title: Reliability of pulse oximetry in hypoxic newborn pigs.

text: OBJECTIVE The reliability of pulse oximetry in the lower SaO2-ranges has not been fully investigated. We wanted to investigate pulse oximeter performance in a pig model of perinatal asphyxia. METHODS Asphyxia was induced in 22 newborn pigs. Pulse oximetry-values for SpO2, as well as SaO2 from blood gas analyses were recorded multiple times before, during and after asphyxiation. The relationship between SpO2 and SaO2 in normoxia and hypoxia in this model was quantified. Calculations were made for 5% increments of SaO2 increasing successively from ≥95% to ≥20%. RESULTS The pigs became severely hypoxic, acidotic and hypotensive. The bias in the total data was +13.7 (p < 0.001), i.e. SpO2 was on average higher than SaO2 for the entire interval of SaO2. However, bias was not significantly different from zero in most SpO2-ranges. Accuracy and precision were considerably higher than stated by the manufacturer in all SpO2-ranges, with both accuracy and precision increasing when SpO2-values down to 60% and lower were included. CONCLUSION Pulse oximetry was less reliable at SaO2-values below 60%. Tissue acidosis and reduced peripheral perfusion may have contributed to this. It is unknown whether the difference between SpO2 and SaO2 is clinically relevant.


title: Acute Stroke in Times of the COVID-19 Pandemic: A Multicenter Study.

text: BACKGROUND AND PURPOSE This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. METHODS In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. RESULTS Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (-85%, -46%, -42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, -60%; thrombectomy, -61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. CONCLUSIONS These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.


title: MR imaging in the presence of ballistic debris of unknown composition: a review of the literature and practical approach.

text: Due to a combination of increasing indications for MR imaging, increased MRI accessibility, and extensive global armed conflict over the last few decades, an increasing number of patients now and in the future will present with retained metallic ballistic debris of unknown composition. To date, there are no guidelines on how to safely image these patients which may result in patients who would benefit from MRI not receiving it. In this article, we review the current literature pertaining to the MRI safety of retained ballistic materials and present the process we use to safely image these patients.


title: [Thoughts and suggestions on analysis of death cases report during COVID-19 epidemic].

text: It is an essential task to discuss the death cases for clinicians. During the emergent public events, the report and analysis of death cases is of far-reaching significance. The epidemic of coronavirus disease 2019(COVID-19) has brought huge losses to China, and the medical system has been sustaining tremendous pressure. The best weapon to defeat the epidemic is medical data and related scientific research, of which the systematic analysis and efficient use of death cases is a key step. Based on the incomplete record of death case report, the lack of humanistic perspective and patient report, every department and institution is facing great challenge in terms of data management. Given that the relevant systems need to be improved, and that the integration of standardized reports and clinical research is not mature,as well as other problems, we put forward several methodological suggestions: ① Establish national medical and health data center and improve relevant laws and regulations. ② Increase investment in medical data management and start data collection and analysis as early as possible during the epidemic. ③ Refine the content of death case report and promote the standardization of report. ④ Pay close attention to the report of death cases, review, summary and analysis. More importantly, we should continue to build and improve platforms and programs related to disease control, carry out epidemic-associated scientific research, enhance the managing efficiency of public health data, elevate the anti-risk capability of our medical system, and promote the steady progress of the health China strategy.


title: Relation Between Platelet Count and Platelet Reactivity to Thrombotic and Bleeding Risk: From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Study.

text: Whether the association between platelet count (PC) and thrombotic and bleeding risk is independent of or varies by residual platelet reactivity to antiplatelet therapies is unclear. We sought to investigate the independent and combined effects of PC and platelet reactivity on thrombotic and bleeding risk after coronary artery implantation of drug-eluting stents (DES). Patients enrolled in the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents study were stratified by PC tertiles. The study cohort comprised 8,402 patients. By linear regression analysis, lower PC was strongly and independently associated with higher platelet reactive units (PRUs) on clopidogrel. After multivariable adjustment (including PRU and aspirin reactive units), high, but not low, PC tertile was independently associated with higher risk of thrombotic complications, including spontaneous myocardial infarction and stent thrombosis. Although no independent association was observed between PC tertiles and hemorrhagic risk, both high and low PC tertiles were associated with increased risk for all-cause mortality. After stratification of PC tertiles by tertiles of PRUs, the crude risk of thrombotic complications was highest in patients in the high PC and high PRU tertiles. By multivariable adjustment, PRU increases were uniformly associated with higher risk of thrombotic events across PC tertiles, without evidence of interaction. In conclusion, higher PCs and higher PRUs act independently and synergistically in determining thrombotic risk. Alongside PRU, PCs could be a simple hematological parameter to consider for risk stratification and in tailoring duration and potency of pharmacologic platelet inhibition after DES implantation.


title: Pain and stress assessment after retinopathy of prematurity screening examination: indirect ophthalmoscopy versus digital retinal imaging.

text: BACKGROUND Increasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress. METHODS The purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination. RESULTS Changes over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3-5). At 30 seconds the score was 8 (6-9) for BIO and 6 (5-7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments. CONCLUSIONS A transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.


Headache is an important symptom in patients with coronavirus disease 2019 (COVID-19).


title: [COVID-19 Pandemic: global epidemiological trends and China's subsequent preparedness and responses].

text: The outbreak of COVID-19 has spread quickly across 114 countries/territories/areas in six continents worldwide and has been announced as a pandemic by WHO. This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China's subsequent preparedness and responses.


title: Diffuse Parenchymal Abnormalities in Acutely Dyspneic Patients: A Pattern-based Approach.

text: Acute dyspnea is a common presenting complaint in the Emergency Room. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities that require further assessment with computed tomography (CT). The aim of this review is to outline a pattern-based approach for the analysis of diffuse pulmonary abnormalities in an acutely dyspneic patient with emphasis on CT appearances. Specific disease entities may be differentiated by their distribution in the lungs and by their radiologic findings. Recognition of the predominant finding and its distribution can generate an appropriate differential diagnosis that is further refined by the presence or absence of ancillary findings. Incorporation of the clinical history, laboratory data, and prior studies narrows the differential diagnosis, indicates the optimum modality for further evaluation, and, in some situations, provides important prognostic data.


title: RFA of primary and metastatic lung tumors: long-term results.

text: The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.


title: The relationship between diet and cognitive function in adult cancer survivors: a systematic review.

text: PURPOSE To perform a systematic review identifying how dietary factors are related to cognitive function in cancer survivors who are not currently undergoing primary treatment. METHODS Using the PRISMA framework, a search was conducted for studies published before February 2019 across multiple databases, identifying 2304 unique articles. Twelve met final inclusion criteria and were evaluated through narrative synthesis. This review was registered with the International Prospective Register Of Systematic Reviews (CRD42018111941). RESULTS Included studies were heterogeneous in methodology and in dietary and cognitive variables investigated making direct comparisons difficult. Evidence of a relationship between diet and cognition was mixed; the most consistent evidence was identified in relation to a positive relationship between fruit and vegetable intake and cognitive function (both self-reported and objectively tested) in five out of six studies, but was not concordant across all studies. CONCLUSION Preliminary evidence exists that a greater fruit and vegetable intake is associated with better cognitive functioning in cancer survivors, as has been reported in healthy populations; however, these data are correlational and include relatively small samples. Most evidence related to breast cancer survivors, with individual studies extending to colorectal and stomach cancer survivors. Experimental trials are needed to identify causal attribution of dietary factors on cognitive function in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS At this time, there is not sufficient evidence to make dietary or nutritional recommendations specifically for improving cognitive function in cancer survivors. This should be considered in light of the general paucity of research on this subject, necessitating further investigations.


title: The effects of culture and self-construal on responses to threatening health information.

text: OBJECTIVE The current studies examined if cultural and self-construal differences in self-enhancement extended to defensive responses to health threats. DESIGN Responses to fictitious medical diagnoses were compared between Asian-Americans and European-North Americans in experiment 1 and between Canadians primed with an interdependent versus an independent self-construal in experiment 3. In experiment 2, the responses of Chinese and Canadians who were either heavy or light soft drink consumers were assessed after reading an article linking soft drink consumption to insulin resistance. MAIN OUTCOME MEASURE The primary-dependent measure reflected participants' defensiveness about threatening versus nonthreatening health information. RESULTS In experiment 1, all participants responded more defensively to an unfavourable than a favourable diagnosis; however, Asian-Americans responded less defensively than did European-North Americans. In experiment 2, all high soft drink consumers were less convinced by the threatening information than were low soft drink consumers; however, among high consumers, Chinese changed their self-reported consumption levels less than did European-Canadians. In experiment 3, interdependence-primed participants responded less defensively to an unfavourable diagnosis than did independence-primed participants. CONCLUSION Defensive reactions to threatening health information were found consistently; however, self-enhancement was more pronounced in individuals with Western cultural backgrounds or independent self-construals.


title: Analysis of Treatment Outcome After Endovascular Treatment in Different Pathological Subtypes of Basilar Artery Occlusion: a Single Center Experience.

text: The current study aimed to evaluate whether patients with different pathologic subtypes of basilar artery occlusion (BAO) stroke could affect the clinical outcome after receiving endovascular treatment (EVT). A total of 187 consecutive patients with acute BAO receiving endovascular treatment (EVT) from January 2012 to July 2018 at the Beijing Tiantan Hospital were recruited in this study. The patients were categorized into three groups: embolism without vertebral artery (VA) steno-occlusion (group 1), in situ atherosclerotic thrombosis (group 2), and embolism from tandem VA steno-occlusion (group 3). Among the 187 patients, 4 patients with embolic combined with ICAS and 1 patient with tandem VA steno-occlusion combined with ICAS were excluded. Of the remaining 182 patients (153 men and 29 women; mean age, 60 years), 43 (23.6%) had embolism without vertebral artery (VA) steno-occlusion (group 1), 116 (63.7%) showed in situ atherosclerotic thrombosis (group 2), and 23 (12.6%) had embolism from tandem VA steno-occlusion (group 3). Overall, successful recanalization (modified thrombolysis in cerebral infarction grade 2b or 3) was achieved in 95.3%, 86.2%, and 60.9% in groups 1, 2, and 3, respectively. The favorable outcome (90-day modified Rankin scale score, 0-3) in the three groups was 51.2%, 52.6%, and 30.4%, respectively. Mortality was higher in group 3 (47.8%) as compared with groups 1 (16.3%) (p = 0.009) and 2 (17.2%) (p = 0.004). Embolism from tandem VA steno-occlusion (group 3) seems to be associated with a lower rate of recanalization and significantly higher rate of mortality as compared with another pathological mechanism of BAO.


title: Mobile phone-based surveillance for animal disease in rural communities: implications for detection of zoonoses spillover.

text: Improving the speed of outbreak detection and reporting at the community level are critical in managing the threat of emerging infectious diseases, many of which are zoonotic. The widespread use of mobile phones, including in rural areas, constitutes a potentially effective tool for real-time surveillance of infectious diseases. Using longitudinal data from a disease surveillance system implemented in 1500 households in rural Kenya, we test the effectiveness of mobile phone animal syndromic surveillance by comparing it with routine household animal health surveys, determine the individual and household correlates of its use and examine the broader implications for surveillance of zoonotic diseases. A total of 20 340 animal and death events were reported from the community through the two surveillance systems, half of which were confirmed as valid disease events. The probability of an event being valid was 2.1 times greater for the phone-based system, compared with the household visits. Illness events were 15 times (95% CI 12.8, 17.1) more likely to be reported through the phone system compared to routine household visits, but not death events (OR 0.1 (95% CI 0.09, 0.11)). Disease syndromes with severe presentations were more likely to be reported through the phone system. While controlling for herd and flock sizes owned, phone ownership was not a determinant of using the phone-based surveillance system, but the lack of a formal education, and having additional sources of income besides farming were associated with decreased likelihood of reporting through the phone system. Our study suggests that a phone-based surveillance system will be effective at detecting outbreaks of diseases such as Rift Valley fever that present with severe clinical signs in animal populations, but in the absence of additional reporting incentives, it may miss early outbreaks of diseases such as avian influenza that present primarily with mortality. This article is part of the theme issue 'Dynamic and integrative approaches to understanding pathogen spillover'.


title: Role of sialic acids in feline enteric coronavirus infections.

text: To initiate infections, many coronaviruses use sialic acids, either as receptor determinants or as attachment factors helping the virus find its receptor underneath the heavily glycosylated mucus layer. In the present study, the role of sialic acids in serotype I feline enteric coronavirus (FECV) infections was studied in feline intestinal epithelial cell cultures. Treatment of cells with neuraminidase (NA) enhanced infection efficiency, showing that terminal sialic acid residues on the cell surface were not receptor determinants and even hampered efficient virus-receptor engagement. Knowing that NA treatment of coronaviruses can unmask viral sialic acid binding activity, replication of untreated and NA-treated viruses was compared, showing that NA treatment of the virus enhanced infectivity in untreated cells, but was detrimental in NA-treated cells. By using sialylated compounds as competitive inhibitors, it was demonstrated that sialyllactose (2,6-α-linked over 2,3-α-linked) notably reduced infectivity of NA-treated viruses, whereas bovine submaxillary mucin inhibited both treated and untreated viruses. In desialylated cells, however, viruses were less prone to competitive inhibition with sialylated compounds. In conclusion, this study demonstrated that FECV had a sialic acid binding capacity, which was partially masked by virus-associated sialic acids, and that attachment to sialylated compounds could facilitate enterocyte infections. However, sialic acid binding was not a prerequisite for the initiation of infection and virus-receptor engagement was even more efficient after desialylation of cells, indicating that FECV requires sialidases for efficient enterocyte infections.


title: Efficacy of the Buzzy Device for Pain Management During Needle-related Procedures: A Systematic Review and Meta-Analysis.

text: OBJECTIVE This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children. MATERIALS AND METHODS Databases search was conducted from inception to December 2017 to identify randomized controlled trials using the Buzzy device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction, and assessment of risk of bias and quality of evidence were independently performed by 2 reviewers. Quantitative and qualitative analyses were conducted. RESULTS A total of 9 studies involving 1138 participants aged between 3 and 18 years old were included in the systematic review and 7 were suitable for meta-analysis. The meta-analysis compared the Buzzy device with a no-treatment comparator and the effect of the device was significant in reducing self-report procedural pain (standardized mean difference [SMD]: -1.11; 95% confidence interval [CI]: -1.52 to -0.70; P<0.0001), parent-reported procedural pain (SMD: -0.94; 95% CI: -1.62 to -0.27; P=0.006), observer-report procedural pain (SMD: -1.19; 95% CI: -1.90 to -0.47; P=0.001), observer-reported procedural anxiety (SMD -1.37; 95% CI: -1.77 to -0.96; P<0.00001), and parent-reported procedural anxiety (SMD -1.36; 95% CI: -2.11 to -0.61; P=0.0004). There was no significant difference for the success of the procedure at first attempt and the occurrence of adverse events. DISCUSSION The Buzzy device seems to be a promising intervention for procedural pain management in children. However, the comparative effect is uncertain due to the presence of significant heterogeneity and very low-quality evidence. There is a need to improve the methodological quality and rigor in the design of future trials to conclude to the efficacy of the Buzzy device.


title: Houttuynia cordata alleviates high-fat diet-induced non-alcoholic fatty liver in experimental rats.

text: CONTEXT Houttuynia cordata Thunb. (Saururaceae) is used traditionally in Asian countries to treat various disease symptoms. OBJECTIVE To study the effect of H. cordata ethyl acetate (HC-EA) extract on high-fat diet (HFD)-induced hepatic steatosis. MATERIALS AND METHODS HFD fed rats were orally dosed with HC-EA (100, 200, or 300 mg/kg) once daily for 8 weeks and the lipid profiles and protein expressions in hepatocytes were evaluated. RESULTS HFD rats showed an increase (p < 0.05) in the plasma lipid levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), free fatty acids (FFAs), and reduced the high-density lipoprotein (HDL) levels. Treatment with HC-EA extract (300 mg/kg) restored the changes in plasma lipid levels of TC, TG, LDL, FFA, and HDL in HFD-fed rats by 34.8, 31.1, 51.4, 32.4, and 56.3%, respectively, compared with control rats (p < 0.01). HC-EA treatment also decreased the hepatic lipid accumulation (p < 0.001 at 300 mg/kg) and improved hepatic histological lesions. HC-EA extract enhanced AMPK phosphorylation and its primary downstream targeting enzyme, acetyl-CoA carboxylase (ACC), up-regulated the gene expression of carnitine palmitoyl transferase-1 (CPT-1), and down-regulated sterol regulatory element binding protein 1, fatty acid synthase, and glutamate pyruvate transaminase protein levels in the livers of HFD-fed rats. Further, the increased expression of hepatic cytochrome P450 (CYP) composition such as CYP2E1 and CYP4A was also suppressed. DISCUSSION AND CONCLUSION Data suggest that HC-EA extract might act by regulating the AMPK-dependent pathway and related mediators and might be used in treating obesity-related liver diseases.


title: Ethics committee meeting by video-conferencing during Covid-19.

text: The Covid-19 pandemic has created a situation demanding rapid ethical review of research on various aspects of the pandemic, while maintaining social distancing norms. Research during an outbreak is important for understanding the disease and its management and allows scientists to study the disease in situ..


title: Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up.

text: BACKGROUND Laparoscopic ventral hernia repair is widely used although its clinical indications are often debated. The aim of this study is to describe our surgical experience in order to establish the safety, efficacy, feasibility of laparoscopic ventral hernia repair and to identify the factors that influence the risk of recurrence in a group of patients treated with only one type of prosthetic mesh and by the same surgical team. MATERIALS AND METHODS Between January 2007 and December 2016, 512 patients were admitted to the General and Urgent Surgery Unit, with diagnosis of ventral hernia. Of these, 244 were operated laparoscopically and 268 in a traditional open surgery. In 244 patients treated by laparoscopy we always used a composite mesh: 185 Parietex™ Composite mesh (Medtronic-Covidien, Minneapolis, USA), the remaining other with other types of prosthetic mesh. The type and size of surgical defects, features of surgical technique, length of hospital stay, rate of conversion, morbidity, mortality, and rate of recurrence at 5 years follow-up were retrospective analysed on the 185 patients who underwent surgery with Parietex™ Composite mesh. RESULTS We performed 185 laparoscopic ventral hernia repair with Parietex™ Composite mesh: 108 (58%) for incisional hernias and 77 (42%) for primary abdominal wall hernias. Mean age was 58 years (19-80). The mean size of abdominal defect was 5 cm (1,5-18), mean BMI was 30,4 kg/m2 (21-47), mean overlap of the mesh was 5 cm (3-6). The mean operative time was 54 min (30-180) and conversion rate was 3,2%. In 61 patients (33%) we performed a transversus abdominis plane block (T.A.P. block) to reduce postoperative pain. The mean length of hospital stay was 5 days (1-26) (2 days, mean value, in patient with preoperative T.A.P. block). The mortality rate was 0%; overall morbidity was 15,6%. At 5-year follow-up we observed 13 (7%) hernia recurrences. The features of patients with recurrence were as follows: mean age 50 years (19-74), mean ASA Score 3 (2-3), mean BMI 31 kg/m2 (21-44), mean size of hernial defect 7,5 cm (larger diameter), mean overlap 4,5 cm (3-6). CONCLUSIONS Laparoscopic repair of ventral hernia using composite mesh is an effective and safe procedure particularly suitable in the following cases: median and paramedian defects, diameter of defect between 5 and 15 cm, "swiss cheese" defects, obesity. In our experience the factors related to the patient and the surgical technique that may influence the onset of early or late recurrence as the follows: a defect size >5 cm (W2 of EHS Classification), an overlap of the mesh < 5 cm, a BMI of 30 kg/m2 or superior and the presence of significant comorbidities (ASA score: 3). Finally, we observed that the T.A.P. Block preoperative procedure can lead to reduced the clinical costs through a lower administration of analgesics used and a lower length of stay.


Optimising routine surveillance systems for informing tuberculosis control policies in China.


title: Early Trajectory of Stroke Severity Predicts Long-Term Functional Outcomes in Ischemic Stroke Subjects: Results From the ESCAPE Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times).

text: BACKGROUND AND PURPOSE The trajectory of neurological improvement after stroke treatment is clinically likely to be an important prognostic signal. We compared the accuracy of early longitudinal National Institutes of Health Stroke Scale (NIHSS) measurement versus other early markers of stroke severity post treatment in predicting subjects' 90-day stroke outcome. METHODS Data are from the Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with ESCAPE trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). Stroke severity was assessed at baseline, 1, 2, 5, 30, and 90 days. Subjects' functional outcome was assessed using the modified Rankin Scale at baseline, 30 days, and 90 days. Group-based trajectory model was used to identify distinct subgroups of longitudinal trajectories of NIHSS measured over the first 2, 5, and 30 days. The accuracy of baseline NIHSS, infarct volume, 24-hour change in NIHSS, infarct volume, and disease severity trajectory subgroups in predicting 90-day stroke outcome were assessed using logistic regression analysis. RESULTS Group-based trajectory model of the 2-day longitudinal NIHSS data revealed 3 distinct subgroups of NIHSS trajectories-large improvement (41.6%), minimal improvement (31.1%), and no improvement (27.3%) subgroups. Individuals in the large improvement group were more likely were more likely to exhibit good outcomes after 90 days than those in the minimal improvement or no improvement subgroup. Among candidate predictors, the 2-day trajectory subgroup variable was the most accurate in predicting 90-day modified Rankin Scale at 84.5%. CONCLUSIONS Early trajectory of neurological improvement defined by 2-day longitudinal NIHSS data predicts functional outcomes with greater accuracy than other common variables. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.


title: Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery.

text: INTRODUCTION The introduction of minimally invasive surgery and the use of laparoscopic techniques have significantly improved patient outcomes and have offered a new range of options for the restoration of intestinal continuity. Various reconstruction techniques have been described and various devices employed but none has been established as superior. This study evaluates our experience with, and modifications of, the orally inserted anvil (OrVil™). METHODS We conducted a prospective observational study on 72 consecutive patients who underwent OrVil™-assisted oesophago-gastric or oesophago-jejunal anastomosis between September 2010 and September 2013. We collected data including patient demographics, disease site, type of procedure, location of the anastomosis, involvement of resection margins and peri-operative complications. RESULTS Seventy-two patients were included in the study. Patient ages ranged from 45 to 92 years (median ± SD = 69 ± 10 years). Total gastrectomy with Roux-en-Y anastomosis was the most-commonly performed procedure (n = 41; 57 %). R 0 resection was achieved in 67 patients (93 %). There were no Orvil™-related clinical leaks during the study period, and just two patients (2.8 %) demonstrated radiological evidence of leak, both of whom were managed conservatively. There were three in-hospital mortalities during the study period; these were unrelated to the anastomotic technique. CONCLUSION Despite a steep learning curve, the OrVil™ device is safe and reliable. It also permits the creation of higher trans-hiatal anastomoses without resorting to thoracotomy in high-risk patients with cardia tumours. Certain shortcomings of the device, that had implications for patient safety, were identified and addressed by intra-operative modification during the study period. We commend the use of a prepared OrVil™ device, as a game changer, for upper gastrointestinal reconstruction.


title: Heartland Virus in Humans and Ticks, Illinois, USA, 2018-2019.

text: In 2018, Heartland disease virus infected 2 persons in Illinois, USA. In 2019, ticks were collected at potential tick bite exposure locations and tested for Heartland and Bourbon viruses. A Heartland virus-positive pool of adult male Amblyomma americanum ticks was found at 2 locations, 439 km apart, suggesting widespread distribution in Illinois.


What's Important: Managing the Impact of Coronavirus on Pediatric Spine Surgery.


title: Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review.

text: Participation in regular physical activity decreases the risk of developing cardiometabolic disease. However, the proportion of people who participate in the recommended amount of physical activity is low, with common barriers including competing interests and inclement weather. In people with chronic cardiorespiratory conditions, participation in physical activity is reduced further by disease-specific barriers; time-burden of treatment and unpleasant symptoms during physical activity. Addressing these barriers during adolescence and early adulthood may promote greater physical activity participation into older age. The aim of this review was, in people aged 15 to 45 years with chronic cardiorespiratory conditions, to classify interventions aimed at optimising participation in physical activity as 'promising' or 'not promising', and categorise the behaviour change techniques (BCTs) within these interventions. Nine databases and registries were searched (October 2017) for studies that reported objective measures of physical activity before and after an intervention period. Interventions were classified as 'promising' if a between-group difference in physical activity was demonstrated. Michie et al.'s (2013) v1 Taxonomy was used to unpack the BCTs within interventions. Across the six included studies (n = 396 participants), 19 (20%) of 93 BCTs were described. The interventions of three studies were classified as 'promising'. The most commonly used BCTs comprised goal setting, action planning and social support. Five BCTs were solely used in 'promising' interventions. Our review demonstrated that only 20% of BCTs have been utilised and isolated those BCTs that were used only in 'promising' physical activity interventions in adolescents and adults with chronic cardiorespiratory conditions. This article is protected by copyright. All rights reserved.


New challenges and workaround: Ultrasound biomicroscopy in time of COVID-19 pandemic.


title: RNA-dependent RNA Polymerase of SARS-CoV-2 as a Therapeutic Target.

text: The global pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), named coronavirus disease 2019 (COVID-19), has infected more than 8.9 million people worldwide. This calls for urgent effective therapeutic measures. RNA-dependent RNA polymerase (RdRp) activity in viral transcription and replication has been recognized as an attractive target to design novel antiviral strategies. Although SARS-CoV-2 shares less genetic similarity with SARS-CoV (~79%) and Middle East respiratory syndrome (MERS)-CoV (~50%), the respective RdRps of the three coronaviruses are highly conserved, suggesting that RdRp is a good broad-spectrum antiviral target for CoVs. In this review, we discuss the antiviral potential of RdRp inhibitors (mainly nucleoside analogues) with an aim to provide a comprehensive account of drug discovery on SARS-CoV-2. This article is protected by copyright. All rights reserved.


title: Management of Heart Failure Patients with COVID-19. A Joint Position Paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology.

text: The Coronavirus Disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with heart failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and United States. This article is protected by copyright. All rights reserved.


Pathological evidence of cardiac papillary fibroelastoma in a retrieved intracranial embolus.


title: The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study.

text: OBJECTIVES This study was conducted to evaluate the added value of an enhanced recovery after surgery (ERAS) programme in laparoscopic liver resections for solid tumours. METHODS Patients undergoing laparoscopic liver resection between July 2005 and July 2008 were included. Indications for resections included presumed benign and malignant liver lesions. Primary outcome was total length of hospital stay (LOS). Secondary outcomes were functional recovery, complications, conversions, blood loss and duration of operation. RESULTS Thirteen patients were treated by laparoscopic liver resections in the ERAS programme in one centre (group 1). Their outcomes were compared with outcomes of 13 laparoscopic procedures performed either before the introduction of the ERAS programme during 2003-2005 in the same centre or during the same period in other centres using traditional care (group 2). Median total LOS was 5.0 days (range 3-10 days) in group 1 and 7.0 days (3-12 days) in group 2. This difference was not statistically significant. Functional recovery occurred 2 days earlier in group 1 (median 3.0 days [range 1-7 days] vs. median 5.0 days [range 2-8 days]; P < 0.044). There were no significant differences in complications, conversions or duration of operation. Blood loss was significantly less in the ERAS group (median 50 ml [range 50-200 ml] vs. median 250 ml [range 50-800 ml]; P < 0.002). CONCLUSIONS This exploratory, multicentre, fast-track laparoscopic liver resection study is the first such study conducted. Although small, the study suggests that a multimodal enhanced recovery programme in laparoscopic liver surgery is feasible, safe and may lead to accelerated functional recovery and reductions in LOS.


Feeding Low-Income Children during the Covid-19 Pandemic.


title: Update on the management of gastroenteropancreatic neuroendocrine tumors with emphasis on the role of imaging.

text: OBJECTIVE The purposes of this article are to review the current management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) based on the 2012 National Comprehensive Cancer Network guidelines and to describe the role of imaging in a multidisciplinary approach. CONCLUSION The management of GEP-NETs has become complex, requiring a multidisciplinary approach. The World Health Organization classification of GEP-NETs has been revised; the U.S. Food and Drug Administration has approved molecular targeted agents (sunitinib, everolimus) for the treatment of pancreatic NETs; and the National Comprehensive Cancer Network clinical practice guidelines have been updated.


title: COVID-19 lockdown effects on air quality by NO2 in the cities of Barcelona and Madrid (Spain).

text: During the months of March and April 2020 we witnessed the largest-scale experiment in history in terms of air quality in cities. Any prediction of this experiment's results may be obvious to science, as it was totally expected, the air quality has improved substantially. Simply stated, it comes as no surprise. The lockdown has made it possible to quantify the limit of decrease in pollution in light of this drastic reduction in traffic, in Madrid and Barcelona showed a significant decrease of the order of 75%. In the case of Spain's two largest cities, the reductions of NO2 concentrations were 62% and 50%, respectively. Hourly measurements were obtained from 24 and 9 air quality stations from the monitoring networks during the month of March 2020. These results allow us to see the limits that can be achieved by implementing low emission zones (LEZ), as well as the amount of contamination that must be eliminated, which in the cases of Madrid and Barcelona, represent 55%. This value defines the levels of effort and scope of actions to be taken in order to ensure that both cities achieve a clean and healthy atmosphere in terms of NO2.


title: Depth of anaesthesia monitoring during procedural sedation and analgesia: a systematic review protocol.

text: BACKGROUND Procedural sedation and analgesia (PSA) is used to attenuate the pain and distress that may otherwise be experienced during diagnostic and interventional medical or dental procedures. As the risk of adverse events increases with the depth of sedation induced, frequent monitoring of level of consciousness is recommended. Level of consciousness is usually monitored during PSA with clinical observation. Processed electroencephalogram-based depth of anaesthesia (DoA) monitoring devices provide an alternative method to monitor level of consciousness that can be used in addition to clinical observation. However, there is uncertainty as to whether their routine use in PSA would be justified. Rigorous evaluation of the clinical benefits of DoA monitors during PSA, including comprehensive syntheses of the available evidence, is therefore required. One potential clinical benefit of using DoA monitoring during PSA is that the technology could improve patient safety by reducing sedation-related adverse events, such as death or permanent neurological disability. We hypothesise that earlier identification of lapses into deeper than intended levels of sedation using DoA monitoring leads to more effective titration of sedative and analgesic medications, and results in a reduction in the risk of adverse events caused by the consequences of over-sedation, such as hypoxaemia. The primary objective of this review is to determine whether using DoA monitoring during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO(2)] less than 90 %). Other potential clinical benefits of using DoA monitoring devices during sedation will be assessed as secondary outcomes. METHODS/DESIGN Electronic databases will be systematically searched for randomized controlled trials comparing the use of depth of anaesthesia monitoring devices with clinical observation of level of consciousness during PSA. Language restrictions will not be imposed. Screening, study selection and data extraction will be performed by two independent reviewers. Disagreements will be resolved by discussion. Meta-analyses will be performed if suitable. DISCUSSION This review will synthesise the evidence on an important potential clinical benefit of DoA monitoring during PSA within hospital settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017251.


title: Obturator hernia as a frequent finding during laparoscopic pelvic exploration: A retrospective observational study.

text: Hernia through the obturator canal is usually unsuspected and hence undiagnosed. Patients with obturator hernias present as acute cases of intestinal obstruction secondary to strangulation or incarceration, with high rate of morbidity and mortality due to delayed diagnosis and treatment. The know incidence of obturator hernia is low, representing 0.073% (11 of 15,098) of all hernias repaired at the Mayo Clinic in a retrospective study of 15 years. In this study, we conducted a retrospective analysis of laparoscopic extraperitoneal hernia repairs that were performed between the years 2003 and 2007. All procedures were undertaken by 2 experienced surgeons who performed more than 150 previous surgeries. In 293 patients who underwent repair of bilateral or recurrent inguinal hernia, exploration of the obturator foramen was conducted looking for obturator hernia, which was found in 20 cases (6.82% of patients). The true incidence of obturator hernia is greater than that reported in the literature, and the chances of detecting hernia are greater if an equal number of men and women are scanned could be higher if pelvic scanning was performed.


Response to: 'Patients with lupus with COVID-19: University of Michigan experience' by Wallace et al.


title: Robot-Assisted Laparoscopic Nephroureterectomy for Transitional Cell Carcinoma of a Right Pelvic Kidney.

text: BACKGROUND Nephroureterectomy is the standard of care for transitional cell carcinoma (TCC) involving the upper urinary tract. However, few published case reports exist describing the surgical treatment of ectopic kidneys with TCC. Surgical removal of a pelvic kidney can be complicated by aberrant vasculature supply, a tortuous ureter and abutting anatomical structures. Thus, it is necessary to determine the most appropriate surgical technique for treatment of pelvic kidneys with suspected malignancy. CASE PRESENTATION A 65-year-old female who presented with hematuria and lower abdominal pain was found to have a right pelvic kidney with a heterogeneous mass on computed tomography (CT) urogram. A robot-assisted laparoscopic nephroureterectomy of the right pelvic kidney was performed. Histopathological analysis revealed high-grade TCC with microscopic extension through the muscularis propria of the renal pelvis and superficially into the renal parenchyma. CONCLUSION This case demonstrates the successful use of robot-assisted laparoscopic nephroureterectomy in the treatment of a pelvic kidney with TCC. Preoperative CT angiography is critical to define vascular anatomy and to prevent significant blood loss and damage to surrounding structures during surgery. This case was presented because TCC of a pelvic kidney is a rare occurrence and the use of robot-assisted nephroureterectomy for treatment of this disease is novel.


title: Comparison of three commonly used CT perfusion software packages in patients with acute ischemic stroke.

text: BACKGROUND AND PURPOSE CT perfusion (CTP) might support decision making in patients with acute ischemic stroke by providing perfusion maps of ischemic tissue. Currently, the reliability of CTP is hampered by varying results between different post-processing software packages. The purpose of this study is to compare ischemic core volumes estimated by IntelliSpace Portal (ISP) and syngo.via with core volumes as estimated by RAPID. METHODS Thirty-five CTP datasets from patients in the MR CLEAN trial were post-processed. Core volumes were estimated with ISP using default settings and with syngo.via using three different settings: default settings (method A); additional smoothing filter (method B); and adjusted settings (method C). The results were compared with RAPID. Agreement between methods was assessed using Bland-Altman analysis and intraclass correlation coefficient (ICC). Accuracy for detecting volumes up to 25 mL, 50 mL, and 70 mL was assessed. Final infarct volumes were determined on follow-up non-contrast CT. RESULTS Median core volume was 50 mL with ISP, 41 mL with syngo.via method A, 20 mL with method B, 36 mL with method C, and 11 mL with RAPID. Agreement ranged from poor (ISP: ICC 0.41; method A: ICC 0.23) to good (method B: ICC 0.83; method C: ICC 0.85). The bias (1.8 mL) and limits of agreement (-27, 31 mL) were the smallest with syngo.via with additional smoothing (method B). Agreement for detecting core volumes ≤25 mL with ISP was 54% and 57%, 85% and 74% for syngo.via methods A, B, and C, respectively. CONCLUSION Best agreement with RAPID software is provided by syngo.via default settings with additional smoothing. Moreover, this method has the highest agreement in categorizing patients with small core volumes.


title: IFN-λ3, not IFN-λ4, likely mediates IFNL3-IFNL4 haplotype-dependent hepatic inflammation and fibrosis.

text: Genetic variation in the IFNL3-IFNL4 (interferon-λ3-interferon-λ4) region is associated with hepatic inflammation and fibrosis. Whether IFN-λ3 or IFN-λ4 protein drives this association is not known. We demonstrate that hepatic inflammation, fibrosis stage, fibrosis progression rate, hepatic infiltration of immune cells, IFN-λ3 expression, and serum sCD163 levels (a marker of activated macrophages) are greater in individuals with the IFNL3-IFNL4 risk haplotype that does not produce IFN-λ4, but produces IFN-λ3. No difference in these features was observed according to genotype at rs117648444, which encodes a substitution at position 70 of the IFN-λ4 protein and reduces IFN-λ4 activity, or between patients encoding functionally defective IFN-λ4 (IFN-λ4-Ser70) and those encoding fully active IFN-λ4-Pro70. The two proposed functional variants (rs368234815 and rs4803217) were not superior to the discovery SNP rs12979860 with respect to liver inflammation or fibrosis phenotype. IFN-λ3 rather than IFN-λ4 likely mediates IFNL3-IFNL4 haplotype-dependent hepatic inflammation and fibrosis.


title: A case study exploring associations between popular media attention of scientific research and scientific citations.

text: The association between mention of scientific research in popular media (e.g., the mainstream media or social media platforms) and scientific impact (e.g., citations) has yet to be fully explored. The purpose of this study was to clarify this relationship, while accounting for some other factors that likely influence scientific impact (e.g., the reputations of the scientists conducting the research and academic journal in which the research was published). To accomplish this purpose, approximately 800 peer-reviewed articles describing original research were evaluated for scientific impact, popular media attention, and reputations of the scientists/authors and publication venue. A structural equation model was produced describing the relationship between non-scientific impact (popular media) and scientific impact (citations), while accounting for author/scientist and journal reputation. The resulting model revealed a strong association between the amount of popular media attention given to a scientific research project and corresponding publication and the number of times that publication is cited in peer-reviewed scientific literature. These results indicate that (1) peer-reviewed scientific publications receiving more attention in non-scientific media are more likely to be cited than scientific publications receiving less popular media attention, and (2) the non-scientific media is associated with the scientific agenda. These results may inform scientists who increasingly use popular media to inform the general public and scientists concerning their scientific work. These results might also inform administrators of higher education and research funding mechanisms, who base decisions partly on scientific impact.


title: Simulation training in vitreoretinal surgery: a systematic review.

text: BACKGROUND The purpose of this study was to perform a systematic review of the current literature on simulator-based training in vitreoretinal surgery (VRS). We examined the results regarding simulated VRS and provided an overview of how the current results may be employed in VRS training. Lastly, we evaluated the quality of these results. METHODS The databases of Pubmed, Embase and Cochrane Library were searched for articles in English involving simulated VRS training. A qualitative analysis was performed, since the studies which met our inclusion criteria did not allow for a quantitative meta-analysis. RESULTS We identified 203 articles of which seven met the inclusion criteria. Of these, six studies investigated simulation with EyeSi® Surgical (VRMagic, Mannheim, Germany). Six studies reported positive performance curves. Four studies showed construct validity. One study attempted to show skill transfer from simulator to vitrectomies performed on cadavers. Methodological quality of the included studies was moderate but lacking in instrument validation. CONCLUSION Simulator-based training in VRS can assess and possibly assist acquisition of a variety of VRS skills. Further research is needed to support transfer from simulator to operating room. Future studies should strive to follow established validation frameworks and streamline study designs.


title: A Rabbit Model of Durable Transgene Expression in Jugular Vein to Common Carotid Artery Interposition Grafts.

text: Vein graft bypass surgery is a common treatment for occlusive arterial disease; however, long-term success is limited by graft failure due to thrombosis, intimal hyperplasia, and atherosclerosis. The goal of this article is to demonstrate a method for placing bilateral venous interposition grafts in a rabbit, then transducing the grafts with a gene transfer vector that achieves durable transgene expression. The method allows the investigation of the biological roles of genes and their protein products in normal vein graft homeostasis. It also allows the testing of transgenes for the activities that could prevent vein graft failure, e.g., whether the expression of a transgene prevents the neointimal growth, reduces the vascular inflammation, or reduces atherosclerosis in rabbits fed with a high-fat diet. During an initial survival surgery, the segments of right and left external jugular vein are excised and placed bilaterally as reversed end-to-side common carotid artery interposition grafts. During a second survival surgery, performed 28 days later, each of the grafts is isolated from the circulation with vascular clips and the lumens are filled (via an arteriotomy) with a solution containing a helper-dependent adenoviral (HDAd) vector. After a 20-min incubation, the vector solution is aspirated, the arteriotomy is repaired, and flow is restored. The veins are harvested at time points dictated by individual experimental protocols. The 28-day delay between the graft placement and the transduction is necessary to ensure the adaptation of the vein graft to the arterial circulation. This adaptation avoids rapid loss of transgene expression that occurs in vein grafts transduced before or immediately after grafting. The method is unique in its ability to achieve durable, stable transgene expression in grafted veins. Compared to other large animal vein graft models, rabbits have advantages of low cost and easy handling. Compared to rodent vein graft models, rabbits have larger and easier-to-manipulate blood vessels that provide abundant tissue for analysis.


title: Chronic toxoplasmosis and sleepiness in obstructive sleep apnea: Is there a link?

text: INTRODUCTION Sleepiness is the main clinical expression of obstructive sleep apnea (OSA) syndrome resulting from upper airway collapse. Recent studies have discussed the fact that the presence of T. gondii cysts in the brain and the resulting biochemical and immunological mechanisms could be linked to neurobehavioral disorders. The aim of the present study was to explore the potential impact of chronic toxoplasmosis on sleepiness and on obstructive sleep apnea (OSA) severity in OSA obese patients. MATERIALS AND METHODS A case control study on obese patients screened for OSA was performed. According to the sleep disorder and matched based on gender, age and body mass index (BMI), two groups of obese patients were selected from our sample collection database. All patients were tested for toxoplasmosis serological status measuring anti-Toxoplasma IgG and IgM levels. Univariable and multivariable logistic regression models were performed to assess the impact of chronic toxoplasmosis on sleepiness and OSA severity. RESULTS 107 obese patients suffering from OSA were included in the study (median age: 53.3 years Interquartile range (IQR): [41.9-59.9]; median BMI: 39.4 kg/m2 IQR: [35.5-44.1], apnea-hypopnea index = 27.5 events/h [10.7-49.9]). Chronic toxoplasmosis was present in 63.4% and 70.7% of patients with or without sleepiness (p = 0.48), respectively and was not associated either to sleepiness (OR: 0.76, 95% CI: [0.52; 2.33], p = 0.64) or OSA severity (OR = 1.75, 95% CI: [0.51; 5.98] p = 0.37). CONCLUSION Although chronic Toxoplasma infection in immunocompetent humans has been associated to several behavioral disorders or pathologies in recent literature, we demonstrate here that chronic toxoplasmosis is not associated to sleepiness and to sleep apnea syndrome severity in obese patients suspected of sleep apnea syndrome.


title: The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation.

text: Birth asphyxia accounts for nearly one million deaths worldwide each year, and is one of the primary causes of early neonatal morbidity and mortality. Many aspects of the current neonatal resuscitation guidelines remain controversial given the difficulties in conducting randomized clinical trials owing to the infrequent and often unpredictable need for extensive resuscitation. Most studies on neonatal resuscitation stem from manikin models that fail to truly reflect physiologic changes or piglet models that have cleared their lung fluid and that have completed the transition from fetal to neonatal circulation. The present protocol provides a detailed step-by-step description on how to create a perinatal asphyxiated fetal lamb model. The proposed model has a transitioning circulation and fluid-filled lungs, which mimics human newborns following delivery, and is, therefore, an excellent animal model to study newborn physiology. An important limitation to lamb experiments is the higher associated cost.


title: Armies of pestilence: CNS infections as potential weapons of mass destruction.

text: Infectious agents have been investigated, developed, and used by both governments and terrorist groups as weapons of mass destruction. CNS infections, though traditionally considered less often than respiratory diseases in this scenario, may be very important. Viruses responsible for encephalitides can be highly infectious in aerosol form. CNS involvement in anthrax is ominous but should change treatment. Brucellosis, plague, Q fever, and other bacteria can uncommonly manifest with meningoencephalitis and other findings. Emerging diseases may also pose threats. We review infectious agents of particular concern for purposes of biowarfare with respect to CNS manifestations and imaging features.


title: The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Classification of Lung Cancer with Separate Tumor Nodules in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.

text: INTRODUCTION Separate tumor nodules with the same histologic appearance occur in the lungs in a small proportion of patients with primary lung cancer. This article addresses how such tumors can be classified to inform the eighth edition of the anatomic classification of lung cancer. Separate tumor nodules should be distinguished from second primary lung cancer, multifocal ground glass/lepidic tumors, and pneumonic-type lung cancer, which are addressed in separate analyses. METHODS Survival of patients with separate tumor nodules in the International Association for the Study of Lung Cancer database were analyzed. This was compared with a systematic literature review. RESULTS Survival of clinically staged patients decreased according to the location of the separate tumor nodule relative to the index tumor (same lobe > same side > other side) in N0 and N-any cohorts (all M0 except possible other-side nodules). However, there was also a decrease in the proportion of patients resected; among only surgically resected or among nonresected patients no survival differences were noted. There were no survival differences between patients with same-lobe nodules and those with other T3 tumors, between patients with same-side nodules and those with T4 tumors, and patients with other-side nodules and those with other M1a tumors. The data correlated with those identified in a literature review. CONCLUSIONS Tumors with same-lobe separate tumor nodules (with the same histologic appearance) are recommended to be classified as T3, same-side nodules as T4, and other-side nodules as M1a. Thus, there is no recommended change between the seventh and eighth edition of the TNM classification of lung cancer.


title: Molecular characteristics of the spike gene of porcine epidemic diarrhoea virus strains in Eastern China in 2016.

text: The outbreak of piglet diarrhoea caused by porcine epidemic diarrhoea virus (PEDV) began to spread in Southern China in late 2010 and resulted in significant economic losses throughout the country. To determine the prevalence and the molecular characteristics of common PEDV strains in China, 1272 faeces and small intestine samples in pigs were collected from 17 provinces and inspected for PEDV; the full-length spike (S) gene of 18 detected PEDV strains collected from five eastern provinces were sequenced and analysed. The epidemiological data revealed that the PEDV-positive rate in diarrhoea specimens was 28.93%. Phylogenetic analysis of the S genes showed that the CH-JSYC-1-2016 strain was clustered into a G2-a subgroup (US and Asian non-S-INDEL), and other seventeen virus strains was clustered into a new subgroup G2-b (Chinese non-S-INDEL). The G2-b subgroup only contained Chinese PEDV strains that were isolated after 2014. Compared with the CV777 vaccine strain, Eastern China PEDVs were genetically distinct and had various amino acid differences in the neutralizing epitope domain of the S protein, as well as different patterns of predicted high-specificity N-glycosylation sites. The prevalence of Chinese non-S-INDEL strains may be responsible for the immunization failure by using currently available commercial vaccines (based on attenuated CV777 strain), and the development of novel vaccines based on these newly identified PEDV variants may contribute to the control of PED outbreaks in China.


title: Topic search filters: a systematic scoping review.

text: BACKGROUND Searching for topics within large biomedical databases can be challenging, especially when topics are complex, diffuse, emerging or lack definitional clarity. Experimentally derived topic search filters offer a reliable solution to effective retrieval; however, their number and range of subject foci remain unknown. OBJECTIVES This systematic scoping review aims to identify and describe available experimentally developed topic search filters. METHODS Reports on topic search filter development (1990-) were sought using grey literature sources and 15 databases. Reports describing the conception and prospective development of a database-specific topic search and including an objectively measured estimate of its performance ('sensitivity') were included. RESULTS Fifty-four reports met inclusion criteria. Data were extracted and thematically synthesised to describe the characteristics of 58 topic search filters. DISCUSSION Topic search filters are proliferating and cover a wide range of subjects. Filter reports, however, often lack clear definitions of concepts and topic scope to guide users. Without standardised terminology, filters are challenging to find. Information specialists may benefit from a centralised topic filter repository and appraisal checklists to facilitate quality assessment. CONCLUSION Findings will help information specialists identify existing topic search filters and assist filter developers to build on current knowledge in the field.


title: Outcome of abdominosacral resection for locally advanced primary and recurrent rectal cancer.

text: BACKGROUND The aim was to assess the indications for and outcomes of abdominosacral resection for patients with locally advanced primary and recurrent rectal cancer. METHODS Consecutive patients undergoing abdominosacral resection between January 2006 and December 2011 were identified from a prospectively maintained database. The main endpoints were 3-year local recurrence-free (LRFS) and disease-free (DFS) survival. RESULTS Thirty patients underwent abdominosacral resection, 22 for recurrent rectal cancer and eight for locally advanced primary cancer. Sacrectomy was performed at S1/2 in five, S3 in 11 and S4/5 in 14 patients. R0 resection was achieved in 23 patients; all seven positive margins (R1) were in patients with recurrent disease. There were no deaths in hospital or within 30 days. S1/2 sacrectomy was associated with the highest rate of major complications (60 per cent versus 27 and 29 per cent for S3 and S4/5 respectively) and long-term complications (60, 36 and 14 per cent). Overall 3-year LRFS was 66 per cent and 3-year DFS was 55 per cent. Both were significantly better in patients with negative compared with positive margins (LRFS: 87 versus 0 per cent, P < 0.001; DFS: 71 versus 0 per cent, P = 0.033). CONCLUSION Abdominosacral resection was associated with long-term survival in carefully selected patients with advanced rectal cancer. Postoperative complications were common and often multiple. Sacrectomy for locally advanced primary rectal cancer was associated with a low margin-positive rate and should be considered as an acceptable treatment. Margin-positive resection was associated with poor survival outcomes and should be avoided.


(99)Mo supply--the times they are a-changing.


title: COVID-19: therapeutic approaches description and discussion.

text: COVID-19 emerged in December 2019 in China, and since then, has disrupted global public health and changed economic paradigms. In dealing with the new Coronavirus, SARS-CoV-2, the world has not faced such extreme global fragility since the "Spanish flu" pandemic in 1918. Researchers globally are dedicating efforts to the search for an effective treatment for COVID-19. Drugs already used in a clinical setting for other pathologies have been tested as a new therapeutic approach against SARS-CoV-2, setting off a frenzy over the preliminary data of different studies. This work aims to compile and discuss the data published thus far. Despite the potential effects of some antivirals and antiparasitic against COVID-19, clinical studies must confirm real effectiveness. However, non-pharmacological approaches have proven to be the most efficient strategy to date.


title: The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta-analysis.

text: We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016. Two reviewers screened titles and abstracts independently, assessed full text eligibility, and extracted information from eligible trials. The primary outcome is glycated hemoglobin (HbA1c), and the secondary outcomes are health-related quality of life, body mass index (BMI), lipid profile, total insulin daily dose, hypoglycaemia, and diabetes ketoacidosis. We screened 736 studies, and included 6 RCTs with 325 patients. All RCTs were of low risk of bias, and included adolescents (mean age 15 years). The meta-analysis showed that the addition of Metformin resulted in decreased total insulin daily dose (TIDD) (unit/kg/d) (mean difference [MD] = -0.15, 95%CI, -0.24, -0.06), and reduced BMI kg/m2 (MD -1.46, 95%CI -2.54, 0.38), and BMI z-score (MD= - 0.11, 95%CI -0.21, -0.01), and similar HbA1c (%) (MD= - 0.05, 95%CI, -0.19, 0.29). The overall evidence quality was high to moderate. Current evidence does not support use of Metformin in T1DM adolescents to improve HbA1c. However, Metformin may provide modest reduction in TIDD and BMI.


title: Synthesising evidence on patient portals: a protocol for an umbrella review.

text: INTRODUCTION Over the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs). METHODS We will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work. ANALYSIS Two researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework. ETHICS AND DISSEMINATION As an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval. PROSPERO REGISTRATION NUMBER CRD42018096657.


title: Thymectomy via a subxiphoid approach: single-port and robot-assisted.

text: BACKGROUND We have previously reported on single-port thymectomy (SPT), which involves performing thymectomy via a single subxiphoid incision, and trans-subxiphoid robotic thymectomy (TRT), which is performed using the da Vinci surgical system. The aim of this study was to investigate the early surgical outcomes of thymectomy using the SPT and TRT subxiphoid approaches and to discuss their appropriate uses. METHODS The subjects included 80 patients who underwent thymectomy via a subxiphoid approach. These patients were selected from among 99 surgical cases of myasthenia gravis or anterior mediastinal tumors at Fujita Health University Hospital between March 2011 and November 2015. The patients were divided into a SPT group (n=72) and a TRT group (n=8). RESULTS The operative time was shorter in the SPT group compared with that in the TRT group (135±48 and 20±40 min, respectively; P=0.0004). There were no significant differences between the groups in terms of blood loss volume (5.9±16.8 and 5.4±4.6 mL, respectively; P=0.48), postoperative hospital stay duration (4.0±2.0 and 4.3±3.6 days, respectively; P=0.21), or the period of postoperative oral analgesic use (10.7±5.4 and 10.1±3.4 days, respectively; P=0.89). There were no intraoperative complications, such as intraoperative bleeding, in either group. In the SPT group, there was one case (1.4%) of postoperative left phrenic nerve paralysis and one case (1.4%) of transient paroxysmal atrial fibrillation. No one died during or after the surgery. CONCLUSIONS TRT may be as equally minimally invasive as SPT. In cases where the thymoma has infiltrated the surrounding organs, the extent of the infiltration should be used to determine whether to select TRT, or median sternotomy.


title: Seroprevalence of turkey coronavirus in North American turkeys determined by a newly developed enzyme-linked immunosorbent assay based on recombinant antigen.

text: Turkey coronavirus (TCoV) causes diarrhea in young turkey poults, but little is known about its prevalence in the field. To address this, the complete nucleocapsid gene was cloned and expressed in Escherichia coli. Expressed nucleocapsid gene produced two distinct proteins (52 and 43 kDa); their specificity was confirmed by Western blotting using two different monoclonal antibodies. Recombinant N protein was purified and used as an antigen to develop an enzyme-linked immunosorbent assay (ELISA) for the serological detection of TCoV that was then validated using experimentally derived turkey serum. The N-based ELISA showed (97%) sensitivity and (93%) specificity for TCoV, which was significantly higher than an infectious bronchitis coronavirus-based commercial test for TCoV. To assess the utility of this recombinant ELISA, 360 serum samples from turkey farms in Ontario, Canada, and 81 serum samples from farms in Arkansas were tested for TCoV-specific antibodies. A high seroprevalence of TCoV was found in turkeys from the Ontario farms with 73.9% of breeders and 60.0% of meat turkeys testing seropositive using the N-based ELISA. Similarly, a high field prevalence was found in the turkeys from Arkansas, for which 64.2% of the serum samples tested seropositive.


Cerebrospinal fluid MinION sequencing of 16S rRNA gene for rapid and accurate diagnosis of bacterial meningitis.


Usefulness of the epidemiological survey and RT-PCR test in pre-surgical patients for assessing the risk of Covid-19.


title: Non-Lethal Endotoxin Injection: A Rat Model of Hypercoagulability.

text: Systemic inflammation co-activates coagulation, which unchecked culminates in a lethal syndrome of multi-organ microvascular thrombosis known as disseminated intravascular coagulation (DIC). We studied an endotoxin-induced inflammatory state in rats to identify biomarkers of hemostatic imbalance favoring hypercoagulability. Intraperitoneal injection of LPS at 15 mg/kg body weight resulted in peripheral leukopenia and widespread neutrophilic sequestration characteristic of an acute systemic inflammatory response. Early indicators of hemostatic pathway activation developed within 4 hours, including increased circulating concentrations of procoagulant extracellular vesicles (EVs), EVs expressing endothelial cell and platelet membrane markers, and high concentration of soluble intercellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor-1 (PAI-1), and D-dimers. Inflammation persisted throughout the 48-hour observation period; however, increases were found in a subset of serum microRNA (miRNA) that coincided with gradual resolution of hemostatic protein abnormalities and reduction in EV counts. Dose-adjusted LPS treatment in rats provides a time-course model to develop biomarker profiles reflecting procoagulant imbalance and rebalance under inflammatory conditions.


title: Solubility profiling of HIV protease inhibitors in human intestinal fluids.

text: The present study pursued to profile the intestinal solubility of nine HIV protease inhibitors (PIs) in fasted- and fed-state human intestinal fluids (FaHIF, FeHIF) aspirated from four volunteers. In addition, the ability of fasted- and fed-state simulated intestinal fluids (FaSSIF, FeSSIF) to predict the intestinal solubility was evaluated. All PIs were poorly soluble in FaHIF (from 7 μM for ritonavir to 327 μM for darunavir) and FeHIF (from 15 μM for atazanavir to 409μM for darunavir). For four of nine PIs, food intake significantly enhanced the solubilizing capacity of intestinal fluids (up to 18.4-fold increase for ritonavir). The intersubject variability (average coefficient of variance CVfed = 60.6%, CVfasted = 40.4%) was higher as compared with the intrasubject variability (CVfed = 41.3%, CVfasted = 20.5%). PI solubilities correlated reasonably well between FaSSIF and FaHIF (R = 0.817), but not between FeSSIF and FeHIF (R = 0.617). To conclude, postprandial conditions increased the inter- and intrasubject variability of the PIs. The inability of FeSSIF to accurately predict the FeHIF solubility emphasizes the need for a multivariate approach to determine solubility profiles, taking into account solid-state characteristics, pH, mixed bile acid/phospholipid micelles, and digestive products.


title: Prospective randomized trial of venous angioplasty in MS (PREMiSe).

text: OBJECTIVE We report the results of the investigation of safety and efficacy of venous angioplasty in patients with multiple sclerosis (MS) with findings of extracranial venous anomalies, considered hallmarks of chronic cerebrospinal venous insufficiency (CCSVI), in a 2-phase study (ClinicalTrials.gov NCT01450072). METHODS Phase 1 was an open-label safety study (10 patients); phase 2 was sham-controlled, randomized, and double-blind (10 sham procedure, 9 treated). All study patients fulfilled venous hemodynamic screening criteria indicative of CCSVI. Assessment was at 1, 3, and 6 months postprocedure with MRI, clinical, and hemodynamic outcomes. Primary endpoints were safety at 24 hours and 1 month, venous outflow restoration >75% at 1 month, and effect of angioplasty on new lesion activity and relapse rate over 6 months. Secondary endpoints included changes in disability, brain volume, cognitive tests, and quality of life. RESULTS No perioperative complications were noted; however, one patient with history of syncope was diagnosed with episodic bradycardia requiring placement of a pacemaker before discharge. Doppler evidence-based venous hemodynamic insufficiency severity score (VHISS) was reduced >75% compared to baseline in phase 1 (at 1 month) but not phase 2. In phase 2, higher MRI activity (cumulative number of new contrast-enhancing lesions [19 vs 3, p = 0.062] and new T2 lesions [17 vs 3, p = 0.066]) and relapse activity (4 vs 1, p = 0.389) were identified as nonsignificant trends in the treated vs sham arm over 6 months. Using analysis of covariance, significant cumulative new T2 lesions were related to larger VHISS decrease (p = 0.028) and angioplasty (p = 0.01) over the follow-up. No differences in other endpoints were detected. CONCLUSION Venous angioplasty is not an effective treatment for MS over the short term and may exacerbate underlying disease activity. CLASSIFICATION OF EVIDENCE This is a Class I study demonstrating that clinical and imaging outcomes are no better or worse in patients with MS identified with venous outflow restriction who receive venous angioplasty compared to sham controls who do not receive angioplasty. This study also includes a Class IV phase 1 study of safety in 10 patients receiving the angioplasty procedure.


title: COMPARISON OF ALLIGATOR SNAPPING TURTLE ( MACROCHELYS TEMMINCKII) PLASMA BIOCHEMICAL PROFILES FROM TWO CLINICAL ANALYZERS.

text: The interpretation of plasma biochemical profiles can be confounded by the methodologies by which samples are analyzed. The goal of this study was to compare agreement between two biochemical analyzers for plasma samples from alligator snapping turtles ( Macrochelys temminckii). Blood was obtained from the dorsal coccygeal vein of captive-reared, juvenile turtles ( n = 34), stored in lithium heparin tubes, and centrifuged to separate plasma from whole blood. Plasma samples were stored at 5°C prior to and in between analyses on VetScan (VetScan2, Abaxis, Union City, CA 94587, USA) and Olympus (Olympus AU640, Beckman Coulter, Brea, CA 92821, USA) analyzers within 2 hr of each other. Agreement between the VetScan and Olympus analyzers was investigated using Passing-Bablok regression analysis for aspartate aminotransferase, creatine kinase, glucose, calcium, phosphorus, total protein, albumin, globulin, potassium, and sodium. Agreement between the two analyzers was outside of acceptance limits and outside of clinical allowable error limits for all analytes as established by the American Society for Veterinary Clinical Pathology. The results of biochemical analyses of alligator snapping turtle plasma cannot be compared between VetScan and Olympus analyzers in a clinical setting. Comparison of biochemical analyses within analyzer units, however, may still be clinically useful. Future studies are warranted to investigate the precision of each analyzer for alligator snapping turtle plasma.


World leaders adopt resolution to study WHO's response to covid-19.


title: Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma.

text: Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. PATIENT SUMMARY: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered.


title: The impact of conflict of interest in abdominal wall reconstruction with acellular dermal matrix.

text: INTRODUCTION Conflict of interest (COI) and disclosure of financial relationships have received increased attention recently owing in part to the passage of the Physician Payments Sunshine Act, which requires manufacturers of drugs, medical devices, and biological to record payments to physicians and health care systems. The impact of financial relationships with industry sponsorship and COI reporting on surgical outcomes of abdominal wall reconstruction with acellular dermal matrices (ADMs) has not been previously explored. METHODS A systematic review of the literature for studies that evaluated surgical outcomes in abdominal wall reconstruction using ADM was conducted. The level of evidence of these studies was evaluated; and data concerning the type of industry, government, or national society sponsorship, primary outcome, complications, and statistical results were collected. The overall favorability of the study with respect to ADM use was systematically assessed. Comparisons between type of sponsorship and significant results were analyzed using the Pearson χ2 test. RESULTS A total of 204 studies were identified, of which 124 fulfilled our inclusion criteria. Sixty-four (52%) studies had a disclosure statement present. Conflict of interest was reported in 39 (61%) of these studies. Taken collectively, studies that report no COI are more likely to be unfunded (P<0.001). Studies with a reported COI are more likely to report a favorable outcome with respect to infection (P<0.01), wound complications (P<0.01), and overall morbidity (P<0.07) and mortality (P<0.05). CONCLUSIONS Industry sponsorship and COI are common in abdominal wall reconstruction studies with ADM. Studies authored by groups disclosing an industry conflict that report clinical outcomes are significantly associated with reporting lower postoperative complications, and consequently describing positive research findings.


title: Development and clinical study of a self-dissolving microneedle patch for transcutaneous immunization device.

text: PURPOSE We previously reported the safety and efficacy in animal experiments of transcutaneous immunization (TCI) using a self-dissolving microneedle patch (MicroHyala; MH) made of hyaluronic acid and collagen. However, this MH was an unsuitable TCI device for the human skin, as collagen is suspected to induce inflammation. In this study, we developed an improved collagen-free MH (new-MH) and conducted clinical study to evaluate the fundamental properties and safety in human. METHODS Microneedle dissolution, skin irritation, and antigen-specific antibody production about new-MH were measured in mice and/or rats. On the basis of the results, the clinical study was conducted in healthy volunteers to evaluate local and systemic adverse events caused by new-MH application. RESULTS We confirmed that the microneedles of new-MH, as well as those on our old-MH that contained collagen, could easily pierce stratum corneum without severe skin irritation, and that TCI using new-MH efficiently increased antibody titer with comparable to TCI using old-MH. Application of new-MH caused no severe adverse reactions in 20 healthy volunteers enrolled in a clinical study. CONCLUSIONS These results verified that new-MH is a safe TCI device in human, and greatly encouraged us to advance PI/PII clinical studies of antigen-loaded new-MH.


title: Accuracy of Transcutaneous Carbon Dioxide Levels in Comparison to Arterial Carbon Dioxide Levels in Critically Ill Children.

text: BACKGROUND Widespread use of transcutaneous PCO2 (PtcCO2 ) monitoring is currently limited by concerns many practitioners have regarding accuracy. We compared the accuracy of PtcCO2 with that of PaCO2 measurements in critically ill children, and we investigated whether clinical conditions associated with low cardiac output or increased subcutaneous tissue affect this accuracy. METHODS We performed a single-center prospective study of critically ill children placed on transcutaneous monitoring. RESULTS There were 184 children enrolled with paired PaCO2 and PtcCO2 values. Subjects had a median age of 31.8 mo (interquartile range 3.5-123.3 mo). Most children were mechanically ventilated (n = 161, 87.5%), and many had cardiac disease (n = 76, 41.3%). The median PaCO2 was 44 mm Hg (interquartile range 39-51 mm Hg). The mean bias between PaCO2 and PtcCO2 was 0.6 mm Hg with 95% limits of agreement from -13.6 to 14.7 mm Hg. The PtcCO2 and PaCO2 were within ±5 mm Hg in 126 (68.5%) measurements. In multivariable modeling, cyanotic heart disease (odds ratio 3.5, 95% CI 1.2-10, P = .02) and monitor number 2 (odds ratio 3.8 95% CI 1.3-10.5, P = .01) remained associated with PtcCO2 ≥ 5 mm Hg higher than PaCO2 . Serum lactate, fluid balance, renal failure, obesity, vasoactive-inotrope score, and acyanotic heart disease were not associated with high or low PtcCO2 values. In 130 children with a second paired PtcCO2 and PaCO2 measurement, predicting the second measured PaCO2 by subtracting the initial observed difference between the PtcCO2 and PaCO2 from the subsequent measured PtcCO2 decreased the mean bias between observed and predicted PaCO2 to 0.2 mm Hg and the 95% limits of agreement to -9.4 to 9.7 mm Hg. CONCLUSIONS PtcCO2 provides an acceptable estimate of PaCO2 in many critically ill children, including those with clinical conditions that may be associated with low cardiac output or increased subcutaneous tissue, although it does not perform as well in children with cyanotic heart disease. PtcCO2 may be a useful adjunct monitoring method, but it cannot reliably replace PaCO2 measurement.


title: Sendai virus as a backbone for vaccines against RSV and other human paramyxoviruses.

text: Human paramyxoviruses are the etiological agents for life-threatening respiratory virus infections of infants and young children. These viruses, including respiratory syncytial virus (RSV), the human parainfluenza viruses (hPIV1-4) and human metapneumovirus (hMPV), are responsible for millions of serious lower respiratory tract infections each year worldwide. There are currently no standard treatments and no licensed vaccines for any of these pathogens. Here we review research with which Sendai virus, a mouse parainfluenza virus type 1, is being advanced as a Jennerian vaccine for hPIV1 and as a backbone for RSV, hMPV and other hPIV vaccines for children.


title: Cortical Venous Filling on Dynamic Computed Tomographic Angiography: A Novel Predictor of Clinical Outcome in Patients With Acute Middle Cerebral Artery Stroke.

text: BACKGROUND AND PURPOSE Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome. METHODS Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT and whole-brain CT perfusion/dynamic CT angiography within 9 hours after stroke-onset. We defined poor outcome as a modified Rankin Scale score of ≥3. Association between the extent and velocity of CVF and poor outcome at 3 months was analyzed with Poisson-regression. Prognostic value of optimal CVF (maximum opacification of cortical veins) in addition to age, stroke severity, treatment, Alberta Stroke Program Early CT score, cerebral blood flow, and collateral status was assessed with logistic regression and summarized with the area under the curve. RESULTS Eighty-eight patients were included, with a mean age of 67 years. By combining the extent and velocity of optimal CVF, we observed a decreased risk of poor outcome in patients with good and fast optimal CVF, risk ratio of 0.5 (95% confidence interval, 0.3-0.7). Extent and velocity of optimal CVF had additional prognostic value (area under the curve, 0.88; 95% confidence interval, 0.77-0.98; P<0.02) compared with a model without CVF information. CONCLUSIONS The combination of extent and velocity of optimal CVF, as assessed with dynamic CT angiography, is useful to identify patients with acute middle cerebral artery stroke at higher risk of poor clinical outcome at 3-month follow-up. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl/trialreg and http://www.clinicaltrials.gov. Unique identifier: NTR1804 and NCT00880113, respectively.


title: Updated EAU Guidelines for Clear Cell Renal Cancer Patients Who Fail VEGF Targeted Therapy.

text: The European Association of Urology renal cancer guidelines have been updated to recommend nivolumab and cabozantinib over the previous standard of care in patients who have failed one or more lines of VEGF targeted therapy.


title: Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity.

text: BACKGROUND The laparoscopic sleeve gastrectomy (LSG) is emerging as an effective bariatric operation and is especially attractive in high-risk populations. In this study we examine the efficacy of LSG as a stand-alone operation in the veteran population. METHODS This is a retrospective review of consecutive patients who underwent LSG as a stand-alone procedure at the Palo Alto Veterans Affairs medical center with a minimum 12-month follow-up. RESULTS Of 205 patients undergoing bariatric surgery, 71 patients had a sleeve gastrectomy, 40 of whom had the operation performed at least 12 months previously. Thirty-six (90%) were available for 1-year follow-up, with a mean follow-up duration of 22 months (range: 12-42), a mean body mass index of 48.3 kg/m(2), and an 83% male population. Mean percent excess weight loss was 61% at an average of 22 months, with no significant difference between severely obese, morbidly obese, and super obese cohorts. Diabetes remission was seen in 56% of patients, hypertension remission in 51.6%, and obstructive sleep apnea remission in 46.4%, and gastroesophageal reflux disease improved or did not change in 83%. Medication use significantly decreased after surgery. CONCLUSION LSG is safe and effective as a stand-alone bariatric operation in the high-risk veteran population. It is effective in severely obese, morbidly obese, and super obese patients. LSG induces remission or improvement in comorbidities of nearly all patients, translating to a decrease in medication use.


COVID-19 brings drug development to a halt.


title: Five new flavonoid glycosides from Nervilia fordii.

text: Five new flavonoid glycosides, namely nervilifordins F-J (1-5), were isolated from the 60% EtOH extract of the aerial parts of Nervilia fordii, along with three first isolated flavonoids (7, 8, and 13) and five known flavonoids (6, 9-12). The structures of new compounds were elucidated on the basis of 1D and 2D NMR and MS studies. Their anti-inflammatory activities were tested by measuring their inhibitory effects on nitric oxide production in lipopolysaccharide-activated RAW264.7 macrophages. Compounds 2 and 5 showed interesting inhibition effects with their EC50 values of 15.15 μM and 14.80 μM, respectively.


A rampage through the body.


title: Low Cerebral Oxygenation Levels during Resuscitation in Out-of-hospital Cardiac Arrest Are Associated with Hyperfibrinolysis.

text: BACKGROUND The authors investigated whether patients with out-of-hospital cardiac arrest with an initial low cerebral oxygen level during cardiopulmonary resuscitation are more prone to develop hyperfibrinolysis than patients with normal cerebral oxygenation levels and which part of the fibrinolytic system is involved in this response. METHODS In 46 patients, hyperfibrinolysis was diagnosed immediately upon emergency department admission using rotational thromboelastometry and defined as a lysis more than 15%. Simultaneously, initial cerebral tissue oxygenation was measured using near-infrared spectroscopy, and oxygen desaturation was defined as a tissue oxygenation index (TOI) of 50% or less. Blood sample analysis included markers for hypoperfusion and fibrinolysis. RESULTS There was no difference in prehospital cardiopulmonary resuscitation duration between patients with or without hyperfibrinolysis. An initial TOI of 50% or less was associated with more clot lysis (91% [17 to 100%; n = 16]) compared with patients with a normal TOI (6% [4 to 11%]; n = 30; P < 0.001), with lower levels of plasminogen (151.6 ± 61.0 vs. 225.3 ± 47.0 μg/ml; P < 0.001) and higher levels of tissue plasminogen activator (t-PA; 18.3 ± 7.4 vs. 7.9 ± 4.7 ng/ml; P < 0.001) and plasminogen activator inhibitor-1 (19.3 ± 8.9 vs. 12.1 ± 6.1 ng/ml; P = 0.013). There were no differences in (activated) protein C levels among groups. The initial TOI was negatively correlated with t-PA (r = -0.69; P < 0001). Mortality rates were highest in patients with hyperfibrinolysis. CONCLUSION Activation of the fibrinolytic system is more common in out-of-hospital cardiac arrest patients with an initial cerebral tissue oxygenation value of 50% or less during resuscitation and is linked to increased levels of t-PA rather than involvement of protein C.