title: Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study.

text: INTRODUCTION The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution. METHODS We conducted a retrospective analysis after replacing the background CEI with PIEB for our labor PCEA. Pre-change pump settings were CEI 12mL/h with PCEA (12mL bolus, lockout 15min); PIEB settings were a 9mL bolus every 45min with PCEA (10mL bolus, lockout 10min). We compared medical records of all women receiving epidural or combined spinal-epidural labor analgesia for vaginal delivery for two months before PIEB implementation to a two-month period of PIEB utilization following a five-month introductory familiarization period. The primary outcome was the proportion of women requiring rescue clinician boluses. RESULTS Fewer patients in the PIEB group required rescue clinician boluses compared to the CEI group (12% vs. 19%, P=0.012). Time to first rescue bolus request and total bolus dose were not different. Peak (median [IQR]) pain scores were 2[0-5] with CEI and 0[0-4] with PIEB. There was no difference in instrumental delivery rates. CONCLUSIONS Using PIEB compared to CEI as the background maintenance epidural analgesia method in conjunction with PCEA reduced the number of women requiring clinician rescue boluses while providing comparable labor analgesia. The findings of this clinical care impact study confirm the results of randomized controlled studies and suggest PIEB may be a preferable technique to CEI for the maintenance of labor analgesia.


title: Stent-assisted embolization of 100 middle cerebral artery aneurysms.

text: OBJECT The introduction of intracranial stents to aneurysm treatment allows endovascular repair of nearly all aneurysms, but the safety and durability of stent-assisted embolization of middle cerebral artery (MCA) aneurysms is unclear. METHODS Ninety-one patients with 100 complex MCA aneurysms not amenable to simple coiling were treated with stent-assisted embolization as a first option. Technical and clinical results, initial follow-up imaging, and long-term annual MR angiography (MRA) were reviewed. RESULTS Intracranial stents were successfully deployed in all 100 aneurysms. There was 1 case of significant neurological morbidity (1%) and 1 case of death (1%) related to treatment. Initial posttreatment angiography revealed complete occlusion of 48 aneurysms (48%), a residual neck in 21 (21%), and residual aneurysm filling in 31 (31%). Follow-up imaging performed in 85 (90.4%) of a possible 94 aneurysms showed complete occlusion of 77 aneurysms (90.6%), residual neck in 3 (3.5%), and residual filling in 5 (5.9%). Four aneurysms (4.7%) required retreatment. Long-term MRA follow-up revealed stability or progressive thrombosis in 47 (97.9%) of 48 aneurysms. In 11 patients Y-configuration stenting caused only 1 minor complication and provided durable occlusion in all cases. CONCLUSIONS Stent-assisted techniques increase the number of aneurysms that may be treated endovascularly and represent an acceptable alternative to craniotomy. Stents provided adequate vessel reconstruction, low complication rates, and good long-term occlusion.


title: Mobile migrants, mobile germs: migration, contagion, and boundary-building in Shenzhen, China after SARS.

text: Shenzhen, a city located on the border between Mainland China and Hong Kong, is populated primarily by internal Chinese migrants. After the 2003 SARS epidemic, the pressure in Shenzhen to contain infectious disease has been considerable. By engaging with issues of global biosecurity, migration and citizenship, and intersubjectivity in medicine, I argue that in their attempts to prevent another SARS and protect their own subject positions as modern, urban citizens, Shenzhen's public health professionals worked to maintain precarious boundaries between themselves and their city's majority migrant population. However, by establishing the migrants as dangerous, biological noncitizens, by denying connections between the migrants' experiences and their own experiences of migration, by failing to engage with the migrants as subjects, and by defending structures that institutionalized these exclusions, they undermined both the health of the migrants and the stability of the city they were trying to protect.


title: Ultrasound-guided transhepatic radiofrequency ablation of renal tumors: a safe and effective approach.

text: PURPOSE This study was designed to determine the feasibility and safety of ultrasound-guided transhepatic radiofrequency ablation (RFA) of masses in the right kidney. METHODS Between June 2001 and December 2011, 18 patients who underwent transhepatic renal RFA procedures to treat 19 tumors were retrospectively identified. Complications (Clavien-Dindo classification system) and local tumor control were evaluated for all patients. RESULTS Median maximal diameter of the treated renal tumors was 1.9 (range 1.1-4.3) cm. No major complication developed during any of the procedures. No hepatic tumor seeding was identified during imaging follow-up. There was a single technical failure (5.3%). Median cross-sectional imaging follow-up was 28 (range 3-121) months. Primary technique failure (local recurrence) occurred in 1 of the 16 tumors with follow-up imaging (5.3%). CONCLUSIONS Percutaneous ultrasound-guided transhepatic RFA of renal neoplasms is technically feasible, effective, and associated with a low rate of complications. The transhepatic approach may allow safe ablation of renal tumors that would otherwise be difficult to treat.


Challenges and opportunities for occupational health and safety after the COVID-19 lockdowns.


title: Safety of unsedated PEG placement using transoral ultrathin endoscopy in patients with amyotrophic lateral sclerosis.

text: BACKGROUND AND AIMS In patients with amyotrophic lateral sclerosis (ALS), percutaneous endoscopic gastrostomy (PEG) placement under sedation often causes apnea or hypoventilation. The aim of the present study was to assess whether unsedated PEG placement in ALS patients using ultrathin endoscopy (UTE) via the transoral route can improve safety. METHODS Between 2003 and 2013, PEG placement was identified and reviewed in 45 patients with ALS. PEG was performed in 14 patients using transoral UTE without sedation (UTE group), 17 patients using conventional normal-diameter esophagogastroduodenoscopy (C-EGD) without sedation (unsedated C-EGD group) and 14 patients using C-EGD with sedation (sedated C-EGD group). We compared the clinical features, cardiopulmonary data before and during PEG placement, and complications related to PEG placement among the three groups. RESULTS There were no significant differences in age, male/female ratio, forced vital capacity, blood pressure, oxygen saturation before and during PEG, or major complications among the three groups. No minor complications were observed in the UTE group, whereas apnea and/or hypoventilation were observed in the sedated C-EGD group and aspiration pneumonia was observed in the unsedated C-EGD group. CONCLUSIONS Unsedated PEG placement using transoral UTE in ALS patients is a safe method.


title: Customization of an open-lung ventilation strategy to treat a case of life-threatening acute respiratory distress syndrome.

text: The ARDS Network low-tidal-volume protocol is considered the standard of care for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The protocol is built on the foundation of low-tidal-volume ventilation, use of a combined PEEP and F(IO(2)) table, and managing alveolar end-inspiratory pressure by limiting the plateau airway pressure to ≤ 30 cm H(2)O. Although this strategy, to date, is the only method that significantly improves ALI/ARDS survival, alternative methods of improving hypoxemia and minimizing ventilator-induced lung injury, in conjunction with low-tidal-volume ventilation, can be used for life-threatening ARDS. We present a case in which we customized the use of alveolar recruitment maneuvers by analyzing the hysteresis of the pressure-volume curve to assess lung recruitability, decremental PEEP to sustain lung recruitment, and careful use of plateau pressure ≥ 30 cm H(2)O, which improved our patient's life-threatening hypoxemia within the first 36 min of arrival to our ICU.


title: IgG4-related Disease in the Stomach which Was Confused with Gastrointestinal Stromal Tumor (GIST): Two Case Reports and Review of the Literature.

text: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory disorder characterized by specific pathological findings and elevated serum IgG4 level. IgG4-RD in the stomach is rare, and occasionally diagnosed as gastric subepithelial tumor (SET) by endoscopy or computed tomography scan. Two female patients in the age group of 40-50 years were diagnosed with 4 cm sized gastric SET. One underwent laparoscopic gastric wedge resection. Another one had a history of subtotal gastrectomy for early gastric cancer and idiopathic thrombocytopenic purpura with oral steroids administration. She underwent a completion total gastrectomy with splenectomy for the gastric SET and ITP. The pathology showed storiform fibrosis, and IgG4 was positive in immunohistochemistry (IHC) stain. IgG4-RD is known as a medical disease that could be treated with oral steroids. The difficulty in preoperative diagnosis of the disease occasionally causes unnecessary gastric resection. Thus, preoperative diagnostic methods for IgG4-RD such as deep biopsy with IHC stain or magnetic resonance imaging are needed.


title: Growth and Reproductive Performance of Rangeland Beef-Cattle as Influenced by Controlled and Uncontrolled Populations of Horn Flies (Diptera: Muscidae).

text: A 4-yr study was conducted on native rangeland to assess the growth and reproductive performance of cows (Bos taurus) infested with naturally occurring seasonal populations of horn flies (Haematobia irritans). One hundred five Angus × Hereford cow-calf pairs were evaluated as a randomized complete block that was replicated across 4 yr. Cows were approximately 39 d postpartum at the beginning of each yearly trial and were randomly allocated to either an untreated control (UTC) or an insecticide-treated (TRT) herd. Horn fly populations were monitored throughout each yearly replication and blood serum progesterone levels were used to estimate postpartum interval lengths and days to pregnancy. Initial body weights of cows were collected in May with final body weights and calf weaning weights acquired in October of each year. Monthly horn fly control ranged from 85.55 to 99.57% throughout the 4 yr. Cows within UTC herds maintained on average 530.10 ± 94.74 more (P = 0.0015) flies per animal than TRT. However, no differences were detected between treatment groups for any of the reproductive parameters evaluated (P > 0.05). Despite a lack of difference in the reproductive parameters measured, TRT cows gained more (P = 0.0492) weight throughout the fly seasons when compared to UTC cattle. Furthermore, calves paired with insecticide-treated cows tended (P = 0.0680) to wean 16.28 ± 8.04 kg heavier than calves paired with cows exposed to naturally occurring horn fly populations.


title: Organ-specific attenuation of murine hepatitis virus strain A59 by replacement of catalytic residues in the putative viral cyclic phosphodiesterase ns2.

text: The Murine hepatitis virus (MHV) strain A59 ns2 protein is a 30-kDa nonstructural protein that is expressed from a subgenomic mRNA in the cytoplasm of virus-infected cells. Its homologs are also encoded in other closely related group 2a coronaviruses and more distantly related toroviruses. Together, these proteins comprise a subset of a large superfamily of 2H phosphoesterase proteins that are distinguished by a pair of conserved His-x-Thr/Ser motifs encompassing catalytically important residues. We have used a vaccinia virus-based reverse genetic system to produce recombinant viruses encoding ns2 proteins with single-amino-acid substitutions in, or adjacent to, these conserved motifs, namely, inf-ns2 H46A, inf-ns2 S48A, inf-ns2-S120A, and inf-ns2-H126R. All of the mutant viruses replicate in mouse 17 clone 1 fibroblast cells and mouse embryonic cells to the same extent as the parental wild-type recombinant virus, inf-MHV-A59. However, compared to inf-MHV-A59, the inf-ns2 H46A and inf-ns2-H126R mutants are highly attenuated for replication in mouse liver following intrahepatic inoculation. Interestingly, none of the mutant viruses were attenuated for replication in mouse brain following intracranial inoculation. These results show that the ns2 protein of MHV-A59 has an important role in virus pathogenicity and that a substitution of the histidine residues of the MHV-A59 ns2 His-x-Thr/Ser motifs is critical for virus virulence in the liver but not in the brain. This novel phenotype suggests a strategy to investigate the function of the MHV-A59 ns2 protein involving the search for organ-specific proteins or RNAs that react differentially to wild-type and mutant ns2 proteins.


Percutaneous tibial nerve stimulation in faecal incontinence.


title: Development of a real-time PCR assay for detection of African swine fever virus with an endogenous internal control.

text: Real-time PCR assays are highly sensitive, specific and rapid techniques for the identification of ASF virus (ASFV) (Section 3.8, OIE Terrestrial Manual, 2019). Although an ASFV p72 gene based real-time PCR assay (a.k.a. the Zsak assay) (Zsak et al. J. Clinical Microbiology, 43, 2005, 112) has been widely used for ASFV detection, several more ASFV sequences have become available in the 15 years since the design of the Zsak assay. In this study, we developed a new ASFV p72 gene based real-time PCR after analysis of all currently available sequences of the p72 gene and multiplexed the new assay with a modified Zsak assay aiming to have a broader coverage of ASFV strain/isolates. To reduce false negative detections, porcine house-keeping gene, beta actin (ACTB), was applied as an internal control. Eight ACTB sequences from the GenBank and 61 partial ACTB sequences generated in this study, and 1,012 p72 sequences from the GenBank and 23 p72 sequences generated at FADDL, were used for ACTB and ASFV primer and probe designs, respectively, to ensure broader host and ASFV coverage. Multiplexing ACTB in the reaction did not inhibit ASFV amplification. The multiplex assay was evaluated for strain/isolate coverage, sensitivity and specificity. The in silico analysis showed high ASFV strain/isolate coverage: 98.4% (978/994) of all p72 sequences currently available. The limit of detection (LOD) was 6 plasmid copies or 0.1-1 TCID50 /ml of ASFV isolates per reaction. Only targeted ASFV isolates and the viruses in the positive clinical samples were detected, indicating that the assay is highly specific (100% specificity). The test results of 26 ASFV isolates with different country origins showed that this newly developed multiplex assay performed better than the Zsak assay that has been widely accepted and used worldwide, indicating that it may be used as an alternative assay for ASFV detection.


title: Operative time and other outcomes of the electrothermal bipolar vessel sealing system (LigaSure) versus other methods for surgical hemostasis: a meta-analysis.

text: A meta-analysis was performed of 29 prospective, randomized trials (published January 1, 2000, to August 14, 2007) comparing an electrothermal bipolar vessel sealing system (EBVS-LigaSure, Covidien) (total n = 1107 patients) with either clamping with suture ligation/ electrocauterization (n = 1079 patients) or ultrasonic energy (eg, Harmonic Scalpel, Johnson & Johnson). Hemorrhoidectomy (12 articles), hysterectomy (4 articles), and thyroidectomy (3 articles) were the most common procedures. For 15 of 26 studies reporting standard deviations, the normalized mean operative time reduction for EBVS equaled 28% (95% confidence interval [CI] 18%-39%, P < .0001) compared with conventional surgical hemostasis. Operative time was reduced with EBVS in 24 of 26 studies (P < .0001). EBVS was associated with 43 mL (95% CI 14-73 mL, P = .0021) less blood loss, fewer complications (odds ratio 0.66, 95% CI 0.47-0.92, P = .02), and mean reduction in postoperative pain of 2.8 units (95% CI 1.5-4.1, P < .0001). Five studies used ultrasonic energy as the comparator, but none reported standard deviation so data could not be pooled.


title: Transarterial ONYX Embolization of Intracranial Dural Arteriovenous Fistulas in Adults.

text: AIM To present our experience on transarterial treatment of dural arteriovenous fistulas (DAVFs) with ONYX in adult patients. MATERIAL AND METHODS Between March 2008 and November 2012, 27 adult patients with DAVFs treated by transarterial ONYX embolization were included. Clinical data, including hospital records, operative reports, and angiograms, were reviewed and analyzed. RESULTS Complete obliteration of the fistula was achieved in 16/27 (59.3%) patients after 32 intra-arterial embolizations. One complication (3.7%) was transient hemiparesis. Follow-up imaging, which was available for 16 fistulas with angiographic cures, showed no evidence of recurrence. At mean 14.5 months follow-up, 26 patients (96.3%) had GOS score of 5 and 1 patient (3.7%) had GOS score of 3. CONCLUSION Transarterial ONYX embolization has become the main treatment for adult intracranial DAVFs and is associated with high safety and efficacy.


The potential impact of COVID-19 on the Canadian Resident Matching Service: Unique future challenges faced by urology residency programs and applicants.


title: Electromagnetic measurement and modeling techniques for microwave ablation probes.

text: Broadband scattering parameter measurement of a commercially available microwave ablation probe over the course of a 10 minute 45 Watt ablation cycle within ex-vivo bovine liver tissue is performed. Measurement results are compared to finite difference time domain simulation of the probe in non-ablated and fully ablated tissue geometries. Measurement and simulation results agree well from 0-3 GHz demonstrating the accuracy of a multi-compartmental ablation geometry modeling technique. The electromagnetic modeling technique presented in this paper introduces a useful design tool for optimizing microwave ablation probes without the need for multi-physics simulation packages. The relevance of tissue complex permittivity change with temperature to microwave ablation probe performance is discussed.


title: Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass.

text: BACKGROUND This study aimed to evaluate differences between three methods of liver retraction during laparoscopic Roux-en-Y Gastric bypass (LRYGB) and to compare novel liver retraction techniques with the traditional mechanical liver retractor in a randomized controlled trial. METHODS In this study, 60 obese patients (26 males and 34 females) who underwent LRYGB between January and July 2010 were randomized to one of three groups (20 in each): group 1 (Nathanson liver retractor), group 2 (liver suspension tape), and group 3 (V-shaped liver suspension technique [V-LIST]). Data regarding demographics (age, sex, body mass index); liver function test (LFT) just before surgery; postoperative results immediately, then 18 h, 1 week, and 1 month after surgery; operative data, and visual analog scale (VAS) for pain on postoperative days (PODs) 1 and 2 were calculated and analyzed. RESULTS The groups did not differ significantly in terms of preoperative LFT or operative data except that group 3 took significantly longer time for liver suspension than group 1 (p = 0.01) or group 2 (p = 0.03). The VAS score in group 2 was significantly lower on POD 1 than in group 1 (p = 0.04). Group 1 showed a significant rise in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at 18 h compared with group 2 (p < 0.01 and p = 0.02, respectively) and group 3 (p < 0.01 and p = 0.01), at 1 week compared with group 2 (p = 0.04 and 0.04), and in AST levels alone during the immediate postoperative compared with group 3 (p = 0.04). CONCLUSION The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique. Both V-LIST and liver suspension tape have a short learning curve and implications for single-port surgery.


title: Reduction of Periodic Motion Artifacts in Photoplethysmography.

text: Periodic motion artifacts affect photoplethysmography (PPG) signals in activities of daily living (ADL), cardiopulmonary exercise testing (CPX), and cardiopulmonary resuscitation (CPR). This hampers measurement of interbeat intervals (IBIs) and oxygen saturation (SpO 2 ). Our objective was to develop a generic algorithm to remove periodic motion artifacts, recovering artifact-reduced PPG signals for beat-to-beat analysis. METHODS The algorithm was retrospectively evaluated on forehead PPG signals measured while walking on a treadmill. The step rate was tracked in a motion reference signal via a second-order generalized integrator with a frequency-locked loop. Two reference signals were compared: sensor motion relative to the skin ( ∆x[n]) measured via self-mixing interferometry and head motion ( av[n] ) measured via accelerometry. The step rate was used in a quadrature harmonic model to estimate the artifacts. Quadrature components need only two coefficients per frequency leading to a short filter and prevent undesired frequency-shifted components in the artifact estimate. Subtracting the estimate from the measured signal reduced the artifacts. RESULTS Compared to ∆x[n] , av[n] had a better signal-to-noise ratio and more consistently contained a component at the step rate. Artifact reduction was effective for distinct step rate and pulse rate, since the artifact-reduced signals provided more stable IBI and SpO 2 measurements. CONCLUSION Accelerometry provided a more reliable motion reference signal. The proposed algorithm can be of significance for monitoring in ADL, CPX, or CPR, by providing artifact-reduced PPG signals for improved IBI and SpO 2 measurements during periodic motion.


Investigation of force received at the upper teeth by video laryngoscopy.


title: CD4 deficiency causes poliomyelitis and axonal blebbing in murine coronavirus induced neuroinflammation.

text: Mouse hepatitis virus (MHV) is a murine β-coronavirus (m-CoV) which causes a wide range of diseases in mouse and rat, including hepatitis, enteritis, respiratory diseases, and encephalomyelitis in the CNS. MHV infection in mice provides an efficient cause-effect experimental model to understand the mechanisms of direct virus induced neural cell damage leading to demyelination and axonal loss which are pathological features of Multiple sclerosis (MS), the most common disabling neurological disease in young adults. Infiltration of T lymphocytes, activation of microglia and their interplay are the primary pathophysiological events leading to the disruption of myelin sheath in MS. However, there are emerging evidences supporting gray matter involvement and degeneration in MS. The investigation of T cell function in the pathogenesis of deep gray matter damage is necessary. Here, we employed RSA59 (isogenic recombinant strain of MHV-A59) induced experimental neuroinflammation model to compare the disease in CD4-/- mice with CD4+/+ mice at days 5, 10, 15, and 30 p.i. Viral titer estimation, nucleocapsid gene amplification and viral anti-nucleocapsid staining confirm enhanced replication of the virions in the absence of functional CD4+ T cells in the brain. Histopathological analyses showed an elevated susceptibility of CD4-/- mice to axonal degeneration in the CNS with augmented progression of acute poliomyelitis, and dorsal root ganglionic inflammation rarely observed in CD4+/+ mice. Depletion of CD4+ T cells shows unique pathological bulbar vacuolation in the brain parenchyma of infected mice with persistent CD11b+ microglia/macrophages in the inflamed regions on day 30 p.i. In summary, the current study suggests that CD4+ T cells are critical for controlling acute stage poliomyelitis (gray matter inflammation) and chronic axonal degeneration, inflammatory demyelination due to loss of protective anti-viral host immunity.IMPORTANCE The current trend in CNS disease biology is to understand the neural cell-immune interaction to investigate the underlying mechanism of neuroinflammation, rather than focusing on peripheral immune activation. Most studies in MS are targeted towards understanding the involvement of CNS white matter. However, the importance of gray matter damage has become critical in understanding the long-term progressive neurological disorder. Our study highlights the importance of CD4+T cells in safeguarding the neurons against axonal blebbing and poliomyelitis from murine Betacoronavirus-induced neuroinflammation. Current knowledge of the mechanisms that lead to gray matter damage in MS is limited, because the most widely used animal model EAE does not present this aspect of the disease. Our results thus, add to the existing limited knowledge in the field. We also show that the microglia, though important for the initiation of neuroinflammation, cannot establish a protective host immune response without the help of CD4+ T cells.


title: The Molecular Basis of Viral Inhibition of IRF- and STAT-Dependent Immune Responses.

text: The antiviral innate immunity is the first line of host defense against virus infections. In mammalian cells, viral infections initiate the expression of interferons (IFNs) in the host that in turn activate an antiviral defense program to restrict viral replications by induction of IFN stimulated genes (ISGs), which are largely regulated by the IFN-regulatory factor (IRF) family and signal transducer and activator of transcription (STAT) family transcription factors. The mechanisms of action of IRFs and STATs involve several post-translational modifications, complex formation, and nuclear translocation of these transcription factors. However, many viruses, including human immunodeficiency virus (HIV), Zika virus (ZIKV), and herpes simplex virus (HSV), have evolved strategies to evade host defense, including alteration in IRF and STAT post-translational modifications, disturbing the formation and nuclear translocation of the transcription complexes as well as proteolysis/degradation of IRFs and STATs. In this review, we discuss and summarize the molecular mechanisms by which how viral components may target IRFs and STATs to antagonize the establishment of antiviral host defense. The underlying host-viral interactions determine the outcome of viral infection. Gaining mechanistic insight into these processes will be crucial in understanding how viral replication can be more effectively controlled and in developing approaches to improve virus infection outcomes.


title: Emotional Arousal During Social Stress in Young Adults With Autism: Insights From Heart Rate, Heart Rate Variability and Self-Report.

text: In order to better understand which factors play a role in non-adaptive social behavior in autism spectrum disorder (ASD) we looked into physiological arousal and awareness of one's own emotions. Heart rate (HR) and heart rate variability (HRV) were measured during a public speaking task in 51 young adults with ASD and 28 typically developing (TD) controls. The results showed no significant group differences in baseline HR/HRV, HR reactivity (change from baseline to the speaking task) or self-reported emotional awareness. However, adults with ASD showed significantly lower HRV reactivity (p = .023, d = 0.6) compared to TD adults. These results suggest a mismatch between arousal regulation and emotional awareness, which may be related to problems in social adaptation in ASD.


title: Laparoscopic ventral rectopexy for rectal prolapse and rectal intussusception using a biological mesh.

text: AIM Laparoscopic ventral rectopexy (LVR) is a nerve-sparing technique for the treatment of rectal prolapse. Concerns about the use of synthetic meshes in the pelvis and the associated risk of erosion have led to the recent use of biological meshes in some colorectal units. This retrospective study aims to assess the outcomes of patients undergoing LVR using a noncross-linked nondermal biological mesh. METHOD The medical notes of all patients who underwent LVR between 1 December 2011 and 31 May 2014 were reviewed. The rate of obstructed defaecation before surgery was retrospectively determined from medical records using the Rome III criteria. The rates of obstructed defaecation and faecal incontinence following surgery were determined using a self-reported questionnaire. RESULTS A total of 51 patients had LVR between 1 December 2011 and 31 May 2014. Their mean age was 57.3 ± 2.5 years and the mean follow-up was 23 ± 1 months. There were seven (13.7%) postoperative complications. In total, 45 (88%) patients completed the functional outcome questionnaires. Before surgery, 33 (73.3%) patients complained of symptoms of obstructed defaecation. At the end of follow-up, 22 (48.8%, P = 0.001) patients continued to have some symptoms of obstructed defaecation. Before surgery, 12 (26.7%) patients complained of faecal incontinence. At the end of follow-up, only three (6.7%, P = 0.004) patients reported faecal incontinence. At the end of follow-up, recurrence of symptoms had occurred in six (13.3%) patients. CONCLUSION LVR using a biological mesh is safe and results in significant reduction in symptoms associated with external rectal prolapse and rectal intussusception.


Treatment for high-risk smoldering myeloma.


title: Comparison of mesh fixation and non-fixation in laparoscopic totally extraperitoneal inguinal hernia repair.

text: PURPOSE The purpose of this study was to compare laparoscopic total extraperitoneal (TEP) hernia repair procedures with or without mesh fixation for non-recurrent inguinal hernia. METHODS 100 male patients with non-recurrent inguinal hernia (62 unilateral and 38 bilateral) were included in the study. The patients were randomly assigned to either the mesh fixation group (n = 50) or the mesh non-fixation group (n = 50). The operative and follow-up data of the two groups were analyzed and compared in terms of recurrence rates, postoperative pain, length of hospital stay, and postoperative changes in testicular arterial blood flow. RESULTS Pain scores were significantly higher in the mesh fixation group prior to discharge and at the 1st postoperative month (p = 0.034 and 0.001, respectively). Necessity to use narcotic analgesics was higher in the fixation group prior to discharge (p = 0.025). Urinary retention was significantly more frequent in the fixation group than in the non-fixation group. (p = 0.007). The mean operative time and length of hospital stay were similar in both groups. Preoperative and postoperative measurements of testicular arterial blood flow showed a substantial but not statistically significant difference for the frequency of impairment (14.2% in the fixation group and 5.8% in the non-fixation group) (p = 0.176). At long-term follow-up, no recurrence and no nerve injury were determined. CONCLUSION Fixation of the mesh to the abdominal wall has been associated with various postoperative complications for no additional benefit in lowering recurrence rates. For non-recurrent inguinal hernia, non-fixation of the mesh is safe and reliable. Further studies with larger sample sizes are necessary for subgroup analyses.


title: Substituting freshwater: Can ocean desalination and water recycling capacities substitute for groundwater depletion in California?

text: While the sustainability of resource depletion is a longstanding environmental concern, wider attention has recently been given to growing water scarcity and groundwater depletion. This study seeks to test the substitutability assumption embedded in weak sustainability indicators using a case study of Californian water supply. The volume of groundwater depletion is used as a proxy for unsustainable water consumption, and defined by synthesising existing research estimates into low, medium and high depletion baselines. These are compared against projected water supply increases from ocean desalination and water recycling by 2035, to determine whether new, drought-proof water sources can substitute for currently unsustainable groundwater consumption. Results show that the maximum projected supply of new water, 2.47 million acre-feet per year (MAF/yr), is sufficient to meet low depletion estimates of 2.02 MAF/yr, but fails to come near the high depletion estimate of 3.44 MAF/yr. This does not necessarily indicate physical limitations of substitutability, but more so socio-economic limitations influenced by high comparative costs. By including capacities in demand-substitutability via urban water conservation, maximum predicted capacities reach 5.57 MAF/yr, indicating wide room for substitution. Based on these results, investment in social and institutional capital is an important factor to enhance demand-side substitutability of water and other natural resources, which has been somewhat neglected by the literature on the substitutability of natural resources.


Universal Masking in the Covid-19 Era.


title: A pilot study of the use of biocide-impregnated gauze as an adjunct to wound care in a burn population.

text: The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-associated infections in burn population. One hundred eight burn patients admitted to the Burn Treatment Center were prospectively enrolled from August 2008 to June 2009 and matched 1:2 with historic controls who were admitted from March 2006 to July 2008. Clinical care remained otherwise unchanged; however, several hospital initiatives (the national surgical improvement project, the surgical care improvement project, and a central venous line bundle) were initiated before and during the study. There were significantly less infections in the study population (18.52% of case patients vs 28.70% of control patients had infections, P = .047). Although there was a decrease in each infection subtype analyzed, a statistically significant reduction was only reached for pneumonias (1.85% in cases vs 5.86 in controls, P = .042). Implementation of polyhexamethylene biguanide biocide-impregnated gauze was temporally correlated with a significant decrease in healthcare-associated infections in burn population. As there was no corresponding decrease in wound infections, the impact of the gauze on healthcare-associated infections, if any, cannot be conclusively determined by this study. A larger prospective study powered to detect a decrease in wound-related infections is warranted.


title: Laparoscopic sleeve gastrectomy for diabetics - 5-year outcomes.

text: OBJECTIVE Although the laparoscopic sleeve gastrectomy (SG) is increasingly performed for morbid obesity, gastric bypass is still considered by many to be the gold standard procedure for obese diabetic patients. The aim of this study was to assess the long-term results of SG in morbidly obese patients with type 2 diabetes. METHODS Diabetic patients who underwent SG at a single center between 2009 and 2011 were included. Outcomes assessed included postoperative complications, weight loss, and resolution or improvement in co-morbidities with an emphasis on diabetes, including glycated hemoglobin (HbA1C) and medication status. RESULTS Fifty-one diabetic patients underwent SG, 35 females and 16 males, with a collective mean age of 49 years and a mean body mass index of 43.2 kg/m2. On average, patients had had diabetes for 5.4 ± 7.3 years before surgery. Mean HbA1C and fasting glucose levels were 7.9 ± 1.6% and 166.9 ± 63 mg/dL, respectively. Eleven patients (22%) were insulin dependent at the time of surgery. Average body mass index at a mean follow-up of 5 years after surgery was 34.4 ± 5.8 kg/m2, with an average HbA1C of 6.6 ± 1% and an average fasting glucose of 123 ± 60 mg/dL. Only 3 patients remained insulin dependent. CONCLUSION SG offers retainable weight loss results, accompanied by longstanding resolution or improvement of diabetes. Prospective, randomized controlled studies are warranted to better compare long-term outcomes between SG and gastric bypass.


title: Cluster of late preterm and term neonates with necrotizing enterocolitis symptomatology: descriptive and case-control study.

text: OBJECTIVE To investigate a necrotizing enterocolitis (NEC) cluster of late preterm and term neonates (gestational age ≥34 weeks). METHODS We conducted a descriptive and a case-control study. Medical records of neonates with modified Bell stage ≥ IB NEC and matched controls were reviewed, in addition to microbiological and environmental investigation. Study variables included maternal/delivery and neonatal factors, medications, procedures and feeding practices. Univariable/multivariable logistic regression analyses were performed for all and for stage ≥ II cases. RESULTS Out of 1841 late preterm and term neonates, 10 stage IB and 10 stage ≥ II [mean(SD) birthweight 2529.3 (493.04) g, gestational age 36.96 (1.48) weeks] presented with NEC symptomatology at mean 4.6 (range 2-8) days. Nearly all (19/20) resulted from high-risk pregnancies and received postpartum intermediate care. All were exclusively or partly formula fed. Most (14/20) were born by cesarean delivery. Eight underwent surgery, with no fatality. Intermediate care (p = 0.006), transient tachypnea (p = 0.049), not receiving breast milk (p = 0.019) and in addition intrauterine growth restriction (IUGR) (p = 0.017) for stage ≥ II cases were independently associated with NEC. CONCLUSIONS Late preterm and term neonates in need of intermediate care, with IUGR and transient tachypnea were susceptible to NEC; feeding with breast milk was an important protective factor.


title: Screening for Barrett's Esophagus.

text: The large increase in the incidence of esophageal adenocarcinoma in the West during the past 30 years has stimulated interest in screening for Barrett's esophagus (BE), a precursor to esophageal cancer. Effective endoscopic treatments for dysplasia and intramucosal cancer, coupled with screening programs to detect BE, could help reverse the increase in the incidence of esophageal cancer. However, there are no accurate, cost-effective, minimally invasive techniques available to screen for BE, reducing the enthusiasm of gastroenterologists. Over the past 5 years, there has been significant progress in the development of screening technologies. We review existing and developing technologies, new minimally invasive imaging techniques, nonendoscopic devices for cell collection, and biomarkers that can be measured in blood or stool samples. We discuss the status of these approaches, data from clinical studies of their effects, and their anticipated strengths and weaknesses in screening. The area is rapidly evolving, and new tools will soon be ready for prime time.


title: Laparoscopic versus open surgical management of small bowel obstruction: an analysis of short-term outcomes.

text: BACKGROUND Laparoscopy in acute care surgery continues to expand. While adhesive small bowel obstruction (SBO) has traditionally been managed via an open approach, appropriately selected patients may benefit from laparoscopy. The objective of our study was to compare short-term postoperative outcomes in patients with adhesive SBO treated with laparotomy versus laparoscopy. METHODS Using the ACS NSQIP participant use files (2005-10), patients with a postoperative diagnosis of adhesive SBO were selected for inclusion in this study. Patients with bowel resections or concomitant procedures were excluded. Both univariate analyses and multivariate logistic regression were performed to compare 30-day outcomes in the open and laparoscopic groups. RESULTS A total of 4,616 patients with adhesive SBO were identified: 3,697 (80.1%) and 919 (19.3%) in the open and laparoscopic groups, respectively. Mean operative time was similar in both groups. The mortality and overall complications were 84 (2.3%) and 819 (22.2%), respectively, in the open group compared to 7 (0.8%) and 81 (8.8%) in the laparoscopic group, with respective unadjusted odds ratios (ORs) of 0.33 (0.13-0.71, P < 0.01) and 0.39 (0.30-0.49, P < 0.01). The adjusted OR for overall complications was 0.46 (0.37-0.59, P < 0.01) favouring the laparoscopic group. The mean postoperative length of stay (LOS) was 8.4 days compared to 3.8 in the open and laparoscopic groups, respectively (P < 0.01). CONCLUSION The laparoscopic approach to treating adhesive SBO resulted in significantly fewer complications and shorter LOS.


title: Prevascular hernias of the abdominal wall: a difficult problem, a difficult repair.

text: INTRODUCTION Secondary prevascular hernias occurring anterior to the iliofemoral vessels and involving the lower abdominal wall are rare. These hernias can be difficult to repair because of loss of the inguinal ligament and the musculofascial elements of the inguinal region. MATERIALS AND METHODS We describe a new technique of repair using an intraperitoneal sling of prosthetic material. The sling is sewn posteriorly to the anterior surface of the sacrum, and is then draped caudally to be sewn to the pubis and Cooper's ligaments before being reflected anterior to be sewn to the posterior surface of the anterior abdominal wall. This sling "patches" the hernia defect as a form of intraperitoneal sublay. CONCLUSIONS We describe three such patients with satisfactory results at follow-ups of 8-16 months. Potential problems and considerations are discussed.


title: Evaluation of infectious complications following percutaneous liver ablation in patients with bilioenteric anastomoses.

text: PURPOSE Prior bilioenteric anastomosis (BEA) has been associated with elevated risk of abscess formation after thermal ablation of hepatic tumors. We assessed the incidence of hepatic abscess after thermal ablation in a BEA cohort treated with extended antibiotic regimens following ablation. MATERIALS AND METHODS Retrospective review was performed to identify patients with BEA who underwent percutaneous hepatic thermal ablation between January 1, 2003-September 1, 2016. Fifteen patients with BEA underwent 18 percutaneous thermal ablation procedures. Patient and procedural characteristics were reviewed, as well as the antibiotic regiment utilized post ablation. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE) v4.03]. RESULTS Fifteen patients with BEA underwent treatment of 49 liver lesions during 18 ablation sessions. Mean follow-up in these patients was 39 months (range 3-138 months). Two patients (11%) developed hepatic abscesses, both of which occurred within 45 days of the ablation procedure while the patients were still on extended prophylactic antibiotic therapy. No additional CTCAE clinically significant complications were observed. CONCLUSION Thermal ablation of hepatic tumors can be accomplished safely in patients with BEA. Long-term post-procedural antibiotics may mitigate the risk of hepatic abscess formation. Due to the high number of patients who are deemed surgically unresectable, patients with BEA may have limited alternate treatment modalities and percutaneous hepatic thermal ablative treatments warrant consideration.


title: A new and rapid approach for detecting COVID-19 based on S1 protein fragments.

text: The pandemic of novel coronavirus disease 2019 (COVID-19) seriously threatened the public health all over the world. A colloidal gold immunochromatography assay for IgM/IgG antibodies against the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) S1 protein was established to assess its rapid diagnostic value. We first designed and manufactured all contents of the test cassette of SARS-CoV-2 rapid test kit: the colloidal gold-labeled mouse-antihuman lgM/lgG antibody, the recombinant SARS-CoV-2 antigen, the nitrocellulose membrane control line, and specimen diluents. Furthermore, reverse transcription-polymerase chain reaction (RT-PCR) assay, colloidal gold immunochromatography assay, serological validation of cross reaction with other common viruses, and clinical validation were performed. The kit was finally evaluated by 75 serum/plasma samples of SARS-CoV-2 infection cases and 139 healthy samples as control, with the result of that the sensitivity, specificity, and accuracy for IgM were 90.67%, 97.84%, and 95.33%, whereas for IgG were 69.33%, 99.28%, and 88.79%, respectively; the combination of IgM and IgG could improve the value: 92.00%, 97.12%, and 95.33%, respectively. Therefore, the rapid detection kit has high sensitivity and specificity, especially for IgM&IgG, showing a critical value in clinical application and epidemic control of COVID-19.


title: Clinical Features and Chest CT Manifestations of Coronavirus Disease 2019 (COVID-19) in a Single-Center Study in Shanghai, China.

text: OBJECTIVE. Confronting the new coronavirus infection known as coronavirus disease 2019 (COVID-19) is challenging and requires excluding patients with suspected COVID-19 who actually have other diseases. The purpose of this study was to assess the clinical features and CT manifestations of COVID-19 by comparing patients with COVID-19 pneumonia with patients with non-COVID-19 pneumonia who presented at a fever observation department in Shanghai, China. MATERIALS AND METHODS. Patients were retrospectively enrolled in the study from January 19 through February 6, 2020. All patients underwent real-time reverse transcription-polymerase chain reaction (RT-PCR) testing. RESULTS. Eleven patients had RT-PCR test results that were positive for severe acute respiratory syndrome coronavirus 2, whereas 22 patients had negative results. No statistical difference in clinical features was observed (p > 0.05), with the exception of leukocyte and platelet counts (p < 0.05). The mean (± SD) interval between onset of symptoms and admission to the fever observation department was 4.40 ± 2.00 and 5.52 ± 4.00 days for patients with positive and negative RT-PCR test results, respectively. The frequency of opacifications in patients with positive results and patients with negative results, respectively, was as follows: ground-glass opacities (GGOs), 100.0% versus 90.9%; mixed GGO, 63.6% versus 72.7%; and consolidation, 54.5% versus 77.3%. In patients with positive RT-PCR results, GGOs were the most commonly observed opacification (seen in 100.0% of patients) and were predominantly located in the peripheral zone (100.0% of patients), compared with patients with negative results (31.8%) (p = 0.05). The median number of affected lung lobes and segments was higher in patients with positive RT-PCR results than in those with negative RT-PCR results (five vs 3.5 affected lobes and 15 vs nine affected segments; p < 0.05). Although the air bronchogram reticular pattern was more frequently seen in patients with positive results, centrilobular nodules were less frequently seen in patients with positive results. CONCLUSION. At the point during the COVID-19 outbreak when this study was performed, imaging patterns of multifocal, peripheral, pure GGO, mixed GGO, or consolidation with slight predominance in the lower lung and findings of more extensive GGO than consolidation on chest CT scans obtained during the first week of illness were considered findings highly suspicious of COVID-19.


title: Laparoscopic and endoscopic cooperative surgery is a feasible treatment procedure for intraluminal gastric gastrointestinal stromal tumors compared to endoscopic intragastric surgery.

text: BACKGROUND Laparoscopic wedge resection of the stomach is an ideal procedure if the gastric gastrointestinal stromal tumors (GISTs) are located in the extraluminal stomach. When the tumor is located in the intraluminal stomach, two minimally invasive surgical procedures involving laparoscopic and endoscopic cooperative surgery (LECS) or endoscopic intragastric surgery (EIGS) are frequently performed. To date, there have been no comparative studies of LECS and EIGS in patients with intraluminal gastric GISTs regarding short-term and long-term outcomes. The aim of this study was to compare the safety and feasibility of LECS and EIGS in patients with intraluminal gastric GISTs. METHODS This was a single-center retrospective study of 46 consecutive patients with intraluminal gastric GISTs who underwent minimally invasive surgery. LECS (n = 21) was performed between 2013 and 2015 and EIGS (n = 26) was performed between 2001 and 2013. RESULTS The overall incidence of perioperative complications was significantly higher in the EIGS group than in the LECS group (40 vs 4.8%; P = 0.006). In the EIGS group, three patients with intraoperative gastric mucosal injury were followed-up throughout surgical repair (12%). An esophageal tear was found in one patient during oral removal of tumor (4%). Postoperative gastric hemorrhage occurred in three patients (12%) and superficial surgical site infection was observed in three patients (12%). In the LECS group, anastomotic leakage requiring additional drainage was observed in one patient (4.8%). EIGS had less favorable results regarding median time to resumption of first oral intake (2 vs 1 days; P = 0.005). Two of 46 patients (4.3%), including one patient who underwent LECS and one patient who underwent EIGS developed recurrence. No cause-specific deaths were observed. CONCLUSION LECS is a feasible and safe procedure for intraluminal gastric GISTs with regard to both short-term surgical and long-term oncological outcomes. Registration number: UMIN000026631.


title: Implementation of a novel efficacy score to compare sealing and cutting devices in a porcine model.

text: BACKGROUND In general surgery, minimally invasive laparoscopic procedures have been steadily increasing over the last decade. The application of advanced bipolar and ultrasonic energy devices for sealing and cutting of blood vessels plays a vital role in routine clinical procedures. The advantages of energy-based instruments are enhanced sealing capability combined with both fast sealing time and minimal thermal injury. The purpose of this study was to compare the safety and efficacy profiles of nine laparoscopic sealing and cutting devices in a porcine model, with a new scoring system. METHODS Comparative studies in a porcine model were performed to assess vessel sealing, burst pressure, thermal spread, maximum heat, sealing/cooling time, and compression strength over the full jaw. Nine different devices from five manufacturers were tested in this study. The sealing and cutting devices (SCD) score has been developed to enable standardized comparisons of various devices. For this purpose, the most important parameters were identified through a consensus approach. RESULTS All sealed vessels with different devices could withstand a median pressure of more than 300 mmHg (range 112-2046 mmHg). The time for the sealing procedure was 7.705 s (range 5.305-18.38 s) for the ultrasonic and 7.860 s (range 5.08-10.17 s) for the bipolar devices. The ultrasonic instruments reached a median temperature of 218.1 °C (range 81.3-349.75 °C) and the bipolar devices a temperature of 125.5 °C (range 94.1-133.35 °C). The tissue reached a median temperature of 61.9 (range 47.1-80.6 °C) after ultrasonic sealing and 76.7 °C (range 63.1-94.2 °C) after bipolar sealing. The median SCD score was 10.47 (range 7.16-13.72). CONCLUSION All the instruments used seemed safe for use on the patient. The SCD score allows an indirect comparability of the instruments.


title: [First case of severe childhood novel coronavirus pneumonia in China].

text: 1例主诉为"间断腹泻、呕吐6 d，发热伴呼吸急促半天"的患儿就诊于武汉儿童医院重症医学科，诊断为儿童危重型新型冠状病毒肺炎（NCP）。以"新型冠状病毒肺炎""儿童""危重型"为关键词检索截至2020年2月8日中国知网、维普网、万方等相关数据库，未见报道。本例为中国首例危重型NCP患儿，以消化道症状起病，早期呼吸道症状不明显，快速进展为急性呼吸窘迫综合征、脓毒症休克并伴有急性肾衰竭。患儿早期连续2次咽拭子2019新型冠状病毒（2019-nCoV）核酸检测阴性。对于重症疑似病例，建议采集下呼吸道样本或重复采集上呼吸道样本进行检测。体外连续血液净化技术可尽早应用到危重型NCP患儿的救治中。.


title: Long-term results and complications related to Crurasoft® mesh repair for paraesophageal hiatal hernias.

text: PURPOSE The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. However, the use of meshes has not completely extended in all the cases of large paraesophageal hiatal hernias (LPHH) due to the complications related to them. The aim of this study is to present our long-term results and complications related to Crurasoft® mesh (Bard) for the treatment of LPHH. METHODS From January 2004 to December 2014, 536 consecutive patients underwent open or laparoscopic fundoplication for gastroesophageal reflux disease or LPHH at Ramón y Cajal University Hospital. Primary simple suture of the crura and additional reinforcement with a Crurasoft® mesh (Bard) was performed in 93 patients (17.35 %). Radiologic hiatal hernia recurrence and mesh-related complications were investigated. RESULTS Of the 93 patients undergoing mesh repair, there were 28 male and 65 female with a mean age of 67.27 years (range 22-87 years). Laparoscopic surgery was attended in 88.2 % of the cases, and open surgery in the rest 11.8 %. Mean operative time was 167.05 min (range 90-370 min). Median postoperative stay was 4.79 days (range 1-41 days). Conversion rate was 8.53 % (7 patients). Intraoperative complications were described in 10.75 % (10 patients), but all of them, except in one case, could be managed laparoscopically. Overall postoperative complications rate was 28 %. Early postoperative complications occurred in 11 patients (12 %), respectively, for grades 2 (6 cases), 3b (1 case) and 5 (4 cases) according to the Clavien-Dindo classification. Late postoperative complications occurred in 15 patients (16 %), respectively, for grades 1 (7 cases), 2 (2 cases), 3b (5 cases) and 5 (1 case) according to the Clavien-Dindo classification. Thirty day-mortality rate was 4.3 %. Mortality rate specific associated with the mesh was 1 %. Reoperation rate was 5.4 %. After a median follow-up of 76.33 months (range 3-130 months), 8 patients (9 %) developed a recurrent hiatal hernia. Mesh was removed in three cases (3.22 %). CONCLUSIONS In our experience, the recurrence rate in patients with a Crurasoft® (Bard) is acceptable. However, the rate of postoperative complications and mortality is excessive. The use of meshes in the hiatus keeps on being controversial due to the severe complications related to them. It would be advisable to compare our results in the non-mesh group in terms of recurrences and complications, to determine if meshes in the hiatus should be given in these patients due to its high rate of complications.


title: αvβ3 imaging can accurately distinguish between mature teratoma and necrosis in 18F-FDG-negative residual masses after treatment of non-seminomatous testicular cancer: a preclinical study.

text: PURPOSE We assessed whether imaging α(v)β(3) integrin could distinguish mature teratoma from necrosis in human non-seminomatous germ cell tumour (NSGCT) post-chemotherapy residual masses. METHODS Human embryonal carcinoma xenografts (six/rat) were untreated (controls) or treated to form mature teratomas with low-dose cisplatin and all-trans retinoic acid (ATRA) over a period of 8 weeks. In another group, necrosis was induced in xenografts with high-dose cisplatin plus etoposide (two cycles). (18)F-Fluorodeoxyglucose ((18)F-FDG) small animal positron emission tomography (SA PET) imaging was performed in three rats (one control and two treated for 4 and 8 weeks with cisplatin+ATRA). Imaging of α(v)β(3) expression was performed in six rats bearing mature teratomas and two rats with necrotic lesions on a microSPECT/CT device after injection of the tracer [(99m)Tc]HYNIC-RGD [6-hydrazinonicotinic acid conjugated to cyclo(Arg-Gly-Asp-D-Phe-Lys)]. Correlative immunohistochemistry studies of human and mouse α(v)β(3) expression were performed. RESULTS Cisplatin+ATRA induced differentiation of the xenografts. After 8 weeks, some glandular structures and mesenchymal cells were visible; in contrast, control tumours showed undifferentiated tissues. SA PET imaging showed that mature teratoma had very low avidity for (18)F-FDG [mean standardised uptake value (SUV(mean)) = 0.48 ± 0.05] compared to untreated embryonal carcinoma (SUV(mean) = 0.92 ± 0.13) (p = 0.005). α(v)β(3) imaging accurately distinguished mature teratoma (tumour to muscle ratio = 4.29 ± 1.57) from necrosis (tumour to muscle ratio = 1.3 ± 0.26) (p = 0.0002). Immunohistochemistry studies showed that α(v)β(3) integrin expression was strong in the glandular structures of mature teratoma lesions and negative in host stroma. CONCLUSION Imaging α(v)β(3) integrin accurately distinguished mature teratoma from necrosis following cisplatin-based treatment in human NSGCT xenografts.


title: Delays in door-to-needle time for acute ischemic stroke in the emergency department: A comprehensive stroke center experience.

text: BACKGROUND Current American Stroke Association guidelines recommend initiating intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) within 60min of patient arrival, given the benefits of IVT for AIS are time dependent. This study aimed to identify the delaying factors in door-to-needle time (DTN) in the emergency department of one of the largest comprehensive stroke centers in New York State. We also recommended measures to reduce the delays. METHODS We retrospectively reviewed the medical charts of all AIS patients who received IVT in our emergency department patients between April 1, 2012 and December 31, 2015 to identify those with a DTN time of >60min. We categorized the factors causing the delay into different groups. For each group, we recommended measures to reduce the treatment delays. RESULTS A total of 487 patients received IVT for AIS during the 3.7-year period. Of these, 96 patients (20.4%) met our DTN time delay criteria. Delays for obtaining stroke imaging and hypertension control were the most common factors. Thirty eight patients (39.5%) had delay in obtaining CT-based stroke imaging. Twenty-two patients (22.9%) required control of elevated blood pressure prior to IVT. Other causes for delay in DTN time included delay in stroke triage and paging (11.4%), fluctuating neurological symptoms (7.2%), uncertainty about diagnosis (12.5%), delays associated with obtaining consent (9.3%), and uncertainty about the time of symptom onset (5.2%). CONCLUSION Important and common causes of delay in IVT for AIS were identified in a review of charts at our comprehensive stroke center. The authors recommend strategies to achieve faster DTN time for each of the delaying factor categories including faster acquisition and interpretation of stroke imaging, more effective triage protocols and faster blood pressure control for AIS patients who are eligible for IVT.


title: Systems Barriers to Assessment and Treatment of COVID-19 Positive Patients at the End of Life.

text: The Novel Coronavirus SARS-CoV-2 (COVID-19) pandemic is changing how we deliver expert palliative care. We can expect many to die prematurely secondary to COVID-19 across the United States. We present a case of how several hospital systems-based interventions, intended to slow viral spread and to protect health care workers, have inadvertently created barriers to routine palliative interventions in this patient population. Isolation of patients, limitation of visitors and interdisciplinary support, and changes in nursing and provider assessment have all had their impact on how we deliver palliative care. These barriers have altered many aspects of our established workflow and algorithms for care, including changes in communication, goals of care discussions, how providers and nurses are monitoring for symptoms, and end-of-life monitoring. These challenges required real-time solutions such as technology utilization, proposing a change in medical delivery systems, and reducing redundancy to preserve personal protective equipment. To continue to deliver quality care for this patient population, palliative medicine must adapt quickly.


title: Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery.

text: WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension. METHODS In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings. RESULTS Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599). CONCLUSIONS In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.


title: Phylogenetic and genome analysis of seven senecavirus A isolates in China.

text: Senecavirus A (SVA) is the only member of genus Senecavirus that causes vesicular lesions in pigs. We have characterized seven SVA isolates from different swine farms in Guangdong, China. The most variable isolate, CH-DL-01-2016, contained a single amino acid insertion at position 219-220 and a 16 amino acid insertion at position 250-251. The VP1 protein also had four nucleotide changes when compared to 31 other SVA VP1 sequences obtained from GenBank. These mutations have not been identified before. Phylogenetic trees demonstrated that the new SVA isolates were clustered into two different clades and shared 96.3%-97.1% similarity with US strains and 97.9%-98.3% similarity with Brazilian stains on nucleotide level, respectively. Prediction of antigenic epitope indicated that SVA VP1 protein contained both potential B-cell and potential T-cell epitopes. This report provides information about variation analysis in SVA in southern China.


title: Uterus transplantation in the baboon: methodology and long-term function after auto-transplantation.

text: BACKGROUND Techniques for uterus transplantation (UTx) have been developed in rodent/domestic animals towards future clinical introduction of UTx to treat uterine factor infertility. The aim of this study was to extend the UTx research into a non-human primate species by developing surgical techniques for uterus retrieval and transplantation in the baboon. METHODS Female baboons (n = 15) underwent surgery, with the initial five animals used for studies of pelvic vascular anatomy. Retrieval surgery included isolation of the ovarian veins and the uterine arteries together with the anterior branches of the internal iliacs. The utero-tubal-ovarian specimen was removed, flushed and kept ex vivo for 2 h when the two arterial ends and two venous ends were anastomosed side-to-side to construct one arterial and one venous end. These were, at auto-transplantation, anastomosed end-to-side to the external iliacs and the animals (n = 10) were evaluated concerning cyclicity and later by laparoscopy/laparotomy. RESULTS The total duration of organ retrieval, backtable preparation and transplantation was around 6 h with an overall ischaemic time of the specimen of about 3 h. One animal died due to cardiomyopathy. Five out of the nine surviving animals resumed cyclicity, as a sign of re-established ovarian function. Only two out of these five animals exhibited resumed menstruation, indicating re-established ovarian and uterine function. Laparoscopy confirmed normal-sized uteri in these two animals. CONCLUSIONS This study demonstrates the feasibility of UTx by vascular anastomosis in a non-human primate species. The low success rate demonstrates the complexity involved in UTx surgery and the need for further methodological developments.


title: No SLE with COVID-19 in Hong Kong: the effect of masking?

text: We read with interests the report by Favalli on the incidence of COVID-19 in Italian patients with connective tissue diseases [1]. None of the 61 patients with SLE surveyed was confirmed to have COVID-19.


Response to: 'COVID-19 in paediatric rheumatology patients treated with b/tsDMARDs: a cross-sectional patient survey study' by Cuceoglu et al.


title: Outbreaks of severe enteric disease associated with Eimeria furonis infection in ferrets (Mustela putorius furo) of 3 densely populated groups.

text: CASE DESCRIPTION 3 unrelated, densely populated, dynamic ferret populations with severe outbreaks of enteric coccidiosis were evaluated. CLINICAL FINDINGS In each outbreak, morbidity rate was high, there were an appreciable number of deaths, and ferrets of all ages were affected. Affected individuals had acute onset of diarrhea, and feces often contained frank or digested blood. Other clinical signs included dehydration, weakness, lethargy, and weight loss. Fecal examinations of affected ferrets revealed sporadic and inconsistent shedding of coccidial oocysts. Necropsy findings included moderate to marked atrophic enteritis associated with numerous intraepithelial and fewer extracellular coccidial life stages. Sporulated oocysts isolated from feces were consistent with Eimeria furonis. A PCR assay was performed on formalin-fixed, paraffin-embedded sections of intestine for the gene encoding the small subunit of rRNA yielded products with sequences identical to those described for E furonis. TREATMENT AND OUTCOME Supportive care and treatment with sulfadimethoxine over the course of these outbreaks was palliative, but long-term treatment was required and failed to completely eradicate infection as identified by the subsequent finding of oocysts in fecal samples. CLINICAL RELEVANCE Enteric coccidiosis due to infection with E furonis has typically been reported to be subclinical rather than to cause severe gastrointestinal disease in ferrets. This report indicated that infection with E furonis may have contributed to severe enteric disease with high morbidity and mortality rates in 3 densely populated, dynamic groups of ferrets. Furthermore, long-term treatment with anti-coccidials may be required in outbreak situations, but may be ineffectual in completely eradicating infection.


title: Cytokine and chemokine mRNA expression profiles in BALF cells isolated from pigs single infected or co-infected with swine influenza virus and Bordetella bronchiseptica.

text: Pigs serve as a valuable animal experimental model for several respiratory pathogens, including Swine Influenza Virus (SIV) and Bordetella bronchiseptica (Bbr). To investigate the effect of SIV and Bbr coinfection on cytokine and viral RNA expression, we performed a study in which pigs were inoculated with SIV, Bbr or both pathogens (SIV/Bbr). Our results indicate that Bbr infection alters SIV clearance. Pulmonary lesions in the SIV/Bbr group were more severe when compared to SIV or Bbr groups and Bbr did not cause significant lesions. Broncho-alveolar lavage fluid (BALF) was examined for inflammatory mediators by qPCR. Interferon (IFN)-α, interleukin IL-8, IL-1 peaked in BALF at 2 DPI, while the virus titres and severity of clinical signs were maximal at the same time. Despite its increased expression in co-infected pigs, interferon-α did not enhance SIV clearance, since the viral replication was detected at the same day as the highest IFN levels. The mRNA levels for IFN-α, IL-1β and IL-8 were significantly higher in BALF of co-infected pigs and correlated with enhanced viral RNA titers in lungs, trachea and nasal swabs. Transcription of mRNA for IL-1β was stable in SIV and SIV/Bbr groups throughout all the study. In Bbr group, the levels of mRNAs for IL-1β were significantly higher at 2, 4 and 9 DPI. The mean levels of mRNAs for TNF-α were lower than the levels of other chemokines and cytokines in all infected groups. Transcript levels of IL-10 and IL-4 did not increase at each time points. Overall, SIV replication was increased by Bbr presence and the enhanced production of pro-inflammatory mediators could contribute to the exacerbated pulmonary lesions.


title: Developing a new methodology to characterize in vivo the passive mechanical behavior of abdominal wall on an animal model.

text: The most common surgical repair of abdominal wall hernia goes through implanting a mesh that substitutes the abdominal muscle/fascia while it is healing. To reduce the risk of relapse or possible complications, this mesh needs to mimic the mechanical behavior of the muscle/fascia, which nowadays is not fully determined. The aim of this work is to develop a methodology to characterize in vivo the passive mechanical behavior of the abdominal wall. For that, New Zealand rabbits were subjected to pneumoperitoneum tests, taking the inner pressure from 0 mmHg to 12 mmHg, values similar to those used in human laparoscopies. Animals treated were divided into two groups: healthy and herniated animals with a surgical mesh (polypropylene Surgipro(TM) Covidien) previously implanted. All experiments were recorded by a stereo rig composed of two synchronized cameras. During the postprocessing of the images, several points over the abdominal surface were tracked and their coordinates extracted for different levels of internal pressure. Starting from that, a three dimensional model of the abdominal wall was reconstructed. Pressure-displacement curves, radii of curvature and strain fields were also analysed. During the experiments, animals tissue mostly deformed during the first levels of pressure, showing the noticeable hyperelastic passive behavior of abdominal muscles. Comparison between healthy and herniated specimen displayed a strong stiffening for herniated animals in the zone where the high density mesh was situated. Cameras were able to discern this change, so this method can be used to measure the possible effect of other meshes.


title: Efficacy of adjunctive aripiprazole in patients with major depressive disorder who showed minimal response to initial antidepressant therapy.

text: To evaluate the efficacy of adjunctive aripiprazole in patients with minimal response to prior antidepressant therapy (ADT). Pooled data from three randomized, double-blind, placebo-controlled studies assessing the efficacy of adjunctive aripiprazole to ADT in patients with major depressive disorder who had a minimal response [< 25% reduction on the Montgomery-Åsberg Depression Rating Scale (MADRS)] to an 8-week prospective ADT. During the 6-week, double-blind adjunctive phase, response was defined as at least 50% reduction in the MADRS score and remission as at least 50% reduction in MADRS score and a MADRS score ≤ 10. Rates were examined using analysis of covariance and Cochran-Mantel-Haenszel tests. Kaplan-Meier curves were used to calculate time to response and remission. Of 1038 patients, 72% (n=746) exhibited a minimal response to ADT (ADT minimal responder). Time to response and remission were significantly shorter for ADT minimal responders receiving aripiprazole+ADT versus adjunctive placebo+ADT. ADT minimal responders on aripiprazole+ADT showed significantly greater improvements in MADRS score at endpoint compared with minimal responders on placebo+ADT (-10.3 vs. -6.5, P<0.0001). In addition, ADT minimal responders exhibited significantly higher response rates with aripiprazole+ADT than placebo+ADT (36 vs. 19%, respectively, P<0.0001) and higher remission rates (24 vs. 12%, respectively, P<0.0001). The numbers needed to treat with aripiprazole+ADT were six for response and eight for remission. Aripiprazole augmentation had a rapid and clinically meaningful effect in ADT minimal responders.


title: Comparison of laparoscopic sleeve gastrectomy and laparoscopic gastric plication: One year follow-up results.

text: OBJECTIVE Various different surgical methods are used for obesity surgery. Among them, laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric plication (LGP) have been both successfully performed in recent years. In this study, we compared the treatment results of patients who underwent LGP, a method that was introduced later consisting of plication of gastric greater curvature to achieve volume reduction, with results of patients who underwent LSG. MATERIAL AND METHODS We analyzed data on morbid obese patients who underwent bariatric surgery with either LSG or LPG in Konya Beyhekim Hospital between 2009 and 2012. Demographic features including age and sex, preoperative blood biochemistry, body mass index (BMI) before and after operation, duration of hospital stay, morbidity, mortality and complications were analyzed. RESULTS Fifty-five patients who were operated for obesity between 2009 and 2012 were included in the study. 29 patients underwent LGP, and 26 patients LSG. The BMI in the LGP and LSG groups was 41.4±3 kg/m(2) and 42.0±3.1 kg/m(2), respectively. There was no significant difference between two groups in terms of BMI. Two groups were also similar in terms of age and gender. In the LGP group, one patient had postoperative necrosis of the suture line. One patient in the LSG group was re-operated due to bleeding. Another patient in this group had leakage at the suture line. Postoperative BMI assessment of groups revealed significantly lower BMI levels in the LSG group. Length of hospital stay was significantly shorter in the LGP group. There was no significant difference in complication rates between two groups. CONCLUSION In this study, we obtained similar results in patients who were treated with LGP or LSG. Moreover, LSG was more efficient in decreasing BMI in morbid obesity surgery when compared to LGP. However, duration of hospital stay was significantly shorter in LGP group. We concluded that both methods could be effectively and safely used in the surgical management of morbid obesity.


title: Resolvin D1 Reduces Infarct Size Through a Phosphoinositide 3-Kinase/Protein Kinase B Mechanism.

text: This study was designed to determine if Resolvin D1 (RvD1), a pro-resolution metabolite of the omega-3 polyunsaturated fatty acid docosahexaenoic acid, could decrease myocardial infarct size with delivered at the onset of ischemia. Male Sprague Dawley rats underwent 40 minutes of myocardial ischemia followed by reperfusion. These animals received 1 intraventricular injection of RvD1 (0.01, 0.1, or 0.3 μg RvD1) or vehicle (saline) before coronary occlusion. Infarct size and neutrophil accumulation were evaluated 24 hours after the onset of reperfusion. Caspase-3, caspase-8, protein kinase B (Akt) activities were evaluated 30 minutes after the reperfusion. Rats receiving 0.1 or 0.3 μg RvD1 showed a significant decrease of infarct size and caspase-3 and caspase-8 activities compared with the vehicle controls. Neutrophil accumulations were reduced in rats administered RvD1 compared with vehicle, independently of dose level. Akt activation was increased only in animals receiving 0.1 or 0.3 μg, whereas no change was observed in the 0.01 μg group. When they were treated with LY-294002, a phosphoinositide 3-kinase (PI3K)/Akt inhibitor, cardioprotection by RvD1 was abrogated. RvD1 treatment at the onset of ischemia decreases infarct size by a mechanism involving the PI3K/Akt pathway.


title: Retroperitoneal minimally invasive pancreatic necrosectomy using single-port access.

text: Infected pancreatic necrosis is a life-threatening complication of acute pancreatitis that has been traditionally managed with open surgical debridement. Over the last decade, minimally invasive techniques have been increasingly used for the treatment of infected pancreatic necrosis and their results are encouraging. Percutaneous retroperitoneal pancreatic necrosectomy is one of the minimally invasive approaches used for debridement of pancreatic necrosis. We report our technique of retroperitoneoscopic necrosectomy using a single-port access.


title: Combined treatment of brain AVMs with use of Onyx embolization followed by radiosurgery.

text: BACKGROUND AND PURPOSE The treatment of cerebral AVMs is complex, reliant on interventions such as embolization, surgery, and radiosurgery, or a combination of these modalities. To date, treatment with the embolic agent Onyx, followed by radiosurgery, has not been evaluated. The goal of this study was to evaluate the safety and efficacy of this combination in a homogeneous, monocentric series. MATERIALS AND METHODS From April 2003 to June 2008, a total of 20 patients (11 women and 9 men; age range, 10-55 years) were treated for AVMs with Onyx embolization followed by radiosurgery. AVM sizes were <3 cm in 7 patients and ≥3 cm in 13 patients. Modalities and complications of the procedure were analyzed as well as the long-term clinical and anatomic outcomes (2-5 years after treatment). RESULTS Of 17 patients evaluated by DSA after radiosurgery, 10 (58.8%) were observed to have complete occlusion of the AVM nidus. Complete occlusion was observed in 5 (71.4%) of 7 Spetzler-Martin grade I-II AVMs and in 5 (50.0%) of 10 Spetzler-Martin grade III-IV AVMs. Complete occlusion was observed in 4 (80.0%) of 5 AVMs of <3 cm and 6 (50.0%) of 12 AVMs of >3 cm. One of 20 patients had significant worsening of clinical status (mRS ≥2) at long-term follow-up. CONCLUSIONS In this preliminary series, the safety and efficacy of combined treatment by Onyx embolization followed by radiosurgery are quite satisfactory, with a low rate of clinical complications (5.0%) and a 58.8% rate of complete obliteration of the AVM.


title: The role of interventional radiology in the management of deep venous thrombosis: advanced therapy.

text: Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer "single-session" techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.


title: A new system architecture improves output power regulation in electrosurgical generators.

text: A new system architecture for electrosurgical generators inherently produces the ideal electrosurgical output characteristic with near-deadbeat control. Compared to existing technology, this converter significantly improves power regulation, leading to improved surgical outcomes by minimizing thermal spread and tissue charring.


title: Fatigue detection in strength training using three-dimensional accelerometry and principal component analysis.

text: Detection of neuro-muscular fatigue in strength training is difficult, due to missing criterion measures and the complexity of fatigue. Thus, a variety of methods are used to determine fatigue. The aim of this study was to use a principal component analysis (PCA) on a multifactorial data-set based on kinematic measurements to determine fatigue. Twenty participants (strength training experienced, 60% male) executed 3 sets of 3 exercises with 50 (12 repetitions), 75 (12 repetitions) and 100%-12 RM (RM). Data were collected with a 3D accelerometer and analysed by a newly developed algorithm to evaluate parameters for each repetition. A PCA with six variables was carried out on the results. A fatigue factor was computed based on the loadings on the first component. One-way ANOVA with Bonferroni post hoc analysis was calculated to test for differences between the intensity levels. All six input variables had high loadings on the first component. The ANOVA showed a significant difference between intensities (p < 0.001). Post-hoc analysis revealed a difference between 100% and the lower intensities (p < 0.05) and no difference between 50 and 75%-12RM. Based on these results, it is possible to distinguish between fatigued and non-fatigued sets of strength training.


title: Ten Days to Implementation of 3D-Printed Masks for a Level-I Orthopaedic Trauma Practice During the COVID-19 Pandemic.

text: The coronavirus disease 2019 (COVID-19) pandemic has substantially impacted the global supply chain of personal protective equipment (PPE) for hospitals. At the time of our project, local and national recommendations for PPE were based on supply rather than provider or patient safety, and we intended to give providers a better option than scarves and cloth masks. Our objective was to utilize in-house 3D-printing capabilities to make 3D-printed face masks for our orthopaedic trauma providers that use filters that were verified to be nearly equivalent to the filtration material that is found in N95 masks. To meet this goal, we used open-source face-mask design files from the National Institutes of Health with use of an Ultimaker S3 desktop printer. We printed 50 reusable face masks with replaceable filter inserts and distributed them to physicians, physician assistants, and residents in a midwestern level-I trauma center. Our work highlights the innovative solutions that are being explored on a local level to confront the nationwide PPE shortage in the United States.


title: A new era for Health Psychology.

text: This editorial discusses the new vision and rejuvenation for the journal of Health Psychology. (PsycINFO Database Record


title: Initial experience with laparoscopic single-incision triangulated umbilical surgery (SITUS) in simple and radical nephrectomy.

text: INTRODUCTION New transumbilical laparoendoscopic procedures are an emerging field in urologic surgery. We introduced the concept of single-incision triangulated umbilical surgery (SITUS) in 2009. SITUS technique uses straight optics and instruments in a triangulated fashion via three trocars placed through an umbilical incision resulting in a familiar laparoscopic environment. Aim of the study was to demonstrate the feasibility of SITUS in simple and radical nephrectomy in daily routine. MATERIALS AND METHODS From October 2009 to July 2010, in 3 patients with cirrhotic kidneys a simple and in 12 patients a radical nephrectomy was performed in SITUS technique. The umbilical fold was incised at three-fourth of its circumference; in the patient with radical nephrectomy, additionally small "c"-shaped skin flaps were removed. After achieving a pneumoperitoneum by Verres technique, a 5-mm camera port and then a cranial 5 mm and a caudal 11 mm working trocar were placed with at a distance of 5-10 cm with the aid of two Langenbeck hooks, thus allowing triangulation except in the radical nephrectomy patients, where an 11-mm caudal trocar (Endopath, Ethicon, Hamburg, GER) was used. Using long conventional laparoscopic instruments, En-Seal pressure coagulator and dissector (Erbe, Tuebingen, Germany), Hem-O-Lock clips (Weck, Teleflex, USA), and a 30° 5-mm optic (Karl Storz, Tuttlingen, GER), the interventions were executed like conventional laparoscopic transperitoneal procedures. RESULTS OR time was mean 127 min [120, 153] for cirrhotic kidney nephrectomy group and mean 137 min [91, 185] in the radical nephrectomy group. Mean hemoglobin drop was 1.5 g/dl [1.2, 1.7] in benign cases and 2.4 [1.1, 4.9] in radial nephrectomies. All except one diabetic patient with wound infection had an uneventful follow-up without postoperative complications. The patients were discharged at postoperative day 5 [3, 29]. CONCLUSION SITUS technique for simple and radical nephrectomy is an attractive alternative to conventional laparoscopy and single-port surgery. It combines the common principles of traditional laparoscopy (straight instruments and triangulation) with single-port surgery (cosmesis and minimally invasiveness) resulting in adequate or time and short learning curve.


title: Licochalcone A enhances geldanamycin-induced apoptosis through reactive oxygen species-mediated caspase activation.

text: BACKGROUND AND PURPOSE Geldanamycin and licochalcone A induce apoptosis in cancer cells. However, whether the combination of geldanamycin and licochalcone A-induced apoptosis in epithelial ovarian cancer cells is mediated by the formation of reactive oxygen species, leading to the activation of apoptotic caspase, has not been studied. EXPERIMENTAL APPROACH Using the human epithelial ovarian carcinoma cell lines OVCAR-3 and SK-OV-3, we investigated the promoting effect of licochalcone A on geldanamycin-induced apoptosis. RESULTS Geldanamycin induced changes in apoptosis-related protein levels, loss of the mitochondrial transmembrane potential, release of cytochrome c, activation of caspases, cleavage of PARP-1, formation of reactive oxygen species and depletion of glutathione (GSH). Licochalcone A enhanced geldanamycin-induced apoptosis-related protein activation, formation of reactive oxygen species, caspase activation and cell death. The combined effect was inhibited by the addition of oxidant scavengers. CONCLUSIONS Licochalcone A may potentiate the apoptotic effect of geldanamycin on ovarian carcinoma cell lines by the activation of the caspase-8- and Bid-dependent pathways and the mitochondria-mediated apoptotic pathway. The apoptosis-promoting effect of licochalcone A may be mediated by its stimulatory action on the formation of reactive oxygen species and the depletion of GSH, which results in the activation of caspases.


Coping with COVID-19: scaling up virtual care to standard practice.


title: Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults.

text: OBJECTIVE The present study aimed to assess the validity and reliability of Geriatric Depression-15 Scale (GDS-15) in Turkish older adults and to compare the results with Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) depression criteria. METHODS A total of 329 outpatients were enrolled. In the first step, the patients underwent the Mini-Mental State Examination. After assessing whether the patients meet the diagnosis of depression based on DSM-5 diagnostic criteria, another researcher applied the long form of GDS. After sorting the items of short form out of the long form, two separate scores were obtained. The scores of GDS-30 and GDS-15 scales were compared with the scores of DSM-5. RESULTS The correlation of GDS-30 with GDS-15 was r=0.966 (p<0.001). The analysis performed considering DSM-5 criteria revealed that the sensitivity, specificity, positive predictive value, and negative predictive value of GDS-15 in determining depression were 92%, 91%, 76%, and 97%, respectively, when the cutoff value was taken as ≥5. The area under the receiver operating characteristics curve [95% confidence interval (CI)] was 0.97 (95% CI=0.947-0.996) for GDS-15 (p<0.001). The Cronbach alpha coefficient for the total scale was 0.920. CONCLUSION GDS-15, just as GDS-30, is a beneficial scale in determining depression in older adults. This study provides an evidence for the validity and reliability of GDS-15 in Turkish elderly population and primary care centers.


title: The human concentrative nucleoside transporter-3 C602R variant shows impaired sorting to lipid rafts and altered specificity for nucleoside-derived drugs.

text: The human concentrative nucleoside transporter-3 C602R (hCNT3C602R), a recently identified human concentrative nucleoside transporter-3 (hCNT3) variant, has been shown to interact with natural nucleosides with apparent K(m) values similar to those of the wild-type transporter, although binding of one of the two sodium ions required for nucleoside translocation is impaired, resulting in decreased V(max) values (Mol Pharmacol 73:379-386, 2008). We have further analyzed the properties of this hCNT3 variant by determining its localization in plasma membrane lipid domains and its interaction with nucleoside-derived drugs used in anticancer and antiviral therapies. When expressed heterologously in HeLa cells, wild-type hCNT3 localized to both lipid raft and nonlipid raft domains. Treatment of cells with the cholesterol-depleting agent methyl-beta-cyclodextrin resulted in a marked decrease in hCNT3-related transport activity that was associated with the loss of wild-type hCNT3 from lipid rafts. It is noteworthy that although exogenously expressed hCNT3C602R was present in nonlipid raft domains at a level similar to that of the wild-type transporter, the mutant transporter was present at much lower amounts in lipid rafts. A substrate profile analysis showed that interactions with a variety of nucleoside-derived drugs were altered in the hCNT3C602R variant and revealed that sugar hydroxyl residues are key structural determinants for substrate recognition by the hCNT3C602R variant.


Severe influenza a cases requiring extra-corporeal membrane oxygenation (ECMO) therapy, 2018-2019.


title: Treatment Algorithm of Peripancreatic Arteries Aneurysm Coexisting with Coeliac Artery Lesion: Single Institution Experience.

text: Introduction True aneurysms of peripancreatic arterial arcades (PAAAs) coexisting with celiac axis lesion are often asymptomatic. However, they may rupture regardless of their size and cause life-threatening hypovolemia. No treatment guidelines exist to date. We present a series of 21 patients and our management algorithm. Material and Methods For ruptured aneurysms we preformed endovascular embolization. Further treatment was dependent on patient's condition and control studies. In case of unruptured aneurysms, we assessed collateral circulation between superior mesenteric artery and celiac axis in angio-CT. If there was a pathway free from aneurysms, endovascular approach was chosen. Otherwise, surgical or combined treatment was favored. Results Endovascular treatment was performed in 14 patients with no complications. Follow-up studies revealed incomplete occlusion of the aneurysms in two cases. Surgical or combined treatment was performed in 7 patients with three serious perioperative complications. They were managed conservatively in two cases and surgically in one. Follow-up studies showed aneurismal dilatation and stenosis of a renohepatic by-pass in one case. Conclusion We present our management algorithm of PAAAs. Our results support the leading role of endovascular treatment. We present its limitations favoring surgical or combined treatment. All patients should be carefully followed.


title: Imaging glioma biology: spatial comparison of amino acid PET, amide proton transfer, and perfusion-weighted MRI in newly diagnosed gliomas.

text: PURPOSE Imaging glioma biology holds great promise to unravel the complex nature of these tumors. Besides well-established imaging techniques such O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET and dynamic susceptibility contrast (DSC) perfusion imaging, amide proton transfer-weighted (APTw) imaging has emerged as a promising novel MR technique. In this study, we aimed to better understand the relation between these imaging biomarkers and how well they capture cellularity and vascularity in newly diagnosed gliomas. METHODS Preoperative MRI and FET-PET data of 46 patients (31 glioblastoma and 15 lower-grade glioma) were segmented into contrast-enhancing and FLAIR-hyperintense areas. Using established cutoffs, we calculated hot-spot volumes (HSV) and their spatial overlap. We further investigated APTw and CBV values in FET-HSV. In a subset of 10 glioblastoma patients, we compared cellularity and vascularization in 34 stereotactically targeted biopsies with imaging. RESULTS In glioblastomas, the largest HSV was found for APTw, followed by PET and CBV (p < 0.05). In lower-grade gliomas, APTw-HSV was clearly lower than in glioblastomas. The spatial overlap of HSV was highest between APTw and FET in both tumor entities and regions. APTw correlated significantly with cellularity, similar to FET, while the association with vascularity was more pronounced in CBV and FET. CONCLUSIONS We found a relevant spatial overlap in glioblastomas between hotspots of APTw and FET both in contrast-enhancing and FLAIR-hyperintense tumor. As suggested by earlier studies, APTw was lower in lower-grade gliomas compared with glioblastomas. APTw meaningfully contributes to biological imaging of gliomas.


title: Effect of COVID-19 on Emergent Stroke Care: A Regional Experience.

text: BACKGROUND AND PURPOSE Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. METHODS Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. RESULTS Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. CONCLUSIONS Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.


title: An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa.

text: OBJECTIVES To describe the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections. DESIGN Retrospective descriptive study. SETTING Pediatric intensive care unit in a tertiary pediatric hospital situated in Cape Town, South Africa. PATIENTS All children (n = 195; 20% pediatric intensive care unit admissions) with positive respiratory viral isolates between April 1 and December 31, 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic, clinical, laboratory, and outcome data were recorded from medical folders. Complete data were available for 175 patients (median age [interquartile range] 4.7 months [2.3-12.9 months]; 49% male). One hundred four (59.4%) patients had comorbid conditions; 30 (17%) were HIV-infected. Rhinovirus (n = 76 [39%]), respiratory syncytial virus (n = 54 [27.7%]), adenovirus (n = 30 [15.4%]), influenza A (n = 26 [13.3%]), parainfluenza (n = 23 [11.8%]), and human metapneumovirus (n = 12 [6.2%]) were most commonly isolated. Ninety-five infections (51.4%) were isolated >48 hrs after admission. Seasonal patterns were identified for respiratory syncytial virus, human metapneumovirus, and influenza A, whereas others occurred throughout the year. Twenty-five patients (14.3%) had more than one viral isolate. Presumed bacterial coinfection, which occurred in 68 (39%) patients (18 [26.5%] HIV-infected), was associated with significantly longer pediatric intensive care unit and hospital stays but not with mortality. Twenty patients died (11%, standardized mortality ratio 0.64). High Pediatric Index of Mortality scores, HIV exposure and infection, nosocomial infection, and influenza A infection were associated with mortality. CONCLUSIONS Viral respiratory tract infection is common in this pediatric intensive care unit associated with significant morbidity and mortality, which may relate to the high burden of comorbidity and HIV.