title: The establishment and characteristics of cell-adapted IBV strain H120.

text: Avian infectious bronchitis virus is an important pathogen in poultry worldwide. Vaccination is the only effective way to prevent and control IBV infection. H120, one of the safest vaccine strains, which has been used worldwide as a primary vaccine, cannot adapt to passaged cells, which severely restricts the quality of the vaccine. Based on the reverse genetics of our previous research work, we constructed the recombinant R-H120-Beaudette-p65(S) strain by replacing the complete spike gene of H120 with the corresponding spike gene from the Beaudette p65 strain. Some biological characteristics, including replication kinetics, virulence and immunological properties of R-H120-Beaudette-p65(S) have been evaluated. The results showed that biological characteristics of R-H120-Beaudette-p65(S), such as replication kinetics in embryonated chicken eggs (ECEs) and embryo virulence, were similar to those of H120. In addition, R-H120-Beaudette-p65(S) could induce a similar antibody titre and provide up to 80 % immune protection in chickens challenged with the M41 strain. These results indicate that R-H120-Beaudette-p65(S) has the potential for further development as a cell-adapted vaccine.


title: Transformation in Dang-ki Healing: The Embodied Self and Perceived Legitimacy.

text: Since spirit possession in mediumship and shamanism resembles psychotic symptoms, early researchers perceived spirit mediums and shamans as psychiatric patients whose psychopathology was culturally sanctioned. However, other researchers have not only challenged this assumption, but also proposed that spirit possession has transformative benefits. The idiom of spirit possession provides cultural meanings for spirit mediums and shamans to express and transform their personal experiences. The present case study focuses on dang-ki healing, a form of Chinese mediumship practiced in Singapore, in which a deity possesses a human (i.e., dang-ki) to offer aid to supplicants. This study seeks to explore whether involvement in dang-ki healing is transformative; and if so, how the dang-ki's transformation is related to his self and the perceived legitimacy of his mediumship. At a shrine, I interviewed 20 participants, including a male dang-ki, 10 temple assistants, and nine clients. The results obtained were supportive of the therapeutic nature of spirit possession. First, there is a relationship between his self-transformation and the perceived legitimacy of his mediumship. As his clients and community have recognized his spirit possession as genuine, and the healing power of his possessing god, he is able to make use of mediumship as a means for spiritual development. Second, he has developed his spirituality by internalizing his god's positive traits (e.g., compassion). Deities worshipped in dang-ki healing can be conceptualized as ideal selves who represent a wide range of positive traits and moral values of Chinese culture. Thus, the possession of a deity is the embodiment of an ideal self. Finally, the dang-ki's transformation may run parallel to his god's transformation. In Chinese religions, gods have to constantly develop their spirituality even though they are already gods. An understanding of the god's spiritual development further sheds light on the dang-ki's self-transformation.


title: Pittsburgh response to endovascular therapy score as a pre-treatment prognostic tool: External validation in Trevo2.

text: Background Optimal patient selection is needed to maximize the therapeutic benefit of endovascular therapy for large vessel occlusion stroke. Aims To validate the Pittsburgh response to endovascular therapy (PRE) score in a randomized controlled trial (Trevo2) comparing stent retriever (Trevo) to the Merci device. Methods Trevo2 participants with internal carotid, M1 and M2 middle cerebral artery occlusions with prospectively collected baseline stroke severity (NIHSS), degree of hypodensity (CT ASPECTS), and three-month modified Rankin Scale (mRS) were included. Multivariable regression was used to confirm association between PRE score variables (age, NIHSS, and ASPECTS), medical comorbidities, randomization arm, and reperfusion status (mTICI2B/3) with good outcome (three-month modified Rankin Scale 0-2). Predictive power (area under the receiver operating characteristic curve) for good outcome of pre-treatment prognostic scores (PRE, THRIVE, HIAT2) was compared. Rates of good outcome were compared between successfully reperfused (mTICI2B/3) and non-reperfused (mTICI0-2A) patients across previously identified PRE score risk groups. Results Age, NIHSS, ASPECTS, reperfusion status, and randomization arm were independent predictors of good outcome. PRE score had moderate predictive power (AUC = 0.75) for good outcome and was comparable to other pre-treatment scores. Reperfusion resulted in maximal treatment benefit in patients with PRE score 0-24 (60% vs. 12.5%, p = 0.002) but not in those with PRE ≥50 (11.8% vs. 0.0%, p = 0.49). Conclusion The PRE score is a validated predictor of functional outcome and a tool for patient selection for endovascular therapy in anterior large vessel occlusion stroke. Our finding of limited benefit of reperfusion in patients with PRE score ≥50 needs to be prospectively validated.


title: The transcription factor STAT5 catalyzes Mannich ligation reactions yielding inhibitors of leukemic cell proliferation.

text: Protein-templated fragment ligations have been established as a powerful method for the assembly and detection of optimized protein ligands. Initially developed for reversible ligations, the method has been expanded to irreversible reactions enabling the formation of super-additive fragment combinations. Here, protein-induced Mannich ligations are discovered as a biocatalytic reaction furnishing inhibitors of the transcription factor STAT5. STAT5 protein catalyzes multicomponent reactions of a phosphate mimetic, formaldehyde, and 1H-tetrazoles yielding protein ligands with greatly increased binding affinity and ligand efficiency. Reactions are induced under physiological conditions selectively by native STAT5 but not by other proteins. Formation of ligation products and (auto-)inhibition of the reaction are quantified and the mechanism is investigated. Inhibitors assembled by STAT5 block specifically the phosphorylation of this protein in a cellular model of acute myeloid leukemia (AML), DNA-binding of STAT5 dimers, expression of downstream targets of the transcription factor, and the proliferation of cancer cells in mice.


title: A retrospective study of the neuropathology and diagnosis of naturally occurring feline infectious peritonitis.

text: Feline infectious peritonitis (FIP) is one of the most important viral diseases of cats worldwide. Our study describes the neuropathology and the diagnostic features of 26 cases of FIP in domestic cats. The average age of affected individuals was 11.8 mo, and there was no sex or breed predisposition. Clinical neurologic signs were noted in 22 cases, and rabies was clinically suspected in 11 cases. Twenty cats had lesions in multiple organs, and 6 cats had lesions only in the brain. Gross neuropathologic changes occurred in 15 cases and consisted of hydrocephalus (10 cases), cerebellar herniation through the foramen magnum (6 cases), cerebral swelling with flattening of gyri (2 cases), and accumulation of fibrin within ventricles (2 cases) or leptomeninges (1 case). Histologically, 3 main distinct distributions of neuropathologic changes were observed, namely periventricular encephalitis (12 cases), rhombencephalitis (8 cases), and diffuse leptomeningitis with superficial encephalitis (6 cases). Fresh tissue samples were submitted for fluorescent antibody testing (FAT) after autopsy in 17 cases, and positive results were found in only 7 cases. Immunohistochemistry (IHC) for feline coronavirus confirmed the diagnosis in all 26 cases. IHC appears to be a more sensitive and reliable test for confirmation of FIP than is FAT.


Emergence of novel coronavirus SARS-CoV2 in China and the response in Mexico.


Idiopathic cutaneous xanthoma in a pet rabbit.


title: A phase II randomized trial of adjuvant chemotherapy with S-1 versus S-1 plus cisplatin for completely resected pathological stage II/IIIA non-small cell lung cancer.

text: OBJECTIVES Platinum-based combination chemotherapy is the standard postoperative adjuvant treatment for pathological stage II/III non-small cell lung cancer (NSCLC). Oral S-1 therapy has good efficacy and relatively low toxicity for the treatment of advanced NSCLC. We investigated whether long-term S-1 monotherapy is also useful as an adjuvant therapy after surgery in patients with NSCLC. PATIENTS AND METHODS We conducted a phase II randomized open-label multi-institutional study in patients with pathological stage II/IIIA NSCLC (7th TNM classification) who underwent complete resection from 2009 to 2013. The primary endpoint, the 2-year disease-free survival (DFS) rate, was evaluated using the Bayesian method. Eligible patients were randomly assigned to two arms: oral S-1 monotherapy (S-1 arm) and S-1 plus cisplatin combination therapy followed by S-1 (S-1 plus cisplatin arm) both for a total of 1 year. RESULTS A total of 70 and 71 patients were enrolled in S-1 arm and S-1 plus cisplatin arm, respectively. The 2-year DFS rates were 52% (95% confidence interval [CI], 0.40-0.63) and 61% (95% CI, 0.48-0.70) for S-1 arm and S-1 plus cisplatin arm, respectively. Both arms met the primary endpoint. Neither DFS nor OS was significantly different between the arms (log-rank test: P = 0.1695 and P = 0.8684, respectively). The main G3/4 adverse events were loss of appetite and anemia (S-1 vs. S-1 plus cisplatin: 4.3% vs. 11.6% and 0% vs. 5.8%, respectively). The treatment completion rate did not differ between the two arms (S-1 vs. S-1 plus cisplatin: 45.7%, 95% CI, 41.9-66.3% vs. 43.5% 95% CI, 44.0-68.4%). CONCLUSIONS Long-term adjuvant chemotherapy with S-1 was a feasible and promising treatment for patients with completely resected NSCLC, regardless of cisplatin addition. S-1 monotherapy should be investigated further, based on its low toxicity and practical convenience.


title: Non-emphysematous chronic obstructive pulmonary disease is associated with diabetes mellitus.

text: BACKGROUND Chronic obstructive pulmonary disease (COPD) has been classically divided into blue bloaters and pink puffers. The utility of these clinical subtypes is unclear. However, the broader distinction between airway-predominant and emphysema-predominant COPD may be clinically relevant. The objective was to define clinical features of emphysema-predominant and non-emphysematous COPD patients. METHODS Current and former smokers from the Genetic Epidemiology of COPD Study (COPDGene) had chest computed tomography (CT) scans with quantitative image analysis. Emphysema-predominant COPD was defined by low attenuation area at -950 Hounsfield Units (LAA-950) ≥10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA-950 < 5%). RESULTS Out of 4197 COPD subjects, 1687 were classified as emphysema-predominant and 1817 as non-emphysematous; 693 had LAA-950 between 5-10% and were not categorized. Subjects with emphysema-predominant COPD were older (65.6 vs 60.6 years, p < 0.0001) with more severe COPD based on airflow obstruction (FEV1 44.5 vs 68.4%, p < 0.0001), greater exercise limitation (6-minute walk distance 1138 vs 1331 ft, p < 0.0001) and reduced quality of life (St. George's Respiratory Questionnaire score 43 vs 31, p < 0.0001). Self-reported diabetes was more frequent in non-emphysematous COPD (OR 2.13, p < 0.001), which was also confirmed using a strict definition of diabetes based on medication use. The association between diabetes and non-emphysematous COPD was replicated in the ECLIPSE study. CONCLUSIONS Non-emphysematous COPD, defined by airflow obstruction with a paucity of emphysema on chest CT scan, is associated with an increased risk of diabetes. COPD patients without emphysema may warrant closer monitoring for diabetes, hypertension, and hyperlipidemia and vice versa. TRIAL REGISTRATION Clinicaltrials.gov identifiers: COPDGene NCT00608764, ECLIPSE NCT00292552.


title: Comparison of proteins in whole blood and dried blood spot samples by LC/MS/MS.

text: Dried blood spot (DBS) sampling methods are desirable for population-wide biomarker screening programs because of their ease of collection, transportation, and storage. Immunoassays are traditionally used to quantify endogenous proteins in these samples but require a separate assay for each protein. Recently, targeted mass spectrometry (MS) has been proposed for generating highly-multiplexed assays for biomarker proteins in DBS samples. In this work, we report the first comparison of proteins in whole blood and DBS samples using an untargeted MS approach. The average number of proteins identified in undepleted whole blood and DBS samples by liquid chromatography (LC)/MS/MS was 223 and 253, respectively. Protein identification repeatability was between 77%-92% within replicates and the majority of these repeated proteins (70%) were observed in both sample formats. Proteins exclusively identified in the liquid or dried fluid spot format were unbiased based on their molecular weight, isoelectric point, aliphatic index, and grand average hydrophobicity. In addition, we extended this comparison to include proteins in matching plasma and serum samples with their dried fluid spot equivalents, dried plasma spot (DPS), and dried serum spot (DSS). This work begins to define the accessibility of endogenous proteins in dried fluid spot samples for analysis by MS and is useful in evaluating the scope of this new approach.


title: Metabolic responses to drought stress in the tissues of drought-tolerant and drought-sensitive wheat genotype seedlings.

text: An in-depth understanding of the effects of drought stress on plant metabolism is necessary to improve the drought tolerance of wheat and to utilize genetic resources for the development of drought stress-tolerant wheat varieties. In this study, the profiles of 58 key metabolites produced by wheat seedlings in response to drought stress were investigated to determine various physiological processes related to drought tolerance between drought-tolerant and drought-sensitive wheat genotypes. Results showed that the wheat metabolome was dominated by sugars, organic acids and amino acids; the wheat metabolome played important roles to enhance the drought tolerance of shoots. Under drought stress, JD17 exhibited higher growth indices and higher photosynthesis ability than JD8. A high level of compatible solutes and energy in shoots were essential for wheat to develop drought tolerance. Drought also caused system alterations in widespread metabolic networks involving transamination, tricarboxylic acid cycle, glycolysis, glutamate-mediated proline biosynthesis, shikimate-mediated secondary metabolisms and γ-aminobutyric acid metabolisms. Long-term drought stress resulted in the drought-tolerant wheat genotype JD17, which induced metabolic shifts in the tricarboxylic acid cycle and glycolysis with the depletion of the γ-aminobutyric acid shut process. In JD17, the prolonged drought stress induced a progressive accumulation of osmolytes, including proline, sucrose, fructose, mannose and malic acid. This research extended our understanding of the mechanisms involved in wheat seedling drought tolerance; this study also demonstrated that gas chromatography-mass spectrometry metabolomics could be an effective approach to understand the drought effects on plant biochemistry.


Macrolide resistance-associated 23S rRNA mutation in Mycoplasma genitalium, Japan.


title: Public-Private-People Partnerships (4P) for Improving the Response to COVID-19 in Iran.

text: Public-Private-People Partnership is a significant element in disaster response. COVID-19 as a pandemic has been the worst disaster in the last decades in Iran in terms of exposure and magnitude. In order to respond effectively, the Iranian government needs an extra capacity which may be provided by the private sector and people. This study aims to collect evidences of Public-Private-People partnerships pertaining to COVID-19 response in Iran from February to April 2020. Partnership case studies are classified into three categories as follows: 1) Public-private partnerships; 2) public-people partnerships; and 3) private-people partnerships. It was found that the Iranian government has removed or diminished some of the barriers to cooperation. There was also more cooperation between the people, the private sector, and the public sector than during normal times (vs disasters). People participated in the response procedure through some associations or groups, such as religious and ethnic communities, as well as through non-governmental organizations. It is showed that 4P is vital in disasters response and in particular to epidemics. The government can be more active in partnerships with private sector, and people in emergencies such as COVID-19 Pandemic. Enhancing social capital, institutionalization, and developing required infrastructures by the government will improve public-private partnerships.


title: Exploring the virome of diseased horses.

text: Metagenomics was used to characterize viral genomes in clinical specimens of horses with various organ-specific diseases of unknown aetiology. A novel parvovirus as well as a previously described hepacivirus closely related to human hepatitis C virus and equid herpesvirus 2 were identified in the cerebrospinal fluid of horses with neurological signs. Four co-infecting picobirnaviruses, including an unusual genome with fused RNA segments, and a divergent anellovirus were found in the plasma of two febrile horses. A novel cyclovirus genome was characterized from the nasal secretion of another febrile animal. Lastly, a small circular DNA genome with a Rep gene, from a virus we called kirkovirus, was identified in the liver and spleen of a horse with fatal idiopathic hepatopathy. This study expands the number of viruses found in horses, and characterizes their genomes to assist future epidemiological studies of their transmission and potential association with various equine diseases.


title: Low rates of recanalization for wide-necked aneurysms treated with stenting after balloon-assisted coiling: combination of techniques delivers stable and improved results during follow-up.

text: PURPOSE In the treatment of wide-necked aneurysms, stenting may be required after balloon-assisted coiling (BAC) for reconstructing the lumen/flow of the parent artery in cases of coil herniation. The potential benefits and complications of both techniques remain unclear when used together. Our aim was to assess the safety and long-term angiographic outcomes of stenting after BAC. METHODS Retrospective review of 87 unruptured wide necked aneurysms (in 80 patients) treated with BAC and requiring stent placement at the final stage of the procedure due to coil prolapse. Aneurysm characteristics, technical issues, clinical records, and MR results were assessed. Post-treatment and follow-up angiograms were evaluated by two independent reviewers and categorized as "stable," "further thrombosis," or "recanalization." RESULTS The mean maximum diameter was 9.1 ± 4.7 mm and aspect ratio 1.20 ± 0.47. Complete and near-complete initial occlusion were observed in 53 (60.9%) and 28 (32.2%) of all treated aneurysms, respectively. Angiographic follow-up (80 aneurysms; mean, 34.68 ± 25.26 months) revealed stability and further thrombosis in 92.4% (74/80). Recanalization was observed in six cases (7.5%, 6/83), four of which were retreated. No significantly different outcomes were found in terms of aneurysm size (p = 0.641). Transient and reversible procedure-related complications occurred in eight (9.2%), minor permanent deficits in 2.3%, and major deficits, including death, in four cases (4.6%). CONCLUSION Our results suggest that treatment of wide-necked aneuryms with stent placement after BAC yields low recanalization rates and enhanced angiographic outcomes in long-term follow-up.


COVID-19 Nonessential Surgery Restrictions and Spine Surgery: A German Experience.


title: Hunting Viral Receptors Using Haploid Cells.

text: Viruses have evolved intricate mechanisms to gain entry into the host cell. Identification of host proteins that serve as viral receptors has enabled insights into virus particle internalization, host and tissue tropism, and viral pathogenesis. In this review we discuss the most commonly employed methods for virus receptor discovery, specifically highlighting the use of forward genetic screens in human haploid cells. The ability to generate true knockout alleles at high saturation provides a sensitive means to study virus-host interactions. To illustrate the power of such haploid genetic screens, we highlight the discovery of the lysosomal proteins NPC1 and LAMP1 as intracellular receptors for Ebola virus and Lassa virus, respectively. From these studies emerges the notion that receptor usage by these viruses is highly dynamic, involving a programmed switch from cell surface receptor to intracellular receptor. Broad application of genetic knockout approaches will chart functional landscapes of receptors and endocytic pathways hijacked by viruses.


The colliding epidemics of COVID-19, Ebola, and measles in the Democratic Republic of the Congo.


title: Fatal human bocavirus infection in an 18-month-old child with chronic lung disease of prematurity.

text: A fatal case of human bocavirus 1 pulmonary infection in an 18-month-old prematurely born child is described. Despite conventional and oscillatory ventilatory support, intractable hyperinflation developed with bilateral pneumothorax and acute cardiac failure 3 days after the onset of respiratory symptoms.


Why baby alligators in some spots could be 98% female by century's end.


title: Endocardial Changes in Nonvalvular Atrial Fibrillation Without Atrial Thrombus-Thrombomodulin and Tissue Factor Pathway Inhibitor.

text: Atrial fibrillation (AF) is a well-known cause for thromboembolism. Although blood stasis in the left atrium and hypercoagulable state of the blood have been emphasized as important mechanisms, limited attention has been paid to the endocardial changes in maintaining the balance of local coagulation, which may also contribute to the thrombus formation in AF. In the present study, left atrial appendage samples were obtained at heart surgery from nonvalvular AF and non-AF patients without atrial thrombus. Immunohistochemistry for endocardial markers including thrombomodulin (TM) and tissue factor pathway inhibitor (TFPI) was performed and semiquantitatively graded. In immunohistochemistry analysis, decreased expression of TM was found in patients with nonvalvular AF compared with those without AF ( P < .001). There was no difference in TFPI expression between the 2 groups ( P = .213). Patients with TM score of 0 or 1 seemed to have larger left atrial diameter (LAD) than those with TM score of 2 or 3 (44.0 (7.9) vs 40.6 (3.9); P = .009), while no relationship between LAD and TFPI expression was found (43.4 (7.0) vs 42.9 (7.8); P = .485). In conclusion, TM expression in the atrial endocardium is decreased in nonvalvular AF without atrial thrombus, while TFPI expression is not. Downregulated TM expression might be associated with enlarged LAD.


title: Video-assisted extirpation of cranial mediastinal masses in dogs: 18 cases (2009-2014).

text: OBJECTIVE To characterize clinical findings, surgical procedures, complications, and outcomes in dogs undergoing extirpation of masses from the cranial mediastinum via video-assisted thoracic surgery (VATS) and establish preliminary guidelines for case selection when considering VATS for thymectomy in dogs. DESIGN Retrospective case series. ANIMALS 18 client-owned dogs that underwent extirpation of a cranial mediastinal mass by means of VATS at 5 academic referral hospitals from 2009 through 2014. PROCEDURES Medical records were reviewed and data extracted regarding signalment, clinical signs, physical examination findings, diagnostic imaging results, surgical approach and duration, cytologic and histologic examination results, complications, outcome, and cause of death, when applicable. RESULTS 16 dogs had a thymoma, 1 had thymic anaplastic carcinoma, and 1 had hemangiosarcoma. Seven had both megaesophagus and myasthenia gravis. Median approximate tumor volume was 113.1 cm3 (interquartile range, 33.5 to 313.3 cm3). Median duration of VATS was 117.5 minutes (interquartile range, 91.5 to 136.3 minutes). Conversion to an open thoracic surgical procedure was required for 2 dogs, 1 of which died during surgery. Median survival time following VATS for dogs with thymoma and concurrent myasthenia gravis and megaesophagus was 20 days. Dogs with thymoma without paraneoplastic syndrome survived for ≥ 60 days, and none of these dogs died of disease-related causes. CONCLUSIONS AND CLINICAL RELEVANCE VATS appeared to be an acceptable approach for extirpation of masses from the cranial mediastinum in dogs under certain conditions. Dogs with myasthenia gravis and megaesophagus had a poor postoperative outcome.


title: Low-dose high-pitch CT angiography of the supraaortic arteries using sinogram-affirmed iterative reconstruction.

text: OBJECTIVE To prospectively evaluate image quality and radiation dose using a low-dose computed tomography angiography protocol and iterative image reconstruction for high-pitch dual-source CT-angiography (DSCTA) of the supraaortic arteries. MATERIAL AND METHODS DSCTA was performed in 42 patients, using either 120 kVp tube voltage, 120 mAS tube current, 2.4 pitch and filtered back projection, or 100 kVp tube voltage, 100 mAs tube current, 3.2 pitch, and sinogram affirmed iterative reconstruction. Measurements of vessel attenuation, of the contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were performed to objectively evaluate image quality. Two readers evaluated subjective image quality and image noise, using a four-point scale. Effective dose was used to compare the differences in radiation dose. RESULTS Low-dose protocol application showed significantly higher vessel opacification (p = 0.013), and non-significantly higher CNR and SNR values. There was no difference in the subjective image quality and image noise reading between the protocols. Effective dose was significantly lower using the low-dose protocol (1.29 ± 0.21 mSv vs. 2.92 ± 0.72 mSv; p < 0.001). CONCLUSION The combined use of reduced tube voltage, reduced tube current, and iterative reconstruction reduces radiation dose by 55.4% in high-pitch DSCTA of the supraaortic arteries without impairment of image quality.


title: Communication of urgent public health messages to urban populations: lessons from the Massachusetts water main break.

text: OBJECTIVE To study when and how an urgent public health message about a boil-water order reached an urban population after the Massachusetts water main break. METHODS In-person surveys were conducted in waiting areas of clinics and emergency departments at a large urban safety net hospital within 1 week of the event. RESULTS Of 533 respondents, 97% were aware of the order; 34% of those who lived in affected cities or towns were potentially exposed to contaminated water. Among those who were aware, 98% took action. Respondents first received the message through word of mouth (33%), television (25%), cellular telephone calls (20%), landline calls (10%), and other modes of communication (12%). In multivariate analyses, foreign-born respondents and those who lived outside the city of Boston had a higher risk of exposure to contaminated water. New modes (eg, cellular telephones) were used more commonly by females and younger individuals (ages 18 to 34). Individuals who did not speak English at home were more likely to receive the message through their personal networks. CONCLUSIONS Given the increasing prevalence of cellular telephone use, public officials should encourage residents to register landline and cellular telephone for emergency alerts and must develop creative ways to reach immigrants and non-English-speaking groups quickly via personal networks.


title: Bioabsorbable hernia plugs in laparoscopic inguinal herniorraphy: short-term and long-term results.

text: PURPOSE To report our short-term and long-term experience with laparoscopic inguinal hernia repair (LIHR) using a bioabsorbable plug. METHODS Patients who underwent LIHR from 2009 to 2011 using a bioabsorbable plug and synthetic mesh patch were reviewed retrospectively. Short-term follow-up information was obtained within 30 days of surgery, whereas long-term follow-up was obtained in 2014. Quality of life was assessed using the Carolinas Comfort Scale. RESULTS Forty-four patients (43 male), including 6 (13.6%) with recurrent disease, underwent 52 LIHR with a bioabsorbable plug. Mean age and body mass index were 60.9 ± 10.5 years and 27.9 ± 4.7 kg/m, respectively. Among 39 (88.6%) patients available for short-term follow-up, early postoperative complications were seen in 10 (25.6%) patients, all of which resolved spontaneously. Mean long-term follow-up duration was 41.6 ± 4.1 months, among 30 (68.2%) patients (40 hernia repairs). There were 2 (5%) hernia recurrences, with 1 requiring a reoperation 12 months after initial repair. Only 2 (6.7%) patients reported moderate or bothersome chronic pain. CONCLUSIONS Bioabsorbable plug combined with a synthetic mesh is safe and effective for use during LIHR. The technique offers an acceptable incidence of chronic pain and recurrence.


What the growing rift between the US and WHO means for COVID-19 and global health.


Research on reducing burnout in health care workers in critical situations such as COVID-19 outbreak.


title: Placement of Absorbable Dermal Staples in Mammaplasty and Abdominoplasty: A 12-Month Prospective Study of 60 Patients.

text: BACKGROUND The duration to close an incision is an important consideration in plastic surgery. The placement of Insorb absorbable subcuticular staples (Insorb, Incisive Surgical, Plymouth, MN) may allow for a decreased closure time compared with other modalities. OBJECTIVES The authors evaluated the utility of Insorb staples for the closure of mammaplasty and abdominoplasty incisions. METHODS Sixty patients who underwent anterior abdominal dermatolipectomy, total circular abdominal dermatolipectomy, bilateral breast reduction, or bilateral mastopexy were evaluated in a prospective study. Dermal closure was achieved on 1 side of each patient with Insorb absorbable staples and on the other with absorbable monofilament sutures. Scar quality, pruritus, and pain were scored according to a modified Vancouver Scar Scale (mVSS) at 1, 6, and 12 months postoperatively. RESULTS Closure with absorbable staples was approximately 7-fold faster than closure with absorbable sutures for all surgical procedures. No significant differences in mVSS scores were noted between incisions closed with staples vs sutures. CONCLUSIONS Absorbable staples enable faster closure of a surgical incision without compromising scar quality or patient comfort. LEVEL OF EVIDENCE 3 Therapeutic.


title: Roles of endotracheal tubes and slip joints in respiratory pressure loss: a laboratory study.

text: PURPOSE The endotracheal tube (ETT) constitutes a significant component of total airway resistance. However, a discrepancy between measured and theoretical values has been reported in airway resistance through ETTs. The causes of the discrepancy were estimated by physical and rheological simulations. METHODS The pressure losses through total lengths of ETTs and slip joints under a volumetric flow rate of 30 L/min were measured, and the pressure losses through the tubular parts of ETTs with internal diameters (IDs) of 6.0-, 6.5-, 7.0-, 7.5-, and 8.0 mm were measured. The Reynolds number of each setting was calculated, and the pressure losses through the total length of the ETT, the tubular part, and the slip joint of each size of tube were estimated. RESULTS The Reynolds numbers were >5000 in all sizes of ETTs. Measured pressure losses were larger in small sized ETTs than in large sized ETTs-520.9 Pascals (Pa) in 6.0-mm ID and 136.4 Pa in 8.0-mm ID tubes. The measured pressure losses through the tubular part were comparable to the predicted values. The measured pressure losses through the slip joints were larger than the predicted values, and they accounted for approximately 25-40% of total pressure losses of the ETTs. CONCLUSION Especially in small sized tubes, the pressure loss through the slip joint accounts for a large percentage of the total pressure loss through the ETT. The pressure loss through the slip joint may play a role in the discrepancy between measured and theoretical pressure losses through ETTs.


title: GTP-dependent membrane fusion.

text: Shape changes and topological remodeling of membranes are essential for the identity of organelles and membrane trafficking. Although all cellular membranes have common features, membranes of different organelles create unique environments that support specialized biological functions. The endoplasmic reticulum (ER) is a prime example of this specialization, as its lipid bilayer forms an interconnected system of cisternae, vesicles, and tubules, providing a highly compartmentalized structure for a multitude of biochemical processes. A variety of peripheral and integral membrane proteins that facilitate membrane curvature generation, fission, and/or fusion have been identified over the past two decades. Among these, the dynamin-related proteins (DRPs) have emerged as key players. Here, we review recent advances in our functional and molecular understanding of fusion DRPs, exemplified by atlastin, an ER-resident DRP that controls ER structure, function, and signaling.


Authors' response.


title: A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients.

text: Cosmesis is a vital concern for patients undergoing plastic and reconstructive surgery. Many variations in wound closure are employed when attempting to minimize a surgical scar's appearance. Barbed sutures are one potential method of achieving improved wound cosmesis and are more common in recent years. To determine if barbed sutures differ from nonbarbed in wound cosmesis, we conducted a single-blinded, randomized, controlled trial of 18 patients undergoing bilateral reduction mammoplasty or panniculectomy. Patients were their own controls, receiving barbed sutures on one side and standard sutures on the contralateral side. Surgical scars were evaluated postoperatively by patient preference self-assessment and an observer. Ten patients were evaluated at 3 months postoperatively, yielding a mean Stony Brook Scar Evaluation Scale (SBSES) rating of 4.4 for barbed suture and 3.5 for regular suture (p = 0.15). At 6 months, 8 patients performed self-assessment to determine their preference; 4 preferred the barbed sutures, 1 preferred the regular sutures, and 3 had no preference. Further research with larger sample sizes is needed to determine if barbed sutures convey any advantage over standard sutures in wound healing. However, our results suggest that barbed sutures are a reasonable alternative to standard sutures particularly with regard to wound cosmesis.


title: Pancreaticogastrostomy in pure laparoscopic pancreaticoduodenectomy--A novel pancreatic-gastric anastomosis technique.

text: BACKGROUND Although many surgical procedures are now routinely performed laparoscopically, pure laparoscopic pancreaticoduodenectomy (LPD) is not commonly performed because of the technical difficulty of pancreatic resection and the associated reconstruction procedures. Several pancreatic-enteric anastomosis techniques for LPD have been reported, but most are adaptations of open procedures. To accomplish pure LPD, we consider it necessary to establish new pancreatic-enteric anastomosis techniques that are specifically developed for LPD and are safe and feasible to perform. RESULTS One patient developed a postoperative pancreatic fistula (International Study Group of Pancreatic Fistula criteria, grade B) and subsequent postoperative delayed gastric emptying (International Study Group of Pancreatic Surgery criteria, grade C). No other major complications occurred. We developed a novel pancreatic-gastric anastomosis technique that enabled us to safely perform pure LPD. The main pancreatic duct was stented with a 4-Fr polyvinyl catheter during pancreatic resection. A small hole was created in the posterior wall of the stomach and was bluntly dilated. A 5-cm incision was made in the anterior stomach, and the pancreatic drainage tube was passed into the stomach through the hole in the posterior wall. The remnant pancreas was pulled into the stomach, and was easily positioned and secured in place with only four to six sutures between the pancreatic capsule and the gastric mucosa. We used this technique to perform pure LPD in five patients between December 2012 and July 2013. CONCLUSIONS Our new technique is technically easy and provides secure fixation between the gastric wall and the pancreas. This technique does not require main pancreatic duct dilatation, and the risk of intra-abdominal abscess formation due to postoperative pancreatic fistula may be minimized. Although this technique requires further investigation as it may increase the risk of delayed gastric emptying, it may be a useful method of performing pancreaticogastrostomy in pure LPD. TRIAL REGISTRATION ISRCTN16761283 . Registered 16 January 2015.


title: Arterial pressure above the upper cerebral autoregulation limit during cardiopulmonary bypass is associated with postoperative delirium.

text: BACKGROUND Mean arterial pressure (MAP) below the lower limit of cerebral autoregulation during cardiopulmonary bypass (CPB) is associated with complications after cardiac surgery. However, simply raising empiric MAP targets during CPB might result in MAP above the upper limit of autoregulation (ULA), causing cerebral hyperperfusion in some patients and predisposing them to cerebral dysfunction after surgery. We hypothesized that MAP above an ULA during CPB is associated with postoperative delirium. METHODS Autoregulation during CPB was monitored continuously in 491 patients with the cerebral oximetry index (COx) in this prospective observational study. COx represents Pearson's correlation coefficient between low-frequency changes in regional cerebral oxygen saturation (measured with near-infrared spectroscopy) and MAP. Delirium was defined throughout the postoperative hospitalization based on clinical detection with prospectively defined methods. RESULTS Delirium was observed in 45 (9.2%) patients. Mechanical ventilation for >48 h [odds ratio (OR), 3.94; 95% confidence interval (CI), 1.72-9.03], preoperative antidepressant use (OR, 3.0; 95% CI, 1.29-6.96), prior stroke (OR, 2.79; 95% CI, 1.12-6.96), congestive heart failure (OR, 2.68; 95% CI, 1.28-5.62), the product of the magnitude and duration of MAP above an ULA (mm Hg h; OR, 1.09; 95% CI, 1.03-1.15), and age (per year of age; OR, 1.01; 95% CI, 1.01-1.07) were independently associated with postoperative delirium. CONCLUSIONS Excursions of MAP above the upper limit of cerebral autoregulation during CPB are associated with risk for delirium. Optimizing MAP during CPB to remain within the cerebral autoregulation range might reduce risk of delirium. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT00769691 and NCT00981474.


title: Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital.

text: OBJECTIVE To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate. DESIGN Retrospective cohort study. SETTING A 472-bed acute-care teaching hospital in Toronto, Canada. PATIENTS Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization. METHODS Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7-10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA. RESULTS Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7-10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7-10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4, 171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1, 12]) were associated with MRSA acquisition. CONCLUSIONS Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.


title: Clinical implications and economic effects of the corona virus pandemic on gynaecology, obstetrics and reproductive medicine in Germany-learning from Italy.

text: The infection with the novel SARS Cov-2 corona virus, the cause of severe acute respiratory distress syndrome, possessing its origin in the Chinese province Hubei, has reached the extent of a global pandemic within a few months. After aerosol infection, most people experience mild respiratory infection with cold symptoms such as cough and fever, and healing within two weeks. In about 5% of those infected, however, a severe course develops with the occurrence of multiple sub pleural bronchopulmonary infiltrates and even death as a result of respiratory failure. The corona virus pandemic has multiple impacts on social life that have not been seen before. For example, the government adopted measures to curb the exponential spread of the virus, which included a significant reduction in social contacts. Furthermore, the specialist societies recommended that no elective treatments be carried out during the pandemic period. This review article considers epidemiological aspects of novel corona virus infection and presents both the clinical as well the possible economic effects of the pandemic on gynaecology, obstetrics and reproductive medicine in Germany in the past, present and future. In addition, useful preventive measures for daily clinical work and the previously known scientific findings dealing with the impact of corona virus on pregnancy and birth are discussed.


title: A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery.

text: Chronic pain following surgery, persistent postsurgical pain, is an important highly prevalent condition contributing to significant symptom burden and lower quality of life. Persistent postsurgical pain is relatively refractory to treatment hence generating a high need for preventive strategies and treatments. Therefore, the identification of patients at risk of developing persistent pain is an area of active ongoing research. Recently it was demonstrated that peri-operative disruptions in central pain processing may be able to predict persistent postsurgical pain at long term follow-up in breast cancer patients. The aim of the current report is to present a short protocol to obtain pain thresholds to different stimuli at multiple sites and a measure of endogenous analgesia in breast cancer patients. We have used this method successfully in a clinical context and detail some representative results from a clinical study.


title: Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization.

text: BACKGROUND AND PURPOSE The clinical benefit of endovascular stroke therapy has been demonstrated in several prospective randomized trials. However, in a relevant percentage of patients, mechanical thrombectomy bears the risk of causing new infarction in initially unaffected vascular territories through thrombus fragmentation and migration of clot debris. The goal of this study was to evaluate the use of the balloon guide catheter (BGC) to effectively achieve flow arrest and thrombus aspiration during the intervention to avoid distal embolization. METHODS A retrospective study was performed in 139 patients between October 2010 and May 2016 to analyze occlusions in the middle cerebral artery (MCA) or internal carotid artery (ICA) by using a stent retriever with a BGC (n = 73) or a non-BGC (n = 66). The following data were collected: patient age and gender, along with history of diabetes mellitus, hypertension, atrial fibrillation, smoking, obesity, dyslipidemia, and previous ischemic stroke. Data on procedure time, number of passes, and angiographic findings were also collected. The final reperfusion score was rated based on the Thrombolysis in Cerebral Infarction (TICI) grading scale. Successful recanalization was defined as TICI 3 or 2b. RESULTS A total of 139 patients underwent mechanical thrombectomy with the stent retriever. Of the 139 patients, 73 (52.5%) underwent placement of a BGC. The mean age was 65.8 ± 13.5 years, and the median National Institutes of Health Stroke Scale (NIHSS) score was 11. The average initial NIHSS score was lower in the BGC group compared with the non-BGC group (mean, 11.2 ± 5.6 vs. 13.2 ± 5.6; P = 0.03). Patients with BGC had fewer incidences of previous ischemic stroke (12.3% vs. 28.8%; P = 0.01). The numbers of passes were similar between the two groups. The procedure time (99 ± 49.4 min vs. 124 ± 72.2 min; P = 0.02) and the time from onset of symptoms to procedure end (302 ± 102 min vs. 357.2 ± 136.1 min; P = 0.009) were shorter in the BGC group. TICI 3 or 2b recanalization scores were higher in the BGC group compared to the non-BGC group [63/73, 86.3% vs. 48/66, 72.7%; odds ratio (OR), 0.6; 95% confidence interval (CI), 0.2-1.4; P = 0.04]. Importantly, distal embolization was less frequent in the BGC group (5/73, 6.8% vs. 21/66, 31.8%; OR, 6.3; 95% CI, 2.2-18.0; P < 0.001). CONCLUSIONS The risk of distal embolization was significantly decreased with the use of a BGC.


title: Intra-Arterial Therapy and Post-Treatment Infarct Volumes: Insights From the ESCAPE Randomized Controlled Trial.

text: BACKGROUND AND PURPOSE The goal of reperfusion therapy in acute ischemic stroke is to limit brain infarction. The objective of this study was to investigate whether the beneficial effect of endovascular treatment on functional outcome could be explained by a reduction in post-treatment infarct volume. METHODS The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial was a multicenter randomized open-label trial with blinded outcome evaluation. Among 315 enrolled subjects (endovascular treatment n=165; control n=150), 314 subject's infarct volumes at 24 to 48 hours on magnetic resonance imaging (n=254) or computed tomography (n=60) were measured. Post-treatment infarct volumes were compared by treatment assignment and recanalization/reperfusion status. Appropriate statistical models were used to assess relationship between baseline clinical and imaging variables, post-treatment infarct volume, and functional status at 90 days (modified Rankin Scale). RESULTS Median post-treatment infarct volume in all subjects was 21 mL (interquartile range =65 mL), in the intervention arm, 15.5 mL (interquartile range =41.5 mL), and in the control arm, 33.5 mL (interquartile range =84 mL; P<0.01). Baseline National Institute of Health Stroke Scale (P<0.01), site of occlusion (P<0.01), baseline noncontrast computed tomographic scan Alberta Stroke Program Early CT score (ASPECTS) (P<0.01), and recanalization (P<0.01) were independently associated with post-treatment infarct volume, whereas age, sex, treatment type, intravenous alteplase, and time from onset to randomization were not (P>0.05). Post-treatment infarct volume (P<0.01) and delta National Institute of Health Stroke Scale (P<0.01) were independently associated with 90-day modified Rankin Scale, whereas laterality (left versus right) was not. CONCLUSIONS These results support the primary results of the ESCAPE trial and show that the biological underpinning of the success of endovascular therapy is a reduction in infarct volume. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.


title: Endoscopic submucosal dissection with a novel traction method using a steerable grasper: a feasibility study in a porcine model.

text: INTRODUCTION Endoscopic submucosal dissection (ESD) is a technically challenging procedure in which complications and operative times depend on the operator's expertise as well as on the location and size of the lesion. Good visualization of the submucosal dissection plane is essential to perform a safe and effective ESD. OBJECTIVES To evaluate the feasibility, efficacy, and safety of a novel traction method using an over-the-scope steerable grasper to improve the exposure of the dissection plane during gastric ESD. RESULTS A total of 24 ESDs were performed without any complications in various locations of porcine stomachs, including antrum, gastric body, and cardia. En bloc complete resections were achieved in all cases. The mean specimen size was 44.92 ± 8.30 mm, mean total procedure time was 29.17 ± 11.27 minutes, and mean dissection time was 15.08 ± 7.21 minutes. The optimal dissection plane could be obtained by controlling the grasper in all cases. CONCLUSIONS Technical feasibility, efficacy, and safety of the over-the-scope steerable grasper technique were demonstrated in order to provide dynamic and controlled traction during ESD at different locations of porcine stomachs.


title: SARS-CoV-2 RNA identification in nasopharyngeal swabs: issues in pre-analytics.

text: Objectives The direct identification of SARS-CoV-2 RNA in nasopharyngeal swabs is recommended for diagnosing the novel COVID-19 disease. Pre-analytical determinants, such as sampling procedures, time and temperature storage conditions, might impact on the end result. Our aim was to evaluate the effects of sampling procedures, time and temperature of the primary nasopharyngeal swabs storage on real-time reverse-transcription polymerase chain reaction (rRT-PCR) results. Methods Each nasopharyngeal swab obtained from 10 hospitalized patients for COVID-19 was subdivided in 15 aliquots: five were kept at room temperature; five were refrigerated (+4 °C); five were immediately mixed with the extraction buffer and refrigerated at +4 °C. Every day and for 5 days, one aliquot per condition was analyzed (rRT-PCR) for SARS-CoV-2 gene E and RNaseP and threshold cycles (Ct) compared. To evaluate manual sampling, 70 nasopharyngeal swabs were sampled twice by two different operators and analyzed separately one from the other. Results A total of 6/10 swabs were SARS-CoV-2 positive. No significant time or storage-dependent variations were observed in SARS-CoV-2 Ct. Re-sampling of swabs with SARS-CoV-2 Ct lower than 33 resulted in highly reproducible results (CV=2.9%), while a high variability was observed when Ct values were higher than 33 (CV=10.3%). Conclusions This study demonstrates that time and temperature of nasopharyngeal swabs storage do not significantly impact on results reproducibility. However, swabs sampling is a critical step, and especially in case of low viral load, might be a potential source of diagnostic errors.


title: Flexible and capsule endoscopy for screening, diagnosis and treatment.

text: Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.


title: The effect of hunger on the acoustic individuality in begging calls of a colonially breeding weaver bird.

text: BACKGROUND In colonially breeding birds, the ability to discriminate between individuals is often essential. During post-fledging care, parents have to recognize their own offspring among many other unrelated chicks in the breeding colony. It is well known that fledglings and food-provisioning parents of many bird species use contact calls to convey their identity. These calls are also often used as hunger-related signals of need in young birds. Here, we investigate how such calls incorporate signals of need and at the same time act as reliable indicators of each chick's identity. RESULTS In a field study, we experimentally manipulated the hunger level of colonially breeding Jackson's golden-backed weaver (Ploceus jacksoni) nestlings close to fledging and investigated its effects on acoustic call parameters. Some acoustic parameters that were related to the time-frequency pattern showed high individuality and were largely unaffected by a nestling's state of hunger. However, the majority of call parameters were significantly affected by hunger. Interestingly, most of these acoustic parameters showed both consistent changes with hunger and high between-individual differences, i.e. potential for individual recognition. CONCLUSION The results indicate that individual recognition processes can be based on static, hunger-independent call parameters, but also on dynamic hunger-related parameters that show high individuality. Furthermore, these signal properties suggest that the assessment of signals of need can be improved if the signal value is referenced to a chick's vocal spectrum.


title: N-glycosylation of infectious bronchitis virus M41 spike determines receptor specificity.

text: Infection of chicken coronavirus infectious bronchitis virus (IBV) is initiated by binding of the viral heavily N-glycosylated attachment protein spike to the alpha-2,3-linked sialic acid receptor Neu5Ac. Previously, we have shown that N-glycosylation of recombinantly expressed receptor binding domain (RBD) of the spike of IBV-M41 is of critical importance for binding to chicken trachea tissue. Here we investigated the role of N-glycosylation of the RBD on receptor specificity and virus replication in the context of the virus particle. Using our reverse genetics system we were able to generate recombinant IBVs for nine-out-of-ten individual N-glycosylation mutants. In vitro growth kinetics of these viruses were comparable to the virus containing the wild-type M41-S1. Furthermore, Neu5Ac binding by the recombinant viruses containing single N-glycosylation site knock-out mutations matched the Neu5Ac binding observed with the recombinant RBDs. Five N-glycosylation mutants lost the ability to bind Neu5Ac and gained binding to a different, yet unknown, sialylated glycan receptor on host cells. These results demonstrate that N-glycosylation of IBV is a determinant for receptor specificity.


COVID-19 and civil war in Libya: the current situation.


To set coronavirus policy, model lives and livelihoods in lockstep.


title: Patient Perceptions of Head and Neck Ambulatory Telemedicine Visits: A Qualitative Study.

text: OBJECTIVE During the COVID-19 pandemic, there has been unprecedented use of telemedicine for otolaryngology ambulatory visits. Patient satisfaction with telemedicine is an important metric, but survey-based questionnaires do not capture the nuances of the patient experience. This study aims to understand head and neck patients' perceptions about telemedicine clinic visits during COVID-19. METHODS Fifty-six established patients who had video-based telemedicine visits with an otolaryngology-head and neck surgery faculty member between March 25, 2020, and April 24, 2020, completed unstructured telephone interviews. Conventional content analysis was used to analyze the interview data. Retrospective chart reviews were conducted to determine the patients' demographic, disease, and treatment information. RESULTS The primary benefits of telemedicine were accessibility and cost and time savings. Primary limitations included the ability to perform a physical examination. Most patients expressed a willingness to participate in future remote visits if appropriate or necessitated by social circumstances. DISCUSSION Telemedicine is a disruptive process, and long-term adoption requires understanding patient perception of and satisfaction with telemedicine. Head and neck cancer patients were generally satisfied with telemedicine. The study elucidated patient perceived benefits and limitations of telemedicine. IMPLICATIONS FOR PRACTICE Continued implementation of telemedicine in otolaryngology-head and neck ambulatory clinics will require consideration of contextual features surrounding the virtual delivery of care, with particular attention to visit appropriateness for telemedicine and social circumstances.


title: COVID-2019 associated overexpressed Prevotella proteins mediated host-pathogen interactions and their role in coronavirus outbreak.

text: MOTIVATION The outbreak of COVID-2019 initiated at Wuhan, China has become a global threat by rapid transmission and severe fatalities. Recent studies have uncovered whole genome sequence of SARS-CoV-2 (causing COVID-2019). In addition, lung metagenomic studies on infected patients revealed overrepresented Prevotella spp. producing certain proteins in abundance. We performed host-pathogen protein-protein interaction analysis between SARS-CoV-2 and overrepresented Prevotella proteins with human proteome. We also performed functional overrepresentation analysis of interacting proteins to understand their role in COVID-2019 severity. RESULTS It was found that over-expressed Prevotella proteins can promote viral infection. As per the results, Prevotella proteins, but not viral proteins are involved in multiple interactions with NF-kB, which is involved in increasing clinical severity of COVID-2019. Prevotella may have role in COVID-2019 outbreak and should be given importance for understanding disease mechanisms and improving treatment outcomes. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.


title: Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques.

text: The shedding of severe acute respiratory syndrome coronavirus (SARS-CoV) into saliva droplets plays a critical role in viral transmission. The source of high viral loads in saliva, however, remains elusive. Here we investigate the early target cells of infection in the entire array of respiratory tissues in Chinese macaques after intranasal inoculations with a single-cycle pseudotyped virus and a pathogenic SARS-CoV. We found that angiotensin-converting enzyme 2-positive (ACE2(+)) cells were widely distributed in the upper respiratory tract, and ACE2(+) epithelial cells lining salivary gland ducts were the early target cells productively infected. Our findings also have implications for SARS-CoV early diagnosis and prevention.


title: Objective evidence for optimum knot configuration.

text: BACKGROUND The knot configurations used in clinical practice often are based on tradition and previous training. This study was designed to test the hypothesis that knot quality improves with the addition of a single throw in two-throw and three-throw knots. We tested this hypothesis by using commonly used knot configurations and suture materials. METHODS Three suture materials, SURGIPRO, BIOSYN and POLYSORB, of 3-0 caliber were used. The break force and integrated force of each material, a single-hitch throw on each material, and 2160 knots of six configurations were measured by using tensiometry. The knot quality scores (KQS) of the different knot configurations were compared by using nonparametric tests. RESULTS A single-hitch throw on the suture material reduced the break force by up to 40%. The addition of an extra throw improved KQS in 2 x 1 x 1, 2 x 2, and 2 x 2 x 1 knots. The four-throw knot configurations resulted in high KQS and low slippage rates. The 2 x 2 knots were most likely to slip and had the lowest KQS. CONCLUSIONS If a double-hitch throw is used in the first throw, two to three further throws are recommended. The four-throw knot configurations have the best knot qualities and should generally be used.


title: Prevalence of Venous Thrombosis Following Venovenous Extracorporeal Membrane Oxygenation in Patients With Severe Respiratory Failure.

text: OBJECTIVES Venovenous extracorporeal membrane oxygenation for patients with severe respiratory failure is increasingly common. There has been a significant change in the population, technology, and approach used for venovenous extracorporeal membrane oxygenation over the last 10 years. The objective of this study is to describe the prevalence of postdecannulation deep vein thrombosis in the cannulated vessel in adults who have received venovenous extracorporeal membrane oxygenation for severe respiratory failure. DESIGN A single-center, retrospective, observational cohort, electronic note review study. SETTING Tertiary referral university teaching hospital. PATIENTS Patients commenced on venovenous extracorporeal membrane oxygenation for severe respiratory failure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified 103 patients commenced on extracorporeal membrane oxygenation with 81 survivors from December 2011 to February 2014. We performed postdecannulation venous Doppler ultrasound in 88.9% of extracorporeal membrane oxygenation survivors. The prevalence of deep vein thrombosis in the cannulated vessel following extracorporeal membrane oxygenation is 8.1/1,000 cannula days in patients who were screened. CONCLUSIONS The prevalence of deep vein thrombosis following decannulation from extracorporeal membrane oxygenation for severe respiratory failure is clinically significant, and routine venous Doppler ultrasound following decannulation is warranted in this population.


title: Detection and characterization of Mycoplasma pneumoniae during an outbreak of respiratory illness at a university.

text: An outbreak at a university in Georgia was identified after 83 cases of probable pneumonia were reported among students. Respiratory specimens were obtained from 21 students for the outbreak investigation. The TaqMan array card (TAC), a quantitative PCR (qPCR)-based multipathogen detection technology, was used to initially identify Mycoplasma pneumoniae as the causative agent in this outbreak. TAC demonstrated 100% diagnostic specificity and sensitivity compared to those of the multiplex qPCR assay for this agent. All M. pneumoniae specimens (n=12) and isolates (n=10) were found through genetic analysis to be susceptible to macrolide antibiotics. The strain diversity of M. pneumoniae associated with this outbreak setting was identified using a variety of molecular typing procedures, resulting in two P1 genotypes (types 1 [60%] and 2 [40%]) and seven different multilocus variable-number tandem-repeat analysis (MLVA) profiles. Continued molecular typing of this organism, particularly during outbreaks, may enhance the current understanding of the epidemiology of M. pneumoniae and may ultimately lead to a more effective public health response.


title: Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea.

text: As a part of measures to decrease spikes in coronavirus disease (COVID-19) cases and deaths outside of hospitals, the government of South Korea introduced a plan for community treatment centers (CTCs) to isolate and monitor patients with mild COVID-19 symptoms. We assessed outcomes of 568 patients admitted to 3 CTCs near Daegu. More (64.6%) women than men (35.4%) were admitted, and the mean age of patients was 36.0 years (SD +15.0 years). Among all patients, 75.7% remained asymptomatic while at the CTCs. The mean time patients remained at CTCs was 19.6 days (SD +5.8 days) from the day of diagnosis until our study ended on March 23, 2020. Because they offer appropriate clinical triaging and daily monitoring for patients, CTCs are a safe alternative to medical institutions for asymptomatic or mildly symptomatic patients with COVID-19.


Dexmetomidine, fentanyl and esmolol on prevention of the hemodynamic effects of laryngoscopy and endotracheal intubation. a prospective, randomized, double-blind study.


title: [Bidirectional knotless barbed sutures during primary total knee arthroplasty: effective solution or new problem?]

text: THE HYPOTHESIS OF THE STUDY The use of bidirectional knotless barbed sutures for closure of capsule and subcutaneous fat tissue in primary total knee arthroplasty (TKA) is safe and time-saving. MATERIAL AND METHODS 302 patients with end-stage osteoarthritis scheduled for primary non-complex TKA were randomly divided into two prospective groups: in group I (N=102) the capsule of the knee joint and subcutaneous fat tissues were closed by continuous braided suture while in group II (N=200) by bidirectional knotless barbed sutures. The skin in both groups was closed by non-absorbable monofilament polycaproamide uninterrupted suture. RESULTS The time of the surgery was significantly shorter in group II (65,25±11,9 min) than in group I (72,5±14,7 min) (p<0.05). The volume of hidden blood loss was similar in both groups. The number of patients with superficial infection during the first two week after surgery did not differ significantly (1,9% (I) and 1% (II)): they all healed successfully after skin debridement and additional closure. There were no cases of deep periprosthetic infection (PPI). At 3-month follow-up no difference found regarding pain level and knee function (Knee Society Score). CONCLUSION The use of bidirectional knotless barbed sutures in TKA reduces the time of surgery, does not affect the volume of hidden blood loss or PPI occurrence.


Preparing for the next pandemic.


title: Specific small interfering RNAs-mediated inhibition of replication of porcine encephalomyocarditis virus in BHK-21 cells.

text: Encephalomyocarditis virus (EMCV) is recognized as a pathogen inducing acute myocarditis and sudden death in preweaned piglets and severe reproductive failure in sows. In this study, eight specific small interfering RNA (siRNA) duplexes targeting different genomic regions of EMCV BJC3 were designed and their ability to inhibit virus replication in BHK-21 cells was investigated. The results showed that BHK-21 cells transfected with siRNA duplexes to 2C gene (JH-4,666, BJC-1,739), 2B gene (BJC-807), 3C gene (BJC-2,363) and 3D gene (BJC-3269) were specifically resistant to EMCV infection when exposed to 500 times the 50% cell culture infective dose (CCID(50)) of EMCV. The levels of the 3D gene in the transfected cells were obviously decreased. IFA and Western blotting analysis confirmed that the expression of VP1 protein in cell culture transfected with the siRNAs was apparently reduced. Of the five siRNAs, JH-4,666, BJC-2,363 and BJC-3,269 were the most effective. Combination of the siRNA duplexes enhanced the inhibition of EMCV replication. Our data indicated that specific siRNAs are able to inhibit the replication of porcine encephalomyocarditis virus in BHK-21 cells, suggesting that RNAi might provide a new approach to prevent EMCV infection.


title: A case of single-incision laparoscopic surgery for a bleeding Meckel's diverticulum diagnosed pre-operatively by double-balloon endoscopy.

text: INTRODUCTION Meckel's diverticulum (MD) is a congenital true diverticulum that is residual yolk duct tissue, and some cases with complications require surgery. It has been reported that laparoscopic surgery is effective for patients with an MD. PRESENTATION OF CASE A 79-year-old man with melena visited our hospital. Upper gastrointestinal series and colonoscopy showed no bleeding lesion. Double-balloon endoscopy was then performed to examine the small intestine. The examination showed a large diverticulum 80cm proximal to the ileocecal valve and a circular ulcer. MD resection was performed using single-incision laparoscopic surgery (SILS) technique through a 3-cm zig-zag incision in the umbilicus. Three ports were inserted for the scope and forceps devices. The MD was located 80cm proximal to the ileocecal valve. There were no other intestinal lesions. From the wound, the lesion could be easily moved outside the body. The MD including the ulcer lesion was then resected. The patient's postoperative course was good, and he rarely felt wound pain. He started dietary intake three days after surgery and was discharged from hospital eight days after surgery. DISCUSSION SILS technique has attracted attention in the field of laparoscopic surgery. Using a single port with multiple working channels, SILS can reduce the number of incisions and the rates of incisional hernia port site-related complications, as well as improve cosmesis. CONCLUSION A definite diagnosis of an MD was made by double-balloon endoscopy preoperatively. The SILS approach was effective for cosmesis, postoperative pain, and a shortened hospital stay.


title: Functional luminal imaging probe geometric and histomorphologic analysis of abdominal wall wound induced by different trocars in pigs.

text: BACKGROUND This study aimed to investigate wound geometry and tissue damage caused by several different trocar types using a quantitative functional luminal imaging probe (FLIP) geometric profile and histomorphologic analysis. METHODS Four pigs were used in this study. After general anesthesia, six different trocars were randomly inserted at preselected locations in the porcine abdominal wall. The hydration status of the animals was monitored and maintained. A bag mounted on a FLIP was used to profile the geometry of the trocar holes during distension. After the FLIP study, the abdominal wall surrounding the trocar holes was harvested. The tissue was fixed in neutral 10% buffered formalin solution for more than 24 h. The samples contained control tissue (undamaged) and test tissue (damaged) through the entire rectangular tissue block. Approximately four to seven slides were cut parallel to the surface from each sample. Each slide was photographed, and the morphometry of the hole and damaged areas were measured and displayed three-dimensionally. The histologic sections were analyzed with regard to acute damage, bleeding, and acute inflammation of the skin, muscle, and fascia. RESULTS The FLIP study demonstrated differences between the six trocars. These were mainly due to differences between the Versaport Plus V2 bladed trocar with the smooth cannula, the Applied Medical Separator nonbladed access system with threaded cannula, and the VersaStep Plus trocar. The morphometry data showed the smallest hole and damage areas for the Versaport Plus V2 bladed trocar with the smooth cannula. The damaged area divided by the trocar hole area was smallest for the VersaStep plus trocar and the Ethicon Endopath bladed trocar with a stability cannula (p < 0.05). The histologic analysis showed that the VersaStep Plus trocar and the Ethicon Endopath bladed trocar with a stability cannula gave the least bleeding and inflammation (p < 0.05). CONCLUSION An agreement was found between the geometric data obtained by FLIP, the morphometric analysis, and the histology.


title: Can We Use the Disposable Laparoscopic Clip Appliers as Suture Anchors? An In Vitro Feasibility Study.

text: INTRODUCTION Intracorporeal suturing is time-consuming and could be difficult in certain operative circumstances. Instead of knot tying, specially designed clips have been introduced to anchor and secure the end of a single strand or suture. Although these clips provide a maximal required holding grip (HG), they considerably increase the cost of the procedure. The aim of this in vitro study was to identify the feasibility, and means of achieving the best HG, of commonly used disposable automatic clip appliers (LCAs) over regular strands. METHODS We placed 2-0 PDS (rigid) and 2-0 Vicryl (soft) sutures through fresh gastric wall specimens. Six different commercial-type LCAs, all having large or medium/large clips, were applied at the distal end of each suture. An IMDA manual digital force gauge was used to measure the HG of each clip at 2 positions: the middle clip position and the angle (at the crouch) position. A total of 192 measurements were taken. The results were classified into 3 HG levels measured by Newton units (N): the strongest grip (> 1 N), medium grip (> 0.5 and < 1 N), and weak grip (< 0.5 N). RESULTS The strongest HG was obtained by applying 10 to 12 mm LCAs with large or medium/large clips over PDS at an angle position (HG = 1.1 ± 0.2 to 1.6 ± 0.3 N). The weakest grip was obtained by applying any type of LCA over Vicryl at the middle position (HG = 0.08 ± 0.04 to 0.2 ± 0.06 N, P < 0.001). The latter was associated with clips freely falling off the sutures even before applying any force. In general, more force was needed to dislodge any brand clip from the PDS compared with Vicryl suture (0.8 ± 0.6 vs. 0.4 ± 0.3 N, P < 0.001). The angle position was always stronger than the middle position (0.9 ± 0.6 vs. 0.3 ± 0.2 N, P < 0.001). There was a trend for the 10 to 12 mm LCA to have a better HG than the 5 mm ones (0.65 ± 0.5 vs. 0.51 ± 0.5 N, P = 0.08). CONCLUSIONS We propose that 10 to 12 mm LCAs generate enough HG to secure a single strand when clips are placed at the angle position. This is especially true over PDS (hard) strands. The application of 5 mm LCA clips to secure the end of the Vicryl strand is not recommended. Further clinical studies are warranted.


Permanently ban wildlife consumption.


title: Multiplex detection of six swine viruses on an integrated centrifugal disk using loop-mediated isothermal amplification.

text: Advances in molecular testing and microfluidic technologies have opened new avenues for rapid detection of animal viruses. We used a centrifugal microfluidic disk (CMFD) to detect 6 important swine viruses, including foot-and-mouth disease virus, classical swine fever virus, porcine reproductive and respiratory swine virus-North American genotype, porcine circovirus 2, pseudorabies virus, and porcine parvovirus. Through integrating the loop-mediated isothermal amplification (LAMP) method and microfluidic chip technology, the CMFD could be successfully performed at 62℃ in 60 min. The detection limit of the CMFD was 3.2 × 102 copies per reaction, close to the sensitivity of tube-type LAMP turbidity methods (1 × 102 copies per reaction). In addition, the CMFD was highly specific in detecting the targeted viruses with no cross-reaction with other viruses, including porcine epidemic diarrhea virus, transmissible gastroenteritis virus, and porcine rotavirus. The coincidence rate of CMFD and conventional PCR was ~94%; the CMFD was more sensitive than conventional PCR for detecting mixed viral infections. The positive detection rate of 6 viruses in clinical samples by CMFD was 44.0% (102 of 232), whereas PCR was 40.1% (93 of 232). Thirty-six clinical samples were determined to be coinfected with 2 or more viruses. CMFD can be used for rapid, sensitive, and accurate detection of 6 swine viruses, offering a reliable assay for monitoring these pathogens, especially for detecting viruses in widespread mixed-infection clinical samples.


title: Use of direct near-infrared fluorescent lymphography for thoracoscopic thoracic duct identification in 15 dogs with chylothorax.

text: OBJECTIVE To describe and assess techniques of intraoperative near-infrared fluorescence lymphography (NIRFL) using indocyanine green (ICG) for lymphatic duct identification during thoracoscopic thoracic duct (TD) ligation in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 15) with naturally occurring chylothorax that underwent TD ligation. METHODS Medical records of dogs treated with thoracoscopic TD ligation in which NIRFL was utilized for intraoperative TD identification were reviewed. Data retrieved included CT lymphography (CTL) and surgical data, fluorophore dose and injection site, and timing and quality of operative TD identification. RESULTS Preoperative CTL was successful in 13/15 dogs and operative NIRFL was successful in 15/15 dogs. Popliteal lymph node injection achieved successful NIRFL within ≤10 minutes in 7/11 in which it was attempted. TDs identified by NIRFL imaging correlated with TDs identified by preoperative CTL in 12/13 cases in which CTL was achieved. In 1/13 cases, NIRFL identified small lymphatics not visible on CTL. In 5/9 cases in which methylene blue (MB) and ICG were combined for operative lymphography, no ducts or fewer ducts were recorded as identifiable by visible MB than by NIRFL or CTL. The median dose of ICG to achieve NIRFL imaging was 0.05 mg/kg. Thoracoscopic TD ligation was successfully achieved in all patients. CONCLUSION NIRFL is a viable technique to aid in TD identification during thoracoscopy. High contrast NIRF illumination of the TD can be achieved with successful intraparenchymal injection of ICG into the popliteal lymph node.


title: Aorto-Esophageal Fistula After Thoracic Endovascular Aortic Repair: Successful Open Treatment.

text: We present the case of a 56-year-old patient suffering from an aorto-esophageal fistula after complex treatment of acute Type A dissection including thoracic endovascular aortic repair (TEVAR) of the descending aorta. Open surgical descending replacement using a pericardial patch, as well as esophagectomy, was performed. After a long and complicated hospital stay, the patient finally recovered and was discharged in stable condition. By choosing an aggressive surgical approach the patient survived this devastating complication of TEVAR, which is associated with high mortality.


title: A two-cohort feasibility study on polyglycolic acid yarn implantation for abolition of saphenous vein reflux.

text: OBJECTIVE The objective of this study was to evaluate the feasibility and safety of a polyglycolic acid (PGA) yarn implant for nonthermal ablation of saphenous vein reflux. METHODS In two consecutive cohort studies (TAHOE I and TAHOE II), the feasibility of abolition of great saphenous vein (GSV) reflux by implantation of a PGA yarn was tested under ultrasound guidance in 51 and 30 patients, respectively. The use of tumescent local anesthesia was not required. Graduated compression stockings and thrombosis prophylaxis with low-molecular-weight heparin were used for 2 weeks after intervention in the first study only. RESULTS Of 81 enrolled patients, 77 (95%) were available at 6-month follow-up. Complete occlusion of the treated GSV was confirmed by duplex ultrasound in all patients except one patient at day 1. In TAHOE II, closure was preserved in a higher percentage of patients at 6 weeks, with 96.4% vs 82.0% in TAHOE I. The 6-month Kaplan-Meier estimated occlusion rates for TAHOE I and TAHOE II were 68% (95% confidence interval [CI], 54%-79%) and 69% (95% CI, 49%-82%), respectively, with an estimated combined occlusion rate of 69% (95% CI, 57%-76%). Kaplan-Meier analysis yielded a combined reflux-free rate of 85% (95% CI, 75%-91%) at 3 months of follow-up and a rate of 81% (95% CI, 71%-88%) at 6 months of follow-up. Venous Clinical Severity Score (VCSS) improved from a combined mean of 4.6 ± 3.1 at baseline to 2.1 ± 2.2 and 1.6 ± 1.9 at 3 and 6 months, respectively (P < .0001 for 3- and 6-month results). In TAHOE II, four patients with venous ulcers healed at an average of 1.3 months after treatment. CONCLUSIONS First-in-human use of an endovenous PGA yarn implant for occlusion of refluxing GSVs proved to be feasible, with no serious adverse events. However, recanalization was observed during a period of 6 months in 31% of patients.


title: Particle Engineering for Enabling a Formulation Platform Suitable for Manufacturing Low-Dose Tablets by Direct Compression.

text: Maintaining good content uniformity (CU) is a significant challenge for low-dose oral tablets in particular when using direct compression (DC). Using 6 model active pharmaceutical ingredients, we show that a platform DC tablet formulation suitable for developing low-dose API with excellent CU can be developed. This platform formulation is enabled by particle engineering, where an API of interest is loaded in a suitable porous carrier to form a uniform API-carrier composite. Powder properties of such composite particles are dictated by the properties of the carrier, which are insensitive to chemical structure and loading level of the API. Powder flowability, tabletability, tablet friability, and tablet disintegration time are all excellent and only vary within a narrow range among the 6 model APIs. Nearly 100% drug can be released in water from tablets composed of the 6 model APIs. Thus, the approach described here holds the promise for broad application in developing low-dose tablet products using DC possessing excellent CU and other critical quality attributes.


title: Reimplantation of an extruded osteoarticular segment of the distal tibia in a 14-year-old girl. Case report and review of the literature.

text: This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambulate for several hours at a time without an assistive device, although arthritis of the ankle joint is present. She scores 43.8 on the physical component of the 36-Item Short Form Health Survey and 49.0 on the mental component. The patient states that she is very pleased with her outcome. This seems to be the first description of an osteoarticular segment reimplantation of a long bone in the orthopaedic literature.


title: Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections.

text: BACKGROUND Natural orifice specimen extraction (NOSE) in colorectal surgery prevents the need for an enlarged port site or minilaparotomy to extract the surgical specimen. The downside of this technique may be an increased risk of bacterial contamination of the peritoneal cavity from the external milieu. The aim of this study was to prospectively analyze the peritoneal bacterial contamination in NOSE and non-NOSE laparoscopic colorectal procedures. METHODS Consecutive patients operated for sigmoid diverticulitis with laparoscopic approach and transanal extraction of the specimen from January to December 2010 at our university hospital were enrolled. Patients who underwent a laparoscopic sigmoidectomy in the same study period with conventional specimen extraction were used as reference. Peritoneal fluid samples were collected under sterile conditions at the end of the procedure and sent for gram stain as well as anaerobic, aerobic, and fungal cultures. RESULTS Twenty-nine patients underwent laparoscopic sigmoidectomy for diverticulitis with transanal NOSE, while 9 patients underwent laparoscopic sigmoidectomy with conventional specimen extraction during the same period. The two groups were successfully matched 1:2 (17 NOSE and 9 non-NOSE) according age, sex, ASA, and Charlson comorbidity score. The contamination rate of peritoneal fluid was 100% vs. 88.9% in NOSE and non-NOSE procedures, respectively (P = 0.23). Overall and major complications rates were 27.6% vs. 11.10% (P = 0.41) and 5.08% vs. 11.1% (P = 1) in NOSE vs. non-NOSE procedures, respectively. In the NOSE group there was a statistically significant lower consumption of oral paracetamol (P = 0.007) and of oral tramadol (P = 0.02). CONCLUSIONS Although a higher peritoneal contamination was found in the NOSE procedures, there were no significant differences in clinical outcomes relative to standard approach. Avoiding a minilaparotomy to extract the specimen resulted in a significantly lower postoperative analgesic requirement in the NOSE group.


title: Ethical challenges related to assistive product access for older adults and adults living with a disability: a scoping review protocol.

text: BACKGROUND Despite the surge of research and development in assistive products for older adults and/or people living with disabilities, policies on access and procurement have lagged in responding to the growing demand from users. Developing policies to address these concerns require an understanding of the ethical challenges underlying approaches for providing assistive products. The purpose of this scoping review is to identify and map the literature pertaining to ethical challenges related to assistive product access and procurement to inform policy development. METHODS/DESIGN We will use established approaches to conducting scoping reviews which include five stages: (1) conducting broad searches to identify potentially relevant literature, (2) refining selection criteria, (3) reviewing search results, (4) mapping literature according to conceptual areas of interest, and (5) summarizing results. We will analyze data by thematically grouping the descriptions of assistive products identified in the included articles and conducting a content analysis to iteratively develop a targeted synthesis of literature focused on ethical challenges in relation to assistive product access and procurement by older adults and/or adults living with disabilities. DISCUSSION Our scoping review findings will focus on and provide insight about the models, frameworks, and principles that have been used to understand ethical challenges related to technology access and procurement. We will use the findings to help inform a series of citizen panels in Canada to identify Canadians' values and preferences for enhancing equitable access to assistive products.


title: Fusion following lateral mass reconstruction in the cervical spine.

text: OBJECT Recently, aggressive surgical techniques and a push toward en bloc resections of certain tumors have resulted in a need for creative spinal column reconstruction. Iatrogenic instability following these resections requires a thoughtful approach to adequately transfer load-bearing forces from the skull and upper cervical spine to the subaxial spine. METHODS The authors present a series of 7 cases in which lateral mass reconstruction with a cage or fibular strut graft was used to provide load-bearing support, including 1 case of bilateral cage placement. RESULTS The authors discuss the surgical nuances of en bloc resection of high cervical tumors and explain their technique for lateral mass cage placement. Additionally, they provide their rationale for the use of these constructs throughout the craniocervical junction and subaxial spine. CONCLUSIONS Lateral mass reconstruction provides a potential alternative or adjuvant method of restoring the load-bearing capabilities of the cervical spine.


title: Multiplex real-time PCR and high-resolution melting analysis for detection of white spot syndrome virus, yellow-head virus, and Penaeus monodon densovirus in penaeid shrimp.

text: A multiplex real-time PCR and high-resolution melting (HRM) analysis was developed to detect simultaneously three of the major viruses of penaeid shrimp including white spot syndrome virus (WSSV), yellow-head virus (YHV), and Penaeus monodon densovirus (PmDNV). Plasmids containing DNA/cDNA fragments of WSSV and YHV, and genomic DNAs of PmDNV and normal shrimp were used to test sensitivity of the procedure. Without the need of any probe, the products were identified by HRM analysis after real-time PCR amplification using three sets of viral specific primers. The results showed DNA melting curves that were specific for individual virus. No positive result was detected with nucleic acids from shrimp, Penaeus monodon nucleopolyhedrovirus (PemoNPV), Penaeus stylirostris densovirus (PstDNV), or Taura syndrome virus (TSV). The detection limit for PmDNV, YHV and WSSV DNAs were 40fg, 50fg, and 500fg, respectively, which was 10 times more sensitive than multiplex real-time PCR analyzed by agarose gel electrophoresis. In viral nucleic acid mixtures, HRM analysis clearly identified each virus in dual and triple infection. To test the capability to use this method in field, forty-one of field samples were examined by HRM analysis in comparison with agarose gel electrophoresis. For HRM analysis, 11 (26.83%), 9 (21.95%), and 4 (9.76%) were infected with WSSV, PmDNV, and YHV, respectively. Agarose gel electrophoresis detected lesser number of PmDNV infection which may due to the limit of sensitivity. No multiple infection was found in these samples. This method provides a rapid, sensitive, specific, and simultaneous detection of three major viruses making it as a useful tool for diagnosis and epidemiological studies of these viruses in shrimp and carriers.


title: Research co-design in health: a rapid overview of reviews.

text: BACKGROUND Billions of dollars are lost annually in health research that fails to create meaningful benefits for patients. Engaging in research co-design - the meaningful involvement of end-users in research - may help address this research waste. This rapid overview of reviews addressed three related questions, namely (1) what approaches to research co-design exist in health settings? (2) What activities do these research co-design approaches involve? (3) What do we know about the effectiveness of existing research co-design approaches? The review focused on the study planning phase of research, defined as the point up to which the research question and study design are finalised. METHODS Reviews of research co-design were systematically identified using a rapid overview of reviews approach (PROSPERO: CRD42019123034). The search strategy encompassed three academic databases, three grey literature databases, and a hand-search of the journal Research Involvement and Engagement. Two reviewers independently conducted the screening and data extraction and resolved disagreements through discussion. Disputes were resolved through discussion with a senior author (PB). One reviewer performed quality assessment. The results were narratively synthesised. RESULTS A total of 26 records (reporting on 23 reviews) met the inclusion criteria. Reviews varied widely in their application of 'research co-design' and their application contexts, scope and theoretical foci. The research co-design approaches identified involved interactions with end-users outside of study planning, such as recruitment and dissemination. Activities involved in research co-design included focus groups, interviews and surveys. The effectiveness of research co-design has rarely been evaluated empirically or experimentally; however, qualitative exploration has described the positive and negative outcomes associated with co-design. The research provided many recommendations for conducting research co-design, including training participating end-users in research skills, having regular communication between researchers and end-users, setting clear end-user expectations, and assigning set roles to all parties involved in co-design. CONCLUSIONS Research co-design appears to be widely used but seldom described or evaluated in detail. Though it has rarely been tested empirically or experimentally, existing research suggests that it can benefit researchers, practitioners, research processes and research outcomes. Realising the potential of research co-design may require the development of clearer and more consistent terminology, better reporting of the activities involved and better evaluation.


title: Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience.

text: BACKGROUND Intravenous thrombolysis is the only therapy for acute ischemic stroke that is approved by the US Food and Drug Association. The use of telemedicine in stroke makes it possible to bring the expertise of academic stroke centers to underserved areas, potentially increasing the quality of stroke care. METHODS All consecutive admissions for stroke were reviewed for 1 year before telemedicine implementation and for variable periods thereafter. A retrospective review identified 2588 admissions for acute stroke between March 2005 and December 2008 at 12 hospitals participating in a telestroke network, including 919 patients before telemedicine was available and 1669 patients after telemedicine was available. The primary outcome measure was the rate of intravenous tissue plasminogen activator (IV tPA) use before and after telemedicine implementation. RESULTS One hundred thirty-nine patients received IV tPA in both study phases, with 26 (2.8%) patients treated before starting telemedicine and 113 (6.8%) after starting telemedicine (P < .001). Incorrect treatment decisions occurred 7 times (0.39%), with 2 (0.2%) pretelemedicine and 5 (0.3%) posttelemedicine (P = .70). Arrivals within 3 hours from symptom onset were more frequent in the posttelemedicine compared to the pretelemedicine phases (55 [6%] vs 159 [9.5%]; P = .002). Among the patients treated with IV tPA, symptomatic intracranial hemorrhage occurred in 2 patients (1 [10.7%] pretelemedicine vs 1 [1.8%] posttelemedicine; P = .34). CONCLUSIONS Telestroke implementation was associated with an increased rate of thrombolytic use in remote hospitals within the telemedicine network.


title: Tumor-secreted SDF-1 promotes glioma invasiveness and TAM tropism toward hypoxia in a murine astrocytoma model.

text: A distinguishing feature of high-grade gliomas is the infiltration of neoplastic cells into adjacent brain tissues that mark most of these tumors surgically incurable. To study the factors associated with tumor invasion, we established a new murine brain tumor model, ALTS1C1 derived from SV40 large T antigen-transfected astrocytes. This new brain tumor model recapitulates several histopathological features of human high-grade glioma including increased cellularity, prominent cellular pleomorphism, geographic necrosis, active mitosis, and extensive invasion of tumor cells into adjacent brain tissues. More importantly, ALTS1C1 expressed a relatively high level of stromal-derived factor-1 (SDF-1/CXCL12) in vitro and in vivo and higher microvascular density (MVD) in vivo. To define the roles of SDF-1 in this tumor model, the expression of SDF-1 in ALTS1C1 cells was inhibited by specific siRNA. SDF-knockdown ALTS1C1 (SDF(kd)) cells took longer than parental ALTS1C1 cells to form tumors and in contrast to the wild-type tumors they had well-defined regular borders and lacked infiltration tracts. The SDF(kd) tumors were also associated with a lower MVD and more hypoxic areas. In contrast to parental tumors, the density of F4/80-positive tumor-associated macrophages (TAMs) in SDF(kd) tumor was higher in non-hypoxic than in hypoxic regions. SDF-1 production by tumor cells therefore seems critical for the aggregation of TAMs into areas of hypoxia and tumor invasiveness. This study not only provides new insight into the role of SDF-1 in brain tumor invasion and the relationship between TAMs and hypoxia, but also provides a new preclinical brain tumor model for designing new treatment options for invasive cases.


title: Performance of Abbott ID NOW COVID-19 rapid nucleic acid amplification test in nasopharyngeal swabs transported in viral media and dry nasal swabs, in a New York City academic institution.

text: The recent emergence of the SARS-CoV-2 pandemic has posed formidable challenges for clinical laboratories seeking reliable laboratory diagnostic confirmation. The swift advance of the crisis in the United States has led to Emergency Use Authorization (EUA) facilitating the availability of molecular diagnostic assays without the more rigorous examination to which tests are normally subjected prior to FDA approval. Our laboratory currently uses two real time RT-PCR platforms, the Roche Cobas SARS-CoV2 and the Cepheid Xpert Xpress SARS-CoV-2. Both platforms demonstrate comparable performance; however, the run times for each assay are 3.5 hours and 45 minutes, respectively. In search for a platform with shorter turnaround time, we sought to evaluate the recently released Abbott ID NOW COVID-19 assay which is capable of producing positive results in as little as 5 minutes. We present here the results of comparisons between Abbott ID NOW COVID-19 and Cepheid Xpert Xpress SARS-CoV-2 using nasopharyngeal swabs transported in viral transport media and comparisons between Abbott ID NOW COVID-19 and Cepheid Xpert Xpress SARS-CoV-2 using nasopharyngeal swabs transported in viral transport media for Cepheid and dry nasal swabs for Abbott ID NOW. Regardless of method of collection and sample type, Abbott ID NOW COVID-19 had negative results in a third of the samples that tested positive by Cepheid Xpert Xpress when using nasopharyngeal swabs in viral transport media and 45% when using dry nasal swabs.


Coronavirus Pandemic Calls for an Immediate Social Work Response.