title: Clinical trials in peripheral vascular disease: pipeline and trial designs: an evaluation of the ClinicalTrials.gov database.

text: BACKGROUND Tremendous advances have occurred in therapies for peripheral vascular disease (PVD); until recently, however, it has not been possible to examine the entire clinical trial portfolio of studies for the treatment of PVD (both arterial and venous disease). METHODS AND RESULTS We examined interventional trials registered in ClinicalTrials.gov from October 2007 through September 2010 (n=40,970) and identified 676 (1.7%) PVD trials (n=493 arterial only, n=170 venous only, n=13 both arterial and venous). Most arterial studies investigated lower-extremity peripheral artery disease and acute stroke (35% and 24%, respectively), whereas most venous studies examined deep vein thrombosis/pulmonary embolus prevention (42%) or venous ulceration (25%). A placebo-controlled trial design was used in 27% of the PVD trials, and 4% of the PVD trials excluded patients >65 years of age. Enrollment in at least 1 US site decreased from 51% of trials in 2007 to 41% in 2010. Compared with noncardiology disciplines, PVD trials were more likely to be double-blinded, to investigate the use of devices and procedures, and to have industry sponsorship and assumed funding source, and they were less likely to investigate drug and behavioral therapies. Geographic access to PVD clinical trials within the United States is limited to primarily large metropolitan areas. CONCLUSIONS PVD studies represent a small group of trials registered in ClinicalTrials.gov, despite the high prevalence of vascular disease in the general population. This low number, compounded by the decreasing number of PVD trials in the United States, is concerning and may limit the ability to inform current clinical practice of patients with PVD.


title: Cytosolic clearance of replication-deficient mutants reveals Francisella tularensis interactions with the autophagic pathway.

text: Cytosolic bacterial pathogens must evade intracellular innate immune recognition and clearance systems such as autophagy to ensure their survival and proliferation. The intracellular cycle of the bacterium Francisella tularensis is characterized by rapid phagosomal escape followed by extensive proliferation in the macrophage cytoplasm. Cytosolic replication, but not phagosomal escape, requires the locus FTT0369c, which encodes the dipA gene (deficient in intracellular replication A). Here, we show that a replication-deficient, ∆dipA mutant of the prototypical SchuS4 strain is eventually captured from the cytosol of murine and human macrophages into double-membrane vacuoles displaying the late endosomal marker, LAMP1, and the autophagy-associated protein, LC3, coinciding with a reduction in viable intracellular bacteria. Capture of SchuS4ΔdipA was not dipA-specific as other replication-deficient bacteria, such as chloramphenicol-treated SchuS4 and a purine auxotroph mutant SchuS4ΔpurMCD, were similarly targeted to autophagic vacuoles. Vacuoles containing replication-deficient bacteria were labeled with ubiquitin and the autophagy receptors SQSTM1/p62 and NBR1, and their formation was decreased in macrophages from either ATG5-, LC3B- or SQSTM1-deficient mice, indicating recognition by the ubiquitin-SQSTM1-LC3 pathway. While a fraction of both the wild-type and the replication-impaired strains were ubiquitinated and recruited SQSTM1, only the replication-defective strains progressed to autophagic capture, suggesting that wild-type Francisella interferes with the autophagic cascade. Survival of replication-deficient strains was not restored in autophagy-deficient macrophages, as these bacteria died in the cytosol prior to autophagic capture. Collectively, our results demonstrate that replication-impaired strains of Francisella are cleared by autophagy, while replication-competent bacteria seem to interfere with autophagic recognition, therefore ensuring survival and proliferation.


docid: igroqbpc

title: Ovarian cortex transplantation in the baboon: comparison of four different intra-abdominal transplantation sites.

text: BACKGROUND Several sites have been used for ovarian cortex transplantation (OCT) in humans. The present study was designed to evaluate different intra-abdominal transplantation sites in the baboon to gain further knowledge about alternative transplantation sites in a human setting. METHODS Autologous fresh OCTs were performed in 12 baboons (Papio anubis). Four different sites were tested: the free portion of the omentum (OMF), the portion of the omentum adjacent to the spleen (OMS), the pouch of Douglas (D) and the pelvic wall on the psoas muscle (PW). Cortex survival, follicle density, cyclicity and hormonal levels were compared between the different sites, 3 and 6 months after transplantation. RESULTS Macroscopically, antral follicles were only found in the OMS and OMF locations, which also showed a higher proportion of follicle-containing cortex at light microscopy (OMF 71.4%, OMS 83.3% versus PW 58.8% and D 40%, P< 0.05). Higher densities of primordial [OMF: 3.54 (0-13.18) follicles/grid, OMS: 3.85 (0-8.53), PW: 0 (0-13.25), D 0 (0-1.33), P< 0.05] and primary follicles [OMF: 3.54 (0-18.52), OMS: 3.85 (0-1), PW: 0 (0-4.58), D 0 (0-0.25), P< 0.05] was also found in the omental locations. CONCLUSIONS Omental locations provide a better site, in terms of follicle survival, for intra-abdominal OCT in the baboon compared with the pelvic wall and the D.


title: Dynamic viral SARS-CoV-2 RNA shedding in in children: preliminary data and clinical consideration of Italian regional center.

text: We evaluated SARS-CoV-2-RNA clearance in 22 children . The estimation of positivity at day 14 from symptom onset is 52% for nasopharyngeal swab and 31% for stool swab. These data underline the significance of nasopharyngeal and stool swab for detecting infected children; further studies are needed for transmissibility.


title: Hemodynamic Changes During Rewarming Phase of Whole-Body Hypothermia Therapy in Neonates with Hypoxic-Ischemic Encephalopathy.

text: OBJECTIVE To delineate the systemic and cerebral hemodynamic response to incremental increases in core temperature during the rewarming phase of therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN Continuous hemodynamic data, including heart rate (HR), mean arterial blood pressure (MBP), cardiac output by electrical velocimetry (COEV), arterial oxygen saturation, and renal (RrSO2) and cerebral (CrSO2) regional tissue oxygen saturation, were collected from 4 hours before the start of rewarming to 1 hour after the completion of rewarming. Serial echocardiography and transcranial Doppler were performed at 3 hours and 1 hour before the start of rewarming (T-3 and T-1; "baseline") and at 2, 4, and 7 hours after the start of rewarming (T+2, T+4, and T+7; "rewarming") to determine Cardiac output by echocardiography (COecho), stroke volume, fractional shortening, and middle cerebral artery (MCA) flow velocity indices. Repeated-measures analysis of variance was used for statistical analysis. RESULTS Twenty infants with HIE were enrolled (mean gestational age, 38.8 ± 2 weeks; mean birth weight, 3346 ± 695 g). During rewarming, HR, COecho, and COEV increased from baseline to T+7, and MBP decreased. Despite an increase in fractional shortening, stroke volume remained unchanged. RrSO2 increased, and renal fractional oxygen extraction (FOE) decreased. MCA peak systolic flow velocity increased. There were no changes in CrSO2 or cerebral FOE. CONCLUSIONS In neonates with HIE, CO significantly increases throughout rewarming. This is due to an increase in HR rather than stroke volume and is associated with an increase in renal blood flow. The lack of change in cerebral tissue oxygen saturation and extraction, in conjunction with an increase in MCA peak systolic velocity, suggests that cerebral flow metabolism coupling remained intact during rewarming.


title: Salpingectomy During Vaginal Hysterectomy: A Surgical Technique to Make It Easier.

text: BACKGROUND Opportunistic salpingectomy at the time of hysterectomy is currently recommended to reduce the lifetime risk of ovarian cancer. The vaginal route is least invasive, but surgeons sometimes may choose to perform this procedure laparoscopically or robotically when anticipating adnexal surgery as a result of limited visibility. TECHNIQUE We describe a surgical technique to make salpingectomy by the vaginal route easier and more feasible. Posterior rotation of the uterus provides excellent access to the tube, which can easily be removed before separation of the adnexa. EXPERIENCE We have performed more than 60 vaginal hysterectomies using this technique. Salpingectomy was always feasible. CONCLUSION We demonstrate a simple technique to safely perform opportunistic salpingectomy during a vaginal hysterectomy.


title: Pathology and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

text: IMPACT STATEMENT The current survey of studies outlines the direct and indirect effects of SARS-CoV-2 on the specific body systems and summarizes the SARS-CoV-2 main pathogenicity mechanisms that require attention during patient hospitalization and for further research.


title: Functional transcriptional regulatory sequence (TRS) RNA binding and helix destabilizing determinants of murine hepatitis virus (MHV) nucleocapsid (N) protein.

text: Coronavirus (CoV) nucleocapsid (N) protein contains two structurally independent RNA binding domains. These are denoted N-terminal domain (NTD) and C-terminal domain and are joined by a charged linker region rich in serine and arginine residues (SR linker). In mouse hepatitis virus (MHV), the NTD binds the transcriptional regulatory sequence (TRS) RNA, a conserved hexanucleotide sequence required for subgenomic RNA synthesis. The NTD is also capable of disrupting a short RNA duplex. We show here that three residues on the β3 (Arg-125 and Tyr-127) and β5 (Tyr-190) strands play key roles in TRS RNA binding and helix destabilization with Ala substitutions of these residues lethal to the virus. NMR studies of the MHV NTD·TRS complex revealed that this region defines a major RNA binding interface in MHV with site-directed spin labeling studies consistent with a model in which the adenosine-rich 3'-region of TRS is anchored by Arg-125, Tyr-127, and Tyr-190 in a way that is critical for efficient subgenomic RNA synthesis in MHV. Characterization of CoV N NTDs from infectious bronchitis virus and from severe acute respiratory syndrome CoV revealed that, although detailed NTD-TRS determinants are distinct from those of MHV NTD, rapid helix destabilization activity of CoV N NTDs is most strongly correlated with CoV function and virus viability.


Student experiences of nursing on the front line during the COVID-19 pandemic.


In the Literature.


title: Ultraviolet-C and other methods of decontamination of filtering facepiece N-95 respirators during the COVID-19 pandemic.

text: During global health emergencies such as the current COVID-19 pandemic, the decontamination of single-use personal protective equipment (PPE) becomes a necessary means to keep up with the growing demand from healthcare workers and patients alike. Many unverified methods are being considered, which can pose the risk of incomplete decontamination and lead to catastrophic results. Several factors come into play when determining the suitability of such methods including the quality of the decontamination technique, the targeted pathogen, cost, ease of installation and use, rate of sterilization, and the surface or material to be sterilized. The germicidal properties of ultraviolet-C are well known. This review will cover the most commonly described methods for the sterilization of N95 respirators, namely, ultraviolet germicidal irradiation, hydrogen peroxide vaporization, microwave-generated steaming, and dry heating. These techniques have been tested previously and have demonstrated efficacy in reducing or inactivating viral and bacterial pathogens, although testing against SARS-CoV-2 specifically has not been done. Moreover, it must be emphasized that proper disposal after a single use is still ideal under normal circumstances.


title: Rotavirus inhibits IFN-induced STAT nuclear translocation by a mechanism that acts after STAT binding to importin-α.

text: The importance of innate immunity to rotaviruses is exemplified by the range of strategies evolved by rotaviruses to interfere with the IFN response. We showed previously that rotaviruses block gene expression induced by type I and II IFNs, through a mechanism allowing activation of signal transducer and activator of transcription (STAT) 1 and STAT2 but preventing their nuclear accumulation. This normally occurs through activated STAT1/2 dimerization, enabling an interaction with importin α5 that mediates transport into the nucleus. In rotavirus-infected cells, STAT1/2 inhibition may limit the antiviral actions of IFN produced early in infection. Here we further analysed the block to STAT1/2 nuclear accumulation, showing that activated STAT1 accumulates in the cytoplasm in rotavirus-infected cells. STAT1/2 nuclear accumulation was inhibited by rotavirus even in the presence of the nuclear export inhibitor Leptomycin B, demonstrating that enhanced nuclear export is not involved in STAT1/2 cytoplasmic retention. The ability to inhibit STAT nuclear translocation was completely conserved amongst the group A rotaviruses tested, including a divergent avian strain. Analysis of mutant rotaviruses indicated that residues after amino acid 47 of NSP1 are dispensable for STAT inhibition. Furthermore, expression of any of the 12 Rhesus monkey rotavirus proteins did not inhibit IFN-stimulated STAT1 nuclear translocation. Finally, co-immunoprecipitation experiments from transfected epithelial cells showed that STAT1/2 binds importin α5 normally following rotavirus infection. These findings demonstrate that rotavirus probably employs a novel strategy to inhibit IFN-induced STAT signalling, which acts after STAT activation and binding to the nuclear import machinery.


title: New amino acid esters of salicylanilides active against MDR-TB and other microbes.

text: Eleven halogenated (S)-2-(phenylcarbamoyl)phenyl 2-acetamido-3-phenylpropanoates (3a-3k) were designed and synthesized as potential antimicrobial agents. They were evaluated in vitro against some mycobacterial, bacterial and fungal strains. These compounds were active against drug-sensitive and atypical mycobacterial strains with general MIC values from 0.25 to 16 μmol/L. The most active compounds were (S)-4-chloro-2-(4-(trifluoromethyl)phenylcarbamoyl)phenyl 2-acetamido-3-phenylpropanoate (3i) and (S)-4-bromo-2-(4-(trifluoromethyl)phenylcarbamoyl)phenyl 2-acetamido-3-phenylpropanoate (3k) which exhibited activity against MDR and XDR-TB strains with MICs from 1 to 2 μmol/L. 3k was shown to be less cytotoxic with higher IC50. Some compounds exhibited low MICs on Gram-positive bacteria (MICs≥0.98 μmol/L) and on fungi (MICs≥3.9 μmol/L).


Colistin-Resistant mcr-1-Positive Pathogenic Escherichia coli in Swine, Japan, 2007-2014.


title: Agility in adversity: Vaccines on Demand.

text: Is the US ready for a biological attack using Ebola virus or Anthrax? Will vaccine developers be able to produce a Zika virus vaccine, before the epidemic spreads around the world? A recent report by The Blue Ribbon Study Panel on Biodefense argues that the US is not ready for these challenges, however, technologies and capabilities that could address these deficiencies are within reach. Vaccine technologies have advanced and readiness has improved in recent years, due to advances in sequencing technology and computational power making the 'vaccines on demand' concept a reality. Building a robust strategy to design effective biodefense vaccines from genome sequences harvested by real-time biosurveillance will benefit from technologies that are being brought to bear on the cancer cure 'moonshot'. When combined with flexible vaccine production platforms, vaccines on demand will relegate expensive and, in some cases, insufficiently effective vaccine stockpiles to the dust heap of history.


title: Methods of Endotoxin Detection.

text: Endotoxin, present in the outer membrane of all gram-negative bacteria, can pose serious risks to human health, from irreversible shock to death. Therefore, it is essential to develop sensitive, accurate, and rapid methods for its detection. The rabbit pyrogen test is the first standard technique for endotoxin detection and, nowadays, has been replaced by the Limulus Amoebocyte Lysate test, which is the most popular detection technique for endotoxin. With in-depth understanding of endotoxin, biosensors based on endotoxin-sensing components are promising alternatives to pursue in developing low-cost, easy-operation, and fast-response endotoxin detection techniques. This article summarizes the recent advances of endotoxin detection methods with a particular emphasis on optical and electrochemical biosensors based on various sensing elements ranging from nature biomolecules to artificial materials. As the research and technological revolution continues, the highly integrated and miniaturized commercial devices for sensitively and reliably detecting endotoxin will provide a wide range of applications in people's daily life.


title: Biocompatibility of reduced graphene oxide nanoscaffolds following acute spinal cord injury in rats.

text: BACKGROUND Graphene has unique electrical, physical, and chemical properties that may have great potential as a bioscaffold for neuronal regeneration after spinal cord injury. These nanoscaffolds have previously been shown to be biocompatible in vitro; in the present study, we wished to evaluate its biocompatibility in an in vivo spinal cord injury model. METHODS Graphene nanoscaffolds were prepared by the mild chemical reduction of graphene oxide. Twenty Wistar rats (19 male and 1 female) underwent hemispinal cord transection at approximately the T2 level. To bridge the lesion, graphene nanoscaffolds with a hydrogel were implanted immediately after spinal cord transection. Control animals were treated with hydrogel matrix alone. Histologic evaluation was performed 3 months after the spinal cord transection to assess in vivo biocompatibility of graphene and to measure the ingrowth of tissue elements adjacent to the graphene nanoscaffold. RESULTS The graphene nanoscaffolds adhered well to the spinal cord tissue. There was no area of pseudocyst around the scaffolds suggestive of cytotoxicity. Instead, histological evaluation showed an ingrowth of connective tissue elements, blood vessels, neurofilaments, and Schwann cells around the graphene nanoscaffolds. CONCLUSIONS Graphene is a nanomaterial that is biocompatible with neurons and may have significant biomedical application. It may provide a scaffold for the ingrowth of regenerating axons after spinal cord injury.


title: Development of a heat-stable and orally delivered recombinant M2e-expressing B. subtilis spore-based influenza vaccine.

text: Highly conserved ectodomain of influenza virus M2 protein (M2e) is an important target for the development of universal influenza vaccines. Today, the use of chemical or genetic fusion constructs have been undertaken to overcome the low immunogenicity of M2e in vaccine formulation. However, current M2e vaccines are neither orally delivered nor heat-stable. In this study, we evaluated the immune efficacy of an orally delivered recombinant M2e vaccine containing 3 molcules of M2e consensus sequence of influenza A viruses, termed RSM2e3. To accomplish this, CotB, a spore coat of Bacillus subtilis (B. subtilis), was used as a fusion partner, and heat-stable nonpathogenic B. subtilis spores were used as the carrier. Our results showed that CotB-M2e3 fusion had no effect on spore structure or function in the resultant recombinant RSM2e3 strain and that heterologous influenza virus M2e protein was successfully displayed on the surface of the recombinant RSM2e3 spore. Importantly, recombinant RSM2e3 spores elicited strong and long-term M2e-specific systemic and mucosal immune responses, completely protecting immunized mice from lethal challenge of A/PR/8/34(H1N1) influenza virus. Taken together, our study forms a solid basis for the development of a novel orally delivered and heat-stable influenza vaccine based on B. subtilis spore surface display.


docid: dakuwflh

title: A comprehensive appraisal of laboratory biochemistry tests as major predictors of COVID-19 severity.

text: Context: A relevant portion of COVID-19 patients develop severe disease with negative outcomes. Several biomarkers have been proposed to predict COVID-19 severity, but no definite interpretative criteria have been established to date for stratifying risk. Objective: To evaluate six serum biomarkers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, ferritin and cardiac troponin T) for predicting COVID-19 severity and to define related cut-offs able to aid clinicians in risk stratification of hospitalized patients. Design: A retrospective study of 427 COVID-19 patients was performed. Patients were divided into groups based on their clinical outcome: non-survivors vs. survivors and patients admitted to intensive care unit vs. others. ROC curves and likelihood ratios were employed to define predictive cut-offs for evaluated markers. Results: Marker concentrations at peak were significantly different between groups for both selected outcomes. At univariate logistic regression analysis, all parameters were significantly associated with higher odds of death and intensive care. At the multivariate analysis, high concentrations of lactate dehydrogenase and low concentrations of albumin in serum remained significantly associated with higher odds of death, while only low lactate dehydrogenase activities remained associated with lower odds of intensive care admission. The best cut-offs for death prediction were >731 U/L for lactate dehydrogenase and ≤18 g/L for albumin, while a lactate dehydrogenase activity <425 U/L was associated with a negative likelihood ratio of 0.10 for intensive treatment. Conclusions: Our study identifies which biochemistry tests represent major predictors of COVID-19 severity and defines the best cut-offs for their use.


title: Oncology Informatics: Status Quo and Outlook.

text: Oncology has undergone rapid progress, with emerging developments in areas including cancer stem cells, molecularly targeted therapies, genomic analyses, and individually tailored immunotherapy. These advances have expanded the tools available in the fight against cancer. Some of these have seen broad media coverage resulting in justified public attention. However, these achievements have only been possible due to rapid developments in the expanding field of biomedical informatics and information technology (IT). Artificial intelligence, radiomics, electronic health records, and electronic patient-reported outcome measures (ePROMS) are only a few of the developments enabling further progress in oncology. The promising impact of IT in oncology will only become reality through a multidisciplinary approach to the complex challenges ahead.


title: COVID-19 epidemiology: Through the eyes of vernacular newspapers.

text: Media plays an indispensable role in society to influence health literacy. To document COVID-19 coverage in Kannada daily newspapers, hardcopies of 455 editions were methodically reviewed. Content analysis and data coding of 11 of the possible 60 terms/concepts related to COVID-19 epidemiology, was undertaken. Across dailies, five different dimensions in reporting documented: reporting of statistics - both numbers and manner of reporting, reporting of epidemiological concepts/terms (frequency of use and frequency of reporting), focus of reporting, density of reporting and finally what is not reported which could have been reported (desirable reporting). Numbers were reported as headlines; >25% of listed items were covered; however, 20% of terms not covered would have helped. We looked at "News" as epidemiological information and identified the gaps in reporting. We conclude that vernacular print media in Karnataka has done a commendable job. A media communication plan is urgently needed.


title: Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial.

text: Dietary supplements have been suggested in the prevention of the common cold, but previous investigations have been inconsistent. The present study was designed to determine the preventive effect of a dietary supplement from fruits and vegetables on common cold symptoms. In a randomised, double-blind, placebo-controlled trial, healthcare professionals (mainly nursing staff aged 18-65 years) from a university hospital in Berlin, Germany, were randomised to four capsules of dietary supplement (Juice Plus+®) or matching placebo daily for 8 months, including a 2-month run-in period. The number of days with moderate or severe common cold symptoms within 6 months (primary outcome) was assessed by diary self-reports. We determined means and 95 % CI, and differences between the two groups were analysed by ANOVA. A total of 529 subjects were included into the primary analysis (Juice Plus+®: 263, placebo: 266). The mean age of the participants was 39·9 (sd 10·3) years, and 80 % of the participants were female. The mean number of days with moderate or severe common cold symptoms was 7·6 (95 % CI 6·5, 8·8) in the Juice Plus+® group and 9·5 (8·4, 10·6) in the placebo group (P = 0·023). The mean number of total days with any common cold symptoms was similar in the Juice Plus+® and in the placebo groups (29·4 (25·8, 33·0) v. 30·7 (27·1, 34·3), P = 0·616). Intake of a dietary supplement from fruits and vegetables was associated with a 20 % reduction of moderate or severe common cold symptom days in healthcare professionals particularly exposed to patient contact.


title: Transumbilical single-incision laparoscopic splenectomy plus pericardial devascularization using conventional instruments: initial experience of 5 cases.

text: PURPOSE Laparoendoscopic single-site surgery (LESS) has been proposed for several intra-abdominal surgical interventions. However, application of the LESS technique in portal hypertension is still in its infancy. We report in this article a new technique of LESS splenectomy plus pericardial devascularization with conventional laparoscopic instruments in patients with portal hypertension. PATIENTS AND METHODS From January 2010 to April 2012, LESS splenectomy plus pericardial devascularization was performed on 5 patients with portal hypertension. Surgical techniques and short-term outcomes were summarized and analyzed retrospectively. RESULTS All the operations were successful with a mean operative duration of 252 minutes (range, 220-270 minutes), intraoperative blood loss of 290 mL (range, 250-350 mL), and hospital stay of 8.2 days (range, 7-9 days). No intraoperative or postoperative complications were recorded. The umbilical incision healed well with a satisfactory cosmetic effect. CONCLUSIONS LESS splenectomy plus pericardial devascularization is feasible when performed by experienced laparoscopic surgeons and may offer safety comparable to that of the conventional laparoscopic operation.


Social Media Impact on a Plastic Surgery Clinic During Shutdown due to COVID-19 in China.


docid: tbjjsaws

title: Systematic community- and hospital-based surveillance for enterovirus-D68 in three Canadian provinces, August to December 2014.

text: Respiratory specimens collected from outpatients with influenza-like illness in three Canadian provinces (British Columbia (BC), Alberta and Quebec) participating in a community-based sentinel surveillance network were prospectively screened for enterovirus-D68 (EV-D68) from 1 August to 31 December 2014 and compared to specimens collected from 1 October 2013 to 31 July 2014. Eighteen (1%) of 1,894 specimens were EV-D68-positive: 1/348 (0.3%) collected from October to December 2013 and 11/460 (2.4%) from October to December 2014, an eight-fold increase in detection rates (p=0.01), consistent with epidemic circulation in autumn 2014. The remaining EV-D68 detections were in September 2014 (6/37). Enhanced passive surveillance was also conducted on all inpatient and outpatient EV-D68 cases (n=211) detected at the BC provincial reference laboratory from 28 August to 31 December 2014. Incidence of hospitalisations was 3/100,000 overall and 21, 17, 4 and 1/100,000 among those<5, 5-9, 10-19 and ≥20-years-old with male-to-female ratios>1 among paediatric but not adult cases. Three cases in BC with comorbidity or co-infection died and five exhibited neurological features persisting >9 months. Active surveillance in outpatient and inpatient settings is needed from more areas and additional seasons to better understand EV-D68 epidemiology and potential at-risk groups for severe or unusual manifestations.


title: Virtual laboratory lessons in enzymology.

text: The recent COVID-19 pandemic has led to widespread lock-down strategies that force universities to perform all educational activities remotely. In this context, laboratory lessons pose a significant challenge. Here, I present an on-line tool that simulates the kinetics of chemical reactions. Enzymatic mechanisms can be easily modeled and followed through time. In addition, professors can customize the interface to hide the reaction mechanism. This setting will force students to design virtual experiments to uncover the mechanism and obtain the relevant enzymatic parameters. While some of the skills developed in a practical lesson cannot be simulated, this tool can be used to teach students important concepts about data acquisition and processing.


title: Population-based study of home-time by stroke type and correlation with modified Rankin score.

text: OBJECTIVE To describe home-time, stratified by stroke type, in a complete population and to determine its correlation with modified Rankin Scale (mRS) scores. METHODS We used linked administrative data to derive home-time in all patients admitted for a cerebrovascular event in Alberta, Canada, between 2012 and 2016. Home-time is the number of days spent outside a health institution in the first 90 days after index hospitalization. We used negative binomial regression, adjusted for age, sex, Charlson comorbidity index, and hospital location, to determine the association between home-time and stroke type. In 552 patients enrolled in 4 acute ischemic stroke clinical trials, we used multivariable ordinal logistic regression analysis to determine the association between home-time and mRS score at 90 days. RESULTS Among 15,644 patients (n = 10,428 with ischemic stroke, n = 1,415 with intracerebral hemorrhage, n = 760 with subarachnoid hemorrhage, n = 3,041 with TIA), patients with TIA have the longest home-time, almost triple the number of days at home compared to patients with intracerebral hemorrhage (incidence rate ratio 2.85, 95% confidence interval [CI] 2.58-3.15). Among clinical trial ischemic stroke patients, longer home-time was associated with a lower mRS score at 90 days (adjusted common odds ratio 1.04, 95% CI 1.04-1.05). CONCLUSIONS We showed that home-time is an objective and graded indicator that is correlated with disability after stroke. It is obtainable from administrative data, applicable to different stroke types, and a valuable outcome indicator in population-based health services research.


title: The COVID-19 pandemics: shall we expect andrological consequences? A call for contributions to ANDROLOGY.

text: The coronavirus 2 (SARS-CoV-2) pandemic represents and will represent the greatest health, economic and social crisis of the new millennium. According to the World Health Organization (WHO) report published on April 14, 2020, the pandemic SARS-CoV-2 affects 213 countries worldwide, with 1,848,439 infected patients and 117,217 confirmed deaths (https://www.who.int/emergencies/diseases/novel-coronavirus-2019) to this date. Men are much more prone to become seriously ill than women. Fortunately, the majority of men, especially in younger age, survive the infection.


title: Titanium versus absorbable tacks comparative study (TACS): a multicenter, non-inferiority prospective evaluation during laparoscopic repair of ventral and incisional hernia: study protocol for randomized controlled trial.

text: BACKGROUND Laparoscopic repair of ventral and incisional hernias has gained popularity since many studies have reported encouraging results in terms of outcomee and recurrence. Choice of mesh and fixation methods are considered crucial issues in preventing recurrences and complications. Lightweight meshes are considered the first choice due to their biomechanical properties and the ability to integrate into the abdominal wall. Titanium helicoidal tacks still represent the "gold standard" for mesh fixation, even if they have been suggested to be involved in the genesis of post-operative pain and complications. Recently, absorbable tacks have been introduced, under the hypothesis that there will be no need to maintain a permanent fixation device after mesh integration. Nevertheless, there is no evidence that absorbable tacks may guarantee the same results as titanium tacks in terms of strength of fixation and recurrence rates. The primary end point of the present trial is to test the hypothesis that absorbable tacks are non-inferior to titanium tacks in laparoscopic incisional and ventral hernia repair (LIVHR) by lightweight polypropylene mesh, in terms of recurrence rates at 3-year follow-up. Surgical complications, post-operative stay, comfort and pain are secondary end points to be assessed. METHODS/DESIGN Two hundred and twenty patients with ventral hernia will be randomized into 2 groups: Group A (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by titanium tacks; Group B (110) patients will be submitted to LIVHR by lightweight polypropylene mesh fixed by absorbable tacks. DISCUSSION A few retrospective studies have reported similar results when comparing absorbable versus non-absorbable tacks in terms of intraoperative and early post-operative outcomes. These studies have the pitfalls to be retrospective evaluation of small series of patients, and the reported results still need to be validated by larger series and prospective studies. The aim of the present trial is to investigate and test the non-inferiority of absorbable versus non-absorbable tacks in terms of hernia recurrence rates, in order to assess whether the use of absorbable tacks may achieve the same results as non-absorbable tacks in mid-term and long-term settings. TRIAL REGISTRATION NUMBER NCT02076984: 5 June 2014 (ClinicalTrials.gov).


title: Chest CT-based differential diagnosis of 28 patients with suspected corona virus disease 2019 (COVID-19).

text: OBJECTIVES The chest CT findings that can distinguish patients with corona virus disease 2019 (COVID-19) from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative have not previously been described in detail. The purpose of this study was to determine the distinctions among patients with COVID-19 by comparing the imaging findings of patients with suspected confirmed COVID-19 and those of patients initially suspected to haveCOVID-19 who were ultimately negative for the disease. METHODS 28 isolated suspected in-patients with COVID-19 were enrolled in this retrospective study from January 22, 2020, to February 6, 2020. 12 patients were confirmed to have positive severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) RNA results, and 16 patients had negative results. The thin-section CT imaging findings and clinical and laboratory data of all the patients were evaluated. RESULTS There were no significant differences between the 12 confirmed COVID-19 (SARS-Cov-2-positive) patients and 16 SARS-CoV-2-negative patients in epidemiology and most of the clinical features or laboratory data. The CT images showed that the incidence of pure/mixed ground-glass opacities (GGOs) was not different between COVID-19 and SARS-CoV-2-negative patients [9/12 (75.0%) vs 10/16 (62.5%), p = 0.687], but pure/mixed GGOs in the peripheral were more common in patients with COVID-19 [11/12 (91.7%) vs 6/16 (37.5%), p = 0.006]. There were no significant differences in the number of lesions, bilateral lung involvement, large irregular/patchy opacities, rounded opacities, linear opacities, crazy-paving patterns, halo signs, interlobular septal thickening or air bronchograms. CONCLUSIONS Although peripheral pure/mixed GGOs on CT may help distinguish patients with COVID-19 from clinically suspected but negative patients, CT cannot replace RT-PCR testing. ADVANCES IN KNOWLEDGE Peripheral pure/mixed GGOs on-chest CT findings can be helpful in distinguishing patients with COVID-19 from those with clinically suspected COVID-19 but subsequently found to be COVID-19 negative.


title: Enhanced viral etiological diagnosis of respiratory system infection outbreaks by use of a multitarget nucleic acid amplification assay.

text: A study was undertaken to assess the utility of the xTAG respiratory viral panel (RVP) for enhanced laboratory investigation of respiratory outbreaks. Specimens (n = 1,108) from 244 suspected respiratory virus outbreaks in 2006 and 2007 in Alberta, Canada, were included in the study. Testing by direct fluorescent antigen detection (DFA) and various in-house nucleic acid amplification tests (NATs) for common respiratory viruses provided an etiological diagnosis in 177 outbreaks (72.5%), with 524 samples testing positive (47.3%) for a respiratory virus. Two hundred samples from 51 unresolved outbreaks were further tested by RVP retrospectively. Fifty-eight samples from 30 unresolved outbreaks had a respiratory virus detected by RVP (47 picornavirus-positive, 9 coronavirus-positive, and 2 influenza virus A-positive samples). Overall, detection of a viral etiological agent was achieved in 90.8% of outbreaks using a combination of DFA, NATs, and RVP. Use of RVP enhances the laboratory investigation of respiratory virus outbreaks and facilitates appropriate patient and outbreak management.


title: Micro- and nanocantilever devices and systems for biomolecule detection.

text: Recent research trends in biosensing have been geared toward developing bioanalytical devices that are label free, small in size, and portable and that can operate in a rapid manner. The performance of these devices has been dramatically improved through the advent of new materials and micro-/nanofabrication technologies. This is especially true for micro-/nanosized cantilever sensors, which undergo a change in mechanical properties upon the specific binding of biomolecules. In this review, we introduce the basic principles of cantilever biosensors in static and dynamic modes. We also summarize a range of approaches to cantilever design, fabrication, and instrumentation according to their applications. More specifically, we describe cantilever-based detections of proteins, DNA molecules, bacteria, and viruses and discuss current challenges related to the targets' biophysical characteristics.


title: Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model.

text: BACKGROUND In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation. METHODS Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams. RESULTS Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly. CONCLUSION We found a proportional correlation between atelectasis and PL during the 'weaning process' in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.


docid: aihzldqc

title: Listeria monocytogenes prevalence varies more within fields than between fields or over time on conventionally farmed New York produce fields.

text: Past studies have shown that the on-farm distribution of Listeria monocytogenes is affected by environmental factors (e.g., weather). However, the majority of studies were conducted at large scales (e.g., across farms), while few studies examined drivers of L. monocytogenes prevalence at smaller scales (e.g., within a single field). This study was performed to address this knowledge gap by (i) tracking L. monocytogenes distribution in two fields on one farm over a growing season, and (ii) identifying factors associated with L. monocytogenes isolation from drag swab, soil, and agricultural water samples. Overall, L. monocytogenes was detected in 78% (21/27), 19% (7/36), and 8% (37/486) of water, drag swab, and soil samples, respectively. All isolates were characterized by pulsed-field gel electrophoresis (PFGE). Of the 43 PFGE types identified, 14 were isolated on multiple sampling visits and/or from multiple sample types, indicating persistence in or repeated introduction into the farm environment during the study. Our findings also suggest that L. monocytogenes prevalence, even at the small spatial scale studied here, (i) was not uniform, and (ii) varied more within fields than between fields or over time. This is illustrated by the fact that plot (in-field variation), field (between field variation), and sampling visit (time) accounted for 18%, 2% and 3% of variance in odds of isolating L. monocytogenes, respectively. Moreover, according to random forest analysis, water-related factors were among the top-ranked factors associated with L. monocytogenes isolation from all sample types. For example, the likelihood of isolating L. monocytogenes from drag and soil samples increased monotonically as rainfall increased. Overall, findings from this single-farm study suggests that mitigation strategies for L. monocytogenes in produce fields should focus on water-associated risk factors (e.g., rain, distance to water), and be tailored to specific high-risk in-field areas.


title: Goal-Aligned, Epidemic Intelligence for the Public Health Response to the COVID-19 Pandemic.

text: For the COVID-19 pandemic, and for future pandemics, public health authorities at the local, state, and national levels must develop, deploy, and routinely disseminate, in as timely a manner as possible, a standard set of metrics that are goal-aligned with the public health response and that enable collective action by the whole of society, including the general public. An effective response to the COVID-19 pandemic requires nimble, intensive, and effective public health action to minimize spread, suffering, and deaths-as well as socioeconomic and racial inequities in these outcomes. "Epidemic intelligence"-a well-chosen, publicly facing set of metrics aligned with the goals of the public health response-is an important public good sometimes neglected early in emergency responses. (Am J Public Health. Published online ahead of print July 2, 2020: e1-e3. doi:10.2105/AJPH.2020.305794).


title: BAIAP2 rs8079781, postnatal smoking exposure, and emotional problems in Japanese children aged 5 years: the Kyushu Okinawa Maternal and Child Health Study.

text: BAIAP2 might be implicated in neurodevelopmental and psychiatric conditions via abnormal development of human cerebral asymmetry. The present prebirth cohort study examined the relationship between BAIAP2 single nucleotide polymorphism (SNP) rs8079781 and the risk of behavioral problems in Japanese children aged 5 years. Subjects were 1175 mother-child pairs. Emotional problems, conduct problems, hyperactivity problems, peer problems, and low prosocial behavior were assessed using the parent version of the Strengths and Difficulties Questionnaire. Compared with the CC genotype of SNP rs8079781, at least one T allele was significantly inversely related to childhood emotional problems: the adjusted OR was 0.68 (95% CI 0.46-0.998, P = 0.049). Nevertheless, this significant inverse association disappeared after adjustment for multiple comparisons (adjusted P = 0.245). No associations were observed between SNP rs8079781 and childhood conduct problems, hyperactivity problems, peer problems, or low prosocial behavior. An independent positive relationship was observed between smoking in the household during the first year of life and emotional problems in children with the CC genotype, but not in those with at least one T allele (P for interaction = 0.04). This study is the first to show that at least one T allele of SNP rs8079781 was independently associated with a reduced risk of emotional problems in children aged 5 years, but this inverse association fell below significance after adjustment for multiple comparisons. The influence of smoking in the household during the first year of life might rely on rs8079781.


docid: fqsmfuxl

title: Subjective Changes in Smell and Taste During the COVID-19 Pandemic: A National Survey-Preliminary Results.

text: Since the COVID-19 pandemic began, many individuals have noted acute loss of smell and/or taste, although not all patients with these symptoms are tested for COVID-19. To better characterize all patients with these rare symptoms, a national survey was created. Over 13 days in April 2020, a total of 220 people completed the survey in its entirety, representing a wide geographic distribution across the United States. Of the 220 respondents, 93 (42%) were diagnosed with COVID-19, and 127 (58%) were not. A total of 37.7% of respondents reported changes in smell/taste as the initial or sole presentation of their condition. Most but not all patients had other symptoms suggestive of COVID-19 at the time of chemosensory loss. Despite its inclusion as a major symptom of COVID-19 by the CDC (Centers for Disease Control and Prevention), respondents with additional CDC-defined symptoms associated with COVID-19 were statistically more likely to be tested/diagnosed than those without.


title: Acute respiratory distress syndrome definition: do we need a change?

text: PURPOSE OF REVIEW Since the first description of the acute respiratory distress syndrome (ARDS) in 1967, no specific clinical sign or diagnostic test has yet been described that identifies ARDS. Its diagnosis is based on a combination of clinical, hemodynamic, and oxygenation criteria. The purpose of this review is to examine the current definition for ARDS and to discuss why this definition may not be the most appropriate definition for this syndrome. RECENT FINDINGS We will briefly review our current understanding of ARDS, discuss the problems with its current diagnosis, and present clinical, pathological, and biochemical evidences supporting a more appropriate definition for ARDS. In addition, we will discuss recent efforts to identify biological markers for lung injury in pulmonary edema fluid and blood collected from critically ill patients. SUMMARY On the basis of current evidence, it is time for a change in the ARDS definition. A newer classification system that recognizes different severities of pulmonary dysfunction is needed. Such a system should be able to identify patients that would be most responsive to supportive therapies and those unlikely to benefit because of the severity of their disease.


The value proposition of health care for the patient.


A 6 months old infant with fever, dyspnea and poor feeding, diagnosed with COVID-19.


title: The influence of basic ventilation strategies and anesthetic techniques on cerebral oxygenation in the beach chair position: study protocol.

text: UNLABELLED BACKGROUND Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process. METHODS/DESIGN This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey's HSD procedure for post hoc contrasts. DISCUSSION If simple maneuvers of ventilation or anesthetic technique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position. TRIAL REGISTRATION NCT01535274.


title: COVID-19: guidance for infection prevention and control in nuclear medicine.

text: This guidance document is a brief consensus document covering the range and breadth of nuclear medicine practice in the UK, and identifies a few steps individual nuclear medicine practitioners and departments can take in the best interests of their patients. This guidance document should be used to inform local practice and does not replace local Trust policies or any relevant legislation. At all times, the best interests of the patients should be paramount. Please read this guidance in conjunction with previous editorial (COVID-19- Nuclear Medicine Departments, be prepared! by Huang HL, Allie R, Gnanasegaran G, Bomanji. J Nucl Med Commun 2020; 41:297-299). Although some aspects of this guidance are time-sensitive due to the nature of the global emergency, we believe that there is still sufficient information to provide some key guiding principles.


title: Evaluation of background soil and air polychlorinated biphenyl (PCB) concentrations on a hill at the outskirts of a metropolitan city.

text: Air and soil sampling was conducted inside a forested area for 22 months. The sampling location is situated to the north of a metropolitan city. Average atmospheric gas and particle concentrations were found to be 180 and 28 pg m(-3) respectively, while that of soil phase was detected to be 3.2 ng g(-1) on dry matter, The congener pairs of PCB#4-10 had the highest contribution to each medium. TEQ concentration was 0.10 pg m(-3), 0.07 pg m(-3), 21.92 pg g(-1), for gas, particle and soil phases, respectively. PCB#126 and PCB#169 contributed to over 99% of the entire TEQ concentrations for each medium. Local sources were investigated by conditional probability function (CPF) and soil/air fugacity. Landfilling area and medical waste incinerator, located to the 8 km northeast, contributed to ambient concentrations, especially in terms of dioxin-like congeners. The industrial settlement (called Dilovasi being to the east southeast of 60 km distant) contributed from southeast direction. Further sources were identified by potential source contribution function (PSCF). Sources at close proximity had high contribution. Air mass transportation from Aliaga industrial region (being to the southwest of 300 km distant) moderately contributed to ambient concentrations. Low molecular weight congeners were released from soil body. 5-CBs and 6-CBs were close to equilibrium state between soil/air interfaces. PCB#171 was close to equilibrium and PCB#180 was likely to evaporate from soil, which constitute 7-CBs. PCB#199, representing 8-CBs deposited to soil. 9-CB (PCB#207) was in equilibrium between soil and air phases.


Six ways to juggle science and childcare from home.


title: Short-Term Quality-of-Life Changes after Endoscopic Pituitary Surgery Rated with SNOT-22.

text: Objective Little data exist on short-term quality-of-life (QOL) outcomes, specifically sinonasal measures, after endoscopic pituitary surgery. Design Prospective case series assessed sinonasal QOL before and after the transnasal endoscopic approach to the sella with resection of nasal cavity and sinus tissues. Setting/Participants/Main Outcome Measures A total of 39 adults scheduled to undergo resection for a pituitary mass preoperatively completed the Sinonasal Outcome Test-22 (SNOT-22). Rating various QOL issues, testing repeated postoperatively at 1 month by 37 patients and 3 months by 35 patients, was analyzed (paired Student t test). Results SNOT-22 scores (5-point scale; total: 110) averaged 23.4 preoperatively and 27.6 at 1 month but had significantly improved to 16.2 at 3 months (p = 0.03). Emotional well-being parameters (e.g., sadness, frustration, concentration, productivity, fatigue) significantly improved 3 months postoperatively (p < 0.05). Physiologic parameters (e.g., olfaction, obstruction, postnasal drainage) that had worsened at 1 month (< 0.05) then normalized at 3 months. Conclusion Total ratings for sinonasal QOL shows that SNOT scores were comparable between preoperative and 1-month testing but were improved significantly at 3 months. Individual questions showed marked improvement in emotional well-being and temporary physiologic changes after surgery. Our findings give surgeons information about what patients can expect immediately after transnasal endoscopic pituitary surgery.


title: Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS).

text: BACKGROUND AND OBJECTIVES Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution. METHODS From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted. RESULTS The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30-90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8. CONCLUSIONS Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions.


title: Update on association between Kawasaki disease and infection.

text: The relationship between infection and Kawasaki disease (KD) remains unclear. Infection has long been considered a key predisposing factor for KD. Bacterial and viral agents may be related to the onset of KD because of superantigen and cytokine production. Various bacterial and viral infections have been reported to be associated with KD, but the actual mechanism remains unknown. The higher association between KD and enterovirus has been well documented by using Taiwan National Health Insurance Research Database. However, no evidence has been obtained that various bacterial and viral infections induce KD. Comprehensive research, including infectious agents, should be conducted to elucidate the pathogenesis of KD.


Management of laparoscopic bladder injuries.


Limited maximal mouth opening in patients with spinal muscular atrophy complicates endotracheal intubation: An observational study.


title: Vaginal vault dehiscence after robotic hysterectomy for gynecologic cancers: search for risk factors and literature review.

text: INTRODUCTION Vaginal vault dehiscence following robotic-assisted hysterectomy for gynecologic cancer may be attributed to surgical techniques and postoperative therapeutic interventions. We searched for risk factors in patients with gynecologic cancers and complemented this with a literature review. METHODS Evaluation of prospectively gathered information on all consecutive robotic surgeries for gynecologic cancers was performed in a tertiary academic cancer center between December 2007 and March 2012. The literature was reviewed for articles relevant to "gynecologic oncology" and "robotics" with "vaginal cuff dehiscence" in the English and French languages. Respective authors were contacted to complete relevant information. RESULTS Seven dehiscences were identified of 441 cases with established gynecologic cancers. The closures in these 7 were performed using interrupted 1-Vicryl (Ethicon Inc) (3/167; 1.8%), combination of interrupted 1-Vicryl and 1-Biosyn (Covidien Inc) (3/156, 1.9%), and V-Loc (Covidien Inc) (1/118, 0.8%) sutures. Associated risk factors included adjuvant chemotherapy and/or brachytherapy, early resumption of sexual activity, and low body mass index (mean, 23 ± 3.23 kg/m²). Dehiscences occurred regardless of suturing by staff or trainees. Review of operative videos did not reveal a detectable etiologic factor, such as excessive cautery damage to the vaginal cuff or shallow tissue sutured. All 7 colporrhexis repairs were performed through a vaginal approach without the need of laparoscopy or laparotomy. CONCLUSIONS Postoperative chemotherapy, brachytherapy, and early resumption of sexual activities are risk factors for vaginal vault dehiscence. Surgical technique, particularly the use of delayed absorbable sutures, deserves further evaluation.


title: Genetic evidence that Chinese chestnut cultivars in Japan are derived from two divergent genetic structures that originated in China.

text: The Chinese chestnut (Castanea mollissima Bl.) was introduced into Japan about 100 years ago. Since then, a number of Chinese chestnut cultivars and Japanese-Chinese hybrid cultivars have been selected by farmers and plant breeders, but little information has been available about their origins and genetic relationships. A classification based on simple sequence repeat markers was conducted using 230 cultivars including Japanese chestnut (Castanea crenata Sieb. et Zucc.) cultivars originated in Japan, Japanese-Chinese hybrid cultivars, and Chinese chestnut cultivars originated in both Japan and China. First, a search for synonyms (cultivars with identical genotypes) revealed 23 synonym groups among the Chinese chestnut cultivars, and all but one cultivar from each synonym group was omitted from further analyses. Second, genetic structure analysis showed a clear division between Japanese and Chinese chestnut, and most of the Japanese and Chinese cultivars had a simple genetic structure corresponding to the expected species. On the other hand, most Japanese-Chinese hybrid cultivars had admixed genetic structure. Through a combination of parentage and chloroplast haplotype analyses, 16 of the 18 hybrid cultivars in this study were inferred to have parent-offspring relationships with other cultivars originated in Japan. Finally, Bayesian clustering and chloroplast haplotype analysis showed that the 116 Chinese chestnut cultivars could be divided into two groups: one originated in the Hebei region of China and the other originated in the Jiangsu and Anhui regions of China. The Chinese chestnut cultivars selected in Japan showed various patterns of genetic structure including Hebei origin, Jiangsu or Anhui origin, and admixed. The chestnut cultivar genetic classifications obtained in this study will be useful for both Japanese and Chinese chestnut breeding programs.


title: Altered interregional molecular associations of the serotonin transporter in attention deficit/hyperactivity disorder assessed with PET.

text: Altered serotonergic neurotransmission has been found to cause impulsive and aggressive behavior, as well as increased motor activity, all exemplifying key symptoms of ADHD. The main objectives of this positron emission tomography (PET) study were to investigate the serotonin transporter binding potential (SERT BPND ) in patients with ADHD and to assess associations of SERT BPND between the brain regions. 25 medication-free patients with ADHD (age ± SD; 32.39 ± 10.15; 10 females) without any psychiatric comorbidity and 25 age and sex matched healthy control subjects (33.74 ± 10.20) were measured once with PET and the highly selective and specific radioligand [11 C]DASB. SERT BPND maps in nine a priori defined ROIs exhibiting high SERT binding were compared between groups by means of a linear mixed model. Finally, adopted from structural and functional connectivity analyses, we performed correlational analyses using regional SERT binding potentials to examine molecular interregional associations between all selected ROIs. We observed significant differences in the interregional correlations between the precuneus and the hippocampus in patients with ADHD compared to healthy controls, using SERT BPND of the investigated ROIs (P < 0.05; Bonferroni corrected). When correlating SERT BPND and age in the ADHD and the healthy control group, we confirmed an age-related decline in brain SERT binding in the thalamus and insula (R2 = 0.284, R2 = 0.167, Ps < 0.05; Bonferroni corrected). The results show significantly different interregional molecular associations of the SERT expression for the precuneus with hippocampus in patients with ADHD, indicating presumably altered functional coupling. Altered interregional coupling between brain regions might be a sensitive approach to demonstrate functional and molecular alterations in psychiatric conditions. Hum Brain Mapp 38:792-802, 2017. © 2016 Wiley Periodicals, Inc.


COVID-19's Crushing Effects on Medical Practices, Some of Which Might Not Survive.


title: Risk factors and prognosis of late acute rejection in Chinese kidney transplant recipients.

text: AIM Accumulating literature indicates that late acute rejection (LAR) after kidney transplantation portends an unfavourable prognosis. There are no data on the incidence of LAR in Asian subjects, or its risk factors and associated clinical outcomes. METHODS We conducted a retrospective single-centre case-+control study to investigate the incidence, risk factors and prognosis of LAR in Chinese kidney transplant recipients. Subjects with or without LAR were matched for age, gender, era of transplantation, allograft type, and maintenance immunosuppression regimen. RESULTS Thirty-two episodes of LAR occurred within an observation period of 12 years giving an incidence rate of 0.46 episodes per 1000 patient-years. Acute rejection within the first year after transplantation was associated with an increased risk of LAR (OR 3.59, P = 0.041). In patients receiving maintenance immunosuppression regimen with steroid, cyclosporin A (CsA) and mycophenolate or an m-TOR inhibitor, patients with LAR showed lower trough CsA levels prior to and at the time of rejection compared to Controls (86.0 ± 26.1 vs. 105.6 ± 13.3 μg/L, P = 0.049; and 75.7 ± 35.7 vs. 106.0 ± 20.5 μg/L, P = 0.032, respectively). Trough CsA level below 80 μg/L was associated with the development of LAR (OR 10.82, P = 0.032). Patients with LAR showed an inferior allograft survival (P < 0.001) while patient survival rates were similar (P = 0.122). CONCLUSIONS Late acute rejection is uncommon in Chinese kidney transplant recipients but is associated with reduced allograft survival. Risk factors include acute rejection in the first post-transplant year and trough CsA level below 80 μg/L in patients on CsA-based maintenance immunosuppression. Minimization of immunosuppression in apparently stable kidney transplant recipients must be exercised with caution.


title: Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey.

text: Background While specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge, the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults. Methods We administered a web-based questionnaire with items assessing the proportion of practice focused on delivery of care to older adults, adherence to recommended practices for older surgical patients, resource needs to improve care, and practice characteristics. Results Responses were collected between May 24, 2018, and June 29, 2018. A total of 25,587 ASA members were invited to participate, and 1737 answered at least one item (6.8%). 96.4% of respondents reported that they had cared for a patient aged 65 or older within the last year. 47.1% of respondents (95% confidence interval, 44.6%, 49.7%) reported using multimodal analgesia among patients aged 65 and older at least 90% of the time, and 25.5% (95% CI, 23.3%, 27.7%) provided preoperative information regarding postoperative cognitive changes at least 90% of the time. Over 80% of respondents reported that preoperative screening for frailty or dementia, postoperative screening for delirium, and preoperative geriatric consultation occurred in fewer than 10% of cases. Development of practice guidelines for geriatric anesthesia care and expansion of web-based resources were most frequently prioritized by respondents as initiatives to improve care in this domain. Discussion Most survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients.


title: To band or not to band--early results of banded sleeve gastrectomy.

text: Laparoscopic sleeve gastrectomy (LSG) is the procedure with the fastest growing numbers worldwide. Although excellent weight loss can be achieved, one major obstacle of LSG is weight regain due to sleeve dilatation. Banded sleeve gastrectomy (BLSG) has been described as an option to counteract sleeve dilatation and ameliorate weight loss over time. In a retrospective study, we analysed 25 patients who underwent BLSG using a MiniMizer® ring. Twenty five patients who had previously undergone a conventional LSG were selected for matched-pair analysis. Patient follow-up was 12 months in both groups. Mean preoperative BMI was 56.1 ± 7.2 kg/m(2) for BLSG and 57.0 ± 6.3 kg/m(2) for LSG, P = 0.522. Operative time was significantly shorter for BLSG (53 ± 27 min vs. 68 ± 20 min, P = 0.0025). Excess weight loss (%EWL) was equal in both groups with %EWL at 12 months of 58.0 ± 14.6 % for BSLG patients vs. 58.4 ± 19.2 % for LSG patients. There was no procedure-related mortality in either group. At 12 months postoperative, vomiting was significantly increased in BSLG patients (OR 6.75, P = 0.035). New onset reflux was equal in both groups (OR 0.67, P = 0.469). Ring implantation does not increase the duration of surgery or early surgical complications. Weight loss in the first follow-up year is not influenced, but the incidence of vomiting is raised after 12 months when patients start to increase eating volume.


docid: sjelgxas

title: A cluster of SARS-CoV-2 infection among Italian tourists visiting India, March 2020.

text: Background & objectives A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India. We report here the epidemiological, clinical, radiological and laboratory findings of the first cluster of SARS-CoV-2 infection among the tourists. Methods Information was collected on demographic details, travel and exposure history, comorbidities, timelines of events, date of symptom onset and duration of hospitalization from the 16 Italian tourists and an Indian with laboratory-confirmed SARS-CoV-2 infection. The clinical, laboratory, radiologic and treatment data was abstracted from their medical records and all tourists were followed up till their recovery or discharge or death. Throat and deep nasal swab specimens were collected on days 3, 8, 15, 18, 23 and 25 to evaluate viral clearance. Results A group of 23 Italian tourists reached New Delhi, India, on February 21, 2020 and along with three Indians visited several tourist places in Rajasthan. By March 3, 2020, 17 of the 26 (attack rate: 65.4%) had become positive for SARS-CoV-2 infection. Of these 17 patients, nine were symptomatic, while eight did not show any symptoms. Of the nine who developed symptoms, six were mild, one was severe and two were critically ill. The median duration between the day of confirmation for COVID-19 and RT-PCR negativity was 18 days (range: 12-23 days). Two patients died with a case fatality of 11.8 per cent. Interpretation & conclusions This study reconfirms higher rates of transmission among close contacts and therefore, public health measures such as physical distancing, personal hygiene and infection control measures are necessary to prevent transmission.


title: Exodontics: extraction of teeth in the dog and cat.

text: Dental disease can have a profound effect on the comfort and well-being of pets. Oral disease can be difficult to detect. Patients often hide their discomfort. The identification and treatment or removal of diseased teeth are the responsibility of the veterinarian. When diseased teeth cannot be saved by specialized care, extraction of teeth is necessary. Proper extraction of teeth in dogs and cats can be challenging and frustrating, but with review of the oral anatomy, proper instrumentation, and gentle tissue-handling techniques, this can be a rewarding part of clinical practice.


title: A simple tool to a complex reality - WhatsApp use in a developing country during COVID-19 pandemic.

text: The consequences of the SARS-CoV-2 pandemic has significantly affected dental practice. Since dental care is considered a high-risk activity (Volgenant et al., 2020), public and private dental clinics are closed to non-urgent cases in many countries. Several new routines and practices have been proposed to reduce this risk in dental offices, but standard dental treatment is expected to happen only after the "first wave" of disease and on an entirely new basis.


title: Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review.

text: BACKGROUND Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. METHODS A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. RESULTS A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. CONCLUSION Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.


Ultrasound-guided CAPD catheter insertion.


title: Coinfection with HIV and SARS-CoV-2 in Wuhan, China: A 12-person case series.

text: BACKGROUND Given the magnitude of the global COVID-19 pandemic, persons living with HIV (PLWH) may become co-infected with SARS-COV-2. SETTING We conducted a survey in Wuhan, China, to characterize the status of co-infected PLWH, their time to clinical improvement, and clinical prognoses. METHODS Using a Wuhan shipping service for antiretroviral medications, the Wuhan LGBT Center screened 2900 PLWH shipping addresses and cross-referenced 36 of them to quarantine sites or hospitals, suggesting possible COVID-19 cases. Via telephone calls and WeChat (social media) messaging, we conducted a survey after obtaining online informed consent. RESULTS We had 12 HIV-infected respondents (10 men, 2 women) who also reported COVID-19. Median age was 36 years (inter-quartile range: 33.0-56.3), mean age 42.4, and range 25-66 years of age. Nine of 10 persons on antiretroviral therapy (ART) presented with only mild COVID-19 symptoms. The tenth person on ART was a 56-year old man who died at home early in the outbreak when healthcare services were overwhelmed. Two additional cases who had been in intensive care with acute COVID-19 were both men, ages 25 and 37; both were ART-naïve until this hospitalization. Excluding the deceased man, 6 of 11 co-infected persons reported feeling depressed even after clinical improvements. CONCLUSION Twelve co-infected persons were identified in Wuhan; nine of 10 were on long-term ART and had favorable outcomes. Two men identified as having started ART only recently were found to have severe symptoms. Our case series suggests the value of ART for potential mitigation of COVID-19 co-infection.


Covid-19: out-of-hours providers are drafted in to manage non-urgent patients in community.


Covid-19: Validity of key studies in doubt after leading journals issue expressions of concern.


title: Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein.

text: Purpose There is limited data on the outcomes of radiofrequency ablation (RFA) for large diameter saphenous veins. This study aimed to determine whether the large-diameter great saphenous vein (GSV) affected closure rate, complications, and clinical and quality of life (QoL) improvement. Methods From January 2012 to September 2016, a total of 722 limbs were treated with ClosureFAST RFA in a single center. Patients were divided into 2 groups according to the vein diameter measured 3 cm below the saphenofemoral junction (group A ≤ 12 mm, group B > 12 mm). Vein closure was evaluated with duplex scan at 3-5 days, 1, 3, 6, and 12 months postoperatively. The incidence of complications, improvements in symptoms (measured by the Venous Clinical Severity Score [VCSS]) and QoL (measured by the Aberdeen Varicose Vein Symptom Severity Score [AVSS]) were evaluated. Results Groups consisted of 663 GSVs in group A (mean diameter, 6.00 ± 1.74 mm) and 59 in group B (mean diameter, 13.17 ± 1.28 mm). Vein closure rates at 12 months were 98.9% in group A and 100% in group B (P = 0.428). There was no significant difference in the incidence of complications. Both groups showed marked improvements in the VCSS and the AVSS with no significant differences. Conclusion For large-diameter veins, RFA showed comparable outcomes in terms of closure rate, complications, clinical and QoL improvements.


title: Tools for predicting patient-reported outcomes in prostate cancer patients undergoing radical prostatectomy: a systematic review of prognostic accuracy and validity.

text: BACKGROUND Radical prostatectomy is a common surgical procedure performed to treat prostate cancer. Patient-reported outcomes after surgery include urinary incontinence, erectile dysfunction, decreased quality of life and psychological effects. Predictive tools to assess the likelihood of an individual experiencing various patient-reported outcomes have been developed to aid decision-making when selecting treatment. METHODS A systematic review was undertaken to identify all papers describing tools for the prediction of patient-reported outcome measures in men with prostate cancer treated with radical prostatectomy. To be eligible for inclusion, papers had to provide a summary measure of accuracy. PubMed and EMBASE were searched from July 2007. Title/abstract screening, and full-text review were undertaken by two reviewers, while data extraction and critical appraisal was performed by a single reviewer. RESULTS The search strategy identified 3217 potential studies, of which 191 progressed to full-text review and 14 were included. From these studies, 27 tools in total were identified, of which 18 predicted urinary symptoms, six predicted erectile function and one predicted freedom from a group of three outcomes ('trifecta') (biochemical recurrence, incontinence and erectile dysfunction). On the basis of tool accuracy (>70%) and external validation, two tools predicting incontinence and two tools predicting erectile dysfunction are ready for implementation. CONCLUSIONS A small number of tools for the prediction of patient-reported outcomes following radical prostatectomy have been developed. Four tools were found to have adequate accuracy and validation and are ready for implementation for the prediction of urinary incontinence and erectile dysfunction.


title: Laparoscopy-assisted distal gastrectomy for early gastric cancer in the elderly.

text: PURPOSE With an increase in life expectancy, more elderly patients are presenting with gastric cancer. As a result it is yet be resolved whether laparoscopy assisted distal gastrectomy is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes of laparoscopy assisted distal gastrectomy between elderly and nonelderly patients with gastric cancer. MATERIALS AND METHODS The study group was comprised of 316 patients who underwent laparoscopy assisted distal gastrectomy between April 2005 and December 2010. Of these patients, 93 patients whose ages were 65 years or more were compared with 223 patients who were younger. RESULTS There were no differences in the short term outcome or minor complication rate between the elderly patients and the nonelderly patients. The hospital stay was significantly longer and the major complication rate was significantly higher for the elderly patients compared with nonelderly patients. CONCLUSIONS Laparoscopy assisted distal gastrectomy for early gastric cancer in the elderly patients had comparable operation time and blood loss with the nonelderly group. However, the safety and advantage of laparoscopy assisted distal gastrectomy in the elderly patients need to be further studied in higher volume trials.


title: The Use of an Autoregressive Integrated Moving Average Model for Prediction of the Incidence of Dysentery in Jiangsu, China.

text: The aim of this study is to forecast the incidence of bacillary dysentery with a prediction model. We collected the annual and monthly laboratory data of confirmed cases from January 2004 to December 2014. In this study, we applied an autoregressive integrated moving average (ARIMA) model to forecast bacillary dysentery incidence in Jiangsu, China. The ARIMA (1, 1, 1) × (1, 1, 2)12 model fitted exactly with the number of cases during January 2004 to December 2014. The fitted model was then used to predict bacillary dysentery incidence during the period January to August 2015, and the number of cases fell within the model's CI for the predicted number of cases during January-August 2015. This study shows that the ARIMA model fits the fluctuations in bacillary dysentery frequency, and it can be used for future forecasting when applied to bacillary dysentery prevention and control.


More on Neurologic Features in Severe SARS-CoV-2 Infection.


Coronavirus: Lombardy lessons for policy and governance.


title: Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model.

text: PURPOSE Knowledge about the influence of underlying biomaterial on behavior of surgical meshes at the esophageal hiatus is rare, but essential for safe and effective hiatal hernia surgery. This study aimed to characterize the influence of polymer material on mesh behavior at the hiatus. METHODS 24 pigs in three groups of eight underwent implantation of either polypropylene (PP), polyester (PET) or polytetrafluoroethylene (PTFE) mesh placed circularly at the esophageal hiatus. After 8 weeks, necropsy and measurements were performed evaluating mesh deformation, adhesion formation, fixation of the esophagogastric junction and mesh position. Foreign body reaction was assessed by mononuclear cell count and immunostaining of Ki-67. Tissue integration was evaluated by immunostaining of type I and type III collagen fibers. RESULTS Mesh shrinkage was the highest for PTFE, lower for PP and the lowest for PET (34.9 vs. 19.8 vs. 12.1 %; p = 0.002). Mesh aperture for the esophagus showed an enlargement within all groups, which was highest for PTFE compared to PP and PET (100.8 vs. 47.0 vs. 35.9 %; p = 0.001). The adhesion score was highest for PP, lower for PTFE and the lowest for PET (11.0 vs. 9.5 vs. 5.0; p = 0.001) and correlated positively with the score of esophagogastric fixation (r s = 0.784, p < 0.001). No mesh migration, erosion or stenosis of the esophagus occurred. Evaluation of foreign body reaction and tissue integration showed no significant differences. CONCLUSIONS In this experimental setting, PP-meshes showed the most appropriate characteristics for augmentation at the hiatus. Due to solid fixation of the esophagogastric junction and low shrinkage tendency, PP-meshes may be effective in preventing hiatal hernia recurrence. The use of PTFE-mesh at the hiatus may be disadvantageous due to high shrinkage rates and correlating enlargement of the aperture for the esophagus.


title: Resection of distal gastric tube cancer with sentinel node biopsy: a case report and review of the literature.

text: BACKGROUND The frequency of gastric tube cancers has increased with advances in surgical techniques and improvement of survival rates in patients with esophageal cancer. However, a standard surgical treatment has not yet been established. Total resection of the gastric tube with lymphadenectomy has been considered a radical treatment, while repeat surgery with both laparotomy and thoracotomy has been associated with severe complications, including anastomotic leakage, recurrent nerve paralysis, bronchotracheal injury, and damage to other organs. CASE PRESENTATION We present a successful case of a gastric tube cancer that was treated with surgical resection in combination with sentinel node biopsy. The tumor was diagnosed as a type 0-IIc lesion with ulceration, and was located proximal to the pyloric ring. Endoscopic submucosal dissection was not indicated because the primary lesion was submucosally invasive, and undifferentiated. By the dye-guided method, sentinel nodes were detected along the right gastroepiploic artery and vein. Intraoperative pathological examination revealed no metastasis of the sentinel nodes. Resection of the distal gastric tube was safely performed with a Roux-en-Y reconstruction, preserving the right gastroepiploic artery and vein and the perfusion of the proximal gastric tube. CONCLUSION We suggest distal resection of the gastric tube with sentinel node biopsy as a novel surgical method for a cT1N0 gastric tube cancer located in the abdomen.


title: Obesity as a social problem in the United States: application of the public arenas model.

text: Obesity rates in the United States have been rising over the past 35 years, resulting in a subsequent increase in nutrition-related chronic disease morbidity and mortality and significant burdens to families, communities, and health care systems. In working to formulate effective public health policy solutions that address the obesity epidemic, it is important to analyze how obesity has been defined and accepted as a social problem. This article applies Hilgartner and Bosk's public arenas model to examine how obesity is defined in the public arena, how competition plays a role in "framing" the obesity issue, and how operatives influence the ways in which obesity is viewed and understood. Implications for nurses and policy makers are addressed in the context of using the public arenas model as a tool to analyze the social problem of obesity.


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title: Survival of two dogs with pyothorax secondary to perforating oesophageal foreign body.

text: CASE REPORT Two dogs with an oesophageal foreign body (FB) were diagnosed with secondary pyothorax at the time of presentation. One dog was managed with surgical FB removal, pleural lavage and thoracostomy tube placement. Following surgery, it was admitted to the intensive care unit for oxygen therapy, antimicrobial and analgesic administration, fluid therapy, thoracic drainage and enteral nutrition. The other dog was managed with endoscopic FB removal, thoracostomy tube placement with continuous suction, and similar aftercare in the intensive care unit. Both survived to discharge from hospital. CONCLUSION This report details the treatment and survival of two dogs with secondary pyothorax associated with oesophageal FB, with successful management through supportive care, oesophageal rest and treatment of infection.


title: Induction and evasion of type I interferon responses by influenza viruses.

text: Influenza A and B viruses are a major cause of respiratory disease in humans. In addition, influenza A viruses continuously re-emerge from animal reservoirs into humans causing human pandemics every 10-50 years of unpredictable severity. Among the first lines of defense against influenza virus infection, the type I interferon (IFN) response plays a major role. In the last 10 years, there have been major advances in understanding how cells recognize being infected by influenza viruses, leading to secretion of type I IFN, and on the effector mechanisms by how IFN exerts its antiviral activity. In addition, we also now know that influenza virus uses multiple mechanisms to attenuate the type I IFN response, allowing for successful infection of their hosts. This review highlights some of these findings and illustrates future research avenues that might lead to new vaccines and antivirals based on the further understanding of the mechanisms of induction and evasion of type I IFN responses by influenza viruses.


title: Current perception of nutrition education in U.S. medical schools.

text: Historically, physicians have perceived the quality of nutrition training during medical school as inadequate. A literature review suggests that this perception has not significantly changed since the 1950s. Many schools have worked to create clinical nutrition curricula for use during medical school. Interestingly, data suggest that medical students' perception of the importance of clinical nutrition can decrease during medical school. Recent data support the importance of targeted nutritional therapy to reduce morbidity and mortality, yet the number of physicians interested in nutrition appears to be declining, and fewer hours of nutrition training are occurring in medical school. One possible solution to improve both training and awareness of the problem is to implement a certification program for both students and preceptors modeled after the Cardiac Life Support training offered by the American Heart Association.


title: Indispensable value of clinical trials in the modernization of traditional Chinese medicine: 12 years' experience at CUHK and future perspectives.

text: The last decade has seen a wealth of information reporting the beneficial effects of Chinese herbal medicines. While a lot more studies were done using in vitro and in vivo research platforms, much fewer investigations were conducted according to evidence-based requirements in clinical settings. The Institute of Chinese Medicine at the Chinese University of Hong Kong (CUHK) has had the opportunity to collaborate with clinicians over the years to initiate and conduct dozens of clinical trials investigating and verifying the therapeutic values of Chinese herbs in selected disease conditions. Of the many disorders, we chose to focus on those that are known for their difficulties achieving perfect results with conventional treatment methods. Examples include non-healing ulcers, allergic conditions, degenerative diseases and cancer. Protective effects of the herbs in such chronic diseases as coronary artery disease and osteoporosis were also part of our focus. Even in healthy individuals and those recovering from chemotherapy, Chinese herbs could help with the immune system and were studied in our clinical trials as well. This paper aims to highlight the important findings from these clinical studies while at the same time, stressing the indispensable value of clinical trials in modernizing the use of Chinese herbs in present-day medicine.


title: The negative impact of COVID-19 on contraception and sexual and reproductive health: Could immediate postpartum LARCs be the solution?

text: The COVID-19 pandemic has taken much of the world by surprise. With over 4 700 000 infections to date across 188 countries and more than 310 000 deaths worldwide over the course of just 5 months, we were remarkably unprepared.[1] Although the focus has rightly been on the provision of adequate health care for those falling ill from the virus and the search for a cure or vaccine, we must be aware that looming in the background are the usual health issues that millions of people face every day, and that these will not go away during the pandemic.


title: Preloss grief in family members of COVID-19 patients: Recommendations for clinicians and researchers.

text: Researchers have long examined grief-related reactions to the diagnosis of a loved one with a terminal illness, including preloss grief (PLG), which is the experience of grief symptoms prior to the loss of a loved one. Families face novel challenges when loved ones with COVID-19 become critically ill-most notably mandated physical separation-and may experience a wide range of PLG responses. This commentary examines the existing literature related to PLG as a means for understanding the psychological impact of COVID-19 deaths, identifies factors professionals can assess for and address when working with a family member of COVID-19 patients, and identifies areas for future research related to COVID-19 and PLG. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


title: A 5-year observational study of lung-protective ventilation in the operating room: a single-center experience.

text: PURPOSE We assessed the evolution of lung-protective ventilation strategies during anesthesia and identified factors associated with the selection of a nonprotective ventilation strategy. METHODS This retrospective observational study covered a 5-year period from March 2006 to March 2011. It included 45575 adult patients who underwent intubation de novo in the operating room. We considered a tidal volume (VT) greater than 10 mL/kg of ideal body weight (IBW) and/or positive end-expiratory pressure (PEEP) less than 5 cm H2O as not lung protective. We evaluated the use of nonprotective ventilation strategies over time in men and women, by American Society of Anesthesiologists classification, and for elective vs emergent surgery. RESULTS Over the duration of the study, there was a significant reduction in the percentage of patients receiving a VT greater than 10 mL/kg IBW (28.5%-16.3%, P < .001), zero PEEP (27.5%-18.2%, P < .001), and VT greater than 10 mL/kg IBW with PEEP less than 5 cm H2O (13.4%-8.0%, P < .001). The odds of receiving nonprotective ventilation were greater for women than for men, in the first year compared with the last year, and for elective compared with emergent surgery. CONCLUSION Although use of nonprotective ventilation decreased over time, an important percentage of patients continue to receive nonprotective ventilation.


title: Role of electromagnetic navigational bronchoscopy in pulmonary nodule management.

text: The incidence of pulmonary nodules and lung cancer is rising. Some of this increase in incidence is due to improved pick up by newer imaging modalities. However, the goal is to diagnose these lesion, many of which are located in the periphery, by safe and relatively non-invasive methods. This has led to the emergence of numerous techniques such as electromagnetic navigational bronchoscopy (ENB). Current evidence supports a role for these techniques in the diagnostic pathway. However, numerous factor influence the diagnostic accuracy. Thus despite significant advances, more research needs to be undertaken to further improve the currently available diagnostic technologies.


title: 'LESS' radical prostatectomy: a pilot feasibility study with a personal original technique.

text: OBJECTIVE We evaluated the feasibility and the potential advantages of a modification of the single-port laparoscopic radical prostatectomy using a periumbilical multichannel port plus a second port placed in the left fossa with the aim of having an adequate working angle during the most critical steps of the procedure. PATIENTS AND METHODS Between March and September 2009 we operated on five patients with early-stage prostate cancer (T1c) and a normal body mass index (<25). The procedure was carried out with a specially-designed multichannel trocar which contains two 5 mm and one 10 mm ports plus a 5 mm port placed in the left iliac fossa in order to have an adequate working angle. The first two patients received a nerve sparing radical prostatectomy. RESULTS All cases were completed successfully in a mean operative time of 225 minutes (range 210-250) with blood losses of less than 100 ml. All patients were discharged from the hospital in 3rd postoperative day and the catheter was always removed seven days from surgery. No intraoperative complications occurred. The pathological tumour stage revealed pT2bNo prostate cancer in all five cases without positive surgical margins. After a mean follow-up of 4 months (range 1-7) all patients have an undetectable prostate-specific antigen level and no postoperative early major complications. The first two patients were fully continent respectively after 3 and 8 weeks after surgery, the third patient uses one safety pad after three month from surgery. The last two patients have a moderate incontinence and are currently under rehabilitation. Regarding potency the first patient had intercourses without any therapies after two months from surgery while the second one (6 months follow up) has partial penile tumescence using oral vardenafil. CONCLUSION Two ports laparoscopic radical prostatectomy is feasible in very selected cases. However, our pilot study should be still considered a technical report and the limits of the technique must still be defined in a larger population and by other investigators.