title: Naso-esophageal extraluminal drainage for postoperative anastomotic leak after thoracic esophagectomy for patients with esophageal cancer.

text: Postoperative anastomotic leaks and subsequent mediastinal abscess are serious complications. The purpose of this study was to assess the efficacy of naso-esophageal extraluminal drainage after thoracic esophagectomy with gastric conduit reconstruction using a posterior mediastinal route. About 50 of 365 patients (13.7%) with esophageal cancer and postoperative anastomotic leak after curative esophagectomy was investigated. Beginning in June 2009, naso-esophageal extraluminal drainage by inserting a naso-esophageal aspiration tube into the abscess cavity when percutaneous abscess drainage was introduced which was ineffective or technically impossible. Twenty-five patients underwent naso-esophageal extraluminal drainage concomitantly with enteral nutrition. Twenty-one (84%) patients had major leaks, one (4%) minor leak and three (12%) had endoscopically proven conduit necrosis. None of the naso-esophageal extraluminal drainage cases (100%) required reintervention or reoperation and all experienced complete cure (100%) during hospitalization. Endoscopic balloon dilatation was performed for four patients after discharge because of anastomotic stricture. Patients with leaks were divided into two groups: current group (n = 32), treated after June 2009, and preceding group (n = 18), treated prior to the introduction of naso-esophageal extraluminal drainage. Significantly more patients in the preceding group suffered respiratory failure (28% vs. 61%, p = 0.024), and higher reoperation rate (0% vs. 17%, p = 0.042) and hospital mortality (0% vs. 22%, p = 0.013). In the current group, 31 (97%) patients experienced complete cure during hospitalization. Naso-esophageal extraluminal drainage and concomitant enteral nutritional support are less invasive, and effective and powerful methods to treat even major leakage after esophagectomy. These methods may be an alternative management to improve mortality for patients with esophageal cancer.


title: Possible involvement of coaxially stacked double pseudoknots in the regulation of -1 programmed ribosomal frameshifting in RNA viruses.

text: -1 programmed ribosomal frameshifting (PRF) in viruses is often stimulated by a pseudoknot downstream from the slippery sequence. At the PRF junction of HIV-1, transmissible gastroenteritis virus (TGEV), Barmah Forest virus (BFV), Fort Morgan virus (FMV), and Equine arteritis virus (EAV), we identified potential double pseudoknots in either a tandem mode or embedded mode. In viruses with tandem pseudoknots (5'PK & 3'PK), the slippery sequence is encompassed in the 5'PK. The ribosome needs to unwind the 5'PK to get to the slippery sequence. In HIV-1, the 3'PK and several alternative structures are mutually exclusive. Disruption of the tandem pseudoknots may enable one of the alternative structures to form as the effective frameshift stimulator. In TGEV/BFV/FMV, the 3'PK is a conventional frameshift stimulator. In all cases, the tandem pseudoknots may slow down the ribosome before it reaches the conventional PRF signals. In EAV, a compact pseudoknot is embedded within loop2 of the otherwise conventional frameshift-stimulating pseudoknot. All double pseudoknots have the potential to stack their stems coaxially. We built structural models of the HIV-1 and EAV double pseudoknots to show that both the tandem and embedded modes are feasible and reasonable. We hypothesize that the fundamental reason for the viruses to utilize coaxially stacked double pseudoknots is to increase the overall stability of the frameshift regulating structure, and avoid an ultra-stable single pseudoknot which may become a ribosomal roadblock. Our results significantly expand the repertoire of RNA structures and dynamics that may potentially involve in -1 PRF regulation.


title: Cultural differences in expectations of change and tolerance for contradiction: a decade of empirical research.

text: Since the publication of Peng and Nisbett's seminal paper on dialectical thinking, a substantial amount of empirical research has replicated and expanded on the core finding that people differ in the degree to which they view the world as inherently contradictory and in constant flux. Dialectical thinkers (who are more often members of East Asian than Western cultures) show greater expectation of change in tasks related to explanation and prediction and greater tolerance of contradiction in tasks involving the reconciliation of contradictory information. The authors show how these effects are manifested in the domains of the self, emotional experience, psychological well-being, attitudes and evaluations, social categorization and perception, and judgment and decision making. They note important topics in need of further investigation and offer predictions concerning possible cultural differences in unexplored domains as a function of the presence or absence of naïve dialecticism.


title: COVID in New York City, the epicenter: A New York University perspective and COVID in Duluth, the Bold North: A University of Minnesota perspective.

text: In the first part of this dual commentary, perspectives are gathered from students at New York University. COVID in New York City is compared with the trauma of the World Trade Center. Triggers, racism, concerns, acts of kindness, and the future are considered for both. The second part of the commentary is written in juxtaposition to the New York City perspective by sharing the Upper Midwest experiences of this COVID-19 pandemic period, particularly in the small city of Duluth. Perspectives are gathered over time from students at the University of Minnesota, Duluth. The Minnesota stories are presented chronologically, from the declaration of the global pandemic to the beginning of the summer semester. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups.

text: OBJECTIVE To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.


title: Single port laparoscopic liver resection for hepatocellular carcinoma: a preliminary report.

text: Single port laparoscopic surgery is an emerging technique, now commonly used in cholecystectomy. The experience of using this technique in liver resection for hepatocellular carcinoma is described in a series of 3 cases with single port laparoscopic liver resection performed during 2010. All patients were male aged 61 to 70 years, with several comorbidities. There were no complications in this early series. The length of hospital stay was 3-5 days. The blood loss was 200-450 mL, with operating time between 142 and 171 minutes. We conclude that this technique is feasible and safe to perform in experienced centers.


docid: efbcmxjd

title: A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era.

text: The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.


docid: naqrrlcu

title: Comparative long-term effectiveness and safety of primary bariatric surgeries in treating type 2 diabetes mellitus in adults: a protocol for systematic review and network meta-analysis of randomised controlled trials.

text: INTRODUCTION Bariatric surgeries are effective in treating obesity related comorbidities, including type 2 diabetes mellitus. More robust evidence is needed to facilitate choice of procedure. In this systemic review, we aim to investigate the comparative long-term effectiveness in inducing remission of type 2 diabetes, halting diabetic complications, reducing mortality and the safety of conventional and emerging bariatric surgeries. METHODS AND ANALYSIS Databases including Cochrane Central Register, EMBASE, MEDLINE and clinical trial registries will be searched for randomised controlled trials with at least 3 years of follow-up, including direct and/or indirect evidence regarding primary bariatric surgeries in overweight or obese adults with type 2 diabetes mellitus, from inception of each database to 2019, with no language or publication type limits imposed. Dual selection of studies, data extraction and risk of bias assessments will be performed. Primary outcomes include full diabetes remission, composite outcome of full or partial diabetes remission and adverse event profiles. Secondary outcomes include anthropometric measurements, cardiovascular risk factor burden, medication burden, diabetic complications and all-cause mortality. Given sufficient homogeneity, network meta-analyses will be performed in a random-effects model based on the Bayesian framework, while assessing for consistency between direct and indirect estimates. Heterogeneities of studies will be explored through meta-regression analysis, and robustness of findings will be checked by sensitivity analysis, and an alternative method under a frequentist framework. All statistical analysis and graphical presentations will be conducted by R software V.3.3.3 (The R Project for Statistical Computing). The overall quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation criteria for each outcome. ETHICS AND DISSEMINATION Ethics approval is not required as individual patient data will not be included. This review will be subject for publication in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018110775.


Novel Middle East respiratory syndrome and renal failure.


title: Transportation capacity for patients with highly infectious diseases in Europe: a survey in 16 nations

text: Abstract Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. In most European Union member states specialized isolation facilities are responsible for the management of such cases. Ground ambulances are often affiliated with those facilities because rapid relocation of patients is most desirable. To date, no pooled data on the accessibility, technical specifications and operational procedures for such transport capacities are available. During 2009, the ‘European Network for HIDs’ conducted a cross-sectional analysis of hospitals responsible for HID patients in Europe including an assessment of (a) legal aspects; (b) technical and infrastructure aspects; and (c) operational procedures for ground ambulances used for HID transport. Overall, 48 isolation facilities in 16 European countries were evaluated and feedback rates ranged from 78% to 100% (n = 37 to n = 48 centres). Only 46.8% (22/47) of all centres have both national and local guidelines regulating HID patient transport. If recommended, specific equipment is found in 90% of centres (9/10), but standard ambulances in only 6/13 centres (46%). Exclusive entrances (32/45; 71%) and pathways (30/44; 68.2%) for patient admission, as well as protocols for disinfection of ambulances (34/47; 72.3%) and equipment (30/43; 69.8%) exist in most centres. In conclusion, the availability and technical specifications of ambulances broadly differ, reflecting different preparedness levels within the European Union. Hence, regulations for technical specifications and operational procedures should be harmonized to promote patient and healthcare worker safety.


title: Shortened protocol for radiofrequency ablation of perforator veins.

text: BACKGROUND Routine radiofrequency ablation (RFA) of an incompetent perforator vein (IPV) using the standard treatment protocol at 85°C has a treatment time of 6 minutes. To make treatment time more efficient, we sought to determine the effect of a shortened protocol for radiofrequency stylet (RFS) ablation by comparing the early success using three different temperatures: 85°C, 90°C, and 95°C. METHODS A retrospective study examined 642 procedures of IPV closures in 255 patients with varying degrees of venous insufficiency treated with RFA from 2009 to 2015. The Covidien (Mansfield, Mass) RFA system allows the operator to regulate temperature and allows increments in temperature of the RFS to 85°C, 90°C, and 95°C. The RFS probe was angled at four 90-degree angles at the mentioned temperatures with a shorter treatment time at 6, 4, and 3 minutes, respectively. The three different treatment protocols were compared. All patients had comparative preoperative and postoperative duplex ultrasound scans. Postoperative duplex ultrasound scans were performed 3 to 7 days after the procedure. Successful obliteration was defined as lack of color flow on postoperative duplex ultrasound scanning. Clinical correlation with age, gender, laterality, presenting symptoms (Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), location, and vein diameter was also performed. RESULTS Of the 255 patients who underwent RFS ablation, 138 were female, with a mean age of 65 years (standard deviation, ±14.6 years). These patients had CEAP presentations from C1 to C6 (0 C1, 1 C2, 57 C3, 118 C4, 4 C5, 75 C6). The location of the 642 IPVs was distributed as 472 in the calf and 170 in the ankle; 322 of these procedures were performed on the right leg. Use of a shortened protocol had no significant effect on the early obliteration rates with the 85°C, 90°C, and 95°C protocols, which were 66.1%, 61.8%, and 67.1%, respectively. Significant correlation was seen between location of targeted vein and successful obliteration (P < .001). There was a borderline inverse linear association between higher stylet temperature and successful obliteration in the proximal calf at 85°C. After accounting for within-patient correlation, the middle and distal calf continued to show higher nonobliteration compared with the ankle. No clinical correlation with age, gender, laterality, presenting symptoms of CEAP, or vein diameter was observed. CONCLUSIONS The study showed that shortening the protocol time for RFA of the perforator did not make a significant difference in the early success rate, regardless of the temperature. The overall early success rate is still low (65.1%). RFA of perforator veins has a higher successful closure rate in proximal calf and ankle areas compared with the middle and distal calf.


title: Effects of an Educational Glass Recycling Program against Environmental Pollution in Spain.

text: In this article, we analyzed the effects of an educational glass recycling program on primary schools and their students in Castilla-La Mancha (Spain). A sample of 89 schools, with 20,710 elementary students, was selected by simple random sampling. For the statistical analysis, descriptive techniques (frequencies and statistics), parametric (One Way ANOVA test), and non-parametric (Chi-Square test) inferential techniques were used, with a 5% significance level (p < 0.05). The program's results showed that 153,576.3 kg of glass (with a value of 17,064.03 €) were recycled. Significant determinants of glass recycling were: School category (p = 0.043), previous environmental/recycling education (p = 0.046), geographic location of school (p = 0.030), gender (p = 0.007), and academic year (p < 0.05). With the program, students learned the importance of glass recycling, obtained a greater knowledge of and habits related to the same, acquired favorable attitudes towards the environment, and promoted glass recycling in their social circles. We conclude that environmental education about glass recycling has positive effects on glass recycling attitudes and behaviors in elementary school students and may be used as a measure to combat the problem of environmental pollution.


title: Outcome after radiofrequency ablation of sarcoma lung metastases.

text: PURPOSE Resection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA). METHODS This is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded. RESULTS Twenty-two patients [15 women; median age 48 (range 10-78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5-2) cm, and 2.5 and 1 (1-7) respectively. Median CT and clinical follow-up were 12 (4-54) and 20 (8-63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival. CONCLUSION RFA is a safe and effective treatment for patients with small-volume sarcoma metastases.


COVID-19 and Cardiac Implantable Electronic Device Remote Monitoring: Crocodile Tears or New Opportunity?


Covid-19: UK starts social distancing after new model points to 260 000 potential deaths.


title: Cryoablation of sternal metastases for pain palliation and local tumor control.

text: PURPOSE To determine safety and effectiveness of cryoablation of sternal metastases for pain palliation and local tumor control. MATERIALS AND METHODS A tumor ablation database was retrospectively reviewed for sternal cryoablation procedures performed between January 2005 and June 2013, which yielded 15 procedures to treat 12 sternal metastases in 12 patients (five men). Median patient age was 57 years (range, 38-80 y). Metastases arose from five primary sites (breast, lung, kidney, ampulla, and thyroid), and median tumor size was 3.8 cm (range, 2.2-7.5 cm). Seven patients (58%) underwent cryoablation for pain palliation, and five (42%) underwent cryoablation for local tumor control of oligometastatic disease. Clinical outcomes (including complications, local tumor control, and pain response) were evaluated retrospectively. RESULTS Mean pain scores decreased from 7.0 ± 1.9 (median, 7; range, 4-10) at baseline to 1.8 ± 1.2 (median, 1.5; range, 0-4) following cryoablation (P = .00049). Two patients had durable pain palliation, and four had greater than 1 month of pain relief, with a median duration of 5.7 months (range, 1.5-14.7 mo). Two patients in whom recurrent pain developed underwent repeat cryoablation, with durable pain relief. Allowing for a single repeat treatment, local tumor control was achieved in four of five patients (80%) treated for this indication, with median follow-up of 8.4 months (range, 2.6-13.6 mo). In one patient (8%), an infectious complication developed that was successfully treated with antibiotics on an outpatient basis. CONCLUSIONS Cryoablation is a safe and potentially effective treatment for patients with painful sternal metastases and can achieve local tumor control in select patients.


title: The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study.

text: PURPOSE To assess whether the preoperative 1-h pad test could predict postoperative urinary incontinence and quality of life after robot-assisted radical prostatectomy. METHODS A total of 329 patients who underwent robot-assisted radical prostatectomy between 2013 and 2016 were prospectively enrolled in this study. These patients were divided into the preoperative urinary continence group and the preoperative urinary incontinence group according to the 1-h pad test. The time to achieve urinary continence, lower urinary tract function evaluated by uroflowmetry and post-voided residual urine volume, and quality of life evaluated by King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form were compared between these two groups. RESULTS There were 190 patients (58%) in the preoperative urinary continence group (1-h pad test ≤ 2 g) and 139 patients (42%) in the preoperative urinary incontinence group (1-h pad test > 2 g). In the preoperative urinary continence/incontinence groups, 83%/76% of patients achieved continence within 12 months, respectively, and urinary incontinence remained significantly longer in the preoperative incontinence group than in the preoperative continence group (P = 0.042). Although there were no significant differences in all quality of life items between the two groups before surgery, several items were significantly higher in the preoperative urinary continence group. CONCLUSION Achievement of urinary continence and improvement of urinary quality of life are delayed in patients with preoperative urinary incontinence assessed by the 1-h pad test. The preoperative 1-h pad test could be a useful predictor of prolonged urinary incontinence and poor quality of life after robot-assisted radical prostatectomy.


title: Discussing Goals of Care in a Pandemic: Precedent for an Unprecedented Situation.

text: The COVID-19 pandemic has precipitated the need for frequent end-of-life discussions. The circumstances surrounding these conversations are quite atypical. Here, I describe one such goals-of-care discussion during the pandemic and how I relied on the precedent of prior goals-of-care discussions to guide me through an unprecedented situation.


title: The accuracy of auditory spatial judgments in the visually impaired is dependent on sound source distance.

text: Blindness leads to substantial enhancements in many auditory abilities, and deficits in others. It is unknown how severe visual losses need to be before changes in auditory abilities occur, or whether the relationship between severity of visual loss and changes in auditory abilities is proportional and systematic. Here we show that greater severity of visual loss is associated with increased auditory judgments of distance and room size. On average participants with severe visual losses perceived sounds to be twice as far away, and rooms to be three times larger, than sighted controls. Distance estimates for sighted controls were most accurate for closer sounds and least accurate for farther sounds. As the severity of visual impairment increased, accuracy decreased for closer sounds and increased for farther sounds. However, it is for closer sounds that accurate judgments are needed to guide rapid motor responses to auditory events, e.g. planning a safe path through a busy street to avoid collisions with other people, and falls. Interestingly, greater visual impairment severity was associated with more accurate room size estimates. The results support a new hypothesis that crossmodal calibration of audition by vision depends on the severity of visual loss.


title: An Overview of Systematic Reviews and Meta- analyses on Acupuncture for Post-acute Stroke Dysphagia.

text: BACKGROUND Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. METHODS Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). RESULTS Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2-96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. CONCLUSION Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.


title: Efficacy of forced-air warming for preventing perioperative hypothermia and related complications in patients undergoing laparoscopic surgery: A randomized controlled trial.

text: BACKGROUND Perioperatively, unexpected hypothermia may cause adverse surgical outcomes. However, few studies have explored the efficacy of forced-air warming in patients undergoing laparoscopic surgery. AIM/OBJECTIVE To determine the efficacy of forced-air warming for preventing perioperative hypothermia and complications in patients undergoing laparoscopic surgery. METHODS A total of 127 participants undergoing laparoscopic thoracic or abdominal surgery were recruited between January and November 2015. Participants were randomly allocated to intervention (forced-air warming, n = 64) and control groups (passive insulation, n = 63). Oesophageal core temperature was measured during surgery, whilst tympanic core temperature was measured every 30 minutes preoperatively and in the postanaesthesia care unit. Levels of shivering and pain, amount of bleeding, and adverse cardiac events were measured before the transfer from the postanaesthesia care unit. The generalized estimating equation was used for data analysis. RESULTS The intervention group had better warming efficacy than the control group between 90 and 330 minutes during surgery. The intervention group had fewer complications than the control group in terms of intraoperative bleeding, time to rewarm to 36°C, pain levels, and shivering levels in the postanaesthesia care unit. CONCLUSION Forced-air warming can increase warming efficacy and reduce complications of perioperative hypothermia in patients undergoing laparoscopic surgery.


docid: frjglovm

title: Retrobulbar and peribulbar regional techniques in cats: a preliminary study in cadavers.

text: OBJECTIVE To compare injectate distribution and potential complications of retrobulbar and peribulbar injections in cat cadavers. STUDY DESIGN Prospective randomized masked study. ANIMALS Ten cat cadavers (20 eyes). METHODS A dorsomedial retrobulbar injection (RB) of 1 mL of 0.5% bupivacaine and iopamidol (1:1) was performed in seven eyes. A dorsomedial peribulbar injection (PB-1) of 4 mL of the same injectate was performed in seven eyes, and two peribulbar injections (PB-2) of the same injectate, divided equally between the dorsomedial and ventrolateral regions (2 mL each) were performed in six eyes. Intraocular pressure (IOP) was measured before, immediately and 15 minutes after injection. Cadavers underwent computed tomography before and following injections. A radiologist scored injectate distribution within the intraconal space (none, moderate, or large) and around the optic nerve (degrees). An injection was defined as likely to provide adequate regional anesthesia if the volume of distribution of intraconal injectate was 'large' and it contacted over 270° of the optic nerve circumference. RESULTS The success rate (95% confidence interval) of RB, PB-1, and PB-2 injections was 71% (29.0-96.3%), 86% (42.1-99.6%), and 67% (22.3-95.7%), respectively. With all three techniques, IOP increased significantly after injection, but returned to baseline by 15 minutes following RB injection. No intraocular, intravascular, intrathecal, or intraneural injectate was observed. CONCLUSION AND CLINICAL RELEVANCE The single-peribulbar injection technique may be superior to retrobulbar or double-peribulbar injections, however, all techniques require further studies in live cats to determine safety and efficacy prior to clinical use.


title: Limb remote ischemic preconditioning attenuates lung injury after pulmonary resection under propofol-remifentanil anesthesia: a randomized controlled study.

text: BACKGROUND Remote ischemic preconditioning (RIPC) may confer the protection in critical organs. The authors hypothesized that limb RIPC would reduce lung injury in patients undergoing pulmonary resection. METHODS In a randomized, prospective, parallel, controlled trial, 216 patients undergoing elective thoracic pulmonary resection under one-lung ventilation with propofol-remifentanil anesthesia were randomized 1:1 to receive either limb RIPC or conventional lung resection (control). Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff served as RIPC stimulus. The primary outcome was PaO2/FIO2. Secondary outcomes included other pulmonary variables, the incidence of in-hospital complications, markers of oxidative stress, and inflammatory response. RESULTS Limb RIPC significantly increased PaO2/FIO2 compared with control at 30 and 60 min after one-lung ventilation, 30 min after re-expansion, and 6 h after operation (238 ± 52 vs. 192 ± 67, P = 0.03; 223 ± 66 vs. 184 ± 64, P = 0.01; 385 ± 61 vs. 320 ± 79, P = 0.003; 388 ± 52 vs. 317 ± 46, P = 0.001, respectively). In comparison with control, it also significantly reduced serum levels of interleukin-6 and tumor necrosis factor-α at 6, 12, 24, and 48 h after operation and malondialdehyde levels at 60 min after one-lung ventilation and 30 min after re-expansion (all P < 0.01). The incidence of acute lung injury and the length of postoperative hospital stay were markedly reduced by limb RIPC compared with control (all P < 0.05). CONCLUSION Limb RIPC attenuates acute lung injury via improving intraoperative pulmonary oxygenation in patients without severe pulmonary disease after lung resection under propofol-remifentanil anesthesia.


title: Robotic-assisted ventral and incisional hernia repair with hernia defect closure and intraperitoneal onlay mesh (IPOM) experience.

text: BACKGROUND The most common technique described for robotic ventral hernia repair (RVHR) is intraperitoneal onlay mesh (IPOM). With the evolution of robotics, advanced techniques including retro rectus mesh reinforcement, and component separation are being popularized. However, these procedures require more dissection, and longer operative times. In this study we reviewed our experience with robotic ventral/incisional hernia repair (RVHR) with hernia defect closure (HDC) and IPOM. METHODS Retrospective chart review and follow-up of 31 consecutive cases of ventral/incisional hernia treated between August 2011 and December 2018. Demographics, operative times, blood loss, length of stay (LOS), hernia size, location, and type, mesh size and type, recurrence, conversion to open ventral hernia repair (OVHR) and complications including bleeding, seroma formation and infection were analyzed. RESULTS Mean age was 63.9 years old, with median BMI of 31.24 kg/m2. Median hernia area was 17 cm2. Mean operating time was 142.61 min (SD 59.79). Mean LOS was 1.46 days (range 1-5), with 48% being outpatient, and overnight stay in 32% for pain control. Conversion was necessary in 12.9% cases. Complication rate was 3% for enterotomy. Recurrence was 14.81% after a mean follow-up of 26.96 months. There was significant association of recurrence with COPD history (P = 0.0215) and multiple hernia defects (P = 0.0376). CONCLUSION Our recurrence rate (14.81%) compares favorably to those reported in literature (16.7%) for LVHR with HDC and IPOM. Our experience also indicates that IPOM is associated with satisfactory outcomes, low conversion and complications rates, and short LOS.


title: Single-incision laparoscopic cholecystectomy in a 6-month pregnant woman: a report of a case.

text: AIM We aimed to present a case of single-incision laparoscopic cholecystectomy (SILC) in a pregnant woman. CASE A 27-year-old, 24-week pregnant woman was referred to our clinic with abdominal pain, nausea, and vomiting. Physical examination and laboratory tests showed that she had acute biliary pancreatitis. An obstetric consultation showed that the patient and the fetus were healthy. After medical treatment the patient was discharged. However, she was again referred to our clinic with a second pancreatitis attack. We examined the patient and recommended cholecystectomy. Preoperative tests were completed and a new obstetric consultation was requested. After the receipt of informed consent for cholecystectomy, SILC was performed. CONCLUSIONS SILC is a feasible surgical method in pregnant women as well.


title: The use of social media among health professionals to facilitate chronic disease self-management with their patients: A systematic review.

text: Objective The objective of this systematic review was to summarize the evidence pertaining to the use of social media by health professionals to facilitate chronic disease self-management with their patients. Methods A systematic approach was used to retrieve and extract relevant data. A total of 5163 citations were identified, of which seven unique studies met criteria for inclusion; one was a randomized controlled trial, two were prospective cohort studies, and four were qualitative studies. The following social media platforms were evaluated: discussion forums (6 studies) and collaborative project (1 study). Results The available evidence suggests that health professionals perceived discussion forums and collaborative projects to be useful social media platforms to facilitate chronic disease self-management with patients. No relevant evidence was found regarding the use of other social media platforms. Most studies indicated positive findings regarding health professionals' intention to use discussion forums, while the one study that used a collaborative project also indicated positive findings with its perceived ease of use as health professionals felt that it was useful to facilitate chronic disease self-management with patients. Mixed findings were seen in regards to health professionals' perceived ease of use of discussion forums. The most common barrier to using social media platforms was the lack of time in health professionals' schedules. Conclusions Discussion forums and collaborative projects appear to be promising resources for health professionals to assist their patients in self-managing their chronic conditions; however, further research comparing various social media platforms is needed.


title: Radiofrequency ablation in patients with large cervical heterotopic gastric mucosa and globus sensation: Closing the treatment gap.

text: BACKGROUND AND AIM Symptomatic cervical heterotopic gastric mucosa, also known as cervical inlet patch (CIP), may present in various shapes and causes laryngopharyngeal reflux (LPR). Unfortunately, argon plasma coagulation, standard treatment of small symptomatic CIP, is limited in large CIP mainly because of concerns of stricture formation. Therefore, we aimed to investigate radiofrequency ablation (RFA), a novel minimally invasive ablation method, in the treatment of CIP focusing on large symptomatic patches. METHODS Consecutive patients with macroscopic and histological evidence of large (≥20 mm diameter) heterotopic gastric mucosa were included in this prospective trial. Primary outcome was complete macroscopic and histological eradication rate of CIP. Secondary outcome measures were symptom improvement, quality of life, severity of LPR and adverse events. RESULTS Ten patients (females, n = 5) underwent RFA of symptomatic CIP. Complete histological and macroscopic eradication of CIP was observed in 80% (females, n = 4) of individuals after two ablations. Globus sensations significantly improved from median visual analog scale score 8 (5-9) at baseline to 1.5 (1-7) after first ablation and 1 (1-2) after final evaluation (P < 0.001). Mental health scores significantly increased from 41.4 (± 8.5) to 54.4 (± 4.4) after RFA (P = 0.007). LPR improved significantly (P = 0.005) with absence of strictures after a mean follow up of 1.9 (± 0.5) years. CONCLUSIONS This is the first study on RFA focusing on therapy of large symptomatic heterotopic gastric mucosa. Hereby, we demonstrate that this new technique can be successfully implemented in patients where treatment was limited so far (NCT03023280).


title: The anthelmintic niclosamide inhibits colorectal cancer cell lines via modulation of the canonical and noncanonical Wnt signaling pathway.

text: BACKGROUND Wnt/β-catenin signaling is known to play an important role in colorectal cancer (CRC). Niclosamide, a salicylamide derivative used in the treatment of tapeworm infections, targets the Wnt/β-catenin pathway. The objective of this study was to investigate niclosamide as a therapeutic agent against CRC. METHODS The antiproliferative effects of 1, 3, 10, and 50 μM concentrations of niclosamide on human (SW480 and SW620) and rodent (CC531) CRC cell lines were determined by MTS assay and direct cell count. The lymphoid enhancer-binding factor 1/transcription factor (LEF/TCF) reporter assay monitored the activity of Wnt signaling. Immunofluorescence staining demonstrated the expression pattern of active β-catenin. Gene expression of canonical and noncanonical Wnt signaling components was analyzed using qRT-PCR. Western blot analysis was performed with antibodies detecting nuclear localization of β-catenin and c-jun. RESULTS Cell proliferation in CRC cell lines was blocked dose dependently after 12 and 24 h of incubation. The Wnt promoter activity of LEF/TCF significantly decreased with niclosamide concentrations of 10 and 50 μM after 12 h of incubation. Active β-catenin did not shift from the nuclear to the cytosolic pool. However, canonical target genes (met, MMP7, and cyclin D1) as well as the coactivating factor Bcl9 were downregulated, whereas the noncanonical key player c-jun was clearly activated. CONCLUSIONS Niclosamide treatment is associated with an inhibitory effect on CRC development and reduced Wnt activity. It may exert its effect by interfering with the nuclear β-catenin-Bcl9-LEF/TCF triple-complex and by upregulation of c-jun representing noncanonical Wnt/JNK signaling. Thus, our findings warrant further research into this substance as a treatment option for patients with advanced CRC.


docid: xzclbzhu

title: Pneumonia eosinofilic in pediatrics, clinical cases.

text: INTRODUCTION Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.


title: Infectious bronchitis virus and brown shell colour: Australian strains of infectious bronchitis virus affect brown eggshell colour in commercial laying hens differently.

text: The aim of the current study was to assess any effect of wild and vaccine Australian infectious bronchitis virus (IBV) strains on shell colour in brown-shelled eggs. In Experiment 1, eggs were collected from day 1 to day 13 post-inoculation (p.i.) from unvaccinated laying hens challenged with IBV wild strains T and N1/88 and from a negative control group of hens. In Experiment 2, eggs were collected from 2 to 22 days p.i. from unvaccinated and vaccinated laying hens challenged with either a wild or a vaccine strain of IBV. In Experiment 1, there was a significant effect (P < 0.05) of day p.i. and of viral strain on shell reflectivity, L* and protoporphyrin IX (PP IX) in eggshells, with and without cuticle. The mean PP IX/g of shell with and without cuticle was significantly higher on day 1 p.i. compared to day 7, after which PP IX increased with day p.i. In Experiment 2, shell reflectivity and L* increased and PP IX decreased with increased day p.i. until day 12. Shell reflectivity and L* decreased slightly after day 12 and increased again towards day 22. Shell reflectivity, L* and PP IX were not significantly different for eggshells from unvaccinated and vaccinated laying hens in the intact eggshell, but were significantly different in shells from which cuticle had been removed. In conclusion, the IBV strains reduced the intensity of brown shell colour to different extents with a lower amount of PP IX in eggshells.


Dosing will be a key success factor in repurposing antivirals for COVID-19.


title: Laparoscopic splenectomy for tuberculous abscess of the spleen.

text: Abscess of the spleen is an uncommon clinical entity and a tuberculous abscess is particularly rare. Although image-guided aspiration has been reported, splenectomy is the preferred modality of treatment. We report a 32-year-old female diagnosed to have a large, multilocular splenic abscess during investigation of a pyrexial illness. Her haemoglobin was 9.8 gm%, ESR 100 mm/1(st) hour and she was HIV negative. She had been on anti-tubercular chemotherapy (started elsewhere) for 2 months but had shown poor response. A laparoscopic splenectomy undertaken using four-ports was challenging due to the presence of perisplenitis and adhesions in the splenic hilum. Also, fundus of stomach densely adherent to the upper pole of the spleen required stapled resection. Postoperatively, she developed a low-output pancreatic fistula that resolved with conservative treatment within a week. Histopathology of the spleen confirmed tuberculosis. She responded well to anti-tubercular chemotherapy and remains well 3 years later.


D1466-like genotype of infectious bronchitis virus responsible for a new epidemic in chickens in Poland.


title: Less is More: Modern Neonatology.

text: Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies.


Orthopaedic nursing and the COVID19 pandemic: the first few months.


title: Electrosurgery: principles and practice to reduce risk and maximize efficacy.

text: Science becomes art and art becomes function when fundamental principles are utilized to dictate surgical practice. Most important, the risk for inadvertent thermal injury during electrosurgery can be minimized by a sound comprehension of the predictable behaviors of electricity in living tissue.Guided by the Hippocratic charge of primum non nocere, the ultimate aim of energy-assisted surgery is the attainment of anatomic dissection and hemostasis with the least amount of collateral damage and subsequent scar tissue formation.Ideally, the surgeon’s final view of the operative field should accurately approximate the topography discoverable after postoperative healing. Despite the continued innovation of products borne to reduce thermal damage and then marketed as being comparatively safer, it is the hands and mind of the surgeon that serve to preserve tissue integrity by reducing the burden of delayed thermal necrosis and taking steps to prevent excessive devitalization of tissue. Regardless of the chosen modality, the inseparable and exponentially linked elements of time and the quantity of delivered energy must be integrated while purposefully moderating to attain the desired tissue effect. Ultimately, the reduction of unwanted thermal injury is inherently linked to good surgical judgment and technique, a sound comprehension of the applied energy modality, and the surgeon’s ability to recognize anatomic structures within the field of surgical dissection as well as those within the zone of significant thermal change.During the use of any energy-based device for hemostasis, out of sight must never mean out of mind. If the bowel, bladder, or ureter is in close proximity to a bleeder,they should be sufficiently mobilized before applying energy. Thermal energy should always be withheld until an orderly sequence of anatomic triage is carried out.Whenever a vital structure cannot be adequately mobilized, hemorrhage is preferentially controlled by using mechanical tamponade or suture ligature.


title: [Experience of tracheotomy for critical patients with COVID-19: a case report].

text: 新型冠状病毒肺炎（新冠肺炎）危重症患者多伴有呼吸衰竭，呼吸支持治疗至关重要。气管插管有创机械通气可以快速改善缺氧状态，是危重症患者出现呼吸衰竭时的首选治疗手段，而气管切开术适用于需长期治疗的患者，可提供有创呼吸支持通道、吸除下呼吸道分泌物、减少长期插管的并发症等。本文报告1例新冠肺炎危重症患者行气管切开术的经过和体会，并就手术适应证和时机、术中防护措施、麻醉选择及手术要点等相关问题进行讨论。.


title: Mavoglurant Augmentation in OCD Patients Resistant to Selective Serotonin Reuptake Inhibitors: A Proof-of-Concept, Randomized, Placebo-Controlled, Phase 2 Study.

text: INTRODUCTION To determine if mavoglurant (modified release) as an augmentation therapy to selective serotonin reuptake inhibitors (SSRIs) could have beneficial effects reducing Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score in patients with obsessive-compulsive disorder (OCD) resistant to SSRI treatment. METHODS This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2 study. Patients remained on their SSRI treatment and mavoglurant or placebo was added on. Non-smoking men and women aged 18-65 years primarily diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria were randomized (1:1) to mavoglurant or placebo groups. After 50 patients were randomized, an interim analysis was conducted to determine whether the study should be continued. The primary outcome measure was absolute change in Y-BOCS from baseline at week 17. Safety was assessed by recording adverse events (AEs) and serious adverse events (SAEs). RESULTS Interim analysis led to a decision to terminate the study. In total 38 (76.0%) participants completed 17 weeks of treatment and 37 (74.0%) completed the study. There was no significant difference in least squares (LS) mean change from baseline at week 17 in Y-BOCS total score for mavoglurant compared with placebo groups [-6.9 (1.75) vs. -8.0 (1.78), respectively; LS mean difference 1.1; 95% CI -3.9, 6.2; p = 0.671]. The incidence of AEs was higher in the mavoglurant compared with the placebo group (80.8% vs. 70.8%, respectively). CONCLUSION This study of mavoglurant in OCD was terminated because of the lack of efficacy at interim analysis. The study did not support the use of an antagonist of mGluR5 receptors for OCD treatment. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov: NCT01813019. FUNDING This study was sponsored by Novartis Pharma AG, Basel, Switzerland.


title: First-in-human use of the OneShot™ renal denervation system from Covidien.

text: Percutaneous transcatheter renal sympathetic denervation (RDN) is a promising treatment for refractory hypertension (HT). RDN was found in one series of clinical studies to reduce systolic blood pressure (SBP) by as much as a mean of 30 mmHg with 85% of subjects experiencing sustained reductions of 10 mm or more out to two years after RDN. This degree of blood pressure reduction may reduce stroke and myocardial infarction rates and is anticipated to translate into improved life expectancy. The lowering of blood pressure by RDN has been shown to improve glycaemic control and reverse left ventricular hypertrophy. Beneficial effects on renal function, sleep apnoea and heart failure are suggested as well. This report describes the first patient treated using the OneShot™ Renal Denervation System (formerly Maya Medical now Covidien, Campbell, CA, USA).


title: A critical appraisal of transanal minimally invasive surgery (TAMIS) in the treatment of rectal adenoma: a 4-year experience with 51 cases.

text: OBJECTIVE The aim of this study was to describe feasibility, postoperative morbidity, and histological outcome of transanal minimally-invasive surgery (TAMIS) in patients with rectal adenoma. MATERIAL AND METHODS All patients who underwent TAMIS at a single institution from December 2011 to December 2015 were retrospectively included in the study. Feasibility was based on tumor size, distance of tumor from the anal verge, operative time, and hospital stay. Thirty-day morbidity was defined by the revised Accordion Classification system. Histological outcome included microscopic resection margin status, specimen fragmentation status, and grading of dysplasia in rectal adenoma. RESULTS A total of 51 patients with rectal adenoma underwent TAMIS. The median tumor diameter was 32 (4-60) mm and the median distance from the anal verge 8 (3-14) cm. Median operative time was 40 (13-116) min and median length of hospital stay was 1 (0-25) days. Overall morbidity was 12% (four grade 1, one grade 2, and one grade 3 complications). 22% had a positive resection margin, whereas 31% had an indefinable resection margin status mostly due to tissue fragmentation. Median follow-up time was 7 (0-40) months. CONCLUSIONS TAMIS is a challenging surgical technique for treatment of rectal adenoma. Our initial experience among 51 patients resulted in a high proportion of positive resection margins and a high fragmentation rate. The role of TAMIS in the treatment of rectal adenoma is to be defined through comparative studies.


title: Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change.

text: Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.


title: [Bioethics guide on scarce medical resource allocation in Mexico].

text: The bioethical inquiry about allocating fairly scarce health resources is not new, all countries around the world that were seriously afflicted by SARS-CoV-2 have issued triage guidelines in order to address the dilemmas raised by the pandemic. There is no question about the need to create bioethical guidelines, since its creation provides a degree of certainty that fair and ethical decisions are taken. This also prevents that decisions are made in solitary and maybe motivated by corrupted actions. In Mexico, the creation of this guidelines was a proactive and preventive measure to what was unavoidable, the exponential contagion phase of the pandemical scenario caused by Covid-19. On April 30, 2020 the General Sanitary Council published the Bioethical Guide to Allocate Scarce Resources on Critical Care Medicine in Emergency Situation. This guide has at the core of its principal that of upmost importance: social justice principle which main thesis is "All lives have the same value". The aim of this contribution is to provide the ethical and legal principles established in the aforementioned bioethical guideline. In sum, a brief exploration of the ethical reasons that supports a specific way to allocate scarce health resources is provided, as well as the foundations of the procedural part from a human rights-based approach.


title: Healthcare delivery in India amid the Covid-19 pandemic: Challenges and opportunities.

text: In India, the Covid-19 pandemic has thrown open challenges on multiple fronts: (a) the reconfiguration of care in hospitals, in response to Covid-19, has led to many patients suffering non-Covid conditions having to delay their treatment, and (b) the lockdown which though necessary has affected people unequally, some being much worse-off than others. This article unpacks the impact of Covid-19 on healthcare systems in India by raising moral and ethical questions about the plight of patients with other medical conditions while accessing care. This article also proposes a set of actions by which healthcare systems can address Covid and non-Covid related healthcare needs..


title: Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis.

text: OBJECTIVE Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. DATA SOURCES Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. MAIN RESULTS From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. CONCLUSIONS Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.


title: Papain-like protease 1 from transmissible gastroenteritis virus: crystal structure and enzymatic activity toward viral and cellular substrates.

text: Coronaviruses encode two classes of cysteine proteases, which have narrow substrate specificities and either a chymotrypsin- or papain-like fold. These enzymes mediate the processing of the two precursor polyproteins of the viral replicase and are also thought to modulate host cell functions to facilitate infection. The papain-like protease 1 (PL1(pro)) domain is present in nonstructural protein 3 (nsp3) of alphacoronaviruses and subgroup 2a betacoronaviruses. It participates in the proteolytic processing of the N-terminal region of the replicase polyproteins in a manner that varies among different coronaviruses and remains poorly understood. Here we report the first structural and biochemical characterization of a purified coronavirus PL1(pro) domain, that of transmissible gastroenteritis virus (TGEV). Its tertiary structure is compared with that of severe acute respiratory syndrome (SARS) coronavirus PL2(pro), a downstream paralog that is conserved in the nsp3's of all coronaviruses. We identify both conserved and unique structural features likely controlling the interaction of PL1(pro) with cofactors and substrates, including the tentative mapping of substrate pocket residues. The purified recombinant TGEV PL1(pro) was shown to cleave a peptide mimicking the cognate nsp2|nsp3 cleavage site. Like its PL2(pro) paralogs from several coronaviruses, TGEV PL1(pro) was also found to have deubiquitinating activity in an in vitro cleavage assay, implicating it in counteracting ubiquitin-regulated host cell pathways, likely including innate immune responses. In combination with the prior characterization of PL2(pro) from other alphacoronaviruses, e.g., human coronaviruses 229E and NL63, our results unequivocally establish that these viruses employ two PL(pro)s with overlapping specificities toward both viral and cellular substrates.


title: Comparison of Reinforcement Techniques Using Suture on Staple-Line in Sleeve Gastrectomy.

text: BACKGROUND Sleeve gastrectomy is a common procedure in recent years for treatment of morbid obesity however leak from staple-line is its main challenging complication. Despite numerous studies regarding leak after sleeve gastrectomy, there is still no conclusion on reinforcement of staple-line in this procedure. The purpose of this study was to compare two methods of oversewing staple-line versus no reinforcement. METHODS Resected stomachs of 30 patients undergoing laparoscopic sleeve gastrectomy were evaluated for bursting pressure immediately after extraction from the abdomen. Reinforcement technique was applied in random order to 3 segments of the staple-line on each specimen: continuous Lembert's sutures, continuous through-and-through sutures, and no reinforcement. Bursting pressure was determined by injection of methylene blue solution into lumen of resected stomach and recording pressure at which leakage occurs. Location of leak, intragastric pressure, and volume at first leak were recorded. RESULTS Baseline characteristics of patients were similar in randomized groups for order of reinforcement technique. Mean ischemia time of specimens was 17.4 ± 10.4 min. No leaks were observed in segments reinforced with Lembert's oversewing technique. The through-and-through reinforcement segments were first to leak in 21 out of 30 cases (70 %) with mean leak pressure of 570 mmHg and mean leak volume of 399 ml. Leakage occurred in 9 segments (30 %) with no reinforcement with a leak pressure of 329 mmHg and volume of 380 ml. CONCLUSIONS In vitro, Lembert's suture reinforcement technique on stapled human stomach is associated with less leakage rate in comparison to through-and-through reinforcement and non-reinforced staple-line.


title: Percutaneous radiofrequency ablation does not affect glomerular filtration rate.

text: PURPOSE To study short- and intermediate-term global renal function in patients undergoing a single percutaneous radiofrequency ablation (pRFA) for a solitary renal parenchymal tumor. MATERIALS AND METHODS We reviewed the records of 62 patients who underwent a single pRFA for solitary renal parenchymal tumor. We used the abbreviated Modified Diet for Renal Disease equation to calculate baseline, 1-month, and 1-year glomerular filtration rate (GFR). We defined normal as >60, moderately diminished as 45-60, and severely diminished GFR as <45 cc/minute/1.73 m². We used the Wilcoxon paired rank sum method to compare 1-month and 1-year GFR to baseline. We fit a linear regression model to test the association of lesion size to GFR controlling for lesion location and baseline GFR. RESULTS There was no difference in GFR from baseline at 1 month or 1 year (55 vs. 58 cc/minute/1.73 m², p=0.24 and 55 vs. 57 cc/minute/1.73 m², p=0.8, respectively). Tumor size did not affect GFR at 1 month or 1 year after controlling for lesion location and baseline GFR. CONCLUSIONS A single application of pRFA does not affect GFR in the short or intermediate term.


The health carer.


title: Perceived vulnerability to Coronavirus infection: impact on dental practice.

text: SARS-CoV-2 is a new virus responsible for the outbreak of the respiratory disease COVID-19, which has spread to several countries around the world, causing considerable consternation and a fear of contagions in global healthcare settings. The objective of this study is to identify, among Madrid's adult population, the impact of COVID-19 on self-perceived vulnerability, infectiousness, aversion to germs, and other behaviors in the current situation regarding dental practice. This cross-sectional observational study involves 1,008 persons randomly surveyed on the streets of Madrid, Spain between March 1 and March 8, 2020. Their perceived vulnerability to disease was measured using the perceived vulnerability to disease scale. An additional questionnaire evaluated basic sociodemographic aspects, medical history, personal hygiene behavior, willingness to go to certain places and the perception of the risk of contagion when going to a dental practice. There are significant differences by sex on the germ aversion subscale (p < 0.05) and in the risk of waiting in the waiting room (p < 0.01), tooth extraction ((p < 0.05), endodontics (p < 0.05) and fillings ((p < 0.05). Women consider the risk to be higher than men do. The risk group (over 60 and with systemic disease) has significant differences on the subscales of infectivity (p < 0.01) and germ aversion (p < 0.01). Our study shows high levels of vulnerability regarding contracting COVID-19 and avoiding dental care as perceived by the population over 60 years old and with a systemic disease.


docid: shsnrhop

title: Covid-19: A systemic disease treated with a wide-ranging approach: A case report.

text: At the end of December 2019, the Health Commission of the city of Wuhan, China, alerted the World Health Organization (WHO) to a pneumonia cluster in the city. The cause was identified as being a new virus, later named SARS-CoV-2. We can distinguish three clinical phases of the disease with a distinct pathogenesis, manifestations and prognosis. Here, we describe the case of a 45-year-old male, successfully treated for Coronavirus disease (COVID-19). The patient was feeling sick in early April 2020; he had a fever and pharyngodynia. When he came to our COVID hospital, his breathing was normal. The nasopharyngeal swab specimen turned out positive. High-resolution computed tomography (HRCT) showed mild interstitial pneumonia. The patient was admitted to our department and treated with hydroxychloroquine, ritonavir, darunavir, azithromycin and enoxaparin. On day seven of the disease, the patient's respiratory condition got worse as he was developing acute respiratory distress syndrome (ARDS). He was given tocilizumab and corticosteroids and was immediately treated with non-invasive mechanical ventilation (NIMV). His condition improved, and in the ensuing days, the treatment gradually switched to a high-flow nasal cannula (HFNC); after 18 days, the patient's clinical condition was good.The successful results we have been able to obtain are closely associated with avoidance of invasive ventilation that may lead to intensive care unit (ICU)-related superinfections. In our opinion, it is fundamental to understand that COVID-19 is a systemic disease that is a consequence of an overwhelming inflammatory response, which can cause severe medical conditions, even in young patients.


title: Recommendations for the COVID-19 Response at the National Level Based on Lessons Learned from the Ebola Virus Disease Outbreak in the Democratic Republic of the Congo.

text: The tenth outbreak of Ebola virus disease (EVD) in North Kivu, the Democratic Republic of the Congo (DRC), was declared 8 days after the end of the ninth EVD outbreak, in the Equateur Province on August 1, 2018. With a total of 3,461 confirmed and probable cases, the North Kivu outbreak was the second largest outbreak after that in West Africa in 2014-2016, and the largest observed in the DRC. This outbreak was difficult to control because of multiple challenges, including armed conflict, population displacement, movement of contacts, community mistrust, and high population density. It took more than 21 months to control the outbreak, with critical innovations and systems put into place. We describe systems that were put into place during the EVD response in the DRC that can be leveraged for the response to the current COVID-19 global pandemic.


title: Active Video Games for Rehabilitation in Respiratory Conditions: Systematic Review and Meta-Analysis.

text: BACKGROUND Exercise and physical activity are key components of treatment for chronic respiratory diseases. However, the level of physical activity and adherence to exercise programs are low in people with these diseases. Active video games (AVGs) may provide a more engaging alternative to traditional forms of exercise. OBJECTIVE This review examines the effectiveness of game-based interventions on physiological outcome measures, as well as adherence and enjoyment in subjects with chronic respiratory diseases. METHODS A systematic search of the literature was conducted, with full texts and abstracts included where they involved an AVG intervention for participants diagnosed with respiratory conditions. A narrative synthesis of included studies was performed. Additionally, meta-analysis comparing AVGs with traditional exercise was undertaken for 4 outcome measures: mean heart rate (HR) during exercise, peripheral blood oxygen saturation (SpO2) during exercise, dyspnea induced by the exercise, and enjoyment of the exercise. RESULTS A total of 13 full-text papers corresponding to 12 studies were included in the review. Interventions predominantly used games released for the Nintendo Wii (8 studies) and Microsoft Xbox Kinect (3 studies). There were 5 studies that examined the acute effects of a single session of AVGs and 7 studies that examined the long-term effects after multiple sessions of AVGs. Trials conducted over more than 1 session varied in duration between 3 and 12 weeks. In these, AVG interventions were associated with either similar or slightly greater improvements in outcomes such as exercise capacity when compared with a traditional exercise control, and they also generally demonstrated improvements over baseline or nonintervention comparators. There were a few studies of unsupervised AVG interventions, but the reported adherence was high and maintained throughout the intervention period. Additionally, AVGs were generally reported to be well liked and considered feasible by participants. For outcome measures measured during a single exercise session, there was no significant difference between an AVG and traditional exercise for HR (mean difference 1.44 beats per minute, 95% CI -14.31 to 17.18), SpO2 (mean difference 1.12 percentage points, 95% CI -1.91 to 4.16), and dyspnea (mean difference 0.43 Borg units, 95% CI -0.79 to 1.66), but AVGs were significantly more enjoyable than traditional exercise (Hedges g standardized mean difference 1.36, 95% CI 0.04-2.68). CONCLUSIONS This review provides evidence that AVG interventions, undertaken for several weeks, can provide similar or greater improvements in exercise capacity and other outcomes as traditional exercise. Within a single session of cardiovascular exercise, an AVG can evoke similar physiological responses as traditional exercise modalities but is more enjoyable to subjects with chronic respiratory diseases. However, there is very limited evidence for adherence and effectiveness in long-term unsupervised trials, which should be the focus of future research.


title: Cardiopulmonary Exercise Testing in Oesophagogastric Surgery: a Systematic Review.

text: BACKGROUND Cardiopulmonary exercise testing (CPX) can objectively measure fitness and oxygen uptake at anaerobic threshold. The relationship between fitness and postoperative outcomes after upper gastro-intestinal surgery is unclear. The aim of the present review is to assess the prognostic ability of CPX in predicting postoperative outcome associated with oesophagogastric surgery. METHODS Relevant studies were identified through a systematic search of EMBASE, Medline, CINAHL, Cochrane Library, and Web of Science to July 2019. The eligibility criteria for studies included prognostic studies of upper gastro-intestinal surgery among adult populations using a preoperative CPX and measurement of postoperative outcome (mortality or morbidity or length of stay). Risk of bias was assessed using the QUIPS Quality in Prognostic Studies validated tool. RESULTS Thirteen papers with a total of 1735 participants were included in data extraction. A total of 7 studies examined the association between CPX variables and postoperative mortality. Patients undergoing gastro-intestinal surgery with lower anaerobic threshold values were found to have an increased risk of postoperative mortality. Similarly, a lower rate of oxygen consumption was found to be associated with higher mortality. There was conflicting evidence regarding the association between CPX variables and postoperative morbidity. The evidence did not demonstrate any association between preoperative CPX variables and hospital length of stay. CONCLUSION Studies report an association between CPX variables and postoperative mortality; however, there is conflicting evidence regarding the association between CPX variables and postoperative morbidity.


title: MRI T2 and T1ρ relaxation in patients at risk for knee osteoarthritis: a systematic review and meta-analysis.

text: BACKGROUND Magnetic resonance imaging (MRI) T2 and T1ρ relaxation are increasingly being proposed as imaging biomarkers potentially capable of detecting biochemical changes in articular cartilage before structural changes are evident. We aimed to: 1) summarize MRI methods of published studies investigating T2 and T1ρ relaxation time in participants at risk for but without radiographic knee OA; and 2) compare T2 and T1ρ relaxation between participants at-risk for knee OA and healthy controls. METHODS We conducted a systematic review of studies reporting T2 and T1ρ relaxation data that included both participants at risk for knee OA and healthy controls. Participant characteristics, MRI methodology, and T1ρ and T2 relaxation data were extracted. Standardized mean differences (SMDs) were calculated within each study. Pooled effect sizes were then calculated for six commonly segmented knee compartments. RESULTS 55 articles met eligibility criteria. There was considerable variability between scanners, coils, software, scanning protocols, pulse sequences, and post-processing. Moderate risk of bias due to lack of blinding was common. Pooled effect sizes indicated participants at risk for knee OA had lengthened T2 relaxation time in all compartments (SMDs from 0.33 to 0.74; p < 0.01) and lengthened T1ρ relaxation time in the femoral compartments (SMD from 0.35 to 0.40; p < 0.001). CONCLUSIONS T2 and T1ρ relaxation distinguish participants at risk for knee OA from healthy controls. Greater standardization of MRI methods is both warranted and required for progress towards biomarker validation.


title: New insights into RNA packaging in porcine reproductive and respiratory syndrome virus.

text: While identifying whether the smallest packaged heteroclite subgenomic RNA (S9) of porcine reproductive and respiratory syndrome virus (PRRSV) contains a packaging signal, we found that S9 was capable of binding to the basic amino acid-rich domain (synthetic peptide of aa 34-53) of the packaging protein (N). In addition, by using truncations at the 5' and 3' ends of S9, a minimal binding region of 35 nt was found to be essential for binding to both the synthetic peptide and to the full-length N protein. Furthermore, by using cell-culture experiments, we found that S9 was capable of packaging non-viral RNA sequence into PRRSV particles and that the 35 nt region was essential for this activity. Taken together, our data suggest that this 35 nt region might be an important element for packaging PRRSV genomic RNA into virus particles.


Clinical and Perioperative Management in Ophthalmology During the COVID-19 Pandemic.


Can interferons stop COVID-19 before it takes hold?


Time to go back to school: several good reasons beyond low infection risk.


title: The Demands of Professional Rugby League Match-Play: a Meta-analysis.

text: BACKGROUND Rugby league is a collision sport, where players are expected to be physically competent in a range of areas, including aerobic fitness, strength, speed and power. Several studies have attempted to characterise the physical demands of rugby league match-play, but these studies often have relatively small sample sizes based on one or two clubs, which makes generalisation of the findings difficult. Therefore, the aim of this review was to synthesise studies that investigated the physical demands of professional rugby league match-play. METHODS SPORTDiscus, CINAHL, MEDLINE (EBSCO) and Embase (EBSCO) databases were systematically searched from inception until October 2018. Articles were included if they (1) recruited professional rugby league athletes aged ≥ 18 years and (2) provided at least one match-play relevant variable (including playing time, total and relative distance, repeat high-intensity efforts (RHIE), efforts per RHIE, accelerations and decelerations, total and relative collisions). Meta-analyses were used to provide pooled estimates ± 95% confidence intervals. RESULTS A total of 30 studies were included. Pooled estimates indicated that, compared to adjustables and backs, forwards have less playing time (- 17.2 ± 5.6 and - 25.6 ± 5.8 min, respectively), cover less 'slow-speed' (- 2230 ± 735 and - 1348 ± 655 m, respectively) and 'high-speed' distance (- 139 ± 108 and - 229 ± 101 m, respectively), but complete more relative RHIEs (+ 0.05 ± 0.05 and + 0.08 ± 0.04 per minute, respectively), and total (+ 12.0 ± 8.1 and + 12.8 ± 7.2 collisions, respectively) and relative collisions (+ 0.32 ± 0.22 and + 0.41 ± 0.22 collisions per minute, respectively). Notably, when the distance was expressed relative to playing time, forwards were not different from adjustables and backs in slow-speed (P ≥ 0.295) and high-speed (P ≥ 0.889) relative distance. The adjustables and backs subgroups were similar in most variables, except playing time (shorter for adjustables, - 8.5 ± 6.2 min), slow-speed distance (greater for adjustables, + 882 ± 763 m) and total relative distance (greater for adjustables, + 11.3 ± 5.2 m·min-1). There were no significant differences between positional groups for efforts per RHIE, accelerations and decelerations (P ≥ 0.745). CONCLUSIONS These results indicate the unique physical demands of each playing position and should be considered by strength and conditioning and tactical coaches when planning for professional rugby league performance. PROTOCOL REGISTRATION: https://osf.io/83tq2/.


title: Is Regional Anesthesia Enough Safe in Suspected or Confirmed COVID-19 Patients?

text: COVID-19 is a new entity in the field of clinical medicine. In near future, anesthesiologists around the globe increasingly will encounter patients who need surgery and at the same time are suspected or confirmed cases of COVID-19. Planning for a safe anesthesia technique is inevitable.


title: What should a cardiologist know about coronavirus disease 2019?

text: Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) is the cause of coronavirus disease 2019 (COVID‑19). The most common symptoms of COVID‑19 are: fever (81.8%-100%), cough (46.3%-86.2%), myalgia and fatigue (11%-50%), expectoration (4.4%-72%), and dyspnea (18.6%-59%). The most common laboratory abnormalities in COVID‑19 include decreased lymphocyte count (35%-82.1%), thrombocytopenia (17%-36.2%), elevated serum C‑reactive protein (60.7%-93%), lactate dehydrogenase (41%-76%), and D‑dimer concentrations (36%-46.4%). Among comorbidities in patients with COVID‑19, cardiovascular disease is most commonly found. In addition, patients with concomitant cardiovascular diseases have worse prognosis and more often require admission to the intensive care unit (ICU), compared with patients without such comorbidities. It is estimated that about 20% of patients with COVID‑19 develop cardiac injury. Cardiac injury is more prevalent among patients with COVID‑19 who require ICU care. In a group of critically ill patients, 27.5% had an elevated N‑terminal pro-B‑type natriuretic peptide concentration, and increased cardiac troponin level was found in 10% of patients. One of the life‑threatening cardiac manifestations is coronavirus fulminant myocarditis, which may also occur without accompanying symptoms of pulmonary involvement. Early recognition and treatment is crucial in these cases. So far, data on the incidence of arrhythmias in patients with COVID‑19 are limited. Coronavirus disease 2019 impacts patients with cardiovascular comorbidities and affects daily practice of cardiologists. Thus, it is important to know typical COVID‑19 symptoms, possible clinical manifestations, complications, and recommended treatment.


title: Genome-wide mapping using new AFLP markers to explore intraspecific variation among pathogenic Sporothrix species.

text: Sporotrichosis is a chronic subcutaneous mycosis caused by Sporothrix species, of which the main aetiological agents are S. brasiliensis, S. schenckii, and S. globosa. Infection occurs after a traumatic inoculation of Sporothrix propagules in mammals' skin and can follow either a classic route through traumatic inoculation by plant debris (e.g., S. schenckii and S. globosa) or an alternative route through zoonotic transmission from animals (e.g., S. brasiliensis). Epizootics followed by a zoonotic route occur in Brazil, with Rio de Janeiro as the epicenter of a recent cat-transmitted epidemic. DNA-based markers are needed to explore the epidemiology of these Sporothrix expansions using molecular methods. This paper reports the use of amplified-fragment-length polymorphisms (AFLP) to assess the degree of intraspecific variability among Sporothrix species. We used whole-genome sequences from Sporothrix species to generate 2,304 virtual AFLP fingerprints. In silico screening highlighted 6 primer pair combinations to be tested in vitro. The protocol was used to genotype 27 medically relevant Sporothrix. Based on the overall scored AFLP markers (97-137 fragments), the values of polymorphism information content (PIC = 0.2552-0.3113), marker index (MI = 0.002-0.0039), effective multiplex ratio (E = 17.8519-35.2222), resolving power (Rp = 33.6296-63.1852), discriminating power (D = 0.9291-0.9662), expected heterozygosity (H = 0.3003-0.3857), and mean heterozygosity (Havp = 0.0001) demonstrated the utility of these primer combinations for discriminating Sporothrix. AFLP markers revealed cryptic diversity in species previously thought to be the most prevalent clonal type, such as S. brasiliensis, responsible for cat-transmitted sporotrichosis, and S. globosa responsible for large sapronosis outbreaks in Asia. Three combinations (#3 EcoRI-FAM-GA/MseI-TT, #5 EcoRI-FAM-GA/MseI-AG, and #6 EcoRI-FAM-TA/MseI-AA) provide the best diversity indices and lowest error rates. These methods make it easier to track routes of disease transmission during epizooties and zoonosis, and our DNA fingerprint assay can be further transferred between laboratories to give insights into the ecology and evolution of pathogenic Sporothrix species and to inform management and mitigation strategies to tackle the advance of sporotrichosis.


title: The regulation and plasticity of root hair patterning and morphogenesis.

text: Root hairs are highly specialized cells found in the epidermis of plant roots that play a key role in providing the plant with water and mineral nutrients. Root hairs have been used as a model system for understanding both cell fate determination and the morphogenetic plasticity of cell differentiation. Indeed, many studies have shown that the fate of root epidermal cells, which differentiate into either root hair or non-hair cells, is determined by a complex interplay of intrinsic and extrinsic cues that results in a predictable but highly plastic pattern of epidermal cells that can vary in shape, size and function. Here, we review these studies and discuss recent evidence suggesting that environmental information can be integrated at multiple points in the root hair morphogenetic pathway and affects multifaceted processes at the chromatin, transcriptional and post-transcriptional levels.


title: Thermoelectrical modeling of bipolar coagulation on posterior spinal artery in a porcine spinal surgery model.

text: The primary objective of our study was to develop a thermoelectrical model with both solid and liquid phases to calculate tissue temperature during bipolar coagulation of a posterior spinal artery on the spinal cord. Control of thermal spread caused by coagulation is a concern in spinal surgery. This model utilizes a nonisothermal flow to account for the heat transfer due to the movement of cerebrospinal fluid that is induced by electrical field and temperature gradient. The model is validated by in situ temperature measurements on a porcine spinal cord model. The maximum error for tissue temperature of this model is 12.6%, and the overall average error is 4.2%. The lesional region (>50°C) is identified to be as wide as 5 mm, and thermal dose cumulative equivalent minutes at 43°C (CEM 43) is also calculated with this model. The incorporation of nonisothermal flow has been shown to be crucial in order to accurately predict thermal dose in tissue. The developed model can be further used to establish a guideline for the use of bipolar coagulation.


title: Minimally Invasive Ivor Lewis Esophagectomy (MILE): technique and outcomes of 100 consecutive cases.

text: BACKGROUND Esophagectomy is the mainstay of therapy for esophageal cancer but is a complex operation that is associated with significantly high morbidity and mortality rates. The primary aim of this study is to report our perioperative outcomes, and long-term survival of Minimally Invasive Ivor Lewis Esophagectomy (MILE). METHODS IRB approved retrospective study of 100 consecutive patients who underwent elective MILE from September 2013 to November 2017 at University of Florida, Jacksonville. RESULTS Primary diagnosis was esophageal cancer (n = 96) and benign esophageal disease (n = 4). Anastomotic leak rate was observed in 6%; 30- and 90-day mortality rates were 2% and 3%, respectively. The mean length of hospital stay was 10.3 days; 87 patients were discharged to home, while 12 patients were discharged to rehabilitation facility, and there was one in-hospital mortality secondary to graft necrosis. At a mean follow-up was 37 months (2-74), the 3- and 5-year overall survivals are 63.9 ± 5.0% (95% CI 53.3-72.7%) and 60.5 ± 5.3% (95% CI 49.4-69.9%), respectively. The 3- and 5-year disease-free survival is 75.0 ± 4.8% (95% CI 64.2-83.0%) and 70.4 ± 5.5% (95% CI 58.0-80.0%). CONCLUSION MILE can be performed with low perioperative mortality, and favorable long-term overall and disease-free survival.


Making allowances for COVID-19.


International Surviving Sepsis Campaign guidelines 2016: the perspective from low-income and middle-income countries.


title: Prospective, multicenter, pairwise analysis of robotic-assisted inguinal hernia repair with open and laparoscopic inguinal hernia repair: early results from the Prospective Hernia Study.

text: PURPOSE To evaluate and compare peri-operative outcomes through 30 days, including pain and quality of life (QOL) through 3 months across three cohorts of inguinal hernia repair (IHR) patients (robotic-assisted, laparoscopic, and open IHR). METHODS The Prospective Hernia Study is an ongoing, multicenter, comparative, open-label analysis of clinical and patient-reported outcomes from robotic-assisted surgery (RAS) versus open and RAS versus laparoscopic IHR procedures. Patient responses to the Carolinas Comfort Scale (CCS) questionnaire provided QOL outcomes. RESULTS 504 enrolled patients underwent unilateral or bilateral IHR (RAS, n = 159; open, n = 190; laparoscopic, n = 155) at 17 medical institutions from May 2016 through December 2018. Propensity score matching provided a balanced comparison: RAS versus open (n = 112 each) and RAS versus laparoscopic (n = 80 each). Overall, operative times were significantly different between the RAS and laparoscopic cases (83 vs. 65 min; p < 0.001). Fewer RAS patients required prescription pain medication than either open (49.5% vs. 80.0%; p < 0.001) or laparoscopic patients (45.3% vs. 65.4%; p = 0.013). Median number of prescription pain pills taken differed for RAS vs. open (0.5 vs. 15.5; p = 0.001) and were comparable for RAS vs laparoscopic (7.0 vs. 6.0; p = 0.482) among patients taking prescribed pain medication. Time to return to normal activities differed for RAS vs. open (3 vs. 4 days; p = 0.005) and were comparable for RAS vs. laparoscopic (4 vs. 4 days; p = 0.657). Median CCS scores through 3 months were comparable for the three approaches. Postoperative complication rates for the three groups also were comparable. One laparoscopic case was converted to open. CONCLUSION This study demonstrates that IHR can be performed effectively with the robotic-assisted, laparoscopic, or open approaches. There was no difference in the median number of prescription pain medication pills taken between the RAS and laparoscopic groups. A difference was observed in the overall number of patients reporting the need to take prescription pain medication. Comparable operative times were observed for RAS unilateral IHR patients compared to open unilateral IHR patients; however, operative times for RAS overall and bilateral subjects were longer than for open patients. Operative times were longer overall for RAS patients compared to laparoscopic patients; however, there was no difference in conversion and complication rate in the RAS vs. laparoscopic groups or the complication rate in the RAS vs. open group. Time to return to normal activities for RAS IHR patients was comparable to that of laparoscopically repaired patients and significantly sooner compared to open IHR patients.


Lost in transition.


docid: ubxvujzi

title: 18F-FDG PET/CT for the prediction and detection of local recurrence after radiofrequency ablation of malignant lung lesions.

text: UNLABELLED The utility of (18)F-FDG PET/CT for response assessment in malignant lung tumors treated with radiofrequency ablation (RFA) and for the detection and prediction of local recurrence was investigated. METHODS Between December 17, 2003, and April 9, 2008, 68 consecutive patients (mean age, 68 y) with 94 pulmonary lesions, including metastases (n = 38) and primary lung cancers (n = 44), underwent RFA. Because of inadequate imaging follow-up in 12 patients, only 82 lesions were analyzed (CT scans, n = 82; (18)F-FDG PET/CT scans, n = 62). The median follow-up was 25 mo (range, 12-66 mo). A baseline study was defined as (18)F-FDG PET/CT performed no more than 3 mo before RFA. The first postablation scan was defined as PET/CT performed between 1 and 4 mo after RFA; additional follow-up studies were obtained in some cases between 6 and 12 mo after RFA. The unidimensional maximum diameter of the lesion was recorded on a pretherapy diagnostic CT scan or on the CT component of a pretherapy (18)F-FDG PET/CT scan, whichever was obtained most recently, using lung windows. Maximum standardized uptake values (SUVs) were recorded for all lesions imaged by (18)F-FDG PET/CT. (18)F-FDG uptake patterns on post-RFA scans were classified as favorable or unfavorable. Survival and recurrence probabilities were estimated using the Kaplan-Meier method. Uni- and multivariate analyses were also performed. RESULTS Before RFA, factors predicting greater local recurrence-free survival included initial lesion size less than 3 cm (P = 0.01) and SUV less than 8 (P = 0.02), although the latter was not an independent predictor in multivariate analysis. Treated metastases recurred less often than treated primary lung cancers (P = 0.03). Important post-RFA factors that related to reduced recurrence-free survival included an unfavorable uptake pattern (P < 0.01), post-RFA SUV (P < 0.01), and an increase in SUV over time after ablation (P = 0.05). CONCLUSION (18)F-FDG PET/CT parameters on both preablation and postablation scans may predict local recurrence in patients treated with RFA for lung metastases and primary lung cancers.


title: Reducing colorectal anastomotic leakage with tissue adhesive in experimental inflammatory bowel disease.

text: BACKGROUND Anastomotic leakage after gastrointestinal surgery remains a challenging clinical problem. This study aimed to investigate the effectiveness of TissuCol (fibrin glue), Histoacryl Flex (n-butyl-2-cyanoacrylate), and Duraseal (polyethylene glycol) on colorectal anastomotic healing during experimental colitis. METHODS We first performed colectomy 7 days after 10 mg trinitrobenzene sulfonic acid (TNBS)-induced colitis to validate a rat TNBS-colitis-colectomy model. Subsequently, this TNBS-colitis-colectomy model was used in 73 Wistar rats that were stratified into a colitis group (CG, no adhesive), a TissuCol group (TG), a Histoacryl group (HG), and a Duraseal group (DG). Anastomotic sealant was applied with one adhesive after constructing an end-to-end hand-sewn anastomosis. Clinical manifestations, anastomotic bursting pressure, and immunohistochemistry of macrophage type-one (M1) and type-two (M2) was performed on postoperative day (POD)3 or POD7. RESULTS TNBS-caused mucosal and submucosal colon damage and compromised anastomotic healing (i.e., abscess formation and low anastomotic bursting pressure). On POD3, higher severity of abscesses was seen in CG. Average anastomotic bursting pressure was 53.2 ± 35.5 mm Hg in CG, which was significantly lower than HG (134.4 ± 27.5 mm Hg) and DG (95.1 ± 54.3 mm Hg) but not TG (83.4 ± 46.7 mm Hg). Furthermore, a significantly higher M2/M1 index was found in HG. On POD7, abscesses were only seen in CG (6/9) but not in other groups; HG had the lowest severity of adhesion. CONCLUSIONS We describe the first surgical IBD model by performing colectomy in rats with TNBS-induced colitis, which causes intra-abdominal abscess formation and compromises anastomotic healing. Anastomotic sealing with Histoacryl Flex prevents these complications in this model. Alternative activation of macrophages seems to be involved in its influence on anastomotic healing.


title: Systematic review of Doppler for detecting intrapartum fetal heart abnormalities and measuring perinatal mortality in low- and middle-income countries.

text: BACKGROUND Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low- and middle-income countries (LMIC) can save lives. OBJECTIVE To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities. SEARCH STRATEGY PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring. SELECTION CRITERIA Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC settings. DATA COLLECTION AND ANALYSIS Two team members independently screened and collected data. Risk of bias was assessed by Cochrane EPOC criteria. RESULTS Eleven studies from eight countries were included. Doppler was superior at detecting abnormal intrapartum FHR as compared with Pinard stethoscope, but was not associated with improved perinatal outcomes. Using Doppler on admission helped to accurately measure perinatal deaths occurring after facility admission. CONCLUSION Studies and program learning are needed to translate improved detection of FHR abnormalities to improved case management in LMICs. Doppler should be used to calculate a facility indicator of intrapartum care quality.