti casting and manipulation were effective in decreasing the pain response in children undergoing manipulation and casting for clubfeet. The sucrose solution administration continued the pain relief into the postcasting period. In addition to the benefits of improving the patient experience during casting, a less irritable child may result in better casting. LEVEL OF EVIDENCE Level 1 evidence.


Groovy RNA polymerase.


title: How to meet the challenge of flexible exposure of the Calot triangle in SILS cholecystectomy.

text: Single-incision laparoscopy was developed to further reduce the operative trauma in routine laparoscopic procedures. However, the method remains challenging because the exposure of the Calot triangle is more difficult as the use of a singular traction device does not allow the flexible 3-dimensional mounting of the structures. We introduce a technical improvement involving both exposure and traction. After installation of the technical devices for single-incision laparoscopy cholecystectomy, as usual, a suture on a Keith needle is inserted subcostally from the right side of the patient, passed midway through the infundibulum, and extracted subcostally on the left side of the patient. The suture is fixed with 2 metal clips on each side of the gallbladder. The gallbladder can be tilted both medially and laterally on a horizontal line and the Calot triangle can be dissected from medial and lateral aspects following the "critical view of safety" criteria used in conventional laparoscopy.


title: Videoendoscopic single-port axillary dissection.

text: Videoendoscopy is newly used in breast and axillary surgery. Single-port surgery is one of the newest methods of minimally invasive surgery. This report describes the first case of videoendoscopic single-port axillary dissection. In histopathological evaluation, 24 lymph nodes were identified and one node was infiltrated by the cancer cells. Videoendoscopic single-port axillary dissection is a precise and improvable technique. Single-port videoendoscopic axillary dissection could be more feasible with individual tools that will be designed for minimally invasive breast surgery.


title: Innate immune responses after resection for lung cancer via video-assisted thoracoscopic surgery and thoracotomy.

text: OBJECTIVE Innate immune responses to pulmonary resection may be critical in the pathogenesis of important postoperative pulmonary complications and potentially longer-term survival. We sought to compare innate immunity of patients undergoing major pulmonary resection for bronchogenic carcinoma via video-assisted thoracoscopic surgery (VATS) and thoracotomy. METHODS Bronchoalveolar lavage was conducted in the contralateral lung before staging bronchoscopy and mediastinoscopy and immediately after lung resection. Blood and exhaled nitric oxide were sampled preoperatively and at 6, 24, and 48 hours postoperatively. RESULTS Forty patients were included (26 VATS and 14 thoracotomy). There was a lower systemic cytokine response from lung resection undertaken by VATS compared with thoracotomy [interleukin 6 (IL-6), analysis of variance (ANOVA) P = 0.026; IL-8, ANOVA P = 0.018; and IL-10, ANOVA P = 0.047]. The VATS patients had higher perioperative serum albumin levels (ANOVA P = 0.001). Lower levels of IL-10 were produced by lipopolysaccharide-stimulated blood monocytes from the VATS patients compared with the thoracotomy patients at 6 hours postoperatively (geometric mean ratio, 1.16; 95% confidence interval, 1.08-1.33; P = 0.011). No statistically significant differences in the neutrophil phagocytic capacity, overall leukocyte count, or differential leukocyte count were found between the surgical groups (ANOVA P > 0.05). No statistically significant differences in bronchoalveolar lavage fluid parameters were found. Exhaled nitric oxide levels fell postoperatively, which reached statistical significance at 48 hours (geometric mean ratio, 1.2; 95% confidence interval, 1.02-1.46; P = 0.029). There were no significant differences found between the surgical groups (ANOVA P = 0.331). CONCLUSIONS Overall, a trend toward greater proinflammatory and anti-inflammatory responses is seen with lung resection performed via thoracotomy compared with VATS.


title: Renal ACE and ACE2 expression in early diabetic rats.

text: BACKGROUND/AIM The role of angiotensin-converting enzyme (ACE)-related carboxypeptidase-2 (ACE2) in the regulation of the renin-angiotensin system is not well characterized. This study investigated the changes in the expression of ACE and ACE2 in the kidney in early diabetic rats. METHODS Streptozotocin-induced diabetic rats were examined. The concentrations of angiotensin II in plasma, urine, and renal cortex were measured by radioimmunoassay. The mRNA expression of ACE, ACE2, angiotensin II type 1 receptor (AT1R), and Mas receptor (MasR) in glomeruli and cortex was assessed using real-time PCR. The glomerular and cortical expression of ACE and ACE2 was assessed by immunohistochemistry. RESULTS For renal cortical tissue, the angiotensin II level was more intensified in the 8-week diabetic rats. Immunohistochemical experiments showed that ACE was increased, but ACE2 was decreased in the glomeruli of 8-week diabetic rats, while both ACE and ACE2 in the tubules were increased. The AT1R mRNA in the glomeruli was decreased, while the MasR mRNA was increased in 2-week diabetic rats. CONCLUSION The combined effects of increased ACE and decreased ACE2 in glomeruli may be associated with the activation of the renin-angiotensin system in early diabetic rats, which is known to increase proteinuria.


title: Blood-based biomarkers of cancer-related cognitive impairment in non-central nervous system cancer: protocol for a scoping review.

text: INTRODUCTION Cancer-related cognitive impairment (CRCI) can have detrimental effects on quality of life, even among patients with non-central nervous system (CNS) cancers. Several studies have been conducted to explore different markers associated with CRCI to understand its pathobiology. It is proposed that the underlying mechanisms of CRCI are related to a cascade of physiological adaptive events in response to cancer and/or treatment. Hence, peripheral blood would be a logical source to observe and identify these physiological events. This paper outlines the protocol for a scoping review being conducted to summarise the extant literature regarding blood-based biomarkers of CRCI among patients with non-CNS cancer. METHODS/ANALYSIS Methods will be informed by the updated guidelines of Arksey and O'Malley. The systematic search for literature will include electronic databases, handsearching of key journals and reference lists, forward citation tracking and consultation with content experts. Study selection will be confirmed by duplicate review and calculation of inter-rater reliability. Data to be charted will include study design, sample size, cancer and treatment characteristics, demographic characteristics, cognitive variable/s and biomarkers assessed, associations between cognitive functioning and biomarkers (including statistics used), and rigour in biomarker sample collection and processing. Results will be presented through: (1) a descriptive numerical summary of studies, including a flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, (2) a list of blood-based biomarkers associated with CRCI and (3) a narrative overview developed through collaboration among the research team and consultation with content experts. DISSEMINATION The findings of this review will highlight current directions and gaps in the current body of evidence that may lead to improved rigour in future CRCI investigations. The dissemination of this work will be facilitated through the involvement of clinicians and researchers on the research team, an external consultation process and the presentation of the results through scholarly publication and presentation.


title: Effects of misalignment on static torsional strength of anterior cervical plate systems.

text: BACKGROUND CONTEXT There is little understanding of cervical plate misalignment as a risk factor for plate failure at the plate-screw-bone interface. PURPOSE To assess the torsional strength and mode of failure of cervical plates misaligned relative to the midsagittal vertical axis. STUDY DESIGN Plastic and foam model spine segments were tested using static compression and torsion to assess effects of misaligned and various lengths anterior cervical plate (ACPs). METHODS Different length ACPs and cancellous fixed angle screws underwent axial torsional testing on a servo-hydraulic test frame at a rate of 0.5°/s. A construct consisted of one ACP, four screws, one ultrahigh-molecular weight polyethylene inferior block, and one polyurethane foam superior block. Group 1 had ACPs aligned in the midsagittal vertical axis, group 2 plates were positioned 20° offset from the midline, and group 3 had the ACP shifted 5 mm away and 20° offset from midline. Torques versus angle data were recorded. The failure criterion was the first sign of pullout determined visually and graphically. RESULTS Group 1 had a more direct screw pullout during failure. For the misaligned plates, failure was a combination of the screws elongating the holes and shear forces acting between the plate and block. The misaligned plates needed more torque to failure. The failure torque was 50% reduced for the longer versus the shorter plates in the neutral position. Graphically shown initial screw slippage inside the block preceded visual identification of slippage in some cases. CONCLUSIONS We observed different failure mechanisms for neutral versus misaligned plates. Clinically, misalignment may have the benefit of needing more torque to fail. Misalignment was a risk factor for failure of the screw-bone interface, especially in longer plate constructs. These comparisons of angulations may be a solid platform for expansion toward a more applicable in vivo model.


title: Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020

text: BACKGROUND & OBJECTIVES: Sentinel surveillance among severe acute respiratory illness (SARI) patients can help identify the spread and extent of transmission of coronavirus disease 2019 (COVID-19). SARI surveillance was initiated in the early phase of the COVID-19 outbreak in India. We describe here the positivity for COVID-19 among SARI patients and their characteristics. METHODS: SARI patients admitted at 41 sentinel sites from February 15, 2020 onwards were tested for COVID-19 by real-time reverse transcription-polymerase chain reaction, targeting E and RdRp genes of SARS-CoV-2. Data were extracted from Virus Research and Diagnostic Laboratory Network for analysis. RESULTS: A total of 104 (1.8%) of the 5,911 SARI patients tested were positive for COVID-19. These cases were reported from 52 districts in 20 States/Union Territories. The COVID-19 positivity was higher among males and patients aged above 50 years. In all, 40 (39.2%) COVID-19 cases did not report any history of contact with a known case or international travel. INTERPRETATION & CONCLUSIONS: COVID-19 containment activities need to be targeted in districts reporting COVID-19 cases among SARI patients. Intensifying sentinel surveillance for COVID-19 among SARI patients may be an efficient tool to effectively use resources towards containment and mitigation efforts.


title: The effect of general anesthesia versus intravenous sedation on diagnostic yield and success in electromagnetic navigation bronchoscopy.

text: BACKGROUND Navigational bronchoscopy is utilized to guide biopsies of peripheral lung nodules and place fiducial markers for treatment of limited stage lung cancer with stereotactic body radiotherapy. The type of sedation used for this procedure remains controversial. We performed a retrospective chart review to evaluate the differences of diagnostic yield and overall success of the procedure based on anesthesia type. METHODS Electromagnetic navigational bronchoscopy was performed using the superDimension software system. Once the targeted lesion was within reach, multiple tissue samples were obtained. Statistical analysis was used to correlate the yield with the type of sedation among other factors. A successful procedure was defined if a diagnosis was made or a fiducial marker was adequately placed. RESULTS Navigational bronchoscopy was performed on a total of 120 targeted lesions. The overall complication rate of the procedure was 4.1%. The diagnostic yield and success of the procedure was 74% and 87%, respectively. Duration of the procedure was the only significant difference between the general anesthesia and IV sedation groups (mean, 58 vs. 43 min, P=0.0005). A larger tumor size was associated with a higher diagnostic yield (P=0.032). All other variables in terms of effect on diagnostic yield and an unsuccessful procedure did not meet statistical significance. CONCLUSIONS Navigational bronchoscopy is a safe and effective pulmonary diagnostic tool with relatively low complication rate. The diagnostic yield and overall success of the procedure does not seem to be affected by the type of sedation used.


title: Health Communication and the Arts in the United States: A Scoping Review.

text: OBJECTIVES Guided by the hypothesis that the arts can play a role in changing attitudes, beliefs, and health behaviors, the objectives of the study were to (1) overview artistic practices, interventions, and research being conducted at the intersection of the arts and health communication and (2) identify desired and observed outcomes and variables measured in these studies. DATA SOURCE The search strategy was developed iteratively with 2 health science librarians and conducted using 8 databases (Applied Social Sciences Index and Abstracts, Art and Architecture Source, CINAHL, Communication and Mass Media Complete, ERIC, PsycINFO, PubMed, and Web of Science) and hand searching. Articles included were published between 2014 and 2018. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria include US nonclinical setting and use of the arts (broadly defined) to change health knowledge, beliefs, behaviors, or awareness. Any articles not meeting inclusion criteria were excluded. DATA EXTRACTION Covidence's data extraction tool exported to MS Excel. DATA SYNTHESIS This final set of results was analyzed and synthesized by research design, population, sample size, health issue, purpose, variables measured, and findings. RESULTS In all, 78 articles met inclusion criteria. Number of participants ranged from 4 to 2140 (mean = 179); 61 (78.2%) outcome studies, including 8 experimental studies; 17 (21.79%) formative research or reports. Many different health topics were addressed and different art forms used. CONCLUSION The arts can help build knowledge and awareness of health issues. The authors highlight the need to build an evidence base for arts and public health.


title: Partial pancreatectomy and splenectomy using a bipolar vessel sealing device in a cat with an anaplastic pancreatic carcinoma.

text: A 14-year old domestic shorthair cat was presented because of vomiting, anorexia and an abdominal mass. A diagnosis could not be made preoperative and during surgery the mass was assigned to the gastric part of the pancreas. A partial pancreatectomy and splenectomy was performed using a Ligasure® vessel sealing device. No surgery related complications occurred. Histological examination revealed an anaplastic carcinoma of the pancreas. The cat was in a good clinical condition 14 days after surgery. After 2 months the cat was euthanized with the suspicion of a bone tumor. Findings of this case demonstrate that pancreatic carcinoma in cats has a poor prognosis but pancreatectomy can be performed using a bipolar vessel sealing device as a safe and fast alternative to standard surgical techniques.


title: COVID-19 Pandemic: Workforce Implications for Gerontological Social Work.

text: The COVID-19 pandemic has been challenging for people of all ages but particularly devastating to adults 65 and older, which has highlighted the critical need for ensuring that all social workers gain the knowledge and skills necessary to work with this population. While there is a critical shortage of gerontological social workers and we must continue to increase that number, we cannot wait for this to occur. In this commentary, the authors call for infusing the current social work curricula with aging content; providing current social workers with trainings on aging practice; and all social work practitioners, faculty, and researchers to address four specific areas that have gained prominence due to the impact of COVID-19: ageism, loneliness and social isolation, technology, and interprofessional practice, in their respective areas.


title: Testosterone and semen seasonality for the sand tiger shark Carcharias taurus†.

text: Understanding the fundamental reproductive biology of a species is the first step towards identifying parameters that are critical for reproduction and for the development of assisted reproductive techniques. Ejaculates were collected from aquarium (n = 24) and in situ (n = 34) sand tiger sharks Carcharias taurus. Volume, pH, osmolarity, sperm concentration, motility, status, morphology and plasma membrane integrity were assessed for each ejaculate. Semen with the highest proportion of motile sperm was collected between April-June for both in situ and aquarium sand tiger sharks indicating a seasonal reproductive cycle. Overall, 17 of 30 semen samples collected from aquarium sharks from April through June contained motile sperm compared to 29 of 29 of in situ sharks, demonstrating semen quality differences between aquarium and in situ sharks. Sperm motility, status, morphology and plasma membrane integrity were significantly higher (P < 0.05) for in situ compared to aquarium sand tiger sharks. Testosterone was measured by an enzyme immunoassay validated for the species. Testosterone concentration was seasonal for both aquarium and in situ sharks with highest concentrations measured in spring and lowest in summer. In situ sharks had higher (P < 0.05) testosterone concentration in spring than aquarium sharks. This study demonstrated annual reproduction with spring seasonality for male sand tiger sharks through marked seasonal differences in testosterone and semen production. Lower testosterone and poorer semen quality was observed in aquarium sharks likely contributing to the species' limited reproductive success in aquariums.


SARS-CoV-2-Related Inflammatory Multisystem Syndrome in Children: Different or Shared Etiology and Pathophysiology as Kawasaki Disease?


State intervention in China.


title: Comparison of three different adenoidectomy techniques in children - has the conventional technique been surpassed?

text: INTRODUCTION Pharyngeal tonsil hyperplasia is the most frequent cause of nasal obstruction and chronic mouth breathing during childhood. Adenoidectomy is the procedure of choice for the resolution of these symptoms. It is not yet known, however, whether the conventional technique ("blind curettage") has been surpassed by more modern adenoidectomy techniques (video-assisted, with the aid of instruments). This study aimed to compare the conventional adenoidectomy technique with two other emerging techniques, performed in a reference otorhinolaryngology center. METHODS This is a prospective and observational study of 33 children submitted to adenoidectomy using 3 different techniques that were followed up for a period of 3 months after surgery. The patients were divided into 3 different groups, according to the adenoidectomy technique: Group A (conventional technique - "blind curettage"); Group B (video-assisted adenoidectomy with microdebrider); Group C (video-assisted adenoidectomy with radiofrequency - Coblation®). The surgical time of each procedure was measured, being considered from the moment of insertion of the mouth gag until complete hemostasis was achieved. The questionnaire for quality of life OSA-18 was applied to all caregivers on the day of the surgery and 30-90 days after the procedure. Postoperative complications were also analyzed. RESULTS For the entire patient sample, there was an improvement in quality of life after the surgery (p < 0.05). When analyzing the evolution of OSA-18 index, all groups showed statistically significant improvement, for all assessed domains. There were no statistically significant differences between the 3 techniques assessed for quality of life improvement after the surgery (p > 0.05). Regarding the duration of the procedure, the conventional technique showed the shortest surgical time when compared to the others (p < 0.05). No postoperative complications were noted, for any patient. CONCLUSIONS The adenoidectomy resulted in improvement of quality of life, and there were no major postoperative complications, for all operated children, regardless of the technique used. The conventional technique was faster when compared to the more modern adenoidectomy techniques.


title: Randomized clinical trial of the impact of insulin therapy on liver function in patients undergoing major liver resection.

text: BACKGROUND Postoperative liver dysfunction is the major source of morbidity and mortality in patients undergoing partial hepatectomy. This study tested the benefits of a metabolic support protocol based on insulin infusion, for reducing liver dysfunction following hepatic resection. METHODS Consecutive consenting patients scheduled for liver resection were randomized to receive preoperative dextrose infusion followed by insulin therapy using the hyperinsulinaemic normoglycaemic clamp protocol (n = 29) or standard therapy (control group, n = 27). Patients in the insulin therapy group followed a strict dietary regimen for 24 h before surgery. Intravenous dextrose was started at 2 mg per kg per min the night before and continued until surgery. Hyperinsulinaemic therapy for a total of 24 h was initiated at 2 munits per kg per min at induction of anaesthesia, and continued at 1 munit per kg per min after surgery. Normoglycaemia was maintained (3.5-6.0 mmol/l). Control subjects received no additional dietary supplement and a conventional insulin sliding scale during fasting. All patients were tested serially to evaluate liver function using the Schindl score. Liver tissue samples were collected at two time points during surgery to measure glycogen levels. RESULTS Demographics were similar in the two groups. More liver dysfunction occurred in the control cohort (liver dysfunction score range 0-8 versus 0-4 with insulin therapy; P = 0.031). Median (interquartile range) liver glycogen content was 278 (153-312) and 431 (334-459) µmol/g respectively (P = 0.011). The number of complications rose with increasing severity of postoperative liver dysfunction (P = 0.032) CONCLUSION: The glucose-insulin protocol reduced postoperative liver dysfunction and improved liver glycogen content. REGISTRATION NUMBER NCT00774098 (http://www.clinicaltrials.gov).


title: Bisphosphonate-anchored PEGylation and radiolabeling of superparamagnetic iron oxide: long-circulating nanoparticles for in vivo multimodal (T1 MRI-SPECT) imaging.

text: The efficient delivery of nanomaterials to specific targets for in vivo biomedical imaging is hindered by rapid sequestration by the reticuloendothelial system (RES) and consequent short circulation times. To overcome these two problems, we have prepared a new stealth PEG polymer conjugate containing a terminal 1,1-bisphosphonate (BP) group for strong and stable binding to the surface of ultrasmall-superparamagnetic oxide nanomaterials (USPIOs). This polymer, PEG(5)-BP, can be used to exchange the hydrophobic surfactants commonly used in the synthesis of USPIOs very efficiently and at room temperature using a simple method in 1 h. The resulting nanoparticles, PEG(5)-BP-USPIOs are stable in water or saline for at least 7 months and display a near-zero ζ-potential at neutral pH. The longitudinal (r(1)) and transverse (r(2)) relaxivities were measured at a clinically relevant magnetic field (3 T), revealing a high r(1) of 9.5 mM(-1) s(-1) and low r(2)/r(1) ratio of 2.97, making these USPIOs attractive as T1-weighted MRI contrast agents at high magnetic fields. The strong T1-effect was demonstrated in vivo, revealing that PEG(5)-BP-USPIOs remain in the bloodstream and enhance its signal 6-fold, allowing the visualization of blood vessels and vascular organs with high spatial definition. Furthermore, the optimal relaxivity properties allow us to inject a dose 4 times lower than with other USPIOs. PEG(5)-BP-USPIOs can also be labeled using a radiolabeled-BP for visualization with single photon emission computed tomography (SPECT), and thus affording dual-modality contrast. The SPECT studies confirmed low RES uptake and long blood circulation times (t(1/2) = 2.97 h). These results demonstrate the potential of PEG(5)-BP-USPIOs for the development of targeted multimodal imaging agents for molecular imaging.


A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses.


title: The outbreak of COVID-19: An overview

text: In late December 2019, a previous unidentified coronavirus, currently named as the 2019 novel coronavirus#, emerged from Wuhan, China, and resulted in a formidable outbreak in many cities in China and expanded globally, including Thailand, Republic of Korea, Japan, United States, Philippines, Viet Nam, and our country (as of 2/6/2020 at least 25 countries). The disease is officially named as Coronavirus Disease-2019 (COVID-19, by WHO on February 11, 2020). It is also named as Severe Pneumonia with Novel Pathogens on January 15, 2019 by the Taiwan CDC, the Ministry of Health and is a notifiable communicable disease of the fifth category. COVID-19 is a potential zoonotic disease with low to moderate (estimated 2%–5%) mortality rate. Person-to-person transmission may occur through droplet or contact transmission and if there is a lack of stringent infection control or if no proper personal protective equipment available, it may jeopardize the first-line healthcare workers. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. To promptly identify patients and prevent further spreading, physicians should be aware of the travel or contact history of the patient with compatible symptoms.


title: Structural and Biochemical Analyses of Swine Major Histocompatibility Complex Class I Complexes and Prediction of the Epitope Map of Important Influenza A Virus Strains.

text: UNLABELLED The lack of a peptide-swine leukocyte antigen class I (pSLA I) complex structure presents difficulties for the study of swine cytotoxic T lymphocyte (CTL) immunity and molecule vaccine development to eliminate important swine viral diseases, such as influenza A virus (IAV). Here, after cloning and comparing 28 SLA I allelic genes from Chinese Heishan pigs, pSLA-3*hs0202 was crystalized and solved. SLA-3*hs0202 binding with sβ2m and a KMNTQFTAV (hemagglutinin [HA]-KMN9) peptide from the 2009 pandemic swine H1N1 strain clearly displayed two distinct conformations with HA-KMN9 peptides in the structures, which are believed to be beneficial to stimulate a broad spectrum of CTL immune responses. Notably, we found that different HA-KMN9 conformations are caused, not only by the flexibility of the side chains of residues in the peptide-binding groove (PBG), but also by the skewing of α1 and α2 helixes forming the PBG. In addition, alanine scanning and circular-dichroism (CD) spectra confirmed that the B, D, and F pockets play critical biochemical roles in determining the peptide-binding motif of SLA-3*hs0202. Based on biochemical parameters and comparisons to similar pockets in other known major histocompatibility complex class I (MHC-I) structures, the fundamental motif for SLA-3*hs0202 was determined to be X-(M/A/R)-(N/Q/R/F)-X-X-X-X-X-(V/I) by refolding in vitro and multiple mutant peptides. Finally, 28 SLA-3*hs0202-restricted epitope candidates were identified from important IAV strains, and two of them have been found in humans as HLA-A*0201-specific IAV epitopes. Structural and biochemical illumination of pSLA-3*hs0202 can benefit vaccine development to control IAV in swine. IMPORTANCE We crystalized and solved the first SLA-3 structure, SLA-3*hs0202, and found that it could present the same IAV peptide with two distinct conformations. Unlike previous findings showing that variable peptide conformations are caused only by the flexibility of the side chains in the groove, the skewing of the α1 and α2 helixes is important in the different peptide conformations in SLA-3*hs0202. We also determined the fundamental motif for SLA-3*hs0202 to be X-(M/A/R)-(N/Q/R/F)-X-X-X-X-X-(V/I) based on a series of structural and biochemical analyses, and 28 SLA-3*hs0202-restricted epitope candidates were identified from important IAV strains. We believe our structure and analyses of pSLA-3*hs0202 can benefit vaccine development to control IAV in swine.


title: Use of fibrin glue for fixation of mesh and approximation of Peritoneum in Transabdominal Preperitoneal (TAPP) inguinal hernia repair: technical feasibility and early surgical outcomes.

text: BACKGROUND It is a common practice to secure both mesh and peritoneum using tacks when performing a transabdominal preperitoneal (TAPP) inguinal hernia repair. The use of tacks to secure the mesh is well documented and has been associated with postoperative chronic pain. Recently, fibrin glue has been used to secure the mesh in these repairs but not used to reapproximate the incised peritoneum. This study assessed the technical feasibility of using fibrin glue for fixation of both mesh and peritoneum. PATIENTS AND METHODS A total of 33 TAPP hernia repairs were carried out in 27 consecutive patients. In all the patients, both mesh and peritoneum were secured with fibrin glue (20 primary inguinal hernia repairs, 5 bilateral hernia repairs, 1 recurrent inguinal hernia, and 1 recurrent bilateral hernia repair). RESULTS Patients were followed up at an outpatient clinic between the second and third week after surgery. Six patients were followed up through telephone. Patients were questioned on the following factors: residual postoperative pain (groin and port sites), unplanned GP or hospital visits, employment status and number of days between their surgery and return to both work and normal activities, and recurrence. No patients had residual groin or port site pain at a median of 21 days after surgery. No patient required an unplanned follow-up appointment with their GP. One patient (recurrent repair) developed a seroma postoperatively. Median time to normal activities was 10 days (range, 3 to 21 d). CONCLUSIONS Total glue fixation of mesh and peritoneum is technically feasible and early results show low rates of postoperative complications and pain. Randomized studies are needed to confirm this.


title: Muscle strength and force development in high- and low-functioning elderly men: Influence of muscular and neural factors.

text: BACKGROUND Aging leads to a loss of muscle strength and functional capacity likely resulting from a combination of neural and muscle alterations. The aim of this study was to identify possible disparities in muscle strength and force development profiles in high- and low-functioning elderly men and to investigate muscular and neurophysiological factors that could explain the differences. METHODS Sixty community-dwelling men in good general health were divided in two groups based on a functional capacity (FC) z-score derived from 6 tests of the Short Physical Performance Battery and Senior Fitness Test (Normal and fast 4m-walk tests, normal and fast Timed-up and go, chair and stair tests). Extensor strength of the lower limbs (LL) was obtained for concentric (CLES) contraction and combined with lean masses of LL (LLLM) to yield concentric (CLES/LLLM) index. Similarly, extensor strength of the right Quadriceps Femoris (IKES) was obtained during maximal voluntary isometric contraction (MVC) and combined with right thigh lean mass (rTLM) to produce an isometric strength (IKES/rTLM) index. A muscular profile was obtained from: ascending and descending force slopes during the MVC; Vastus Lateralis (VL) muscle twitches parameters (amplitude, contraction and ½ relaxation times); the knee joint velocity (KV) as well as integrated EMG (iEMG) were determined for a sit-to-stand functional evaluation; muscle phenotype. A neurophysiological profile was established from: the spinal excitability (Hmax/Mmax ratio); motoneuron conduction velocity (CV); the completeness of muscle activation (% of force reserve), median power frequency (MPF) and mean amplitude (MA) of the VL EMG signal during MVC. RESULTS Coincidently, age did not differ between groups. Strength and force indices, descending force slopes for MVC, KV and iEMG during the sit-to-stand evaluation and FC parameters were all significantly (p<0.05) lower in the LoFC group than in the HiFC group. In contrast, no difference was observed between groups in: LLLM and rTLM, Hmax/Mmax ratio, CV, twitch parameters and muscle phenotype. CONCLUSION The lower concentric and isometric strengths found in the LoFC group could not be accounted for by muscular factors. Similarly, peripheral nervous systems alterations could not explain group differences. It can be suggested that modifications within the central nervous system may be responsible for the differences in the functional status of healthy elderly individuals. Finally, more complex and demanding tasks, such as those requiring greater intensity or coordination, may further clarify how healthy elderly individuals with low and high functional capacities differ.


title: The significance of sonographically thickened endometrium in asymptomatic postmenopausal women.

text: Objective To investigate the correlation between sonographic, hysteroscopic, and pathological findings in postmenopausal asymptomatic patients with sonographically thickened endometrium. Methods The records of postmenopausal patients who attended the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey between January 1, 2012 and December 15, 2013 were retrieved. A total of 266 postmenopausal women without vaginal bleeding underwent hysteroscopic evaluation and endometrial sampling. Patients whose pathological records indicated an endometrial thickness equal to or greater than 6 mm (double layer) on transvaginal ultrasonography without any symptoms were included in the study. Results The most frequently detected focal intrauterine lesions in asymptomatic women were endometrial polyps, which were diagnosed in 168 (63.1%) cases. Twenty-four (9%) patients were diagnosed as having simple hyperplasia, 4 (1%) atypical hyperplasia, and 8 (3%) endometrial adenocarcinoma. Two of the patients with adenocarcinoma were diagnosed based on endometrial polyps, and 6 cases showed endometrial hyperplasia on hysteroscopy, while histological examination showed endometrial carcinoma. Conclusion We suggest 10.5 mm as the cutoff value for endometrial thickness and recommend hysteroscopy following dilatation and curettage to increase diagnostic efficacy and provide definitive treatment in asymptomatic postmenopausal women with thickened endometrium.


title: Update of endovenous treatment modalities for insufficient saphenous veins--a review of literature.

text: Lower-limb venous insufficiency resulting from saphenous vein incompetence is a common disorder, increasing with age. For decades, surgical stripping of the great saphenous vein has been the gold standard in varicose vein treatment. The desire to optimize outcomes of treatment and reduce surgical trauma has led to the development of endovenous techniques. Today, several endovenous techniques are available to ablate the saphenous vein segments with abnormal vein valve function. In this review, we discuss the techniques, mechanisms of action, outcomes, and complications of all endovenous treatment modalities for the treatment of symptomatic lower-limb varicose veins.


title: Health information and communication system for emergency management in a developing country, Iran.

text: Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.


title: Back-Table Surgeon Modification of a t-Branch.

text: BACKGROUND Surgeon modification of commercially available aortic stent grafts represents a salvage option to treat complex aortic pathologies in high-risk patients. TECHNIQUE A 68-year-old male was referred to our hospital with a contained rupture of the visceral aorta. The patient was previously treated with an infrarenal tube graft 16 years earlier as well as with a Crawford procedure with island patch of the celiac trunk (TC) and the superior mesenteric artery (SMA) and bypasses to both renal arteries 6 years before admission. The computed tomography demonstrated a "blowout aneurysm" of the TC and SMA patch. The bypass to the left renal artery originated from the level of the TC. We therefore modified a commercially available t-branch (Cook® Medical, Bloomington, IN) with surgeon-made fenestrations for both renal arteries. The procedure was successful, and the patient could be discharged to home on the seventh postoperative day. CONCLUSIONS The use of surgeon-modified "off-the-shelf" t-branches broadens the possibilities of treating even anatomically very challenging aortic pathologies otherwise not suitable for the t-branch.


Toward better clinical data in emerging infectious diseases.


Frontline fighters: the continued fight against COVID-19.


title: Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?

text: PURPOSE Short term morbidity, functional outcome, recurrence and quality of life outcomes after robotic assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) were compared. METHODS This study includes 51 consecutive patients having operations for external rectal prolapse (ERP) in a tertiary centre between October 2009 and December 2012. Of these, 17 patients had RVMR and 34 underwent LVMR. The groups were matched for age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) grades. The same operative technique and mesh was used and follow up was 12 months. Data was collected on patient demographics, surgery duration, blood loss, duration of hospital stay and operative complications. Functional outcomes were measured using the faecal incontinence severity index (FISI) and Wexner faecal incontinence scoring. Quality of life was scored using SF36 questionnaires pre and postoperatively. RESULTS All patients were female except three (median 59, range 25-89). There was one laparoscopic converted to open procedure. RVMR procedures were longer in duration (p = 0.013) but with no difference in blood loss between the groups. The average duration of stay was 2 days in both groups. There were six minor postoperative complications in LVMR procedures and none in the RVMR group. Pre and postoperative Wexner and FISI scoring were significantly lower in the RVMR group (p = 0.042 and p = 0.024, respectively). SF-36 questionnaires showed better scoring in physical and emotional component in RVMR group (p = 0.015). There was no recurrence in either group during follow-up. CONCLUSIONS Both LVMR and RVMR are similar in terms of safety and efficacy. Although not randomized, this data may suggest a better functional outcome and quality of life in patients having RVMR for ERP.


title: Upper respiratory tract infection during pregnancy: is it associated with adverse perinatal outcome?

text: We sought to determine whether there is an association between upper respiratory tract infection (URTI) requiring hospitalization during pregnancy and adverse perinatal complications. A retrospective population-based study comparing all singleton pregnancies of patients with and without URTI requiring hospitalization was performed. Multiple logistic regression models were performed to control for confounders. Data were collected from the computerized perinatal database. Out of 186,373 deliveries, 0.13% ( N = 246) required hospitalization due to URTI during pregnancy. URTI was significantly associated with preterm deliveries (PTD; 15.9% versus 7.9%; P < 0.001), lower birth weight (3082 +/- 624 versus 3183 +/- 546 g; P < 0.001), and higher rate of cesarean deliveries (CD; 20.3% versus 13.2%; P < 0.001) as compared with the comparison group. Even after controlling for possible confounders using multivariable analyses, the significant association between URTI and PTD (weighted odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.6 to 3.1; P < 0.001) and CD (weighted OR = 1.5; 95% CI 1.1 to 2.2; P = 0.020) persisted. In contrast, no significant association was documented between URTI and premature rapture of membranes (4.9% versus 6.9%; P = 0.212), low Apgar scores (< 7) at 5 minutes (0.4% versus 0.6%; P = 0.761), and perinatal mortality (0 to 4% versus 1.3%; P = 0.223). Maternal URTI requiring hospitalization is an independent risk factor for PTD and CD.


title: Design and current status of CONTINT: continuous versus interrupted abdominal wall closure after emergency midline laparotomy - a randomized controlled multicenter trial [NCT00544583].

text: BACKGROUND The optimal strategy for abdominal wall closure has been an issue of ongoing debate. Available studies do not specifically enroll patients who undergo emergency laparotomy and thus do not consider the distinct biological characteristics of these patients. The present randomized controlled trial evaluates the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. METHODS/DESIGN The CONTINT trial is a multicenter, open label, randomized controlled trial with a two-group parallel design. Patients undergoing a primary emergency midline laparotomy are enrolled in the trial. The two most commonly applied strategies of abdominal wall closure after midline laparotomy are compared: the continuous, all-layer suture technique using slowly absorbable monofilament material (two Monoplus loops) and the interrupted suture technique using rapidly absorbable braided material (Vicryl sutures). The primary endpoint within the CONTINT trial is an incisional hernia within 12 months or a burst abdomen within 30 days after surgery. As reliable data on this primary endpoint is not available for patients undergoing emergency surgery, an adaptive interim analysis will be conducted after the inclusion of 80 patients, allowing early termination of the trial if necessary or modification of design characteristics such as recalculation of sample size. DISCUSSION This is a randomized controlled multicenter trial with a two-group parallel design to assess the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy. TRIAL REGISTRATION NCT00544583.


No significant correlation between ACE Ins/Del genetic polymorphism and COVID-19 infection.


title: Precise Measurement of the Outer Diameters of Antibiotic-Laden Cement Nails Produced by Various Sized Thoracostomy Catheter Molds.

text: OBJECTIVES At our institution, custom-made antibiotic-laden cement nails (ACNs) fabricated during surgery using a thoracostomy catheter as a mold are commonly used to treat long-bone infection. As the outer diameter of the nails produced has not previously been described, we designed a study to measure the outer diameter of ACNs fashioned using commercially available and commonly utilized thoracostomy catheters of various sizes. METHODS Six thoracostomy catheters from 2 different manufactures (Argyle PVC Thoracic Catheters; Covidien Ltd and Atrium PVC Thoracic Catheters; Atrium Medical Corporation), ranging from 20 French to 40 French, were utilized in this study. Each catheter was filled with antibiotic-laden cement, and the most proximal segment (largest outer diameter) and most distal segment (smallest outer diameter) were detached for study. Once the cement was cured, the thoracostomy catheters were cut away and the segments were measured using a calibrated digital caliper (Mitutoyo Corp, Aurora, IL). Because the ACNs produced using the technique taper from proximal to distal according to the shape of the thoracostomy catheter design, data were recorded as a maximum and minimum outer diameter for each ACN produced by each of the 6 thoracostomy catheter sizes studied. All measurements were in millimeters and were rounded to the nearest one-tenth of a millimeter. RESULTS The ACNs produced using the various sized thoracostomy catheters had segments with outer diameters ranging from 4.2 mm to 11.2 mm. Both brands of catheters produced nails with similar distal diameters. Specifically, the mean distal diameter measurements were 4.2 mm for a 20 French catheter, 5.5 mm for a 24 French catheter, 6.6 mm for a 28 French catheter, 7.7 mm for a 32 French catheter, 8.4 mm for a 36 French catheter, and 9.9 mm for a 40 French catheter. The Argyle brand catheters produced nails with proximal diameters that increased with the catheter's size, from 7.1 mm for a 20 French catheter to 11.2 mm for a 40 French catheter. The Atrium brand catheters produced nails with a much tighter range of proximal diameters ranging from 9.4 mm to 11.1 mm. CONCLUSIONS Thoracostomy catheters are commonly utilized to produce ACNs. The results of our study confirm that the fabricated nails taper in diameter from proximal to distal. Knowledge of the specific dimensions of the ACN produced by each size thoracostomy catheter will aid the orthopaedic surgeon in selecting the right size based on the diameter of the medullary canal being treated.