title: Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients

text: BACKGROUND: Studies of the novel coronavirus-induced disease COVID-19 in Wuhan, China, have elucidated the epidemiological and clinical characteristics of this disease in the general population. The present investigation summarizes the clinical characteristics and early prognosis of COVID-19 infection in a cohort of patients with fractures. METHODS: Data on 10 patients with a fracture and COVID-19 were collected from 8 different hospitals located in the Hubei province from January 1, 2020, to February 27, 2020. Analyses of early prognosis were based on clinical outcomes and trends in laboratory results during treatment. RESULTS: All 10 patients presented with limited activity related to the fracture. The most common signs were fever, cough, and fatigue at the time of presentation (7 patients each). Other, less common signs included sore throat (4 patients), dyspnea (5 patients), chest pain (1 patient), nasal congestion (1 patient), headache (1 patient), dizziness (3 patients), abdominal pain (1 patient), and vomiting (1 patient). Lymphopenia (<1.0 × 10(9) cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive protein. Three patients underwent surgery, whereas the others were managed nonoperatively because of their compromised status. Four patients died on day 8 (3 patients) or day 14 (1 patient) after admission. The clinical outcomes for the surviving patients are not yet determined. CONCLUSIONS: The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation. Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19-affected areas, especially older individuals with intertrochanteric fractures. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


title: Reoperative parathyroidectomy.

text: Reoperative surgery for hyperparathyroidism is associated with increased incidence of complications including vocal cord paralysis, permanent hypoparathyroidism, and persistent hypercalcemia. Surgical re-exploration should consist of symptomatic or low-risk patients. The use of nuclear medicine imaging, ultrasound, and high-resolution CT and MRI may aid in surgical planning. Knowledge of potential.


The "venous perspective" in Lombardia (Italy) during the first weeks of the COVID-19 epidemic.


title: Experiences and practices in the current prevention and control of the novel coronavirus pneumonia in China.

text: Since December 2019, a number of new infectious diseases, mainly lung diseases caused by novel coronavirus infections, have been discovered in Wuhan, Hubei province. With the spread of the epidemic, cases in other regions of China and abroad have been confirmed. This sudden outbreak of a new type of infectious disease has seriously threatened people's health and safety, and China has adopted strong prevention and control measures in response. To provide a reference for international health emergency management workers, this article summarizes, from an academic perspective, the main prevention and control measures taken in China.


title: Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004-2005, 2005-2006, and 2006-2007: a prospective study.

text: BACKGROUND The person-to-person transmission of influenza-like illness (ILI) and influenza has been described mostly in long-term care units. Studies in acute hospital settings are rare and mostly retrospective. METHODS We prospectively estimated the relative risk (RR) of hospital-acquired (HA) ILI during hospitalization according to in-hospital exposures to contagious individuals. Surveillance of ILI and laboratory-confirmed influenza was undertaken at Edouard Herriot Hospital (1100 beds) during 3 influenza seasons. A total of 21 519 patients and 2153 health care workers (HCWs) from 2004 to 2007 were included. The RR of HA-ILI in patients was calculated according to exposure to other contagious patients and HCWs. RESULTS For patients exposed to at least 1 contagious HCW compared with those with no documented exposure in the hospital, the RR of HA-ILI was 5.48 (95% confidence interval [CI], 2.09-14.37); for patients exposed to at least 1 contagious patient, the RR was 17.96 (95% CI, 10.07-32.03); and for patients exposed to at least 1 contagious patient and 1 contagious HCW, the RR was 34.75 (95% CI, 17.70-68.25). CONCLUSIONS Hospitalized patients exposed to potentially infectious patients and HCWs with ILI inside the hospital are at greater risk for HA-ILI. Such results identify priorities regarding preventive measures for seasonal or pandemic influenza.


title: Risk of Cerebral Venous Thrombosis in Obese Women.

text: IMPORTANCE Obesity is a risk factor for deep vein thrombosis of the leg and pulmonary embolism. To date, however, whether obesity is associated with adult cerebral venous thrombosis (CVT) has not been assessed. OBJECTIVE To assess whether obesity is a risk factor for CVT. DESIGN, SETTING, AND PARTICIPANTS A case-control study was performed in consecutive adult patients with CVT admitted from July 1, 2006 (Amsterdam), and October 1, 2009 (Berne), through December 31, 2014, to the Academic Medical Center in Amsterdam, the Netherlands, or Inselspital University Hospital in Berne, Switzerland. The control group was composed of individuals from the control population of the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis study, which was a large Dutch case-control study performed from March 1, 1999, to September 31, 2004, and in which risk factors for deep vein thrombosis and pulmonary embolism were assessed. Data analysis was performed from January 2 to July 12, 2015. MAIN OUTCOMES AND MEASURES Obesity was determined by body mass index (BMI). A BMI of 30 or greater was considered to indicate obesity, and a BMI of 25 to 29.99 was considered to indicate overweight. A multiple imputation procedure was used for missing data. We adjusted for sex, age, history of cancer, ethnicity, smoking status, and oral contraceptive use. Individuals with normal weight (BMI <25) were the reference category. RESULTS The study included 186 cases and 6134 controls. Cases were younger (median age, 40 vs 48 years), more often female (133 [71.5%] vs 3220 [52.5%]), more often used oral contraceptives (97 [72.9%] vs 758 [23.5%] of women), and more frequently had a history of cancer (17 [9.1%] vs 235 [3.8%]) compared with controls. Obesity (BMI ≥30) was associated with an increased risk of CVT (adjusted odds ratio [OR], 2.63; 95% CI, 1.53-4.54). Stratification by sex revealed a strong association between CVT and obesity in women (adjusted OR, 3.50; 95% CI, 2.00-6.14) but not in men (adjusted OR, 1.16; 95% CI, 0.25-5.30). Further stratification revealed that, in women who used oral contraceptives, overweight and obesity were associated with an increased risk of CVT in a dose-dependent manner (BMI 25.0-29.9: adjusted OR, 11.87; 95% CI, 5.94-23.74; BMI ≥30: adjusted OR, 29.26; 95% CI, 13.47-63.60). No association was found in women who did not use oral contraceptives. CONCLUSIONS AND RELEVANCE Obesity is a strong risk factor for CVT in women who use oral contraceptives.


title: Student nurses' ethical views on responses to the severe acute respiratory syndrome outbreak.

text: BACKGROUND Fifteen years have passed since the outbreak of severe acute respiratory syndrome in Hong Kong. At that time, there were reports of heroic acts among professionals who cared for these patients, whose bravery and professionalism were highly praised. However, there are concerns about changes in new generation of nursing professionals. OBJECTIVE We aimed to examine the attitude of nursing students, should they be faced with severe acute respiratory syndrome patients during their future work. RESEARCH DESIGN A questionnaire survey was carried out to examine the attitude among final-year nursing students to three ethical areas, namely, duty of care, resource allocation, and collateral damage. ETHICAL CONSIDERATIONS This study was carried out in accordance with the requirements and recommendations of the Central Research and Ethics Committee, School of Health Sciences at Caritas Institute of Higher Education. FINDINGS Complete responses from 102 subjects were analyzed. The overwhelming majority (96.1%) did not agree to participate in the intubation of severe acute respiratory syndrome patients if protective measures, that is, N95 mask and gown, were not available. If there were insufficient N95 masks for all the medical, nursing, and allied health workers in the hospital (resource allocation), 37.3% felt that the distribution of N95 masks should be by casting lot, while the rest disagreed. When asked about collateral damage, more than three-quarters (77.5%) said that severe acute respiratory syndrome patients should be admitted to intensive care unit. There was sex difference in nursing students' attitude toward severe acute respiratory syndrome care during pregnancy and influence of age in understanding intensive care unit care for these patients. Interestingly, 94.1% felt that there should be a separate intensive care unit for severe acute respiratory syndrome patients. CONCLUSION As infection control practice and isolation facilities improved over the years, relevant knowledge and nursing ethical issues related to infectious diseases should become part of nursing education and training programs, especially in preparation for outbreaks of infectious diseases or distress.


title: ANOSMIA AND AGEUSIA: NOT AN UNCOMMON PRESENTATION OF COVID-19 INFECTION IN CHILDREN AND ADOLESCENTS.

text: Since the emergence of a cluster of viral pneumonia cases in Wuhan, Hubei Province, People's Republic of China, at the end of December 2019, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), a novel coronavirus also known as "coronavirus disease 2019 (COVID-19)," as of 7 April 2020, more than 1,214,466 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in more than 67,767 deaths. The disease was recognized by World Health Organization (WHO) as a pandemic on 11 March 2020. Published reports of adult patients with COVID-19 infection described symptoms including fever, cough, fatigue, sputum production, headache, dyspnoea and diarrhoea. Children usually showed milder respiratory symptoms or were asymptomatic, while loss of taste or sensation of smell were seldom reported. In this paper, we report three cases of pediatric patients with COVID-19 infection who presented with anosmia and/or ageusia.


title: Purkinje fiber dysplasia (histiocytoid cardiomyopathy) with ventricular noncompaction in a savannah kitten.

text: In a 2-month-old female savannah kitten that died unexpectedly, the pathologic findings of significance were restricted to the heart and included abnormal Purkinje fibers and biventricular myocardial trabeculation or noncompaction. The Purkinje fibers were large, angular, and tightly packed. They contained few disorganized myofibrils among a rarified cytoplasm. The fibers were distinct from adjacent myocytes and were immunohistochemically positive for desmin, muscle actin, myoglobin, sarcomeric actin, and chromogranin A. These findings are identical to those that occur in children with histiocytoid cardiomyopathy, a fatal genetic mitochondrial disorder of Purkinje fibers. Ventricular noncompaction likely has a multifactoral cause that results from fetal arrest of ventricular organizational development that might occur in conjunction with, or independent of, histiocytoid cardiomyopathy.


title: Exploring the Current Landscape of Intravenous Infusion Practices and Errors (ECLIPSE): protocol for a mixed-methods observational study.

text: INTRODUCTION Intravenous medication is essential for many hospital inpatients. However, providing intravenous therapy is complex and errors are common. 'Smart pumps' incorporating dose error reduction software have been widely advocated to reduce error. However, little is known about their effect on patient safety, how they are used or their likely impact. This study will explore the landscape of intravenous medication infusion practices and errors in English hospitals and how smart pumps may relate to the prevalence of medication administration errors. METHODS AND ANALYSIS This is a mixed-methods study involving an observational quantitative point prevalence study to determine the frequency and types of errors that occur in the infusion of intravenous medication, and qualitative interviews with hospital staff to better understand infusion practices and the contexts in which errors occur. The study will involve 5 clinical areas (critical care, general medicine, general surgery, paediatrics and oncology), across 14 purposively sampled acute hospitals and 2 paediatric hospitals to cover a range of intravenous infusion practices. Data collectors will compare each infusion running at the time of data collection against the patient's medication orders to identify any discrepancies. The potential clinical importance of errors will be assessed. Quantitative data will be analysed descriptively; interviews will be analysed using thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from an NHS Research Ethics Committee (14/SC/0290); local approvals will be sought from each participating organisation. Findings will be published in peer-reviewed journals and presented at conferences for academic and health professional audiences. Results will also be fed back to participating organisations to inform local policy, training and procurement. Aggregated findings will inform the debate on costs and benefits of the NHS investing in smart pump technology, and what other changes may need to be made to ensure effectiveness of such an investment.


title: Systems pharmacology approach to investigate the molecular mechanisms of herb Rhodiola rosea L. radix.

text: Rhodiola rosea L. radix (RRL) is one of the most popular medical herb which has been widely used for the treatment of different diseases effectively, including cardiovascular diseases and nerve system diseases. However, due to the multiple compounds in RRL, the underlying molecular mechanisms of RRL are remained unclear. To decipher the action mechanisms of RRL from a systematic perspective, a systems pharmacology approach integrated absorption, distribution, metabolism, and excretion (ADME) system, drug targeting, and network analysis was introduced. First, by the ADME screening system and the target fishing process, 56 potential active compounds and 62 targets were obtained, respectively. In addition, compound-target network demonstrated that most compounds interacted with multiple targets, indicating that RRL may enhance its therapeutic effects probably through hitting on multiple targets in a holistic level. Moreover, target-pathway network and gene ontology analysis showed that multiple targets of RRL were involved in several biological pathways, i.e. Neuroactive ligand-receptor interaction, calcium signaling pathway, adrenergic signaling in cardiomyocytes, and VEGF signaling pathway, which dissecting the therapeutic effects of RRL on various diseases, such as cardiovascular diseases, depression, adaptation diseases, etc. In summary, this work successfully explains the potential active compounds and the multi-scale curative action mechanisms of RRL for treating various diseases; meanwhile, it implies that RRL could be applied as a novel therapeutic agent in arthritic diseases. Most importantly, this work provides an in silico strategy to understand the action mechanisms of herbal medicines from molecular/system levels, which will promote the new drug development of traditional Chinese medicine.


title: Impact of the COVID-19 pandemic on the workflow of an ambulatory endoscopy center: an assessment by discrete event simulation.

text: BACKGROUND AND AIMS As community-based ambulatory endoscopy centers across the nation are trying to reopen and safely resume outpatient endoscopic procedures after the unprecedented lockdown related to the COVID-19 pandemic, guidelines recommend pre-testing and screening for COVID-19 along with other mitigation measures for the safety of patients and staff. The impact of such changes in the workflow of ambulatory endoscopy centers on throughput and other performance indicators is largely unknown although a significant reduction in revenue stream is expected. METHODS A discrete event simulation-based model was developed in the setting of a small to medium community-based single-specialty ambulatory endoscopy center to quantify the impact of COVID-19 related workflow changes on performance indicators and cost per case compared with the pre-COVID-19 baseline. RESULTS In the simulation model, post-COVID-19 recommended workflow changes significantly impacted the operational and productivity metrics and, in turn, adversely affected the financial metrics. Overall, there was a significant decrease in staff utilization, and consequent increase in total facility time, waiting time for patients, and cost per case because of a bottleneck at the time of preprocedure COVID-19 screening and testing while practicing social distancing. Strategies to minimize this adverse impact on productivity were assessed. CONCLUSION Pretesting and screening for COVID-19 as recommended by current guidelines will significantly impact the productivity and revenue stream of ambulatory endoscopy centers. Urgent measures by the payors are needed to adjust the facility reimbursement of endoscopy centers to ensure successful reopening and ramping up outpatient endoscopy services in these facilities already hit hard by the pandemic.


title: Identification and characterization of peptides that bind the PPIase domain of Parvulin17.

text: Peptidyl-prolyl cis-trans isomerases (PPIases) are the enzymes that increase the rate of isomerization of the peptide bond N-terminal to the proline substrate. Par14 and its isoform Par17 belong to the Parvulin family of PPIases. Par14 can bind AT-rich double-stranded DNA and was shown to be part of the pre-ribosomal ribonucleoprotein (pre-rRNP) complexes, where it functions as an RNA processing factor that is involved in ribosome biogenesis. Its longer isoform Par17 is expressed only in cells of hominids, where it is targeted to the mitochondria. To find binding partners (peptides or proteins) for Par17, we applied the phage display technology. We panned 7-mer and 12-mer peptide libraries against Par17. The consensus sequence XHSXVHØ, where X can be any amino acid and Ø is a hydrophobic amino acid, was enriched from both libraries. We demonstrate the binding of this motif to the PPIase domain of Par17 using phage ELISA and NMR spectroscopy. We propose that residues Met90, Val91, Phe94, Gln95, Glu96, and Ala98 of Par17 are involved in substrate recognition, and that the phage display-selected motif XHSXVHØ can be recognized by Par17 PPIase domain in vivo.


title: Marine cloud brightening.

text: The idea behind the marine cloud-brightening (MCB) geoengineering technique is that seeding marine stratocumulus clouds with copious quantities of roughly monodisperse sub-micrometre sea water particles might significantly enhance the cloud droplet number concentration, and thereby the cloud albedo and possibly longevity. This would produce a cooling, which general circulation model (GCM) computations suggest could-subject to satisfactory resolution of technical and scientific problems identified herein-have the capacity to balance global warming up to the carbon dioxide-doubling point. We describe herein an account of our recent research on a number of critical issues associated with MCB. This involves (i) GCM studies, which are our primary tools for evaluating globally the effectiveness of MCB, and assessing its climate impacts on rainfall amounts and distribution, and also polar sea-ice cover and thickness; (ii) high-resolution modelling of the effects of seeding on marine stratocumulus, which are required to understand the complex array of interacting processes involved in cloud brightening; (iii) microphysical modelling sensitivity studies, examining the influence of seeding amount, seed-particle salt-mass, air-mass characteristics, updraught speed and other parameters on cloud-albedo change; (iv) sea water spray-production techniques; (v) computational fluid dynamics studies of possible large-scale periodicities in Flettner rotors; and (vi) the planning of a three-stage limited-area field research experiment, with the primary objectives of technology testing and determining to what extent, if any, cloud albedo might be enhanced by seeding marine stratocumulus clouds on a spatial scale of around 100×100 km. We stress that there would be no justification for deployment of MCB unless it was clearly established that no significant adverse consequences would result. There would also need to be an international agreement firmly in favour of such action.


title: The use of a detachable anvil enables an easier and safer stapled hemorrhoidopexy.

text: Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks. Hemorrhoidopexy, an alternative treatment for hemorrhoids introduced in the late nineties, replaced hemorrhoid excision by a reduction of the hemorrhoids to their normal anatomical position, via an excision of a mucosal ring above the internal hemorrhoidal cushions. The latter excision results in minimal or no postoperative pain. In 2010, a new variant of the hemorrhoidopexy set was introduced in the European market. The variations of this set, including a detachable anvil and a lined proctoscope, aid the surgeon in performing an easier and safer hemorrhoidopexy.


title: Cardiac injuries in coronavirus disease 2019 (COVID-19).

text: As the coronavirus disease 2019 (COVID-19) epidemic worsens, this global pandemic is impacting more than 200 countries/regions and more than 4,500,000 confirmed cases worldwide. COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which might attack not only the respiratory system, but also the other important organs, including the heart. It was reported that COVID-19 patients with a past history of cardiovascular diseases would have a higher mortality. Meanwhile, elevated troponin levels were frequently observed in COVID-19 cases. Besides the comprehensive treatments for COVID-19, as a cardiologist, we should also remain vigilant about the cardiac injuries, especially those with severe emergent cardiovascular symptoms.


title: Gastrointestinal bleeding after gastric bypass surgery: nuisance or catastrophe?

text: BACKGROUND Bleeding in the early postoperative period after gastric bypass surgery is a rare complication reported in 1-4% of cases. In most cases, the bleeding will be self-limited, resolving after discontinuation of anticoagulation for deep venous thrombosis prophylaxis. Occasionally, however, bleeding can be problematic, resulting in significant postoperative morbidity or even mortality. The purpose of the present study was to review cases of early postoperative gastrointestinal bleeding after gastric bypass to identify possible risk factors and examine outcomes. METHODS A prospective weight loss surgery patient database was reviewed to examine the cases occurring from January 2005 to July 2008. Patients with early postoperative bleeding were identified. The demographics and co-morbidities were compared between those with and without postoperative bleeding. The outcomes of interest included the transfusion requirement, postoperative morbidity, need for reoperation, length of hospital stay, intensive care unit admission, and 30-day mortality. RESULTS A total of 776 patients had undergone gastric bypass during the study period. Of these, 26 (3.3%) were identified with early postoperative bleeding. No significant differences were found in the demographics between the patients with early postoperative bleed and those without. Of the patients with early postoperative bleeding, the most common presenting sign or symptom was tachycardia (46%) followed by melena (32%) and hematemesis (18%). The transfusion requirement range was 0-11 U (average 3.2 U/patient). Of the 26 patients, 4 (15%) required intensive care unit admission and 8 (31%) required reoperation. Four gastrointestinal leaks, one stomal ulceration, and one gastrogastric fistula were identified in the early postoperative bleeding group. One patient (3.8%) in the early postoperative bleeding group died. Compared with nonbleeding patients, those with early postoperative bleeding had a significantly longer hospital stay (4.8 versus 3, P <.0001) and greater mortality rate (7.1% versus .9%, P <.01). CONCLUSION Postoperative bleeding is a significant complication after gastric bypass surgery. Although in many cases, the bleeding will be self-limited, it can result in additional notable complications. In the present study, postoperative bleeding contributed to significantly longer hospital stays and resulted in 1 death. A patient with bleeding after gastric bypass should raise due concern, with attention to the potential attendant complications.


title: Diagnostic Impact of Bone-Subtraction CT Angiography for Patients with Acute Subarachnoid Hemorrhage.

text: BACKGROUND AND PURPOSE Detection and evaluation of ruptured aneurysms is critical for choosing an appropriate endovascular or neurosurgical intervention. Our aim was to assess whether bone-subtraction CTA is capable of guiding treatment for cerebral aneurysms in patients with acute SAH and could replace DSA. MATERIALS AND METHODS We prospectively studied 116 consecutive patients with SAH with 16-detector row bone-subtraction CTA and DSA before intracranial aneurysm treatment. Two independent neuroradiologists reviewed the bone-subtraction CTA blinded to DSA (reference standard). We determined the accuracy of bone-subtraction CTA for aneurysm detection and the measurement of aneurysm dimensions and compared the radiation doses of the 2 imaging modalities. RESULTS Seventy-one patients (61%) had 74 aneurysms on DSA. Bone-subtraction CTA detected 73 of these aneurysms, but it detected 1 additional aneurysm. On a per-aneurysm basis, sensitivity, specificity, and positive and negative predictive values for bone-subtraction CTA were 99%, 98%, and 99% and 98%, respectively. For aneurysms of ≤3 mm, sensitivity was 94% (95% CI, 73%-99%). Bone-subtraction CTA slightly overestimated neck and dome diameters by <0.2 mm and overestimated the dome-to-neck ratios by 2% on average. Dose-length product was 565 ± 201 mGy × cm for bone-subtraction CTA and 1609 ± 1300 mGy × cm for DSA. CONCLUSIONS Bone-subtraction CTA is as accurate as DSA in detecting cerebral aneurysms after SAH, provides similar information about aneurysm configuration and measures, and reduces the average effective radiation dose for vascular diagnostics by 65%. Diagnostic equivalence in association with dose reduction suggests replacing DSA with bone-subtraction CTA in the diagnostic work-up of spontaneous SAH.


title: Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review.

text: This systematic review and meta-analysis summarizes the clinical effects of increasing perioperative blood flow using fluids with or without inotropes/vasoactive drugs to explicit defined goals in adults. We included randomized controlled trials of adult patients (aged 16 years or older) undergoing surgery. We included 31 studies of 5292 participants. There was no difference in mortality at the longest follow-up: 282/2615 (10.8%) died in the control group and 238/2677 (8.9%) in the treatment group, RR of 0.89 (95% CI: 0.76-1.05; P=0.18). However, the results were sensitive to analytical methods and withdrawal of studies with methodological limitations. The intervention reduced the rate of three morbidities (renal failure, respiratory failure, and wound infections) but not the rates of arrhythmia, myocardial infarction, congestive cardiac failure, venous thrombosis, and other types of infections. The number of patients with complications was also reduced by the intervention. Hospital length of stay was reduced in the treatment group by 1.16 days. There was no difference in critical care length of stay. The primary analysis of this review showed no difference between groups but this result was sensitive to the method of analysis, withdrawal of studies with methodological limitations, and was dominated by a single large study. Patients receiving this intervention stayed in hospital 1 day less with fewer complications. It is unlikely that the intervention causes harm. The balance of current evidence does not support widespread implementation of this approach to reduce mortality but does suggest that complications and duration of hospital stay are reduced.


title: Systematic mapping of checklists for assessing transferability.

text: BACKGROUND Systematic reviews of research evidence have become an expected basis for decisions about practice guidelines and policy decisions in the health and welfare sectors. Review authors define inclusion criteria to help them determine which studies to search for and include in their reviews. However, these studies may still vary in the extent to which they reflect the context of interest in the review question. While most review authors would agree that systematic reviews should be relevant and useful for decision makers, there appears to be few well known, if any, established methods for supporting review authors to assess the transferability of review findings to the context of interest in the review. With this systematic mapping and content analysis, we aim to identify whether there exists checklists to support review authors in considering transferability early in the systematic review process. The secondary aim was to develop a comprehensive list of factors that influence transferability as discussed in existing checklists. METHODS We conducted a systematic mapping of checklists and performed a content analysis of the checklist criteria included in the identified checklists. In June 2016, we conducted a systematic search of eight databases to identify checklists to assess transferability of findings from primary or secondary research, without limitations related to publication type, status, language, or date. We also conducted a gray literature search and searched the EQUATOR repository of checklists for any relevant document. We used search terms such as modified versions of the terms "transferability," "applicability," "generalizability," etc. and "checklist," "guideline," "tool," "criteria," etc. We did not include papers that discussed transferability at a theoretical level or checklists to assess the transferability of guidelines to local contexts. RESULTS Our search resulted in 11,752 titles which were screened independently by two review authors. The 101 articles which were considered potentially relevant were subsequently read by two authors, independently in full text and assessed for inclusion. We identified 31 relevant checklists. Six of these examined transferability of economic evaluations, and 25 examined transferability of primary or secondary research findings in health (n = 23) or social welfare (n = 2). The content analysis is based on the 25 health and social welfare checklists. We identified seven themes under which we grouped categories of checklist criteria: population, intervention, implementation context (immediate), comparison intervention, outcomes, environmental context, and researcher conduct. CONCLUSIONS We identified a variety of checklists intended to support end users (researchers, review authors, practitioners, etc.) to assess transferability or related concepts. While four of these checklists are intended for use in systematic reviews of effectiveness, we found no checklists for qualitative evidence syntheses or for the field of social welfare practice or policy. Furthermore, none of the identified checklists for review authors included guidance to on how to assess transferability, or present assessments in a systematic review. The results of the content analysis can serve as the basis for developing a comprehensive list of factors to be used in an approach to support review authors in systematically and transparently considering transferability from the beginning of the review process.


title: Social isolation and the mitigation of coronavirus anxiety: The mediating role of meaning.

text: This study examined core belief violation and meaning making as mechanisms mediating the relationship between adherence to social isolation policies for mitigating coronavirus transmission and reduced coronavirus anxiety (CA). Adherence to social isolation policies (social distancing, sheltering in place, and cessation of long-distance travel), use of nonsocial precautionary measures (handwashing, wearing a mask), core belief violation, meaning made of the COVID pandemic, and CA were assessed in a sample of 408 North Americans. Process analysis revealed that adhering to social isolation policies predicted lower levels of CA and that this effect was largely mediated by conservation of core beliefs (e.g., in predictability, control, and self-agency) and ability to make meaning of the pandemic. In contrast, exclusive reliance on nonsocial protections such as handwashing and mask wearing was associated with high levels of CA. These results suggest that social isolation policies support the integrity of adherents' meaning systems, thereby mitigating distress, which carries useful implications for both policy and psychological intervention.


title: The neutralization breadth of HIV-1 develops incrementally over four years and is associated with CD4+ T cell decline and high viral load during acute infection.

text: An understanding of how broadly neutralizing activity develops in HIV-1-infected individuals is needed to guide vaccine design and immunization strategies. Here we used a large panel of 44 HIV-1 envelope variants (subtypes A, B, and C) to evaluate the presence of broadly neutralizing antibodies in serum samples obtained 3 years after seroconversion from 40 women enrolled in the CAPRISA 002 acute infection cohort. Seven of 40 participants had serum antibodies that neutralized more than 40% of viruses tested and were considered to have neutralization breadth. Among the samples with breadth, CAP257 serum neutralized 82% (36/44 variants) of the panel, while CAP256 serum neutralized 77% (33/43 variants) of the panel. Analysis of longitudinal samples showed that breadth developed gradually starting from year 2, with the number of viruses neutralized as well as the antibody titer increasing over time. Interestingly, neutralization breadth peaked at 4 years postinfection, with no increase thereafter. The extent of cross-neutralizing activity correlated with CD4(+) T cell decline, viral load, and CD4(+) T cell count at 6 months postinfection but not at later time points, suggesting that early events set the stage for the development of breadth. However, in a multivariate analysis, CD4 decline was the major driver of this association, as viral load was not an independent predictor of breadth. Mapping of the epitopes targeted by cross-neutralizing antibodies revealed that in one individual these antibodies recognized the membrane-proximal external region (MPER), while in two other individuals, cross-neutralizing activity was adsorbed by monomeric gp120 and targeted epitopes that involved the N-linked glycan at position 332 in the C3 region. Serum antibodies from the other four participants targeted quaternary epitopes, at least 2 of which were PG9/16-like and depended on the N160 and/or L165 residue in the V2 region. These data indicate that fewer than 20% of HIV-1 subtype C-infected individuals develop antibodies with cross-neutralizing activity after 3 years of infection and that these antibodies target different regions of the HIV-1 envelope, including as yet uncharacterized epitopes.


title: Technical note: An improved surgical model for the long-term studies of kinetics and quantification of nutrient absorption in swine.

text: An improved technique to study kinetics and quantitative absorption of nutrients in pigs is described. Three female pigs (35 kg of BW) were surgically modified with catheters in the hepatic portal vein and carotid artery and an ultrasonic flow probe around the portal vein. Catheter placement and patency was secured using distal modifications (rings and holes) and nonabsorbable suture. Catheters and flow probe cable were tunneled subcutaneously after exteriorization for further protection. Fibrosis and adhesions in the body cavity were minimized by avoiding excessive manipulation and drying of viscera. Pigs were supported during recovery by intravenous fluid therapy of AA and electrolytes until regular feeding resumed. Catheters were flushed daily with heparinized saline (200 IU/L). After 10 d, pigs were fed a diet based on wheat and soybean meal for 6 consecutive 7-d periods. On d 7, blood was collected postprandially every 15 min from -15 to 60 min, 30 to 240 min, 60 to 480 min, and 120 to 720 min. Blood flow was measured simultaneously. Plasma was analyzed for glucose, and net glucose absorption was calculated from plasma portal-arterial differences x plasma flow [blood flow x (1 - hematocrit)]. The specific improvements for long-term use of this model are distal modifications of the catheters, postoperative treatment using parental nutrition and gut motility drug, prevention of infection of body cavity by further tunneling of catheters and blood flow probe cable, and use of ultrasonic blood flow probes and meter. Blood flow measurements using an ultrasonic blood flow probe was not changed after 52 d compared with 10 d post-surgery, indicating the reliability of this model. This catheterized pig model, thus, will allow the long-term study of the kinetics of nutrient absorption.


title: Lung lobe torsion in seven juvenile dogs.

text: CASE DESCRIPTION 7 juvenile (< 12 months old) dogs with lung lobe torsion were evaluated. CLINICAL FINDINGS All patients were male; breeds included Pug (n = 5), Chinese Shar-Pei (1), and Bullmastiff (1). Dyspnea and lethargy were the most common initial complaints, with a duration of clinical signs ranging from 1 to 10 days. A CBC showed leukocytosis and neutrophilia in all dogs. Anemia was present in 6 dogs, 2 of which received packed RBC transfusions. The diagnosis was made on the basis of results of thoracic radiography, CT, ultrasonography, or a combination of modalities. The left cranial lung lobe was most commonly affected (n = 4), followed by the right middle lung lobe (2) and the right cranial lung lobe (1). TREATMENT AND OUTCOME A lateral intercostal thoracotomy with lobectomy of the affected lobe was performed in all patients. All dogs survived to be discharged between 1 and 2 days postoperatively. Six of 7 owners contacted for follow-up information 7 to 170 months after discharge reported satisfaction with the treatment and no apparent signs of recurrence of disease. CLINICAL RELEVANCE The juvenile patients of this report were successfully treated surgically with no apparent complications. Clinicians should be aware of the possibility of lung lobe torsion when evaluating young dogs with clinical signs related to the respiratory system, including those with vague signs, to avoid undue delays in treatment.


title: COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan.

text: Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.


Being a rheumatologist and a patient with a rheumatic disease today: A perspective at the time of COVID-19.


title: Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study.

text: BACKGROUND Post hoc analyses of clinical trial data suggested that linezolid may be more effective than vancomycin for treatment of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial pneumonia. This study prospectively assessed efficacy and safety of linezolid, compared with a dose-optimized vancomycin regimen, for treatment of MRSA nosocomial pneumonia. METHODS This was a prospective, double-blind, controlled, multicenter trial involving hospitalized adult patients with hospital-acquired or healthcare-associated MRSA pneumonia. Patients were randomized to receive intravenous linezolid (600 mg every 12 hours) or vancomycin (15 mg/kg every 12 hours) for 7-14 days. Vancomycin dose was adjusted on the basis of trough levels. The primary end point was clinical outcome at end of study (EOS) in evaluable per-protocol (PP) patients. Prespecified secondary end points included response in the modified intent-to-treat (mITT) population at end of treatment (EOT) and EOS and microbiologic response in the PP and mITT populations at EOT and EOS. Survival and safety were also evaluated. RESULTS Of 1184 patients treated, 448 (linezolid, n = 224; vancomycin, n = 224) were included in the mITT and 348 (linezolid, n = 172; vancomycin, n = 176) in the PP population. In the PP population, 95 (57.6%) of 165 linezolid-treated patients and 81 (46.6%) of 174 vancomycin-treated patients achieved clinical success at EOS (95% confidence interval for difference, 0.5%-21.6%; P = .042). All-cause 60-day mortality was similar (linezolid, 15.7%; vancomycin, 17.0%), as was incidence of adverse events. Nephrotoxicity occurred more frequently with vancomycin (18.2%; linezolid, 8.4%). CONCLUSIONS For the treatment of MRSA nosocomial pneumonia, clinical response at EOS in the PP population was significantly higher with linezolid than with vancomycin, although 60-day mortality was similar.


title: [Neuromonitoring and awareness].

text: Awareness is a rare but in some cases severe complication of general anesthesia. In clinical practice vegetative signs such as sweating, lacrimation, tachycardia and hypertension are used to assess the anesthetic depth. Awareness however may also occur without any of these signs. Different systems based on the electroencephalogram (EEG) have been developed to monitor hypnosis. Some studies have shown that the use of EEG based monitor systems can reduce the incidence of awareness in patients of high risk. A similar reduction of the incidence was reached in studies using protocols based on concentrations of volatile anesthetics. Other systems to monitor anesthetic depth have been developed, but their influence on awareness has not yet been investigated sufficiently. Further studies are needed to clarify their impact concerning the incidence of awareness.


title: The Impact of ADHD on Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis.

text: The objective our study was to carry out a systematic review and meta-analysis to examine the impact of attention-deficit and hyperactivity disorder (ADHD) on bariatric surgery outcomes. Despite the effectiveness of bariatric surgery, about 10 to 20% of patients continue to regain weight after the procedure. New evidence supports that ADHD may be directly associated with obesity and may affect outcomes following bariatric surgery. However, certain psychiatric illnesses, such as ADHD, are rarely screened for, leading to a continued lack of data on the interaction between ADHD and bariatric surgery. A comprehensive literature search for both published and unpublished studies of ADHD and bariatric surgery from 1946 to August 2018 was performed. The search was conducted using the Medline, EMBASE, Scopus, the Cochrane Library, and Web of Science databases as well as conference abstracts. Our search strategy terms included "(ADHD OR attention deficit hyperactivity disorder) AND (bariatrics OR obesity surgery OR gastric bypass OR gastric sleeve OR Roux-en-Y OR RYGB OR sleeve gastrectomy)" and was limited to human studies in the English language. Preliminary database search of the literature yielded 104 articles after 70 duplicates were removed. A total of five studies with 492 patients were included. The overall ADHD rate was 20.9% with reported rates ranging from 7 to 38%. The weighted mean age was 44.0 ± 10.2 years, the weighted sex was 83.6% female, and the weighted mean follow-up was 22.2 months. Preoperative weighted mean BMI was 43.7 versus a postoperative weighted mean BMI of 34.7. No statistical significance was observed for mean BMI difference between non-ADHD vs. ADHD patients undergoing bariatric surgery (three studies; MD - 2.66; CI - 7.54 to 2.13; p = 0.28). Statistical significance was, however, observed for postoperative follow-up between patients with ADHD vs. non-ADHD subjects (three studies; MD - 7.28; - 13.83 to -0.73; p = 0.03). Patients with ADHD do not have a statistically significant mean BMI difference following bariatric surgery but have a statistically significant reduction in postoperative follow-up versus non-ADHD patients. Targeted strategies aimed at improving clinic attendance for this at-risk ADHD population may improve bariatric outcomes and minimize recidivism rates.


title: Malpractice carrier underwrites Fundamentals of Laparoscopic Surgery training and testing: a benchmark for patient safety.

text: BACKGROUND Fundamentals of Laparoscopic Surgery (FLS) is a validated program developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to educate and assess competency in minimally invasive surgery (MIS). This study reports the first malpractice carrier-sponsored FLS course for surgeons in practice underwritten by the Controlled Risk Insurance Company of Harvard's Risk Management Foundation (CRICO/RMF). The study investigated the participating surgeons' pattern of MIS skills acquisition, subjective laparoscopic comfort level, operative activity, and perception of the FLS role in surgical education, credentialing, and patient safety. METHODS A 1-day postgraduate continuous medical education (CME) course consisted of didactic presentations of the leading MIS faculty, proctored FLS hands-on training, psychomotor testing, and cognitive computer-based examination. Voluntary anonymous pre- and postcourse surveys were distributed to the participants at registration and at completion of both the didactic teaching and the skills modules of the program. RESULTS The course was attended by 37 practicing surgeons in the Harvard system, and 86% of the survey forms were returned. The major driving forces for attending the course were directive from the chief/chairman (50%), improvement in MIS didactic knowledge (56%), and the belief that FLS would become a standard such as advanced trauma life support (ATLS), advanced cardiac life support (ACLS), or the like (53%). Surgeons reported that the FLS exam content was appropriate (Likert 4.41 +/- 0.91) and that mastery of the course material would improve safety (Likert 4.13 +/- 0.79) and technical knowledge of MIS (Likert 4.03 +/- 1.00). CONCLUSIONS This unique cooperative effort between a liability carrier, a professional surgical society, and proactive surgeons should be considered a model for advancing competency and patient safety. The survey results indicate a positive view of FLS in surgical training, safety, and MIS education.


Pneumococcal pneumonia in preschool children: viral coinfection does not worsen clinical outcome.


title: [First case of 2019 novel coronavirus infection in children in Shanghai].

text: 报道上海第l例确诊新型冠状病毒(2019-nCoV)感染患儿的诊治经过。患儿 男，7岁，因"发热3 h伴咳嗽"以及父亲被确诊2019-nCoV感染的肺炎收入复旦大学附属儿科医院负压病房。经过对症治疗后治愈。儿童2019-nCoV感染临床表现相对成人较轻，家庭内传播是儿童感染重要的途径。本例患儿虽然症状轻，但恢复期连续2次2019-nCoV核酸检测阳性，提示需要观察轻症儿童病例在恢复期无症状排毒的传染性。.


title: Comparison of Hemodynamic Factors Predicting Prognosis in Heart Failure: A Systematic Review.

text: OBJECTIVES We systematically reviewed the literature to address the question of which of the three hemodynamic factors predicts prognosis best in heart failure patients when directly compared to each other: cardiac output, preload or afterload. METHODS Prognostic studies in heart failure (HF) were searched that included at least two of the three hemodynamic variables: (1) cardiac output or cardiac index (CI), (2) preload represented by pulmonary capillary wedge pressure (PCWP) and (3) afterload simplified to systolic blood pressure (SBP). Critical appraisal was done according to the QUIPS format for prognostic studies. The main endpoint was all-cause mortality, which could be combined with other endpoints. We report the number of studies in which CI, PCWP and SBP remained significant prognostic predictors in multivariate analysis. We also assessed whether hemodynamic predictors of prognosis varied in four different HF-populations. RESULTS Included were 18 studies containing a multivariate analysis. PCWP was an independent predictor of prognosis in 10 of 18 studies, SBP in 3 of 14 studies and CI in none of 18 studies. Results were not specific for any of the HF-populations. CONCLUSIONS A higher PCWP and lower SBP are independent predictors of poor prognosis in HF. In spite of the frequently used concept behind HF, this review demonstrates that CI is not an independent predictor of prognosis in HF.


title: Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis.

text: Background There is paucity of evidence on the effectiveness of facemask use in COVID-19 in community settings. Objectives We aimed to estimate the effectiveness of facemask use alone or along with hand hygiene in community settings in reducing the transmission of viral respiratory illness. Methods We searched PubMed and Embase for randomized controlled trials on facemask use in community settings to prevent viral respiratory illnesses published up to April 25, 2020. Two independent reviewers were involved in synthesis of data. Data extraction and risk-of-bias assessment were done in a standard format from the selected studies. Outcome data for clinically diagnosed or self-reported influenza-like illness (ILI) was recorded from individual studies. Pooled effect size was estimated by random-effects model for "facemask only versus control" and "facemask plus hand hygiene versus control." Results Of the 465 studies from PubMed and 437 studies from Embase identified from our search, 9 studies were included in qualitative synthesis and 8 studies in quantitative synthesis. Risk of bias was assessed as low (n = 4), medium (n = 3), or high (n = 1) risk. Interventions included using a triple-layered mask alone or in combination with hand hygiene. Publication bias was not significant. There was no significant reduction in ILI either with facemask alone (n = 5, pooled effect size: -0.17; 95% confidence interval [CI]: -0.43-0.10; P = 0.23; I2 = 10.9%) or facemask with handwash (n = 6, pooled effect size: (n=6, pooled effect size: -0.09; 95% CI: -0.58 to 0.40; P = 0.71, I2 = 69.4%). Conclusion : Existing data pooled from randomized controlled trials do not reveal a reduction in occurrence of ILI with the use of facemask alone in community settings.


title: Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation.

text: OBJECTIVES Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. METHODS Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. RESULTS A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). CONCLUSIONS A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. KEY POINTS • SDAVF treatment must be aimed to occlude the fistula point shunt. • Native post-operative cone-beam CT permits high-spatial-resolution imaging of the embolic cast. • The automated double-cone-beam CT fusion technique (pre/post) accurately demonstrates intravascular glue distribution after embolisation. • Patient movements should be avoided to obtain good technical results.


title: Muscle pain, fever, cough, and progressive dyspnea in a woman with eosinophilic pneumonia.

text: The diagnosis of eosinophilic pneumonia (EP) is rare and challenging. This condition is frequently misdiagnosed as pulmonary tuberculosis, lymphoma, schistosomiasis, Wegener's granuloma, severe acute respiratory syndrome, or severe community-acquired pneumonia. Herein, we report a case in which computed tomography (CT)-guided percutaneous lung biopsy was used to diagnose EP without alveolar eosinophilia or peripheral eosinophilia. A roundworm identified in the patient's stool confirmed the precise diagnosis to be parasitic EP. This is, to our knowledge, the first reported case of EP confirmed by CT-guided percutaneous lung biopsy. CT-guided percutaneous lung biopsy may represent a new tool for the diagnosis of EP in patients without typical alveolar eosinophilia or peripheral eosinophilia.


Public health. Linking funds to actions for global health emergencies.


title: Chemical adhesion barriers: do they affect the intraperitoneal behavior of a composite mesh?

text: INTRODUCTION The intraperitoneal behavior of a prosthetic material used to repair a hernia is key to the success of the postimplant repair process. This study was designed to laparoscopically examine the real-time behavior of three composite meshes incorporating a chemical adhesion barrier when placed in contact with the visceral peritoneum. MATERIAL AND METHODS The defects of 7 × 5 cm were created in the ventral abdominal wall of 18 New Zealand White rabbits and repaired using Parietex Composite® (n = 6), Sepramesh® (n = 6), or Proceed® (n = 6). At 24 hr, 3, 7, and 14 days postimplant, adhesion formation was quantified by subjecting photographs obtained during laparoscopy to image analysis. At 14 days, specimens of the implants and surrounding host tissue were obtained for histologic, morphometric, and immunohistochemical analyses. RESULTS There were no cases of infection and/or rejection of the implant. Adhesion formation followed by laparoscopy 3, 7, and 14 days after implant was significantly lower for Parietex® than the other biomaterials. Degradation of the chemical barrier occurred earliest in Sepramesh®, this barrier being most stable at 14 days for the Parietex® implants. Macrophage counts were significantly greater for Sepramesh®. The thickness of the neoformed peritoneum formed on the three implants varied significantly (p < .05): 276.89 ± 38.87 μm, 84.49 ± 19.05 μm, and 161.97 ± 47.05 μm, respectively for Paritex®, Sepramesh®, and Proceed®. CONCLUSIONS (a) The most stable barrier against biodegradation was that of Parietex®; (b) the first postimplant week was the most critical period for adhesion formation; and (c) all three biomaterials showed good intraperitoneal behavior.


title: Prospective Comparison and Quality of Life for Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy in a Series of Morbidly Obese Patients.

text: BACKGROUND Laparoscopic sleeve gastrectomy has gained a wide acceptance in the surgical community with an increasing popularity in the field of bariatric surgery. Simultaneously more surgeons have become acquainted with the single port techniques and sleeve gastrectomy has been regarded as an ideal field of application. Literature is scarce about operative and clinical outcomes of single port sleeve gastrectomy compared to conventional laparoscopy. The primary purpose of the study was to compare operative outcomes in the two study groups. Assessment and comparison of functional outcomes in terms of quality of life between groups was also performed. METHODS Prospective data on 130 consecutive patients who underwent randomized SI or CL sleeve gastrectomy were collected between January 2009 to December 2014. Preoperative parameters, outcomes, post-operative functional results and quality of life, according to the short-form SF-36 questionnaire, were evaluated and compared between groups. RESULTS 65 patients underwent conventional laparoscopic (CL) and 65 single incision (SI) sleeve gastrectomy. Operative time, post-operative pain, in-hospital stay, and complications were similar in the two groups. No difference emerged with respect to passage of flatus and resumption of oral intake (p = NS). Cosmetic results were excellent in SI patients with higher satisfaction rates. Post-operative quality of life was significant higher compared to baseline (p < 0.05), and comparable between the two procedures. CONCLUSIONS Single incision sleeve gastrectomy is safe, effective and comparable to the conventional laparoscopic technique in terms of outcomes. Post-operative quality of life is comparable between the two procedures.


title: Gastric supply manipulation to modulate ghrelin production and enhance vascularization to the cardia: proof of the concept in a porcine model.

text: INTRODUCTION Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized. AIM To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ. MATERIALS AND METHODS A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks. RESULTS Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs. 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs. 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008 mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences. CONCLUSIONS Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation.


title: Effects of Covid-19 Lockdown on Mental Health and Sleep Disturbances in Italy.

text: Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored. A national cross-sectional survey was performed during the last 14 days of the Italian lockdown. Questionnaires assessed socio-demographics characteristic, behaviors and healthcare access. The outcomes were assessed using Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2. Participants with sleep disturbances completed the Insomnia Severity Index. The sample size was 1515. Depression and anxiety symptom prevalence was 24.7% and 23.2%; 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, an increased time spent on the internet and an avoidance of activities through peer pressure increased the likelihood of at least one mental health outcome. Increasing age, an absence of work-related troubles and being married or being a cohabitant reduced such a probability. Females and participants with chronic conditions were associated with a higher prevalence of sleep disturbances. It is crucial to study effective interventions, specifically planning strategies, for more vulnerable groups and to consider the role of the internet.


Coronavirus: global stocks of protective gear are depleted, with demand at "100 times" normal level, WHO warns.


title: Prioritising references for systematic reviews with RobotAnalyst: A user study.

text: Screening references is a time-consuming step necessary for systematic reviews and guideline development. Previous studies have shown that human effort can be reduced by using machine learning software to prioritise large reference collections such that most of the relevant references are identified before screening is completed. We describe and evaluate RobotAnalyst, a Web-based software system that combines text-mining and machine learning algorithms for organising references by their content and actively prioritising them based on a relevancy classification model trained and updated throughout the process. We report an evaluation over 22 reference collections (most are related to public health topics) screened using RobotAnalyst with a total of 43 610 abstract-level decisions. The number of references that needed to be screened to identify 95% of the abstract-level inclusions for the evidence review was reduced on 19 of the 22 collections. Significant gains over random sampling were achieved for all reviews conducted with active prioritisation, as compared with only two of five when prioritisation was not used. RobotAnalyst's descriptive clustering and topic modelling functionalities were also evaluated by public health analysts. Descriptive clustering provided more coherent organisation than topic modelling, and the content of the clusters was apparent to the users across a varying number of clusters. This is the first large-scale study using technology-assisted screening to perform new reviews, and the positive results provide empirical evidence that RobotAnalyst can accelerate the identification of relevant studies. The results also highlight the issue of user complacency and the need for a stopping criterion to realise the work savings.


title: Minimally invasive donor nephrectomy: current state of the art.

text: BACKGROUND The concept of a minimally invasive live donor nephrectomy developed over 20 years ago. Surgeons gained expertise with the laparoscopic technique and utilized multiple variations that are now utilized in transplant centers throughout the world. Recent modifications include laparoendoscopic single-site and robotic approaches that have been adopted by an additional smaller set of programs. PURPOSE Review was performed of the following eight different surgical approaches to a "minimally invasive" live donor nephrectomy: laparoscopic (LDN), hand-assisted laparoscopic (HALDN), retroperitoneoscopic (RLDN), hand-assisted retroperitoneoscopic (HARS), single-port laparoscopic (LESS), robotic-assisted laparoscopic (RALDN), mini open, and natural orifice transluminal endoscopic (NOTES). The techniques are described and summaries of available outcomes and complications are presented. CONCLUSIONS Traditional surgical techniques of open donor nephrectomy have transitioned to minimally invasive techniques. With adoption of these techniques as the preferred approach, several variations have and continue to evolve. The current minimally invasive donor nephrectomy techniques share low complication rates and excellent outcomes.


title: [Consideration of surgeons participating in COVID-19 emergency medical rescue].

text: As a newly epidemic, COVID-19 with a concentrated outbreak poses a great challenge to medical treatment. The severe and critical patients are complex complicatied with the psychological problems, and the medical staff are overworked and under tremendous psychological pressure. The surgeon participated in emergency medical rescue could provide professional treatment for the patients combined with surgical diseases, specialized training for the non-surgeon crew, to reduce surgical-related mortality. With the advantages of good team consciousness, strong aseptic concept and good psychological quality, the surgeons can quickly adapt to and carry out rescue work under the premise of good self-protection. Surgeons need to develop critical care management concepts and focus on the critical care support equipment associated with the outbreak. Some suggestions are put forward for the standardized training of resident surgeons to cultivate compound talents. It is hoped that this artical can lead to the thinking of how to participate in the emergency medical rescue of infectious diseases among surgeons and provide some enlightenment for future surgical education.


title: Human rhinovirus and coronavirus detection among allogeneic hematopoietic stem cell transplantation recipients.

text: Little is known about clinical and virologic manifestations of rhinovirus (HRV) and coronavirus (HCoV) infections after hematopoietic cell transplantation (HCT). We performed surveillance for 1 year and describe the natural history of these infections during the first 100 days after allogeneic HCT, when symptom surveys and upper respiratory samples were collected weekly. Samples were tested using RT-PCR for HRVs and HCoVs (OC43, 229E, HKU1, and NL63). Among 215 patients, 64 (30%) patients had 67 infections. Day 100 cumulative incidence estimate was 22.3% for HRV and 11.1% for HCoV. Median duration of viral shedding was 3 weeks; prolonged shedding of at least 3 months occurred in 6 of 45 patients with HRV and 3 of 22 with HCoV. Six patients with HRV and 9 with HCoV were asymptomatic. HRV infection was associated with rhinorrhea, congestion, postnasal drip, sputum, and cough; HCoV infection was not associated with respiratory symptoms or hepatic dysfunction. Lower respiratory infection developed in 2 patients with HRV before day 100, and 1 each with HRV and HCoV after day 100. HRV and HCoV infections are common in the first 100 days after HCT, viral shedding lasts more than 3 weeks in half, and lower respiratory infection is rare.


title: Robotic-assisted major pancreatic resection and reconstruction.

text: HYPOTHESIS Robotic-assisted pancreatic resection and reconstruction are safe and can reproduce perioperative results seen in open surgery. DESIGN Single-institution retrospective review. SETTING Tertiary care center. PATIENTS Patients undergoing completed robotic-assisted pancreatic resection and reconstruction at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, between October 3, 2008, and February 26, 2010. MAIN OUTCOME MEASURES Primary pathology, operative time, operative blood loss, perioperative blood transfusions, pancreatic fistula, 90-day morbidity and mortality, and readmission rate. RESULTS Thirty patients with a median age of 70 years (range, 32-85 years) underwent completed robotic-assisted pancreatic resection and reconstruction. Procedures were robotic-assisted non-pylorus-preserving pancreaticoduodenectomy (n = 24), robotic-assisted central pancreatectomy (n = 4), and the robotic-assisted Frey procedure (n = 2). The median operative time was 512 minutes (range, 327-848 minutes). The median blood loss was 320 mL (range, 50-1000 mL), with a median length of hospital stay of 9 days (range, 4-87 days). The final diagnoses included periampullary adenocarcinoma (n = 7), pancreatic ductal adenocarcinoma (n = 6), pancreatic neuroendocrine tumor (n = 5), intraductal papillary mucinous neoplasm (n = 4), mucinous cystic neoplasm (n = 3), serous cystic adenoma (n = 2), chronic pancreatitis (n = 2), and solid pseudopapillary neoplasm (n = 1). There was 1 postoperative death. The overall pancreatic fistula rate was 27% (n = 8). The clinically significant pancreatic fistula rate (International Study Group on Pancreatic Fistula grades B and C) was 10% (n = 3). Clavien grade III and IV complications occurred in 7 patients (23%), while Clavien grade I and II complications occurred in 8 patients (27%). CONCLUSIONS Robotic-assisted complex pancreatic surgery can be performed safely in a high-volume pancreatic tertiary care center with perioperative outcomes comparable to those of open surgery. Advances in robotic technology and increasing experience may improve long operative times.


COVID-19 Strikes the Vulnerable.


title: Electrical Stimulation as an Alternative Treatment in Gastroesophageal Reflux Disease - Clinical Study.

text: Background: Recently, there was described the possibility to increase the lower esophageal sphincter (LES) tone by means of implantable electrical stimulator. Although, this method has already been used in clinical practice, however, the optimal parameters of LES electrical stimulation are still unknown. Aims: The goals of this study were to get clinical data regarding the effects of different types of electrical stimulation on LES and to elaborate and test the prototype on laboratory animals. Material and Methods: In the Department of Surgery no 4, during 4 years (2015-2018), there has been achieved one clinical-experimental study of LES electrical stimulation. During the first stage, the electrical stimulation of the LES, using an external pulse generator, was assessed in 15 patients. These patients underwent an antireflux intervention, with an additional insertion of 2 temporary electrodes on the LES. During the second stage, there was created an experimental device which consisted of a re-insertable microstimulator using wireless energy transfer. During the third stage, it was tested in the experimental surgery center "Pius Branzeu", Timisoara, on laboratory animals (pigs). Results: Values of the LES resting pressure and integrated relaxation pressure (IRP) were significantly different during the prestimulation and poststimulation periods. Conclusions: There was successfully demonstrated the possibility to increase the LES tone. Modifications in the LES functionality and tone, during the electrical stimulation and in the period immediately after the stimulation, depend upon the pulse frequency and length. Also, the additional change of the Bluetooth transmitter antenna is necessary to offset the screening effect of the biological tissues.


title: Endocrine cells of the adenohypophysis in severe acute respiratory syndrome (SARS).

text: It is known that severe acute respiratory syndrome (SARS), a severe infectious illness, which caused an epidemic in Asia in 2003, has extensive and complex effects on human organ systems. It has been reported that the serum levels of prolactin (PRL), follicle stimulating hormone (FSH), and luteinizing hormone (LH) of SARS patients are significantly higher than those of control groups, while estradiol (E2), pregnancy hormone (P), and thyroid stimulating hormone (TSH) are considerably lower than those of normal controls. This phenomenon suggests that the adenohypophyseal endocrine cells in SARS patients may be damaged. However, up to now there has been no direct histological investigation on the endocrine cells of patients' pituitary. Here we investigated the endocrine cells in the adenohypophysis obtained from autopsies of 5 SARS patients. The immunohistochemistry and quantitative image results showed that compared with control cases, both the number of positive cells and the staining intensity of immunoreactivity for growth hormone, TSH, and adrenocorticotrophic hormone in these cells were remarkably decreased, while that of PRL, FSH, and LH were significantly increased in all SARS cases studied. These findings indicated that alterations occurred in the patients' adenohypophyseal endocrine cells, and these changes were consistent with the serum levels of relevant endocrine hormones reported previously. It appears that changes in these endocrine cells and their hormones are affected by the severity of this new infectious disease.


title: Associations of Serum Selenium Levels in the First Trimester of Pregnancy with the Risk of Gestational Diabetes Mellitus and Preterm Birth: a Preliminary Cohort Study.

text: Women with gestational diabetes mellitus (GDM) may have lower serum selenium levels than healthy controls, which may be associated with preterm birth. We explored the association of serum selenium levels in early pregnancy with the risk of GDM and preterm birth among Chinese women. We included 398 women with a singleton pregnancy, who were followed up prospectively from the first prenatal visit until delivery. Serum selenium levels were measured in the first trimester. After delivery, data concerning mothers and their children were sourced from medical records by researchers who were blind to the participants' selenium status. Of the 398 women, 71 (17.8%) had GDM, 21(5.3%) had preterm birth, and 266 (66.8%) had selenium deficiency (serum selenium < 70 μg/L). Women in the upper three quartiles of serum selenium level did not have a significantly lower risk of GDM or preterm birth than those in the lowest quartile after adjustment for covariates (all p > 0.05). When serum selenium levels were classified as normal or deficient, the risk of GDM or preterm birth among women with normal serum selenium levels was still not lower than that of women with deficient serum selenium levels after adjustment for covariates (all p > 0.05). Although selenium deficiency was common in the Chinese women in our cohort, our results indicate that low serum selenium level during early pregnancy may not be a strong predictor of the risk of GDM and preterm birth. However, our sample size was small, and future studies with larger populations are warranted.


title: Investigation of influenza and respiratory viruses in hospitalised patients with influenza-like illness in an emergency room.

text: INTRODUCTION Influenza-like illness (ILI) surveillance is usually performed using outpatient data, and information on the surveillance of patients hospitalised for ILI, which is critical for the complete assessment of the influenza burden, is lacking. METHODOLOGY In this prospective active surveillance study, patients with community-acquired ILI hospitalised for at least 24 hours in the Emergency Room (ER) of Gazi University Hospital were identified according to the ICD-10 codes at hospital admission through active surveillance of the 2013-2014 and 2014-2015 influenza seasons. The presence of influenza and other respiratory viruses was analysed in the nasopharyngeal or pharyngeal specimens by real-time polymerase chain reaction. RESULTS 351 patients admitted to emergency room with certain ICD-10 codes were assessed, and 111 patients with ILI were included in the study. We detected 15 influenza and 23 other respiratory viruses in 33 of the 111 patients. More than one virus was detected in 5 patients. No virus was detected in a majority of the patients with ILI. The sensitivity of hospital admission/discharge ICD-10 codes used in the study to detect real influenza cases was low. Patients with influenza were admitted to the hospital more frequently with high fever symptoms compared with patients with influenza virus-negative and other respiratory virus-positive (p < 0.05). CONCLUSIONS This study revealed that non-influenza respiratory viruses were a major contributor to ILI. Patients admitted with fever during the influenza seasons should be evaluated for influenza virus infection, and the use of diagnostic codes in surveillance studies can lead to incorrect results.


title: Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management.

text: Intracerebral hemorrhage (ICH) secondary to intravenous and intraarterial revascularization strategies for emergent treatment of acute ischemic stroke is associated with high mortality. ICH from systemic thrombolysis typically occurs within the first 24-36 hours of treatment initiation and is characterized by rapid hematoma development and growth. Pathophysiological mechanisms of revascularization therapy-induced ICH are complex and involve a combination of several distinct processes, including the direct effect of thrombolytic agents, disruption of the blood-brain barrier secondary to ischemia, and direct vessel damage from wire and microcatheter manipulations during endovascular procedures. Several definitions of ICH secondary to thrombolysis currently exist, depending on clinical or radiological characteristics used. Multiple studies have investigated clinical and laboratory risk factors associated with higher rates of ICH in this setting. Early ischemic changes seen on noncontrast CT scanning are strongly associated with higher rates of hemorrhage. Modern imaging techniques, particularly CT perfusion, provide rapid assessment of hemodynamic parameters of the brain. Specific patterns of CT perfusion maps can help identify patients who are likely to benefit from revascularization or to develop hemorrhagic complications. There are no established guidelines that describe management of revascularization therapy-induced ICH, and great variability in treatment protocols currently exist. General principles that apply to the management of spontaneous ICH might not be as effective for revascularization therapy-induced ICH. In this article, the authors review current knowledge of risk factors and radiological predictors of ICH secondary to stroke revascularization techniques and analyze medical and surgical management strategies for ICH in this setting.


title: Role of canine circovirus in dogs with acute haemorrhagic diarrhoea.

text: Canine circovirus (CanineCV) has been detected in some dogs with severe haemorrhagic diarrhoea, but its pathogenic role is unclear. This study evaluated a suspected association between the presence of CanineCV and acute haemorrhagic diarrhoea syndrome (AHDS) in dogs. The prevalence of CanineCV in dogs with AHDS was compared with that in healthy dogs and those infected with canine parvovirus (CPV). Additionally, time to recovery and mortality rate were compared between CanineCV-positive and CanineCV-negative dogs. Faecal samples of dogs with AHDS (n=55), healthy dogs (n=66) and dogs infected with CPV (n=54) were examined by two real-time TaqMan PCR assays targeting the replicase and capsid genes of CanineCV. CanineCV was detected in faecal samples of two dogs with AHDS, three healthy controls and seven dogs infected with CPV. Among the three groups, there was no significant difference in prevalence of CanineCV. CPV-infected animals that were coinfected with CanineCV had a significantly higher mortality rate compared with those negative for CanineCV. CanineCV does not appear to be the primary causative agent of AHDS in dogs, but might play a role as a negative co-factor in disease outcome in dogs with CPV infection.


title: Injecting epidemiology into population viability analysis: avian cholera transmission dynamics at an arctic seabird colony.

text: Infectious diseases have the potential to spread rapidly and cause high mortality within populations of immunologically naïve hosts. The recent appearance of avian cholera, a highly virulent disease of birds caused by the bacterium Pasteurella multocida, at remote Arctic seabird colonies is an emerging conservation concern. Determining disease risk to population viability requires a quantitative understanding of transmission potential and the factors that regulate epidemic persistence. Estimates of the basic (R0 ) and real-time (Rt ) reproductive number are critical in this regard - enumerating the number of secondary infections caused by each primary infection in a newly invaded host population and the decline in transmission rate as susceptible individuals are removed via mortality or immunized recovery. Here, we use data collected at a closely monitored common eider (Somateria mollissima) breeding colony located in the Canadian Arctic to examine transmission and host population dynamics. Specifically, we infer epidemic curves from daily mortality observations and use a likelihood-based procedure to estimate changes in the reproductive number over a series of annual outbreaks. These data are interpreted in relation to concurrent changes in host numbers to assess local extinction risk. Consistent with expectations for a novel pathogen invasion, case incidence increased exponentially during the initial wave of exposure (R0 = 2·5; generation time = 6·5 days ± 1·1 SD). Disease conditions gradually abated, but only after several years of smouldering infection (Rt ≈ 1). In total, 6194 eider deaths were recorded during outbreaks spanning eight consecutive breeding seasons. Breeding pair abundance declined by 56% from the pre-outbreak peak; however, a robust population of >4000 pairs remained intact upon epidemic fade-out. Overall, outbreak patterns were consistent with herd immunity acting as a mitigating factor governing in the extent and duration of mortality. Disease mortality is frequently modelled as a form of stochastic catastrophe in wildlife population assessments, whereas our approach gives shape to the functional response between transmission and host population dynamics. We conclude that increased emphasis on integrating epidemiological and population processes is essential to predicting the conservation impact of emerging infectious diseases in wildlife.


title: COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected.

text: In this commentary, researchers, health care consumers, and medical providers reflect on institutional betrayal during the COVID-19 pandemic in American and Canadian health care systems. Examples of institutional betrayal experienced by patients and their family members, as well as medical providers, are described. Although such examples may be more evident to the general public during the current pandemic, they do not represent new problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Epidemiology of canine parvovirus and coronavirus in dogs presented with severe diarrhoea to PDSA PetAid hospitals.

text: Canine parvovirus (CPV) and canine enteric coronavirus (CECoV) are often cited as causes of diarrhoea in dogs. This study aimed to determine the prevalence of CPV and CECoV in dogs presenting with severe diarrhoea to PDSA PetAid hospitals throughout the UK. A total of 355 samples were collected from the PDSA between 2006 and 2008. All samples were tested for CPV using a long range PCR and for CECoV using RT-PCR. The prevalence of CPV was 58 per cent (95 per cent confidence interval [CI] 52 to 63 per cent), with some evidence for regional variation. The prevalence of CECoV was 7.9 per cent (95 per cent CI 5.1 to 10.7 per cent). Analysis showed that animals with no history of vaccination were more likely to be CPV positive, with greatest effect in younger animals. CPV-positive animals were more likely to present with depression/lethargy than CPV-negative cases. The volume of diarrhoea and the presence of haemorrhage did not appear to be associated with the likelihood of detecting CPV. This study shows that CPV is a common finding in dogs presenting to PDSA hospitals with severe diarrhoea, and that CECoV is a less common but still potentially important pathogen. It also confirms that young and unvaccinated animals appear to be more at risk of presenting with CPV.


US Emergency Legal Responses to Novel Coronavirus: Balancing Public Health and Civil Liberties.


Reply to: Are COVID-19 Patients Dying of or with Cardiac Injury?


title: Microtubule-assisted altered trafficking of astrocytic gap junction protein connexin 43 is associated with depletion of connexin 47 during mouse hepatitis virus infection.

text: Gap junctions (GJs) are important for maintenance of CNS homeostasis. GJ proteins, connexin 43 (Cx43) and connexin 47 (Cx47), play a crucial role in production and maintenance of CNS myelin. Cx43 is mainly expressed by astrocytes in the CNS and forms gap junction intercellular communications between astrocytes-astrocytes (Cx43-Cx43) and between astrocytes-oligodendrocytes (Cx43-Cx47). Mutations of these connexin (Cx) proteins cause dysmyelinating diseases in humans. Previously, it has been shown that Cx43 localization and expression is altered due to mouse hepatitis virus (MHV)-A59 infection both in vivo and in vitro; however, its mechanism and association with loss of myelin protein was not elaborated. Thus, we explored potential mechanisms by which MHV-A59 infection alters Cx43 localization and examined the effects of viral infection on Cx47 expression and its association with loss of the myelin marker proteolipid protein. Immunofluorescence and total internal reflection fluorescence microscopy confirmed that MHV-A59 used microtubules (MTs) as a conduit to reach the cell surface and restricted MT-mediated Cx43 delivery to the cell membrane. Co-immunoprecipitation experiments demonstrated that Cx43-β-tubulin molecular interaction was depleted due to protein-protein interaction between viral particles and MTs. During acute MHV-A59 infection, oligodendrocytic Cx47, which is mainly stabilized by Cx43 in vivo, was down-regulated, and its characteristic staining remained disrupted even at chronic phase. The loss of Cx47 was associated with loss of proteolipid protein at the chronic stage of MHV-A59 infection.


title: Guideline Recommendations for Oral Care After Acquired Brain Injury: Protocol for a Systematic Review.

text: BACKGROUND Oral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. OBJECTIVE This systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. METHODS A search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. RESULTS This project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. CONCLUSIONS Nursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/17249.


title: Association Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Infection in South Korea.

text: The severe acute respiratory syndrome coronavirus 2 is known to infect host cells by interacting with ACE2 (angiotensin-converting enzyme 2) expressed in the respiratory epithelium. There have been concerns on whether alterations of ACE2 expression by renin-angiotensin-aldosterone system (RAAS) inhibitors would contribute to the infectivity and severity of coronavirus disease 2019 (COVID-19). We performed a case-control study to investigate the association between RAAS inhibitors and risk and severity of COVID-19 infection in South Korea using the population-based data provided by the Korean National Health Insurance System. Of 16 281 subjects with hypertension, there were 950 (5.8%) confirmed COVID-19 cases. After case-control matching, multivariable-adjusted conditional logistic regression analysis was performed. The adjusted odds ratio and 95% CIs for COVID-19 infection and long-term hospitalization comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors was 1.161 (0.958-1.407) and 0.863 (0.533-1.397), respectively. When comparing exposure to RAAS inhibitors and nonexposure to RAAS inhibitors for intensive care unit admission, high-flow oxygen therapy, and death, the adjusted odds ratios (95% CIs) were 1.515 (0.402-5.701), 0.663 (0.272-1.619), and 1.363 (0.513-3.662), respectively. In all analyses, P values were not significant (P>0.05). The present study demonstrates the absence of an identifiable association between the exposure to RAAS inhibitors and risk and severity of COVID-19 infection, supporting the current medical guidelines and recommendations that patients should not discontinue RAAS inhibitors out of a concern that they are at increased risk for infection or severe illness of COVID-19.


title: Single-incision Laparoscopic Surgery (SILS) in general surgery: a review of current practice.

text: Single-incision laparoscopic surgery (SILS) aims to eliminate multiple port incisions. Although general operative principles of SILS are similar to conventional laparoscopic surgery, operative techniques are not standardized. This review aims to evaluate the current use of SILS published in the literature by examining the types of operations performed, techniques employed, and relevant complications and morbidity. This review considered a total of 94 studies reporting 1889 patients evaluating 17 different general surgical operations. There were 8 different access techniques reported using conventional laparoscopic instruments and specifically designed SILS ports. There is extensive heterogeneity associated with operating methods and in particular ways of overcoming problems with retraction and instrumentation. Published complications, morbidity, and hospital length of stay are comparable to conventional laparoscopy. Although SILS provides excellent cosmetic results and morbidity seems similar to conventional laparoscopy, larger randomized controlled trials are needed to assess the safety and efficacy of this novel technique.


title: Review of Indoor Aerosol Generation, Transport and Control in the Context of COVID-19.

text: The coronavirus disease 2019 (COVID-19) pandemic has heightened awareness of aerosol generation by human expiratory events and their potential role in viral respiratory disease transmission. Concerns over high Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) viral burden of mucosal surfaces has raised questions about the aerosol generating potential and dangers of many otorhinolaryngologic procedures. However, the risks of aerosol generation and associated viral transmission by droplet or airborne routes for many otorhinolaryngology procedures are largely unknown. Indoor aerosol and droplet viral respiratory transmission risk is influenced by four factors: 1) aerosol or droplet properties, 2) indoor airflow, 3) virus-specific factors, and 4) host-specific factors. Here we elaborate on known aerosol versus droplet properties, indoor airflow, and aerosol generating events to provide context for risks of aerosol infectious transmission. We also provide simple but typically effective measures for mitigating the spread and inhalation of viral aerosols in indoor settings. Understanding principles of infectious transmission, aerosol and droplet generation, as well as concepts of indoor airflow, will aide in the integration of new data on SARS-CoV-2 transmission and activities that can generate aerosol to best inform on the need for escalation or de-escalation from current societal and institutional guidelines for protection during aerosol generating procedures. This article is protected by copyright. All rights reserved.


title: Technologies for enhanced efficacy of DNA vaccines.

text: Despite many years of research, human DNA vaccines have yet to fulfill their early promise. Over the past 15 years, multiple generations of DNA vaccines have been developed and tested in preclinical models for prophylactic and therapeutic applications in the areas of infectious disease and cancer, but have failed in the clinic. Thus, while DNA vaccines have achieved successful licensure for veterinary applications, their poor immunogenicity in humans when compared with traditional protein-based vaccines has hindered their progress. Many strategies have been attempted to improve DNA vaccine potency including use of more efficient promoters and codon optimization, addition of traditional or genetic adjuvants, electroporation, intradermal delivery and various prime-boost strategies. This review summarizes these advances in DNA vaccine technologies and attempts to answer the question of when DNA vaccines might eventually be licensed for human use.


The pandemic pipeline.


title: Do we know the diagnostic properties of the tests used in COVID-19? A rapid review of recently published literature.

text: COVID-19 has brought death and disease to large parts of the world. Governments must deploy strategies to screen the population and subsequently isolate the suspect cases. Diagnostic testing is critical for epidemiological surveillance, but the accuracy (sensitivity and specificity) and clinical utility (impact on health outcomes) of the current diagnostic methods used for SARS-CoV-2 detection are not known. I ran a quick search in PubMed/MEDLINE to find studies on laboratory diagnostic tests and rapid viral diagnosis. After running the search strategies, I found 47 eligible articles that I discuss in this review, commenting on test characteristics and limitations. I did not find any papers that report on the clinical utility of the tests currently used for COVID-19 detection, meaning that we are fighting a battle without proper knowledge of the proportion of false negatives that current testing is resulting in. This shortcoming should not be overlooked as it might hamper national efforts to contain the pandemic through testing community-based suspect cases.


Covid-19: Coroners needn't investigate PPE policy failures in deaths of NHS staff, new guidance says.


Can we beat influenza?


title: Robotic assistance in right hemicolectomy: is there a role?

text: PURPOSE The purpose of this study was to evaluate the results, postoperative outcomes, and cost of robotic assistance in right hemicolectomy and determine its safety, feasibility, and efficacy as compared with the conventional laparoscopic approach. METHODS From August 2005 to February 2009, 40 robot-assisted right hemicolectomies were performed by the authors at a single institution. These were compared with 135 laparoscopic right hemicolectomies performed by the authors, at the same hospital and during the same time period. Cost data from July 2006 until the end of the study period were compared between the 2 groups. RESULTS Both groups were comparable with respect to age, sex, body mass index, American Society of Anesthesiologists' class, history of prior abdominal surgery, and diagnosis. There was no significant difference in the lymph node harvest, estimated blood loss, conversion rate, length of stay, or incidence of complications and wound infection between the 2 groups. A robotic procedure was associated with a longer operative time (P < .001) and a higher cost (P = .003). CONCLUSION Robotic assistance in right hemicolectomy is safe and feasible but is associated with a longer operative time and, at present, with a higher cost compared with laparoscopy. However, right hemicolectomy serves as an ideal procedure to begin the learning curve in robotic colorectal surgery, which can subsequently progress to robotic rectal resections where the robot has the greatest potential for benefit.