title: Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial.

text: OBJECTIVE To determine: (i) whether the use of ankle-foot orthoses over a period of 26 weeks affects tibialis anterior muscle activity; (ii) whether the timing of provision of ankle-foot orthoses (early or delayed) affects the results; (iii) whether the provision of ankle-foot orthoses affects tibialis anterior muscle activity within a single measurement. DESIGN Randomized controlled trial. SUBJECTS Unilateral hemiparetic subjects, a maximum of 6 weeks post-stroke. METHODS Subjects were assigned randomly to early (at inclusion; week 1) or delayed provision of ankle-foot orthoses (8 weeks later; week 9). Tibialis anterior electromyography was measured with and without ankle-foot orthoses, in study weeks 1, 9, 17 and 26. RESULTS A total of 26 subjects were analysed. In a single measurement, use of an ankle-foot orthosis significantly reduced the activity levels of the tibialis anterior muscle during the swing phase (p = 0.041) compared with walking without an ankle-foot or-thosis. During the 26-week follow-up, no changes were found in tibialis anterior muscle activity in the swing phase without an ankle-foot orthosis, both within-groups (p = 0.420 early; p = 0.282 delayed), and between-groups (p = 0.987). After 26 weeks, no differences were found in tibialis anterior muscle activity between both groups in the swing phase, with (p = 0.207) or without ankle-foot orthoses (p = 0.310). CONCLUSION Use of ankle-foot orthoses post-stroke reduced tibialis anterior muscle activity in the swing phase within 1 measurement; however, long-term use of ankle-foot orthoses for 26 weeks did not affect such activity. Early or delayed provision of ankle-foot orthoses did not affect the findings. The results indicate that there is no need to fear negative consequences on tibialis anterior-activity because of long-term AFO-use (early) after stroke.


title: Development and Validation of a Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke.

text: Importance Predicting the duration of poststroke dysphagia is important to guide therapeutic decisions. Guidelines recommend nasogastric tube (NGT) feeding if swallowing impairment persists for 7 days or longer and percutaneous endoscopic gastrostomy (PEG) placement if dysphagia does not recover within 30 days, but, to our knowledge, a systematic prediction method does not exist. Objective To develop and validate a prognostic model predicting swallowing recovery and the need for enteral tube feeding. Design, Setting, and Participants We enrolled participants with consecutive admissions for acute ischemic stroke and initially severe dysphagia in a prospective single-center derivation (2011-2014) and a multicenter validation (July 2015-March 2018) cohort study in 5 tertiary stroke referral centers in Switzerland. Exposures Severely impaired oral intake at admission (Functional Oral Intake Scale score <5). Main Outcomes and Measures Recovery of oral intake (primary end point, Functional Oral Intake Scale ≥5) or return to prestroke diet (secondary end point) measured 7 (indication for NGT feeding) and 30 (indication for PEG feeding) days after stroke. Results In total, 279 participants (131 women [47.0%]; median age, 77 years [interquartile range, 67-84 years]) were enrolled (153 [54.8%] in the derivation study; 126 [45.2%] in the validation cohort). Overall, 64% (95% CI, 59-71) participants failed to recover functional oral intake within 7 days and 30% (95% CI, 24-37) within 30 days. Prolonged swallowing recovery was independently associated with poor outcomes after stroke. The final prognostic model, the Predictive Swallowing Score, included 5 variables: age, stroke severity on admission, lesion location, initial risk of aspiration, and initial impairment of oral intake. Predictive Swallowing Score prediction estimates ranged from 5% (score, 0) to 96% (score, 10) for a persistent impairment of oral intake on day 7 and from 2% to 62% on day 30. Model performance in the validation cohort showed a discrimination (C statistic) of 0.84 (95% CI, 0.76-0.91; P < .001) for predicting the recovery of oral intake on day 7 and 0.77 (95% CI, 0.67-0.87; P < .001) on day 30, and a discrimination for a return to prestroke diet of 0.94 (day 7; 95% CI, 0.87-1.00; P < .001) and 0.71 (day 30; 95% CI, 0.61-0.82; P < .001). Calibration plots showed high agreement between the predicted and observed outcomes. Conclusions and Relevance The Predictive Swallowing Score, available as a smartphone application, is an easily applied prognostic instrument that reliably predicts swallowing recovery. It will support decision making for NGT or PEG insertion after ischemic stroke and is a step toward personalized medicine.


Endoscopic negative-pressure therapy for duodenal leakage using new open-pore film and polyurethane foam drains with the pull-through technique.


title: Understanding the financial impact of robotics in gynecologic surgery.

text: As surgical innovation and technological advancements evolve, the associated costs cannot be overlooked. Currently, the United States health care system is undergoing an attempted overhaul with technology such as robotics sitting front and center of the financial debate. As patient demand for less invasive surgical options increases and standards of practice change, patient outcomes must be carefully evaluated to justify the costs increase from traditional, often more invasive treatments. The collection of financial data is quite varied among hospital systems and so is the models used to determine the costs of robotics. Although limited thus far, various cost data have been ascertained in the areas of reproductive surgery, hysterectomy (both benign and oncologic), and pelvic reconstructive surgery.


title: Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study.

text: BACKGROUND Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. We analysed whether perioperative bilateral BIS monitoring may detect abnormalities before the onset of POD in cardiac surgery patients. METHODS In a prospective observational study, 81 patients undergoing cardiac surgery were included. Bilateral Bispectral Index (BIS)-monitoring was applied during the pre-, intra- and postoperative period, and BIS, EEG Asymmetry (ASYM), and Burst Suppression Ratio (BSR) were recorded. POD was diagnosed according to the Confusion Assessment Method for the Intensive Care Unit, and patients were divided into a delirium and non-delirium group. RESULTS POD was detected in 26 patients (32%). A trend towards a lower ASYM was observed in the delirium group as compared to the non-delirium group on the preoperative day (ASYM = 48.2 ± 3.6% versus 50.0 ± 4.7%, mean ± sd, p = 0.087) as well as before induction of anaesthesia, with oral midazolam anxiolysis (median ASYM = 49.5%, IQR [47.4;51.5] versus 50.6%, IQR [49.1;54.2], p = 0.081). Delirious patients remained significantly (p = 0.018) longer in a burst suppression state intraoperatively (107 minutes, IQR [47;170] versus 44 minutes, IQR [11;120]) than non-delirious patients. Receiver operating analysis revealed burst suppression duration (area under the curve = 0.73, p = 0.001) and BSR (AUC = 0.68, p = 0.009) as predictors of POD. CONCLUSIONS Intraoperative assessment of BSR may identify patients at risk of POD and should be investigated in further studies. So far it remains unknown whether there is a causal relationship or rather an association between intraoperative burst suppression and the development of POD. TRIAL REGISTRATION clinicaltrials.gov NCT01048775.


title: Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States.

text: We updated estimates of adults at risk for coronavirus disease complications on the basis of data for China by using recent US hospitalization data. This update to our previous publication substitutes obesity for cancer as an underlying condition and increases adults reporting any of the conditions from 45.4% to 56.0%.


title: Novel Coronavirus disease 2019 (COVID-19): new challenges and new responsibilities in developing countries.

text: Novel coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus, which belongs to the genus Coronaviridae with its high mutation rate. From the current perspective, we discuss the current status of COVID-19, new challenges, and potential interventions to control the pandemic in developing counties such as Pakistan.


title: Surgical Technique: Laparoscopic Gastric Sleeve Resection in Super-Obese Patients.

text: Laparoscopic gastric sleeve (LGS) resection in super-obese patients (BMI > 50 kg/m2) is a challenging procedure. We have developed a unique approach and technique for LGS with no buttress stapling and without oversewing. After 102 operations there have been no leaks and late complications.


title: [Interpretation of pathological changes for "Guidelines for the Diagnosis and Treatment of COVID-19 by the National Health Commission (Trial Version 7)"].

text: 国家卫生健康委员会发布《新型冠状病毒肺炎诊疗方案（试行第七版）》，首次将病理变化纳入其中。这些病理变化信息是基于当时所获得的有限病例病理观察（重庆和武汉共7例遗体穿刺、5例系统尸检）结果，经过多名病理专家和临床专家讨论总结并达成共识，是目前较为全面的新型冠状病毒感染疾病（COVID-19）病理变化的总结，是COVID-19诊疗方案的重要指导性指标。本文根据COVID-19病理学研究结果，结合严重急性呼吸综合征（SARS）的病理变化，对两种疾病的多器官病理变化进行了比较分析，发现COVID-19与SARS导致的机体病理变化大致相同，主要病变发生在肺、免疫系统（脾脏、淋巴结）及各器官的血管，但SARS肺、脾脏及各器官的血管病变严重且广泛，而COVID-19 Ⅱ型肺泡上皮细胞的增生不如SARS显著，肺内支气管内甚至肺泡腔内可见较多支气管栓，SARS则少见，这可能是通气和换气功能障碍的直接而重要的病理基础，关于COVID-19病理变化，由于掌握的材料有限，尚需将来积累更多的尸体解剖资料予以补充，目前相关的病理变化信息仅供参考。.


title: Prevalence of common mental disorders in widowhood: A systematic review and meta-analysis.

text: BACKGROUND Widowed people have a high risk of common mental disorders, however no summary estimates of the prevalences exist. The aim of this study was to conduct a systematic review and meta-analysis of the prevalence of common mental disorders in widowed people in the community. METHODS MEDLINE, Embase and PsycInfo were searched for papers reporting on prevalence of common mental disorders and widowhood. Eligible studies were included in random effects meta-analyses of the prevalence of depression and anxiety disorders. Subgroup analyses were performed on method of assessment of depression and age and sex. RESULTS The literature search identified 13,781 titles of which 42 were eligible for meta-analysis. The pooled prevalence of depression in studies using a screening scale was 40.6% (33.6%-47.6%) (n = 30). For studies using full diagnostic criteria the pooled prevalence of depression was 19.2% (13.4%-25.0%) (n = 12). Subgroup analyses of age (≥ or < 65) and sex did not show any differences regarding depression. Five studies reported the prevalence of anxiety disorders. The pooled prevalence estimate was 26.9% (8.1%-45.7%). LIMITATIONS The prevalence estimates in this study are summary estimates of prevalences from existing literature. Although the reporting bias assessment showed no evidence, there could be some reporting bias, as studies might only present results if there is a high prevalence. CONCLUSIONS Widowed people have a high prevalence of depression and anxiety disorders. The high prevalence of depression was independent of age and sex. The study identifies a population group at high risk needing special attention in clinical practice.


title: Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

text: OBJECTIVES/HYPOTHESIS To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. STUDY DESIGN Anatomical study. METHODS Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. RESULTS The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. CONCLUSION Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. LEVEL OF EVIDENCE N/A. Laryngoscope, 127:585-591, 2017.


Alarm at the Gate-Health and Social Inequalities are Comorbid Conditions of HIV and COVID-19.


title: Implementation of HIV care in Western Kenya during corona virus disease 2019 response.

text: : To ensure the continuity of high-quality HIV care in Kisumu County, Kenya during the corona virus disease 2019 pandemic, the Ministry of Health implemented a strategy to promote physical distancing and corona virus disease 2019 case detection. A total of 23 262 (84.2%) of the 27 641 patients eligible for early refill received an extra 3-month supply of antiretrovirals. Across 60 Ministry of Health clinics, average attendance decreased from 1298 to 640 patients per day postintervention, representing a 50.7% reduction.


title: Therapeutic strategies in an outbreak scenario to treat the novel coronavirus originating in Wuhan, China [version 1;peer review: awaiting peer review]

text: A novel coronavirus (2019-nCoV) originating in Wuhan, China presents a potential respiratory viral pandemic to the world population Current efforts are focused on containment and quarantine of infected individuals Ultimately, the outbreak could be controlled with a protective vaccine to prevent 2019-nCoV infection While vaccine research should be pursued intensely, there exists today no therapy to treat 2019-nCoV upon infection, despite an urgent need to find options to help these patients and preclude potential death Herein, I review the potential options to treat 2019-nCoV in patients, with an emphasis on the necessity for speed and timeliness in developing new and effective therapies in this outbreak I consider the options of drug repurposing, developing neutralizing monoclonal antibody therapy, and an oligonucleotide strategy targeting the viral RNA genome, emphasizing the promise and pitfalls of these approaches Finally, I advocate for the fastest strategy to develop a treatment now, which could be resistant to any mutations the virus may have in the future The proposal is a biologic that blocks 2019-nCoV entry using a soluble version of the viral receptor, angiotensin-converting enzyme 2 (ACE2), fused to an immunoglobulin Fc domain, providing a neutralizing antibody with maximal breath to avoid any viral escape, while also helping to recruit the immune system to build lasting immunity The sequence of the ACE2-Fc protein is provided to investigators, allowing its possible use in recombinant protein expression systems to start producing drug today to treat patients under compassionate use, while formal clinical trials are later undertaken Such a treatment could help infected patients before a protective vaccine is developed and widely available in the coming months to year(s)


title: Comprehensive evaluation of manikin-based airway training with second generation supraglottic airway devices.

text: Background Supraglottic airway devices (SADs) are an essential second line tool during difficult airway management after failed tracheal intubation. Particularly for such challenging situations the handling of an SAD requires sufficient training. We hypothesized that the feasibility of manikin-based airway management with second generation SADs depends on the type of manikin. Methods Two airway manikins (TruCorp AirSim® and Laerdal Resusci Anne® Airway Trainer™) were evaluated by 80 experienced anesthesia providers using 5 different second generation SADs (LMA® Supreme™ [LMA], Ambu® AuraGain™, i-gel®, KOO™-SGA and LTS-D™). The primary outcome of the study was feasibility of ventilation measured by assessment of the manikins' lung distention. As secondary outcome measures, oropharyngeal leakage pressure (OLP), ease of gastric tube insertion the insertion time, position and subjective assessments were evaluated. Results Ventilation was feasible with all combinations of SAD and manikin. By contrast, an OLP exceeding 10 cm H2O could be reached with most of the SADs in the TruCorp but with the LTS-D only in the Laerdal manikin. Gastric tube insertion was successful in above 90% in the Laerdal vs 87% in the TruCorp manikin (P<0.009). Insertion times differed significantly between manikins. The SAD positions were better in the Laerdal manikin for LMA, Ambu, i-gel and LTS-D. Participant's assessments were superior in the Laerdal manikin for LMA, Ambu, i-gel and KOO-SGA. Conclusions Ventilation is possible with all combinations. However, manikins are variable in their ability to adequately represent additional functions of second generation SADs. In order to achieve the best performance during training, the airway manikin should be chosen depending on the SAD in question.


China coronavirus: Six questions scientists are asking.


title: Detection of coronaviruses in children with acute gastroenteritis in Maddina, Saudi Arabia.

text: BACKGROUND The role of coronaviruses in paediatric gastro-enteritis is not well defined. We investigated the detection rate and epidemiological features of infection with coronavirus in children receiving hospital care for acute gastro-enteritis in Maddina, Saudi Arabia. METHODS Stool specimens were collected from children less than 5 years of age who were either hospitalised in Maddina or given oral rehydration therapy as outpatients between April 2004 and April 2005. Coronaviruses were detected by electron microscopy. RESULTS Coronaviruses were detected in 63 (6%) of 984 children with acute gastro-enteritis and were more commonly detected in outpatients (47/423, 11%) than in inpatients (16/561, 3%). The median age (range) of children with coronavirus infection was 42 months (10-60). Coronaviruses were detected throughout the year with the highest detection rate at the end of the winter season. CONCLUSIONS Coronaviruses were commonly identified in children with diarrhoea in Saudi Arabia. Their role in paediatric gastro-enteritis warrants further evaluation.


title: Minimally invasive endovascular stent-electrode array for high-fidelity, chronic recordings of cortical neural activity.

text: High-fidelity intracranial electrode arrays for recording and stimulating brain activity have facilitated major advances in the treatment of neurological conditions over the past decade. Traditional arrays require direct implantation into the brain via open craniotomy, which can lead to inflammatory tissue responses, necessitating development of minimally invasive approaches that avoid brain trauma. Here we demonstrate the feasibility of chronically recording brain activity from within a vein using a passive stent-electrode recording array (stentrode). We achieved implantation into a superficial cortical vein overlying the motor cortex via catheter angiography and demonstrate neural recordings in freely moving sheep for up to 190 d. Spectral content and bandwidth of vascular electrocorticography were comparable to those of recordings from epidural surface arrays. Venous internal lumen patency was maintained for the duration of implantation. Stentrodes may have wide ranging applications as a neural interface for treatment of a range of neurological conditions.


title: Anxiety and depression are more prevalent in patients with graves' disease than in patients with nodular goitre.

text: BACKGROUND AND OBJECTIVE Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Graves' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease. METHODS 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable 'anxiety'/probable 'depression'. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression. RESULTS In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves' disease versus 4% in nodular goitre (p = 0.038), anxiety was 18 versus 13% (p = 0.131). Symptoms of anxiety (p = 0.04) and depression (p = 0.01) increased with comorbidity. Anxiety symptoms increased with duration of Graves' disease (p = 0.04). Neither thyroid function nor autoantibody levels were associated with anxiety and depression symptoms. CONCLUSIONS Anxiety and depression symptoms were more severe in Graves' disease than in nodular goitre. Symptoms were positively correlated to comorbidity and duration of Graves' disease but neither to thyroid function nor thyroid autoimmunity.


title: Infection prophylaxis and management of viral infection.

text: Viral infections are associated with significant morbidity and mortality in lung transplant recipients. Importantly, several viral infections have been associated with the development of chronic lung allograft dysfunction (CLAD). Community-acquired respiratory viruses (CARV) such as influenza and respiratory syncytial virus (RSV), are frequently associated with acute and chronic rejection. Cytomegalovirus (CMV) remains a significant burden in regards to morbidity and mortality in lung transplant recipients. Epstein-Barr virus (EBV) is mostly involved with the development of post-transplant lymphoproliferative disorder (PTLD), a lymphoid proliferation that occurs in the setting of immunosuppression. On the other hand, the development of direct acting antivirals for hepatitis C virus (HCV) is changing the use of HCV-positive organs in transplantation. In this article we will focus on reviewing common viral infections that have a significant impact on lung transplant recipients looking at epidemiology, prevention and potential treatment.


title: Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis.

text: BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase and the Cochrane Library up to January 2018. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised by whether they examined a low/high intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12-months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mmHg, [95%CI -4.78, -1.46 mmHg]; p value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (p<0.001 for all outcomes), and possibly stroke (p<0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high intensity co-interventions.


title: Massive traumatic abdominal hernia repair with biologic mesh.

text: Traumatic abdominal wall hernias (TAWHs) are rare. They can arise from either high or low impact trauma and can be associated with significant associated injury. We present the case of a 27-year-old male involved in a high-impact road traffic accident resulting in a TAWH. He sustained significant disruption to the abdominal wall and sustained injuries to the thoracic cage. Operative management was undertaken with a porcine dermal collagen mesh, using a bridge technique.


title: [Virus and Atypical Pathogens Detected in Community-Acquired Lower Respiratory Tract Infection in Infants and Children of Sfax Region, Tunisia].

text: Little is known about viral and atypical bacteria pathogen spectra of community-acquired lower respiratory tract infection in children in Tunisia. Thus, a prospective study was carried out between January 2009 and March 2010 in Sfax. Nasopharyngeal aspirates collected from 368 patients (78 with pneumonia and 290 with acute bronchiolitis) were analyzed by indirect immunofluorescence assay and PCR to detect influenza viruses, parainfluenza viruses, respiratory syncytial virus (RSV), human metapneumovirus, human rhinovirus, human enterovirus, adenovirus, coronavirus, Mycoplasma pneumonia (Mpn) and Chlamydia pneumonia (Cpn). One or more etiology was documented in 319 cases (86.7%). The most detected viruses were RSV (42.7%), rhinovirus (32.9%) and adenovirus (28.5%). Co-detection of two or three pathogens was found in 40% of positive samples. This study highlights the importance of respiratory viruses in lower respiratory tract infection in children of Sfax region as well as the high rate of co-detection of multiple viruses, resulting in challenges in clinical interpretation.


Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic.


title: Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience.

text: MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia.


title: The evolving role of infectomics in drug discovery.

text: Signatures of infectomes, which are encoded by both host and microbial genomes, and mirror the interplay between pathogens and their hosts, provide invaluable knowledge in the search for novel antimicrobial drugs. Infectomics is the study of infectomes by using systems biology and high-throughput omic approaches. There are three types of infectomic approaches that can be used for drug discovery: ecological infectomics, immunoinfectomics and chemical infectomics. Ecological infectomics, which is the ecological study of infectomes, explores symbiotic solutions to microbial infections. Research on drug discovery using infectomic signatures and immunomic approaches falls within the field of immunoinfectomics. Advances in chemical infectomics will lead to the development of a new generation of chemical drugs for therapeutics for microbial infections.


title: Tensile strength testing for resorbable mesh fixation systems in laparoscopic ventral hernia repair.

text: BACKGROUND In an attempt to improve patient outcome and quality of life after laparoscopic ventral hernia repair, resorbable fixation devices have been developed to allow adequate mesh fixation while minimizing accompanying side-effects as tack erosion and adhesion formation. MATERIALS AND METHODS In experimental set-up, 24 pigs were treated by laparoscopic mesh placement. Two different meshes (PP/ORC and PP/ePTFE) and four fixation devices were evaluated: a 6.4 mm poly(D,L: )-lactide pushpin (tack I), a 6.8 mm poly(D,L: )-lactide with blunt tip (tack II), a 4.1 mm poly(glycolide-co-L-lactide) (tack III) and one titanium tack (control tack). A first group of animals (n = 12) was euthanized after 2 weeks survival and a second group (n = 12) after 6 months. At euthanasia, a relaparoscopy was performed to assess adhesion formation followed by laparotomy with excision of the entire abdominal wall. Tensile strength of the individual fixation systems was tested with the use of a tensiometer by measuring the force to pull the tack out of the mesh. Additionally, the foreign body reaction to the fixation systems was evaluated histologically as was their potential degradation. RESULTS At 2 weeks the tensile strength was significantly higher for the control tack (31.98 N/cm²) compared to the resorbable devices. Except for tack II, the tensile strength was higher when the devices were fixed in a PP/ePTFE mesh compared to the PP/ORC mesh. After 6 months only tack III was completely resorbed, while tack I (9.292 N/cm²) had the lowest tensile strength. At this time-point similar tensile strength was observed for both tack II (29.56 N/cm²) and the control tack (27.77 N/cm²). Adhesions seem to be more depending on the type of mesh, in favor of PP/ePTFE. CONCLUSION At long term, the 4.1 mm poly(glycolide-co-L-lactide) tack was the only tack completely resorbed while the 6.8 mm poly(D,L: )-lactide tack with blunt tip reached equal strengths to the permanent tack.


title: Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon.

text: PURPOSES To compare the clinical and functional results of anterior cruciate ligament (ACL) reconstruction using an autologous four-strand single semitendinosus (ST) tendon or a ST and gracilis tendon. It was hypothesized that successful ACL reconstruction using a single ST tendon without the gracilis tendon could provide comparable knee stability and reduce donor site morbidity. METHODS This study evaluated 144 cases of single-bundle ACL reconstruction using an autologous hamstring tendon. The ST group included 85 cases of reconstruction using a single ST tendon, and the ST/G group included 59 cases of reconstruction using a ST tendon and a gracilis tendon. An extracortical suspension device and a suture tied around a screw post with an additional bioabsorbable screw were used to fix the femoral and tibial tunnels, respectively. Clinical evaluations involved the Lachman, pivot-shift, and one-leg hop tests; an isokinetic test; a KT-2000 arthrometer; an assessment of return to pre-injury activities; and Lysholm, Tegner activity, and International Knee Documentation Committee (IKDC) subjective scores. RESULTS No significant differences were found between the ST and ST/G groups with respect to the Lysholm, Tegner activity, and subjective IKDC scores; the Lachman, pivot-shift, and one-leg hop tests; KT-2000 arthrometer side-to-side differences; or return to pre-injury activities. However, mean peak torque deficit, as determined using the isokinetic test during flexion at 60°/s, was significantly lower in the ST group than in the ST/G group (p = 0.047). CONCLUSION This study showed good results for ACL reconstruction using a single ST tendon without deterioration of stability. This provides the evidence that ACL reconstruction using a single ST tendon without the gracilis tendon decreases donor site morbidity without compromising joint stability. LEVEL OF EVIDENCE IV.


title: Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis.

text: AIMS To assess accuracy of multidetector computed tomography (MDCT) and individual radiological signs in the diagnosis of anastomotic leaks. MATERIALS AND METHODS Patients undergoing anterior resection with a stapled anastomosis over a 2 year period were identified. Electronic and clinical records of these patients were reviewed. Unenhanced and/or enhanced MDCT was performed with intravenous and/or per-rectal contrast medium and read by a radiologist blinded to the patients' clinical details to determine the sensitivity and specificity of specific findings at MDCT for identifying leaks. RESULTS Seventeen percent (30/170) of the anterior resections were suspected to have an anastomotic leak. Ninety-three percent (28/30) of patients underwent MDCT. Seven point six percent (11+2/170) had a confirmed leak. Two patients underwent surgery without MDCT. A leak was confirmed by MDCT in 91% (10/11) of patients. The sensitivity, specificity, and positive and negative predictive values of MDCT in diagnosing a leak was 0.91, 1, 1, and 0.95, respectively. The sensitivity of peri-anastomotic air, peri-anastomotic collection, extravasation of rectal contrast medium, and staple line integrity was 0.81, 0.63, 0.54, and 0.72, respectively. Use of rectal contrast medium (8/11 cases) increased the subjective ease of diagnosis and was the only sign in one patient. CONCLUSIONS Presence of peri-anastomotic air is a reliable marker of anastomotic leaks at MDCT. Leakage of rectal contrast medium is highly accurate and increases confidence of diagnosis. The appearance of the staple line itself is not accurate in assessing anastomotic integrity.


title: A novel imaging technique for better detecting new lesions in multiple sclerosis.

text: We developed a tool that performs longitudinal subtraction of 3D double inversion recovery (DIR) images in follow-up magnetic resonance (MR) examinations of patients with multiple sclerosis. As DIR sequences show a high lesion-to-parenchyma contrast, we hypothesized that such a tool might lead to increased sensitivity for new lesions as well as to speeding up the routine clinical work-up of follow-up MR imaging in multiple sclerosis by directly visualizing new lesions. DIR subtraction images of serial MR examinations were calculated in 106 patients with multiple sclerosis. Existence of new lesions was assessed in three different ways: by standard visual comparison, by FLAIR, and by DIR subtraction maps. A reference standard, to which the single modalities were compared, was defined by combining all information from all readouts and all readers. The presence and number of new lesions were determined and the time needed for analysis measured. Accuracy of detecting overall existence of new lesions using DIR subtraction maps was significantly higher than using visual comparison (96 vs. 86%, p = 0.013) or FLAIR subtraction maps (p < 0.001), with increased sensitivity and higher negative predictive value. Significantly more new lesions were detected when using DIR subtraction maps (p < 0.001). Analyzing subtraction maps took less than a third of the time needed for the standard visual comparison (p = 0.007). Thus, DIR subtraction maps improve the detection of new lesions in a clinical setting both in terms of accuracy and in terms of speed.


Protecting older adults during social distancing.


title: Increased mucosal CD4+ T cell activation in rhesus macaques following vaccination with an adenoviral vector.

text: UNLABELLED The possibility that vaccination with adenovirus (AdV) vectors increased mucosal T cell activation remains a central hypothesis to explain the potential enhancement of HIV acquisition within the Step trial. Modeling this within rhesus macaques is complicated because human adenoviruses, including human adenovirus type 5 (HAdV-5), are not endogenous to macaques. Here, we tested whether vaccination with a rhesus macaque-derived adenoviral vector (simian adenovirus 7 [SAdV-7]) enhances mucosal T cell activation within rhesus macaques. Following intramuscular SAdV-7 vaccination, we observed a pronounced increase in SAdV-7-specific CD4(+) T cell responses in peripheral blood and, more dramatically, in rectal mucosa tissue. Vaccination also induced a significant increase in the frequency of activated memory CD4(+) T cells in SAdV-7- and HAdV-5-vaccinated animals in the rectal mucosa but not in peripheral blood. These fluctuations within the rectal mucosa were also associated with a pronounced decrease in the relative frequency of naive resting CD4(+) T cells. Together, these results indicate that peripheral vaccination with an AdV vector can increase the activation of mucosal CD4(+) T cells, potentially providing an experimental model to further evaluate the role of host-vector interactions in increased HIV acquisition after AdV vector vaccination. IMPORTANCE The possibility that vaccination with a human adenovirus 5 vector increased mucosal T cell activation remains a central hypothesis to explain the potential enhancement of human immunodeficiency virus (HIV) acquisition within the Step trial. In this study, we tested whether vaccination with a rhesus macaque-derived adenoviral vector in rhesus macaques enhances mucosal CD4(+) T cell activation, the main cell target of simian immunodeficiency virus (SIV)/HIV. The results showed that vaccination with an adenoviral vector indeed increases activation of mucosal CD4(+) T cells and potentially increases susceptibility to SIV infection.


How GPs can contribute to the challenge of covid-19.


title: ACE2 Expression is Increased in the Lungs of Patients with Comorbidities Associated with Severe COVID-19.

text: PATIENTS who died from COVID-19 often had comorbidities, such as hypertension, diabetes, and chronic obstructive lung disease. Although angiotensin-converting enzyme 2 (ACE2) is crucial for SARS-CoV2 to bind and enter host cells, no study has systematically assessed the ACE2 expression in the lungs of patients with these diseases. Here, we analyzed over 700 lung transcriptome samples of patients with comorbidities associated with severe COVID-19 and found that ACE2 was highly expressed in these patients, compared to control individuals. This finding suggests that patients with such comorbidities may have higher chances of developing severe COVID-19. Correlation and network analyses revealed many potential regulators of ACE2 in the human lung, including genes related to histone modifications, such as HAT1, HDAC2, and KDM5B. Our systems biology approach offers a possible explanation for increase of COVID-19 severity in patients with certain comorbidities.


Rapid Publication, Knowledge Sharing, and Our Responsibility During the COVID-19 Pandemic.


title: Comparison of a Novel Cadaver Model (Fix for Life) With the Formalin-Fixed Cadaver and Manikin Model for Suitability and Realism in Airway Management Training.

text: BACKGROUND Manikins are widely used in airway management training; however, simulation of realism and interpatient variability remains a challenge. We investigated whether cadavers embalmed with the novel Fix for Life (F4L) embalmment method are a suitable and realistic model for teaching 3 basic airway skills: facemask ventilation, tracheal intubation, and laryngeal mask insertion compared to a manikin (SimMan 3G) and formalin-fixed cadavers. METHODS Thirty anesthesiologists and experienced residents ("operators") were instructed to perform the 3 airway techniques in 10 F4L, 10 formalin-fixed cadavers, and 1 manikin. The order of the model type was randomized per operator. Primary outcomes were the operators' ranking of each model type as a teaching model (total rank), ranking of the model types per technique, and an operator's average verbal rating score for suitability and realism of learning the technique on the model. Secondary outcomes were the percentages of successfully performed procedures per technique and per model (success rates in completing the respective airway maneuvers). For each of the airway techniques, the Friedman analysis of variance was used to compare the 3 models on mean operator ranking and mean verbal rating scores. RESULTS Twenty-seven of 30 operators (90%) performed all airway techniques on all of the available models, whereas 3 operators performed the majority but not all of the airway maneuvers on all models for logistical reasons. The total number of attempts for each technique was 30 on the manikin, 292 in the F4L, and 282 on the formalin-fixed cadavers. The operators' median total ranking of each model type as a teaching model was 1 for F4L, 2 for the manikin and, 3 for the formalin-fixed cadavers (P < .001). F4L was considered the best model for mask ventilation (P = .029) and had a higher mean verbal rating score for realism in laryngeal mask airway insertion (P = .043). The F4L and manikin did not differ significantly in other scores for suitability and realism. The formalin-fixed cadaver was ranked last and received lowest scores in all procedures (all P < .001). Success rates of the procedures were highest in the manikin. CONCLUSIONS F4L cadavers were ranked highest for mask ventilation and were considered the most realistic model for training laryngeal mask insertion. Formalin-fixed cadavers are inappropriate for airway management training.


title: Responses of migratory species and their pathogens to supplemental feeding.

text: Migratory animals undergo seasonal and often spectacular movements and perform crucial ecosystem services. In response to anthropogenic changes, including food subsidies, some migratory animals are now migrating shorter distances or halting migration altogether and forming resident populations. Recent studies suggest that shifts in migratory behaviour can alter the risk of infection for wildlife. Although migration is commonly assumed to enhance pathogen spread, for many species, migration has the opposite effect of lowering infection risk, if animals escape from habitats where pathogen stages have accumulated or if strenuous journeys cull infected hosts. Here, we summarize responses of migratory species to supplemental feeding and review modelling and empirical work that provides support for mechanisms through which resource-induced changes in migration can alter pathogen transmission. In particular, we focus on the well-studied example of monarch butterflies and their protozoan parasites in North America. We also identify areas for future research, including combining new technologies for tracking animal movements with pathogen surveillance and exploring potential evolutionary responses of hosts and pathogens to changing movement patterns. Given that many migratory animals harbour pathogens of conservation concern and zoonotic potential, studies that document ongoing shifts in migratory behaviour and infection risk are vitally needed.This article is part of the theme issue 'Anthropogenic resource subsidies and host-parasite dynamics in wildlife'.


title: West Nile Virus Fitness Costs in Different Mosquito Species.

text: West Nile virus (WNV) remains an important public health problem causing annual epidemics in the United States. Grubaugh et al. observed that WNV genetic divergence is dependent on the vector mosquito species. This suggests that specific WNV vector-bird species pairings may generate novel genotypes that could promote outbreaks.


title: Review on the clinical pharmacology of hydroxychloroquine sulfate for the treatment of COVID-19.

text: BACKGROUND As the number of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infected people is skyrocketing worldwide, the international medical situation becomes very serious. Potential therapeutic drugs, vaccine and stem cell replacement methods are emerging, it is urgent to find specific therapeutic drugs and the best treatment regimens. After the publication of hydroxychloroquine (HCQ) with anti-SARS-COV-2 activity in vitro, a small, non-randomized, open-label clinical trial showed that HCQ treatment was significantly associated with reduced viral load in patients with coronavirus disease-19 (COVID-19). Meanwhile, a large prophylaxis study of HCQ sulfate for COVID-19 has been initiated in the United States. HCQ offered a promising efficacy in the treatment of COVID-19, but the optimal administration is still being explored. METHODS Use the keyword 'Hydroxychloroquine' to conduct a literature search in PubMed to collect relevant literature on the mechanism of action of HCQ, clinical efficacy and safety, pharmacokinetic characteristics, precautions for clinical use and drug interactions, and extract and organize information. RESULTS This paper reviews the mechanism, clinical efficacy and safety, pharmacokinetic characteristics, exposure-response relationship and precautions and drug interactions of HCQ, and summarized dosage recommendations for HCQ sulfate. CONCLUSION It has been proved that HCQ, which has an established safety profile, is effective against SARS-CoV-2 with sufficient pre-clinical rationale and evidence. Data from high-quality clinical trials are urgently needed worldwide.


Correction to: Protecting Medical Trainees on the COVID-19 Frontlines Saves Us All.


title: Characterization of the subgenomic RNAs produced by Pelargonium flower break virus: Identification of two novel RNAs species.

text: Pelargonium flower break virus (PFBV), a member of the genus Carmovirus, has a single-stranded positive-sense genomic RNA (gRNA) of 3.9kb. The 5' half of the gRNA encodes two proteins involved in replication, the p27 and its readthrough product, p86 (the viral RNA dependent-RNA polymerase, RdRp), and the 3' half encodes two small movement proteins, p7 and p12, and the coat protein (CP). As other members of the family Tombusviridae, carmoviruses express ORFs that are not 5'-proximal from subgenomic RNAs (sgRNAs). Analysis of double-stranded RNAs extracted from PFBV-infected leaves and Northern blot hybridizations of total RNA from infected plants or protoplasts revealed than PFBV produces four 3'-coterminal sgRNAs of 3.2, 2.9, 1.7 and 1.4kb, respectively. The 5' termini of the 1.7 and 1.4kb sgRNAs mapped 26 and 143 nt upstream of the initiation codons of the p7 and CP genes, respectively, whereas the 5'-ends of the 3.2 and 2.9kb sgRNAs were located within the readthrough portion of the RdRp gene. The PFBV sgRNAs begin with a motif which is also present at the 5' terminus of the gRNA and the minus polarity of the regions preceding their corresponding start sites (in the gRNA) may be folded into hairpin structures resembling those found for the sgRNA promoters of other carmoviruses. The results indicate that, besides the sgRNAs involved in the translation of the movement proteins and the CP identified in most carmoviral infections, PFBV produces two additional sgRNAs whose biological significance is currently unknown. The possible participation of the 3.2 and 2.9kb PFBV sgRNAs in the expression of readthrough portions of the RdRp is discussed.


title: Ex-vivo Mechanical Testing of Novel Laryngeal Clamps Used for Laryngeal Advancement Constructs.

text: Rostral laryngeal advancement, also known as laryngeal tie-forward, is used to treat horses for intermittent dorsal displacement of the soft palate and has a morbidity rate of about 6%. We hypothesized that a novel laryngeal clamp would prevent morbidity associated with the sutures tearing through the thyroid cartilage. Larynges (n = 35 horses) were used for ex vivo testing. For uniaxial testing, 15 equine larynges were tested in one of three laryngeal tie-forward constructs [standard laryngeal tie-forward; modified laryngeal tie-forward using a suture-button; and modified laryngeal tie-forward using a laryngeal clamp]. For biaxial testing, 20 larynges were tested in one of two treatment groups: laryngeal tie-forward and laryngeal tie-forward using a laryngeal clamp. Constructs were tested in single cycle-to-failure. Statistical analyses were performed using ANOVA for uniaxial testing and t-tests for biaxial testing. The laryngeal tie-forward using a laryngeal clamp construct was superior to laryngeal tie-forward and laryngeal tie-forward using a suture-button constructs in resistance to pullout in uniaxial testing. The laryngeal tie-forward using a laryngeal clamp presented a significantly different method of failure than the standard laryngeal tie-forward in the biaxial testing. Failure modes for each construct were primarily by suture failure at the clamp (laryngeal tie-forward using a laryngeal clamp), suture pullout through the thyroid cartilage, or, less commonly, tearing of the cricothyroid ligament (laryngeal tie-forward). In uniaxial testing, the laryngeal tie-forward using a laryngeal clamp failed most commonly due to tearing of the cricothyroid ligament, whereas the standard laryngeal tie-forward and the laryngeal tie-forward using a suture-button failed due to the tearing of the cartilage. The laryngeal clamps provided greater stiffness, load at yield, and tensile stress at yield than did the standard construct. Laryngeal clamps may offer an alternative to standard methods of anchoring the thyroid cartilage when performing the laryngeal tie-forward procedure. Further testing and clinical trials are needed to elucidate the utility of the laryngeal tie-forward using a laryngeal clamp.


title: Polyester mesh dressings reduce delayed wound healing rates after total hip arthroplasty compared with silver-impregnated occlusive dressings.

text: Background New dressings purport to reduce surgical wound complications after total hip arthroplasty (THA). This study compared delayed wound healing rates and reoperations between 2 increasingly popular dressings: a silver-impregnated occlusive (standard) dressing and a 2-octyl cyanoacrylate adhesive with polyester mesh. Methods This retrospective cohort study reviewed 431 consecutive THAs performed by 2 surgeons between January 2017 and May 2019. One hundred and eight were excluded for not using standard or mesh dressings. A final 323 cases were separated into 2 cohorts: mesh (n = 186) and standard dressings (n = 137). Standard dressings were removed at 1 week. Mesh persisted until nonadherent, approximately 3-4 weeks. The surgeon assessed delayed wound healing at the 2-week postoperative visit. Secondary outcomes include deep infection and return to the operating room for a wound-related diagnosis. Differences were determined using the chi-square test. Results There were no demographic, comorbidity, or surgical differences between groups. There were 22 total cases of delayed wound healing with 7 (3.8%) in the mesh group and 15 (10.9%) in the standard dressing group (P = .01). There were no significant differences in reoperations (2 [1.1%] vs 2 [1.5%], P = .76) or deep infections (2 [1.1%] vs 1 [0.7%], P = .75). Conclusions Mesh dressings are a safe and reliable dressing type for THA and were associated with a decrease in early wound healing complications when compared with standard, silver-impregnated occlusive dressings in this retrospective series. The mesh tension sharing properties and longer duration of occlusive protection may explain this difference. Level of Evidence Level III.


Inpatient Teledermatology During the COVID-19 Pandemic.


title: Virtual surgical planning: a novel aid to robot-assisted laparoscopic partial nephrectomy.

text: BACKGROUND AND PURPOSE Incidental detection of small renal masses has significantly increased over the last two decades with the advent of cross-sectional imaging. The shift in stage has been met with a shift in treatment modality because the preservation of renal parenchyma can prevent adverse outcomes. Robot-assisted laparoscopic partial nephrectomy (RALPN) needs significant surgeon expertise, and preoperative planning is imperative. PATIENTS AND METHODS Between December 2010 and September 2011, virtual surgical planning (VSP) was used in consecutive patients with renal tumors that were suspicious for renal-cell carcinoma who were undergoing RALPN by a single surgeon. Three-dimensional (3D) reconstructions were examined and manipulated preoperatively, and an operative plan formulated. Intraoperative anatomy and preoperative 3D reconstructions were compared in real time. RESULTS A total of 10 patients underwent RALPN with preoperative VSP. Average patient age at intervention was 54.6 years and average tumor size was 4.3 cm (range 1.7-7.5 cm). Tumor laterality was evenly distributed. Nephrometry score ranged from 5A to 10P, and final tumor pathology results revealed malignancy in 80%. No complications occurred intraoperatively, and an excellent correlation was noted between preoperative 3D reconstruction and intraoperative anatomy. All patients underwent a successful partial nephrectomy with no positive margins on final pathology results. Mean length of surgery was 232.9 minutes (range 156-435 min), and mean estimated blood loss was 370 mL (range 75-1800 mL). Warm ischemia time ranged from 20 to 50 minutes (mean 33.9 min). Data regarding postoperative renal function were available for six patients with an average loss of function of 9.5% (range 2%-17%). CONCLUSIONS The implementation of this novel technology has significantly improved our ability to plan RALPN preoperatively. Tumor depth and complexity of tumor resection are assessed and the appropriate operative intervention and approach planned. Tumor proximity to vascular structures and collecting system were reliably predicted and therefore anticipated. Overall, these advantages created a safer surgical endeavor.


title: Common and emerging infectious diseases in the animal shelter.

text: The beneficial role that animal shelters play is unquestionable. An estimated 3 to 4 million animals are cared for or placed in homes each year, and most shelters promote public health and support responsible pet ownership. It is, nonetheless, inevitable that shelters are prime examples of anthropogenic biological instability: even well-run shelters often house transient, displaced, and mixed populations of animals. Many of these animals have received minimal to no prior health care, and some have a history of scavenging or predation to survive. Overcrowding and poor shelter conditions further magnify these inherent risks to create individual, intraspecies, and interspecies stress and provide an environment conducive to exposure to numerous potentially collaborative pathogens. All of these factors can contribute to the evolution and emergence of new pathogens or to alterations in virulence of endemic pathogens. While it is not possible to effectively anticipate the timing or the pathogen type in emergence events, their sites of origin are less enigmatic, and pathologists and diagnosticians who work with sheltered animal populations have recognized several such events in the past decade. This article first considers the contribution of the shelter environment to canine and feline disease. This is followed by summaries of recent research on the pathogenesis of common shelter pathogens, as well as research that has led to the discovery of novel or emerging diseases and the methods that are used for their diagnosis and discovery. For the infectious agents that commonly affect sheltered dogs and cats, including canine distemper virus, canine influenza virus, Streptococcus spp, parvoviruses, feline herpesvirus, feline caliciviruses, and feline infectious peritonitis virus, we present familiar as well as newly recognized lesions associated with infection. Preliminary studies on recently discovered viruses like canine circovirus, canine bocavirus, and feline norovirus indicate that these pathogens can cause or contribute to canine and feline disease.


title: Laparoscopic major hepatectomy: a systematic literature review and comparison of 3 techniques.

text: OBJECTIVE This review assesses the current status of laparoscopic liver resection. BACKGROUND The trend in laparoscopic liver resection has been moving from limited resections toward major hepatectomy. The surgical techniques for laparoscopic major hepatectomy include pure laparoscopic, hand-assisted laparoscopic, and laparoscopy-assisted methods. We performed a literature search and systematic review to assess the current status of laparoscopic major hepatectomy. METHODS Our literature review was conducted in Medline using the keywords "laparoscopy" or "laparoscopic" combined with "liver resection" or "hepatectomy." Articles written in English containing more than 10 cases of laparoscopic major hepatectomy were selected. RESULTS AND CONCLUSIONS Twenty-nine articles were selected for this review. The laparoscopic major hepatectomies achieved similar patient and economic outcomes compared with open liver resections in selected (noncirrhotic) patients. Surgeon experience with the techniques affected the results; thus, a learning period is mandatory. Of these 3 techniques, the pure laparoscopic method is suitable for experienced surgeons to achieve better cosmetic outcomes, whereas the hand-assisted laparoscopic method was associated with better perioperative outcomes; the laparoscopy-assisted method is used by surgeons for unique resections such as resection of cirrhotic livers, laparoscopic resection of tumors in unfavorable locations, and living donor hepatectomies. In addition, the laparoscopic major hepatectomy-specific, long-term oncologic outcomes remain to be addressed in future publications.


title: Hepatitis C virus, human immunodeficiency virus and Pseudomonas phage PS5 triad share epitopes of immunogenic determinants.

text: A lytic phage for Pseudomonas aeruginosa belongs to the Myoviridea family was isolated from urine for use in therapeutics. Pair of hepatitis C virus (HCV) primers highlighted segments on the genome of this phage. The sequence of these PCR products as well as the possible serological cross reactivity/relationship between HCV and the phage were investigated. One hundred HCV positive human sera were analyzed by ELISA. Ninety six well plates were coated with multiple epitopes of HCV proteins (Kit), phage and Pseudomonas cells. Initially the positive and negative control sera supplied in the test kit were used to evaluate the cross reactivity between the phage and anti-HCV antibodies. The results suggested a value over than 0.105 for a HCV positive reaction. Of the 100 HCV positive sera tested, sixty five and thirty percent showed cross reaction with phage lysate and Pseudomonas aeruginosa, respectively. High HCV antibody titer correlated to high cut off value for phage cross reaction, whereas no such correlation existed between HCV antibody titer and Pseudomonas cross reaction. The PCR products were sequenced and aligned with the HCV genome of H77. Sequence homology was detected in the 5', 3' UTRs and NS3 regions. Further these products showed similarity with HIV-1 Env, Pol & 3'LTR regions as well.


title: Albumin-gated zwitterion-stabilized mesoporous silica nanorod as a pH-responsive drug delivery system.

text: Silica nanoparticles as drug delivery systems (DDS) have received huge attention in nanomedicine research. However, their drug release processes were usually discussed in the absence of proteins, which are abundant in real delivery media and likely to affect the release behaviors. In this work, novel pH-sensitive silica-based DDSs were constructed using the endogenous protein, human serum albumin (HSA), as the gatekeeper, and their release properties in protein-containing media were measured for the first time. As-synthesized mesoporous silica nanorod (MSNR) was modified with zwitterions to suppress the nonspecific adsorption of protein and to improve the dispersity. HSA was fixed onto MSNR through drug-protein interactions and covalent bonds, respectively. Benzoic-imine bonds were introduced into the designs to realize pH responsiveness. The fluorescence quenching effect of drugs on HSA was used to monitor the drug release in simulated body fluids containing proteins. The results indicated that protein gating could effectively reduce premature release in normal blood environment. The endogenous protein capping, high dispersity and stability, considerable loading content, low cytotoxicity and favorable responsiveness to acidic microenvironment enable the present structures to be promising carriers for chemotherapy drugs.


Ethnicity and covid-19.


title: Three-dimensional printed PLA scaffold and human gingival stem cell-derived extracellular vesicles: a new tool for bone defect repair.

text: BACKGROUND The role of bone tissue engineering in the field of regenerative medicine has been a main research topic over the past few years. There has been much interest in the use of three-dimensional (3D) engineered scaffolds (PLA) complexed with human gingival mesenchymal stem cells (hGMSCs) as a new therapeutic strategy to improve bone tissue regeneration. These devices can mimic a more favorable endogenous microenvironment for cells in vivo by providing 3D substrates which are able to support cell survival, proliferation and differentiation. The present study evaluated the in vitro and in vivo capability of bone defect regeneration of 3D PLA, hGMSCs, extracellular vesicles (EVs), or polyethyleneimine (PEI)-engineered EVs (PEI-EVs) in the following experimental groups: 3D-PLA, 3D-PLA + hGMSCs, 3D-PLA + EVs, 3D-PLA + EVs + hGMSCs, 3D-PLA + PEI-EVs, 3D-PLA + PEI-EVs + hGMSCs. METHODS The structural parameters of the scaffold were evaluated using both scanning electron microscopy and nondestructive microcomputed tomography. Nanotopographic surface features were investigated by means of atomic force microscopy. Scaffolds showed a statistically significant mass loss along the 112-day evaluation. RESULTS Our in vitro results revealed that both 3D-PLA + EVs + hGMSCs and 3D-PLA + PEI-EVs + hGMSCs showed no cytotoxicity. However, 3D-PLA + PEI-EVs + hGMSCs exhibited greater osteogenic inductivity as revealed by morphological evaluation and transcriptomic analysis performed by next-generation sequencing (NGS). In addition, in vivo results showed that 3D-PLA + PEI-EVs + hGMSCs and 3D-PLA + PEI-EVs scaffolds implanted in rats subjected to cortical calvaria bone tissue damage were able to improve bone healing by showing better osteogenic properties. These results were supported also by computed tomography evaluation that revealed the repair of bone calvaria damage. CONCLUSION The re-establishing of the integrity of the bone lesions could be a promising strategy in the treatment of accidental or surgery trauma, especially for cranial bones.


title: Impact of COVID-19 on gaming disorder: Monitoring and prevention.

text: The global coronavirus disease 2019 (COVID-19) outbreak has necessitated physical distancing, lockdown, contact tracing, and self-quarantine so as to prevent the spread of the disease. Amid the outbreak, gaming data usage has reportedly increased in the United States, and game download volume has reached a record high in Europe. Because gaming can be used to cope with the psychological stress from the outbreak, therefore mental health professionals should be aware of how increased gaming during the pandemic may contribute to risk of gaming disorder, especially if the pandemic persists. Mental health professionals should thus formulate safe social interaction alternatives for people, particularly adolescents, who have gaming disorder risk.


title: Indian Association of Gastrointestinal Endo Surgeons COVID-19 endoscopy recommendations.

text: These are recommendations from the Indian Association of Gastro Intestinal Endo Surgeons for safe performance of diagnostic and therapeutic endoscopy during the COVID-19 pandemic.


title: A tetravalent dengue vaccine based on a complex adenovirus vector provides significant protection in rhesus monkeys against all four serotypes of dengue virus.

text: Nearly a third of the human population is at risk of infection with the four serotypes of dengue viruses, and it is estimated that more than 100 million infections occur each year. A licensed vaccine for dengue viruses has become a global health priority. A major challenge to developing a dengue vaccine is the necessity to produce fairly uniform protective immune responses to all four dengue virus serotypes. We have developed two bivalent dengue virus vaccines, using a complex adenovirus vector, by incorporating the genes expressing premembrane (prM) and envelope (E) proteins of dengue virus types 1 and 2 (dengue-1 and -2, respectively) (CAdVax-Den12) or dengue-3 and -4 (CAdVax-Den34). Rhesus macaques were vaccinated by intramuscular inoculation of a tetravalent dengue vaccine formulated by combining the two bivalent vaccine constructs. Vaccinated animals produced high-titer antibodies that neutralized all four serotypes of dengue viruses in vitro. The ability of the vaccine to induce rapid, as well as sustained, protective immune responses was examined with two separate live-virus challenges administered at 4 and 24 weeks after the final vaccination. For both of these virus challenge studies, significant protection from viremia was demonstrated for all four dengue virus serotypes in vaccinated animals. Viremia from dengue-1 and dengue-3 challenges was completely blocked, whereas viremia from dengue-2 and dengue-4 was significantly reduced, as well as delayed, compared to that of control-vaccinated animals. These results demonstrate that the tetravalent dengue vaccine formulation provides significant protection in rhesus macaques against challenge with all four dengue virus serotypes.


title: Transfusion practices and infectious risks.

text: Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks.


title: Serum and hepatic vitamin A levels in captive and wild marine toads (Bufo marinus).

text: The captive breeding program for the endangered Puerto Rican crested toad (Peltophryne [Bufo] lemur) has been hampered by an undiagnosed condition called "Brown Skin Disease" (BSD). Toads develop widespread skin darkening, skin thickening and abnormal shedding and eventually succumb to a chronic loss of viability. This project evaluated the marine toad (Bufo marinus) as a model for the PRCT, examining vitamin A deficiency as a potential cause of BSD. Wild caught marine toads had significantly higher liver vitamin A concentrations (61.89 ± 63.49 µg/g) than captive born marine toads (0.58 ± 0.59 µg/g); P<0.001). A significant difference in serum vitamin A concentration was found between the captive and wild caught toads (P=0.013) and between the low vitamin A-fed and wild caught toads (P=0.004), when controlling for liver vitamin A concentrations. After captive toads were treated with topical and/or oral vitamin A, their hepatic vitamin A concentrations were similar to those of the wild toads, averaging 48.41 ± 37.03 µg/g. However, plasma vitamin A concentrations pre- and post-vitamin A supplementation did not differ statistically. We concluded that plasma vitamin A concentrations do not provide a linear indication of liver/body vitamin A status, and that both topical and oral supplementation with an oil-based vitamin A formulation can increase liver stores in amphibians. No evidence of BSD or other signs of deficiency were noted in the marine toads, although this feeding trial was relatively short (127 days). To date, clinical, pathological and research findings do not support vitamin A deficiency as a primary factor underlying BSD.


title: Altered gene expression in gingival tissues and enhanced bone loss in rats with diabetes with experimental periodontitis.

text: BACKGROUND Systemic hyperglycemia is clearly related to severity of periodontitis, meaning that periodontitis can be exacerbated by diabetes mellitus (DM). However, the biologic mechanisms responsible for this relationship remain unclear. Thus, in this study, the global gene expression in gingival tissue with periodontitis is profiled in Zucker diabetic fatty (ZDF) rats compared with Zucker normoglycemic littermates (Lean). METHODS At age 8 weeks, ZDF and Lean rats received ligature placement around the maxillary right second molar. At 0, 14, 28, 42, and 56 days after ligature placement, the maxilla around the molar was analyzed using microcomputed tomography. Two and 7 days after ligature placement, total RNA in the gingival tissue was isolated, and gene expression analysis was conducted using a rat oligo array. To validate the microarray findings, the selected genes were analyzed using real-time quantitative polymerase chain reaction assays. RESULTS There was a significant difference regarding the average amount of bone resorption between ZDF and Lean rats from days 14 to 56. On day 2, it was found that 113 genes were regulated (20 upregulated, 93 downregulated) in the presence of DM. Lipopolysaccharide binding protein (LBP) messenger RNA (mRNA) expression was significantly higher in gingival tissue with periodontitis from ZDF rats compared with that from Lean rats. On day 7, interleukin (IL)-10 and IL-24 mRNA levels were significantly lower, whereas IL-2 level was significantly elevated. CONCLUSION The results of this study indicate that the role of DM in modulating bone breakdown related to periodontitis may involve an increased level of LBP and reduced levels of T-helper 2 cytokines.


title: The risk of the collapse of public health centres under the current system to prevent the spread of COVID-19.

text: None.


title: Laparoendoscopic single-site surgery using innovative articulating instruments: preclinical evaluation of the prototype.

text: Conventional articulating instruments for laparoendoscopic single-site (LESS) surgery have three major drawbacks: Weak articulating force, internal and external crowding, and mirror imaging and motion. The RoboHand™ is a recently developed novel articulating instrument. The goal of its development was to minimize the abovementioned three major drawbacks. In an ex vivo test, the joint force of the RoboHand was 2.5 to 3 times stronger than that of the LaparoAngle™ or the SILS™ instrument. In the porcine nephrectomy model, the operative times in the RoboHand group (28.8±6.6 min) were shorter than those in the LaparoAngle group (39.7±5.4 min), although not significant (P=0.146). The RoboHand prototype seems to be superior to other articulating laparoscopic instruments in its mechanical properties, such as joint force, and not to be clinically inferior to LaparoAngle for LESS. We describe the techniques for using this innovative instrument and discuss its advantages.


title: Gestational age-dependent relationship between cerebral oxygen extraction and blood pressure.

text: BackgroundPremature infants may lack mature cerebrovascular autoregulatory function and fail to adapt oxygen extraction to decreasing systemic perfusion.MethodsInfants ≤28 weeks of gestational age (GA) were recruited. Systemic oxygen saturation (SpO2), mean arterial blood pressure (MABP), and cerebral saturation (near-infrared spectroscopy, SctO2) were measured continuously over the first 72 h. Resulting data underwent error-processing. For each remaining 10 m window, the mean MABP and fractional tissue oxygen extraction (FTOE) were calculated. The infants were divided into two groups (23-25 and 26-28 weeks). The median FTOE at low, medium, and high MABP values (empirically defined within each group based on the 25th and 75th centile) were compared between estimated gestational age (EGA) groups.ResultsSample n=68, mean±SD GA=25.5±1.3 weeks, and birthweight (BW)=823±195 g. The median FTOE in the more preterm group vs. more mature group was statistically different at lower value of MABP (P<0.01) and higher values of MABP (P=0.01), but not at medium values (P=0.55).ConclusionThe more mature group (GA 26-28 weeks) displayed an appropriate increase in oxygen extraction during hypotension, steadily decreasing as MABP increased, suggesting mature autoregulation. An opposite response was noted in the more preterm group, suggesting an inability to mount a compensatory response when BP is outside of the physiologic range.


Coronavirus Disease COVID-19: A New Threat to Public Health.


Licking the lungs, biting the brain: malignant MCA infarct in a patient with COVID 19 infection.


title: The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups.

text: OBJECTIVE Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer-specific mortality by 20%. METHOD The American Association for Thoracic Surgery created a multispecialty task force to create screening guidelines for groups at high risk of developing lung cancer and survivors of previous lung cancer. RESULTS The American Association for Thoracic Surgery guidelines call for annual lung cancer screening with low-dose computed tomography screening for North Americans from age 55 to 79 years with a 30 pack-year history of smoking. Long-term lung cancer survivors should have annual low-dose computed tomography to detect second primary lung cancer until the age of 79 years. Annual low-dose computed tomography lung cancer screening should be offered starting at age 50 years with a 20 pack-year history if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years. Lung cancer screening requires participation by a subspecialty-qualified team. The American Association for Thoracic Surgery will continue engagement with other specialty societies to refine future screening guidelines. CONCLUSIONS The American Association for Thoracic Surgery provides specific guidelines for lung cancer screening in North America.


title: Strategies to minimize adhesions to intraperitoneally placed mesh in laparoscopic ventral hernia repair.

text: INTRODUCTION Adhesions to mesh/tacks in laparoscopic ventral hernia repair are often cited as reasons not to adopt its evidence-based superiority over conventional open methods. This pilot study assessed the occurrence of adhesions to full-sized Polypropylene and Gore-tex DualMesh Plus meshes and the possibility for adhesion prevention using fibrin sealant. METHODS Two 10-cm to 15-cm pieces of mesh were placed and fixed laparoscopically in pigs (25kg to 55kg). Group I: 2 animals with Polypropylene mesh on one side and DualMesh on other side. Group II: 2 animals with DualMesh on each side with fibrin sealant applied to the periphery of mesh and staples to one side. Group III: 1 animal with 2 pieces of Polypropylene mesh with fibrin sealant applied to the entire mesh. All animals underwent laparoscopy 3 months later to assess the extent of adhesions, and full-thickness specimens were removed for histological evaluation. RESULTS More Polypropylene mesh was involved in adhesions than DualMesh. However, with the DualMesh involved in adhesions, more of the surface area was involved in forming adhesions than with Polypropylene mesh. None of the implanted DualMesh had visceral adhesions, while 2 out of 3 Polypropylene meshes had adhesions to both the liver and spleen but none to the bowel. Implanted Polypropylene mesh with fibrin sealant had no adhesions. DualMesh had shrunk more significantly than Polypropylene mesh. Histological evaluation showed absence of acute inflammatory response, significantly more chronic inflammatory response to DualMesh compared to Polypropylene and complete mesothelialization with both meshes. There was extensive collagen deposition between Polypropylene mesh fibers, while fibrosis occurred on both sides of DualMesh with synovial metaplasia over its peritoneal surface akin to encapsulation. CONCLUSIONS DualMesh caused fewer omental and visceral adhesions than Polypropylene mesh did. Fibrin sealant eliminated adhesions to DualMesh and prevented adhesions to Polypropylene mesh when applied over the entire surface. These results support our current use of DualMesh and fibrin sealant in LVHR.


title: [Attach importance to COVID-19 infection on maternal and infant outcomes].

text: 新型冠状病毒肺炎（COVID-19）是我国今冬突发的公共卫生事件，具有高度传染性的疾病。孕产妇作为一类特殊的人群，更成为感染防控的重点人群。基于现有的临床数据及研究资料，妊娠中晚期合并COVID-19感染孕妇的临床特征与非妊娠期成人患者相似，暂无证据表明COVID-19孕妇容易发展为重症肺炎或死亡。且尚未发现妊娠晚期新型冠状病毒感染可导致宫内垂直传播和乳汁传播的证据。后续的临床及科研工作中，应继续对妊娠合并COVID-19感染的临床病例进行收集、归纳和总结，并加强对COVID-19感染产妇及其新生儿的随访。.


Covid-19: Lack of testing in Brazil is a "major failure," says MSF.


title: Transvenous Curative Embolization of Cerebral Arteriovenous Malformations: A Prospective Cohort Study.

text: BACKGROUND Curative transvenous embolization is an emerging strategy for treatment of cerebral arteriovenous malformations (AVMs). OBJECTIVE To assess contemporary outcomes of transvenous embolization as a stand-alone therapy for cerebral AVMs. METHODS We prospectively followed 40 patients with 41 AVMs who underwent transvenous endovascular therapy between January 2008 and January 2015. Patient demographics, AVM characteristics, endovascular techniques used, angiographic results, clinical outcomes, and complications were assessed independently. RESULTS Thirty-eight of 41 (92.6%) AVMs were anatomically cured. The mean patient age was 37.7 yr (range, 18-69 yr) and 55% were female. Twenty-seven (67.5%) patients presented with hemorrhage. The mean size of the AVM nidus was 2.8 ± 1.2 cm, and low Spetzler-Martin grade AVMs comprised 41.5% of lesions. The majority of patients were treated in 1 session (56%; n = 23). The mean follow-up period was 28.4 (range, 6-106 mo). There was 1 (2.5%) hemorrhagic complication related to microcatheter navigation and 1 (2.5%) venous infarction was observed without clinical consequences. At 6-mo follow-up, 1 (2.5%) patient had significant disability. There were no recurrences during the follow-up period. Overall mortality was 2.5% and procedure-related mortality was 0%. CONCLUSION This prospective contemporary series demonstrates a high rate of complete AVM obliteration and excellent functional outcomes in patients with both ruptured and unruptured AVMs treated with transvenous embolization. This approach is promising and warrants further investigation as a treatment for select AVMs.


title: Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer.

text: BACKGROUND The aim of this study was to compare the results of laparoscopy-assisted total gastrectomy with those of open total gastrectomy for early gastric cancer. METHODS Patients with gastric cancer who underwent total gastrectomy with curative intent in three Korean tertiary hospitals between January 2003 and December 2010 were included in this multicentre, retrospective, propensity score-matched cohort study. Cox proportional hazards regression models were used to evaluate the association between operation method and survival. RESULTS A total of 753 patients with early gastric cancer were included in the study. There were no significant differences in the matched cohort for overall survival (hazard ratio (HR) for laparoscopy-assisted versus open total gastrectomy 0.96, 95 per cent c.i. 0.57 to 1.65) or recurrence-free survival (HR 2.20, 0.51 to 9.52). The patterns of recurrence were no different between the two groups. The severity of complications, according to the Clavien-Dindo classification, was similar in both groups. The most common complications were anastomosis-related in the laparoscopy-assisted group (8.0 per cent versus 4.2 per cent in the open group; P = 0.015) and wound-related in the open group (1.6 versus 5.6 per cent respectively; P = 0.003). Postoperative death was more common in the laparoscopy-assisted group (1.6 versus 0.2 per cent; P = 0.045). CONCLUSION Laparoscopy-assisted total gastrectomy for early gastric cancer is feasible in terms of long-term results, including survival and recurrence. However, a higher postoperative mortality rate and an increased risk of anastomotic leakage after laparoscopic-assisted total gastrectomy are of concern.


title: A multifactorial regression analysis of the features of community-acquired rotavirus requiring hospitalization in Spain as represented in the Minimum Basic Data Set.

text: Over 10% of acute rotavirus gastroenteritis (ARGE) requires hospitalization because of complications. The aggravating factors have been widely analysed, but in an isolated way. We aimed to explore the interrelationship between the clinical and epidemiological factors that characterize rotavirus hospitalizations in Spain using information from the Minimum Basic Data Set (MBDS). Using ICD-9-CM codes, we classified acute gastroenteritis (AGE) cases by principal diagnosis fields and then categorized their comorbidities, complications, and epidemiological features by secondary fields. A multivariable, logistic, step-wise regression model was then constructed. We identified 1657 ARGE cases from 17 415 cases of AGE. Rotavirus hospitalizations were associated with place of residence, age, and season (P < 0·0001), as well as with dehydration [odds ratio (OR) 12·44, 95% confidence interval (CI) 1·52-40·38], intravenous rehydration (OR 1·74, 95% CI 1·29-2·35), metabolic acidosis (OR 1·51, 95% CI 1·24-1·83), respiratory tract infections (RTIs) (OR 1·60, 95% CI 1·09-1·98), and concomitant AGE (OR 1·52, 95% CI 1·03-2·25). Dehydration was four times more likely in patients aged <5 years (OR 4·36, 95% CI 1·20-12·96) and was associated with acidosis when ARGE and RTI were present simultaneously (P < 0·0001). Specific co-infecting viruses may play a role in acute respiratory symptoms and aggravation of gastrointestinal manifestations of rotaviruses, thus leading to complications requiring hospitalization.


COVID-19-Associated Leukoencephalopathy.


title: The adoption of advanced surgical techniques: are surgical masterclasses enough?

text: BACKGROUND The surgical master class is a traditional method for a surgeon to learn new operations. However, there is limited evidence to support that it can help a surgeon adopt a new technique. The aim of this study was to investigate the adoption of surgical techniques after attendance at a surgical master class. METHODS A questionnaire was sent to surgeons attending surgical master classes in laparoscopic bariatric and colorectal surgery. The questionnaire examined operative experience before attending the master class and the consequent adoption of techniques. RESULTS There was a significant adoption of colorectal procedures, from 33% to 79% (P = .00011), and bariatric procedures, from 27% to 66% (P = .014), after attendance at the surgical master classes. CONCLUSIONS This study shows a significant increase in surgeons' performing advanced surgical procedures after attendance at a surgical master class. This is the first study to demonstrate the effectiveness of the master class in terms of surgeons' adopting new techniques.


title: Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Metallic Stents.

text: BACKGROUND Recent evidence suggests that bioresorbable vascular scaffolds (BVS) are associated with an excess of thrombotic complications compared with metallic everolimus-eluting stents (EES). OBJECTIVES This study sought to investigate the comparative effectiveness of the Food and Drug Administration-approved BVS versus metallic EES in patients undergoing percutaneous coronary intervention at longest available follow-up. METHODS The authors searched MEDLINE, Scopus, and web sources for randomized trials comparing BVS and EES. The primary efficacy and safety endpoints were target lesion failure and definite or probable stent thrombosis, respectively. RESULTS Seven trials were included: in sum, 5,583 patients were randomized to receive either the study BVS (n = 3,261) or the EES (n = 2,322). Median time of follow-up was 2 years (range 2 to 3 years). Compared with metallic EES, risk of target lesion failure (9.6% vs. 7.2%; absolute risk difference: +2.4%; risk ratio: 1.32; 95% confidence interval: 1.10 to 1.59; number needed to harm: 41; p = 0.003; I2 = 0%) and stent thrombosis (2.4% vs. 0.7%; absolute risk difference: +1.7%; risk ratio: 3.15; 95% confidence interval: 1.87 to 5.30; number needed to harm: 60; p < 0.0001; I2 = 0%) were both significantly higher with BVS. There were no significant differences in all-cause or cardiovascular mortality between groups. The increased risk for ST associated with BVS was concordant across the early (<30 days), late (30 days to 1 year), and very late (>1 year) periods (pinteraction = 0.49). CONCLUSIONS Compared with metallic EES, the BVS appears to be associated with both lower efficacy and higher thrombotic risk over time. (Bioresorbable vascular scaffold compare to everolimus stents in long term follow up; CRD42017059993).


Anterior mediastinal masses: look before you leap.


title: Why the immune system fails to mount an adaptive immune response to a Covid -19 infection.

text: The Covid-19 pandemic has already affected many thousands of people and has become the greatest health challenge worldwide [1]. The range of clinical presentations varies from asymptomatic and mild clinical symptoms to acute respiratory-distress syndrome (ARDS) and death. Due to the unknown number of asymptomatic viral-shedding and pauci-symptomatic people in the community, the total number of infections is uncertain. As yet, effective treatment is unavailable. However, the results of preliminary studies and clinical trials are improving our understanding of the pathogenesis and treatment of Covid-19. Herein, we share our personal opinions on the immunopathogenesis of this infection.


title: Laparoscopic ventral rectopexy: a prospective long-term evaluation of functional results and quality of life.

text: BACKGROUND Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy. METHODS Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI). RESULTS Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3-7 days). After a mean follow-up of 42 ± 7 months (range 32-52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients' Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001). CONCLUSIONS This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation.


title: Protecting and Improving the Lives of Older Adults in the COVID-19 Era.

text: The COVID-19 pandemic has impacted the lives of people throughout the world, either directly, due to exposure to the virus, or indirectly, due to measures taken to mitigate the virus' effects. Older adults have been particularly hard hit, dying in disproportionately higher numbers, especially in long-term care facilities. Local, regional, and national government actions taken to mitigate the spread of COVID-19 have thus served, in part, to shield older adults from the virus, though not without adverse side effects, including increased social isolation, enhanced economic risk, revealed ageism, delayed medical treatment, and challenges getting basic needs met. This special issue of the Journal of Aging & Social Policy explores the myriad ways in which the COVID-19 pandemic has affected older adults and their families, caregivers, and communities. It proposes policies and strategies for protecting and improving the lives of older people during the pandemic. It draws lessons for aging policy and practice more generally, given underlying challenges brought to the fore by government, provider, community, and individual responses to the pandemic.


title: The effects of a recruitment manoeuvre with positive end-expiratory pressure on lung compliance in patients undergoing robot-assisted laparoscopic radical prostatectomy.

text: The effects of a recruitment manoeuvre (RM) with positive end-expiratory pressure (PEEP) on lung compliance (CLUNG) are not well characterised in robot-assisted laparoscopic radical prostatectomy (RARP). Patients were allocated to group R (n = 10; with an RM) or C (n = 9; without an RM). An RM involved sustained inflation of 30 cmH2O for 30 s. The lungs were ventilated with volume-controlled ventilation with tidal volume of 7 mL kg-1 of predicted body weight and fraction of inspired oxygen of 0.5. End-tidal carbon dioxide pressure was maintained at normocapnia. Patients were in the horizontal lithotomy position (pre-op). After pneumoperitoneum, patients underwent RARP in a steep Trendelenburg lithotomy position at a PEEP level of 0 cmH2O (RARP0). An RM was used in the R group but not in the C group. Patients were then ventilated with 5 cmH2O PEEP for 1 h after RARP0 (RARP5.1) and 2 h after RARP0 (RARP5.2). Oesophageal pressure and airway pressure were measured for calculating CLUNG and chest wall compliance. CLUNG significantly decreased from pre-op to RARP0 and did not significantly increase from RARP0 to RARP5.1 and RARP5.2 in either group. CLUNG differed significantly between groups at RARP5.1 and RARP5.2 (103 ± 30 vs. 68 ± 11 mL cm-1 H2O and 106 ± 35 vs. 72 ± 9 mL cm-1 H2O; P < 0.05). In patients undergoing RARP, with the addition of RM, the CLUNG was effectively increased from the horizontal lithotomy position to the steep Trendelenburg lithotomy position under pneumoperitoneum.


title: Single-port access in laparoscopic cholecystectomy.

text: BACKGROUND Single-port access cholecystectomy is a new laparoscopic procedure using only one, transumbilical-placed port. The method has been denominated by some authors as "scarless." We report one of the initial clinical experiences in Europe with this new technique. METHODS Fourteen patients underwent laparoscopic cholecystectomy using the ASC TriPort. In all cases, a small transumbilical incision was used to insert two 5-mm rigid laparoscopic instruments and a 5-mm 30 degrees telescope via the Triport. Hemostasis control was obtained by using an ultrasonic cutting device (SonoSurg, Olympus), Endo Clips (Covidien), and Lapro-Clips (Covidien). RESULTS All cases were completed successfully. There were no perioperative port-related or surgical complications. No extra skin incisions were needed. Operative time was longer than in common laparoscopic cholecystectomy. CONCLUSIONS Transumbilical single-port access cholecystectomy (SPACE) is a feasible technique for operating with less scars and reducing postoperative discomfort at the same time. The transumbilical single-port access for laparoscopic cholecystectomy has multiple benefits, such as better cosmetic results, less wound infections, and less incisional hernias. That is why SPACE is even more appropriate for obese patients. Using one-hand specialized instruments, which are curved at the shaft, and a semiflexible laparoscopic camera (LTFVH, Olympus) will make SPACE more comfortable and more time-saving.


title: Simultaneous liquefaction, saccharification, and fermentation of L-lactic acid using aging paddy rice with hull by an isolated thermotolerant Enterococcus faecalis DUT1805.

text: Simultaneous liquefaction, saccharification, and fermentation (SLSF) has attracted much attention for the production of bio-based chemicals, including L-lactic acid, due to its high efficiency and low cost. In this study, a lactic acid-producing bacterium with high tolerance of temperature up to 55 °C was isolated and characterized as Enterococcus faecalis DUT1805. Various strategies of stepwise controlled temperature were proposed and investigated for glucose utilization. The results indicated that E. faecalis DUT 1805 exhibited an optimal temperature at 50 °C, which could achieve temperature compatibility of enzyme, saccharification, and fermentation, and decrease the possibility of contamination by the other microorganisms during the large-scale fermentation. To reduce the cost of raw material and operation for lactic acid production, aging paddy rice with hull (APRH) was used in L-lactic acid production by simultaneous liquefaction, saccharification, and fermentation (SLSF). An open SLSF operation at 50 °C and pH 6.5, and 17% (w/v) solid loading in 5 L bioreactors was demonstrated with the lactic acid titer, yield, and productivity of 73.75 g/L, 87% to initial starch, and 2.17 g/(L h), respectively.


title: The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol.

text: INTRODUCTION Early identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, 'To what degree does CAPA work, for whom and under what circumstances?'. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting client and system outcomes. METHODS AND ANALYSIS We will conduct a realist-informed scoping review of the literature related to CAPA in either child and adolescent or adult community mental health and addictions services. Relevant studies, reports and documentation will be identified by searching the following online databases: MEDLINE, Embase, CINAHL, PsycINFO, Academic Search Premier, ERIC, Web of Science, Cochrane, Dissertations Abstracts, NCBI Bookshelf, PubMed Central and the Canadian Health Research Collection. The search strategy was developed by a health sciences library scientist and informed by a multidisciplinary team comprising methodological and content knowledge experts. The search will gather evidence from multiple online databases of peer-reviewed literature and grey literature repositories. All articles will be independently assessed for inclusion by pairs of reviewers. The key themes derived from a thematic analysis of extracted data will be presented in a narrative overview. ETHICS AND DISSEMINATION Research ethics review is not required for this scoping review. The results will be disseminated through meetings with stakeholders (including clients and families, clinicians and decision-makers), conference presentations and peer-reviewed publication. The results of this review will inform an overarching programme of research, policy and quality indicator development to ultimately improve mental health and addictions care and subsequent mental health outcomes for children and adolescents.


It is Time to Address Airborne Transmission of COVID-19.


Thalidomide combined with low-dose short-term glucocorticoid in the treatment of critical Coronavirus Disease 2019.


Dietary supplement linked to cases of acute hepatitis.