title: A Randomized Trial on the Effect of Bone Tissue on Vibration-induced Muscle Strength Gain and Vibration-induced Reflex Muscle Activity.

text: BACKGROUND Whole-body vibration (WBV) induces reflex muscle activity and leads to increased muscle strength. However, little is known about the physiological mechanisms underlying the effects of whole-body vibration on muscular performance. Tonic vibration reflex is the most commonly cited mechanism to explain the effects of whole-body vibration on muscular performance, although there is no conclusive evidence that tonic vibration reflex occurs. The bone myoregulation reflex is another neurological mechanism used to explain the effects of vibration on muscular performance. Bone myoregulation reflex is defined as a reflex mechanism in which osteocytes exposed to cyclic mechanical loading induce muscle activity. AIMS The aim of this study was to assess whether bone tissue affected vibration-induced reflex muscle activity and vibration-induced muscle strength gain. STUDY DESIGN A prospective, randomised, controlled, double-blind, parallel-group clinical trial. METHODS Thirty-four participants were randomised into two groups. High-magnitude whole-body vibration was applied in the exercise group, whereas low-magnitude whole-body vibration exercises were applied in the control group throughout 20 sessions. Hip bone mineral density, isokinetic muscle strength, and plasma sclerostin levels were measured. The surface electromyography data were processed to obtain the Root Mean Squares, which were normalised by maximal voluntarily contraction. RESULTS In the exercise group, muscle strength increased in the right and left knee flexors (23.9%, p=0.004 and 27.5%, p<0.0001, respectively). However, no significant change was observed in the knee extensor muscle strength. There was no significant change in the knee muscle strength in the control group. The vibration-induced corrected Root Mean Squares of the semitendinosus muscle was decreased by 2.8 times (p=0.005) in the exercise group, whereas there was no change in the control group. Sclerostin index was decreased by 15.2% (p=0.031) in the exercise group and increased by 20.8% (p=0.028) in the control group. A change in the sclerostin index was an important predictor of a change in the vibration-induced normalised Root Mean Square of the semitendinosus muscle (R2=0.7, p=0.0001). Femoral neck bone mineral density was an important predictor of muscle strength gain (R2=0.26, p=0.035). CONCLUSION This study indicates that bone tissue may have an effect on vibration-induced muscle strength gain and vibration-induced reflex muscle activity. TRIAL REGISTRATION ClinicalTrials.gov: NCT01310348.


Welcome to the Eastern Front: the VIDOC-19 outbreak in Mulhouse.


A sleeve gastrectomy blast: how long should the bariatric patient fast?


title: Rapid Emergence of Highly Pathogenic Avian Influenza Subtypes from a Subtype H5N1 Hemagglutinin Variant.

text: In 2014, novel highly pathogenic avian influenza A H5N2, H5N5, H5N6, and H5N8 viruses caused outbreaks in Asia, Europe, and North America. The H5 genes of these viruses form a monophyletic group that evolved from a clade 2.3.4 H5N1 variant. This rapid emergence of new H5Nx combinations is unprecedented in the H5N1 evolutionary history.


title: Use of laterally placed vacuum drains for management of aural hematomas in five dogs.

text: CASE DESCRIPTION 5 dogs (a Newfoundland, Golden Retriever, Shiba Inu, Staffordshire Terrier, and Vizsla) were referred for evaluation and treatment of unilateral aural hematomas within a week after their formation. CLINICAL FINDINGS Aural hematomas involved the left (3) or right (2) ears. TREATMENT AND OUTCOME With patients under anesthesia, the aural hematomas were approached surgically from the convex, or lateral, pinnal surface. Two small incisions were used to position a vacuum drain into the incised hematoma cavity. The drain exited at the base of the pinna and adjacent cervical skin. The free end of the drain was attached to a vacuum reservoir for 18 to 21 days. Drains and skin sutures were removed at this time along with the protective Elizabethan collar. All hematomas resolved and surgical sites healed during the minimum 6-month follow-up period. Cosmetic results were considered excellent in 4 of 5 patients. Slight wrinkling of the pinna in 1 patient resulted from asymmetric enlargement of the cartilaginous walls of the hematoma, where vacuum application resulted in a slight folding of the redundant lateral cartilage wall. CLINICAL RELEVANCE The described treatment was efficient, economical, and minimally invasive and required no bandaging or wound care. Placement of the drain tubing on the convex (lateral) aspect sheltered the system from displacement by patients with an Elizabethan collar in place. Overall cosmetic results were excellent; asymmetric enlargement of the cartilaginous walls of the hematoma with slight folding of the pinna was seen in 1 patient.


title: A Novel Machine Learning-derived Radiomic Signature of the Whole Lung Differentiates Stable From Progressive COVID-19 Infection: A Retrospective Cohort Study.

text: OBJECTIVE This study aimed to use the radiomics signatures of a machine learning-based tool to evaluate the prognosis of patients with coronavirus disease 2019 (COVID-19) infection. METHODS The clinical and imaging data of 64 patients with confirmed diagnoses of COVID-19 were retrospectively selected and divided into a stable group and a progressive group according to the data obtained from the ongoing treatment process. Imaging features from whole-lung images from baseline computed tomography (CT) scans were extracted and dimensionality reduction was performed. Support vector machines were used to construct radiomics signatures and to compare differences between the 2 groups. We also compared the differences of signature scores in the clinical, laboratory, and CT image feature subgroups and finally analyzed the correlation between the radiomics features of the constructed signature and the other features including clinical, laboratory, and CT imaging features. RESULTS The signature has a good classification effect for the stable group and the progressive group, with area under curve, sensitivity, and specificity of 0.833, 80.95%, and 74.42%, respectively. Signature score differences in laboratory and CT imaging features between subgroups were not statistically significant (P>0.05); cough was negatively correlated with GLCM Entropy_angle 90_offset4 (r=-0.578), but was positively correlated with ShortRunEmphhasis_AllDirect_offset4_SD (r=0.454); C-reactive protein was positively correlated with Cluster Prominence_ AllDirect_offset 4_ SD (r=0.47). CONCLUSION The radiomics signature of the whole lung based on machine learning may reveal the changes of lung microstructure in the early stage and help to indicate the progression of the disease.


title: Cecal infarction in neonatal calves.

text: Cecal infarction is an uncommon lesion in calves that results in localized peritonitis and, on occasion, perforation with secondary diffuse peritonitis and death. This lesion in calves has not been described previously. We reviewed the postmortem cases of cecal infarction in dairy calves ≤30 d of age that had been submitted over the course of 5 y to the Tulare branch of the California Animal Health and Food Safety Laboratory System. The area of cecal infarction and the associated lesion margins were examined histologically. Ischemic necrosis of the mucosal side of the cecal wall with various degrees of neutrophilic inflammation of subjacent tissues was found consistently, and thrombosis and vascular occlusion within the areas of necrosis and inflammation was found in 21 of 34 cases. Cecal infarction cases were then compared to controls using a retrospective matched case-control study design. Cases ( n = 34) and controls ( n = 86) were compared with respect to bacteremia (as defined by pure culture of a single bacterial agent from lung and/or liver), species of bacteria isolated, and for the presence of K99 Escherichia coli (calves ≤5 d), attaching and effacing E. coli, Cryptosporidium (calves ≥5 d of age), Salmonella isolation from the intestine, rotavirus, Bovine coronavirus, and Bovine viral diarrhea virus. In addition, the presence of rumenitis or abomasitis, and omphalitis were compared between cases and controls. There were no significant differences in ruminal, abomasal, or umbilical cord tissue inflammation, or pathogen test-positive status between cases and controls.


title: The COVID-19 challenge to cardiac electrophysiologists: optimizing resources at a referral center

text: PURPOSE: To describe how a referral center for cardiac electrophysiology (EP) rapidly changed to comply with the ongoing COVID-19 healthcare emergency. METHODS: We present retrospective data about the modification of daily activities at our EP unit, following the pandemic outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Italy. In particular, in the context of a pre-existing “hub-and-spoke” network, we describe how procedure types and volumes have changed in the last 3 months. RESULTS: Since our institution was selected as a COVID-19 referral center, the entire in-hospital activity was reorganized to assist more than 1000 COVID-positive cases. Only urgent EP procedures, including ventricular tachycardia ablation and extraction of infected devices, were both maintained and optimized to meet the needs of external hospitals. In addition, most of the non-urgent EP procedures were postponed. Finally, following prompt internal reorganization, both outpatient clinics and on-call services underwent significant modification, by integrating telemedicine support whenever applicable. CONCLUSION: We presented the fast reorganization of an EP referral center during the ongoing COVID-19 healthcare emergency. Our hub-and-spoke model may be useful for other centers, aiming at a cost-effective management of resources in the context of a global crisis.


Why and when should we use public deliberation?


The HAREM (Had Appendicitis and Resolved/Recurred Emergency Morbidity/Mortality) Study.


title: COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms.

text: Severe restrictions have been imposed in most countries for oral health care to the general population, allowing treatment only for emergencies, because of the generation of aerosols during clinical procedures and to ration personal protective equipment (PPE) during the pandemic. This article stresses the critical situation that affects oral health for older persons in the complex times of the COVID-19 pandemic. Older adults are at high risk for the viral infection, but neglected dental conditions may worsen their health, triggering infections that can lead to local and systemic complications, compromising general health. We propose that under current and possibly future scenarios, teledentistry and the minimal intervention dentistry approach may play a pivotal role in reshaping the profession. The already existent inequities in oral health care may be exacerbated due to the pandemic, especially in the developing world. More research along with a strong educational component in the dental curriculum must be emphasized. COVID-19 may be an opportunity to change canonical paradigms. The dental profession must reflect and take action to face future challenges. Knowledge Transfer Statement: This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.


QUESTION Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? DESIGN Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. PARTICIPANTS Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. INTERVENTION All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. OUTCOME MEASURES Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. RESULTS Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35days (95% CI 0.45 to 4.24, I2=0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI -0.01 to 0.19, I2=0%), and health-related quality of life (SMD 0.10, 95% CI -0.01 to 0.20, I2=0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. CONCLUSION The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. REGISTRATION PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142-158].


Serving meals and mopping floors: the consultant psychiatrist working differently during the covid-19 pandemic.


Oxygen: Breath of Life or Kiss of Death.


title: Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients.

text: BACKGROUND Conversion to open during minimally invasive liver resection has a high rate. To identify the reasons to convert could help in defining a strategy to decrease the event "conversion." METHODS A systematic review has been performed. Our large series of robotic hepatic resections were analyzed and included in the review. RESULTS Fifty papers were selected and carefully evaluated in full text. Twenty-nine were ultimately used for analysis, including all published robotic liver resections. Our series included 11 conversions out of 139 patients (7.9%). Adhesions were not a declared reason to convert. The robotic approach still had a high percentage of open conversions because of difficulties in assessing the tumor margin. CONCLUSIONS Causes for conversion were carefully analyzed and compared with what previously described for the pure laparoscopic approach. This could be crucial in defining how to improve the performance and minimize the conversion rate.


title: Genomic discovery of an evolutionarily programmed modality for small-molecule targeting of an intractable protein surface.

text: The vast majority of intracellular protein targets are refractory toward small-molecule therapeutic engagement, and additional therapeutic modalities are needed to overcome this deficiency. Here, the identification and characterization of a natural product, WDB002, reveals a therapeutic modality that dramatically expands the currently accepted limits of druggability. WDB002, in complex with the FK506-binding protein (FKBP12), potently and selectively binds the human centrosomal protein 250 (CEP250), resulting in disruption of CEP250 function in cells. The recognition mode is unprecedented in that the targeted domain of CEP250 is a coiled coil and is topologically featureless, embodying both a structural motif and surface topology previously considered on the extreme limits of "undruggability" for an intracellular target. Structural studies reveal extensive protein-WDB002 and protein-protein contacts, with the latter being distinct from those seen in FKBP12 ternary complexes formed by FK506 and rapamycin. Outward-facing structural changes in a bound small molecule can thus reprogram FKBP12 to engage diverse, otherwise "undruggable" targets. The flat-targeting modality demonstrated here has the potential to expand the druggable target range of small-molecule therapeutics. As CEP250 was recently found to be an interaction partner with the Nsp13 protein of the SARS-CoV-2 virus that causes COVID-19 disease, it is possible that WDB002 or an analog may exert useful antiviral activity through its ability to form high-affinity ternary complexes containing CEP250 and FKBP12.


Die WHO hat am 11.03.20 die Verbreitung des SARS-CoV-2 als weltweite Pandemie eingestuft 1. Eine hohe Basisreproduktionszahl ermöglicht in einer globalisierten Welt die schnelle Verbreitung des Virus. Die Basisreproduktionszahl liegt bei SARS-CoV-2 bei 2–3.3, d. h. dass jede infizierte Person 2–3.3 weitere Personen infizieren wird, sofern keine Schutzmaßnahmen ergriffen werden 2. Diese Basisreproduktionszahl liegt höher als bei der klassischen Influenza und ist bei COVID-19, der durch das SARS-CoV-2 verursachten Lungenerkrankung, gekoppelt mit einer substanziellen Zahl an schweren Verläufen, die eine stationäre oder intensivmedizinisch-stationäre Betreuung der Patienten erfordern 3. Auch weisen erste Daten darauf hin, dass die Zahl an Langzeitbeatmungen unter den beatmungspflichtigen Patienten möglicherweise hoch ist 4. Die Kombination aus hoher Ansteckungsrate, einer substanziellen Zahl schwerer Verläufe sowie längerfristiger Beatmungspflichtigkeit birgt das Risiko einer bislang nicht erlebten Belastung der Gesundheitssysteme weltweit.Die Radiologie, Neuro- und Kinderadiologie sind über die Diagnostik und die interventionellen Verfahren sowohl im ambulanten, als auch im stationären Sektor bei der Versorgung faktisch aller Krankheitsbilder zentral beteiligt. In der aktuellen SARS-CoV-2 Pandemie kommt der Radiologie zusätzlich eine zentrale Bedeutung bei der Diagnose und der Verlaufskontrolle der Patienten mit COVID-19 zu. Ambulante und stationäre radiologische Abteilungen müssen daher auf die Versorgung von COVID-19 Patienten vorbereitet sein 5. In der folgenden Zusammenfassung geben die beteiligten Fachgesellschaften Empfehlungen für die radiologische Versorgung während der SARS-Cov-2 Pandemie.


title: Effects of pyrolysis temperature on soil-plant-microbe responses to Solidago canadensis L.-derived biochar in coastal saline-alkali soil.

text: Because salinity of coastal soils is drastically increasing, the application of biochars to saline-alkali soil amendments has attracted considerable attention. Various Solidago-canadensis-L.-derived biochars prepared through pyrolysis from 400 to 600 °C were applied to coastal saline-alkali soil samples to optimise the biochar pyrolysis temperature and investigate its actual ecological responses. All biochars reduced the soil bulk density and exchangeable sodium stress and increased soil water-holding capacity, cation exchange capacity, and organic matter content. Principal-component-analysis results showed that pyrolysis temperature played an important role in the potential application of biochars to improve the coastal saline-alkali soil, mainly contributed to ameliorating exchangeable sodium stress and decreasing biochar-soluble toxic compounds. Furthermore, soil bulk density and organic matter, as well as carboxylic acids, phenolic acids and amines of biochar were major driving factors for bacterial community composition. Compared to low-temperature biochar (pyrolyzed below 550 °C), which showed higher toxicity for Brassica chinensis L. growth due to the higher content of carboxylic acids, phenols and amines, high-temperature biochar (pyrolyzed at or above 550 °C) possessed less amounts of these toxic functional groups, more beneficial soil bacteria and healthier for plant growth. Therefore, high-temperature biochar could be applied as an effective soil amendment to ameliorate the coastal saline-alkali soil with acceptable environmental risk.


title: Clinical educators' skills and qualities in allied health: a systematic review.

text: BACKGROUND The skills and qualities of effective clinical educators are linked to improved student learning and ultimately patient care; however, within allied health these have not yet been systematically summarised in the literature. AIMS To identify and synthesise the skills and qualities of clinical educators in allied health and their effect on student learning and patient care. METHOD A systematic search of the literature was conducted across five electronic databases in November 2017. Study identification, data extraction and quality appraisal were performed in duplicate. Qualitative and quantitative data were extracted separately but analysed together using a thematic analysis approach whereby items used in quantitative surveys and themes from qualitative approaches were interpreted together. RESULTS Data revealed seven educator skills and qualities: (i) intrinsic and personal attributes of clinical educators; (ii) provision of skillful feedback; (iii) teaching skills; (iv) fostering collaborative learning; (v) understanding expectations; (vi) organisation and planning; and (vii) clinical educators in their professional role. Across all themes was the concept of taking time to perform the clinical educator role. No studies used objective measurements as to how these skills and qualities affect learning or patient care. DISCUSSION AND CONCLUSION Despite much primary evidence of clinical educator skills and qualities, this review presents the first synthesis of this evidence in allied health. There is a need to examine clinical education from new perspectives to develop deeper understanding of how clinical educator qualities and skills influence student learning and patient care.


title: Postoperative Blood Glucose Levels Predict Infection After Total Joint Arthroplasty.

text: BACKGROUND Perioperative hyperglycemia has many etiologies, including medication, impaired glucose tolerance, uncontrolled diabetes mellitus, or stress, the latter of which is common in patients postoperatively. Our study investigated the influence of postoperative blood glucose levels on periprosthetic joint infection after elective total joint arthroplasty to determine a threshold for glycemic control for which surgeons should strive during a patient's hospital stay. METHODS A single-institution retrospective review was conducted on 24,857 primary total joint arthroplasties performed from 2001 to 2015. Of these, 13,196 had a minimum follow-up of 1 year (mean, 5.9 years). Postoperative day 1 morning blood glucose levels were utilized and were correlated with periprosthetic joint infection, as defined by the International Consensus Group on Periprosthetic Joint Infection. Multivariable analysis was used to determine the influence of several important covariates on infection. An alpha level of 0.05 was used to determine significance. RESULTS The rate of periprosthetic joint infection increased linearly from blood glucose levels of ≥115 mg/dL. Multivariable analysis revealed that blood glucose levels were significantly associated with periprosthetic joint infection (p = 0.028). The optimal blood glucose threshold to reduce the likelihood of periprosthetic joint infection was 137 mg/dL. The periprosthetic joint infection rate in the entire cohort was 1.59% (1.46% in patients without diabetes compared with 2.39% in patients with diabetes; p = 0.001). There was no significant association between blood glucose level and periprosthetic joint infection in patients with diabetes (p = 0.276), although there was a linear trend. CONCLUSIONS The relationship between postoperative blood glucose levels and periprosthetic joint infection increased linearly, with an optimal cutoff of 137 mg/dL. Immediate and strict postoperative glycemic control may be critical in reducing postoperative complications, as even mild hyperglycemia was significantly associated with periprosthetic joint infection. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


title: Immediate Single-Stage Cranioplasty Following Calvarial Resection for Benign and Malignant Skull Neoplasms Using Customized Craniofacial Implants.

text: UNLABELLED Craniectomy defects following resection of calvarial lesions are most often reconstructed using on-table manufacturing. With the advent of computer-aided design/manufacturing and customized craniofacial implants (CCIs), there seems to be more suited alternatives. In this study, the authors report their institutional experience and outcome using immediate, single-stage, CCI-based reconstruction for benign and malignant skull neoplasm defects. METHODS A retrospective review of a prospectively maintained database of all implant cranioplasties performed between 2011 and 2014, by a single craniofacial surgeon at a tertiary academic medical institution was performed. Preoperative and postoperative computed tomography scans with 3D reconstruction were performed for the purpose of assessing adequate resection and reconstructive outcomes. Primary endpoints included length of surgery, predicted defect versus postoperative implant surface area, contour irregularities, and complications. RESULTS Of the 108 patients with cranioplasty identified, 7 patients were found to undergo immediate CCI-based reconstruction for calvarial neoplasms; 4 patients (4/7, 57%) presented with malignant pathology. All defects were >5 cm2. As compared with their original size, all implants were modified intraoperatively between 0.2% and 40.8%, with a mean of 13.8%. With follow-up ranging between 1 and 16 months, there were no implant-related complications identified. The immediate and long-term aesthetic results, as well as patient satisfaction, were ideal. CONCLUSION With this preliminary experience, the authors have successfully demonstrated that immediate customized implant reconstructive techniques, by way of intraoperative modification, are both safe and feasible for benign and malignant skull neoplasms. The authors believe that with wider acceptance of this multidisciplinary approach and increased surgeon familiarity, this technique will soon become the reconstructive standard of care.


title: Proportional assist ventilation and neurally adjusted ventilatory assist.

text: Patient-ventilator synchrony is a common problem with all patients actively triggering the mechanical ventilator. In many cases synchrony can be improved by vigilant adjustments by the managing clinician. However, in most institutions clinicians are not able to spend the time necessary to ensure synchrony in all patients. Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) were both developed to improve patient-ventilator synchrony by proportionally unloading ventilatory effort and turning control of the ventilatory pattern over to the patient. This paper discusses PAV's and NAVA's theory of operation, general process of application, and the supporting literature.


title: Influence of technique used to attach the infusion set to peristaltic finger smart-pumps on dispensing time: an experimental study.

text: Background Infusion sets designed for peristaltic finger smart pumps (PFSPs) are necessary for the pumps' accurate handling. We previously found that medication dispensing is occasionally incomplete following the calculated infusion time when using certain combinations of PFSPs and infusion sets at a Japanese hospital. Thus, in this study, we investigated the cause of this observed delay by determining the effect of infusion set attachment technique on dispensing time using a combination of three kinds of PFSPs and five kinds of polyvinyl chloride (PVC) and polybutadiene (PB) infusion sets. Methods PFSPs with their exclusive infusion sets were used. The PVC and PB infusion sets were either not stretched or stretched to 1-3 cm and attached to the PFSP's liquid delivery system. PFSP dispensing rates were set at 25-400 mL/h. The primary outcome was the time required to dispense 100 mL of saline in a volumetric flask. Results The complete dispensing time correlated with the input time for all equipment combinations when the infusion sets were not stretched before attachment to the PFSP (R2 = 0.9998-1.0000). When stretched, the complete dispensing time was longer than the input time (P < 0.01-0.05, analysis of variance with Tukey-Kramer multiple comparisons). The maximum dispensing time extension ratio for the PVC and PB infusion sets was 141.8% and 113.0%, respectively. Conclusion Certain attachment techniques for infusion sets can adversely prolong drug dispensing time. As such, pharmacists should provide medical staff with information about the devices used to administer drugs, as well as about the drugs themselves.


title: Kinesiology taping does not change fibularis longus latency time and postural sway.

text: BACKGROUND Kinesiology tape seems to improve muscle force, although little is known regarding its effect on latency time and postural sway. OBJECTIVES To examine the effects of kinesiology taping on fibularis longus latency time and postural sway in healthy subjects. METHODS Thirty participants were equally randomized into three groups, two experimental groups receiving kinesiology tape (EG1, from origin to insertion; EG2, from insertion to origin) and a control group. Before and 20-min after the intervention, postural sway was assessed on a force platform and fibularis longus latency time was recorded with surface electromyography during a sudden inversion perturbation. RESULTS At baseline, no differences were found between groups regarding age, anthropometrics variables, postural sway and fibularis longus latency time. In both experimental groups, the application of tape did not change postural sway and fibularis longus latency time (EG1: 93.7 ± 15.0 to 89.9 ± 15.6 ms; EG2, 81.24 ± 14.21 to 81.57 ± 16.64, p < 0.05). Also, no changes were observed in the control group. CONCLUSION Kinesiology tape seems not to enhance fibularis longus reaction time and postural sway in young healthy subjects.


title: Therapeutic hypothermia after cardiac arrest: outcome predictors.

text: OBJECTIVE The determination of coma patient prognosis after cardiac arrest has clinical, ethical and social implications. Neurological examination, imaging and biochemical markers are helpful tools accepted as reliable in predicting recovery. With the advent of therapeutic hypothermia, these data need to be reconfirmed. In this study, we attempted to determine the validity of different markers, which can be used in the detection of patients with poor prognosis under hypothermia. METHODS Data from adult patients admitted to our intensive care unit for a hypothermia protocol after cardiac arrest were recorded prospectively to generate a descriptive and analytical study analyzing the relationship between clinical, neurophysiological, imaging and biochemical parameters with 6-month outcomes defined according to the Cerebral Performance Categories scale (good 1-2, poor 3-5). Neuron-specific enolase was collected at 72 hours. Imaging and neurophysiologic exams were carried out in the 24 hours after the rewarming period. RESULTS Sixty-seven patients were included in the study, of which 12 had good neurological outcomes. Ventricular fibrillation and electroencephalographic theta activity were associated with increased likelihood of survival and improved neurological outcomes. Patients who had more rapid cooling (mean time of 163 versus 312 minutes), hypoxic-ischemic brain injury on magnetic resonance imaging or neuron-specific enolase > 58ng/mL had poor neurological outcomes (p < 0.05). CONCLUSION Hypoxic-ischemic brain injury on magnetic resonance imaging and neuron-specific enolase were strong predictors of poor neurological outcomes. Although there is the belief that early achievement of target temperature improves neurological prognoses, in our study, there were increased mortality and worse neurological outcomes with earlier target-temperature achievement.


title: Coronavirus and interpersonal violence: A need for digital mental health resources.

text: Since the declaration of COVID-19 restrictions and lockdowns, countries across the world have seen an increase in reports of interpersonal violence. During these trying times, digital mental health resources tailored to interpersonal violence are needed. Through the use of online platforms such as websites, mobile applications, and social media, survivors and perpetrators alike can access tools that help them manage stressors induced by the coronavirus as well as practice emotional regulation techniques and communication strategies at home. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Selectivity of conventional electrodes for recording motor evoked potentials: An investigation with high-density surface electromyography.

text: INTRODUCTION The objective of this study was to determine whether motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation and measured with conventional bipolar electromyography (EMG) are influenced by crosstalk from non-target muscles. METHODS MEPs were recorded in healthy participants using conventional EMG electrodes placed over the extensor carpi radialis muscle (ECR) and high-density surface EMG (HDsEMG). Fifty MEPs at 120% resting and active motor threshold were recorded. To determine the contribution of ECR to the MEPs, the amplitude distribution across HDsEMG channels was correlated with EMG activity recorded during a wrist extension task. RESULTS Whereas the conventional EMG identified MEPs from ECR in >90% of the stimulations, HDsEMG revealed that spatial amplitude distribution representative of ECR activation was observed less frequently at rest than while holding a contraction (P < 0.001). CONCLUSIONS MEPs recorded with conventional EMG may contain crosstalk from non-target muscles, especially when the stimulation is applied at rest. Muscle Nerve 55: 828-834, 2017.


title: Multicenter prospective randomized study comparing the technique of using a bovine pericardium biological prosthesis reinforcement in parietal herniorrhaphy (Tutomesh TUTOGEN) with simple parietal herniorrhaphy, in a potentially contaminated setting.

text: The use of parietal synthetic prosthetic reinforcement material in potentially contaminated settings is not recommended, as there is a risk that the prosthesis may become infected. Thus, simple parietal herniorrhaphy, is the conventional treatment, even though there is a significant risk that the hernia may recur. Using new biomaterials of animal origin presently appears to offer a new therapeutic solution, but their effectiveness has yet to be demonstrated. The purpose of this multicenter prospective randomized single-blind study was to compare the surgical treatment of inguinal hernia or abdominal incisional hernia by simple parietal herniorrhaphy without prosthetic reinforcement (Group A), with Tutomesh TUTOGEN biological prosthesis reinforcement parietal herniorrhaphy (Group B), in a potentially contaminated setting. We examined early postoperative complications in the first month after the operation, performed an assessment after one year of survival without recurrence and analyzed the quality of life and pain of the patients (using SF-12 health status questionnaire and Visual Analog Pain Scale) at 1, 6, and 12 months, together with an economic impact study. Hundred and thirty four patients were enrolled between January 2009 and October 2010 in 20 French hospitals. The groups were comparable with respect to their enrollment characteristics, their history, types of operative indications and procedures carried out. At one month post-op, the rate of infectious complications (n(A) = 11(18.33%) vs. n(B) = 12(19.05%), p = 0.919) was not significantly different between the two groups. The assessment after one year of survival without recurrence revealed that survival was significantly greater in Group B (Group A recurrence: 10, Group B: 3; p = 0.0475). No difference in the patients' quality of life was demonstrated at 1, 6, or 12 months. However, at the 1 month follow-up, the "perceived health" rating seemed better in the group with Tutomesh (p = 0.022). No significant difference between the two parietal repair groups was observed during the follow-ups with respect to the criterion of pain (using a visual analog scale). There was a significant difference between the two parietal repair groups with regard to the number of days spent in intensive care unit, in favor of the Tutomesh technique (p = 0.010). The use of a Tutomesh bioprosthesis for hernia repair or postincisional hernia in a potentially contaminated workplace reduces the risk of short-term recurrence without increasing overall comorbidity.


title: Natural small molecules as inhibitors of coronavirus lipid-dependent attachment to host cells: a possible strategy for reducing SARS-COV-2 infectivity?

text: BACKGROUND Viral infectivity depends on interactions between components of the host cell plasma membrane and the virus envelope. Here we review strategies that could help stem the advance of the SARS-COV-2 epidemic. METHODS AND RESULTS We focus on the role of lipid structures, such as lipid rafts and cholesterol, involved in the process, mediated by endocytosis, by which viruses attach to and infect cells. Previous studies have shown that many naturally derived substances, such as cyclodextrin and sterols, could reduce the infectivity of many types of viruses, including the coronavirus family, through interference with lipid-dependent attachment to human host cells. CONCLUSIONS Certain molecules prove able to reduce the infectivity of some coronaviruses, possibly by inhibiting viral lipid-dependent attachment to host cells. More research into these molecules and methods would be worthwhile as it could provide insights the mechanism of transmission of SARS-COV-2 and, into how they could become a basis for new antiviral strategies.


title: Multidisciplinary management of clubfeet using the Ponseti method in a district general hospital setting.

text: PURPOSE Idiopathic congenital talipes equinovarus (CTEV) is a relatively common complex deformity of the foot that can be successfully managed by the Ponseti method. The purpose of this study was to see if the latter can be effectively administered by non-medical specialists outside a specialist or teaching hospital setting. METHOD Retrospective review of 24 children (39 feet) with idiopathic congenital talipes equinovarus managed by a physiotherapist-led service in a district general hospital. RESULTS The median Pirani score at presentation was 4.5 (mean 4.2, range 1.5-6). The median Pirani score for feet requiring tenotomy was 6 (4.5-6), whereas feet not requiring tenotomy had a median Pirani score of 2.5 (1.5-5). A total of 18 feet (46%) underwent an Achilles tenotomy. Foot correction was achieved with an average of 3.4 (2-6) cast changes in the non-tenotomy group, and an average of 7.5 (5-13) in the tenotomy group. Successful initial correction of the deformity was achieved in 37 (95%) of the feet studied. One patient (2 feet, 5%) failed local conservative management, requiring tertiary referral. Two children (2 feet) have relapsed, requiring further serial casting. No children required open surgical release. Follow-up was for a mean of 31 months (17-50). CONCLUSIONS Early results suggest that a combined consultant/physiotherapist-delivered Ponseti service can be effectively and successfully administered in a district general hospital.


Signs of an increase in suicides due to the effects of COVID-19.


title: Artificial Intelligence and Primary Care Research: A Scoping Review.

text: PURPOSE Rapid increases in technology and data motivate the application of artificial intelligence (AI) to primary care, but no comprehensive review exists to guide these efforts. Our objective was to assess the nature and extent of the body of research on AI for primary care. METHODS We performed a scoping review, searching 11 published or gray literature databases with terms pertaining to AI (eg, machine learning, bayes* network) and primary care (eg, general pract*, nurse). We performed title and abstract and then full-text screening using Covidence. Studies had to involve research, include both AI and primary care, and be published in Eng-lish. We extracted data and summarized studies by 7 attributes: purpose(s); author appointment(s); primary care function(s); intended end user(s); health condition(s); geographic location of data source; and AI subfield(s). RESULTS Of 5,515 unique documents, 405 met eligibility criteria. The body of research focused on developing or modifying AI methods (66.7%) to support physician diagnostic or treatment recommendations (36.5% and 13.8%), for chronic conditions, using data from higher-income countries. Few studies (14.1%) had even a single author with a primary care appointment. The predominant AI subfields were supervised machine learning (40.0%) and expert systems (22.2%). CONCLUSIONS Research on AI for primary care is at an early stage of maturity. For the field to progress, more interdisciplinary research teams with end-user engagement and evaluation studies are needed.


title: Early dialogue with health technology assessment bodies: a European perspective.

text: INTRODUCTION Evidence requirements may differ across HTA bodies, and so pharmaceutical companies must plan to synergize their evidence generation strategy, across global regulatory and HTA bodies. Until recently, companies had no official platform to discuss the clinical development of a drug with HTA bodies; however, this is changing. OBJECTIVES To achieve broad usage in the EU, products must achieve both regulatory and reimbursement approval, the latter of which is based on HTA appraisal in many markets. The objective of this study is to present and evaluate the different options available for early HTA consultation (during drug development/Phase III) in the major European markets from the industry perspective. METHODS An exploratory (nonsystematic) literature review was performed to identify the European markets offering early HTA consultations, and each process was analyzed using a set of predefined metrics that are relevant to industry (the ability to consult with the regulatory body in parallel, consultation fees, length of consultation meeting, language of consultation meeting, maximum number of pharmaceutical company employees attending, procedural timelines, nature of data for which consultative advice can be sought, the output of the process, and the ability to involve external experts). RESULTS Four different types of early HTA consultation processes were identified across the major European HTA markets. The nature of these processes varied in terms of the types and number of questions that can be addressed, the length of the meeting, the reporting output, and the ability to involve external experts. CONCLUSIONS The availability of various options for early HTA consultation may help to avoid a mismatch between the evidence generated by means of a product's clinical development program, and the evidence expected by HTA bodies and payers, which can facilitate the pricing and reimbursement process upon a product's market authorization.


title: Utility and feasibility of integrating pulse oximetry into the routine assessment of young infants at primary care clinics in Karachi, Pakistan: a cross-sectional study.

text: BACKGROUND Hypoxemia may occur in young infants with severe acute illnesses or congenital cardiac anomalies, but is not reliably detected on physical exam. Pulse oximetry (PO) can be used to detect hypoxemia, but its application in low-income countries has been limited, and its feasibility in the routine assessment of young infants (aged 0-59 days) has not been previously studied. The aim of this study was to characterize the operational feasibility and parent/guardian acceptability of incorporating PO into the routine clinical assessment of young infants in a primary care setting in a low-income country. METHODS This was a cross-sectional study of 862 visits by 529 infants at two primary care clinics in Karachi, Pakistan (March to June, 2013). After clinical assessment, oxygen saturation (Sp02) was measured by a handheld PO device (Rad-5v, Masimo Corporation) according to a standardized protocol. Performance time (PT) was the time between sensor placement and attainment of an acceptable PO reading (i.e., stable SpO2 + 1% for at least 10 s, heart rate displayed, and adequate signal indicators). PT included the time for one repeat attempt at a different anatomical site if the first attempt did not yield an acceptable reading within 1 min. Parent/guardian acceptability of PO was based on a questionnaire and unprompted comments about the procedure. All infants underwent physician assessment. RESULTS Acceptable PO readings were obtained in ≤ 1 and ≤ 5 min at 94.4% and 99.8% of visits, respectively (n = 862). Median PT was 42 s (interquartile range 37; 50). Parents/guardians overwhelmingly accepted PO (99.6% overall satisfaction, n = 528 first visits). Of 10 infants with at least one visit with Sp02 <92% on a first PO attempt, 3 did not have a significant acute illness on physician assessment. There were no PO-related adverse events. DISCUSSION Using a commercially available handheld pulse oximeter, acceptable Sp02 measurements were obtained in nearly all infants in under 1 minute. The procedure was readily integrated into existing assessment pathways and parents/guardians had positive views of the technology. CONCLUSIONS When incorporated into routine clinical assessment of young infants at primary care clinics in a low-income country, PO was feasible and acceptable to parents/guardians. Future research is needed to determine if the introduction of routine PO screening of young infants will improve outcomes in low-resource settings.


title: Incidence of Complications During Initial Experience with Revision of the Agility and Agility LP Total Ankle Replacement Systems: A Single Surgeon's Learning Curve Experience.

text: As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. Currently, no published data exist on the incidence of intraoperative and early postoperative complications during revision of the Agility or Agility LP Total Ankle Replacement Systems during the surgeon learning curve period; therefore, the authors sought to determine this incidence during the senior author's learning curve period.


Deeply reconsidering elective surgery: worldwide concerns regarding colorectal surgery in a COVID-19 pandemic and a Singapore perspective.


title: Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature.

text: Pyogenic spondylodiscitis includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. This is a rare complication of sacral colpopexy, but can lead to devastating consequences for the patient. We present two cases of pyogenic spondylodiscitis following sacral colpopexy. In addition, we discuss 26 cases of pyogenic spondylodiscitis reported in the literature from 1957 to 2012. Techniques to decrease rates of infection include proper identification of the S1 vertebra, awareness of the suture placement depth at the level of the sacrum and at the vagina, and early treatment of post-operative urinary tract and vaginal infections. Awareness of symptoms, timely diagnosis and multidisciplinary approach to management is essential in preventing long-term complications.


title: Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions.

text: BACKGROUND Minimally invasive esophagectomy (MIE) is being performed at an increasing number of institutions. The thoracoscopic portion is generally performed in the left lateral decubitus position. Recently there has been increasing interest in esophageal mobilization in the prone position and the potential benefits of this technique with regard to operative time, surgeon ergonomics, and operative exposure. We sought to objectively compare thoracoscopic mobilization of the esophagus in the left lateral decubitus position versus the prone position and identify potential differences between the two techniques. METHODS A retrospective review of a prospectively maintained esophagectomy database identified 44 patients undergoing MIE during a 20-month period (June 2005-February 2007). Of these, 32 patients underwent thoracoscopic esophageal mobilization with cervical esophagogastric anastomosis. Eleven cases were performed in the left lateral decubitus position and 21 performed in the prone position. RESULTS The patients were comparable in age, tumor stage, and fraction undergoing neoadjuvant therapy. There was no statistically significant difference between decubitus position and prone position with regard to number of lymph nodes procured (14.6 versus 15.5, p = 0.69), complications (6/11 versus 10/21, p = 1.0), length of stay (9 versus 10 days, p = 1.0), or intraoperative blood loss (85 versus 65 cc, p = 0.14). Thoracoscopic operative times were significantly shorter in the prone group than the decubitus group (86 versus 123 min, p = 0.0001). CONCLUSIONS Prone thoracoscopic esophageal mobilization appears to be equivalent to decubitus thoracoscopic esophageal mobilization with respect to blood loss, number of lymph nodes dissected, and complications, but with a significant reduction in thoracoscopic surgical time.


Coronavirus vaccines: five key questions as trials begin.


title: Transorbital Cavernous Sinus Direct Puncture : Alternative to treat dural arteriovenous fistula.

text: INTRODUCTION The authors present a retrospective series of their clinical experience in the treatment of cavernous dural arteriovenous fistulas (DAVF) by direct transorbital puncture of the cavernous sinus as an alternative to the endovascular approach. METHODS Between October 2012 and September 2014, eight patients harboring cavernous DAVF underwent percutaneous treatment by direct transorbital puncture of the cavernous sinus at three institutions. All patients presented with ocular symptoms. Standard endovascular approaches, including transvenous and transarterial routes, were primarily attempted without success in all cases. Direct puncture was performed through two different approaches, namely inferolateral and superomedial. The entry point was the inferior and superior eyelid, respectively. Embolization was performed with coils or Onyx (Covidien, Irvine, CA). Immediate and late angiographies were used to evaluate the occlusion of the fistula. RESULTS Of the patients seven had complete occlusion of the cavernous DAVFs noted on the immediate and follow-up angiograms and one patient had residual filling but reduction of the shunt resulted in clinical improvement. None of the patients had worsening of neurological function. One case was complicated by inadvertent internal carotid puncture but without clinical manifestations. One patient experienced postoperative superior ophthalmic vein thrombosis. CONCLUSION In very specific cases, when endovascular access is not possible or fails to occlude cavernous DAVF, direct transorbital puncture of the cavernous sinus was shown to be feasible, safe and very effective.


title: Effects of transcranial photobiomodulation with near-infrared light on sexual dysfunction.

text: OBJECTIVES Transcranial photobiomodulation (t-PBM) consists of the delivery of near-infrared (NIR) or red light to the scalp designed to penetrate to subjacent cortical areas of the brain. NIR t-PBM has recently emerged as a potential therapy for brain disorders. This study assessed the efficacy of repeated sessions of NIR t-PBM on sexual dysfunction. METHODS We performed a secondary analysis of a double-blind clinical trial on t-PBM for major depressive disorder (MDD). Twenty individuals received NIR t-PBM (n = 9) or sham therapy (n = 11) twice a week for 8 weeks. Sexual desire, arousal, and orgasm were assessed using the Systematic Assessment for Treatment-Emergent Effects-Specific Inquiry (SAFTEE-SI). RESULTS The mean improvement in sexual function (decrease in SAFTEE sex total score) in subjects receiving t-PBM in NIR-mode was significantly greater than in subjects receiving sham-mode in the whole sample (NIR [n = 9] -2.55 ± 1.88 vs. sham [n = 11] -0.45 ± 1.21; z = 2.548, P = 0.011]) and in the completers (NIR [n = 5] -3.4 ± 1.95 vs. sham [n = 7] -0.14 ± 1.21; z = 2.576, P = 0.010]). CONCLUSION This exploratory study with a small sample size indicates that repeated sessions of NIR t-PBM may be associated with therapeutic effects on sexual dysfunction. The latter appeared unrelated to the antidepressant effect of t-PBM in our cohort. Lasers Surg. Med. 51:127-135, 2019. © 2018 Wiley Periodicals, Inc.


title: Structure-Activity Relationship Studies of Substituted 2-(Isoxazol-3-yl)-2-oxo-N'-phenyl-acetohydrazonoyl Cyanide Analogues: Identification of Potent Exchange Proteins Directly Activated by cAMP (EPAC) Antagonists.

text: Exchange proteins directly activated by cAMP (EPAC) as guanine nucleotide exchange factors mediate the effects of the pivotal second messenger cAMP, thereby regulating a wide variety of intracellular physiological and pathophysiological processes. A series of novel 2-(isoxazol-3-yl)-2-oxo-N'-phenyl-acetohydrazonoyl cyanide EPAC antagonists was synthesized and evaluated in an effort to optimize properties of the previously identified high-throughput (HTS) hit 1 (ESI-09). Structure-activity relationship (SAR) analysis led to the discovery of several more active EPAC antagonists (e.g., 22 (HJC0726), 35 (NY0123), and 47 (NY0173)) with low micromolar inhibitory activity. These inhibitors may serve as valuable pharmacological probes to facilitate our efforts in elucidating the biological functions of EPAC and developing potential novel therapeutics against human diseases. Our SAR results have also revealed that further modification at the 3-, 4-, and 5-positions of the phenyl ring as well as the 5-position of the isoxazole moiety may allow for the development of more potent EPAC antagonists.


title: Endovascular treatment of debilitating tinnitus secondary to cerebral venous sinus abnormalities: a literature review and technical illustration.

text: BACKGROUND AND OBJECTIVE Pulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT. METHODS We conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included. RESULTS A total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25-72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality. CONCLUSIONS In patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.


title: Pediatric ophthalmology, strabismus and neuro-ophthalmology practice in the COVID-19 era: All India Ophthalmological Society guidelines.

text: The COVID-19 Pandemic has prompted substantial changes in the way ophthalmology is practiced globally. General guidelines on safe ophthalmic practice have been issued by various bodies across the globe including the All India Ophthalmological Society. While these are suitable to ophthalmology overall, they are not entirely suitable to a subspecialty practice, particularly pediatric ophthalmology, strabismus and neuro-ophthalmology, which entails dealing with children, surgery under general anesthesia and managing possible life threatening situations. A group of sub-specialists and anesthetists met virtually and arrived at a consensus with regard to practice and general anesthesia protocols pertaining to these subspecialties of ophthalmology. The recommendations made by the expert group are specific yet can be universally followed to ensure the best and safest outcome for the practitioner and patient alike. The recommendations pertain to listing conditions which need emergency or urgent care in the fields of pediatric ophthalmology and neuro-ophthalmology, precautions and technique of pediatric and neuro-ophthalmic eye examination and a protocol for delivering a safe general anesthesia for a pediatriceye surgery.


title: Cross-linking in biomaterials: a primer for clinicians.

text: The purpose of this primer is to provide the clinical surgeon with a survey overview of the basic biochemistry of collagen and the methods and rationale of collagen cross-linking in the processing and preparation of bioprosthetics for surgical implantation. The author highlights the critical biologic factors, such as strength over time, integration, and rate, and type of remodeling, that are to an extent controllable by the cross-linking of collagen tissues so that clinicians may be better capable of understanding differences among the devices, which may be more applicable to their clinical indications.


title: Fear, anger, and media-induced trauma during the outbreak of COVID-19 in the Czech Republic.

text: Fear, anger and hopelessness were the most frequent traumatic emotional responses in the general public during the first stage of outbreak of the COVID-19 epidemic in the Czech Republic (N = 1,000). The four most frequent categories of fear were determined: (a) fear of the negative impact on household finances, (b) fear of the negative impact on the household finances of significant others, (c) fear of the unavailability of health care, and (d) fear of an insufficient food supply. The pessimistic communications used by the Czech mass media contributed to intensifying traumatic feelings, fears and psychological distress in the general public during the outbreak of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Laparoscopic treatment of a large cystic adenomyosis of the uterus: A case report.

text: INTRODUCTION We describe a patient with a large cystic adenomyosis of the uterus who was treated by a laparoscopic approach. CASE PRESENTATION A 38-year-old woman presented with dysmenorrhoea for 4 months. A 104 mm × 55 mm × 60 mm cystic mass was detected on the right side of the posterior wall of the uterus by ultrasound. Laparoscopy was performed, during which a bumpy mass was discovered protruding from the surface of the uterine myometrium. Both ovaries were normal. When the wall of the cystic mass was opened, chocolate-colored fluid was visible. The cyst was completely removed, and postoperative histopathology confirmed a cystic adenomyosis. One month later, the uterus was found to be normal on ultrasound. DISCUSSION Endometriosis is a common disease in women and is divided into ovarian endometrioid cysts, superficial endometriosis, deep infiltrating endometriosis and other special types according to pathological characteristics. As a special type of endometriosis, the incidence of cystic adenomyosis is low, and its specific incidence is unknown. Cystic adenomyosis is clinically characterized by the appearance of one or more cystic cavities between the walls of the uterine muscles. CONCLUSION Laparoscopic surgery is an effective method for the diagnosis and treatment of large cystic masses in the uterine myometrium.


title: Factorial validity of the Urdu version of the obsession with COVID-19 scale: Preliminary investigation using a University Sample in Pakistan.

text: The psychological toll of the COVID-19 pandemic is being felt by people around the world. Persistent and disturbed thinking about the disease appears to be contributing to this mental health concern. Although the Obsession with COVID-19 Scale (OCS) has been shown to be a reliable and valid instrument in the U.S., it has not been examined with in Pakistan. The current study addressed this problem by examining the validity of an Urdu translated version of the OCS using online survey data from 240 university students and teachers in Pakistan. The results showed that the OCS exhibited factorial validity, as well as measurement invariance for gender. However, the OCS also showed limited evidence of construct validity in terms of showing weak positive correlations with the total scale and social dysfunction and self-confidence subscales of the General Heath Questionnaire and no correlation with the depression and anxiety subscale (GHQ-12). These findings suggest that further research is necessary before the Urdu version of the OCS is widely adopted in Pakistan.


title: Conical polyurethane implants: an uplifting augmentation.

text: BACKGROUND Polyurethane-coated conical implants were introduced by Silimed (US distributor: Sientra, Santa Barbara, California) in 2008 and offer an alternative to round or anatomically shaped implants. By their design and volume distribution, they naturally create central volume and give a reasonable fullness to the upper pole while lifting some ptotic breasts, thus avoiding the need for classical mastopexy. OBJECTIVES The authors discuss the advantages of conical implants as an alternative to conventional silicone implants for women with breast ptosis. METHODS In the 2-year period between December 2010 and December 2012, a consecutive series of 302 women underwent implant-based breast surgery procedures (236 primary augmentations, 59 revisions, and 7 mastopexy-augmentations) with conical polyurethane devices. Implant volumes ranged from 225 to 560 cc, with low- to medium-profile devices predominating. No extra-high-profile implants were used. Only 1 patient had a drain inserted on completion of a revision augmentation. RESULTS There were no infections (0%) and no wound dehiscence (0%). Four cases required reoperation (1.3%). Patient satisfaction scores were universally high (average, 9.94/10). There have been no capsular contractures to date, but follow-up is short. CONCLUSION The modern conical, polyurethane implant has many advantages over the conventional round or anatomically shaped implants and offers patients an ideal compromise between volume, natural upper pole fullness, and a lift without mastopexy scars.


title: Transtracheal ventilation with a novel ejector-based device (Ventrain) in open, partly obstructed, or totally closed upper airways in pigs.

text: BACKGROUND Transtracheal access and subsequent jet ventilation are among the last options in a 'cannot intubate-cannot oxygenate' scenario. These interventions may lead to hypercapnia, barotrauma, and haemodynamic failure in the event of an obstructed upper airway. The aim of the present study was to evaluate the efficacy and the haemodynamic effects of the Ventrain, a manually operated ventilation device that provides expiratory ventilation assistance. Transtracheal ventilation was carried out with the Ventrain in different airway scenarios in live pigs, and its performance was compared with a conventional jet ventilator. METHODS Pigs with open, partly obstructed, or completely closed upper airways were transtracheally ventilated either with the Ventrain or by conventional jet ventilation. Airway pressures, haemodynamic parameters, and blood gases obtained in the different settings were compared. RESULTS Mean (SD) alveolar minute ventilation as reflected by arterial partial pressure of CO2 was superior with the Ventrain in partly obstructed airways after 6 min in comparison with traditional manual jet ventilation [4.7 (0.19) compared with 7.1 (0.37) kPa], and this was also the case in all simulated airway conditions. At the same time, peak airway pressures were significantly lower and haemodynamic parameters were altered to a lesser extent with the Ventrain. CONCLUSIONS The results of this study suggest that the Ventrain device can ensure sufficient oxygenation and ventilation through a small-bore transtracheal catheter when the airway is open, partly obstructed, or completely closed. Minute ventilation and avoidance of high airway pressures were superior in comparison with traditional hand-triggered jet ventilation, particularly in the event of complete upper airway obstruction.


title: Use of human immunoglobulins as an anti-infective treatment: the experience so far and their possible re-emerging role.

text: INTRODUCTION Pooled human immunoglobulins (IGs) are prepared from plasma obtained from healthy donors as a concentrated antibody-containing solution. In addition, high-titer IGs (hyperimmune) against a specific pathogen can be obtained from vaccinated or convalescing donors. Currently, IGs can be used for the treatment of a variety of infections for which no specific therapy exists or that remain difficult to treat. Moreover, the recent pathogen outbreaks for which there is no approved treatment have renewed attention to the role of convalescent plasma and IGs. Areas covered: In this review, a historical perspective of the use of sera and IGs in humans as anti-infective agents (any viral, bacterial, parasitic infection), excluding immunodeficient patients, is presented from early development to the latest clinical studies. A Medline search was conducted to examine the peer-reviewed literature, with no date limits. Expert commentary: Human pooled plasma-derived IG products benefit from the polyclonal response of every individual donor and from the interindividual variability in such response. The trend to increased availability of vaccines for infectious diseases also opens new potential applications of hyperimmune IGs for emerging or re-emerging infectious diseases (e.g.: Ebola, Zika, Dengue), for the prevention and treatment in the general population, healthcare personnel and caregivers.


title: Immunogenicity and protective efficacy in mice and hamsters of a β-propiolactone inactivated whole virus SARS-CoV vaccine.

text: The immunogenicity and efficacy of β-propiolactone (BPL) inactivated whole virion SARS-CoV (WI-SARS) vaccine was evaluated in BALB/c mice and golden Syrian hamsters. The vaccine preparation was tested with or without adjuvants. Adjuvant Systems AS01(B) and AS03(A) were selected and tested for their capacity to elicit high humoral and cellular immune responses to WI-SARS vaccine. We evaluated the effect of vaccine dose and each adjuvant on immunogenicity and efficacy in mice, and the effect of vaccine dose with or without the AS01(B) adjuvant on the immunogenicity and efficacy in hamsters. Efficacy was evaluated by challenge with wild-type virus at early and late time points (4 and 18 wk post-vaccination). A single dose of vaccine with or without adjuvant was poorly immunogenic in mice; a second dose resulted in a significant boost in antibody levels, even in the absence of adjuvant. The use of adjuvants resulted in higher antibody titers, with the AS01(B)-adjuvanted vaccine being slightly more immunogenic than the AS03(A)-adjuvanted vaccine. Two doses of WI-SARS with and without Adjuvant Systems were highly efficacious in mice. In hamsters, two doses of WI-SARS with and without AS01(B) were immunogenic, and two doses of 2 μg of WI-SARS with and without the adjuvant provided complete protection from early challenge. Although antibody titers had declined in all groups of vaccinated hamsters 18 wk after the second dose, the vaccinated hamsters were still partially protected from wild-type virus challenge. Vaccine with adjuvant provided better protection than non-adjuvanted WI-SARS vaccine at this later time point. Enhanced disease was not observed in the lungs or liver of hamsters following SARS-CoV challenge, regardless of the level of serum neutralizing antibodies.


title: Mobility and interactions of coronavirus nonstructural protein 4.

text: Green fluorescent protein (GFP)-tagged mouse hepatitis coronavirus nonstructural protein 4 (nsp4) was shown to localize to the endoplasmic reticulum (ER) and to be recruited to the coronavirus replicative structures. Fluorescence loss in photobleaching and fluorescence recovery after photobleaching experiments demonstrated that while the membranes of the ER are continuous with those harboring the replicative structures, the mobility of nsp4 at the latter structures is relatively restricted. In agreement with that observation, nsp4 was shown to be engaged in homotypic and heterotypic interactions, the latter with nsp3 and nsp6. In addition, the coexpression of nsp4 with nsp3 affected the subcellular localization of the two proteins.


title: Differential inhibitory effects of cyanovirin-N, griffithsin, and scytovirin on entry mediated by envelopes of gammaretroviruses and deltaretroviruses.

text: The antiviral lectins griffithsin (GRFT), cyanovirin-N (CV-N), and scytovirin (SVN), which inhibit several enveloped viruses, including lentiviruses, were examined for their ability to inhibit entry mediated by Env proteins of delta- and gammaretroviruses. The glycoproteins from human T-cell leukemia virus type 1 (HTLV-1) were resistant to the antiviral effects of all three lectins. For gammaretroviruses, CV-N inhibited entry mediated by some but not all of the envelopes examined, whereas GRFT and SVN displayed only little or no effect.


Endoscopic vacuum therapy in Boerhaave's syndrome with open-pore polyurethane foam and a new open-pore film drainage.


title: Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report.

text: OBJECTIVE The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. METHODS Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway pressure of >25 cm H2O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. RESULTS The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. CONCLUSION Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size.


Books for our time: seven classics that speak to us now.


title: Rhabdomyolysis: a review of clinical presentation, etiology, diagnosis, and management.

text: Rhabdomyolysis is a condition that results from many underlying etiologies and can present in a myriad of ways to the emergency physician. However, some clinical and laboratory features are almost always present and, if noted, can help in making the diagnosis. This review article will focus on the presenting symptoms, the various etiologies, the underlying mechanisms, and the current management of pediatric rhabdomyolysis.


title: Pilot-testing an applied competency-based approach to health human resources planning.

text: A competency-based approach to health human resources (HHR) planning is one that explicitly considers the spectrum of knowledge, skills and judgement (competencies) required for the health workforce based on the health needs of the relevant population in some specific circumstances. Such an approach is of particular benefit to planners challenged to make optimal use of limited HHR as it allows them to move beyond simply estimating numbers of certain professionals required and plan instead according to the unique mix of competencies available from the existing health workforce. This kind of flexibility is particularly valuable in contexts where healthcare providers are in short supply generally (e.g. in many developing countries) or temporarily due to a surge in need (e.g. a pandemic or other disease outbreak). A pilot application of this approach using the context of an influenza pandemic in one health district of Nova Scotia, Canada, is described, and key competency gaps identified. The approach is also being applied using other conditions in other Canadian jurisdictions and in Zambia.


Secondary acquired cholesteatoma after adenoidectomy and myringotomy.


title: A simplified measurement of pulse wave velocity is not inferior to standard measurement in young adults and children.

text: The standard measurement of pulse wave velocity (PWV) is restricted by the need for simultaneous tonometry measurements requiring two technicians and expensive equipment, limiting this technique to well-resourced settings. In this preliminary study, we compared a simplified method of pulse wave detection from the finger and toe to pulse wave detection from the carotid and radial arteries using applanation tonometry in children and young adults. We hypothesized that the simplified method of PWV measurement would strongly correlate with the standard measurement in different age groups and oxygen conditions. Participants included (a) boys and girls aged 8-12 years and (b) men and women aged 18-40 years. Participants rested supine while carotid and radial artery pulse waves were measured using applanation tonometry and finger and toe pulse waves were simultaneously collected using a Finometer Midi and a piezo-electric pulse transducer, respectively. These measurements were repeated under hypoxic conditions. Finger-toe PWV measurements were strongly correlated to carotid-radial PWV in adults (R=0.58; P=0.011), but not in children (R=0.056; P=0.610). Finger-toe PWV was sensitive enough to show increases in PWV with age (P<0.0001) and hypoxia in children (P<0.0001) and adults (P=0.003). These results indicate that the simplified measurement of finger-toe PWV strongly correlates with the standard measurement of carotid-radial PWV in adults, but not in children. However, finger-toe PWV can be used in either population to determine changes with hypoxia.


title: COVID-19, Australia: Epidemiology Report 11 (Reporting week to 23:59 AEST 12 April 2020).

text: Confirmed cases in Australia notified up to 12 April 2020: notifications = 6,394; deaths = 46. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of the disease. Notifications in Australia remain predominantly among people with recent overseas travel, with some locally-acquired cases being detected. Most locally-acquired cases are able to be linked back to a confirmed case, with a small portion unable to be epidemiologically linked. The distribution of overseas-acquired cases to locally acquired cases varies by jurisdiction. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained. The epidemiology differs from country to country depending not only on the disease, but also on differences in case detection, testing and implemented public health measures.


title: Is immunosuppression status a risk factor for noninvasive ventilation failure in patients with acute hypoxemic respiratory failure? A post hoc matched analysis.

text: BACKGROUND Recent European/American guidelines recommend noninvasive ventilation (NIV) as a first-line therapy to manage acute hypoxemic respiratory failure in immunocompromised patients. By contrast, NIV may have deleterious effects in nonimmunocompromised patients and experts have been unable to offer a recommendation. Immunocompromised patients have particularly high mortality rates when they require intubation. However, it is not clear whether immunosuppression status is a risk factor for NIV failure. We assessed the impact of immunosuppression status on NIV failure in a post hoc analysis pooling two studies including patients with de novo acute hypoxemic respiratory failure treated with NIV. Patients with hypercapnia, acute exacerbation of chronic lung disease, cardiogenic pulmonary edema, or with do-not-intubate order were excluded. RESULTS Among the 208 patients included in the analysis, 71 (34%) were immunocompromised. They had higher severity scores upon ICU admission, higher pressure-support levels, and minute ventilation under NIV, and were more likely to have bilateral lung infiltrates than nonimmunocompromised patients. Intubation and in-ICU mortality rates were higher in immunocompromised than in nonimmunocompromised patients: 61% vs. 43% (p = 0.02) and 38% vs. 15% (p < 0.001), respectively. After adjustment or using a propensity score-matched analysis, immunosuppression was not associated with intubation, whereas it remained independently associated with ICU mortality with an adjusted odds ratio of 2.64 (95% CI 1.24-5.67, p = 0.01). CONCLUSIONS Immunosuppression status may directly influence mortality but does not seem to be associated with an increased risk of intubation in patients with de novo acute hypoxemic respiratory failure treated with NIV. Studies in this specific population are needed.


title: Advanced imaging in acute ischemic stroke.

text: The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history. Transcranial Doppler ultrasonography can be used in the acute setting as a minimally invasive way of identifying large vessel occlusions or monitoring the response to stroke treatment. It can also be used to assist in the workup for cryptogenic stroke or to diagnose a patent foramen ovale. Four-dimensional CTA and MRA provide a less invasive alternative to digital subtraction angiography to determine the extent of the clot burden and the degree of collateral blood flow in large vessel occlusions. Along with technological advances, these new imaging modalities are improving the diagnosis, workup, and management of acute ischemic stroke- roles that will continue to expand in the future.


Medical and dental consultants' association of nigeria (MDCAN) standard operating procedure (SOP) on COVID-19 outbreaks for use by consultants and other health workers at service points within hospitals in Nigeria.


title: The deformation monitoring of foundation pit by back propagation neural network and genetic algorithm and its application in geotechnical engineering.

text: The objective is to improve the prediction accuracy of foundation pit deformation in geotechnical engineering, thereby provide early warning for engineering practice. The digital close-range photogrammetry is used to obtain monitoring data. The error compensation method is used to optimize the center of the monitoring point. Aiming at the limitations of back propagation neural network (BPNN), a genetic algorithm (GA)-optimized BPNN algorithm is proposed. Then, the optimized algorithm is applied to predict the deformation and displacement of foundation pits from three aspects, i.e., simple horizontal displacement, simple longitudinal displacement, and the combination of horizontal and longitudinal displacements. Meanwhile, the time domain, space domain, and time-space domain are used as input features to compare the prediction results of the BPNN model and the GA-optimized BPNN model. Finally, the GA-improved BPNN is compared with the Support Vector Regression (SVR) model and Random Forest (RF) model. The results show that the prediction result, obtained by simultaneously using horizontal displacement and longitudinal displacement as input features, has smaller errors; also, the actual output is closer to the expected output. Compared with the prediction result with time domain and space domain as input features, the prediction result with time-space domain as input features is closer to the expected output. Taking the combination of time and space domains as input features, compared with the BPNN model, the GA-optimized BPNN model has a lower Root Mean Squared Error (RMSE) value (0.0163), a larger Index of Agreement (IA) value (0.9800), and a shorter training time (7.08 s). Compared with the SVR model and RF model, the GA-improved BPNN model has a lower Root Mean Squared Error (RMSE) value (0.0211), a larger Index of Agreement (IA) value (0.9706), and shorter training time (7.61 s). Therefore, the foundation pit deformation prediction model based on BPNN and GA has strong prediction ability, which can be popularized and applied in similar geotechnical engineering.


title: Truncation of the enzootic nasal tumor virus envelope protein cytoplasmic tail increases Env-mediated fusion and infectivity.

text: Enzootic nasal tumor virus (ENTV) and Jaagsiekte sheep retrovirus (JSRV) are highly related ovine betaretroviruses that induce nasal and lung tumours in small ruminants, respectively. While the ENTV and JSRV envelope (Env) glycoproteins mediate virus entry using the same cellular receptor, the glycosylphosphatidylinositol-linked protein hyaluronoglucosaminidase, ENTV Env pseudovirions mediate entry into cells from a much more restricted range of species than do JSRV Env pseudovirions. Unlike JSRV Env, ENTV Env does not induce cell fusion at pH 5.0 or above, but rather requires a much lower pH (4.0-4.5) for fusion to occur. The cytoplasmic tail of retroviral envelope proteins is a key modulator of envelope-mediated fusion and pseudotype efficiency, especially in the context of virions composed of heterologous Gag proteins. Here we report that progressive truncation of the ENTV Env cytoplasmic tail improves transduction efficiency of pseudotyped retroviral vectors and that complete truncation of the ENTV Env cytoplasmic tail increases transduction efficiency to wild-type JSRV Env levels by increasing fusogenicity without affecting sensitivity to inhibition by lysosomotropic agents, subcellular localization or efficiency of inclusion into virions. Truncation of the cytoplasmic domain of ENTV Env resulted in a significant advantage in viral entry into all cell types tested, including foetal ovine lung and nasal cells. Taken together, we demonstrate that the cytoplasmic tail modulates the fusion activity of the ENTV Env protein and that truncation of this region enhances Eenv-mediated entry into target cells.


title: Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study.

text: PURPOSE To describe a novel technique for multimodality positron emission tomography (PET) fusion-guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure. MATERIALS AND METHODS Subjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded. RESULTS Seven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13-54 min). Total procedure time was 95 minutes (range 51-240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3-6.2 min). CONCLUSIONS An integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware.


title: Coronavirus replicase-reporter fusions provide quantitative analysis of replication and replication complex formation.

text: UNLABELLED The replication of coronaviruses occurs in association with multiple virus-induced membrane structures that evolve during the course of infection; however, the dynamics of this process remain poorly understood. Previous studies of coronavirus replication complex organization and protein interactions have utilized protein overexpression studies and immunofluorescence of fixed cells. Additionally, live-imaging studies of coronavirus replicase proteins have used fluorescent reporter molecules fused to replicase proteins, but expressed from nonnative locations, mostly late-transcribed subgenomic mRNAs, in the presence or absence of the native protein. Thus, the timing and targeting of native replicase proteins expressed in real time from native locations in the genome remain unknown. In this study, we tested whether reporter molecules could be expressed from the replicase polyprotein of murine hepatitis virus as fusions with nonstructural protein 2 or 3 and whether such reporters could define the targeting and activity of replicase proteins during infection. We demonstrate that the fusion of green fluorescent protein and firefly luciferase with either nonstructural protein 2 or 3 is tolerated and that these reporter-replicase fusions can be used to quantitate replication complex formation and virus replication. The results show that the replicase gene has flexibility to accommodate a foreign gene addition and can be used directly to study replicase complex formation and evolution during infection as well as to provide highly sensitive and specific markers for protein translation and genome replication. IMPORTANCE Coronaviruses are a family of enveloped, positive-sense RNA viruses that are important agents of disease, including severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus. Replication is associated with multiple virus-induced membrane structures that evolve during infection; however, the dynamics of this process remain poorly understood. In this study, we tested whether reporter molecules expressed from native locations within the replicase polyprotein of murine hepatitis virus as fusions with nonstructural proteins could define the expression and targeting of replicase proteins during infection in live cells. We demonstrate that the replicase gene tolerates the introduction of green fluorescent protein or firefly luciferase as fusions with replicase proteins. These viruses allow early quantitation of virus replication as well as real-time measurement of replication complexes.


title: Nasopharyngeal Lactobacillus is associated with a reduced risk of childhood wheezing illnesses following acute respiratory syncytial virus infection in infancy.

text: BACKGROUND Early life acute respiratory infection (ARI) with respiratory syncytial virus (RSV) has been strongly associated with the development of childhood wheezing illnesses, but the pathways underlying this association are poorly understood. OBJECTIVE To examine the role of the nasopharyngeal microbiome in the development of childhood wheezing illnesses following RSV ARI in infancy. METHODS We conducted a nested cohort study of 118 previously healthy, term infants with confirmed RSV ARI by RT-PCR. We used next-generation sequencing of the V4 region of the 16S ribosomal RNA gene to characterize the nasopharyngeal microbiome during RSV ARI. Our main outcome of interest was 2-year subsequent wheeze. RESULTS Of the 118 infants, 113 (95.8%) had 2-year outcome data. Of these, 46 (40.7%) had parental report of subsequent wheeze. There was no association between the overall taxonomic composition, diversity, and richness of the nasopharyngeal microbiome during RSV ARI with the development of subsequent wheeze. However, the nasopharyngeal detection and abundance of Lactobacillus was consistently higher in infants who did not develop this outcome. Lactobacillus also ranked first among the different genera in a model distinguishing infants with and without subsequent wheeze. CONCLUSIONS The nasopharyngeal detection and increased abundance of Lactobacillus during RSV ARI in infancy are associated with a reduced risk of childhood wheezing illnesses at age 2 years.


title: A new arenavirus in a cluster of fatal transplant-associated diseases.

text: BACKGROUND Three patients who received visceral-organ transplants from a single donor on the same day died of a febrile illness 4 to 6 weeks after transplantation. Culture, polymerase-chain-reaction (PCR) and serologic assays, and oligonucleotide microarray analysis for a wide range of infectious agents were not informative. METHODS We evaluated RNA obtained from the liver and kidney transplant recipients. Unbiased high-throughput sequencing was used to identify microbial sequences not found by means of other methods. The specificity of sequences for a new candidate pathogen was confirmed by means of culture and by means of PCR, immunohistochemical, and serologic analyses. RESULTS High-throughput sequencing yielded 103,632 sequences, of which 14 represented an Old World arenavirus. Additional sequence analysis showed that this new arenavirus was related to lymphocytic choriomeningitis viruses. Specific PCR assays based on a unique sequence confirmed the presence of the virus in the kidneys, liver, blood, and cerebrospinal fluid of the recipients. Immunohistochemical analysis revealed arenavirus antigen in the liver and kidney transplants in the recipients. IgM and IgG antiviral antibodies were detected in the serum of the donor. Seroconversion was evident in serum specimens obtained from one recipient at two time points. CONCLUSIONS Unbiased high-throughput sequencing is a powerful tool for the discovery of pathogens. The use of this method during an outbreak of disease facilitated the identification of a new arenavirus transmitted through solid-organ transplantation.


title: Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis.

text: Importance Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations. Objective To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. Data Sources Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017. Study Selection Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. Data Extraction and Synthesis Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. Main Outcomes and Measures Total direct hospital costs. Results This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged from 2.2 to 3.5 among the studies. When patients were pooled irrespective of diagnosis, there was a statistically significant reduction in costs (-$3237; 95% CI, -$3581 to -$2893; P < .001). In the stratified analyses, there was a reduction in costs for the cancer (-$4251; 95% CI, -$4664 to -$3837; P < .001) and noncancer (-$2105; 95% CI, -$2698 to -$1511; P < .001) subsamples. The reduction in cost was greater in those with 4 or more comorbidities than for those with 2 or fewer. Conclusions and Relevance The estimated association of early hospital PCC with hospital costs may vary according to baseline clinical factors. Estimates may be larger for primary diagnosis of cancer and more comorbidities compared with primary diagnosis of noncancer and fewer comorbidities. Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.


Searching for the ideal endobronchial blocker.


title: Laparoscopic percutaneous jejunostomy with intracorporeal V-Loc jejunopexy in esophageal cancer.

text: BACKGROUND Barbed sutures are widely used in various laparoscopic digestive surgeries. The purpose of this paper is to present our initial experience of laparoscopic percutaneous jejunostomy with unidirectional barbed sutures in esophageal cancer patients and compare it with our early cases using traditional transabdominal sutures. METHODS A total of 118 esophageal cancer patients who underwent laparoscopic percutaneous jejunostomy were identified in a single institution in Taiwan from June 2014 to May 2016. The authors' traditional technique consisted of using transabdominal sutures with bolsters to fix a jejunum loop onto the anterior abdominal wall. A novel technique was introduced using intracorporeal suturing with knotless unidirectional barbed monofilament absorbable sutures (V-Loc) to attain a seal around the feeding catheter. A comparison between these two techniques was performed. RESULTS Twenty cases with barbed V-Loc sutures and 98 cases with transabdominal sutures were identified. The V-Loc sutures appeared to reduce peristomal skin ulcers (19.4 vs. 0 %, p = 0.040), postoperative pain scores during the first 24 h (1.8 ± 1.4 vs. 0.9 ± 1.1, p = 0.007) and on postoperative day 2 (1.7 ± 1.4 vs. 1.0 ± 0.8, p = 0.026) when compared to patients receiving transabdominal sutures. The mean suturing time using V-Loc sutures was 22 min (14-60 min). The mean onset to resumption of enteral feeding was 1.8 ± 0.8 days and the mean duration of postoperative hospital stay was 8 ± 5.1 days, both of which were comparable in the two groups. There was no surgical mortality in our series. CONCLUSIONS In the study cohort, the use of knotless unidirectional barbed sutures instead of traditional transabdominal sutures had similar outcomes and appears to be a feasible option for intracorporeal jejunopexy when performing laparoscopic jejunostomy in patients with esophageal cancer.


Commentary: The molecular pandemonium of coronavirus disease 2019.


Assessment of immune response to SARS-CoV-2 with fully automated MAGLUMI 2019-nCoV IgG and IgM chemiluminescence immunoassays.