title: Watershed Hepatocellular Carcinomas: The Risk of Incomplete Response following Transhepatic Arterial Chemoembolization.

text: PURPOSE Hepatocellular carcinomas (HCCs) bridging two or more Couinaud-Bismuth segments of the liver ("watershed tumors") can recruit multiple segmental arteries. The primary hypothesis of this study was that fewer watershed tumors show complete response (CR) after chemoembolization, with shorter time to local recurrence. Secondary analysis on the impact on transplantation eligibility in the presence of progressive disease was also performed. MATERIALS AND METHODS A total of 155 transplantation-eligible patients whose HCC met Milan criteria (watershed, n = 83; nonwatershed, n = 72) and was treated with chemoembolization were included. Cone-beam computed tomography (CT) was used for guidance and for confirmation of circumferential uptake. Local response to chemoembolization per modified Response Evaluation Criteria In Solid Tumors and local disease-free survival (DFS) for the index tumor were calculated. Differences were assessed by univariate and multivariate analyses. RESULTS CR after a single of chemoembolization was observed in 55.4% of watershed tumors and in 72.2% of nonwatershed tumors (P = .045). Estimated DFS intervals were 151 days (95% confidence interval [CI], 93-245 d) and 336 days (95% CI, 231-747 d; P = .040) in the watershed and nonwatershed groups, respectively. Worse DFS was observed with a Model for End-Stage Liver Disease score > 20 (P = .0001), higher Child-Pugh-Turcotte score (P = .049), and watershed location (P = .040). Waiting list drop-off rates were statistically similar between groups. CONCLUSIONS Hepatocellular carcinomas located in the watershed region of the liver have a poorer response to chemoembolization than those located elsewhere. These tumors are associated with worse DFS and require additional treatments to maintain transplantation eligibility per Milan criteria. Cone-beam CT can identify crossover supply and confirm complete geographic drug uptake, possibly reducing (but not eliminating) the risk of incomplete response.


title: Is Outpatient Thyroid Surgery for Everyone?

text: Thyroidectomy is a common surgical procedure. Traditionally, surgeons have performed thyroidectomy on an inpatient basis. However, consistent with current trends in surgery, some practices are transitioning thyroidectomy to an outpatient setting. Although concerns for hypocalcemia and postoperative bleeding exist regardless of surgeon experience, multiple studies demonstrate that outpatient thyroidectomy is safe in the hands of high-volume surgeons. Indeed, experienced thyroid surgeons who perform thyroidectomy in an outpatient setting experience excellent patient outcomes and reduced costs. However, outpatient thyroidectomy may not be suitable for all surgeons, hospitals, or patients. When evaluating whether to implement an outpatient thyroid program, a practice should consider a number of important factors including the team performing the procedure, the hospital, and the patient. With the appropriate staff education and experience, hospital setting, and patient selection, practices in a multitude of settings can successfully develop a safe, cost-effective outpatient thyroid program.


title: Adhesive performance of biomimetic adhesive-coated biologic scaffolds.

text: Surgical repair of a discontinuity in traumatized or degenerated soft tissues is traditionally accomplished using sutures. A current trend is to reinforce this primary repair with surgical grafts, meshes, or patches secured with perforating mechanical devices (i.e., sutures, staples, or tacks). These fixation methods frequently lead to chronic pain and mesh detachment. We developed a series of biodegradable adhesive polymers that are synthetic mimics of mussel adhesive proteins (MAPs), composed of 3,4-dihydroxyphenylalanine (DOPA)-derivatives, polyethylene glycol (PEG), and polycaprolactone (PCL). These polymers can be cast into films, and their mechanical properties, extent of swelling, and degradation rate can be tailored through the composition of the polymers as well as blending with additives. When coated onto a biologic mesh used for hernia repair, these adhesive constructs demonstrated adhesive strengths significantly higher than fibrin glue. With further development, a precoated bioadhesive mesh may represent a new surgical option for soft tissue repair.


title: Intra-Rater and Inter-Rater Reliability of Tongue Coating Diagnosis in Traditional Chinese Medicine Using Smartphones: Quasi-Delphi Study.

text: BACKGROUND There is a growing trend in the use of mobile health (mHealth) technologies in traditional Chinese medicine (TCM) and telemedicine, especially during the coronavirus disease (COVID-19) outbreak. Tongue diagnosis is an important component of TCM diagnosis. However, the procedure of obtaining tongue images has not been standardized and the reliability of tongue diagnosis by smartphone tongue images has yet to be evaluated. OBJECTIVE The first objective of this study was to develop an operating classification scheme for tongue coating diagnosis. The second and main objective of this study was to determine the intra-rater and inter-rater reliability of tongue coating diagnosis using the operating classification scheme. METHODS An operating classification scheme for tongue coating was developed using a stepwise approach and a quasi-Delphi method. First, tongue images (n=2023) were analyzed by 2 groups of assessors to develop the operating classification scheme for tongue coating diagnosis. Based on clinicians' (n=17) own interpretations as well as their use of the operating classification scheme, the results of tongue diagnosis on a representative tongue image set (n=24) were compared. After gathering consensus for the operating classification scheme, the clinicians were instructed to use the scheme to assess tongue features of their patients under direct visual inspection. At the same time, the clinicians took tongue images of the patients with smartphones and assessed tongue features observed in the smartphone image using the same classification scheme. The intra-rater agreements of these two assessments were calculated to determine which features of tongue coating were better retained by the image. Using the finalized operating classification scheme, clinicians in the study group assessed representative tongue images (n=24) that they had taken, and the intra-rater and inter-rater reliability of their assessments was evaluated. RESULTS Intra-rater agreement between direct subject inspection and tongue image inspection was good to very good (Cohen K range 0.69-1.0). Additionally, when comparing the assessment of tongue images on different days, intra-rater reliability was good to very good (K range 0.7-1.0), except for the color of the tongue body (K=0.22) and slippery tongue fur (K=0.1). Inter-rater reliability was moderate for tongue coating (Gwet AC2 range 0.49-0.55), and fair for color and other features of the tongue body (Gwet AC2=0.34). CONCLUSIONS Taken together, our study has shown that tongue images collected via smartphone contain some reliable features, including tongue coating, that can be used in mHealth analysis. Our findings thus support the use of smartphones in telemedicine for detecting changes in tongue coating.


title: Funding vaccines for emerging infectious diseases.

text: Immunization has played a large role in substantially reducing the infected and death tolls from infectious diseases. In the case of emerging diseases, the identity of the pathogen responsible, as well as the time and location for the next outbreak, cannot be accurately predicted using current means. Coupled with disjointed efforts towards the development of vaccines and a lack of funds and desire to advance promising products against known emerging pathogens to clinical trials, there has been a shortage of approved products ready for emergency use. Recent outbreaks have exposed these weaknesses, and the Coalition for Epidemic Preparedness Innovations (CEPI) was created in 2016 to address these issues. In this commentary, we discuss the establishment of such a global vaccine fund, and provide some additional points to consider for stimulating further discussion on this comprehensive, ambitious initiative.


title: The developmental history of the gadolinium chelates as intravenous contrast media for magnetic resonance.

text: The developmental history of the gadolinium chelates, which spans 30 years, is described, focusing, in part, on the seminal work with each of the major agents in use today. By examining this history, insight is gained into important issues of efficacy and safety, with valuable lessons to be learned from the mistakes made during this period. An overview of physicochemical characteristics and chemical structures is also provided. The review concludes with a discussion of current research directions involving this field, which is that of the intravenous contrast media for magnetic resonance, in the past 5 years.


title: Structure-activity relationships and design of viral mutagens and application to lethal mutagenesis.

text: While mutation is the driving force behind evolution, most mutations are detrimental; therefore, elevating the mutation rate of a virus should diminish fitness. Because riboviruses and retroviruses have high mutation rates, a small increase in their mutation rates could exceed their threshold of viability. This approach, elevation of the viral mutation rate beyond the threshold of viability, extinction catastrophe or lethal mutagenesis, was proposed over a decade ago as a novel chemotherapeutic strategy. Extinction catastrophe induced by promutagenic nucleosides has been demonstrated in cell culture models, but most mutagens are carcinogenic and are poorly tolerated. Thus, clinical translation of viral mutagens has been difficult, casting doubt on the clinical viability of this strategy. This Perspective covers recent advances in the use of promutagenic nucleosides and the Vif-APOBEC interaction as chemotherapeutic strategies for targeting viral mutation rates.


title: No Love Lost Between Viruses and Interferons.

text: The interferon system protects mammals against virus infections. There are several types of interferons, which are characterized by their ability to inhibit virus replication and resultant pathogenesis by triggering both innate and cell-mediated immune responses. Virus infection is sensed by a variety of cellular pattern-recognition receptors and triggers the synthesis of interferons, which are secreted by the infected cells. In uninfected cells, cell surface receptors recognize the secreted interferons and activate intracellular signaling pathways that induce the expression of interferon-stimulated genes; the proteins encoded by these genes inhibit different stages of virus replication. To avoid extinction, almost all viruses have evolved mechanisms to defend themselves against the interferon system. Consequently, a dynamic equilibrium of survival is established between the virus and its host, an equilibrium that can be shifted to the host's favor by the use of exogenous interferon as a therapeutic antiviral agent.


title: Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy.

text: BACKGROUND Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. STUDY DESIGN Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. RESULTS A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). CONCLUSIONS This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety.


title: Anchoring Pipeline Flow Diverter Construct in the Treatment of Traumatic Distal Cervical Carotid Artery Injury.

text: Background Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage. Recognized interventional treatments include parent artery occlusion with or without revascularization, endovascular coil embolization, and covered stenting. Summary A wide variety of endovascular stents are available that are capable of opening a stenosed vessel while obliterating the associated false lumen and providing a scaffold for embolization of the pseudoaneurysm. The use of the Pipeline Embolization Device (PED) in the management of traumatic intracranial pseudoaneurysms has been described. However, there are few reports on the usage of the PED for treating traumatic extracranial ICA dissection and/or pseudoaneurysms. However, a potential complication of the use of PED in the extracranial ICA is a hypothetical tendency to migrate in a mobile vessel. Thus, the risk of migration of the PED has encouraged practitioners to adopt strategies to limit this risk. Key Messages We describe different techniques employed to anchor the flow-diverting construct within tortuous, mobile vessels.


Research on covid-19 is suffering "imperfect incentives at every stage".


title: Acute effects of insulin on circulating natriuretic peptide levels in humans.

text: BACKGROUND The natriuretic peptide hormones play an important role in salt and blood pressure regulation. In observational studies, obesity and insulin resistance have been consistently associated with lower concentrations of natriuretic peptides. It has been proposed that insulin influences natriuretic peptide production. OBJECTIVE We sought to determine the acute effects of insulin administration on natriuretic peptide concentrations. METHODS 31 men and women (11 lean, 10 overweight, and 10 obese), ages 30-70 years, without cardiovascular disease or overt diabetes underwent a hyperinsulinemic-euglycemic insulin clamp. Plasma concentrations of N-terminal pro atrial natriuretic peptide (NT-proANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured at baseline and steady-state (the final 30 minutes of the clamp protocol). RESULTS From baseline to steady-state, insulin levels increased from a mean level of 9.5 to 176.7 μU/ml (p<0.001). Over this period, circulating NT-proANP concentrations decreased by 9% (-1933 ng/L, p = 0.01). The changes in NT-proANP did not differ between lean, overweight, and obese individuals. Steady-state NT-proANP levels, adjusted for baseline, were lower in individuals with greater insulin resistance, independent of BMI. In contrast to NT-proANP, NT-proBNP levels did not change significantly during the clamp (p = 0.41). CONCLUSION Insulin administration was associated with a moderate decrease in circulating NT-proANP, but not NT-proBNP. The lowest NT-proANP concentrations were found in insulin-resistant individuals. Further investigations are warranted to elucidate potential mechanisms underlying the effects of insulin on the cardiac hormonal axis.


title: The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head.

text: BACKGROUND The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. METHODS Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. RESULTS There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 ± 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 ± 6.7 (P < 0.001) and 26.7 ± 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 ± 8.8 (P < 0.001) and 29.9 ± 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. CONCLUSIONS The position change from supine to prone without head movement can cause a change in ETT cuff pressure.


title: Reduction of CT beam hardening artefacts of ethylene vinyl alcohol copolymer by variation of the tantalum content: evaluation in a standardized aortic endoleak phantom.

text: OBJECTIVES Our aim was to develop an aortic stent graft phantom to simulate endoleak treatment and to find a tantalum content (TC) of ethylene-vinyl-alcohol-copolymer that causes fewer computed tomography (CT) beam hardening artefacts, but still allows for fluoroscopic visualization. METHODS Ethylene-vinyl-alcohol-copolymer specimens of different TC (10-50 %, and 100 %) were injected in an aortic phantom bearing a stent graft and endoleak cavities with simulated re-perfusion. Fluoroscopic visibility of the ethylene-vinyl-alcohol-copolymer specimens was analyzed. In addition, six radiologists analyzed endoleak visibility, and artefact intensity of ethylene-vinyl-alcohol-copolymer in CT. RESULTS Reduction of TC significantly decreased CT artefact intensity of ethylene-vinyl-alcohol-copolymer and increased visibility of endoleak re-perfusion (p < 0.000). It also significantly decreased fluoroscopic visibility of ethylene-vinyl-alcohol-copolymer (R = 0.883, p ≤ 0.01), and increased the active embolic volumes prior to visualization (Δ ≥ 40 μl). Ethylene-vinyl-alcohol-copolymer specimens with a TC of 45-50 % exhibited reasonable visibility, a low active embolic volume and a tolerable CT artefact intensity. CONCLUSIONS The developed aortic stent graft phantom allows for a reproducible simulation of embolization of endoleaks. The data suggest a reduction of the TC of ethylene-vinyl-alcohol-copolymer to 45 -50 % of the original, to interfere less with diagnostic imaging in follow-up CT examinations, while still allowing for fluoroscopic visualization.


title: The influence of mood and information processing strategies on recall, persuasion, and intention to get a flu vaccine.

text: This study investigates the interactions between mood (positive/negative) and information processing style (item-specific/relational/narrative processing) on responses to three types of advertising messages (ungrouped list/grouped list/narrative ads). A mood congruency effect was postulated and found to influence recall, persuasion and behavioral intention. Results supported the hypothesis that message effectiveness was moderated by mood in the direction of congruency. That is, participants in a positive mood recalled more information, were more persuaded, and were more likely to adopt the recommended behavior after exposure to advertisements with a grouped list format. Evidence regarding similarity of factors influencing relational and narrative processing is presented.


Suicide Mortality and Coronavirus Disease 2019-A Perfect Storm?


title: Long-Term Effect of Flow Diversion on Large and Giant Aneurysms: MRI-DSA Clinical Correlation Study.

text: BACKGROUND The long-term effect of flow diversion (FD) on aneurysms has not been well studied. OBJECTIVE We aimed to assess the effect of the Pipeline embolization device (Covidien, Irvine, California, USA) on large and giant intracranial aneurysms with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) and then correlate with clinical follow-up. METHODS We conducted a retrospective analysis of aneurysms treated solely with Pipeline without adjunctive therapy. The largest aneurysm diameters were compared with pretreatment and post treatment MRI and correlated with DSA and clinical symptoms. RESULTS Twelve patients harboring large and giant saccular unruptured aneurysms, treated with Pipeline, were included. Mean follow-up times were as follows: MRI 22.8 months (range 1-57), DSA 18.2 months (range 1-33), and clinical 29 months (range 1-48). Ten (83%) of 12 treated aneurysms decreased in size on MRI, which was first seen at an average of 17 months (range 4-57). In 70% of patients the change was noted on MRI ≤1 year after treatment, at an average of 9.1 months (range 4-12). MRI reduction was more likely in angiographically occluded aneurysms. Five aneurysms with complete occlusion on early angiogram showed size reduction on MRI only at ≥12 months. Mean aneurysm size reduction was 57% (range 19.6-94.2), which correlated well with improvement of cranial neuropathies in 75% and headaches in 100% of patients. CONCLUSION Most aneurysms treated with Pipeline decreased in size, correlating with clinical improvement. Some aneurysms remained unchanged on MRI until a later time point despite early DSA occlusion. It may be reasonable to eliminate early postprocedural imaging and start follow-up only as late as 1 year after FD treatment in clinically stable, asymptomatic patients.


title: Prevalence of Dumping Syndrome After Laparoscopic Sleeve Gastrectomy and Comparison with Laparoscopic Roux-en-Y Gastric Bypass.

text: BACKGROUND Dumping syndrome is a well-known side effect of laparoscopic gastric bypass (LRYGB), and it is commonly believed that dumping syndrome is less likely to occur after laparoscopic sleeve gastrectomy (LSG), due to the preservation of the pyloric sphincter. However, it is not uncommon for patients undergoing LSG at our center to report symptoms suggestive of dumping syndrome. OBJECTIVE To assess the prevalence of symptoms of dumping syndrome after LSG compared with LRYGB. SETTING A single surgical group at a high-volume (700 cases per year) Bariatric and Metabolic Surgery Center of Excellence. METHODS One thousand four hundred seventy-one LRYGB (366) and LSG (1105) patients received a questionnaire to assess symptoms of dumping syndrome, utilizing a modified version of the Sigstad scoring system. Dumping syndrome was considered to be present when the questionnaire score exceeded a threshold value. RESULTS A total of 360 responses were received (249 LSG, 111 LRYGB). 26.5% (66) LSG and 41.4% (46) LRYGB exceeded the threshold for dumping syndrome (p < 0.01). 84.8% (56) LSG and 84.7% (39) LRYGB reported early dumping syndrome (p > 0.05). Thirty-six percent (24) LSG and 28% (13) LRYGB reported late dumping syndrome (p > 0.05). Twenty-seven percent (62) LSG and 44.4% (44) LRYGB reported at least one symptom of dumping syndrome with sweets (p < 0.05). 34.3% (85) LSG and 35.5% (39) LRYGB reported symptoms when drinking with or within 30 min of a meal (p > 0.05). 14.5% (36) LSG and 17.3% (19) LRYGB reported symptoms after alcohol consumption (p > 0.05). CONCLUSION Dumping syndrome after LSG is prevalent but has not been widely reported. This finding may impact clinicians and patients in their choice of procedure and has relevance in post-operative education and care.


title: Watertight Sealing Without Lumbar Drainage for Incidental Ventral Dural Defect in Transthoracic Spine Surgery: A Retrospective Review of 53 Cases.

text: STUDY DESIGN A retrospective review. OBJECTIVES To evaluate the therapeutic efficacy of the triple layer closure technique to establish watertight sealing without diversion of lumbar drainage, in preventing persistent incidental subarachnoid-pleural fistula and other neurological complications related to excessive drainage of cerebrospinal fluid (CSF) after dural defect in transthoracic ossified posterior longitudinal ligament (OPLL) surgery. SUMMARY OF BACKGROUND DATA CSF leakage into the pleural cavity leads to unfavorable conditions for natural healing of incidental durotomy due to the negative pressure environment of the pleural space and lack of wound healing around the bony cavity near the decompressed spinal cord. This often leads to a persistent incidental subarachnoid-pleural fistula. In addition, diversion of lumbar drainage may lead to excessive CSF drainage resulting in intracranial hypotension. To avoid this, we studied the efficacy of a modified sealing method to establish a more watertight covering at the ventral dural defect without lumbar CSF drainage. METHODS Fifty-three patients who had CSF leakage from the ventral aspect of the spinal cord during transthoracic spine surgery for thoracic OPLL between 2004 and 2013 were retrospectively reviewed. Patients were divided into 2 groups: a conventional group (group A) and a triple layer closure group (group B). In group A (n=33 patients), the dural defect was covered with fibrin glue (Beriplast P) mixed with gelfoam (Spongostan Standard) with subsequent subarachnoid lumbar drainage. In group B (n=20 patients), the dural defect was sealed using the triple layer technique with 2 layers of fibrin glue and gelatin sponge plus a third layer of synthetic hydrogel (Duraseal, Dural Sealant System) without subsequent subarachnoid lumbar drainage. Both groups had chest tubes that drained through an underwater seal. Clinical data including duration and total amount of drainage (chest tube and lumbar drainage), related complications, and duration of hospital stay were compared between the 2 groups. RESULTS Compared with the patients in group A, group B had a significantly smaller total volume of drainage and shorter chest tube drainage time (P<0.05) during their hospital stay. In group A, complications occurred in 6 cases (18.2%), including 3 cases of intracranial hypotension combined with transient mental status alteration, postural headache, and dizziness, 1 case of regional atelectasis with pneumonia, and 2 cases of revision thoracotomy. Revision thoracotomy was performed to treat persistent subarachnoid-pleural fistula due to significant and prolonged CSF leakage. In group B, there were no complications and no revision thoracotomy was needed. The mean duration of hospital stay was shorter in group B (15.6 d) compared with group A (22.4 d). CONCLUSIONS The established watertight closure of the dural defect using the triple layer sealing method without lumbar drainage was more effective and safe.


title: An investigation of sound levels on intensive care units with reference to the WHO guidelines.

text: INTRODUCTION Patients in intensive care units (ICUs) suffer from sleep deprivation arising from nursing interventions and ambient noise. This may exacerbate confusion and ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 dB overnight. We monitored five ICUs to check compliance with these guidelines. METHODS Sound levels were recorded in five adult ICUs in the UK. Two sound level monitors recorded concurrently for 24 hours at the ICU central stations and adjacent to patients. Sample values to determine levels generated by equipment and external noise were also recorded in an empty ICU side room. RESULTS Average sound levels always exceeded 45 dBA and for 50% of the time exceeded between 52 and 59 dBA in individual ICUs. There was diurnal variation with values decreasing after evening handovers to an overnight average minimum of 51 dBA at 4 AM. Peaks above 85 dBA occurred at all sites, up to 16 times per hour overnight and more frequently during the day. WHO guidelines on sound levels could be only achieved in a side room by switching all equipment off. CONCLUSION All ICUs had sound levels greater than WHO recommendations, but the WHO recommended levels are so low they are not achievable in an ICU. Levels adjacent to patients are higher than those recorded at central stations. Unit-wide noise reduction programmes or mechanical means of isolating patients from ambient noise, such as earplugs, should be considered.


title: Vancomycin lung concentration in acute and hyperacute rejection models of lung transplantation in rats.

text: OBJECTIVES This study assesses vancomycin concentrations in allogenic transplanted rat lung tissue in acute and hyperacute rejection models of the lung. METHODS Left lung allotransplantation was performed from a male Brown Norway donor to a male Fisher F344 recipient in the case of an acute rejection model (the animals were sacrificed 5 days after transplantation) as well as a male Brown Norway donor to a male Wistar recipient in the case of hyperacute rejection (the animals were sacrificed 2 days after transplantation). Control rats were sham-operated and sacrificed on day 2 or 5, respectively, of the experimental model. Rejection was confirmed by blood gas assessment and lung histological examination. A single intraperitoneal dose of vancomycin 30 mg kg(-1) body weight was administered on the day of autopsy (day 2 or 5 from transplantation, respectively, of the experimental model), and then the blood and lung specimens were sampled at 0, 5, 1, 2, 4 and 6h from the time of drug injection. RESULTS Arterial blood gas assessment (Wistar rats - pO(2): 44.33 ± 21.73 mmHg (mean ± standard deviation (SD)); Fisher rats - pO(2:) 50.67 ± 14.30 mmHg (mean ± SD)) as well as histopathologic examinations of lung grafts confirmed rejection. Vancomycin lung/plasma concentration ratio was significantly higher in transplanted rats than in sham-operated animals. CONCLUSIONS Both acute and hyperacute lung rejection affect the lung/serum of vancomycin in the transplanted lung resulting in higher drug accumulation, especially in late post-dosage time.


title: Laparoscopic resection for Meckel's diverticulum causing intestinal obstruction.

text: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system with an estimated incidence of approximately 2% of the population. Although most cases are asymptomatic, it has the potential to create complications, such as hemorrhage, inflammation, intestinal obstruction, perforation, and intussusception. Meckel's diverticulum is generally diagnosed incidentally or upon investigation of unexplained gastrointestinal bleeding, perforation, inflammation, or obstruction for both pediatric and adult patients. Complications are often present as surgical emergencies and require resection of the diseased intestinal segment. In doubtful cases, laparoscopy should be the surgical method for both diagnosing and treating MD. Here we present a case of MD causing intestinal obstruction and that was treated by laparoscopic resection.


title: Ultrasensitive electrochemical immunosensor for alpha fetoprotein detection based on platinum nanoparticles anchored on cobalt oxide/graphene nanosheets for signal amplification.

text: An ultrasensitive sandwich-type electrochemical immunosensor was developed for quantitative monitoring of Alpha fetoprotein (AFP). To achieve this objective, an incorporated signal amplification strategy of platinum nanoparticles anchored on cobalt oxide/graphene nanosheets (Pt NPs/Co3O4/graphene) was proposed by acting as the label of secondary antibodies. The prepared label not only empowered by advantages of each component but exhibited better electrochemical performance than single Pt NPs, Co3O4 and graphene, which has shown large specific surface area and good catalytic activity towards the reduction of H2O2. Meanwhile, the nanocomposite of gold nanoparticles adhered on 3-mercaptopropyltriethoxysilane functionalized graphene sheets (Au@MPTES-GS) was used as matrix to accelerate electron transfer and immobilize primary antibodies in this system. The signal amplification mechanism of the matrix and the label were explored successfully. Under optimal conditions, the electrochemical immunosensor exhibited a wide linear range from 0.1 pg mL-1 to 60 ng mL-1 with a low detection limit of 0.029 pg mL-1for AFP. The proposed immunosensor may have promising application in the clinical diagnosis of AFP and other tumor markers.


title: Culture-Independent Diagnostics for Health Security.

text: The past decade has seen considerable development in the diagnostic application of nonculture methods, including nucleic acid amplification-based methods and mass spectrometry, for the diagnosis of infectious diseases. The implications of these new culture-independent diagnostic tests (CIDTs) include bypassing the need to culture organisms, thus potentially affecting public health surveillance systems, which continue to use isolates as the basis of their surveillance programs and to assess phenotypic resistance to antimicrobial agents. CIDTs may also affect the way public health practitioners detect and respond to a bioterrorism event. In response to a request from the Department of Homeland Security, Los Alamos National Laboratory and the Centers for Disease Control and Prevention cosponsored a workshop to review the impact of CIDTs on the rapid detection and identification of biothreat agents. Four panel discussions were held that covered nucleic acid amplification-based diagnostics, mass spectrometry, antibody-based diagnostics, and next-generation sequencing. Exploiting the extensive expertise available at this workshop, we identified the key features, benefits, and limitations of the various CIDT methods for providing rapid pathogen identification that are critical to the response and mitigation of a bioterrorism event. After the workshop we conducted a thorough review of the literature, investigating the current state of these 4 culture-independent diagnostic methods. This article combines information from the literature review and the insights obtained at the workshop.


title: Varied application of intercostal trans-diaphragmatic ports for laparoscopic hepatectomy.

text: BACKGROUND The ribcage and diaphragm are mechanical barriers for laparoscopic access during hepatectomy. Here, we introduce the varied application of intercostal trans-diaphragmatic ports during laparoscopic hepatectomy, and describe the management of intercostal ports with key technical points. METHODS From January 2013 to December 2017, 180 patients underwent laparoscopic hepatectomy. In 32 of these patients (17.8%), intercostal ports (31 right and one left) were applied, and we analyzed the feasibility and safety of intercostal ports during laparoscopic hepatectomy. RESULTS The main tumor location was segment VII and VIII (78%). The major type of laparoscopic hepatectomy was partial hepatectomy (91%). In the majority of cases (66%) the number and size of intercostal trocars was a single 5-mm port. The median operative time and blood loss were 232 min and 50 mL, respectively. A chest drain was placed via the hole of the intercostal port on the chest wall in two cases (6.3%). The median duration of the post-operative hospital stay was 6 days. There was no conversion, and a pure laparoscopic hepatectomy was achieved in all cases. There was no mortality. As for complications due to the application of intercostal ports, an asymptomatic pneumothorax was detected in only one case, and it was cured by conservative treatment. CONCLUSIONS The ribcage and diaphragm could be overcome as barriers to laparoscopic access by the placement of intercostal ports with minimal access during laparoscopic hepatectomy. The use of an intercostal port and proper management allows for a feasible approach and safe resection during laparoscopic hepatectomy.


title: The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial.

text: BACKGROUND As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. METHODS In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5-15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively. RESULTS Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0-1.5) mg compared to 1.5 (1-2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later. CONCLUSION Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol. TRIAL REGISTRATION ClinicalTrials.gov - NCT02327923. Date of registration: December 31, 2014.


title: Oxygen injection site affects FIO2 during noninvasive ventilation.

text: BACKGROUND Most portable bi-level positive airway pressure devices are not equipped with air-oxygen blenders for precisely regulating oxygen concentrations, and supplemental oxygen must be added to increase the F(IO2). Very few studies have investigated the factors that affect F(IO2), and their conclusions have been inconsistent. We investigated in vitro noninvasive ventilation (NIV) parameters and their effects on F(IO2), particularly the effect of the oxygen injection site. METHODS NIV was simulated with a test lung and manikin setup. F(IO2) was measured with 4 oxygen injection sites (mask, in front of the exhalation valve, at the humidifier outlet, and proximal to the ventilator), with 3 exhalation valve types, with 2 oxygen flows, and with 4 combinations of inspiratory and expiratory pressure. RESULTS Oxygen flow, inspiratory and expiratory pressure, and exhalation valve type all affected F(IO2). For a given oxygen flow, the oxygen injection site was the most important factor that affected F(IO2). The oxygen injection site that was closest to the patient (on the mask) had the higher F(IO2) (P < .001). CONCLUSIONS The oxygen injection site had the greatest effect on F(IO2) during NIV.


title: Exploring optimistic bias and the integrative model of behavioral prediction in the context of a campus influenza outbreak.

text: This study aims to determine the utility of constructs from the Integrative Model of Behavioral Prediction in predicting behaviors associated with flu prevention in a college campus. Building on previous studies that document substantial optimistic bias among college students, this study explores possible roles for optimistic bias in the Integrative Model of Behavioral Prediction. The authors conducted an online survey among a stratified random sample (N = 429) of undergraduate students in a university that experienced a large H1N1 influenza outbreak in the fall of 2009. The authors offer 3 major findings: (a) the 3 primary components in the Integrative Model of Behavioral Prediction predicted the intention to perform hand washing and sanitizing, with self-efficacy being the strongest predictor; (b) unrealistic optimists had significantly lower intentions to perform hand hygiene practices compared with realists or unrealistic pessimists; and (c) comparative optimism was a significant moderator of the relation between self-efficacy and behavioral intention, controlling for perceived risk. Theoretical and practical implications of these findings are discussed.


title: In vivo endoscopic tissue identification by rapid evaporative ionization mass spectrometry (REIMS).

text: Gastrointestinal cancers are a leading cause of mortality, accounting for 23 % of cancer-related deaths worldwide. In order to improve outcomes from these cancers, novel tissue characterization methods are needed to facilitate accurate diagnosis. Rapid evaporative ionization mass spectrometry (REIMS) is a technique developed for the in vivo classification of human tissue through mass spectrometric analysis of aerosols released during electrosurgical dissection. This ionization technique was further developed by utilizing surface induced dissociation and was integrated with an endoscopic polypectomy snare to allow in vivo analysis of the gastrointestinal tract. We tested the classification performance of this novel endoscopic REIMS method in vivo. It was shown to be capable of differentiating between healthy layers of the intestinal wall, cancer, and adenomatous polyps based on the REIMS fingerprint of each tissue type in vivo.


title: Blockage of Src by Specific siRNA as a Novel Therapeutic Strategy to Prevent Destructive Repair in Steroid-Associated Osteonecrosis in Rabbits.

text: Vascular hyperpermeability and highly upregulated bone resorption in the destructive repair progress of steroid-associated osteonecrosis (SAON) are associated with a high expression of VEGF and high Src activity (Src is encoded by the cellular sarcoma [c-src] gene). This study was designed to prove our hypothesis that blocking the VEGF-Src signaling pathway by specific Src siRNA is able to prevent destructive repair in a SAON rabbit model. Destructive repair in SAON was induced in rabbits. At 2, 4, and 6 weeks after SAON induction, VEGF, anti-VEGF, Src siRNA, Src siRNA+VEGF, control siRNA, and saline were introduced via intramedullary injection into proximal femora for each group, respectively. Vascularization and permeability were quantified by dynamic contrast-enhanced (DCE) MRI. At week 6 after SAON induction, proximal femurs were dissected for micro-computed tomography (μCT)-based trabecular architecture with finite element analysis (FEA), μCT-based angiography, and histological analysis. Histological evaluation revealed that VEGF enhanced destructive repair, whereas anti-VEGF prevented destructive repair and Src siRNA and Src siRNA+VEGF prevented destructive repair and enhanced reparative osteogenesis. Findings of angiography and histomorphometry were consistent with those determined by DCE MRI. Src siRNA inhibited VEGF-mediated vascular hyperpermeability but preserved VEGF-induced neovascularization. Bone resorption was enhanced in the VEGF group and inhibited in the anti-VEGF, Src siRNA, Src siRNA+VEGF groups as determined by both 3D μCT and 2D histomorphometry. FEA showed higher estimated failure load in the Src siRNA and Src siRNA+VEGF groups when compared to the vehicle control group. Blockage of VEGF-Src signaling pathway by specific Src siRNA was able to prevent steroid-associated destructive repair while improving reconstructive repair in SAON, which might become a novel therapeutic strategy.


title: The "omega" jejunostomy tube: A preferred alternative for postpyloric feeding access.

text: AIM We present our technique for construction of the "Omega Jejunostomy" (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population. MATERIALS AND METHODS We retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014. Primary outcomes include operating time, length of hospital stay, time to feeding goals, and postoperative complications. RESULTS We identified 12 children (6 males) with multiple comorbidities who underwent OJ procedures. The median age at surgery was 11years (range 3months-23years). Eleven patients had failed previous alternative feeding access or antireflux procedures. All patients eventually reached their feeding goals. Eight were at goal feeds in <10days. Two achieved goal feeds <1month, one <4months, and one within 7months. There was one OJ failure because of fistula formation requiring surgical revision, and one child was treated successfully but died of unrelated causes. Four children eventually transitioned to PO or G-tube feeds, and six were tolerating feeds via OJ at last follow-up (8-74months). CONCLUSIONS OJ provides a durable alternative to gastrojejunostomy tube for patients who are poor candidates for or have failed Nissen fundoplication. It is technically easier to perform than a gastroesophageal disconnect procedure, has minimal surgical comorbidities, and can provide durable feeding access and achievement of goal feeds in a complex and refractory patient subset.


title: Laparoscopic-guided transversus abdominis plane block following laparoscopic sleeve gastrectomy is associated with an earlier return to activity: a study of 271 patients.

text: BACKGROUND The morbidly obese (MO) patient presents a unique challenge to pain control in the postoperative period due to associated comorbidities and the amplified impact of opiates. In order to reduce potential complications associated with narcotic use in the MO patient, multimodal analgesia has been advocated. In this study, we examined the effect of laparoscopic-guided transversus abdominis plane block (LG TAP) for further optimizing multimodal pain control. METHODS This is a retrospective analysis of a prospectively collected database of 140 consecutive patients undergoing LSG without TAP block (pre-TAP group) compared to 131 patients undergoing LSG with LGTAP (TAP group). All operations were performed laparoscopically utilizing uniform clinical pathways. Baseline characteristics for both groups were comparable. Both groups received standardized anesthesia. Outcomes included time to postoperative ambulation, pain scores, PCA volume, length of hospital stay, utilization of oral opiate medications, and return to activity (RTA). RESULTS Pre-TAP versus TAP groups were comparable, mean age 42 years (p = 0.99), women 81.4% versus 87.8% (p = 0.148), mean BMI (kg/m2) 46 versus 45 (p = 0.394). Most patients ambulated within 2 h after arrival to the floor (87.9% vs. 76.3%, p = 0.013). On postoperative day (POD) 1, mean reported pain score (0-10) was 4.50 vs. 5.06 (p = 0.063) and a mean PCA morphine used for 24 h was 26.3 mL versus 26 mL, p = 0.35. Mean days of postoperative opiate medication were 2.19 versus 1.24 (p < 0.001). Return to activity was 2.81 versus 2.08 days (p < 0.001). When controlled for age, BMI, OR time, PCA volume used, and average pain score, TAP block was an independent predictor of earlier return to activities (p < 0.001). CONCLUSIONS LGTAP block following LSG is an additional valuable modality of pain control in the perioperative period. Our study shows that TAP block is associated with an earlier RTA and decreased opiate use in patients undergoing LSG.


title: Endovascular Management of Hemarthrosis in Patients with Bleeding Diatheses: Systematic Review.

text: PURPOSE In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated. RESULTS The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3-116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications. CONCLUSION Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.


title: Detection of links between Ebola nucleocapsid and virulence using disorder analysis.

text: The underlying reasons for the differences in the virulence of various types of Ebola virus (EBOV) remain unknown. Comparison of the percentage of disorder (PID) in nucleocapsid proteins VP30 and NP reveals high correlation between nucleocapsid PIDs and the case-fatality rates of EBOV. The higher disorder of these proteins is likely to be needed for more efficient multiplication of virus copies via more efficient viral RNA transcription and more promiscuous protein binding potential. This is important for the more efficient assistance of nucleocapsid in viral particle budding and of the assembly and mobility of viral proteins across the host membrane and within the cytoplasm. A more comprehensive knowledge of the molecular mechanisms of EBOV virulence would also lead to new and more effective strategies in vaccine development.


title: Monitoring for opioid-induced advancing sedation and respiratory depression: ASPMN membership survey of current practice.

text: Adverse events secondary to opioid-induced advancing sedation and respiratory depression continue to occur during hospitalizations despite efforts to increase awareness and clinical practice guidelines to address prevention strategies. In 2009, ASPMN surveyed membership on current practices surrounding this topic. ASPMN clinical practice guidelines were then published in 2011. In winter of 2013, ASPMN membership was again surveyed to assess progress in preventing adverse events. This is a report of the follow-up membership survey. In general, monitoring practices are slowly improving over time, but there are many facilities that have not instituted best practices for avoiding adverse events.


title: Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure.

text: INTRODUCTION Obstructive sleep apnea (OSA), particularly intermittent nocturnal hypoxemia, is associated with erectile dysfunction (ED). AIM We investigated in patients with OSA whether continuous positive airway pressure (CPAP) therapy has a long-term effect on sexual function, including ED, in the presence of other risk factors for ED. METHODS Within a long-term observational design, we reassessed 401 male patients who had been referred for polysomnography, with respect to erectile and overall sexual function. Mean ± standard deviation follow-up time was 36.5 ± 3.7 months. Patients with moderate to severe ED were stratified according to the regular use of CPAP. MAIN OUTCOME MEASURE Changes of sexual function were assessed by the 15-item International Index of Erectile Function (IIEF-15) questionnaire, including the domains erectile function (EF), intercourse satisfaction, orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS). RESULTS Of the 401 patients, 91 returned a valid IIEF-15 questionnaire at follow-up. Their baseline characteristics were not different from those of the total study group. OSA (apnea-hypopnea index >5/hour) had been diagnosed in 91.2% of patients. In patients with moderate to severe ED (EF domain <17), CPAP users (N = 21) experienced an improvement in overall sexual function (IIEF-15 summary score; P = 0.014) compared with CPAP non-users (N = 18), as well as in the subdomains OF (P = 0.012), SD (P = 0.007), and OS (P = 0.033). Similar results were obtained in patients with poor overall sexual dysfunction (IIEF-15 summary score <44). In patients with moderate to severe ED and low mean nocturnal oxygen saturation (≤93%, median), also the EF subdomain improved in CPAP users vs. non-users (P = 0.047). CONCLUSIONS These data indicate that long-term CPAP treatment of OSA and the related intermittent hypoxia can improve or preserve sexual function in men with OSA and moderate to severe erectile or sexual dysfunction, suggesting a certain reversibility of OSA-induced sexual dysfunctions.


title: Splanchnic Circulation and Intraabdominal Metabolism in Two Porcine Models of Low Cardiac Output.

text: The impact of acute cardiac dysfunction on the gastrointestinal tract was investigated in anesthetized and instrumented pigs by sequential reductions of cardiac output (CO). Using a cardiac tamponade (n = 6) or partial inferior caval vein balloon inflation (n = 6), CO was controllably reduced for 1 h each to 75% (CO75%), 50% (CO50%), and 35% (CO35%) of the baseline value. Cardiac output in controls (n = 6) was not manipulated and maintained. Mean arterial pressure, superior mesenteric arterial blood flow, and intestinal mucosal perfusion started to decrease at CO50% in the intervention groups. The decrease in superior mesenteric arterial blood flow was non-linear and exaggerated at CO35%. Systemic, venous mesenteric, and intraperitoneal lactate concentrations increased in the intervention groups from CO50%. Global and mesenteric oxygen uptake decreased at CO35%. In conclusion, gastrointestinal metabolism became increasingly anaerobic when CO was reduced by 50%. Anaerobic gastrointestinal metabolism in low CO can be detected using intraperitoneal microdialysis.


title: Massive haemothorax after pulmonary endostapling preloaded with bioabsorbable tissue reinforcement material.

text: Reinforced endostapling can prevent postoperative air leakage from surgical stumps. We herein present a 58-year old woman with idiopathic interstitial pneumonia who developed lethal haemothorax after a thoracoscopic lung biopsy with the use of an endostapler preloaded with bioabsorbable tissue reinforcement material. This lethal haemothorax, which occurred on the day after the lung biopsy, required an emergency operation. The bleeding point was an intercostal artery of the inferior chest wall adjacent to the surgical stump. The operative findings suggested that the reinforced material on the surgical stump scratched the chest wall through respiratory movement.


title: Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study.

text: BACKGROUND Standard laparoscopic colectomy (SLC) for cancer is a safe, feasible, and oncologically effective procedure with better short-term and similar long-term results of open colectomy. Conversely, owing to technical difficulties in colonic resection and full mesenteric dissection, single-incision laparoscopic colectomy (SILC) has been considered unsuitable for oncologic purposes. We compared the technical feasibility and early clinical outcomes of SLC and SILC for cancer. METHODS In this prospective randomized clinical trial, 16 (50%) patients underwent SLC (10 left and 6 right) and 16 (50%) patients underwent SILC (8 left and 8 right). RESULTS Demographics, preoperative data, and characteristics of the tumor were similar. The mean number of resected lymph nodes was 16 ± 5 in the SLC and 18 ± 6 in the SILC group (P = NS). Surgical time was 124 ± 8 minutes and 147 ± 5 minutes, respectively (P = NS). Surgical mortality was nil and the major morbidity rate was 6.3% in both groups. CONCLUSIONS SILC for cancer is a technically feasible and safe oncologic procedure with short-term results similar to those obtained with a traditional laparoscopic approach.


title: Infection Screening System Using Thermography and CCD Camera with Good Stability and Swiftness for Non-contact Vital-Signs Measurement by Feature Matching and MUSIC Algorithm.

text: Screening systems for infectious diseases based on fever have been implemented at international airports to prevent the spread of infection for over a decade. Currently, only Infrared Thermography (IRT) is used for screening and measuring facial skin temperature, which is one of clinical indicators of potential infection. Aiming at higher accuracy in screening, our group adopted heart rate (HR) and respiration rate (RR) for the first time as the new screening parameters. In our previous study, we proposed a screening system based on dual image sensors, which include IRT and a charged-coupled devices (CCD) camera. The sensors can measure three vital signs simultaneously, namely HR, RR, and facial skin temperature. For the measurement of RR in this system, stability and swiftness must be applied for application in airports. In this study, we introduce feature matching and multiple signal classification (MUSIC) algorithm in this system. Feature matching between thermal images and RGB images captured by a CCD camera and IRT, respectively, is used to detect the nose and mouth in IRT, which helps extract respiration signals corresponding to airflow from breathing. In addition, the MUSIC algorithm improves the accuracy of RR frequency estimations in limited time respiration signal and achieves swiftness. The proposed method improves stability by simultaneously detecting the nose and mouth in thermal images, and enhances the accuracy of estimated RR using the MUSIC algorithm. By using this system, we evaluate the accuracy of the estimated vital signs. The performance of this screening system was evaluated using data obtained from 12 influenza patients and 13 healthy subjects at a clinical facility in Fukushima, Japan.


title: Development of anti-infectives using phage display: biological agents against bacteria, viruses, and parasites.

text: The vast majority of anti-infective therapeutics on the market or in development are small molecules; however, there is now a nascent pipeline of biological agents in development. Until recently, phage display technologies were used mainly to produce monoclonal antibodies (MAbs) targeted against cancer or inflammatory disease targets. Patent disputes impeded broad use of these methods and contributed to the dearth of candidates in the clinic during the 1990s. Today, however, phage display is recognized as a powerful tool for selecting novel peptides and antibodies that can bind to a wide range of antigens, ranging from whole cells to proteins and lipid targets. In this review, we highlight research that exploits phage display technology as a means of discovering novel therapeutics against infectious diseases, with a focus on antimicrobial peptides and antibodies in clinical or preclinical development. We discuss the different strategies and methods used to derive, select, and develop anti-infectives from phage display libraries and then highlight case studies of drug candidates in the process of development and commercialization. Advances in screening, manufacturing, and humanization technologies now mean that phage display can make a significant contribution in the fight against clinically important pathogens.


Covid-19: RCGP apologises for covid-19 "lifestyle" event title.


docid: biqyshoy

title: A comparison of cardiopulmonary function, recovery quality, and total dosages required for induction and total intravenous anesthesia with propofol versus a propofol-ketamine combination in healthy Beagle dogs.

text: OBJECTIVE To compare cardiopulmonary function, recovery quality, and total dosages required for induction and 60 minutes of total intravenous anesthesia (TIVA) with propofol (P) or a 1:1 mg mL(-1) combination of propofol and ketamine (KP). STUDY DESIGN Randomized crossover study. ANIMALS Ten female Beagles weighing 9.4 ± 1.8 kg. METHODS Dogs were randomized for administration of P or KP in a 1:1 mg mL(-1) ratio for induction and maintenance of TIVA. Baseline temperature, pulse, respiratory rate (fR), noninvasive mean blood pressure (MAP), and hemoglobin oxygen saturation (SpO2) were recorded. Dogs were intubated and spontaneously breathed room air. Heart rate (HR), fR, MAP, SpO2, end tidal carbon dioxide tension (Pe'CO2), temperature, and salivation score were recorded every 5 minutes. Arterial blood gas analysis was performed at 10, 30, and 60 minutes, and after recovery. At 60 minutes the infusion was discontinued and total drug administered, time to extubation, and recovery score were recorded. The other treatment was performed 1 week later. RESULTS KP required significantly less propofol for induction (4.0 ± 1.0 mg kg(-1) KP versus 5.3 ±1.1 mg kg(-1) P, p = 0.0285) and maintenance (0.3 ± 0.1 mg kg(-1) minute(-1) KP versus 0.6 ±0.1 mg kg(-1) minute(-1) P, p = 0.0018). Significantly higher HR occurred with KP. Both P and KP caused significantly lower MAP compared to baseline. MAP was significantly higher with KP at several time points. P had minimal effects on respiratory variables, while KP resulted in significant respiratory depression. There were no significant differences in salivation scores, time to extubation, or recovery scores. CONCLUSIONS AND CLINICAL RELEVANCE Total intravenous anesthesia in healthy dogs with ketamine and propofol in a 1:1 mg mL(-1) combination resulted in significant propofol dose reduction, higher HR, improved MAP, no difference in recovery quality, but more significant respiratory depression compared to propofol alone.


title: Disease appearance and evolution against a background of climate change and reduced resources.

text: Global health continues to face increasing challenges owing to a variety of reasons that include the almost constant changes in disease appearance and evolution. Most, but not all, of these changes affect low-income countries and are influenced by climate change. Tracking the recent and anticipated changes in the demographics and global distribution of these changes is essential for evolving effective new methods for dealing with the problems. The recent recognition by the United Nations of the importance of non-communicable diseases is a major positive step. For the sake of this paper, the following diseases were chosen: dengue and malaria, to highlight the role of climate change on vector-borne diseases. Drug-resistant tuberculosis illustrates the role of globalization and reduced resources on disease evolution. The continuing rise in cardiovascular mortality and morbidity, particularly in resource-poor countries is largely attributed to lack of preventive and therapeutic measures against such conditions as hypertension, diabetes, atherosclerosis and congenital heart disease as well as neglected diseases, of which Chagas and rheumatic heart disease will be discussed further.


title: COVID-19: emerging protective measures.

text: The COVID-19 (Coronavirus disease 2019) spreads primarily through droplets of saliva or discharge from the nose. COVID-19 is predominantly considered as an unavoidable pandemic, and scientists are very curious about how to provide the best protection to the public before a vaccine can be made available. There is an urge to manufacture a greater number of masks to prevent any aerosol with microbes. Hence, we aim to develop an efficient viral inactivation system by exploiting active compounds from naturally occurring medicinal plants and infusing them into nanofiber-based respiratory masks. Our strategy is to develop fibrous filtration with three-layered masks using the compounds from medicinal plants for viral deactivation. These masks will be beneficial not just to healthcare workers but common citizens as well. In the absence of vaccination, productive masks can be worn to prevent transmission of airborne pathogenic aerosols and control diseases.


Response to: Can Transdermal Photobiomodulation Help Us at the Time of COVID-19?


title: Non-Human Primate-Derived Adenoviruses for Future Use as Oncolytic Agents?

text: Non-human primate (NHP)-derived adenoviruses have formed a valuable alternative for the use of human adenoviruses in vaccine development and gene therapy strategies by virtue of the low seroprevalence of neutralizing immunity in the human population. The more recent use of several human adenoviruses as oncolytic agents has exhibited excellent safety profiles and firm evidence of clinical efficacy. This proffers the question whether NHP-derived adenoviruses could also be employed for viral oncolysis in human patients. While vaccine vectors are conventionally made as replication-defective vectors, in oncolytic applications replication-competent viruses are used. The data on NHP-derived adenoviral vectors obtained from vaccination studies can only partially support the suitability of NHP-derived adenoviruses for use in oncolytic virus therapy. In addition, the use of NHP-derived adenoviruses in humans might be received warily given the recent zoonotic infections with influenza viruses and coronaviruses. In this review, we discuss the similarities and differences between human- and NHP-derived adenoviruses in view of their use as oncolytic agents. These include their genome organization, receptor use, replication and cell lysis, modulation of the host's immune responses, as well as their pathogenicity in humans. Together, the data should facilitate a rational and data-supported decision on the suitability of NHP-derived adenoviruses for prospective use in oncolytic virus therapy.


title: Palliative treatment and care for dying nursing home patients with COVID-19.

text: Frail elderly patients with multimorbidity are at high risk of serious illness and death in cases of corona virus infection. Unlike ‘normal deaths’ in nursing homes with time to prepare, the condition can change rapidly and cause organ failure. In this article we describe palliative non-invasive and invasive interventions for frail elderly patients in nursing homes who are dying due to COVID-19.


title: Long-term durability of radiofrequency ablation for Barrett's-related neoplasia.

text: PURPOSE OF REVIEW Here, we examine data on the long-term durability of endoscopic therapy in patients with mucosal neoplasia in Barrett's esophagus. RECENT FINDINGS Short-term success is seen in most patients undergoing endoscopic therapy for Barrett's esophagus neoplasia, but long-term outcomes are only just becoming available. SUMMARY The incidence of esophageal adenocarcinoma (EAC) continues to rise with poor survival seen in the majority of patients. The only known precursor to EAC is Barrett's esophagus. Although the risk of progression from metaplastic Barrett's esophagus to neoplasia is low, surveillance is advocated as patients who progress to mucosal neoplasia carry a significantly higher risk of progressing to invasive EAC. Minimally invasive endoscopic therapy with endoscopic resection and radiofrequency ablation are now the gold standard treatments for patients with intramucosal neoplasia in Barrett's esophagus. After successful treatment, follow-up is still required as long-term durability is not 100% and recurrences are not rare. This review highlights the need for vigilant follow-up, but emphasizes the consensus that most patients have durable disease reversal.


title: Usefulness of national respiratory virus surveillance data for clinicians who manage adult patients.

text: The Korean Centers for Disease Control and Prevention (KCDC) provides weekly respiratory virus (RV) surveillance reports on its website (the KCDC data). Clinicians in clinical settings wherein the use of PCR for RVs is not a routine laboratory test for adult patients with acute respiratory illness (ARI) may question the clinical utility of such a national RV surveillance dataset in predicting RV outbreaks among their adult patients. We compared the KCDC data to the RV PCR data of adult patients who visited a tertiary care center. During a period of 108 weeks, a total of 6,955 (5,598 pediatric and 1,257 adult) patients underwent RV PCR tests for ARI; most of these tests were administered while the patients were admitted (n = 6,920; 99.5%). From the KCDC website, we collected the RV PCR test results of 22,540 patients. Three graphs of weekly positivity rates were made for adults, children, and the KCDC data per each RV, and these graphs were then compared with one another. Whereas RV outbreaks were coincident between the KCDC and the adult graph with respect to influenza virus, respiratory syncytial virus, human metapneumovirus, and human coronavirus, the same was not true for human bocavirus, parainfluenza virus, rhinovirus, and adenovirus. However, a negative predictive value of the KCDC data in the prediction of the occurrence of an outbreak in the adult graph was high for the respective eight RVs (85-100%). A national RV surveillance dataset may be useful in identifying RV outbreaks in adult patients with severe ARI. This article is protected by copyright. All rights reserved.


title: Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 Is an Important Surface Attachment Factor That Facilitates Entry of Middle East Respiratory Syndrome Coronavirus.

text: UNLABELLED The spike proteins of coronaviruses are capable of binding to a wide range of cellular targets, which contributes to the broad species tropism of coronaviruses. Previous reports have demonstrated that Middle East respiratory syndrome coronavirus (MERS-CoV) predominantly utilizes dipeptidyl peptidase 4 (DPP4) for cell entry. However, additional cellular binding targets of the MERS-CoV spike protein that may augment MERS-CoV infection have not been further explored. In the current study, using the virus overlay protein binding assay (VOPBA), we identified carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) as a novel cell surface binding target of MERS-CoV. CEACAM5 coimmunoprecipitated with the spike protein of MERS-CoV in both overexpressed and endogenous settings. Disrupting the interaction between CEACAM5 and MERS-CoV spike with anti-CEACAM5 antibody, recombinant CEACAM5 protein, or small interfering RNA (siRNA) knockdown of CEACAM5 significantly inhibited the entry of MERS-CoV. Recombinant expression of CEACAM5 did not render nonpermissive baby hamster kidney (BHK21) cells susceptible to MERS-CoV infection. Instead, CEACAM5 overexpression significantly enhanced the attachment of MERS-CoV to the BHK21 cells. More importantly, the entry of MERS-CoV was increased when CEACAM5 was overexpressed in permissive cells, which suggested that CEACAM5 could facilitate MERS-CoV entry in conjunction with DPP4 despite not being able to support MERS-CoV entry independently. Taken together, the results of our study identified CEACAM5 as a novel cell surface binding target of MERS-CoV that facilitates MERS-CoV infection by augmenting the attachment of the virus to the host cell surface. IMPORTANCE Infection with the Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with the highest mortality rate among all known human-pathogenic coronaviruses. Currently, there are no approved vaccines or therapeutics against MERS-CoV infection. The identification of carcinoembryonic antigen-related cell adhesion molecule 5 (CEACAM5) as a novel cell surface binding target of MERS-CoV advanced our knowledge on the cell binding biology of MERS-CoV. Importantly, CEACAM5 could potentiate the entry of MERS-CoV by functioning as an attachment factor. In this regard, CEACAM5 could serve as a novel target, in addition to dipeptidyl peptidase-4 (DPP4), in the development of antiviral strategies for MERS-CoV.


title: The effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization.

text: BACKGROUND Arterial bifurcations are common locations for aneurysm development given the altered hemodynamic forces and shear stress variations present at these locations. Recent reports indicate that a wide basilar artery bifurcation angle is an independent predictor of aneurysm development, growth, and subsequent rupture. METHODS To determine the effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization, the records of 46 patients with basilar artery apex aneurysms treated with endovascular coil embolization from 2007 to 2013 were analyzed. RESULTS A wide basilar artery bifurcation angle was associated with a Raymond-Roy Occlusion Classification (RROC) III occlusion in univariate analysis, but was not a statistically significant factor in multivariate modeling. An increasing basilar artery bifurcation angle was not associated with aneurysm recanalization or retreatment following coil embolization. Increasing packing density (p < .01) was the only statistically significant predictor of a RROC I or II closure. The initial RROC designation was the most powerful predictor of both eventual aneurysm recanalization (p = .01) and retreatment (p = .02). While increasing aneurysm size (p < .01), increasing aneurysm volume (p < .01), and increasing neck size (p < .01) were associated with wide basilar artery bifurcation angles, neck size (p = .03) was the only statistically significant predictor of basilar artery bifurcation angle on multivariate analyses. CONCLUSION Basilar artery bifurcation angle fails to predict rates of initial occlusion, recanalization, and retreatment on multivariate modeling in our series. Basilar artery apex aneurysm neck size independently correlates with basilar artery bifurcation angle.


title: Seoul virus enhances regulatory and reduces proinflammatory responses in male Norway rats.

text: Zoonotic pathogens, including hantaviruses, are maintained in the environment by causing persistent infection in the absence of disease in their reservoir hosts. Spillover of hantaviruses to humans can cause severe disease that is mediated by excessive proinflammatory responses. The mechanisms mediating hantaviral persistence in rodent reservoirs remain largely unknown. Male Norway rats were inoculated with their species-specific hantavirus, Seoul virus (SEOV), and viral RNA, cytokine, and chemokine responses were evaluated in spleen and lung tissue. More viral RNA was detectable in the lungs than spleen, with copies of SEOV peaking 15-30 days post-inoculation (p.i.) and persisting for 60 days p.i. In the lungs, the expression and production of proinflammatory mediators (i.e., IL-1beta, IL-6, TNF-alpha, IFN-gamma, CCL5, CCL2, CX3CL1, CXCL10, VCAM, VEGF, and NOS2) remained at or below baseline throughout SEOV infection; whereas, regulatory factors, including TGF-beta and FoxP3 were elevated. Conversely, in the spleen, proinflammatory responses were induced while regulatory responses remained unchanged during infection. To determine whether reduced proinflammatory responses mediate hantavirus persistence in the lungs, male rats were administered rIL-1beta or vehicle for 30 days during SEOV infection. SEOV persistence and shedding were not affected by IL-1beta treatment. Proinflammatory responses were elevated in rIL-1beta-treated rats, but remained within physiological levels, suggesting that supra-physiological concentrations may be necessary for viral clearance at the cost of causing disease. Elevated regulatory responses may suppress excessively high proinflammatory responses at a site of elevated SEOV replication to contribute to viral persistence and prevent proinflammatory-mediated disease in reservoir hosts.


title: Transanal minimally invasive surgery: impact on quality of life and functional outcome.

text: BACKGROUND Transanal minimally invasive surgery (TAMIS) is emerging as an alternative to transanal endoscopic microsurgery. Quality of life (QOL) and functional outcome are important aspects when valuing a new technique. The aim of this prospective study was to assess both functional outcome and QOL after TAMIS. METHODS From 2011 to 2013, patients were prospectively studied prior to and at least 6 months after TAMIS for rectal adenomas and low-risk T1 carcinomas using a single-site laparoscopy port. Functional outcome was determined using the Faecal Incontinence Severity Index (FISI). Quality of life was measured using functional [Faecal Incontinence Quality of Life (FIQL)] and generic (EuroQol EQ-5D) questionnaires. RESULTS The study population consisted of 24 patients 13 men, median age 59 (range 42-83) with 24 tumours [median distance from the dentate line 8 cm (range 2-17 cm); median tumour size 6 cm(2) (range 0.25-51 cm(2)); 20 adenomas; 4 low-risk T1 carcinomas]. Post-operative complications occurred in one patient (4 %; grade IIIb according to Clavien Dindo classification). Compared to baseline, FISI remained unaffected (9.8 vs 7.3; P = 0.26), FIQL remained unaffected, and EuroQol EQ-5D improved (EQ-VAS: 77 vs 83; P = 0.04). CONCLUSION There was no detrimental effect of TAMIS on anorectal function. Overall QOL was improved after TAMIS, probably due to removal of the tumour, and at 6 months was equal to the general population.


docid: fcdesvfi

title: Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic.

text: This study aimed to evaluate the behavioral aspects and beliefs of the population of Ceará in the face of the COVID-19 pandemic. An online questionnaire was conducted on sociodemographic aspects and opinions related to the pandemic. Absolute and relative frequencies were calculated, the association between variables was performed with Chi-square, and the level of significance was 5%. The final sample had 2,259 participants, and an association was observed between females and perceiving themselves with a high risk of infection (p = 0.044) and males with non-performance of voluntary quarantine (p < 0.001). People aged 80 years and over were partially quarantined due to the flow of people at home (p < 0.001). Participants with elementary school education had a lower risk of infection than participants with a higher level of education (p < 0.001). This group includes people who did voluntary quarantine the least (p < 0.001). Participants living in the inland region of the state had less direct contact with someone tested positive for the Coronavirus (p = 0.031) and are less reclusive (p < 0.001). We can conclude that the approach to the COVID-19 pandemic varies by social aspects, such as gender, age, education, and place of residence, as well as the belief system of the population of the State of Ceará.


Atypical Imaging Findings in Leukemia With SARS-CoV-2 Infection.


title: A systematic review of financial and economic assessments of bovine viral diarrhea virus (BVDV) prevention and mitigation activities worldwide.

text: Infection with bovine viral diarrhea virus (BVDV) results in major economic losses either directly through decreased productive performance in cattle herds or indirectly, such as through expenses for control programs. The aim of this systematic review was to review financial and/or economic assessment studies of prevention and/or mitigation activities of BVDV at national, regional and farm level worldwide. Once all predefined criteria had been met, 35 articles were included for this systematic review. Studies were analyzed with particular focus on the type of financially and/or economically-assessed prevention and/or mitigation activities. Due to the wide range of possible prevention and/or mitigation activities, these activities were grouped into five categories: i) control and/or eradication programs, ii) monitoring or surveillance, iii) prevention, iv) vaccination and v) individual culling, control and testing strategies. Additionally, the studies were analyzed according to economically-related variables such as efficiency, costs or benefits of prevention and/or mitigation activities, the applied financial and/or economic and statistical methods, the payers of prevention and/or mitigation activities, the assessed production systems, and the countries for which such evaluations are available. Financial and/or economic assessments performed in Europe were dominated by those from the United Kingdom, which assessed mostly vaccination strategies, and Norway which primarily carried out assessments in the area of control and eradication programs; whereas among non-European countries the United States carried out the majority of financial and/or economic assessments in the area of individual culling, control and testing. More than half of all studies provided an efficiency calculation of prevention and/or mitigation activities and demonstrated whether the inherent costs of implemented activities were or were not justified. The dairy sector was three times more likely to be assessed by the countries than beef production systems. In addition, the dairy sector was approximately eight times more likely to be assessed economically with respect to prevention and/or mitigation activities than calf and youngstock production systems. Furthermore, the private sector was identified as the primary payer of prevention and/or mitigation activities. This systematic review demonstrated a lack of studies relating to efficiency calculations, in particular at national and regional level, and the specific production systems. Thus, we confirmed the need for more well-designed studies in animal health economics in order to demonstrate that the implementation and inherent costs of BVDV prevention and/or mitigation activities are justified.


title: Healthcare workers' stress when caring for COVID-19 patients: An altruistic perspective.

text: BACKGROUND When the contagious COVID-19 spread worldwide, the frontline staff faced unprecedented excessive work pressure and expectations of all of the society. OBJECTIVE The aim was to explore healthcare workers' stress and influencing factors when caring for COVID-19 patients from an altruistic perspective. METHODS A cross-sectional, descriptive study was conducted in a tertiary hospital during the outbreak of COVID-19 between February and March 2020 in Wuhan, the capital city of Hubei province in China. Data were collected from 1208 healthcare workers. Descriptive statistics and multiple linear regression were used to analyze the data. ETHICAL CONSIDERATIONS Research ethics approval (with the code of TJ-IRB20200379) was obtained from Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology. Written informed consent was also received from participants. RESULTS Less than 60% of participants chose moderate or severe stress on all stressors, indicating a low stress level among healthcare workers. The main source of stress among frontline healthcare workers caring for COVID-19 patients came from the fear of being infected, the fear of family members being infected, and the discomfort caused by protective equipment. Frontline staff who were nurses, were married, and had worked more than 20 days suffered higher stress, whereas rescue staff showed lower stress. CONCLUSION The healthcare workers caring for patients with COVID-19 had low stress level, although they still had the fear of being infected or uncomfortable feeling caused by personal protective equipment. A low stress level among healthcare workers indicated their professional devotion and altruism during COVID-19 epidemic. Medical institutions and the government should continue to strengthen infection prevention measures and provide more comprehensive care involving families of frontline healthcare workers, especially nurses and married staff. It will be a lesson to other countries that awaking healthcare workers' inside motivation and providing necessary support from government and society were significant.


title: Performance of conventional and antimicrobial-treated filtering facepiece respirators challenged with biological aerosols.

text: This study evaluated the filtration performance of four commercially available models of National Institute of Occupational Safety and Health (NIOSH)-certified filtering facepiece respirators (FFR) against both biological and inert aerosols at a flow rate of 85 L/min. Conventional N95 and P100 FFRs and two antimicrobial (AM)-treated FFRs (an N95 and a P95, both with iodine-based AM treatments) were tested for both physical penetration (PEN(P)) and viable penetration (PEN(V)) with three different bioaerosols, including MS2 bacteriophage virus, and the spores and vegetative cells of Bacillus atrophaeus bacteria, in addition to inert sodium chloride (NaCl) aerosol. For each FFR model, the PEN(P) measured with NaCl was predictive of its MS2 PEN(P), and it was observed that spores and bacteria aerosols were also filtered similarly to the inert aerosol. For both conventional FFRs, up to a 1-log reduction in PEN(V) in comparison with PEN(P) was observed and attributed to the experimental variability of the test system. For both models of AM-FFRs, no statistically significant differences between PEN(V) and PEN(P) for any of the three different bioaerosol challenges were observed. Thus, no bioaerosol filtration enhancement over the conventional FFRs was detected for either iodine-based AM-FFR. In the absence of any standardized test methods, we recommend that future studies evaluating the filtration performance of AM-treated FFRs incorporate the experimental best practices described herein.


title: Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography.

text: PURPOSE The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. MATERIALS AND METHODS A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. RESULTS Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation. CONCLUSION 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples.


title: Viral membranes: an emerging antiviral target for enveloped viruses?

text: Evaluation of: Wolf MC, Freiberg AN, Zhang T et al. A broad-spectrum antiviral targeting entry of enveloped viruses. Proc. Natl Acad. Sci. USA 107, 3157-3162 (2010). The emergence and re-emergence of viruses and the widespread antiviral resistance calls for the development of a broad-spectrum strategy for viral infection. The article under review describes an approach to achieve this goal by developing an antiviral rhodanine derivative effective against enveloped viruses targeting the viral lipid membrane. By intercalating into the viral membrane, the compound irreversibly inactivates the virions with virucidal effects. Potential toxic effects on hosts could be minimized by continuous regeneration of cellular membranes. The present strategy exploits the therapeutic window that exists between static viral membranes and biogenic cellular membranes and provides a useful guideline for future research endeavors towards broad-spectrum antiviral approaches for enveloped viruses. Developing a formulation that ensures efficient delivery and pharmacokinetic properties while minimizing systemic toxicity on cell membranes remains a challenge. The advantages and disadvantages of a viral membrane-targeting approach for the control of emerging and re-emerging viruses will be discussed.


title: Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients.

text: BACKGROUND Stroke patients of lower socioeconomic status have worse outcomes. It remains poorly understood whether this is due to illness severity or personal or health system barriers. We explored the experiences of stroke patients with financial barriers in a qualitative descriptive pilot study, seeking to capture perceived challenges that interfere with their poststroke health and recovery. METHODS We interviewed six adults with a history of stroke and financial barriers in Alberta, Canada, inquiring about their: (1) experiences after stroke; (2) experience of financial barriers; (3) perceived reasons for financial barriers; (4) health consequences of financial barriers; and (5) mechanisms for coping with financial barriers. Two reviewers analyzed data using inductive thematic analysis. RESULTS The participants developed new or worsened financial circumstances as a consequence of stroke-related disability. Poststroke impairments and financial barriers took a toll on their mental health. They struggled to access several aspects of long-term poststroke care, including allied health professional services, medications, and proper nutrition. They described opportunity costs and tradeoffs when accessing health services. In several cases, they were unaware of health resources available to them and were hesitant to disclose their struggles to their physicians and even their families. CONCLUSION Some patients with financial barriers perceive challenges to accessing various aspects of poststroke care. They may have inadequate knowledge of resources available to them and may not disclose their concerns to their health care team. This suggests that providers themselves might consider asking stroke patients about financial barriers to optimize their long-term poststroke care.


title: Functional and molecular imaging techniques in aortic aneurysm disease.

text: PURPOSE OF REVIEW Functional and molecular aortic imaging has shown great promise for evaluation of aortic disease, and may soon augment conventional assessment of aortic dimensions for the clinical management of patients. RECENT FINDINGS A range of imaging techniques is available for evaluation of patients with aortic disease. Magnetic resonance blood flow imaging can identify atherosclerosis prone aortic regions and may be useful for predicting aneurysm growth. Computational modeling can demonstrate significant differences in wall stress between abdominal aortic aneurysms of similar size and may better predict rupture than diameter alone. Metabolic imaging with fluorodeoxyglucose-PET [(FDG)-PET] can identify focal aortic wall inflammation that may portend rapid progression of disease. Molecular imaging with probes that target collagen and elastin can directly exhibit changes in the vessel wall associated with disease. SUMMARY The complexity of aortic disease is more fully revealed with new functional imaging techniques than with conventional anatomic analysis alone. This may better inform surveillance imaging regimens, medical management and decisions regarding early intervention for aortic disease.


title: Tumor complexity predicts malignant disease for small renal masses.

text: PURPOSE Approximately 20% to 30% of suspicious small renal tumors are benign. A significant proportion of malignant tumors are low grade and potentially indolent. We evaluated whether preoperative patient and tumor characteristics are associated with adverse pathological features. MATERIALS AND METHODS A total of 886 patients underwent robot-assisted partial nephrectomy, as done by 1 of 5 high volume surgeons. Demographic and clinical data were compared between patients with benign/malignant disease, clear cell/nonclear cell renal cell carcinoma and high/low grade tumors. Tumor complexity was quantified by R.E.N.A.L. (radius, exophytic/endophytic, nearness of tumor to collecting system or sinus, anterior/posterior, hilar and location relative to polar lines) nephrometry score and described as low--4 to 6, intermediate--7 to 9 or high--10 or greater. Logistic regression analyses were performed to test the association between tumor and patient characteristics, and high grade renal cell carcinoma. Subanalyses were done for patients with renal tumors 4 cm or less. RESULTS High grade renal cell carcinoma was larger and more likely to develop in men. Patients with malignant tumors and with clear cell histology were more likely to have intermediate or high complexity tumors. Increasing tumor complexity independently predicted malignancy, high grade malignancy and clear cell histology on multivariate regression analysis (each p <0.05). Male gender was independently associated with malignancy and high grade renal cell carcinoma. When considering tumors 4 cm or less, tumor complexity predicted malignancy but not tumor grade. CONCLUSIONS High R.E.N.A.L nephrometry score and male gender are associated with an increased risk of malignancy and high grade malignancy in tumors treated with partial nephrectomy.


title: Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid.

text: OBJECTIVE Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. METHODS This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSIONS The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.


title: Neurological manifestations of COVID-19.

text: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has turned out to be a formidable pandemic. Upcoming evidence from confirmed cases of COVID-19 suggests an anticipated incursion of patients with neurological manifestations in the weeks to come. An expression of the angiotensin-converting enzyme 2 (ACE 2), the cellular receptor for SARS-CoV-2 over the glial cells and neurons have made the brain a potential target. Neurotoxicity may occur as a result of direct, indirect and post-infectious complications. Attention to neurological deficits in COVID-19 is fundamental to ensure appropriate, timely, beneficial management of the affected patients. Most common neurological manifestations seen include dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Anosmia and ageusia have recently been hinted as significant early symptoms in COVID-19. As cases with neurological deficits in COVID-19 emerge, the overall prognosis is yet unknown.