title: Associations between sleep duration and suicidality in adolescents: A systematic review and dose-response meta-analysis.

text: Sleep duration has received considerable attention as a potential risk factor of suicidality in youths; however, evidence on the dose-response association between sleep duration and suicidality has not been synthesized. This meta-analysis examined linear and nonlinear dose-response relationships between sleep duration and the risk of suicidality in adolescents and explored potential moderators of the associations. Electronic databases, namely EMBASE, PubMed, PsycINFO, ProQuest Dissertations & Theses A&I Wanfang Data (Chinese database), and the China Knowledge Resource Integrated Database, were searched from their inception to April 18, 2017. Studies examining the association between sleep duration and suicidality in adolescents were included. A random-effects dose-response model was used to estimate the linear and nonlinear dose-response relationships. We identified 13 reports that included a total of 598,281 participants for a systematic review, and 12 reports were further used for a dose-response meta-analysis. Strong curvilinear dose-response associations were obtained for both suicidal ideation and attempts, with the lowest suicidal ideation and attempt risks at sleep durations of 8 h and 8-9 h per day (all Pnonlinearity < 0.001). A linear dose-response relationship between sleep duration and suicide plans (pooled OR = 0.89, 95% confidence interval [CI] = 0.88-0.90) was obtained, indicating that the risk of suicide plans statistically decreased by 11% for every 1-h increase in sleep duration. Depression did not moderate the association between sleep duration and suicidality in youths. Our findings suggest curvilinear dose-response associations between sleep duration and the risks of suicidal ideation and attempts and a linear dose-response relationship between sleep duration and suicide plan risk. Additional longitudinal studies are warranted to establish causality.


title: Does electrocautery damage cochlear implants?

text: OBJECTIVES 1) Evaluate the effects of monopolar cautery on cochlear implant devices. 2) Determine whether voltage fluctuations within the cochlear implant adversely affect the cochlear implant devices STUDY DESIGN Two Med-El cochlear implants modified to record voltage difference from the apical and proximal electrodes were implanted into an unembalmed, fresh cadaver. Cautery was applied to the ipsilateral pectoralis major muscle and ipsilateral temporalis muscle at bipolar, monopolar coagulation, and monopolar cut settings of 50 W. The intensity in each modality setting was increased by increments of 10 W to a maximum of 100 W. Integrity testing was performed before, during, and after each cautery setting. Voltage fluctuations were measured during cautery, and maximal voltage changes for each setting were noted. After explantation, devices were returned to the manufacturer for in-depth failure analysis to evaluate for any damage to the devices. SETTING Tertiary medical center. SUBJECTS Cadaveric study. METHODS Basic science laboratory. RESULTS No change in impedance or integrity testing occurred at any cautery setting when applied to either to pectoralis major or temporalis. The maximum voltage change was 22 V. Comprehensive device analysis showed no evidence of device damage from the study. CONCLUSIONS The cochlear implant devices had no evidence of electrical damage by monopolar cautery, even up to levels of 100 W in the temporalis muscle. The maximum voltage change was 22 V, likely resulting from protecting diodes within the implant. Additional study is necessary, but more flexible recommendations regarding electrosurgery in cochlear implant recipients should be considered.


title: Safety and Immunogenicity of an Anti-Zika Virus DNA Vaccine - Preliminary Report.

text: Background Although Zika virus (ZIKV) infection is typically self-limiting, other associated complications such as congenital birth defects and the Guillain-Barré syndrome are well described. There are no approved vaccines against ZIKV infection. Methods In this phase 1, open-label clinical trial, we evaluated the safety and immunogenicity of a synthetic, consensus DNA vaccine (GLS-5700) encoding the ZIKV premembrane and envelope proteins in two groups of 20 participants each. The participants received either 1 mg or 2 mg of vaccine intradermally, with each injection followed by electroporation (the use of a pulsed electric field to introduce the DNA sequence into cells) at baseline, 4 weeks, and 12 weeks. Results The median age of the participants was 38 years, and 60% were women; 78% were white, and 22% black; in addition, 30% were Hispanic. At the interim analysis at 14 weeks (i.e., after the third dose of vaccine), no serious adverse events were reported. Local reactions at the vaccination site (e.g., injection-site pain, redness, swelling, and itching) occurred in approximately 50% of the participants. After the third dose of vaccine, binding antibodies (as measured on enzyme-linked immunosorbent assay) were detected in all the participants, with geometric mean titers of 1642 and 2871 in recipients of 1 mg and 2 mg of vaccine, respectively. Neutralizing antibodies developed in 62% of the samples on Vero-cell assay. On neuronal-cell assay, there was 90% inhibition of ZIKV infection in 70% of the serum samples and 50% inhibition in 95% of the samples. The intraperitoneal injection of postvaccination serum protected 103 of 112 IFNAR knockout mice (bred with deletion of genes encoding interferon-α and interferon-β receptors) (92%) that were challenged with a lethal dose of ZIKV-PR209 strain; none of the mice receiving baseline serum survived the challenge. Survival was independent of the neutralization titer. Conclusions In this phase 1, open-label clinical trial, a DNA vaccine elicited anti-ZIKV immune responses. Further studies are needed to better evaluate the safety and efficacy of the vaccine. (Funded by GeneOne Life Science and others; ZIKA-001 ClinicalTrials.gov number, NCT02809443 .).


title: Immune responses to killed reassorted influenza virus supplemented with natural adjuvants.

text: In this study, we investigated the immunomodulatory effects of a supplemented killed influenza virus (V) by Echinacea purpurea (E) and Nigella sativa (N) extracts and effect of changing the route of immunization from intramuscular (IM) to intraperitoneal (IP). At the 2nd-, 3rd- and 4th-week post-IM immunizations (WPIMI), the supplemented V with N (VN) induced the most significant IgM response unlike N alone. At the 2nd WPIMI, V or VN induced the highest significant IgG levels. At the 2nd-week post-IP immunization (WPIPI), E and VN induced the most significant IgG levels. Both at the 3rd and 4th WPIMI or WPIPI, various treatments induced significant increases in IgG. At the 4th WPIMI, E, V, and V with E (VE) induced significant increases in the CD4+ thymocytes while all IP treatments caused significant increase in their counts. V and VN induced the most significant IM induction of CD8+ thymocytes while their best IP stimulation was induced by N, VE, and VN. At the 4th WPIMI, various treatments caused significant increases in the mesenteric lymph node (MLN) CD4+, CD8+ counts. WPIPI with V or VE caused significant increases in both the CD4+- and CD8+ MLN cells, whereas VN significantly induced CD8+ MLN cells only. WPIPI with various treatments caused significant increases in the B-cell counts and the peak was obtained by VN.


title: 2-Vinyl-4H-1,3-Dithiin, a Bioavailable Compound from Garlic, Inhibits Vascular Smooth Muscle Cells Proliferation and Migration by Reducing Oxidative Stress.

text: Organosulfur compounds (OSCs) of garlic have various health benefits including anti-hypertensive effect. It has been described that volatile OSCs uptake occurs into a moderate extent. Among the bioavailable OSCs present in garlic, 2-vinyl-4H-1,3-dithiin (2VD) is a main component in garlic macerated oil and stir-fried garlic but has been poorly investigated compared with others OSCs, such allyl mercaptan (AM) and S-allyl cysteine (SAC). The aim of this study was to evaluate the effects of 2VD on vascular smooth muscle cells (VSMCs) isolated from spontaneous hypertensive rats (SHR) and compare them with those produced by AM and SAC. Cell viability and proliferation were measured using tetrazolium dye MTT assay and flow cytometry. Cell migration was evaluated by scrape-wound migration assay. OSCs anti-oxidative capacity was determined by measuring reactive oxygen species (ROS) generation, and total antioxidant status (TAS). Non-toxic plasmatic concentrations (10 μg L-1) of 2VD and AM inhibited VSMCs proliferation stimulated with 5% fetal bovine serum and impaired cell migration. In further flow cytometry analysis 2VD treatment resulted in a partial cell cycle arrest at G2 phase. The OSCs tested were able to prevent ROS increase after angiotensin II stimulation and surprisingly 2VD induced higher total antioxidant status compared with AM and SAC. Our results showed that 2VD produces equivalent or superior beneficial effects on VSMCs to those reported for other bioavailable compounds of garlic. This preliminary evidence suggests that 2VD intake could also exert important protective effects against arterial remodeling in hypertension.


title: The Enemy Which Sealed the World: Effects of COVID-19 Diffusion on the Psychological State of the Italian Population.

text: BACKGROUND Starting from the first months of 2020, worldwide population has been facing the COVID-19 pandemic. Many nations, including Italy, took extreme actions to reduce the diffusion of the virus, profoundly changing lifestyles. The Italians have been faced with both the fear of contracting the infection and the consequences of enforcing social distancing. This study was aimed to understand the psychological impact of the COVID-19 outbreak and the psychopathological outcomes related to the first phase of this emergency. METHODS The study included 2291 respondents. An online survey collected information on socio-demographic variables, history of direct or indirect contact with COVID-19, and additional information concerning the COVID-19 emergency. Moreover, psychopathological symptoms such as anxiety, mood alterations and post-traumatic symptomatology were assessed. RESULTS The results revealed that respectively 31.38%, 37.19% and 27.72% of respondents reported levels of general psychopathological symptomatology, anxiety, and PTSD symptoms over the cut-off scores. Furthermore, a significant worsening of mood has emerged. Being a female or under the age of 50 years, having had direct contact with people infected by the COVID-19, and experiencing uncertainty about the risk of contagion represent risk factors for psychological distress. CONCLUSIONS Our findings indicate that the first weeks of the COVID-19 pandemic appear to impact not only on physical health but also on psychological well-being. Although these results need to be considered with caution being based on self-reported data collected at the beginning of this emergency, they should be used as a starting point for further studies aimed to develop interventions to minimize both the brief and long-term psychological consequences of the COVID-19 pandemic.


title: COVID 19 era: a beginning of upsurge in unwanted pregnancies, unmet need for contraception and other women related issues.

text: The Novel Coronavirus disease that started in Wuhan city of China in December 2019 has emerged as one of the fastest spreading pandemics all over the world affecting millions of people and causing millions of deaths worldwide. In an attempt to control its spread, countries have imposed local and national lockdowns, affecting many healthcare services, especially sexual and reproductive health services which are actually essential and lifesaving. In near future this will result in a large number of grave consequences including increased unmet need for modern contraceptives, unintended pregnancies, increased unsafe abortions, maternal and neonatal deaths and other harmful practices like female genital mutilation and child marriages in developing countries. The present short review focusses on such issues which will be dramatically increased depending on the duration of lockdowns and the time for which the sexual and reproductive health services will remain halted. It also reflects the need for considering reproductive health services as essential, allowing the people to avail these services without any fear and hence, saving many more lives which will be lost not due to coronavirus infection. Methodology: The data was searched from various governmental and non-governmental organisation sites including the World Health Organisation, United Nations, United Nations Population Fund, Guttmacher Institute and many PubMed indexed journals.


title: [Clinical Study and CT Findings of a Familial Cluster of Pneumonia with Coronavirus Disease 2019 (COVID-19)].

text: We studied the epidemiological and clinical data collected from a family with 5 people, in which there were 3 family member diagnosed as coronavirus disease 2019 (COVID-19). We found that the first patient in this family had Wuhan city travel history. Close contact in daily life was the route of infection. The most common symptoms were fever, cough and weakness. Characteristic imaging changes were found with grass opacity (GGO), consolidation and septal thickening mainly distributed in peripheral and posterior area by thoracic CT scan in the 3 patients. The abnormality in laborotary test included lower white blood cell count, neutrophil count and lymphocyte count，increasing fibrinogen and C-reactive protein，decreasing myohaemoglobin and increasing lactate dehydrogenase. The epidemiological and clinical features could provide quicker diagnosis and better management for the COVID-19 infected patients.


title: Acute and chronic Achilles tendon ruptures in athletes.

text: The Achilles tendon is the most injured tendon of athletes in the lower extremities and is the most common tendon to rupture spontaneously. Operative repair provides earlier return to sporting activities and lesser rate of rerupture. The general goal is to attempt anastomosis of the acute ruptured ends; however, delayed ruptures may require more extensive procedures. New surgical approaches, including percutaneous and mini-open techniques, are being introduced to potentially diminish perioperative complications. Advent of early protective range of motion and rehabilitation has shown a potential for earlier return to sporting activities for Achilles ruptures.


title: On identifying magnocellular and parvocellular responses on the basis of contrast-response functions.

text: It has been proposed that magnocellular and parvocellular sensitivity in schizophrenic individuals can be assessed using steady-state visually evoked potentials (VEPs) to either low-contrast stimuli or stimuli whose contrast is modulated around a high contrast "pedestal" (Green MF, Butler PD, Chen Y, et al. Schizophr Bull. 2009;35:163-181). This suggestion faces 2 difficulties: (1) To use low-contrast stimuli to activate the magnocellular system is inconsistent with lesion studies that have shown that under many conditions, the parvocellular system responds to the lowest contrasts and (2) To rely on contrast-response relationships to identify magnocellular and parvocellular responses is difficult because other neurons exist in the visual system that have contrast-response relationships similar to those of magnocellular and parvocellular cells.


title: Inositol-requiring enzyme 1 inhibits respiratory syncytial virus replication.

text: Despite being a major health problem, respiratory syncytial virus (RSV) infections remain without specific therapy. Identification of novel host cellular responses that play a role in the pathogenesis of RSV infection is needed for therapeutic development. The endoplasmic reticulum (ER) stress response is an evolutionarily conserved cellular signaling cascade that has been implicated in multiple biological phenomena, including the pathogenesis of some viral infections. In this study, we investigate the role of the ER stress response in RSV infection using an in vitro A549 cell culture model. We found that RSV infection induces a non-canonical ER stress response with preferential activation of the inositol-requiring enzyme 1 (IRE1) and activated transcription factor 6 (ATF6) pathways with no concomitant significant activation of the protein kinase R-like ER kinase (PERK) pathway. Furthermore, we discovered that IRE1 has an inhibitory effect on RSV replication. Our data characterize, for the first time, the nature of the ER stress response in the setting of RSV infection and identify the IRE1 stress pathway as a novel cellular anti-RSV defense mechanism.


Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.


title: Sago supplementation for recovery from cycling in a warm-humid environment and its influence on subsequent cycling physiology and performance.

text: This study determined whether sago porridge ingested immediately after exercise (Exercise 1) in warm-humid conditions (30 ± 1°C, 71 ± 4 % RH; 20 km·h-1 frontal airflow) conferred more rapid recovery, as measured by repeat performance (Exercise 2), compared to a control condition. Eight well-trained, male cyclists/triathletes (34 ± 9 y, VO2peak 70 ± 10 ml·kg-1·min-1, peak aerobic power 413 ± 75 W) completed two 15-min time-trials pre-loaded with 15-min warm-up cycling following >24h standardization of training and diet. Mean power output was not different between trials during Exercise 1 (286 ± 67 vs. 281 ± 59 W), however, was reduced during Exercise 2 for control (274 ± 61 W) but not sago (283 ± 60 W) that led to a significant performance decrement (vs. Exercise 1) of 3.9% for control and an improvement (vs. control) of 3.7% for sago during Exercise 2 (P < 0.05). Sago ingestion was also associated with higher blood glucose concentrations during recovery compared to control. These results indicate that feeding sago during recovery from exercise in a warm-humid environment improves recovery of performance during a subsequent exercise bout when compared to a water-only control. As these effects were larger than the test-retest coefficient of variation for work completed during the 15-min time-trial (2.3%) it can be confidently concluded that the observed effects are real.


Convalescent plasma and covid-19 treatment.


Audio Interview: What Clinicians Need to Know in Diagnosing and Treating Covid-19.


title: European Association of Urology Guidelines for Clear Cell Renal Cancers That Are Resistant to Vascular Endothelial Growth Factor Receptor-Targeted Therapy.

text: The European Association of Urology renal cancer guidelines panel recommends nivolumab and cabozantinib over the previous standard of care in patients who have failed one or more lines of vascular endothelial growth factor-targeted therapy. New data have recently become available showing a survival benefit for cabozantinib.


title: The theoretical mortality risk of an asymptomatic patient with a negative SARS-CoV-2 test developing COVID-19 following elective orthopaedic surgery.

text: AIMS The risk to patients and healthcare workers of resuming elective orthopaedic surgery following the peak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been difficult to quantify. This has prompted governing bodies to adopt a cautious approach that may be impractical and financially unsustainable. The lack of evidence has made it impossible for surgeons to give patients an informed perspective of the consequences of elective surgery in the presence of SARS-CoV-2. This study aims to determine, for the UK population, the probability of a patient being admitted with an undetected SARS-CoV-2 infection and their resulting risk of death; taking into consideration the current disease prevalence, reverse transcription-polymerase chain reaction (RT-PCR) testing, and preassessment pathway. METHODS The probability of SARS-CoV-2 infection with a false negative test was calculated using a lower-end RT-PCR sensitivity of 71%, specificity of 95%, and the UK disease prevalence of 0.24% reported in May 2020. Subsequently, a case fatality rate of 20.5% was applied as a worst-case scenario. RESULTS The probability of SARS-CoV-2 infection with a false negative preoperative test was 0.07% (around 1 in 1,400). The risk of a patient with an undetected infection being admitted for surgery and subsequently dying from the coronavirus disease 2019 (COVID-19) is estimated at approximately 1 in 7,000. However, if an estimate of the current global infection fatality rate (1.04%) is applied, the risk of death would be around 1 in 140,000, at most. This calculation does not take into account the risk of nosocomial infection. Conversely, it does not factor in that patients will also be clinically assessed and asked to self-isolate prior to surgery. CONCLUSION Our estimation suggests that the risk of patients being inadvertently admitted with an undetected SARS-CoV-2 infection for elective orthopaedic surgery is relatively low. Accordingly, the risk of death following elective orthopaedic surgery is low, even when applying the worst-case fatality rate. Cite this article: Bone Joint J 2020;102-B(9):1-5.


title: The use of synthetic mesh for vaginal prolapse in the UK: a review of cases submitted to the British Society of Urogynaecology database.

text: INTRODUCTION AND HYPOTHESIS The use of mesh for vaginal prolapse gained popularity during the 1990s. More recently, concerns have been raised regarding the safety of mesh procedures. Mesh can be inserted vaginally, laparoscopically or via an open abdominal route, but there are few data comparing the outcomes. Most previous published data relate to small numbers of procedures. METHODS This was a review of data submitted to the British Society of Urogynaecology (BSUG) database of all cases reporting the use of mesh placed vaginally or abdominally (open or laparoscopic) between January 2006 and December 2016. The primary outcome was based on the reported patient global impression of improvement (PGI-I). RESULTS A total of 6,709 cases of mesh prolapse repair were entered during the study period. Women in the laparoscopic group had a lower BMI and were younger. Significantly more patients in the open group (96.4%) described themselves as very much better or much better compared with the laparoscopic group (91%) and the vaginal mesh group (90.7%; p < 0.001). Only 0.5% of patients reported that they were worse or very much worse. CONCLUSIONS This dataset suggests that the effectiveness of mesh repair might be good regardless of the route of insertion. The improvement in PGI-I seems to be greatest with open sacrocolpopexy.


First US MERS-CoV cases underscore need for preparedness.


title: Preen gland removal increases plumage bacterial load but not that of feather-degrading bacteria.

text: The preen gland is a holocrine sebaceous gland of the avian integument which produces an oily secretion that is spread on the plumage during preening. It has been suggested that birds may defend themselves against feather-degrading bacteria (FDB) and other potential pathogens using preen gland secretions. However, besides some in vitro studies, the in vivo bacterial inhibitory effects of the preen oil on the abundance of feather-associated bacterial species has not yet been studied in passerines. Here we tested the effect of gland removal on the abundance of FDB and other-cultivable bacterial loads (OCB) of male house sparrows (Passer domesticus). Our results did not support earlier results on in vitro antibacterial activity of preen oil against FDB since the absence of the preen gland did not significantly affect their loads related to the control birds. In contrast, we found that preen gland removal led to higher loads of OCB. This result suggests that the antimicrobial spectrum of the preen oil is broader than previously thought and that, by reducing the overall feather bacterial loads, the preen gland could help birds to protect themselves against a variety of potentially harmful bacteria.


title: Lab-on-a-Chip Devices for Point-of-Care Medical Diagnostics.

text: The recent coronavirus (COVID-19) pandemic has underscored the need to move from traditional lab-centralized diagnostics to point-of-care (PoC) settings. Lab-on-a-chip (LoC) platforms facilitate the translation to PoC settings via the miniaturization, portability, integration, and automation of multiple assay functions onto a single chip. For this purpose, paper-based assays and microfluidic platforms are currently being extensively studied, and much focus is being directed towards simplifying their design while simultaneously improving multiplexing and automation capabilities. Signal amplification strategies are being applied to improve the performance of assays with respect to both sensitivity and selectivity, while smartphones are being integrated to expand the analytical power of the technology and promote its accessibility. In this chapter, we review the main technologies in the field of LoC platforms for PoC medical diagnostics and survey recent approaches for improving these assays.


title: Establishment of reverse transcription polymerase chain reaction assay for simultaneous detection of human parainfluenza virus types 1 to 4 in children with influenza like illnesses.

text: OBJECTIVES The aim of this study was to develop an in-house multiplex reverse transcription polymerase chain reaction (mRT-PCR), which can recognize HPIV1-4 in clinical samples. BACKGROUND Human parainfluenza virus (HPIV) is one of the major causes of viral respiratory infections and can affect people at any age, especially infants and young children. METHODS Four sets of specific primers targeting conserved areas of hemagglutinin-neuraminidase (HN) genes of HPIV1-4, were designed and tested with type-related plasmid controls. Specificity and sensitivity of mPCR were tested. One-step mRT-PCR was set up using a viral panel containing 10 respiratory viruses, including HPIVs. One hundred nasopharyngeal samples of respiratory infection patients were tested using the set One-step mRT-PCR. RESULTS The specificity of set mPCR for HPIV1-4 using plasmid positive controls was proved and reaction sensitivity was measured. The specificity of set mRT-PCR was confirmed and 4 and 5 out of 100 clinical samples were HPIV1 and HPIV2 positive, respectively. CONCLUSION The developed one-step mRT-PCR in this study is an effective and specific assay for clinical diagnosis of HPIV1 to 4 (Tab. 1, Fig. 6, Ref. 28).


title: The effect of iodinated contrast agent properties on renal kinetics and oxygenation.

text: OBJECTIVE We analyzed renal kinetics and renal oxygenation in rats after administration of several classes and formulations of contrast agents (CAs) with a focus on the influence of osmolality and substance-specific properties. MATERIALS AND METHODS We investigated the renal kinetics of a nonionic, dimeric CA (iodixanol) formulated in 3 different osmolalities (hypo-osmolar, iso-osmolar, low-osmolar) and compared it to nonionic, low-osmolar (iopromide), and ionic, low-osmolar CAs (ioxaglate) using computed tomography for a period of 24 hours. The CAs were administered intravenously at a dosage of 4 g iodine/kg body weight. The average exposure was calculated, and urine viscosities were compared before the injection and during the time intervals of 0 to 60 minutes and 60 to 120 minutes after the injection. Renal oxygenation levels of the renal cortex and medulla were estimated using blood-oxygen-level-dependent magnetic resonance imaging. We used histologic methods to systematically analyze the gravity of vacuole formation based on the physicochemical and substance-specific properties of each CA. RESULTS Iso-osmolar and hypo-osmolar iodixanol and, to a lesser extent, iodixanol/mannitol accumulated rapidly in the kidneys during the first 5 minutes of the injection and remained higher 2, 4, 6, and 24 hours after the injection compared with iopromide and ioxaglate, which showed fast iodine excretion. Similarly, lower renal blood oxygen levels were estimated for all iodixanol formulations as compared with ioxaglate and iopromide. The incidence of vacuole formation was high for all iodixanol formulations and for ioxaglate (6 of 6 rats) and low for iopromide (1 of 6 rats). Moderate severity of vacuoles was determined for the iodixanol solutions; minimal severity, for ioxaglate and iopromide. CONCLUSIONS We identified a superior profile for the low-osmolar CAs compared with the iso-osmolar CAs regarding rapid excretion, short-term renal exposure, and renal oxygenation.


Simple physical interventions such as handwashing and wearing masks can reduce spread of epidemic respiratory viruses.


title: Epidemiological and Clinical Predictors of COVID-19.

text: BACKGROUND Rapid identification of COVID-19 cases, which is crucial to outbreak containment efforts, is challenging due to the lack of pathognomonic symptoms and in settings with limited capacity for specialized nucleic acid-based reverse transcription polymerase chain reaction (PCR) testing. METHODS This retrospective case-control study involves subjects (7 to 98 years) presenting at the designated national outbreak screening centre and tertiary care hospital in Singapore for SARS-CoV-2 testing from January 26 to February 16, 2020. COVID-19 status was confirmed by PCR testing of sputum, nasopharyngeal swabs or throat swabs. Demographic, clinical, laboratory and exposure-risk variables ascertainable at presentation were analyzed to develop an algorithm for estimating the risk of COVID-19. Model development used Akaike's information criterion in a stepwise fashion to build logistic regression models, which were then translated into prediction scores. Performance was measured using receiver operating characteristics curves, adjusting for over-confidence using leave-out-one cross validation. RESULTS The study population included 788 subjects, of whom 54 (6.9%) were SARS-CoV-2 positive and 734 (93.1%) were SARS-CoV-2 negative. The median age was 34 years and 407 (51.7%) were female. Using leave-out-one cross validation, all the models incorporating clinical tests (Models 1, 2 and 3) performed well with areas under the receiver operating characteristics curve (AUC) of 0.91, 0.88 and 0.88 respectively. In comparison, Model 4 had an AUC of 0.65. CONCLUSIONS Rapidly ascertainable clinical and laboratory data could identify individuals at high risk of COVID-19 and enable prioritization of PCR-testing and containment efforts. Basic laboratory test results were crucial to prediction models.


title: Obesity and COVID-19 Severity in a Designated Hospital in Shenzhen, China.

text: OBJECTIVE Patients with obesity are at increased risk of exacerbations from viral respiratory infections. However, the association of obesity with the severity of coronavirus disease 2019 (COVID-19) is unclear. We examined this association using data from the only referral hospital in Shenzhen, China. RESEARCH DESIGN AND METHODS A total of 383 consecutively hospitalized patients with COVID-19 admitted from 11 January 2020 to 16 February 2020 and followed until 26 March 2020 at the Third People's Hospital of Shenzhen were included. Underweight was defined as a BMI <18.5 kg/m2, normal weight as 18.5-23.9 kg/m2, overweight as 24.0-27.9 kg/m2, and obesity as ≥28 kg/m2. RESULTS Of the 383 patients, 53.1% were normal weight, 4.2% were underweight, 32.0% were overweight, and 10.7% were obese at admission. Obese patients tended to have symptoms of cough (P = 0.03) and fever (P = 0.06) compared with patients who were not obese. Compared with normal weight patients, those who were overweight had 1.84-fold odds of developing severe COVID-19 (odds ratio [OR] 1.84, 95% CI 0.99-3.43, P = 0.05), while those who were obese were at 3.40-fold odds of developing severe disease (OR 3.40, 95% CI 1.40-2.86, P = 0.007), after adjusting for age, sex, epidemiological characteristics, days from disease onset to hospitalization, presence of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, liver disease and cancer, and drug used for treatment. Additionally, after similar adjustment, men who were obese versus those who were normal weight were at increased odds of developing severe COVID-19 (OR 5.66, 95% CI 1.80-17.75, P = 0.003). CONCLUSIONS In this study, obese patients had increased odds of progressing to severe COVID-19. As the severe acute respiratory syndrome coronavirus 2 may continue to spread worldwide, clinicians should pay close attention to obese patients, who should be carefully managed with prompt and aggressive treatment.


docid: yqavopdn

title: A half-billion-dollar bid to head off emerging diseases.


title: Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis.

text: PURPOSE OF REVIEW To critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury. RECENT FINDINGS Though 5 of the included 13 studies were published in the last 2-3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC). Of the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In the 7 studies that utilized RTOG/EORTC, 75% of patients saw an improvement in hematuria of at least one grade (out of possible 5 total). Of the 499 patients with documented follow-up, 14% experienced recurrence, with a median time to recurrence of 10 months (6 to 16.5 months).


title: Treatment options in people with COVID19: Selecting the best armamentarium against the novel virus.

text: Novel coronavirus disease (COVID-19) infection is a global pandemic, of high infectivity, variable mortality, with currently no established treatment. This review summarizes different molecules which are being evaluated for COVID19 treatment. PubMed and Medline, search for articles published to March 2020 was done using terms "COVID19" OR "corona-virus 2019" OR "2019-nCoV" or "severe acute respiratory syndrome coronavirus" AND "treatment". As of today, we have >350 RCTs happening with different agents. COVID19 treatment agents can be broadly classified into immuno-modulators (prevent hyperimmune-activation and cytokine storm) and anti-viral therapies (prevent virus entry, replication or viricidal). Hydroxychloroquine/chloroquine, Interferon-l, glucocorticoids, interleukin antagonists, Ulinastatin, intravenous immunoglobulins, plasmapheresis are main immunomodulators showing initial positive outcomes. Umifenovir. Lopinavir/Ritonavir, Ribavirin, remdesivir and Ravipiravir are some of the major antiviral agents showing initial encouraging results. It may be concluded that the most successful regimen is going to be multi-drug therapy, a combination of immunomodulatory agent with anti-viral agent.


title: Evaluation of peracetic acid fog for the inactivation of Bacillus anthracis spore surrogates in a large decontamination chamber.

text: The purpose of this study was to evaluate the sporicidal (inactivation of bacterial spores) effectiveness and operation of a fogging device utilizing peracetic acid/hydrogen peroxide (PAA). Experiments were conducted in a pilot-scale 24 m(3) stainless steel chamber using either biological indicators (BIs) or bacterial spores deposited onto surfaces via aerosolization. Wipe sampling was used to recover aerosol-deposited spores from chamber surfaces and coupon materials before and after fogging to assess decontamination efficacy. Temperature, relative humidity, and hydrogen peroxide vapor levels were measured during testing to characterize the fog environment. The fog completely inactivated all BIs in a test using a 60 mL solution of PAA (22% hydrogen peroxide/4.5% peracetic acid). In tests using aerosol-deposited bacterial spores, the majority of the post-fogging spore levels per sample were less than 1 log colony forming units, with a number of samples having no detectable spores. In terms of decontamination efficacy, a 4.78 log reduction of viable spores was achieved on wood and stainless steel. Fogging of PAA solutions shows potential as a relatively easy to use decontamination technology in the event of contamination with Bacillus anthracis or other spore-forming infectious disease agents, although additional research is needed to enhance sporicidal efficacy.


title: Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy.

text: OBJECTIVE To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS). SUMMARY BACKGROUND DATA LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other. METHODS A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes. RESULTS A total of 874 (49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio): 0.39, 95% CI: 0.18-0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27-0.76), wound occurrences (OR: 0.37, 95% CI: 0.11-0.79), and sepsis (OR: 0.52, 95% CI: 0.26-0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS. CONCLUSIONS LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patient's clinical status.


title: Dying still matters in the age of COVID-19.

text: The ongoing COVID-19 pandemic is having a significant impact on people with palliative care needs.


docid: cxhchwiq

title: Pregnancy promotes tolerance to future offspring by programming selective dysfunction in long-lived maternal T cells.

text: Fetal antigen available during pregnancy induces the proliferation of maternal T cells. It is unknown, however, whether these antigen-activated T cells differentiate into long-lived memory T cells that are capable of mediating rapid-recall responses to tissue antigens. To test the hypothesis that pregnancy induces an alternative fate in fetal-specific maternal T cells, we used a murine model to track longitudinally fetal-specific T cells in pregnant and postpartum animals and test the response of these cells when challenged with the same antigen during sequential pregnancy or skin transplantation. Fetal-specific CD8+ T cells were robustly primed during pregnancy but failed to acquire robust effector functions. These primed cells persisted long term in postpartum animals, frequently maintained a programmed death 1 (PD-1)+ phenotype, and failed to expand or produce cytokines robustly in response to second pregnancy or skin transplantation. However, whereas there was no impact on second pregnancy as a result of the persistence of fetal-primed memory CD8+ T cells in the mother, skin grafts bearing the same antigen were rejected more rapidly. Altogether, our data suggest that fetal antigen exposure during pregnancy induces the differentiation of long-lived maternal CD8+ T cells with context-dependent, selective effector dysfunction. This programmed effector dysfunction provides temporal and systemic restraint of maternal anti-fetal alloreactivity to promote reproductive fitness efficiently, while preserving potentially protective effector T cell responses.


title: Step-wise integration of single-port laparoscopic surgery into routine colorectal surgical practice by use of a surgical glove port.

text: INTRODUCTION The cost associated with single-port laparoscopic access devices may limit utilisation of single-port laparoscopic surgery by colorectal surgeons. This paper describes a simple and cheap access modality that has facilitated the widespread adoption of single-port technology in our practice both as a stand-alone procedure and as a useful adjunct to traditional multiport techniques. METHODS A surgical glove port is constructed by applying a standard glove onto the rim of the wound protector/retractor used during laparoscopic resectional colorectal surgery. To illustrate its usefulness, we present our total experience to date and highlight a selection of patients presenting for a range of elective colorectal surgery procedures. RESULTS The surgical glove port allowed successful completion of 25 single-port laparoscopic procedures (including laparoscopic adhesiolysis, ileo-rectal anastomosis, right hemicolectomy, total colectomy and low anterior resection) and has been used as an adjunct in over 80 additional multiport procedures (including refashioning of a colorectal anastomosis made after specimen extraction during a standard multiport laparoscopic anterior resection). CONCLUSIONS This simple, efficient device can allow use of single-port laparoscopy in a broader spectrum of patients either in isolation or in combination with multiport surgery than may be otherwise possible for economic reasons. By separating issues of cost from utility, the usefulness of the technical advance inherent within single-port laparoscopy for colorectal surgery can be better appreciated. We endorse the creative innovation inherent in this approach as surgical practice continues to evolve for ever greater patient benefit.


title: Mechanical revascularization of acute iatrogenic anterior cerebral artery occlusions: use of a new coaxial dual-lumen balloon catheter results in rapid access and flow restoration.

text: Acute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an acute vasospastic response. There are several options for flow restoration including pharmacological, mechanical and microsurgical. Mechanical flow restoration, usually by thrombectomy, is typically performed in large cerebral vessels. Current mechanical thrombectomy devices have limited utility in smaller vessels that are more difficult to access, such as the anterior cerebral artery (ACA). We present two cases where successful flow restoration of an intraoperative acutely occluded or thrombotic ACA was rapidly achieved by balloon dilation using a new coaxial dual-lumen balloon catheter. The time elapsed from the decision to use the balloon catheter until revascularization for each patient was 5 min and 46 s (case 1) and 10 min and 25 s (case 2).


title: NOTES-assisted transvaginal splenectomy: the next step in the minimally invasive approach to the spleen.

text: HYPOTHESIS Natural orifice transluminal endoscopic surgery (NOTES) has marked yet another step forward in less-invasive surgical procedures. Access to solid organs located deep in the left hypochondrium can be difficult using this technique but the transvaginal approach with the patient positioned in full lateral decubitus may be an option. MATERIAL AND METHODS We present the case of a 60-year-old woman with a symptomatic splenic polycystic tumor. The procedure was carried out by a multidisciplinary team using a standard flexible videogastroscope and endoscopic instruments. Transvaginal visualization of the spleen and standard dissection of attachments were feasible, and splenectomy was completed using transvaginal stapling of the splenic hilum. The organ was extracted transvaginally. RESULTS The postoperative course was uneventful. The patient had minimal postoperative pain and minimal scars, and was discharged on the second postoperative day. CONCLUSIONS Transvaginal access can be safely used for operative visualization, hilum transection, and spleen removal with conventional instrumentation, reducing parietal wall trauma to a minimum. The clinical, esthetic, and functional advantages require further analysis.


docid: ywtakoal

title: Postoperative fever in the time of COVID-19.

text: Summary Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. This is particularly problematic when asymptomatic or presymptomatic patients infected with SARS-CoV-2 require urgent surgery and cannot be screened effectively. One approach is to treat every patient as though they were SARS-CoV-2-positive in preparation for surgery, but doing so could exacerbate shortages of personal protective equipment and staffing limitations. Uncertainty regarding the etiology of postoperative fever could be significantly reduced by universal SARS-CoV-2 testing of all surgical patients at the time of hospital admission in addition to routine screening, but testing capacity and a rapid turnaround time would be required.


title: A systematic review of trials evaluating success factors of interventions with computerised clinical decision support.

text: BACKGROUND Computerised clinical decision support (CDS) can potentially better inform decisions, and it can help with the management of information overload. It is perceived to be a key component of a learning health care system. Despite its increasing implementation worldwide, it remains uncertain why the effect of CDS varies and which factors make CDS more effective. OBJECTIVE To examine which factors make CDS strategies more effective on a number of outcomes, including adherence to recommended practice, patient outcome measures, economic measures, provider or patient satisfaction, and medical decision quality. METHODS We identified randomised controlled trials, non-randomised trials, and controlled before-and-after studies that directly compared CDS implementation with a given factor to CDS without that factor by searching CENTRAL, MEDLINE, EMBASE, and CINAHL and checking reference lists of relevant studies. We considered CDS with any objective for any condition in any healthcare setting. We included CDS interventions that were either displayed on screen or provided on paper and that were directed at healthcare professionals or targeted at both professionals and patients. The reviewers screened the potentially relevant studies in duplicate. They extracted data and assessed risk of bias in independent pairs or individually followed by a double check by another reviewer. We summarised results using medians and interquartile ranges and rated our certainty in the evidence using the GRADE system. RESULTS We identified 66 head-to-head trials that we synthesised across 14 comparisons of CDS intervention factors. Providing CDS automatically versus on demand led to large improvements in adherence. Displaying CDS on-screen versus on paper led to moderate improvements and making CDS more versus less patient-specific improved adherence modestly. When CDS interventions were combined with professional-oriented strategies, combined with patient-oriented strategies, or combined with staff-oriented strategies, then adherence improved slightly. Providing CDS to patients slightly increased adherence versus CDS aimed at the healthcare provider only. Making CDS advice more explicit and requiring users to respond to the advice made little or no difference. The CDS intervention factors made little or no difference to patient outcomes. The results for economic outcomes and satisfaction outcomes were sparse. CONCLUSION Multiple factors may affect the success of CDS interventions. CDS may be more effective when the advice is provided automatically and displayed on-screen and when the suggestions are more patient-specific. CDS interventions combined with other strategies probably also improves adherence. Providing CDS directly to patients may also positively affect adherence. The certainty of the evidence was low to moderate for all factors. TRIAL REGISTRATION PROSPERO, CRD42016033738.


Thanks to reviewers.


title: COVID-19 in Singapore - a case series from primary care.

text: As the coronavirus disease 2019 (COVID-19) pandemic worsens, early case detection is vital to limiting community spread. We describe our experiences with four COVID-19 cases at the polyclinics in January and February 2020. This retrospective case series highlights the challenges primary care clinicians face in the early identification of suspect cases based on clinical criteria only. To improve case detection, clinicians can sharpen their clinical acumen by keeping abreast with the latest COVID-19 developments and by maintaining a high state of vigilance.


title: Maternal vaccination: moving the science forward.

text: BACKGROUND Infections remain one of the leading causes of morbidity in pregnant women and newborns, with vaccine-preventable infections contributing significantly to the burden of disease. In the past decade, maternal vaccination has emerged as a promising public health strategy to prevent and combat maternal, fetal and neonatal infections. Despite a number of universally recommended maternal vaccines, the development and evaluation of safe and effective maternal vaccines and their wide acceptance are hampered by the lack of thorough understanding of the efficacy and safety in the pregnant women and the offspring. METHODS An outline was synthesized based on the current status and major gaps in the knowledge of maternal vaccination. A systematic literature search in PUBMED was undertaken using the key words in each section title of the outline to retrieve articles relevant to pregnancy. Articles cited were selected based on relevance and quality. On the basis of the reviewed information, a perspective on the future directions of maternal vaccination research was formulated. RESULTS Maternal vaccination can generate active immune protection in the mother and elicit systemic immunoglobulin G (IgG) and mucosal IgG, IgA and IgM responses to confer neonatal protection. The maternal immune system undergoes significant modulation during pregnancy, which influences responsiveness to vaccines. Significant gaps exist in our knowledge of the efficacy and safety of maternal vaccines, and no maternal vaccines against a large number of old and emerging pathogens are available. Public acceptance of maternal vaccination has been low. CONCLUSIONS To tackle the scientific challenges of maternal vaccination and to provide the public with informed vaccination choices, scientists and clinicians in different disciplines must work closely and have a mechanistic understanding of the systemic, reproductive and mammary mucosal immune responses to vaccines. The use of animal models should be coupled with human studies in an iterative manner for maternal vaccine experimentation, evaluation and optimization. Systems biology approaches should be adopted to improve the speed, accuracy and safety of maternal vaccine targeting.


Twitter storm forces Chimerix's hand in compassionate use request.


title: "Acute intrathoracic stomach!" How should we deal with complicated type IV paraesophageal hernias?

text: PURPOSE Management of emergently admitted patients due to a complicated large paraesophageal hernia with acute symptoms of an "intrathoracic stomach" is controversial. The aim of this study was to clarify whether emergency surgery in such cases should be the procedure of choice. METHODS The retrospective analysis of patients who were hospitalized due to emerging acute symptoms of an "intrathoracic stomach" between January 2009 and May 2013 was used as method. Patients were categorized into three groups: emergency operation within 24 h after admission, semi-elective operation within the first 7 days after admission and elective operation. RESULTS Twenty-four patients were identified. Only three (12.5 %) patients required laparoscopic emergency surgery and two incurred a perioperative complication. In consequence of persistent or early recurrent complaints a laparoscopic operation was required prior to discharge semi-elective in 6/24 (25 %) patients without complications. The remaining 15/24 (62.5 %) patients were free of complaints after conservative therapy, but all of them decided upon elective operation after informed consent. One minor complication occurred. CONCLUSION The majority of patients with acute symptoms due to an intrathoracic stomach can primarily be treated conservatively and timing of elective repair should be performed after resuscitation in a center of laparoscopic antireflux surgery.


title: Updated European Association of Urology Guidelines Recommendations for the Treatment of First-line Metastatic Clear Cell Renal Cancer.

text: The randomised phase III clinical trial Checkmate-214 showed a survival superiority for the combination of ipilimumab and nivolumab when compared with the previous standard of care in first-line metastatic/advanced clear cell renal cell carcinoma (RCC) (Escudier B, Tannir NM, McDermott DF, et al. CheckMate 214: efficacy and safety of nivolumab plus ipilimumab vs sunitinib for treatment-naïve advanced or metastatic renal cell carcinoma, including IMDC risk and PD-L1 expression subgroups. LBA5, ESMO 2017, 2017). These results change the frontline standard of care for this disease and have implications for the selection of subsequent therapies. For this reason the European Association of Urology RCC guidelines have been updated. PATIENT SUMMARY The European Association of Urology guidelines will be updated based on the results of the phase III Checkmate-214 clinical trial. The trial showed superior survival for a combination of ipilimumab and nivolumab (IN), compared with the previous standard of care, in intermediate- and poor-risk patients with metastatic clear cell renal cell carcinoma. When IN is not safe or feasible, alternative agents such as sunitinib, pazopanib, and cabozantinib should be considered. Furthermore, at present, the data from the trial are immature in favourable-risk patients. Therefore, sunitinib or pazopanib remains the favoured agent for this subgroup of patients.


Mounting evidence suggests coronavirus is airborne - but health advice has not caught up.


title: Evaluation of Lung Radiofrequency Ablation With Dual-Energy Computed Tomography: Analysis of Tumor Composition and Lung Perfusion.

text: OBJECTIVE The aim of this study was to evaluate radiofrequency ablation (RFA) of lung tumors with dual-energy computed tomography while focusing on tumor composition and lung perfusion. METHODS The 36 tumors in 25 patients were included. Dual-energy computed tomography was performed before RFA and at 2 days and 1, 3, and 6 months thereafter. The effective atomic number (Zeff) of the tumors before RFA was compared with the Zeff at each follow-up using the paired t test. Lung perfusion was evaluated by iodine map images. When decreased perfusion was suspected after RFA, lung perfusion scintigraphy was performed. RESULTS The mean Zeff of the tumors significantly (P < 0.001) decreased at each follow-up, compared with that before RFA. Lung perfusion in the parenchyma peripheral to the tumors appeared to decrease at 2 days in 9 tumors, which was confirmed by scintigraphy in 7 tumors. CONCLUSIONS Dual-energy computed tomography was useful by providing additional information on tumor composition and lung perfusion.


Interpreting Diagnostic Tests for SARS-CoV-2.


title: Chest wall reconstruction with MatrixRib system: avoiding pitfalls.

text: Reconstructions of the chest wall using commercially available artificial metallic rib systems are gaining in popularity. The MatrixRib system involves use of plates and screws to bridge any defect and provide support for the chest wall following resection. So far, there has been no publication focusing on describing the use of this new technology in a step-by-step approach. We describe our technique and discuss potential pitfalls and difficulties of using the system.


docid: drotoirh

title: Minimally invasive adrenal surgery: an update.

text: PURPOSE OF REVIEW To summarize the recent developments in minimally invasive adrenal surgery. RECENT FINDINGS Modern adrenal surgery continues to evolve with new techniques. Both the laparoscopic transabdominal and retroperitoneoscopic approaches are now the standard of care for the removal of nonmalignant adrenal tumors. Other recent developments include robotic retroperitoneal adrenalectomy, single-incision laparoendoscopic surgery, and ambulatory adrenalectomy. SUMMARY Here, we review the literature of minimally invasive adrenal surgery over the last year to highlight new developments and technical refinements.


title: Timing of Community Mitigation and Changes in Reported COVID-19 and Community Mobility - Four U.S. Metropolitan Areas, February 26-April 1, 2020.

text: Community mitigation activities (also referred to as nonpharmaceutical interventions) are actions that persons and communities can take to slow the spread of infectious diseases. Mitigation strategies include personal protective measures (e.g., handwashing, cough etiquette, and face coverings) that persons can use at home or while in community settings; social distancing (e.g., maintaining physical distance between persons in community settings and staying at home); and environmental surface cleaning at home and in community settings, such as schools or workplaces. Actions such as social distancing are especially critical when medical countermeasures such as vaccines or therapeutics are not available. Although voluntary adoption of social distancing by the public and community organizations is possible, public policy can enhance implementation. The CDC Community Mitigation Framework (1) recommends a phased approach to implementation at the community level, as evidence of community spread of disease increases or begins to decrease and according to severity. This report presents initial data from the metropolitan areas of San Francisco, California; Seattle, Washington; New Orleans, Louisiana; and New York City, New York* to describe the relationship between timing of public policy measures, community mobility (a proxy measure for social distancing), and temporal trends in reported coronavirus disease 2019 (COVID-19) cases. Community mobility in all four locations declined from February 26, 2020 to April 1, 2020, decreasing with each policy issued and as case counts increased. This report suggests that public policy measures are an important tool to support social distancing and provides some very early indications that these measures might help slow the spread of COVID-19.


title: Covid-19 and co-morbidities: a role for Dipeptidyl Peptidase 4 (DPP4) in disease severity?

text: The Covid-19 pandemic is caused by a novel betacoronavirus, SARS-CoV-2, similar to SARS-CoV and MERS-CoV, which cause acute respiratory distress syndrome and case fatalities. Covid-19 disease severity is worse in older obese patients with comorbidities such as diabetes, hypertension, cardiovascular disease and chronic lung disease. Cell binding and entry of betacoronaviruses is via their surface spike glycoprotein; SARS-CoV binds to the metalloprotease angiotensin-converting enzyme 2, abbreviated hereafter to ACE2, MERS-CoV utilises dipeptidyl peptidase 4, abbreviated hereafter to DPP4, and recent modelling of the structure of SARS-CoV-2 spike glycoprotein predicts that it can interact with human DPP4 in addition to ACE2. DPP4 is a ubiquitous membrane-bound aminopeptidase that circulates in plasma; it is multifunctional with roles in nutrition, metabolism, immune and endocrine systems. DPP4 activity differentially regulates glucose homeostasis and inflammation via its enzymatic activity and non-enzymatic immunomodulatory effects. The importance of DPP4 for the medical community has been highlighted by the approval of DPP4 inhibitors, or gliptins, for the treatment of Type 2 diabetes mellitus. This review discusses the dysregulation of DPP4 in Covid-19 comorbid conditions; DPP4 activity is higher in older individuals and increased plasma DPP4 is a predictor of the onset of metabolic syndrome. DPP4 upregulation may be a determinant of Covid-19 disease severity, which creates interest regarding the use of gliptins in management of Covid-19. Also, knowledge of the chemistry and biology of DPP4 could be utilised to develop novel therapies to block viral entry of some betacoronaviruses, potentially including SARS-CoV-2. This article is protected by copyright. All rights reserved.


title: Development of a potent DOTA-conjugated bombesin antagonist for targeting GRPr-positive tumours.

text: PURPOSE Radiolabelled somatostatin-based antagonists show a higher uptake in tumour-bearing mouse models than agonists of similar or even distinctly higher receptor affinity. Very similar results were obtained with another family of G protein-coupled receptor ligands, the bombesin family. We describe a new conjugate, RM2, with the chelator DOTA coupled to D-Phe-Gln-Trp-Ala-Val-Gly-His-Sta-Leu-NH(2) via the cationic spacer 4-amino-1-carboxymethyl-piperidine for labelling with radiometals such as (111)In and (68)Ga. METHODS RM2 was synthesized on a solid support and evaluated in vitro in PC-3 cells. IC(50) and K(d) values were determined. The antagonist potency was evaluated by immunofluorescence-based internalization and Ca(2+) mobilization assays. Biodistribution studies were performed in PC-3 and LNCaP tumour-bearing mice with (111)In-RM2 and (68)Ga-RM2, respectively. PET/CT studies were performed on PC-3 and LNCaP tumour-bearing nude mice with (68)Ga-RM2. RESULTS RM2 and (111)In-RM2 are high-affinity and selective ligands for the GRP receptor (7.7 ± 3.3 nmol/l for RM2; 9.3 ± 3.3 nmol/l for (nat)In-RM2). The potent antagonistic properties were confirmed by an immunofluorescence-based internalization and Ca(2+) mobilization assays. (68)Ga- and (111)In-RM2 showed high and specific uptake in both the tumour and the pancreas. Uptake in the tumour remained high (15.2 ± 4.8%IA/g at 1 h; 11.7 ± 2.4%IA/g at 4 h), whereas a relatively fast washout from the pancreas and the other abdominal organs was observed. Uptake in the pancreas decreased rapidly from 22.6 ± 4.7%IA/g at 1 h to 1.5 ± 0.5%IA/g at 4 h. CONCLUSION RM2 was shown to be a potent GRPr antagonist. Pharmacokinetics and imaging studies indicate that (111)In-RM2 and (68)Ga-RM2 are ideal candidates for clinical SPECT and PET studies.


title: Transanal total mesorectal excision for restorative coloproctectomy in an obese high-risk patient with colitis-associated carcinoma.

text: Transanal total mesorectal excision (TaTME) offers great potential for the treatment of malign and benign diseases. However, laparoscopic-assisted TaTME in ulcerative colitis has not been described in more than a handful of patients. We present a 47-year-old highly comorbid female patient with an ulcerative colitis-associated carcinoma of the ascending colon and steroid- refractory pancolitis. A two-stage restorative coloproctectomy including right-sided complete mesocolic excision was conducted. The second step consisted of a successful nerve-sparing TaTME and a handsewn ileal pouch-anal anastomosis. TaTME may extend the possible treatment options in inflammatory bowel disease, especially for high-risk patients.


docid: mbkukepx

title: Reversible locoregional lymph node enlargement after radiofrequency ablation of lung tumors.

text: OBJECTIVE The objective of our study was to assess the characteristics of locoregional lymph node enlargement after successful radiofrequency ablation (RFA) in the treatment of malignant lung tumors. MATERIALS AND METHODS Follow-up CT examinations of 14 patients (seven men, seven women; age range, 30-90 years) who underwent 16 RFA sessions for the treatment of primary (n = 9) or metastatic (n = 5) lung tumors with a mean follow-up of 35 +/- 15 (SD) months (range, 7-60 months) were retrospectively reviewed by two thoracic radiologists. The site and size of hilar and mediastinal lymph nodes were recorded at baseline and at follow-up 1, 3, and 6 months after RFA sessions. In addition, the size, type, and location of the ablated lesion or lesions were recorded. All complications from RFA were recorded. Data were analyzed using the Fisher's exact test. RESULTS An increase in lymph node size was detected after 10 of 16 (62.5%) RFA sessions at 1-month follow-up. In four of 10 patients, only one node had enlarged, and in the remaining six patients, more than one nodal region had enlarged. The average increase in nodal size was 3 mm in the short-axis diameter and 4 mm in the long-axis diameter. Twenty-eight percent of RFA sessions were associated with enlargement of at least one lymph node to greater than 10 mm in short-axis diameter at 1-month follow-up. CT showed that nodes had decreased in size at 3- and 6-month follow-ups. Lesion size, location, and complications were not shown to be significantly associated with mediastinal lymph node enlargement (p > 0.05). CONCLUSION Recognition of reversible locoregional lymph node enlargement after RFA is important to prevent misdiagnosis of nodal metastatic disease.


title: Outcomes after toxic alcohol poisoning: a systematic review protocol.

text: BACKGROUND Toxic alcohols have been implicated in accidental ingestions and intentional exposures. Recognition of toxic alcohol poisoning is challenging. The main treatment modalities include antidotes with alcohol dehydrogenase inhibitors and dialysis. Current guidelines exist for both methanol and ethylene glycol intoxication. However, treatment consensus related to other toxic alcohols is limited. Furthermore, uncertainties regarding thresholds for when to initiate antidotes and dialysis persist. As a consequence, variations exist in the interventions utilized for management of all toxic alcohol poisonings. To our knowledge, no prior systematic review of clinical outcomes of toxic alcohols exists. The objective of this study is to summarize existing evidence on short- and long-term outcomes of patients following toxic alcohol poisonings, including methanol, ethylene glycol, isopropanol, propylene glycol, and diethylene glycol. METHODS A literature search in PubMed, MEDLINE, and EMBASE will be performed based on pre-determined criteria. There will be no restrictions on publication dates or languages. The search will be supplemented by manual scan of bibliographies of eligible studies and gray literature assessment. Observational studies and clinical trials will be included in this review. Once eligible studies have been selected based on pre-specified criteria, two investigators will extract relevant data independently and perform quality assessment per validated tools. A pooled analysis of mortality and short- and long-term secondary outcomes will be performed. Pre-specified subgroup analyses will be performed according to the type of toxic alcohol intoxication, mode of renal replacement therapy, and medical interventions received. A meta-analysis will be performed if three or more studies with similar populations, type of toxic alcohol poisoning, and outcome measures, as well as adequate quality, are identified. This review will be reported according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Statement. DISCUSSION This systematic review aims to synthesize current evidence in the short- and long-term outcomes of post-toxic alcohol poisoning. The results will enhance the understanding of patient morbidity and mortality after toxic alcohol poisoning, help inform uniform concrete management guideline development, identify gaps in the current state of knowledge, and provide evidence to help implement post-treatment follow-up. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018101955.


title: Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities: Implications for Emergency Preparedness.

text: An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling.


title: Comparative Outcome Analysis of Enterprise and Neuroform Stent-Assisted Coiling of Cerebral Aneurysms: A Review of the Literature.

text: Introduction One of the popular treatment strategies for complex cerebral aneurysms with wide necks or low dome-to-neck ratios is stent-assisted coiling. The most widely used intracranial stents for stent-assisted coiling are Neuroform (NF) and Enterprise (EP) stents. The purposes of this study are to review the recent literature of the past 5 years to compare outcomes between the EP and NF stent-assist coiling systems so as to comment on the safety, efficacy, complications, and recurrence rate of stent-assisted coiling in general. Methods PubMed was used to search for all published literature of NF or EP stent-assisted coiling of unruptured cerebral aneurysms from January 2014 to August 2019 with the search terms of "Enterprise stent-assisted coiling," "Neuroform stent," and "Neuroform vs. Enterprise stent." Results Twenty two publications met the inclusion criteria which encompass 1764 patients and 1873 aneurysms. Out of these 1873 aneurysms, 1007 aneurysms were treated with EP stent and 866 aneurysms were treated with NF stent. The overall outcome was low rates of thromboembolic complications (4.37%) and intracranial hemorrhage (1.13%), low permanent morbidity (1.70%) and mortality (0.40%), and lower rate of recanalization (11%). Data analysis shows an overall higher rate of complication and recurrence of aneurysm and lower overall rate of aneurysmal occlusion in the patients where EP stent was used in comparison to NF stent. However, this difference was not statistically significant. Conclusions The review of two stent-assisted coiling devices using EP and NF stents including 1873 aneurysms in 1764 patients revealed that overall, it is safe and effective with comparable outcomes.


title: A comparison of technologies used for estimation of body temperature.

text: Body temperature measurement is an important clinical parameter. The performance of a number of non-invasive thermometers was measured by comparing intra- and inter-operator variability (n = 100) and clinical accuracy (n = 61). Variability was elevated in febrile compared to normothermic subjects for axillary and oral electronic contact thermometer measures and a temporal artery thermometer (p < 0.001 for both). Temporal artery thermometry and one mode of an infrared tympanic thermometer demonstrated significant clinical inaccuracy (p < 0.001 for both). Electronic contact thermometer repeatability and reproducibility are highly variable in febrile adults both in the axilla and oral cavity. Infrared thermometry of the skin over the superficial temporal artery is unreliable for measuring core body temperature, particularly in febrile subjects and patients in theatre. The infrared tympanic thermometers tested are acceptable for clinical practice; however, care should be exercised with the different modes of operation offered.


title: Burnout among medical and health sciences information professionals who support systematic reviews: an exploratory study.

text: Objective The aim of this exploratory study was to assess personal, work-related, and client-related burnout among information professionals who support systematic review (SR) work. Methods The Copenhagen Burnout Inventory, a validated tool for assessing burnout, was administered to information professionals who support SR work. A broad range of health sciences or medical librarians and information professionals were targeted via professional email discussion lists and news outlets. Questionnaire responses were captured electronically using Qualtrics Survey Software and quantitatively analyzed. Results Respondents experienced an average personal burnout score of 48.6, work-related score of 46.4, and client-related score of 32.5 out of 100. Respondents who reported spending >80% of their job duties on SR work had significantly lower personal burnout scores than those who reported spending <10% of their job duties on SR work (average, 31.5 versus 50.9, respectively). Also, respondents who reported using an SR support tool had significantly lower personal burnout scores than those who reported sometimes using a tool (average, 43.7 versus 54.7, respectively). Conclusion The results suggest that information professionals who dedicate more time to SR work or who consistently use an SR support tool experience less burnout. This study provides groundwork for further investigation with the aim of developing approaches to prevent or combat SR-related burnout among information professionals.


docid: hfzcejzi

title: Shewanella algae: a rare cause of necrotizing fasciitis.

text: BACKGROUND The genus Shewanella consists of motile, gram-negative, facultative anaerobes found in marine environments. Shewanella putrefaciens and Shewanella algae are the two species with documented pathogenicity in human beings. Most documented cases of S. algae infection worldwide have been reported in the context of bacteremia, cellulitis, and acute exacerbations of chronic otitis media in predisposed individuals. We report a rare case of necrotizing soft tissue infection by S. algae in an immunocompetent individual. The infection followed exposure to S. algae in contaminated water in New York City, New York. METHODS We reviewed the English-language literature on similar cases of soft tissue infection using PubMed. Search terms included "Shewanella algae" and "Shewanella putrefaciens" in conjunction with "necrotizing" and "infection." Cognizant that this search method may not have yielded early (pre-1985) reports about Shewanella because of changes in classification and nomenclature, we also searched for "Pseudomonas putrefaciens." RESULTS After prompt surgical debridement and culture-directed antibiotic therapy, the patient recovered from his infection without the need for re-intervention. CONCLUSIONS This case may reflect the geographic spread and emergence of S. algae infection in the United States. Clinicians should be aware of the virulence of S. algae and potential for the rapid clinical deterioration of persons it infects even among immunocompetent individuals.


docid: tmfcjqmr

title: Effective nurse leadership in times of crisis.

text: The emergence of coronavirus disease 2019 (COVID-19) has meant that nurse leaders need to respond rapidly and decisively to the demands and challenges of a pandemic in a context of increased staff shortages and limited resources. This article suggests essential leadership skills and characteristics that nurses can use to underpin effective leadership in a crisis, emphasising the importance of decision-making and emotional intelligence. It also addresses two important questions: 'what do leaders in a crisis need to do that differs from any other time?' and 'what does effective leadership look like in a crisis?'


Transanal total mesorectal excision: the new kid on the block or a false dawn?


Pandemic and the PCMR.


Median arcuate ligament release.


title: Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center.

text: BACKGROUND Anatomical hepatectomy is an ideal curative treatment for hepatocellular carcinoma (HCC). We have standardized our laparoscopic anatomical hepatectomy (LAH) procedure, gradually extending its indications. In the present study, we describe our experience and the perioperative and oncological outcomes of LAH for HCC compared to those of open anatomical hepatectomy (OAH) during the gradual introduction of LAH. METHODS Seventy patients with primary HCC underwent anatomical hepatectomy in our institution from November 2008 to April 2014. As we gained experience with LAH, our indications for choosing LAH over OAH gradually expanded. Ultimately, 40 and 30 patients underwent LAH and OAH, respectively. Perioperative and oncological outcomes were compared between the two groups. RESULTS There were no significant differences in age, sex, background of liver disease, liver function, tumor size, tumor number, or type of liver resection between the two groups. Major complications and mortality rates were similar between the LAH and OAH groups (12.5% vs. 20%; p = 0.582, and 0% vs. 3.3%; p = 0.429, respectively). The median follow-up time after surgery was 40.5 months in the LAH group and 32.9 months in the OAH group (p = 0.835). The 1-, 3-, and 5-year overall survival rates were 89.9, 84.7, and 70.9%, in the LAH group, and 89.8, 68.0, and 63.1% in the OAH group, respectively (p = 0.255). The 1-, 3-, and 5-year disease-free survival rates were 79.5, 58.0, and 42.5%, in the LAH group, and 72.4, 56.1, and 50.4% in the OAH group, respectively (p = 0.980). CONCLUSIONS Through gradual introduction of LAH, we obtained comparable results to those achieved with OAH. LAH can be a feasible surgical treatment for primary HCC, with good oncological outcomes.


title: Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China.

text: Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world. Among 1565 samples tested from children, 41 (2.6%) were positive for HEV and 223 (14.3%) for human rhinovirus (HRV). Seven (17.1%) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack. The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China. In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.


title: New dog, new tricks: trends in performance on the Fundamentals of Laparoscopic Surgery simulator for incoming surgery residents.

text: BACKGROUND Exposure to laparoscopic surgery during medical school has increased over recent years. The Fundamentals of Laparoscopic Surgery (FLS) simulator allows for objective assessment of laparoscopic skills. This study aimed to determine whether the fundamental laparoscopic skills of incoming surgery residents have improved. METHODS The initial FLS performance of first-year residents between 2003 and 2008 was identified from a prospective database. Linear regression was used to determine the effect of incoming year on performance of the five FLS simulator tasks (peg transfer, pattern cut, endoloop placement, suture with an extracorporeal knot [EC], suture with an intracorporeal knot [IC]) and the total score. Statistical significance was defined as a p value less than 0.05. RESULTS A total of 63 first-year residents were identified from the database. The total FLS scores improved over time (r = 0.39; p = 0.001). The scores for peg transfer did not change significantly, but the scores for pattern cutting (r = 0.37; p = 0.002), endoloop placement (r = 0.36; p = 0.004), suture with EC (r = 0.32; p = 0.02), and suture with IC (r = 0.26; p = 0.03) all improved significantly over the 5 years. CONCLUSION The baseline fundamental laparoscopic skills of incoming surgery residents appear to have improved over time. This may be due to increased clinical laparoscopic exposure and availability of laparoscopic simulation in medical school.


Association of Black Race with Outcomes in COVID-19 Disease: A Retrospective Cohort Study.


title: A career in sport does not eliminate risk of cardiovascular disease: A systematic review and meta-analysis of the cardiovascular health of field-based athletes.

text: OBJECTIVES To determine the prevalence of cardiovascular disease (CVD) risk factors in current field-based athletes. DESIGN Meta-analysis. METHODS This review was conducted and reported in accordance with PRISMA and pre-registered with PROSPERO. Articles were retrieved via online database search engines, with no date or language restriction. Studies investigating current field-based athletes (>18years) for CVD risk factors according to the European Society of Cardiology and American Heart Association were screened. Full texts were screened using Covidence and Cochrane criteria. Eligible articles were critically appraised using the AXIS tool. Individual study estimates were assessed by random-effect meta-analyses to examine the overall effect. RESULTS This study was ascribed a 1b evidence level, according to the Oxford Centre for Evidence-based Medicine. 41 studies were identified, including 5546 athletes from four sports; American football; soccer; rugby and baseball mean ages: 18-28. Despite participation in sport, increased body mass was associated with increased total cholesterol, low-density lipoprotein, triglycerides, hypertension, systolic blood pressure, and decreased high-density lipoprotein. Linemen had increased prevalence of hypertension compared to non-athletes. Conflicting findings on fasting glucose were prevalent. There were inconsistencies in screening and reporting of CVD risk factors. Sport specific anthropometric demands were associated with elevated prevalence of CVD risk factors, most notably: elevated body mass; dyslipidemia; elevated systolic blood pressure and; glucose. CONCLUSIONS There are elevated levels of risk for CVD in some athletes, primarily football players. Lifestyle behaviours associated with elite athleticism, particularly football linemen potentially expose players to greater metabolic and CVD risk, which is not completely offset by sport participation.


title: Medicoeconomic analysis of lobectomy using thoracoscopy versus thoracotomy for lung cancer: a study protocol for a multicentre randomised controlled trial (Lungsco01).

text: INTRODUCTION In the last decade, video-assisted thoracoscopic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) has had a major effect on thoracic surgery. Retrospective series have reported benefits of VATS when compared with open thoracotomy in terms of postoperative pain, postoperative complications and length of hospital stay. However, no large randomised control trial has been conducted to assess the reality of the potential benefits of VATS lobectomy or its medicoeconomic impact. METHODS AND ANALYSIS The French National Institute of Health funded Lungsco01 to determine whether VATS for lobectomy is superior to open thoracotomy for the treatment of NSCLC in terms of economic cost to society. This trial will also include an analysis of postoperative outcomes, the length of hospital stay, the quality of life, long-term survival and locoregional recurrence. The study design is a two-arm parallel randomised controlled trial comparing VATS lobectomy with lobectomy using thoracotomy for the treatment of NSCLC. Patients will be eligible if they have proven or suspected lung cancer which could be treated by lobectomy. Patients will be randomised via an independent service. All patients will be monitored according to standard thoracic surgical practices. All patients will be evaluated at day 1, day 30, month 3, month 6, month 12 and then every year for 2 years thereafter. The recruitment target is 600 patients. ETHICS AND DISSEMINATION The protocol has been approved by the French National Research Ethics Committee (CPP Est I: 09/06/2015) and the French Medicines Agency (09/06/2015). Results will be presented at national and international meetings and conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02502318.


Left atrioesophageal fistula following catheter ablation for atrial fibrillation: off-bypass, primary repair using an extrapericardial approach.


title: Fistulizing Crohn's disease: Diagnosis and management.

text: Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.


title: Effect of Diameter of Saphenous Vein on Stump Length after Radiofrequency Ablation for Varicose Vein.

text: PURPOSE Radiofrequency ablation (RFA) has gained popularity for treatment of varicose veins. The diameter of the saphenous vein should be considered before RFA because occlusion of the vein may differ depending on its diameter. Until now, however, there have been few data about the correlation between the diameter of the saphenous vein and the stump length after RFA. The purpose of our study was to investigate its correlation. MATERIALS AND METHODS A retrospective review was performed from prospectively collected data of RFA patients between March 2009 and December 2011. Preoperatively, the saphenous vein diameter was measured. Ablation was initiated 2 cm distal from the junction. Postoperatively, stump length was measured at 1 week and 6 months. After 2 years, we measured the length from the saphenofemoral junction to the leading point of occlusion for great saphenous vein, and length from the saphenopopliteal junction to the leading point of occlusion for small saphenous vein. The paired t-test, independent t-test, and correlation analysis were used for statistical analysis. P-value <0.05 was considered statistically significant. RESULTS During the study period, RFA was performed in 201 patients. Endovenous heat-induced thrombosis developed in 3 patients (1.5%). After 2 years, the stump length was obtained in 74 limbs. The mean diameter and stump length of the saphenous vein were 6.7±1.8 mm and 12.5±8.5 mm, respectively. Correlation analysis showed that the Pearson correlation coefficient of these factors was -0.017. CONCLUSION There was no correlation between the diameter of saphenous vein and stump length.


Air pollution and SARS-CoV-2 in the Po Valley: possible environmental persistence?


title: Robotic en bloc first-rib resection for Paget-Schroetter disease, a form of thoracic outlet syndrome: technique and initial results.

text: OBJECTIVE First-rib resection is a key component of the treatment of Paget-Schroetter disease. There are many controversies regarding the management of this disease. We report a safe, effective, minimally invasive robotic transthoracic approach for resection of the first rib. METHODS Over an 8-month period, five patients underwent robotic first-rib resection. Preoperative assessment included physical examination and bilateral venous angiography. On a thoracoscopic platform using three 2-cm incisions and one 1-cm incision, the robot was used to dissect the first rib and divide the scalene muscles. Success of the first-rib resection was assessed by postoperative venous angiography. RESULTS There were four men and one woman. Mean age was 34.6 ± 10 years. Mean operative time was 195 ± 24.6 minutes. There were no complications and no mortality. All patients had a patent subclavian vein on the postoperative venogram and were anticoagulated with warfarin for 3 months. At a median follow-up of 12 months, all patients had an open subclavian vein for a patency rate of 100%. CONCLUSIONS Robotic thoracoscopic first-rib resection represents a feasible minimally invasive approach to en bloc resection of the first rib. This technique minimizes the risk of neurovascular complications that are associated with conventional techniques.


title: Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: racial considerations for 250 consecutive cases.

text: Our objective is to report the functional and oncologic outcomes of a cohort of 250 consecutive prostate cancer patients undergoing a Retzius-sparing approach and to assess for racial differences in continence outcomes. This was a prospective, single-center, case series of 250 consecutive prostate cancer patients who underwent a Retzius-sparing robotic-assisted laparoscopic radical prostatectomy by a single surgeon between May 2015 and April 2019. Our primary objective was to report post-operative continence outcomes of patients undergoing this technique. Continence was defined as using zero or one precautionary pad per day. Median follow-up was 24.0 months [interquartile range (IQR) 18.0-30.0 months]. Median age and body mass index were 62.0 years (IQR 57.0-67.0) and 29.0 kg/m2 (IQR 26.0-33.0), respectively. Median PSA was 8.22 ng/ml (IQR 5.74-13.31). 84.8% of patients were intermediate risk or high risk pre-operatively, as per AUA/ASTRO/SUO guidelines. 96.0% had Gleason Score 7 or worse disease on final pathologic analysis. Positive margin incidence was 18.1% and 44.4% in patients with pT2 and pT3 disease, respectively, of which 75.4% were unifocal. Immediate continence (i.e., continence achieved within 1 month post-operatively) was achieved in 45.2% of patients. Three-month and 1-year continence rates were 70.0% and 92.0%, respectively. Caucasian patients experienced earlier return of continence (77% versus 65% at 3 months) compared to African American patients. IPSS scores gradually improved from 8.0 pre-operatively to 4.0 1-year later. Median PSA level was 0.01 ng/ml (IQR 0.01-9.01) post-operatively. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy is an oncologically safe surgical technique with excellent short- and long-term continence outcomes. Caucasian patients may have earlier return of continence compared to African Americans.


title: Retroperitoneal and retrograde total laparoscopic hysterectomy as a standard treatment in a community hospital.

text: OBJECTIVE To report our experience with a modified procedure for total laparoscopic hysterectomy based on a retrograde and retroperitoneal technique. This surgical approach is analyzed on a consecutive series of patients in a community hospital and theoretical educational advantages are proposed. STUDY DESIGN All patients undergoing hysterectomy from January 2012 to April 2013 were included in the study. A detailed description of the technique is given. As main outcome measures we evaluated: the number and rate of patients excluded from laparoscopic approach, the rate of late complications need readmission, the rate of transfusions, the rate of conversion to laparotomy and the number of minor complications. The main concern of the study was ureteral complications. RESULTS Overall 174 patients underwent hysterectomy in our unit. The rate of patients submitted to laparoscopic hysterectomy was 97.5%. The number of complications needing re-admission was three (2%). The rate of conversion was 2.7%. In the study period, two (1.2%) ureteral complications were observed (late fistulae). There were four bladder lesions but the patients were released on the same day as the patients with no lesion. CONCLUSIONS Opening the retroperitoneum allows rapid control of the main uterine vessels by coagulation, and constant checks on the ureter. Difficult benign situations can be managed. Even in a non-referral center about 94% of hysterectomies can be performed by laparoscopic surgery. This approach is helpful and may be reproducible in gynecological procedures.


docid: vvepyxjm

title: Modeling SARS-CoV-2 infection in mice.


title: The LEVANT I (Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis) trial for femoropopliteal revascularization: first-in-human randomized trial of low-dose drug-coated balloon versus uncoated balloon angioplasty.

text: OBJECTIVES This study sought to evaluate the safety and efficacy of the Lutonix drug-coated balloon (DCB) coated with 2 μg/mm(2)paclitaxel and a polysorbate/sorbitol carrier for treatment of femoropopliteal lesions. BACKGROUND Percutaneous treatment of peripheral vascular disease is associated with a high recurrence. Paclitaxel-coated balloons at 3 μg/mm(2) formulated differently have shown promising results with reduced restenosis. Methods Subjects at 9 centers with Rutherford class 2 to 5 femoropopliteal lesions were randomized between June 2009 and December 2009 to treatment with Lutonix DCB (n = 49) versus uncoated balloons (control group [n = 52]), stratified by whether balloon-only treatment (n = 75) or stenting (n = 26) was intended. The primary endpoint was angiographic late lumen loss at 6 months. Secondary outcomes included adjudicated major adverse events (death, amputation, target lesion thrombosis, reintervention), functional outcomes, and pharmacokinetics. RESULTS Demographic, peripheral vascular disease, and lesion characteristics were matched, with mean lesion length of 8.1 3.8 cm and 42% total occlusions. At 6 months, late lumen loss was 58% lower for the Lutonix DCB group (0.46 1.13 mm) than for the control group (1.09 1.07 mm; p = 0.016). Composite 24-month major adverse events were 39% for the DCB group, including 15 target lesion revascularizations, 1 amputation, and 4 deaths versus 46% for uncoated balloon group, with 20 target lesion revascularizations, 1 thrombosis, and 5 deaths. Pharmacokinetics showed biexponential decay with peak concentration (Cmax) of 59 ng/ml and total observed exposure (AUC(all)) of 73 ng h/ml. For successful DCB deployment excluding 8 malfunctions, 6-month late lumen loss was 0.39 mm and the 24-month target lesion revascularization rate was 24%. CONCLUSIONS Treatment of femoropopliteal lesions with the low-dose Lutonix DCB reduced late lumen loss with safety comparable to that of control angioplasty. (LEVANT I, The Lutonix Paclitaxel-Coated Balloon for the Prevention of Femoropopliteal Restenosis; NCT00930813)