title: Additional cusp reconstruction does not compromise valve durability and mid-term survival after the David procedure: results from 449 patients.

text: OBJECTIVES The aim of this study was to evaluate whether additional cusp interventions and valve types affect aortic valve-related reoperation and mortality rates after the David procedure. METHODS Between 1997 and 2018, a total of 449 patients {372 males; mean age 54.2 [standard deviation (SD) 15.2] years, range: 12.7-79.9 years} underwent elective valve-sparing aortic root replacement (David procedure) for aortic regurgitation and were prospectively followed up clinically and echocardiographically. RESULTS The follow-up was 94% complete. Cumulative follow-up time was 2268 patient-years [mean follow-up time 5.1 (4.3 SD) years]. Thirty-day mortality was 2.2% (n = 10). Late (>30 days) survival did not differ from that of the age- and gender-matched general population. Freedom from reoperation in patients without additional cusp reconstruction was 94% [95% confidence interval (CI) 91-98] and 92% (95% CI 88-97) at 5 and 10 years, respectively, which was not significantly different (P = 1) for patients who did require additional cusp reconstruction 98% (95% CI 95-100) and 89% (95% CI 81-99). In patients with tricuspid aortic valves (n = 338), freedom from reoperation was 96% (95% CI 94-99) and 93% (95% CI 88-97) at 5 and 10 years, respectively. Patients with bicuspid aortic valves (n = 111) had a freedom from reoperation of 94% (95% CI 89-99) at 5 years and 88% (95% CI 79-98) at 10 years (P = 0.021 for the comparison to tricuspid aortic valve). Overall, 23 patients (5%; 1%/patient-year) required reoperation with a mean interval of 4.5 (4.8 SD) months. CONCLUSIONS The David procedure revealed low mid-term reoperation risk and excellent survival independent of adjunctive cusp interventions/valve morphology and is comparable with that of the age- and gender-matched general population.


Guest Editorial: Ethics and equity in the time of Coronavirus.


title: Reverse-Surge Planning During the COVID-19 Pandemic: A Cautionary Ramp-up for the Otolaryngologist.

text: As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This "reverse-surge" planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams.


title: Diagnostic value of Light's criteria and albumin gradient in classifying the pathophysiology of pleural effusion formation in cats.

text: The primary aim of this study was to assess whether human Light's criteria with the cut-off values previously published for cats are useful and superior to the traditional veterinary classification in diagnosing pathophysiology of fluid formation in cats with pleural effusion. The secondary aim was to assess if the albumin gradient (ALBg) is a reliable criterion for differentiating exudates from transudates in patients with pleural effusion thought to be transudative by clinical criteria but identified as exudative by Light's criteria. Nineteen client-owned cats with pleural effusion were studied. The aetiology of the pleural effusion was used to establish the pathophysiology of its formation. Parameters measured or calculated undergoing statistical analysis included Light's criteria, total protein and total nucleated cell count in the pleural effusions, and the ALBg. Based on the pathophysiology of fluid formation there were seven transudates caused by increased hydrostatic pressure and 12 exudates. There was a significant difference in the accuracy of the Light's criteria in correctly classifying origin of the pleural fluid formation compared with the traditional veterinary classification (84% vs 53%). ALBg values were significantly different between transudates and exudates. One of the three transudates misclassified as exudates by Light's criteria was correctly identified as a transudate by the ALBg. In conclusion, pleural effusion should be classified as either a transudate or an exudate using Light's criteria. In cats with pleural effusion thought to be transudative by clinical criteria, but identified as exudative by Light's criteria, the ALBg may further help in correctly differentiating exudates from transudates.


title: Clinical predictors of operative complexity in laparoscopic ventral hernia repair: a prospective study.

text: BACKGROUND Because of uncertainties about the complexity of laparoscopic ventral hernia repair for varying patient populations, surgeons may be reluctant to perform this procedure. This study aimed to delineate the risk factors that can be identified in the preoperative setting predictive of longer operative times and complexity in laparoscopic ventral hernia repair. METHODS Patient demographics including body mass index (BMI), comorbidities, previous laparoscopic and open surgical procedures, ventral hernia repairs, and hernia characteristics (defect size and location, adhesions, incarceration) were recorded prospectively. Data are given as mean +/- standard deviation. Times (min) required for abdominal access, adhesiolysis, and mesh placement as well as the total operative time were recorded during each case as outcome measures of operative difficulty. Univariate analyses were performed with the t-test or the Mann-Whitney U test as well as multivariate analyses using the stepwise analysis of covariance model to determine demographic and clinical variables influencing operative times. RESULT The study enrolled 180 patients (78 men and 102 women) with a mean age of 54.8 +/- 12.2 years and a mean BMI of 33.3 +/- 13.0 kg/m(2). Multivariate analysis demonstrated significantly longer (p < 0.05) adhesiolysis and total operative times for patients with prior ventral hernia repairs, suprapubic hernia, bowel adhesion to the abdominal wall or hernia sac, and larger hernia defect. The total operative time also was increased (p < 0.05) with incarcerated hernia contents. Mesh placement time was increased (p < 0.05) with incarcerated hernia contents, suprapubic hernia location, hernias requiring larger mesh for repair, and decreased postgraduate year of the surgical assistant. The time required to obtain abdominal access was longer (p < 0.05) with a greater BMI and a higher American Society of Anesthesiology (ASA) classification. The operative times were not increased with a history of peritonitis, diabetes, immunosuppression, cancer, or with higher numbers of previous open or laparoscopic surgeries. CONCLUSIONS At least 10 preoperatively identifiable patient variables, either alone or in combination, are predictive of prolonged operative times during laparoscopic ventral hernia repair and may be used as surrogates to determine the complexity of a minimally invasive approach.


title: Laparoendoscopic Single-Site (LESS) Surgery in Pediatric Urology: A 4-Year Experience.

text: Objective The aim of the study was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single-site (LESS) surgery. Materials and Methods We retrospectively collected charts of all patients who underwent LESS procedures in our department from January 2013 to December 2016. Data included demographic characteristics, type of procedures, intraoperative details, hospital stay, and complications. The umbilicus was used as the surgical site in all cases. All procedures were performed with a homemade glove port and standard straight 3- or 5-mm laparoscopic instruments. Results Seventy-three patients (55 males, 18 females) were identifed. Procedures included 46 orchidop-exies, 21 pyeloplasties, 8 varicocelectomies, 3 nephrecto-mies, 3 nephroureterectomies, 3 orchiectomies, and 1 renal hydatid cyst treatment. Median operative time for the entire cohort was 47 min (range 26-156 min). There was no signifcant intraoperative blood loss. No conversion to conventional laparoscopy or open surgery was needed. All patients required paracetamol postoperatively. The mean follow-up was 18 months. Two patients had testicular atrophy after a Fowler-Stephens procedure and 1 patient had testicular reascension. Cosmetic results were excellent. Forty-five (62.5%) patients were discharged on the day of surgery. Conclusion Our study demonstrated that LESS surgery using our glove port technique and conventional laparoscopic instruments is a feasible and safe technique for the surgical management of various pediatric urological conditions.


title: Stapled versus hand-sewn anastomoses in emergency general surgery: a retrospective review of outcomes in a unique patient population.

text: BACKGROUND Recent studies have identified unique clinical and physiologic characteristics of emergency general surgery (EGS) patients and called for outcomes data in this population. There are no data in the US literature analyzing the impact of technique on anastomotic failure rates in EGS patients. The purpose of the current study was to compare outcomes of hand-sewn (HS) versus stapled (ST) bowel anastomoses in EGS patients. METHODS A retrospective chart review of all patients admitted by our EGS service undergoing bowel resection for emergent indications from January 2007 to July 2011 was performed. Time from surgery to diagnosis of anastomotic failure was recorded as were the diagnostic modality and treatment of each anastomotic failure. Specific data on damage-control techniques, if used, were also collected. RESULTS There were 100 HS (43%), and 133 ST (57%) anastomoses in 231 patients. Operative times were shorter in ST anastomosis technique (205 minutes for HS vs. 193 minutes for ST, p = 0.02). Anastomotic failures were identified in 26 patients (11%) and were significantly higher in the ST group than the HS group (15.0% vs. 6.1%, p = 0.003). A multivariate logistic regression analysis, controlling for age and preoperative nutritional status, revealed ST technique to be an independent risk factor for anastomotic failure (odds ratio, 2.65; 95% confidence interval, 1.08-6.50; p = 0.034). CONCLUSION Anastomotic failures are more than twice as likely with ST than HS anastomoses in the EGS population. This is true even when controlling for markers of preoperative nutrition and demographics. These data suggest that the HS anastomosis should be the preferred method of reconstruction after bowel resection in EGS patients.


title: Therapeutic Whole-Lung Lavage for Pulmonary Alveolar Proteinosis: A Procedural Update.

text: Pulmonary alveolar proteinosis is a disease caused by increased accumulation and impaired clearance of surfactant by alveolar macrophages. This narrative review summarizes the role of therapeutic whole-lung lavage in the management of pulmonary alveolar proteinosis. We describe the preprocedural evaluation, indications, and anesthetic considerations, along with step-by step technical aspects of the procedure, postoperative recovery, potential complications, and long-term outcomes.


title: Facts and myths: Efficacies of repurposing chloroquine and hydroxychloroquine for the treatment of COVID-19.

text: The emergence of coronavirus disease 2019 (COVID-19) is caused by the 2019 novel coronavirus (2019-nCoV). The 2019-nCoV first broke out in Wuhan and subsequently spreads worldwide owing to its extreme transmission efficiency. The fact that the COVID-19 cases and mortalities are reported in globally and the WHO has declared this outbreak as the pandemic. The international health authorities have focused on rapid diagnosis and isolation of patients as well as search for therapies able to counter the disease severity. Due to the lack of known specific, effective and proven therapies as well as the situation of public-health emergency, drug repurposing appears to be the best armour to find therapeutic solution against 2019-nCoV infection. Repurposing anti-malarial drugs, chloroquine (CQ)/ hydroxychloroquine (HCQ) have shown efficacy to inhibit most coronaviruses, including SARS-CoV-1 coronavirus. These CQ analogues have shown potential efficacy to inhibit 2019-nCoV in vitro that lead to focus in several future clinical trials. This review discusses the possible effective roles and mechanisms of CQ analogues for interfering with the 2019-nCoV replication cycle and infection.


title: Feasibility and safety of modified inverted T-shaped method using linear stapler with movable cartridge fork for esophagojejunostomy following laparoscopic total gastrectomy.

text: BACKGROUND We previously reported the use of an inverted T-shaped method to obtain a suitable view for hand sewing to close the common entry hole when the linear stapler was fired for esophagojejunostomy after laparoscopic total gastrectomy (LTG). This conventional method involved insertion of the fixed cartridge fork to the Roux limb and the fine movable anvil fork to the esophagus to avoid perforation of the jejunum. However, insertion of the movable anvil fork to the esophagus during this procedure often requires us to strongly push down the main body of the stapler with the fixed cartridge fork to bring the direction of the anvil fork in line with the direction of the long axis of the esophagus while controlling the opening of the movable anvil fork. We therefore modified this complicated inverted T-shaped method using a linear stapler with a movable cartridge fork. This modified method involved insertion of the movable cartridge fork into the Roux limb followed by natural, easy insertion of the fixed anvil fork into the esophagus without controlling the opening of the movable cartridge fork. METHODS We performed LTG in a total of 155 consecutive patients with gastric cancer from November 2007 to December 2015 in Kyushu University Hospital. After LTG, we performed the conventional inverted T-shaped method using a linear stapler with a fixed cartridge fork in 61 patients from November 2007 to July 2011 (fixed cartridge group). From August 2011, we used a linear stapler with a movable cartridge fork and performed the modified inverted T-shaped method in 94 patients (movable cartridge group). We herein compare the short-term outcomes in 94 cases of LTG using the modified method (movable cartridge fork) with those in 61 cases using the conventional method (fixed cartridge fork). RESULTS We found no significant differences in the perioperative or postoperative events between the movable and fixed cartridge groups. One case of anastomotic leakage occurred in the fixed cartridge group, but no anastomotic leakage occurred in the movable cartridge group. CONCLUSIONS Although there were no remarkable differences in the short-term outcomes between the movable and fixed cartridge groups, we believe that the modified inverted T-shaped method is technically more feasible and reliable than the conventional method and will contribute to the improved safety of LTG.


title: Can melatonin reduce the severity of COVID-19 pandemic?

text: The current COVID-19 pandemic is one of the most devastating events in recent history. The virus causes relatively minor damage to young, healthy populations, imposing life-threatening danger to the elderly and people with diseases of chronic inflammation. Therefore, if we could reduce the risk for vulnerable populations, it would make the COVID-19 pandemic more similar to other typical outbreaks. Children don't suffer from COVID-19 as much as their grandparents and have a much higher melatonin level. Bats are nocturnal animals possessing high levels of melatonin, which may contribute to their high anti-viral resistance. Viruses induce an explosion of inflammatory cytokines and reactive oxygen species, and melatonin is the best natural antioxidant that is lost with age. The programmed cell death coronaviruses cause, which can result in significant lung damage, is also inhibited by melatonin. Coronavirus causes inflammation in the lungs which requires inflammasome activity. Melatonin blocks these inflammasomes. General immunity is impaired by anxiety and sleep deprivation. Melatonin improves sleep habits, reduces anxiety and stimulates immunity. Fibrosis may be the most dangerous complication after COVID-19. Melatonin is known to prevent fibrosis. Mechanical ventilation may be necessary but yet imposes risks due to oxidative stress, which can be reduced by melatonin. Thus, by using the safe over-the-counter drug melatonin, we may be immediately able to prevent the development of severe disease symptoms in coronavirus patients, reduce the severity of their symptoms, and/or reduce the immuno-pathology of coronavirus infection on patients' health after the active phase of the infection is over.


Filovirus infections.


title: Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy.

text: BACKGROUND We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed. METHODS A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. RESULTS Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015). CONCLUSIONS The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.


title: Pentraxin-3 modulates lipopolysaccharide-induced inflammatory response and attenuates liver injury.

text: Acute-on-chronic liver injury is characterized by an important inflammatory response frequently associated with endotoxemia. In this context, acute-phase proteins such as Pentraxin-3 (PTX3) are released; however, little is known about their role in chronic liver disease. The aim of this study was to elucidate the role of PTX3 in liver injury. The role of PTX3 was evaluated in cultured human cells, liver tissue slices, and mice with acute-on-chronic liver injury. PTX3 expression was assessed in tissue and serum samples from 54 patients with alcoholic hepatitis. PTX3 expression was up-regulated in animal models of liver injury and strongly induced by lipopolysaccharide (LPS). Liver cell fractionation showed that macrophages and activated hepatic stellate cells were the main cell types expressing PTX3 in liver injury. Ex vivo and in vivo studies showed that PTX3 treatment attenuated LPS-induced liver injury, inflammation, and cell recruitment. Mechanistically, PTX3 mediated the hepatic stellate cell wound-healing response. Moreover, PTX3 modulated LPS-induced inflammation in human primary liver macrophages and peripheral monocytes by enhancing a TIR domain-containing adapter-inducing interferon-dependent response and favoring a macrophage interleukin-10-like phenotype. Additionally, hepatic and plasma PTX3 levels were increased in patients with alcoholic hepatitis, a prototypic acute-on-chronic condition; and its expression correlated with disease severity scores, endotoxemia, infections, and short-term mortality, thus suggesting that expression of PTX3 found in patients could be a counterregulatory response to injury. CONCLUSION Experimental and human evidence suggests that, in addition to being a potential biomarker for alcoholic hepatitis, PTX3 participates in the wound-healing response and attenuates LPS-induced liver injury and inflammation; therefore, administration of PTX3 could be a promising therapeutic strategy in acute-on-chronic conditions, particularly those associated with endotoxemia. (Hepatology 2017;66:953-968).


title: Long-term clinical outcomes of dual-cycle radiofrequency ablation technique for treatment of osteoid osteoma.

text: PURPOSE Radiofrequency ablation technique for treatment of OO including ablation time and temperature vary greatly between and within reported studies. This study evaluates the immediate and long-term efficacy and complication rate of a two sequential RFA technique for OO. MATERIALS AND METHODS We retrospectively reviewed medical records and attempted interview follow-up for 25 patients treated with RFA for OO. Each treatment included 2 consecutive RFAs at 90 °C for 6 min with inter-ablation cooling to 40 °C and occasional inter-ablation probe adjustment. Additionally, we statistically compared the proportion of successful ablations using the DCRFA technique with published studies that utilized alternative OO ablation procedures. RESULTS Long-term follow-up was obtained for 24 patients (96 %). Mean patient age at DCRFA was 17.2 years (range, 2.2-50.0 years). Mean time to follow-up was 60 ± 42 months (range 12-152 months). No acute DCRFA-related complications nor long-term recurrences were reported. All 24 interviewed patients reported partial relief of pre-procedural pain within 1 day of DCRFA and total relief within 1 week of DCRFA. One patient ultimately developed a major late complication (complex regional pain syndrome of the left ankle) after DCRFA of a cuboid lesion. Additionally, the DCRFA success rate was significantly higher when compared to two other published OO RFA treatment results. CONCLUSION DCRFA employing two sequential 6-min cycles is an effective treatment of OO. The 100 % primary success rate, 0 % long-term recurrence rate, and low complication rate compare favorably and may be superior to results of prior reports.


title: Gasless single-port access laparoscopy using a J-shaped retractor in patients undergoing adnexal surgery.

text: OBJECTIVE The aim of this study was to compare gasless single-port access (SPA) laparoscopy using a J-shaped retractor and conventional SPA laparoscopy in patients undergoing adnexal surgery. Study design The medical records of 80 patients who underwent laparoscopic adnexal surgery between May 2017 and April 2019 were reviewed. Of the 80 patients, 40 patients underwent gasless SPA laparoscopy using a J-shaped retractor and 40 underwent conventional SPA laparoscopy. All surgeries were performed by one laparoscopic surgeon. Surgical outcomes were compared between the two groups. RESULTS There are no significant differences in age, body mass index, parity, previous abdominal surgery, tumor marker, and tumor diameter between the gasless and conventional groups. The median retraction setup time from skin incision was 7 min (range 5-12 min) in gasless SPA laparoscopic adnexal surgery. The median total operation times were 55.5 min (range 30-155 min) in the gasless group and 55 min (range 30-165 min) in the conventional group without a significant difference. Additionally, there were no differences in operation type, conversion rate of laparotomy, use of an additional trocar, and pathological outcomes between the two groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSIONS Gasless SPA laparoscopy using a J-shaped retractor appears to offer a better alternative to conventional SPA laparoscopy that avoids the potential negative effects of carbon dioxide gas in selected cases.


title: Real-time Estimation of Epidemiologic Parameters from Contact Tracing Data During an Emerging Infectious Disease Outbreak.

text: BACKGROUND Contact tracing can provide accurate information on relevant parameters of an ongoing emerging infectious disease outbreak. This is crucial to investigators seeking to control such an outbreak. However, crude contact tracing data are difficult to interpret and methods for analyzing these data are scarce. We present a method to estimate and visualize key outbreak parameters from contact tracing information in real time by taking into account data censoring. METHODS/RESULTS Exposure type-specific attack rates and the reproduction number R(t) are estimated from contact tracing data by using maximum likelihood estimation to account for censored data. The attack rates reflect, in the context of contact tracing, the specificity of the contact definition; a higher value indicates relatively efficient contact tracing. The evolution of R(t) over time provides information regarding the effectiveness of interventions. To allow a real-time overview of the outbreak, the attack rates and the evolution of R(t) over time are visualized together with the case-contact network and epicurve. We applied the method to a well-documented smallpox outbreak in The Netherlands to demonstrate the added value. CONCLUSION Our method facilitates the analysis of contact tracing information by quickly turning it into accessible information, helping outbreak investigators to make real-time decisions to more effectively and efficiently control infectious disease outbreaks.


title: Anosmia Is a Key Symptom of COVID-19 Infection and Should Be Used as a Diagnostic Tool.

text: Based on observations described in our letter, we can draw the following conclusions: (1) anosmia must imperatively be added to the list of specific symptoms of COVID-19 infection, (2) anosmia can serve as a free and specific diagnostic tool for developing countries currently affected by the pandemic, (3) the mechanisms of COVID-19 anosmia seem not to directly involve nasal obstruction but rather seem to be related to damage the olfactory neuroepithelium.


title: Rare Anaemias, Sickle-Cell Disease and COVID-19.

text: For rare haematological diseases (RHD), the first question to be answered is if patients with be- nign red blood cell (RBC) defects like haemoglobinopathies, membranopathies and enzymopathies are more vulnerable to COVID-19 infection. Up to now, there is no yet literature on the subject, but, like in general population, the presence of comorbidities such as diabetes, heart disease, pulmonary hypertension, reduced kidney and/or liver function, worsen the effects of the infection. Splenectomy may be an additional risk factor.


title: Approximation of papillary muscles for ischaemic mitral regurgitation combined with coronary artery bypass grafting and left ventricular aneurysmectomy: a case report.

text: A 72-year-old female presented with severe ischaemic mitral regurgitation following a recent myocardial infarction. She had no significant past medical history. Pre-operative echocardiogram assessment demonstrated preserved tendinous cords of the mitral leaflets, a mitral valve annulus measuring 3.2 cm with end systolic coaptation of 0.3 cm, impaired left ventricular function with an ejection fraction of 35% and significant ventricular dilatation. Cardiac magnetic resonance imaging (MRI) showed delayed enhancement in the anterolateral, septal and lateral walls and confirmed the impairment of the left ventricle and a large aneurysmal deformation. On-table transoesophageal echo showed that the distance between the two papillary muscles was over 4 cm. We performed coronary artery bypass grafting combined with a Dor Procedure and papillary muscle approximation using a polytetrafluoroethylene (PTFE) vascular graft as a sling, without the insertion of a mitral annuloplasty ring. Postoperative echo and cardiac MRI showed improved left ventricular systolic function and reduced left ventricle volume associated with mild mitral regurgitation. We conclude that papillary muscles approximation as a method of mitral valve repair is a very effective procedure for functional ischaemic mitral regurgitation.


title: Left ventricular compressions improve return of spontaneous circulation and hemodynamics in a swine model of traumatic cardiopulmonary arrest.

text: BACKGROUND Prehospital cardiopulmonary resuscitation, including closed chest compressions, has commonly been considered ineffective in traumatic cardiopulmonary arrest (TCPA) because traditional chest compressions do not produce substantial cardiac output. However, recent evidence suggests that chest compressions located over the left ventricle (LV) produce greater hemodynamics when compared to traditional compressions. We hypothesized that chest compressions located directly over the LV would improve return of spontaneous circulation (ROSC) and hemodynamics when compared with traditional chest compressions, in a swine model of TCPA. METHODS Transthoracic echocardiography was used to mark the location of the aortic root (traditional compressions), and the center of the LV on animals (n = 26) which were randomized to receive chest compressions in one of the two locations. After hemorrhage, ventricular fibrillation was induced. After 10 minutes of ventricular fibrillation, basic life support (BLS) with mechanical cardiopulmonary resuscitation was initiated and performed for 10 minutes followed by advanced life support (ALS) for an additional 10 minutes. During BLS, the area of maximal compression was verified using transesophageal echocardiography. Hemodynamic variables were averaged over the final 2 minutes of the BLS and ALS periods. RESULTS Five (38%) of the LV group achieved ROSC compared with zero of the aortic root group (p = 0.04). Additionally, there was an increase in aortic systolic blood pressure (SBP), aortic diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) at the end of both the BLS (95% confidence interval, SBP, -49 to -21; DBP, -14 to -5.6; and CPP, -15 to -7.4) and ALS (95% confidence interval: SBP, -66 to -21; DBP, -49 to -6.8; and CPP, -51 to -7.5) resuscitation periods among the LV group. CONCLUSION In our swine model of TCPA, chest compressions performed directly over the LV improved ROSC and hemodynamics when compared with traditional chest compressions.


Shifting Paradigms in Head and Neck Reconstructive Surgery During the COVID-19 Crisis.


Management of ART and COVID-19: Infertility in times of pan- demic. What now?


title: [Perioperative management of cesarean section for pregnant women with suspected or confirmed COVID-19].

text: 2019年年末，湖北省武汉市新型冠状病毒肺炎（COVID-19）疫情突发，鉴于COVID-19具有强烈的传染性，为了增强实施COVID-19孕妇剖宫产术医护人员防控工作的针对性和有效性，武汉大学中南医院作为本次抗击疫情的孕产妇保健定点一线医院，结合救治经验并结合文献，对于疑似或确诊COVID-19孕妇的剖宫产术围手术期管理提出有针对性的建议，内容涉及术前准备、手术和麻醉、术后管理以及需要注意的问题，供同道参考，希望能有所裨益。.


title: The effect of short-term isometric training on core/torso stiffness.

text: "Core" exercise is a basic part of many physical training regimens with goals ranging from rehabilitation of spine and knee injuries to improving athletic performance. Core stiffness has been proposed to perform several functions including reducing pain by minimising joint micro-movements, and enhancing strength and speed performance. This study probes the links between a training approach and immediate but temporary changes in stiffness. Passive and active stiffness was measured on 24 participants; 12 having little to no experience in core training (inexperienced), and the other 12 being athletes experienced to core training methods; before and after a 15 min bout of isometric core exercises. Passive stiffness was assessed on a "frictionless" bending apparatus and active stiffness assessed via a quick release mechanism. Short-term isometric core training increased passive and active stiffness in most directions for both inexperienced and experienced participants, passive left lateral bend among experienced participants being the exception (P < 0.05). There was no difference between the inexperienced and experienced groups. The results confirm that the specific isometric training exercise approach tested here can induce immediate changes in core stiffness, in this case following a single session. This may influence performance and injury resilience for a brief period.


The hidden vulnerability of homelessness in the COVID-19 pandemic: Perspectives from India.


Prevention and infection control of COVID-19 in Nursing Homes: experience from China.


MERS coronovirus has probably been present in bats for many years, research shows.


Infection prevention and control guideline for cystic fibrosis: 2013 update.


title: Percutaneous Removal of Intravascular Pellet Following Penetrating Cardiac Trauma.

text: There is controversy regarding the management of projectile embolization, a rare complication of penetrating trauma. We present the case of a 5-year-old, 20 kg male with retrograde venous projectile embolization following traumatic injury with a pellet gun. The projectile was successfully removed utilizing a novel, percutaneous approach.


title: What Does Resilience Signify? An Evaluation of Concepts and Directions for Future Research.

text: Throughout the life course, individuals are confronted with adversities that challenge their ability to live the life they imagined. Adversities that are the most prominently studied and shown to bring about the most serious consequences for adjustment across the adult lifespan include job loss, disease and disability onset, and spousal and child bereavement. However, not all individuals show sustained declines to adversity; some are able to bounce back. The resilience literature is built on the premise that individuals are able to bounce back, or adapt to adversity. The past 15-20 years have seen an abundance of resilience research examining resilience to diverse types of adversity across the adult life-span. The overarching goal of this paper is to evaluate psychological concepts of resilience in adulthood and old age and recommend avenues for future research. To do so, I first evaluate and discuss definitions of resilience and their overlap across literatures with an emphasis on sociological approaches to studying adversity across the adult lifespan. Second, I discuss promising conceptual and methodological approaches to advance the resilience literature in adulthood and old age. Conceptual approaches to furthering the resilience literature include incorporating an anticipation component into the definition of resilience. Methodological approaches to furthering the resilience literature include prospective longitudinal designs that incorporate quantitative and qualitative approaches, multidimensional assessments, and the need to examine repeated adversities or multiple adversities that transpire in relatively close proximity to one another.


title: The amount of cytokine-release defines different shades of Sars-Cov2 infection.

text: The recent outbreak of coronavirus disease (COVID 19), spreading from China all around the world in early 2020, has led scientists to investigate the immuno-mediated mechanisms underlying the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) infection. Depending on the amount of cytokines released as the result of the immunological activation induced by SARS-CoV2, three major clinical phenotypes can be identified: "mild",symbolized as a "drizzle" of cytokines, severe as a "storm", and critical as a "hurricane". In patients with mild symptoms, the release of pro-inflammatory cytokines is balanced to obtain a defense response against the virus which is often self-limiting and overcomes without tissue damage. In severe phenotype, resembling a "cytokine-release syndrome", SARS-CoV2 causes the lysis of the immune-mediators leading to a cytokine storm able to induce lung epithelium damage and acute respiratory distress syndrome. In critical patients, the immune response may become uncontrolled, thus the cytokine burst resembles a form of secondary hemophagocytic lymphohistiocytosis which may result in a multi organ failure. In addition to the standard of care, an immune-modulatory therapy tailored to each one of the different phenotypes should be used in order to prevent or reduce the release of cytokines responsible for organ damage and disease progression.


title: The Synthetic Curcumin Analogue GO-Y030 Effectively Suppresses the Development of Pressure Overload-induced Heart Failure in Mice.

text: Curcumin is a naturally occurring p300-histone acetyltransferase (p300-HAT) inhibitor that suppresses cardiomyocyte hypertrophy and the development of heart failure in experimental animal models. To enhance the therapeutic potential of curcumin against heart failure, we produced a series of synthetic curcumin analogues and investigated their inhibitory activity against p300-HAT. The compound with the strongest activity was further evaluated to determine its effects on cardiomyocyte hypertrophy and pressure overload-induced heart failure in mice. We synthesised five synthetic curcumin analogues and found that a compound we have named GO-Y030 most strongly inhibited p300-HAT activity. Furthermore, 1 μM GO-Y030, in a manner equivalent to 10 µM curcumin, suppressed phenylephrine-induced hypertrophic responses in cultured cardiomyocytes. In mice undergoing transverse aortic constriction surgery, administration of GO-Y030 at a mere 1% of an equivalently-effective dose of curcumin significantly attenuated cardiac hypertrophy and systolic dysfunction. In addition, this low dose of GO-Y030 almost completely blocked histone H3K9 acetylation and eliminated left ventricular fibrosis. A low dose of the synthetic curcumin analogue GO-Y030 effectively inhibits p300-HAT activity and markedly suppresses the development of heart failure in mice.


title: Innovative Interventional and Imaging Registries: Precision Medicine in Cerebrovascular Disorders.

text: BACKGROUND Precision medicine in cerebrovascular disorders may be greatly advanced by the use of innovative interventional and imaging-intensive registries. Registries have remained subsidiary to randomized controlled trials, yet vast opportunities exist to leverage big data in stroke. SUMMARY This overview builds upon the rationale for innovative, imaging-intensive interventional registries as a pivotal step in realizing precision medicine for several cerebrovascular disorders. Such enhanced registries may serve as a model for expansion of our translational research pipeline to fully leverage the role of phase IV investigations. The scope and role of registries in precision medicine are considered, followed by a review on the history of stroke and interventional registries, data considerations, critiques or barriers to such initiatives, and the potential modernization of registry methods into efficient, searchable, imaging-intensive resources that simultaneously offer clinical, research and educational added value. KEY MESSAGES Recent advances in technology, informatics and endovascular stroke therapies converge to provide an exceptional opportunity for registries to catapult further progress. There is now a tremendous opportunity to deploy registries in acute stroke, intracranial atherosclerotic disease and carotid disease where other clinical trials leave questions unanswered. Unlike prior registries, imaging-intensive and modernized methods may leverage current technological capabilities around the world to efficiently address key objectives and provide added clinical, research and educational value.


title: TEAMWORKING IN ENDOSCOPY: A HUMAN FACTORS TOOLKIT FOR THE COVID-19 ERA.

text: Background and Aims Endoscopy services have had to rapidly adapt working practices in response to COVID-19. As recovery of endoscopy proceeds, there are numerous challenges facing our workforce which can impair effective teamworking. We designed and developed a novel toolkit to support teamworking in endoscopy during the pandemic. Methods A human factors model was developed to understand the impact of COVID-19 on endoscopy teams. From this, we identified a set of key teamworking goals which informed the development of a toolkit to support several team processes. The toolkit was refined following expert input and refinement over a six-week period. Results The toolkit consists of four cognitive aids that can be used to support team huddles, briefings and debriefs, alongside techniques to optimise endoscopic non-technical skills across the patient procedure pathway. We describe the processes that local endoscopy units can employ to implement this toolkit. Conclusion A toolkit of cognitive aids, based on human factors principles, may be useful in supporting teams, helping them adapt to working safely in the era of COVID-19.


title: Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system.

text: BACKGROUND Mediastinal ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism, traditionally treated by open surgery. Thoracoscopic access is associated with reduced morbidity in mediastinal surgery. The aim of this study was to evaluate the feasibility and effectiveness of robot-assisted dissection for mediastinal ectopic parathyroid glands. METHODS Two patients with recurrent secondary hyperparathyroidism and three with complicated primary hyperparathyroidism were operated on between July 2004 and August 2008 for ectopic mediastinal parathyroid glands. Fusion of single-photon emission computed tomography and computed tomography led to an exact identification of the culprit glands. Surgery was performed thoracoscopically with the da Vinci robotic system using a three-trocar approach. RESULTS All procedures were completed successfully with the robotic system. No perioperative morbidity or mortality was noted. Median operating time was 58 (range 42-125) min. Intraoperative parathyroid hormone reduction indicated complete resection. Median hospital stay was 3 (range 2-4) days. CONCLUSION Robot-assisted dissection is a promising approach for resection of ectopic parathyroid glands in remote narrow anatomical locations such as the mediastinum.


title: [The Agreed Experts' Position of the Eurasian Association of Therapists on Some new Mechanisms of COVID-19 Pathways: Focus on Hemostasis, Hemotransfusion Issues and Blood gas Exchange].

text: The article discusses pathogenesis and treatment of COVID-19. The authors presented state-of-the-art insight into hemostatic disorders in patients with COVID-19 and clinical recommendations on prevention of thrombosis and thromboembolism in patients infected with SARS-CoV-2. The article discussed in detail a new hypothesis proposed by Chinese physicians about a new component in the pathogenesis of COVID-19, namely, about the effect of SARS-CoV-2 virus on the hemoglobin beta-chain and the formation of a complex with porphyrin, which results in displacement of the iron ion. Thus, hemoglobin loses the capability for transporting oxygen, which aggravates hypoxia and worsens the prognosis. The article stated rules of hemotransfusion safety in the conditions of COVID-19 pandemic.


title: [Protection suggestions on medical staff in obstetrics and gynecology in COVID-19-designated hospitals].

text: 新型冠状病毒肺炎是1类具有很强传染性的疾病。本文结合新型冠状病毒感染的特点、国家卫生健康委相关要求、妇产科工作的特殊性以及实际工作的经验，对新型冠状病毒肺炎定点救治医院中妇产科医护人员在诊治过程中的防护措施进行分析及建议，以期在完成妇产科诊疗工作的同时，实现妇产科工作人员"零感染"的目标。.


title: Effects of antiretroviral therapy in HIV-positive adults on new HIV infections among young women: a systematic review protocol.

text: BACKGROUND The HIV/AIDS pandemic has struck regions, countries, and populations in different ways. With the introduction of antiretroviral drugs, people living with HIV (PLHIV) have a much better prognosis, even though there are still many new infections in young women. The role of widespread antiretroviral therapy (ART) on the incidence of HIV in young women is unknown. METHODS We will conduct a comprehensive search of MEDLINE (PubMed), Excerpta Medica database (EMBASE), Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization's (WHO's) library database, Latin American and Caribbean Health Sciences Literature (LILACS), conference abstracts, and gray literature sources to identify any relevant literature. We will include randomized and non-randomized clinical trials and cohort studies in which ART was offered to adults aged 18 and above reporting outcomes in females aged 15 to 24 years. The outcomes of interest are HIV incidence, ART initiation, adherence, retention, and viral load suppression. We will screen titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements will be resolved by consensus. We will extract data on the risk of HIV infection in younger females after the use of ART in the adult population. DISCUSSION To our knowledge, this is the first systematic review to look at the impact of ART use among adults on HIV incidence in young women. The results of this review will be used in a modeling study to simulate the effects of using ART as an effective tool to prevent sexual transmission of HIV to young women. Our findings will inform the treatment-as-prevention (TasP) strategy to reduce new HIV infections among young women. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018099174 .


title: Laparoscopic excision of a giant splenic vascular tumor.

text: The splenic vascular tumor referred to as a hemangioma is rare and typically presents as a small asymptomatic lesion. We report a case of a giant splenic cyst in a 13-year-old boy with abdominal distension. He underwent laparoscopic excision of the splenic cyst without complication. Pathology revealed a vascular tumor. At 15 months of follow-up, he continued to be asymptomatic, and abdominal ultrasound showed no recurrence of his disease. Laparoscopic excision of giant splenic cysts is a viable option in children, allowing for preservation of normal splenic tissue.


title: High-resolution angioscopic imaging during endovascular neurosurgery.

text: BACKGROUND Endoluminal optical imaging, or angioscopy, has not seen widespread application during neurointerventional procedures, largely as a result of the poor imaging resolution of existing angioscopes. Scanning fiber endoscopes (SFEs) are a novel endoscopic platform that allows high-resolution video imaging in an ultraminiature form factor that is compatible with currently used distal access endoluminal catheters. OBJECTIVE To test the feasibility and potential utility of high-resolution angioscopy with an SFE during common endovascular neurosurgical procedures. METHODS A 3.7-French SFE was used in a porcine model system to image endothelial disruption, ischemic stroke and mechanical thrombectomy, aneurysm coiling, and flow-diverting stent placement. RESULTS High-resolution, video-rate imaging was shown to be possible during all of the common procedures tested and provided information that was complementary to standard fluoroscopic imaging. SFE angioscopy was able to assess novel factors such as aneurysm base coverage fraction and side branch patency, which have previously not been possible to determine with conventional angiography. CONCLUSION Endovascular imaging with an SFE provides important information on factors that cannot be assessed fluoroscopically and is a novel platform on which future neurointerventional techniques may be based because it allows for periprocedural inspection of the integrity of the vascular system and the deployed devices. In addition, it may be of diagnostic use for inspecting the vascular wall and postprocedure device evaluation.


title: A three-component cyclocondensation reaction for the synthesis of new triazolo[1,5-a]pyrimidine scaffolds using 3-aminotriazole, aldehydes and ketene N,S-acetal.

text: This study describes the use of 3-aminotriazole, different aldehydes and N-methyl-1-(methylthio)-2-nitroethenamine as a ketene N,S-acetal in a three-component condensation for the synthesis of a novel library of triazolo[1,5-a]pyrimidine scaffolds. The presence of trichloroacetic acid as a Brønsted-Lowry acidic promoter in acetonitrile or water solvent and room temperature condition resulting novel triazolo[1,5-a]pyrimidine systems named N-methyl-6-nitro-5-aryl-3,5-dihydro-[1, 2, 4]triazolo[1,5-a]pyrimidine-7-amine. The structure of products and direction of the N-cyclization could be confirmed using spectral data. The effect of various solvents on the progress of process was investigated in the paper. The presence of five nitrogen heteroatoms, the use of various aldehydes affording a range of skeletally distinct triazolo[1,5-a]pyrimidine-based heterocycles, the potency to create numerous hydrogen bonds in the product structure, and direction of cyclization are attractive features of this reaction.


title: Alternative uses of lumen apposing metal stents.

text: The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.


title: Effects of Dexmedetomidine on motor- and somatosensory-evoked potentials in patients with thoracic spinal cord tumor: a randomized controlled trial.

text: BACKGROUND We hypothesized that the addition of dexmedetomidine in a clinically relevant dose to propofol-remifentanil anesthesia regimen does not exert an adverse effect on motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) in adult patients undergoing thoracic spinal cord tumor resection. METHODS Seventy-one adult patients were randomized into three groups. Propofol group (n = 25): propofol-remifentanil regimenand the dosage was adjusted to maintain the bispectral index (BIS) between 40 and 50. DP adjusted group (n = 23): Dexmedetomidine (0.5 μg/kg loading dose infused over 10 min followed by a constant infusion of 0.5 μg/kg/h) was added to the propofol-remifentanil regimen and propofol was adjusted to maintain BIS between 40 and 50. DP unadjusted group (n = 23): Dexmedetomidine (administer as DP adjusted group) was added to the propofol-remifentanil regimen and propofol was not adjusted. All patients received MEP, SSEP and BIS monitoring. RESULTS There were no significant changes in the amplitude and latency of MEP and SSEP among different groups (P > 0.05). The estimated propofol plasma concentration in DP adjusted group (2.7 ± 0.3 μg/ml) was significantly lower than in propofol group (3.1 ± 0.2 μg/ml) and DP unadjusted group (3.1 ± 0.2 μg/ml) (P = 0.000). BIS in DP unadjusted group (35 ± 5) was significantly lower than in propofol group (44 ± 3) (P = 0.000). CONCLUSIONS The addition of dexmedetomidine to propofol-remifentanil regimen does not exert an adverse effect on MEP and SSEP monitoring in adult patients undergoing thoracic spinal cord tumor resection. TRIAL REGISTRATION The study was registered with the Chinese Clinical Trial Registry on January 31st, 2014. The reference number was ChiCTR-TRC-14004229.


The COVID-19 outbreak: a snapshot from down under.


title: Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19.

text: The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon's model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.


Challenges for the Pediatricians During the Coronavirus Disease 2019 (COVID-19 Coronavirus Disease 2019) Pandemic Start From the Neonatal Period.


title: Preliminary case report on the SARS-CoV-2 cluster in the UK, France, and Spain

text: Almost half of the confirmed COVID-19 cases detected so far in the United Kingdom are part of a large cluster of 13 British nationals who tested positive for SARS-CoV-2 in the UK, Spain, and France. Transmissions among this cluster occurred at a ski resort in France, and originated from a single infected traveller returning from a conference in Singapore where he acquired the virus. At least 21 individuals were exposed to the virus, tested, and quarantined, with 13 of those testing positive between the period of 6th February and 15th February. Here, all publicly available information about the primarily UK/France cluster is consolidated, providing a complete and accessible summary of the cases and their connections. Notable in this cluster are the number of individuals infected, the apparent absence of any severe illness among those infected, and a case of a “delayed positive” test during isolation after initially testing negative, at least 7 days after last possible contact.


title: Structural insights into calicivirus attachment and uncoating.

text: The Caliciviridae family comprises positive-sense RNA viruses of medical and veterinary significance. In humans, caliciviruses are a major cause of acute gastroenteritis, while in animals respiratory illness, conjunctivitis, stomatitis, and hemorrhagic disease are documented. Investigation of virus-host interactions is limited by a lack of culture systems for many viruses in this family. Feline calicivirus (FCV), a member of the Vesivirus genus, provides a tractable model, since it may be propagated in cell culture. Feline junctional adhesion molecule 1 (fJAM-1) was recently identified as a functional receptor for FCV. We have analyzed the structure of this virus-receptor complex by cryo-electron microscopy and three-dimensional image reconstruction, combined with fitting of homology modeled high-resolution coordinates. We show that domain 1 of fJAM-1 binds to the outer face of the P2 domain of the FCV capsid protein VP1, inducing conformational changes in the viral capsid. This study provides the first structural view of a native calicivirus-protein receptor complex and insights into the mechanisms of virus attachment and uncoating.


title: Long-term complaints after elective repair for small umbilical or epigastric hernias.

text: PURPOSE Elective repair for umbilical or epigastric hernia is a frequent minor surgical procedure. Several studies have demonstrated chronic pain after groin hernia repair but long-term complaints have been only scarcely studied. This study was undertaken to investigate long-term pain and discomfort after open repair for small umbilical or epigastric hernias. METHODS This is a retrospective study with prospective long-term follow-up. Only elective primary umbilical or epigastric hernias with an open mesh or sutured repair were included. A structured follow-up questionnaire was sent to all patients regarding verbal rating scores (VRS) of pain and discomfort (no, little, moderate, or severe) and recurrence. Patients with suspected recurrence were clinically examined. RESULTS There were 139 eligible patients, and 132 patients answered the questionnaire (95 % response rate). The median follow-up time was 36 months (range 15-85), and defect size was 1.0 cm (0.2-8.0). Sixteen patients reported moderate or severe pain and/or discomfort (12 %, 95 % confidence interval (CI): 6-18). The cumulated risk of recurrence was 11.5 %. Of the 15 patients with clinical recurrence or reoperation for recurrence, 5 patients reported moderate/severe complaints (31 %) whereas 11 of the remaining 116 patients with no recurrence (10 %) reported moderate/severe complaints (P = 0.014). CONCLUSION Surprisingly, many patients complained about pain and discomfort 3 years after elective repair for a small umbilical or epigastric hernia.


title: Deep RNA sequencing reveals complex transcriptional landscape of a bat adenovirus.

text: Bat adenoviruses are a group of recently identified adenoviruses (AdVs) which are highly prevalent in bats yet share low similarity to known AdVs from other species. In this study, deep RNA sequencing was used to analyze the transcriptome at five time points following the infection of a bat AdV in a kidney cell line derived from a myotis bat species. Evidence of AdV replication was observed with the proportion of viral RNAs ranging from 0.01% at 6 h to 1.3% at 18 h. Further analysis of viral temporal gene expression revealed three replication stages, the early-stage genes encoding mainly host interaction proteins, the intermediate-stage genes for the DNA replication and assembly proteins, and the late-stage genes for most structural proteins. Several bat AdV genes were expressed at stages that differed from those of their counterpart genes previously reported for human AdV type 2. In addition, single-base resolution splice sites of several genes and promoter regions of all 30 viral genes were fully determined. Simultaneously, the temporal cellular gene expression profiles were identified. The most overrepresented functional categories of the differentially expressed genes were related to cellular immune response, transcription, translation, and DNA replication and repair. Taken together, the deep RNA sequencing provided a global, transcriptional profile of the novel bat AdV and the virus-host interactions which will be useful for the understanding and investigation of AdV replication, pathogenesis, and specific virus-bat interactions in future research.


title: Noninvasive fractional flow on MRA predicts stroke risk of intracranial stenosis.

text: BACKGROUND AND PURPOSE Fractional flow may identify hemodynamic effects and ischemic risk beyond percent stenosis of an artery. We hypothesized that diminished TOF-MRA signal intensity distal to an intracranial stenosis predicts stroke risk. METHODS TOF-MRA was acquired prospectively in the SONIA-WASID trials. The distal/proximal signal intensity ratio (SIR) was calculated from 3 mm regions of interest, blinded to outcome. Univariate and multivariate analyses included clinical variables, SIR, and invasive angiography measures to identify predictors for risk of stroke in the territory. RESULTS 189 patients with 50-99% symptomatic intracranial stenosis in SONIA-WASID had TOF-MRA available. In univariate analysis, the hazard ratio (HR) for stroke in the territory of the symptomatic artery with SIR < .9 was 5.2 (1.8, 15.3; P < .001) as compared to SIR ≥ .9. Multivariate analysis correcting for baseline systolic blood pressure, LDL, centrally measured percent stenosis, recency of symptoms, TICI and downstream collaterals, the HR for SIR < .9 was 10.9 (2.0, 58.9; P < .001). In those with <70% stenosis, a SIR < .9 maintained a significant association with recurrent stroke in the territory (P = .006), with a 2-year event rate of 17.3%. CONCLUSIONS Fractional flow assessed by TOF-MRA SIR may be a useful noninvasive tool to identify high-risk intracranial lesions. CLINICAL TRIAL REGISTRATION-URL This trial was not registered because enrollment began prior to July 1, 2005.


title: Validation of stationary phases in (111)In-pentetreotide planar chromatography.

text: INTRODUCTION Since Pall-German stopped manufacturing ITLC-SG, it has become necessary to validate alternative stationary phases. OBJECTIVE To validate different stationary phases versus ITLC-SG Pall-Gelman in the determination of the radiochemical purity (RCP) of (111)In-pentetreotide ((111)In-Octreoscan) by planar chromatography. MATERIAL AND METHODS We conducted a case-control study, which included 66 (111)In-pentetreotide preparations. We determined the RCP by planar chromatography, using a freshly prepared solution of 0,1M sodium citrate (pH 5) and the following stationary phases: ITLC-SG (Pall-Gelman) (reference method), iTLC-SG (Varian), HPTLC silica gel 60 (Merck), Whatman 1, Whatman 3MM and Whatman 17. For each of the methods, we calculated: PRQ, relative front values (RF) of the radiopharmaceutical and free (111)In, chromatographic development time, resolution between peaks. We compared the results obtained with the reference method. The statistical analysis was performed using the SPSS program. The p value was calculated for the study of statistical significance. RESULTS The highest resolution is obtained with HPTLC silica gel 60 (Merck). However, the chromatographic development time is too long (mean=33.62minutes). Greater resolution is obtained with iTLC-SG (Varian) than with the reference method, with lower chromatographic development time (mean=3.61minutes). Very low resolutions are obtained with Whatman paper, essentially with Whatman 1 and 3MM. Therefore, we do not recommend their use. CONCLUSIONS Although iTLC-SG (Varian) and HPTLC silica gel 60 (Merck) are suitable alternatives to ITLC-SG (Pall-Gelman) in determining the RCP of (111)In-pentetreotide, iTLC-SG (Varian) is the method of choice due to its lower chromatographic development time.


Developing a new, national approach to surveillance for ventilator-associated events: executive summary.


title: A Specifically Designed Stent for Anastomotic Leaks after Bariatric Surgery: Experiences in a Tertiary Referral Hospital.

text: BACKGROUND The management of anastomotic leakage after either laparoscopic Roux-en-Y gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG) remains a burden. Various options are available for the treatment of these leaks. A newer and less invasive option for the treatment of leaks is the use of endoluminal stents. The main drawback for this treatment is stent migration. The current study describes the outcome of a new, specifically designed stent for the treatment of anastomotic leaks after bariatric surgery. METHODS For this retrospective observational study, the medical charts of patients undergoing bariatric surgery between October 1, 2010 and July 1, 2013 were reviewed. All patients with anastomotic leakage, treated with the bariatric Hanarostent, were included. RESULTS Twelve patients were included out of a total of 1702 bariatric patients in the described period. Seven had a leakage after LSG, five after LGBP. An average of 2.4 endoscopic procedures and 1.25 stents were used per patient. Successful treatment was seen in nine out of 12 patients (75 %). Most common complication was dislocation or migration of the stent, occurring in eight patients (66.7 %). CONCLUSIONS The ECBB Hanarostent®, which was specifically designed for post bariatric leakages, shows equal but not favorable success rates in this small series compared to previous reports on other types of stenting techniques. Despite the stent design, the complication rate is not reduced and the main future goal should be to target the high stent migration rate.


title: Laparoscopic totally extra-peritoneal groin hernia repair with self-gripping polyester mesh: a series of 780 repairs.

text: BACKGROUND Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post-operative pain and infection. Post-operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self-gripping mesh, has a theoretical benefit of avoiding tacks for mesh-fixation. This case series reflects our long-term experience of this technique. METHODS We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re-operation as primary data points. RESULTS A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self-gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo-hernia repairs (0.38%). Post-operative follow-up was up to 4.4 years. CONCLUSIONS Our series of laparoscopic groin hernia repair with self-gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.


title: Propensity Score Analysis Comparing Videothoracoscopic Lobectomy With Thoracotomy: A French Nationwide Study.

text: BACKGROUND Video-assisted thoracoscopic surgery (VATS) lobectomy has recently become the recommended approach for stage I non-small cell lung cancer. However, these guidelines are not based on any large randomized control trial. Our study used propensity scores and a sensitivity analysis to compare VATS lobectomy with open thoracotomy. METHODS From 2005 to 2012, 24,811 patients (95.1%) were operated on by open thoracotomy and 1,278 (4.9%) by VATS. The end points were 30-day postoperative death, postoperative complications, hospital stay, overall survival, and disease-free survival. Two propensity scores analyses were performed: matching and inverse probability of treatment weighting, and one sensitivity analysis to unmask potential hidden bias. A subgroup analysis was performed to compare "high-risk" with "low-risk" patients. Results are reported by odds ratios or hazard ratios and their 95% confidence intervals. RESULTS Postoperative death was not significantly reduced by VATS whatever the analysis. Concerning postoperative complications, VATS significantly decreased the occurrence of atelectasis and pneumopathy with both analysis methods, but there were no differences in the occurrence of other postoperative complications. VATS did not provide a benefit for high-risk patients. The VATS approach decreased the hospital length of stay from 2.4 days (95% confidence interval, -1.7 to -3 days) to -4.68 days (95% confidence interval, -8.5 to 0.9 days). Overall survival and disease-free survival were not influenced by the surgical approach. The sensitivity analysis showed potential biases. CONCLUSIONS The results must be interpreted carefully because of the differences observed according to the propensity scores method used. A multicenter randomized controlled trial is necessary to limit the biases.


title: Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy.

text: Background Comprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity. Methods The final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge). Results Compared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death. Conclusions The most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.


title: Which stroke patients gain most from intermittent pneumatic compression: further analyses of the CLOTS 3 trial.

text: BACKGROUND The CLOTS 3 trial showed that intermittent pneumatic compression (IPC) reduced the risk of DVT and improved survival after stroke. AIMS To provide additional information which may help clinicians target IPC on the most appropriate patients by exploring the variation in its effects on subgroups defined by predicted prognosis. METHODS A multicentre, parallel group, randomized trial enrolled immobile acute stroke patients and allocated them to IPC or no IPC. The primary outcome was proximal DVT at 30 days. Secondary outcomes at six-months included survival, disability, quality of life, and hospital costs. We stratified patients into quintiles according to their predicted prognosis at randomization, based on the Six Simple Variable model. RESULTS Between December 2008 and September 2012, we enrolled 2876 patients in 94 UK hospitals. Patients with the best predicted outcome had the lowest absolute risk of proximal DVT (6·7%) and death by six-months (9·3%). Allocation to IPC had little effect on DVT, survival, disability, quality of life, hospital length of stay, or costs. In patients with the worst predicted outcomes, the overall risk of DVT and death was 16·0% and 51·3%, respectively. IPC reduced DVT (odds reduction 34%) and improved survival 17% and significantly increased length of stay and hospital costs. In the three intermediate quintiles, IPC reduced the odds of DVT (35-43%) and improved survival (11-13%). Disability and quality of life at six-months depended on baseline severity but was not influenced significantly by IPC. CONCLUSIONS IPC appears to reduce the risk of DVT and probably improves survival in all immobile stroke patients, other than the fifth with the best prognosis. It therefore seems reasonable to recommend that IPC should be considered in all immobile stroke patients, but that the final decision should be based on a judgment about the individual's prognosis. In some, their prognosis for survival with an acceptable quality of life will be so poor that use of IPC might be considered futile, while at the other end of the spectrum, patients' risk of DVT, and of dying from VTE, may not be high enough to justify the modest cost and inconvenience of IPC use.


title: A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease.

text: BACKGROUND The purpose of this study was to compare the ability of 3 portable oxygen concentrators (POCs) to maintain S(pO2) ≥ 90% during exercise in patients with chronic lung disease. METHODS Twenty-one subjects with chronic lung disease (18 with COPD, 3 with pulmonary fibrosis) and documented room air exertional S(pO2) ≤ 85% performed four 6-min walk tests: a control walk using the subject's current oxygen system and prescribed exertional flow rate, and 1 walk with each of the 3 POCs (Eclipse 3, EverGo, and iGo) at their maximum pulse-dose setting. RESULTS S(pO2) was significantly higher pre-walk and post-walk with the Eclipse 3, compared to the other POCs (all P < .01). The subjects also walked farther and maintained a mean S(pO2) ≥ 90% with the Eclipse 3 (both P < .01), which delivers the largest oxygen bolus. The subjects indicated that they preferred the EverGo's physical characteristics, but that the Eclipse 3 responded best to their breathing. The iGo was rated less favorably than Eclipse 3 or EverGo. CONCLUSIONS The Eclipse 3 was best at meeting the subjects' clinical needs. POC users should be appropriately tested during all activities of daily living, to ensure adequate oxygenation. The healthcare provider should provide information and help to direct the subject toward the most clinically appropriate oxygen system, while being mindful of the patient's preferences and lifestyle. (Clinicaltrials.gov NCT01653730).


title: TransAnal Minimally Invasive Surgery (TAMIS) with SILS™ port versus Transanal Endoscopic Microsurgery (TEM): a comparative experimental study.

text: BACKGROUND TransAnal Minimally Invasive Surgery (TAMIS) has been proposed as an alternative to Transanal Endoscopic Microsurgery (TEM) for resection of benign polyps and early cancers of rectum. Since clinical application has begun in the absence of any experimental validation, we assessed its feasibility and efficacy ex vivo in a pilot study. METHODS In a dedicated trainer box for transanal procedures, 10 surgeons with no experience in transanal surgery were asked to perform a dissection/suture task using both TAMIS and TEM in randomly allocated order. Surgeons were asked to dissect two identically drawn lesions of ~3 cm in larger diameter. Precision of dissection was assessed using a quantitative photographic method, while the time needed for dissection and suturing was considered a measure of quantitative evaluation. Each participant expressed a subjective opinion regarding difficulty with dissection, difficulty with suturing, vision quality, and conflict between instruments on a scale from 1 to 5. RESULTS No difference was observed between the two techniques regarding the accuracy of dissection as the margin was interrupted along 4.1 % of the circumference in the TEM group compared with 2.48 % in the SILS group (P = 0.271). Dissection and suturing were significantly quicker in the TEM group [04:30 vs. 06:35 min (P = 0.049) and 14:34 versus 19:18 min (P = 0.003)]. In three cases in the SILS group, completing the suture was not considered possible, and the procedures were terminated by TEM. Subjective evaluation revealed a better appreciation of TEM in all proposed comparisons: dissection (2.6 vs. 3.5, P = 0.004), suturing difficulty (3.1 vs. 4.6, P < 0.001), quality of vision (2.3 vs. 2.8, P = 0.18), and instrument conflicts (3.1 vs. 4.0, P = 0.054). CONCLUSIONS In the ex vivo setting, both techniques were comparable for achieving a good dissection, although TAMIS failed to prove effective in suturing the rectal wall. Moreover, TEM was significantly quicker despite the small groups and was better appreciated by the surgeons.


title: Viral respiratory infections during the 2009 influenza A(H1N1) outbreak in the West Midlands Region, UK.

text: In spring 2009 a new strain of influenza A(H1N1) emerged and caused a worldwide pandemic. This study utilized a large collection of respiratory specimens from suspected cases of influenza A(H1N1) in the UK West Midlands during the pandemic in order to investigate which other respiratory viruses were circulating and whether they played any role in the increased hospitalization rates seen during that period. Study specimens were selected from community and hospitalized patients positive and negative for influenza A(H1N1) and tested by PCR for other respiratory viruses. A number of infections diagnosed as influenza during the summer influenza outbreak were found to be due to other virus infections (most commonly rhinovirus). No statistically significant difference was found between the rates of respiratory virus co-infection with H1N1 in patients from community or hospital locations suggesting underlying factors were likely to be more significant than viral co-infections in determining severity of influenza A(H1N1) disease.


title: Pure transumbilical SILS gastric bypass with mechanical circular gastrojejunal anastomosis feasibility.

text: BACKGROUND Since Wittgrove introduced the laparoscopic version of the gastric bypass in 1994, the interest still remains in the decrease of the abdominal wall trauma in order to optimize the benefits of laparoscopy on postoperative pain, cosmesis, hospital stay, and convalescence in bariatric patients. This work is to report the feasibility of gastric bypass surgery by a pure transumbilical single-incision laparoscopic surgery (SILS) with a mechanical circular gastrojejunal anastomosis. METHODS Thirty-four patients (10 males and 24 females) were offered to receive gastric bypass with circular mechanical gastrojejunal anastomosis by Single Incision Laparoscopic Surgery (SILS) using pure transumbilical access. Anastomotic leak occurrence was the primary end-point. Patients demographics, operative time, additional trocarts, hemorrhage, intra abdominal abscess, length of post-operative stay, readmission, 30 days death, gastrojejunal anastomosis stricture, marginal ulcers, reflux complains, seromas, incisional hernias, and % excess BMI loss were also recorded in a prospective database. RESULTS Primary end-point showed no anastomotic leak occurrence during the hospital stay or during the first 30 post-operative days. SILS gastric bypass with a circular mechanical gastrojejunal anastomosis is feasible and seems to be safe.


title: Common carotid artery puncture in anterior circulation thrombectomy in patients with unfavorable vascular anatomy: A case-control study.

text: The objective of this study was to compare clinical outcomes in patients who with unfavorable vascular anatomy underwent mechanical thrombectomy (MT) by common carotid artery access versus transfemoral approach.A retrospective review was performed in our hospital database to identify patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion (LVO) between August 2015 and November 2018. Transcarotid and transfemoral cohorts were compared. Patient characteristics, procedural techniques, clinical outcomes were recorded.A total of 52 patients were included, 16 (31%) underwent MT via transcarotid access. There were no significant differences in patient characteristics, intravenously recombinant tissue plasminogen activator therapy, clot location, or carotid tortuosity and presence of aortic arch type. There were significant differences in clinical outcomes between the 2 cohorts, including mean access-to-reperfusion time (84 vs 44 minutes; P = .000), poor clinical outcome (modified Rankin scale >2) at 90 days follow-up (37.5% vs 63.9%; P = .034). But there were no significant differences in successful revascularization rates (thrombolysis in cerebral infarction score ≥2b 87.5% vs 80.6%; P = .541), post-thrombectomy symptomatic intracranial hemorrhage (12.5% vs 13.9%; P = .892), and mortality (12.5% vs 22.2%; P = .412) were similar between transcarotid and transfemoral cohorts.Our results demonstrate that transcarotid access for MT of anterior circulation LVO in patients with unfavorable vascular anatomy may be considerable. Transcarotid access may be better than transfemoral access in well-selected unfavorable vascular anatomy patients undergoing MT.


title: The psychological subtype of intimate partner violence and its effect on mental health: protocol for a systematic review and meta-analysis.

text: BACKGROUND/AIM Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. METHOD The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). RESULTS AND DISCUSSION The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual "type" of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116026 .


title: Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts.

text: PURPOSE A panel of Japanese experts on tumor ablation therapy gathered to reach a general consensus on topics surrounding ablation therapy. MATERIALS AND METHODS Questionnaires relating to ablation protocols for radiofrequency ablation (RFA) and cryoablation, as well as ancillary procedures required for safe and secure ablation therapy, were sent to seven institutions. Experts from these institutions discussed each topic based on the evidence and the questionnaire data, and a consensus was reached at an annual meeting of the Japan Image-guided Ablation Group in Maebashi, Japan, in October 2015. RESULTS A consensus was reached on each of six topics, including "management of antiplatelet and anticoagulation drug therapy"; "pain control in the perioperative period"; "arterial embolization combined with ablation therapy"; "protection of non-target organs"; "RFA and cryoablation protocols"; and "ablative margins." CONCLUSIONS The consensus achieved here will serve as the framework for tumor ablation therapies in Japan.


Is there a future for hydroxychloroquine/chloroquine in prevention of SARS-CoV-2 infection (COVID-19)?


title: Rumor-Related and Exclusive Behavior Coverage in Internet News Reports Following the 2009 H1N1 Influenza Outbreak in Japan.

text: OBJECTIVE We sought to elucidate news article reporting of adverse public psychosocial behaviors, in particular, rumor-related coverage (eg, panic, demagoguery) and exclusive behavior coverage (negative behaviors, eg, discrimination, bullying) during the 2009 influenza A (H1N1) influenza pandemic in Japan. METHODS We examined 154 Internet news-site articles reporting adverse public psychosocial responses in the first 60 days of the outbreak. Rumor-related coverage and exclusive behavior coverage were dichotomously coded as included or not. Moreover, we assessed whether or not health information (eg, coping methods, virus toxicity information) or emphasis on information quality (eg, importance of information, cautions about overreactions) were simultaneously reported. RESULTS Rumor-related coverage (n=120, 77.9%) was less likely to simultaneously report public health information (eg, toxicity information, health support information, and cautions about overreactions; P<.05). Conversely, exclusive behavior coverage (n=41, 26.6%) was more likely to report public health information (P<.05). CONCLUSIONS Rumor-related coverage was less likely to have accompanying public health information, whereas exclusive behavior coverage was more likely to include it. During public health crises, it is essential to understand that rumors and exclusive behaviors have adverse effects on the public and that accompanying public health information may help people take proactive coping actions.


title: Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?

text: OBJECTIVE To evaluate the prevalence and risk factors of wrist pain. METHODS Systematic review. DATA SOURCES The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers. RESULTS In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study). CONCLUSIONS Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population. TRIAL REGISTRATION The review protocol was registered with PROSPERO under the registration number CRD42018090834. LEVEL OF EVIDENCE 1 (Prognostic study).


title: French national consensus clinical guidelines for the management of ulcerative colitis.

text: BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory bowel disease of multifactorial etiology that primarily affects the colonic mucosa. The disease progresses over time, and clinical management guidelines should reflect its dynamic nature. There is limited evidence supporting UC management in specific clinical situations, thus precluding an evidence-based approach. AIM To use a formal consensus method - the nominal group technique (NGT) - to develop a clinical practice expert opinion to outline simple algorithms and practices, optimize UC management, and assist clinicians in making treatment decisions. METHODS The consensus was developed by an expert panel of 37 gastroenterologists from various professional organizations with experience in UC management using the qualitative and iterative NGT, incorporating deliberations based on the European Crohn's and Colitis Organisation recommendations, recent reviews of scientific literature, and pertinent discussion topics developed by a steering committee. Examples of clinical cases for which there are limited evidence-based data from clinical trials were used. Two working groups proposed and voted on treatment algorithms that were then discussed and voted for by the nominal group as a whole, in order to reach a consensus. RESULTS A clinical practice guideline covering management of the following clinical situations was developed: (i) moderate and severe UC; (ii) acute severe UC; (iii) pouchitis; (iv) refractory proctitis, in the form of treatment algorithms. CONCLUSIONS Given the limited available evidence-based data, a formal consensus methodology was used to develop simple treatment guidelines for UC management in different clinical situations that is now accessible via an online application.


title: Molecular cloning and transcriptional regulation of Indian peafowl (Pavo cristatus) IFN-α gene.

text: Interferon-α (IFN-α) resists viral infections by triggering the transcription of a diverse range of antiviral IFN-stimulated genes (ISGs). However, information about the Indian peafowl (Pavo cristatus) IFN-α (PcIFN-α) has not been reported. In this study, a PcIFN-α gene was amplified, which encoded a protein of 193 amino acids with a 26-amino acid signal peptide sharing 72.16-95.70% identity with other avians in Aves. After expression in prokaryote, PcIFN-α was analyzed for its physicochemical property and antiviral activity. Intriguingly, compared with chicken IFN-α, an effective viral infection therapeutic agent, PcIFN-α showed superior anti-VSV, NDV, and AIV activities, which were then abrogated by rabbit anti-PcIFN-α antibodies in vitro. Moreover, PcIFN-α was shown to be highly sensitive to trypsin; however, it remained stable despite changes in pH and temperature. Additionally, PcIFN-α induced the transcriptional or translational levels of Mx1 and ISG12 genes time-dependently. Overall, the present study revealed that PcIFN-α is a potential novel effective therapeutic agent in antiviral defense responses in peafowl, improving understanding of its involvement in bird antiviral defense.


title: Issues and updates in emerging neurologic viral infections.

text: This review discusses the recent advances in the identification of viral pathogens and other etiologies responsible for cases of suspected viral encephalitis. The authors describe new molecular diagnostic strategies for identifying novel causes of viral encephalitis, including MassTag PCR, DNA microarrays, and high-throughput DNA pyrosequencing. They also highlight the increasing recognition of immune-mediated causes of encephalitis among those cases previously thought to be viral encephalitis of unknown etiology. Lastly, they review some of the most recent updates in the field of emerging neurologic viral infections impacting the United States, including the neurologic complications of H1N1 virus and the reemergence of dengue virus in the Florida Keys.


title: SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results.

text: BACKGROUND The long-term efficacy of laparoscopic Roux-en-Y gastric bypass (RYGB) in the treatment of morbid obesity has been demonstrated. Laparoscopic sleeve gastrectomy (SG) as a single procedure has shown promising short-term results, but the long-term efficacy of SG has not yet been demonstrated. The aim of this study was to determine the preliminary 30-day morbidity and mortality of RYGB and SG in a prospective multicenter randomized setting. METHODS A total of 240 morbidly obese (BMI = 35-66 kg/m²) patients evaluated by a multidisciplinary team were randomized to undergo either RYGB or SG. There were 117 patients in the RYGB group and 121 in the SG group; two patients had to be excluded after randomization. Both study groups were comparable regarding age, gender, BMI, and comorbidities. RESULTS There was no 30-day mortality. The median operating time was significantly shorter in the SG group (66 min vs. 94 min, p < 0.001). All complications were recorded thoroughly. There were 7 (5.8 %) major complications following SG and 11 (9.4 %) after RYGB (p = 0.292). Nine (7.4 %) SG patients and 20 (17.1 %) RYGB patients had minor complications (p = 0.023). The overall morbidity was 13.2 % after SG and 26.5 % after RYGB (p = 0.010). There were three (2.5 %) early reoperations after SG and four (3.3 %) after RYGB (p = 0.719). CONCLUSIONS At 30-day analysis SG is associated with a shorter operating time and fewer early minor complications compared to RYGB. There were no significant differences in major complications or early reoperations. Long-term follow-up is required to determine the effect on weight loss, resolution of obesity-related comorbidities, and improvement of quality of life.


title: Evaluation of advanced airway management in absolutely inexperienced hands: a randomized manikin trial.

text: AIMS Endotracheal intubation (ETI) and basic ventilation techniques (i.e. mouth-to-mouth/nose, bag-valve-mask ventilation) require skills and training. As an alternative, supraglottic airway devices (SAD) are efficient and technically easy to insert. We therefore evaluated the time to ventilation, success rate, and skill retention for various airway management approaches by medical laypersons using a manikin model. METHODS Fifty medical laypersons with no previous experience whatsoever in airway management or resuscitation were enrolled. All participants received a 1-h-long theoretical lecture and a practical demonstration of mouth-to-mouth ventilation, ETI, and six SAD. Afterwards, the laypersons performed mouth-to-mouth ventilation and used each of the seven airway-management systems on an advanced patient simulator (SimMan) in a random sequence. All participants were re-evaluated 3 months later without any further practical or theoretical demonstration. RESULTS The success rates for ETI were 74% during the first evaluation and 64% during the second, whereas the success rate for all six SAD was 100% during all application attempts. The success rate for mouth-to-mouth ventilation was 86% initially and 84% 3 months later. The time to adequate mouth-to-mouth ventilation was 15 ± 13 s initially and 16 ± 7 s subsequently. ETI required 53 ± 21 s during the initial evaluation and 44 ± 16 s 3 months later. CONCLUSION A variety of SAD all proved to reliably secure airways quickly, even in the hands of complete novices. The SAD were much more effective than ETI, which often failed, and were even superior to mouth-to-mouth ventilation. SAD may thus be an appropriate first-line approach to field ventilation.


International Organization for the Study of Inflammatory Bowel Disease Recommendations for Surgery in Patients with Inflammatory Bowel Disease During the COVID-19 Pandemic.


title: Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (AO 31-A1 and AO 31-A2): a systematic review.

text: OBJECTIVES Intramedullary nails are used increasingly in the surgical treatment of intertrochanteric femur fractures (IFFs). However, controversy has developed regarding the length of the nail itself. The purpose of this study is to investigate differences in reoperation rate, as well as operating time, length of hospital stay and 1-year mortality between short and long intramedullary nails in IFF-type AO 31-A1 and AO 31-A2. DATA SOURCES A search was conducted using PUBMED, Embase and Cochrane Central (January 1, 2000-August 1, 2018). Articles written in English, German or Scandinavian language were included. STUDY SELECTION Studies with patients > 18 years having an IFF comparing short nail with long nail and a least one of the clinical outcomes on interest (reoperation rate, operating time, length of hospital stay, 1-year mortality) were included. DATA EXTRACTION A total of 2680 studies were identified and screened according to PRISMA guidelines. Cochrane risk of bias tool for RCTs and non-randomized studies was used to assess the risk of bias. DATA SYNTHESIS Odds ratio and 95% confidence interval were calculated. CONCLUSIONS No difference in complication rate leading to reoperation was found in the individual studies or in the meta-analysis [OR 0.89 (0.49; 1.16)]. There is no difference in the length of hospital stay between the two nail cohorts; a shorter operating time inserting a short nail compared to inserting a long nail was found (p < 0.0001). In the meta-analysis, we found no difference in 1-year mortality [OR 1.20 (0.80; 1.79)].


title: Severe postvaccinia encephalitis with acute disseminated encephalomyelitis: recovery with early intravenous immunoglobulin, high-dose steroids, and vaccinia immunoglobulin.

text: We report the second case of severe postvaccinial encephalitis with acute disseminated encephalomyelitis since smallpox vaccination was reintroduced in 2002. Both affected patients responded dramatically with early intervention of intravenous immunoglobulin. Our patient, who also received concurrent vaccinia immunoglobulin and corticosteroids, demonstrated full recovery.


Efforts to Minimize the Impact of Lockdown on Migrant Workers in India During the COVID-19 Pandemic.