title: Influence of intraoperative neuromonitoring on surgeons' technique during thyroidectomy.

text: BACKGROUND When assessing the value of intraoperative nerve monitoring (IONM) during routine thyroidectomy, it is necessary to consider its influence on the surgeon's dissection technique. We investigated the effect of IONM on individual surgeon performance by determining the learning curve associated with this tool. METHODS A one-year prospective study was conducted between May 2008 and April 2009 within a team of three experienced endocrine surgeons. The measure of surgical performance was based on the detection of immediate postoperative recurrent laryngeal nerve palsy by laryngoscopy. Individual learning curves associated with IONM acquisition were drawn with the cumulative sum (CUSUM) chart. Each surgeon was questioned about possible changes he had experienced in his own surgical technique after the introduction of IONM. RESULTS A total of 475 consecutive patients who underwent thyroid surgery with IONM were included. The pattern of learning curves varied among surgeons and ranged from 35 to 304 procedures required for complete IONM acquisition. The surgeon with the longest learning curve also described a drastic modification of his technique related to nerve dissection. CONCLUSIONS Intraoperative nerve monitoring can induce changes in surgical practice. The different learning curve patterns among surgeons may reflect the variable degree to which surgeons will modify their own dissection technique. Such an effect on learning must be considered when assessing the impact of using IONM on patient safety.


title: Preventing healthcare workers from acquiring influenza.

text: Our survey of 133 on-duty medical ward nurses showed that, during peak influenza season, 30 (23%) developed an influenza-like illness, despite wearing a mask at work. Suboptimal adherence to standard precautions, such as the use of a face shield (odds ratio, 3.56) during high-risk procedures, and failure to receive influenza vaccination (odds ratio, 4.82) were independent risk factors, adjusted for household contacts.


title: Prospects of Replication-Deficient Adenovirus Based Vaccine Development against SARS-CoV-2.

text: The current appearance of the new SARS coronavirus 2 (SARS-CoV-2) and it quickly spreading across the world poses a global health emergency. The serious outbreak position is affecting people worldwide and requires rapid measures to be taken by healthcare systems and governments. Vaccinations represent the most effective strategy to prevent the epidemic of the virus and to further reduce morbidity and mortality with long-lasting effects. Nevertheless, currently there are no licensed vaccines for the novel coronaviruses. Researchers and clinicians from all over the world are advancing the development of a vaccine against novel human SARS-CoV-2 using various approaches. Herein, we aim to present and discuss the progress and prospects in the field of vaccine research towards SARS-CoV-2 using adenovirus (AdV) replication deficient-based strategies, with a comprehension that may support research and combat this recent world health emergency.


title: Current status of robot-assisted partial nephrectomy.

text: The incidence of incidentally diagnosed small renal masses is rising. Although open partial nephrectomy (OPN) remains the reference standard for clinically localized renal lesions, growing experience with minimally invasive PN has demonstrated equivalent oncologic efficacy and improved short-term perioperative outcomes compared to open techniques. Compared to the technically demanding laparoscopic PN (LPN), robotic PN (RPN) overcomes a number of the technical hurdles of LPN with a shorter learning curve, and now has emerged as an attractive minimally invasive treatment option for amenable tumors. Although experience with RPN has been limited to date, early series have demonstrated short-term oncologic outcomes comparable to OPN and equivalent perioperative outcomes to LPN (all ≤ level III evidence). Although prospective evidence would be ideal, clinical trial comparisons with LPN and OPN will be fraught with accrual challenges and are not expected in the near future. This review summarizes the advantages and indications for a robotic approach, operative principles and emerging technologies, early functional and oncologic outcomes, and expected future advances of RPN for localized renal tumors.


title: Infectious Risks of Traveling Abroad.

text: A popular leisure activity, international travel can be associated with some infections. The most common travel-related illnesses appear to be gastrointestinal, dermatologic, respiratory, and systemic febrile syndromes. The pretravel medical consultation includes immunizations, malaria chemoprophylaxis, self-treatment for traveler's diarrhea, and advice on the prevention of a myriad of other infectious causes including dengue, chikungunya, rickettsiosis, leptospirosis, schistosomiasis, and strongyloidiasis. Travel to locations experiencing outbreaks such as Ebola virus disease, Middle East respiratory syndrome, avian influenza, and chikungunya call for specific alerts on preventive strategies. After travel, evaluation of an ill traveler must explore details of exposure, including destinations visited; activities; ingestion of contaminated food or drinks; contact with vectors, animals, fresh water, or blood and body fluids; and other potential exposures. Knowledge of the geographic distribution of infectious diseases is important in generating the differential diagnoses and testing accordingly. Empiric treatment is sometimes necessary when suspicion of a certain diagnosis is strong and confirmatory tests are delayed or lacking, particularly for infections that are rapidly progressive (for example, malaria) or for which timing of testing is prolonged (such as leptospirosis).


title: Fast-track Innovation: Area Agencies on Aging Respond to the COVID-19 Pandemic.

text: Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs. Social distancing requirements and the closure of congregate activities due to COVID-19 resulted in a rapid and dramatic shift in service delivery modes. Area Agencies on Aging were able to quickly pivot due to their long-standing expertise in community needs assessment and cross-sectoral partnerships. The federal Coronavirus relief measures also infused one billion dollars into the Aging Network. As the pandemic response evolves, Area Agencies on Aging are poised to be key partners in a transformed health system.


title: When Is Evidence Enough Evidence? A Systematic Review and Meta-Analysis of the Trabectome as a Solo Procedure in Patients with Primary Open-Angle Glaucoma.

text: The purpose of this systematic review and meta-analysis was to examine the availability of evidence for one of the earliest available minimally invasive glaucoma surgery (MIGS) procedures, the Trabectome. Various databases were searched up to December 20, 2016, for any published studies assessing the use of the Trabectome as a solo procedure in patients with primary open-angle glaucoma (POAG). The standardized mean differences (SMD) were calculated for the change in intraocular pressure (IOP) and number of glaucoma mediations used at 1-month, 6-month, and 12-month follow-up. After screening, three studies and one abstract with analyzable data were included. The meta-analysis showed statistically significant reductions in IOP and number of glaucoma medications used at all time points. Though the Trabectome as a solo procedure appears to lower IOP and reduces the number of glaucoma medications, more high-quality studies are required to make definitive conclusions. The difficulty of obtaining evidence may be one of the many obstacles that limit a full understanding of the potential safety and/or efficacy benefits compared to standard treatments. The time has come for a thoughtful and integrated approach with stakeholders to determine optimal access to care strategies for our patients.


title: Early biocompatibility of crosslinked and non-crosslinked biologic meshes in a porcine model of ventral hernia repair.

text: PURPOSE Biologic meshes have unique physical properties as a result of manufacturing techniques such as decellularization, crosslinking, and sterilization. The purpose of this study is to directly compare the biocompatibility profiles of five different biologic meshes, AlloDerm(®) (non-crosslinked human dermal matrix), PeriGuard(®) (crosslinked bovine pericardium), Permacol(®) (crosslinked porcine dermal matrix), Strattice(®) (non-crosslinked porcine dermal matrix), and Veritas(®) (non-crosslinked bovine pericardium), using a porcine model of ventral hernia repair. METHODS Full-thickness fascial defects were created in 20 Yucatan minipigs and repaired with the retromuscular placement of biologic mesh 3 weeks later. Animals were euthanized at 1 month and the repair sites were subjected to tensile testing and histologic analysis. Samples of unimplanted (de novo) meshes and native porcine abdominal wall were also analyzed for their mechanical properties. RESULTS There were no significant differences in the biomechanical characteristics between any of the mesh-repaired sites at 1 month postimplantation or between the native porcine abdominal wall without implanted mesh and the mesh-repaired sites (P > 0.05 for all comparisons). Histologically, non-crosslinked materials exhibited greater cellular infiltration, extracellular matrix (ECM) deposition, and neovascularization compared to crosslinked meshes. CONCLUSIONS While crosslinking differentiates biologic meshes with regard to cellular infiltration, ECM deposition, scaffold degradation, and neovascularization, the integrity and strength of the repair site at 1 month is not significantly impacted by crosslinking or by the de novo strength/stiffness of the mesh.


Embolic strokes of undetermined source: support for a new clinical construct.


Global health under fire: Trump and covid are just two of the threats.


title: COVID-19 in solid organ transplant recipients: dynamics of disease progression and inflammatory markers in ICU and non-ICU admitted patients.

text: BACKGROUND COVID-19 infection varies in severity from minimal symptoms to critical illness associated with a hyperinflammatory response. Data on disease progression in immunosuppressed solid organ transplant (SOT) recipients are limited. METHODS We examined the electronic medical records of all SOT recipients with COVID-19 from 12 Massachusetts hospitals between February 1st and May 6th, 2020. We analysed the demographics, clinical parameters, course and outcomes of illness in these patients. RESULTS Of 52 COVID-19 positive SOT patients, 77% were hospitalized and 35% required ICU admission. Sixty nine percent of hospitalized patients had immunosuppression reduced, 6% developed suspected rejection. Co-infections occurred in 45% in ICU vs 5% in non-ICU patients (p=0.037). A biphasic pattern of evolution of laboratory tests was observed. In the first 5 days of illness, inflammatory markers were moderately increased. Subsequently, WBC, CRP, ferritin and D-dimer increased with increasing stay in the ICU, lymphocyte counts were similar. Five patients (16%) died. CONCLUSIONS Our data indicate that SOT is associated with high rate of hospitalization, ICU admission and death from COVID-19 compared to data in the general population of patients with COVID-19. Despite reduction in immunosuppression, suspected rejection was rare. The clinical course and trend of laboratory biomarkers is biphasic with a later, pronounced peak in inflammatory markers seen in those admitted to an ICU. CRP is a useful marker to monitor disease progression in SOT.


title: Flat-panel cone-beam CT-guided radiofrequency ablation of very small (≤ 1.5 cm) liver tumors: technical note on a preliminary experience.

text: PURPOSE The aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors. MATERIALS AND METHODS Patients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤ 1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients' lesions and procedural variables were recorded and analyzed. RESULTS Three patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up. CONCLUSION Percutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.


title: A case of thoracic pneumatosis due to severe coughs and tracheal tube displacement induced by tracheal tube size mismatch.

text: BACKGROUND Thoracic pneumatosis during mechanical ventilation may be life-threatening. We encountered a patient with thoracic pneumatosis after frequent displacement of the tracheal tube with an overinflated cuff. CASE PRESENTATION We admitted a 62-year-old man to the intensive care unit (ICU) due to respiratory failure. We secured his airway using a cuffed 8.5-mm tracheal tube. However, air leakage did not stop with the regular intracuff pressure (25 cm H2O) because the diameter of his trachea was too large for the tracheal tube inserted. In addition, a chest X-ray examination revealed rostral tube displacement. Therefore, we applied a higher intracuff pressure (35 cm H2O) to prevent air leakage and tracheal tube movement. However, severe coughing episodes developed, and 3 days after ICU admission, a chest X-ray and CT scan revealed pneumomediastinum and pneumothorax. We did not have larger tracheal tubes in stock. We decided to use a tracheostomy tube instead, which we expected to be placed securely and to prevent tube displacement. After tracheostomy, the severe coughing episodes became infrequent. Finally, we weaned the patient from mechanical ventilation 12 days after ICU admission. CONCLUSIONS The clinical signs and symptoms in our patient point to tracheal tube size mismatch as the cause of pneumothorax.


title: Limited Cross-Protection against Infectious Bronchitis Provided by Recombinant Infectious Bronchitis Viruses Expressing Heterologous Spike Glycoproteins.

text: Gammacoronavirus infectious bronchitis virus (IBV) causes an economically important respiratory disease of poultry. Protective immunity is associated with the major structural protein, spike (S) glycoprotein, which induces neutralising antibodies and defines the serotype. Cross-protective immunity between serotypes is limited and can be difficult to predict. In this study, the ability of two recombinant IBV vaccine candidates, BeauR-M41(S) and BeauR-4/91(S), to induce cross-protection against a third serotype, QX, was assessed. Both rIBVs are genetically based on the Beaudette genome with only the S gene derived from either M41 or 4/91, two unrelated serotypes. The use of these rIBVs allowed for the assessment of the potential of M41 and 4/91 S glycoproteins to induce cross-protective immunity against a heterologous QX challenge. The impact of the order of vaccination was also assessed. Homologous primary and secondary vaccination with BeauR-M41(S) or BeauR-4/91(S) resulted in a significant reduction of infectious QX load in the trachea at four days post-challenge, whereas heterologous primary and secondary vaccination with BeauR-M41(S) and BeauR-4/91(S) reduced viral RNA load in the conjunctiva-associated lymphoid tissue (CALT). Both homologous and heterologous vaccination regimes reduced clinical signs and birds recovered more rapidly as compared with an unvaccinated/challenge control group. Despite both rIBV BeauR-M41(S) and BeauR-4/91(S) displaying limited replication in vivo, serum titres in these vaccinated groups were higher as compared with the unvaccinated/challenge control group. This suggests that vaccination with rIBV primed the birds for a boosted humoral response to heterologous QX challenge. Collectively, vaccination with the rIBV elicited limited protection against challenge, with failure to protect against tracheal ciliostasis, clinical manifestations, and viral replication. The use of a less attenuated recombinant vector that replicates throughout the respiratory tract could be required to elicit a stronger and prolonged protective immune response.


title: Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender.

text: BACKGROUND The COVID-19 pandemic is having negative effects on societies' mental health. Both the pandemic and the measures taken to combat it can affect individuals' mental health. AIMS The purpose of this study was to evaluate the levels of depression, anxiety and health anxiety in Turkish society during the COVID-19 pandemic, and to examine the factors affecting these. METHOD The study was performed using an online questionnaire. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale (HADS) and the Health Anxiety Inventory (HAI). The effects on depression, anxiety and health anxiety levels of factors such as age, sex, marital status, living with an individual aged above 60, the presence of a new Coronavirus+ patient among friends or relatives, previous and current psychiatric illness and presence of accompanying chronic disease were then investigated. RESULTS In terms of HADS cut-off points, 23.6% (n = 81) of the population scored above the depression cut-off point, and 45.1% (n = 155) scored above the cut-off point for anxiety. In regression analysis, female gender, living in urban areas and previous psychiatric illness history were found as risk factors for anxiety; living in urban areas was found as risk factor for depression; and female gender, accompanying chronic disease and previous psychiatric history were found as risk factors for health anxiety. CONCLUSION The results of this cross-sectional study suggest that the groups most psychologically affected by the COVID-19 pandemic are women, individuals with previous psychiatric illness, individuals living in urban areas and those with an accompanying chronic disease. Priority might therefore be attached to these in future psychiatric planning.


title: H3N2 Canine Influenza Virus Infection in a Dog.

text: In 2015, H3N2 canine influenza emerged in dogs in the greater Chicago area. During this time, a 10-year-old German Shepherd dog presented to the referring veterinarian with lethargy and coughing that quickly progressed to death. This report describes the macroscopic and microscopic lesions and the molecular testing performed to identify the novel North American H3N2 strain of canine influenza. The larynx, pharynx, and trachea were covered by a fibrinonecrotic membrane. Bilaterally, the lungs had multifocal subpleural necrosis of the caudal lung lobes with hemorrhage, congestion, and pulmonary edema. Staphylococcus pseudointermedius was isolated from the lung. Mycoplasma cynos was identified by real-time polymerase chain reaction from nasal passages, oropharynx, larynx, trachea, and cranial lung lobes. The neuraminidase gene sequence from the influenza virus isolated obtained from this dog had ≥98% homology to the strain circulating in the Chicago area.


COVID-19 and Schools Closure: Implications for School Nurses.


title: Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases.

text: OBJECTIVE To conduct a systematic review to identify surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy (LSG). BACKGROUND LSG is growing in popularity as a primary bariatric procedure. Technical aspects of LSG including bougie size remain controversial. METHODS Our systematic review yielded 112 studies encompassing 9991 LSG patients. A general estimating equation (GEE) model was used to calculate the odds ratio (OR) for leak based on bougie size, distance from the pylorus, and use of buttressing on the staple line. Baseline characteristics, including age and body mass index (BMI), were included. A linear repeated measures regression model compared excess weight loss (%EWL) between bougie sizes. RESULTS A total of 198 leaks in 8922 patients (2.2%) were identified. The GEE model revealed that the risk of leak decreased with bougie ≥40 Fr (OR = 0.53, 95% CI = [0.37-0.77]; P = 0.0009). Buttressing did not impact leak. There was no difference in %EWL between bougie <40 Fr and bougie ≥40 Fr up to 36 months (mean: 70.1% EWL; P = 0.273). Distance from the pylorus did not affect leak or %EWL. CONCLUSIONS Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. Distance from the pylorus does not impact leak or weight loss. Buttressing does not seem to impact leak; however, if surgeons desire to buttress, bioabsorbable material is the most common type used. Longer-term studies are needed to definitively determine the effect of bougie size on weight loss after LSG.


Renal Association Clinical Practice Guideline on nutrition in CKD.


title: Different potential of C-type lectin-mediated entry between Marburg virus strains.

text: The glycoproteins (GPs) of filoviruses are responsible for virus entry into cells. It is known that GP interacts with cellular C-type lectins for virus attachment to cells. Since primary target cells of filoviruses express C-type lectins, C-type lectin-mediated entry is thought to be a possible determinant of virus tropism and pathogenesis. We compared the efficiency of C-type lectin-mediated entry between Marburg virus strains Angola and Musoke by using a vesicular stomatitis virus (VSV) pseudotype system. VSV pseudotyped with Angola GP (VSV-Angola) infected K562 cells expressing the C-type lectin, human macrophage galactose-type C-type lectin (hMGL), or dendritic cell-specific ICAM-3-grabbing nonintegrin (DC-SIGN) more efficiently than VSV pseudotyped with Musoke GP (VSV-Musoke). Unexpectedly, the binding affinity of the C-type lectins to the carbohydrates on GPs did not correlate with the different efficiency of C-type lectin-mediated entry. Site-directed mutagenesis identified the amino acid at position 547, which switched the efficiency of C-type lectin-mediated entry. In a three-dimensional model of GP, this amino acid was in close proximity to the putative site of cathepsin processing. Interestingly, the cathepsin inhibitors reduced the infectivity of VSV-Angola less efficiently than that of VSV-Musoke in C-type lectin-expressing K562 cells, whereas only a limited difference was found in control cells. The amino acid at position 547 was critical for the different effects of the inhibitors on the virus infectivities. These results suggest that the efficiency of C-type lectin-mediated entry of filoviruses is controlled not only by binding affinity between C-type lectins and GP but also by mechanisms underlying endosomal entry, such as proteolytic processing by the cathepsins.


title: Economic burden of ventilator-associated pneumonia based on total resource utilization.

text: OBJECTIVES To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals. DESIGN AND SETTING We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%). METHODS Case patients with microbiologically confirmed VAP (n = 30)were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP (n = 90). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups. RESULTS Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients (P < .001); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients (P = .001). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; P < .001) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P < .05) and respiratory therapy (P < .05). CONCLUSIONS VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP. TRIAL REGISTRATION NASCENT study ClinicalTrials.gov Identifier: NCT00148642.


Inimical Effects of COVID-19 on Surgical Residency: Correspondence.


title: Reduction of the dimensionality of the EEG channels during scoliosis correction surgeries using a wavelet decomposition technique.

text: This paper presents a comparison between the electroencephalogram (EEG) channels during scoliosis correction surgeries. Surgeons use many hand tools and electronic devices that directly affect the EEG channels. These noises do not affect the EEG channels uniformly. This research provides a complete system to find the least affected channel by the noise. The presented system consists of five stages: filtering, wavelet decomposing (Level 4), processing the signal bands using four different criteria (mean, energy, entropy and standard deviation), finding the useful channel according to the criteria's value and, finally, generating a combinational signal from Channels 1 and 2. Experimentally, two channels of EEG data were recorded from six patients who underwent scoliosis correction surgeries in the Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) (the Medical center of National University of Malaysia). The combinational signal was tested by power spectral density, cross-correlation function and wavelet coherence. The experimental results show that the system-outputted EEG signals are neatly switched without any substantial changes in the consistency of EEG components. This paper provides an efficient procedure for analyzing EEG signals in order to avoid averaging the channels that lead to redistribution of the noise on both channels, reducing the dimensionality of the EEG features and preparing the best EEG stream for the classification and monitoring stage.


title: Role of inflammatory markers in corona virus disease (COVID-19) patients: A review.

text: IMPACT STATEMENT In late 2019, a novel virus called SARS-CoV-2, expanded globally from Wuhan, China and was declared a pandemic on 11 March 2020 by the WHO. The mechanism of virus entry inside the host cell depends upon the cellular proteases including cathepsins, HAT, and TMPRSS2, which splits up the spike protein and causes further penetration. MERS coronavirus uses DPP4, while coronavirus HCoV-NL63 and SARS-CoV and SARS-CoV-2 employ ACE-2 as the key receptor. Cytokine storm syndrome was analyzed in critically ill nCOVID-19 patients and it is presented with high inflammatory mediators, systemic inflammation, and multiple organ failure. Among various inflammatory mediators, the level of interleukins (IL-2, IL-7, IL-10), G-CSF, MIP1A, MCP1, and TNF-α was reported to be higher in critically ill patients. Understanding this molecular mechanism of ILs, T cells, and dendritic cells will be helpful to design immunotherapy and novel drugs for the treatment of nCOVID-19 infection.


title: One, two, or three ports in laparoscopic cholecystectomy?

text: Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data.


title: Effect on ovarian reserve of hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas.

text: STUDY OBJECTIVE To compare the postoperative decrease in ovarian reserve between hemostasis by bipolar coagulation and suture during laparoendoscopic single-site cystectomy (LESS-C) for ovarian endometriomas. DESIGN Prospective comparative study (Canadian Task Force Classification II-1). SETTING University hospital. PATIENTS One hundred twenty-five patients with ovarian endometriomas. INTERVENTIONS Patients with endometrioma were managed by hemostasis with either bipolar coagulation (n = 62) or suturing (n = 63) during LESS-C. We evaluated the impact of surgery on ovarian reserve using serum anti-Müllerian hormone (AMH) levels, which were measured before surgery and 3 months after surgery in all patients. MEASUREMENT AND MAIN RESULTS Baseline characteristics such as age, bilaterality of endometriomas, and preoperative AMH levels were similar between the 2 study groups. There were also no differences between the 2 groups in surgical outcomes, such as operative time, operative blood loss, or operative complications. In both study groups, postoperative AMH levels were lower than preoperative AMH levels (p < .001). The decline rate of AMH levels was significantly greater in the bipolar coagulation group than in the suture group (42.2% [interquartile range, 16.5%-53.0%] and 24.6% [interquartile range, 11.6%-37.0%], respectively, p = .001). CONCLUSION Hemostasis by bipolar coagulation after stripping of the endometrioma during LESS-C reduces ovarian reserve more than suturing does, as determined by serial AMH levels. Therefore, suturing may be a better hemostatic choice after stripping ovarian endometriomas.


title: Neurological manifestations and COVID-19: Experiences from a tertiary care center at the Frontline.

text: OBJECTIVE To report neurological manifestations seen in patients hospitalized with Coronavirus disease 2019 (COVID-19) from a large academic medical center in Chicago, Illinois. METHODS We retrospectively reviewed data records of 50 patients with COVID-19 who were evaluated by the neurology services from March 1, 2020 - April 30, 2020. Patients were categorized into 2 groups based on timing of developing neurological manifestations: the "Neuro first" group had neurological manifestations upon initial assessment, and the "COVID first" group developed neurological symptoms greater than 24 h after hospitalization. The demographics, comorbidities, disease severity and neurological symptoms and diagnoses of both groups were analyzed. Statistical analysis was performed to compare the two groups. RESULTS A total of 50 patients (48% African American and 24% Latino) were included in the analysis. Most common neurological manifestations observed were encephalopathy (n = 30), cerebrovascular disease (n = 20), cognitive impairment (n = 13), seizures (n = 13), hypoxic brain injury (n = 7), dysgeusia (n = 5), and extraocular movement abnormalities (n = 5). The "COVID-19 first" group had more evidence of physiologic disturbances on arrival with a more severe/critical disease course (83.3% vs 53.8%, p 0.025). CONCLUSION Neurologic manifestations of COVID-19 are highly variable and can occur prior to the diagnosis of or as a complication of the viral infection. Despite similar baseline comorbidities and demographics, the COVID-19 patients who developed neurologic symptoms later in hospitalization had more severe disease courses. Differently from previous studies, we noted a high percentage of African American and Latino individuals in both groups.


title: Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial.

text: BACKGROUND/OBJECTIVES This trial evaluated the safety and effectiveness of the Orbera Intragastric Balloon as an adjunct to lifestyle intervention. SUBJECTS/METHODS In this multicenter, randomized, open-label clinical trial, 255 adults with a body mass index of 30-40 kg m-2 were treated and outcomes were assessed up to 12 months. Participants were randomized to endoscopic placement of an intragastric balloon plus lifestyle or lifestyle intervention alone. Balloons were removed at 6 months and lifestyle intervention continued for both groups through 12 months. At 9 months, coprimary end points were two measures of weight loss. RESULTS At 6 months, weight loss was -3.3% of total body weight (-3.2 kg) in the lifestyle arm vs -10.2% (-9.9 kg) in the balloon plus lifestyle arm (P<0.001); at 9 months (3 months postballoon removal), weight loss was -3.4% (-3.2 kg) vs -9.1% (-8.8 kg, P⩽0.001); and at 12 months, -3.1% (-2.9 kg) vs -7.6% (-7.4 kg, P⩽0.001). For the primary end points, at 9 months, mean percent loss of weight in excess of ideal body weight (s.d.) at 9 months was 26.5% (20.7) (P=0.32) and 9.7% (15.1) in the balloon and control groups, respectively. Also, 45.6% (36.7, 54.8) of the subjects randomized to the balloon achieved at least 15% loss of weight in excess of ideal body weight greater than the control group (P<0.001). The majority of balloon subjects experienced adverse events; 86.9% nausea, 75.6% vomiting, 57.5% abdominal pain and 18.8% had their device removed before 6 months because of an adverse event or subject request. Five subjects (3.1%) in the balloon group had a gastric abnormality at the time of device removal, and no ulcers were found. CONCLUSIONS AND RELEVANCE Intragastric balloon achieved greater short-term weight loss at 3 and 6 months postballoon removal than lifestyle intervention alone. Adverse gastrointestinal events were common.


title: Development and multicenter performance evaluation of fully automated SARS-CoV-2 IgM and IgG immunoassays.

text: Objectives The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally. The laboratory diagnosis of SARS-CoV-2 infection has relied on nucleic acid testing; however, it has some limitations, such as low throughput and high rates of false negatives. Tests of higher sensitivity are needed to effectively identify infected patients. Methods This study has developed fully automated chemiluminescent immunoassays to determine IgM and IgG antibodies to SARS-CoV-2 in human serum. The assay performance has been evaluated at 10 hospitals. Clinical specificity was evaluated by measuring 972 hospitalized patients and 586 donors of a normal population. Clinical sensitivity was assessed on 513 confirmed cases of SARS-CoV-2 by RT-PCR. Results The assays demonstrated satisfied assay precision with coefficient of variation of less than 4.45%. Inactivation of specimen did not affect assay measurement. SARS-CoV-2 IgM showed clinical specificity of 97.33 and 99.49% for hospitalized patients and the normal population respectively, and SARS-CoV-2 IgG showed clinical specificity of 97.43 and 99.15% respectively. SARS-CoV-2 IgM showed clinical sensitivity of 82.54, 92.93, and 84.62% before 7 days, 7-14 days, and after 14 days respectively, since onset of symptoms, and SARS-CoV-2 IgG showed clinical sensitivity of 80.95, 97.98, and 99.15% respectively at the same time points above. Conclusions We have developed fully automated immunoassays for detecting SARS-CoV-2 IgM and IgG antibodies in human serum. The assays demonstrated high clinical specificity and sensitivity, and add great value to nucleic acid testing in fighting against the global pandemic of the SARS-CoV-2 infection.


title: Evaluation of HTLV-1 HBZ and proviral load, together with host IFN λ3, in pathogenesis of HAM/TSP.

text: Human T-cell lymphotropic virus 1 (HTLV-1) is associated with two progressive diseases: HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL). Although HTLV-1 proviral load (PVL) has been introduced as a risk factor for these diseases' progression, it is not sufficient on its own to yield an accurate estimation of the outcome of the infection. In the present study, PVL and HTLV-1 basic leucine zipper factor (HBZ) expression level as viral factors, and IFN λ3 as a host factor, were evaluated in HAM/TSP patients and HTLV-1 asymptomatic carriers (ACs). During 2014-2015, 12 HAM/TSP patients and 18 ACs who had been referred to the HTLV-1 Clinic, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran, were enrolled in this study. Peripheral blood mononuclear cells (PBMCs) were isolated and the DNA and mRNA were extracted for quantification of HBZ, IFN λ3 expression, and PVL using real-time PCR (TaqMan method). Although the PVL was higher in the HAM/TSP group, with a 94% confidence interval, there were no considerable differences in terms of HBZ mRNA and PVL between ACs and HAM patients. IFN λ3 expression in the HAM/TSP group was significantly higher than in the ACs (P = 0.02). To the best of our knowledge, no study has evaluated the expression level of IFN λ3 in HTLV-1 positive patients. The immune response against HTLV-1 viral antigens and virulent factors will therefore further refine our knowledge of interactions between the virus and host in the pathogenesis of HTLV-1-related disorders. The virus PVL and the host IFN λ3 can be used as pathogenic factors of HTLV-1 infected patients at risk of HAM/TSP manifestation. J. Med. Virol. 89:1102-1107, 2017. © 2016 Wiley Periodicals, Inc.


title: Significance of a Single-Time-Point Somatostatin Receptor SPECT/Multiphase CT Protocol in the Diagnostic Work-up of Gastroenteropancreatic Neuroendocrine Neoplasms.

text: UNLABELLED This prospective study compared a 1-d SPECT/CT protocol with the commonly used 3-d protocol for somatostatin receptor scintigraphy in patients with gastroenteropancreatic neuroendocrine neoplasms. Additionally, the influence of SPECT/CT on patient management was evaluated. METHODS From October 2011 to October 2012, all gastroenteropancreatic neuroendocrine neoplasm patients undergoing restaging with somatostatin receptor scintigraphy on a modern SPECT/CT device were enrolled in this study. The protocol consisted of planar imaging at 4, 24, and 48 h; low-dose SPECT/CT at 24 and 48 h; diagnostic CT at 24 h using a triple-phase delay after administration of contrast; and diagnostic SPECT/CT at 24 h. All components of the imaging data were reassessed by 3 masked interpreters. The results were compared with a reference standard based on all clinical, imaging, and histopathology follow-up data available (follow-up range, 24-36 mo; mean, 29.9 mo). The reference standard was defined by a study-specific interdisciplinary tumor board that also reassessed treatment decisions. RESULTS Thirty-one patients were eligible for analysis (18 men and 13 women; mean age, 60.4 y). Ten had no imaging signs of disease and remained disease-free during follow-up. Twenty-one had persistent or recurrent disease (82 lesions: 24 in the liver, 21 in the lymph nodes, 16 in bone, 12 in the pancreas, and 9 in other locations). The respective lesion detection rates for interpreters 1, 2, and 3 were 51.9%, 49.4%, and 71.6% for low-dose SPECT/CT at 24 h; 51.9%, 55.6%, and 67.9% for low-dose SPECT/CT at 48 h; 63.0%, 70.4%, and 85.2% for diagnostic CT; and 77.8%, 84.0%, and 88.9% for diagnostic SPECT/CT. Interobserver agreement was moderate for diagnostic SPECT/CT (κ = 0.44), diagnostic CT (κ = 0.43), low-dose SPECT/CT at 48 h (κ = 0.61), and low-dose SPECT/CT at 24 h (κ = 0.55). For planar imaging, interobserver agreement was fair after 48 h (κ = 0.36) and 24 h (κ = 0.38) and moderate after 4 h (κ = 0.42). Every lesion detectable on planar imaging or low-dose SPECT/CT was also detectable on diagnostic SPECT/CT. The CT and SPECT components of diagnostic SPECT/CT strongly complemented each other, as 34 of 82 lesions (41.4%) were detected on only the CT component or only the SPECT component. Therapeutic management was influenced by the diagnostic SPECT/CT interpretation in 8 of 31 patients (25.8%). CONCLUSION The highest detection rates were achieved by diagnostic SPECT/CT. Thus, a more patient-friendly 1-d protocol is feasible. Furthermore, multiphase SPECT/CT affected management in about a quarter of patients.


docid: bwhbdgnm

title: Description of robotically assisted single-site transabdominal preperitoneal (RASS-TAPP) inguinal hernia repair and presentation of clinical outcomes.

text: BACKGROUND The aim of our study is to report our initial clinical experience with robotically assisted single-site transabdominal preperitoneal (RASS-TAPP) hernia repair, to verify the safety and efficacy of the procedure and to describe the surgical procedure. METHODS We retrospectively reviewed all patients undergoing RASS-TAPP at our institution from March 2013 through December 2013. Data regarding patient demographics, type and location of hernia, operative time and clinical outcomes were collected and analyzed. RESULTS Fourty five hernias were repaired in 34 patients (30M, 4F) by a single surgeon. The mean age was 49.3 years and mean BMI was 26.5. 31 lateral defects, 13 medial defects and 1 femoral defect were repaired. Three patients presented with recurrent hernias and nine had bilateral defects. The mean operative time for all cases was 80.5 min and for all unilateral hernias 69 min. Considering just the unilateral hernias without any additional procedures, operative time was 63 min. The mean follow-up time was 5.5 months. There has been one superficial surgical site infection, but no observed clinical recurrence or neuralgia to date. CONCLUSION Robotically assisted single-site transabdominal preperitoneal hernia repair is safe and effective. The absence of clinical evidence of recurrence or neuralgia is encouraging and should promote further study.


title: Porcine Reproductive and Respiratory Syndrome Virus Nucleocapsid Protein Interacts with Nsp9 and Cellular DHX9 To Regulate Viral RNA Synthesis.

text: UNLABELLED Porcine reproductive and respiratory syndrome virus (PRRSV) nucleocapsid (N) protein is the main component of the viral capsid to encapsulate viral RNA, and it is also a multifunctional protein involved in the regulation of host cell processes. Nonstructural protein 9 (Nsp9) is the RNA-dependent RNA polymerase that plays a critical role in viral RNA transcription and replication. In this study, we demonstrate that PRRSV N protein is bound to Nsp9 by protein-protein interaction and that the contacting surface on Nsp9 is located in the two predicted α-helixes formed by 48 residues at the C-terminal end of the protein. Mutagenesis analyses identified E646, E608, and E611 on Nsp9 and Q85 on the N protein as the pivotal residues participating in the N-Nsp9 interaction. By overexpressing the N protein binding fragment of Nsp9 in infected Marc-145 cells, the synthesis of viral RNAs, as well as the production of infectious progeny viruses, was dramatically inhibited, suggesting that Nsp9-N protein association is involved in the process of viral RNA production. In addition, we show that PRRSV N interacts with cellular RNA helicase DHX9 and redistributes the protein into the cytoplasm. Knockdown of DHX9 increased the ratio of short subgenomic mRNAs (sgmRNAs); in contrast, DHX9 overexpression benefited the synthesis of longer sgmRNAs and the viral genomic RNA (gRNA). These results imply that DHX9 is recruited by the N protein in PRRSV infection to regulate viral RNA synthesis. We postulate that N and DHX9 may act as antiattenuation factors for the continuous elongation of nascent transcript during negative-strand RNA synthesis. IMPORTANCE It is unclear whether the N protein of PRRSV is involved in regulation of the viral RNA production process. In this report, we demonstrate that the N protein of the arterivirus PRRSV participates in viral RNA replication and transcription through interacting with Nsp9 and its RdRp and recruiting cellular RNA helicase to promote the production of longer viral sgmRNAs and gRNA. Our data here provide some new insights into the discontinuous to continuous extension of PRRSV RNA synthesis and also offer a new potential anti-PRRSV strategy targeting the N-Nsp9 and/or N-DHX9 interaction.


title: AKI and Collapsing Glomerulopathy Associated with COVID-19 and APOL 1 High-Risk Genotype.

text: BACKGROUND Kidney involvement is a feature of COVID-19 and it can be severe in black patients. Previous research linked increased susceptibility to collapsing glomerulopathy, including in patients with HIV-associated nephropathy, to apo L1 (APOL1) variants that are more common in those of African descent. METHODS To investigate genetic, histopathologic, and molecular features in six black patients with COVID-19 presenting with AKI and de novo nephrotic-range proteinuria, we obtained biopsied kidney tissue, which was examined by in situ hybridization for viral detection and by NanoString for COVID-19 and acute tubular injury-associated genes. We also collected peripheral blood for APOL1 genotyping. RESULTS This case series included six black patients with COVID-19 (four men, two women), mean age 55 years. At biopsy day, mean serum creatinine was 6.5 mg/dl and mean urine protein-creatinine ratio was 11.5 g. Kidney biopsy specimens showed collapsing glomerulopathy, extensive foot process effacement, and focal/diffuse acute tubular injury. Three patients had endothelial reticular aggregates. We found no evidence of viral particles or SARS-CoV-2 RNA. NanoString showed elevated chemokine gene expression and changes in expression of genes associated with acute tubular injury compared with controls. All six patients had an APOL1 high-risk genotype. Five patients needed dialysis (two of whom died); one partially recovered without dialysis. CONCLUSIONS Collapsing glomerulopathy in black patients with COVID-19 was associated with high-risk APOL1 variants. We found no direct viral infection in the kidneys, suggesting a possible alternative mechanism: a "two-hit" combination of genetic predisposition and cytokine-mediated host response to SARS-CoV-2 infection. Given this entity's resemblance with HIV-associated nephropathy, we propose the term COVID-19-associated nephropathy to describe it.


title: Frequent detection of respiratory viruses without symptoms: toward defining clinically relevant cutoff values.

text: Highly sensitive techniques, such as PCR, have greatly improved the detection of respiratory viruses. However, the sensitivity of PCR tests also complicates clinical interpretation, as the presence of small amounts of viral targets may not necessarily have clinical relevance. We performed a prospective case-control study in asymptomatic and symptomatic young children. PCR detection of 14 respiratory viruses was performed in nasal washes, and results were quantified in copies per milliliter. A total of 141 cases and 157 controls were included. In 72% of the cases and 28% of the controls, at least one virus was identified. When stratified for age, at least one virus was identified in 47% of the controls younger than 1 year old. Rhinovirus (RV) was frequently detected in both symptomatic and asymptomatic individuals. Receiver operating characteristic analysis for quantitative rhinovirus detection showed that cutoff values for clinical relevance are feasible for RV. In contrast to rhinovirus, respiratory syncytial virus (RSV) was rarely detected in controls, suggesting that a positive RSV test result is almost always of clinical relevance, independent of viral quantity. In conclusion, our study shows that asymptomatic carriage of a respiratory virus occurs frequently in young children. However, significant differences in the amount of virus present were observed between cases and controls. This suggests that defining cutoff levels should be feasible and represents the next necessary step for diagnosing viral respiratory infections using molecular tests.


title: Judicious Use of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Diabetes on Coronavirus-19 Pandemic.

text: Sodium glucose cotransporter-2 inhibitors (SGLT2i), a novel anti-diabetic drug blocks the reabsorption of glucose in proximal tubules of kidney, are demonstrated to have cardiovascular and renal benefits for people with diabetes. The benefits are associated with the significant increase of intrarenal angiotensin-converting enzyme II (ACE2) expression and blood volume contraction. However, the increased ACE2 may be detrimental to patients infected with the coronavirus infection 2019 (COVID-19), which is found to invades cells via the entry receptor of ACE2. Besides, SGLT2i induced natriuretic effect may also increase the risk of acute kidney injury and affect the hemodynamic stability during systemic infection disease. In the article, we explain the mechanisms why the use of SGLT2i in people with diabetes may lead to worse outcomes and suggest clinician to judiciously use it during COVID-19 pandemic.


docid: xvpiczew

title: The lab without walls: a deployable approach to tropical infectious diseases.

text: The Laboratory Without Walls is a modular field application of molecular biology that provides clinical laboratory support in resource-limited, remote locations. The current repertoire arose from early attempts to deliver clinical pathology and public health investigative services in remote parts of tropical Australia, to address the shortcomings of conventional methods when faced with emerging infectious diseases. Advances in equipment platforms and reagent chemistry have enabling rapid progress, but also ensure the Laboratory Without Walls is subject to continual improvement. Although new molecular biology methods may lead to more easily deployable clinical laboratory capability, logistic and technical governance issues continue to act as important constraints on wider implementation.


title: Laparoscopic transabdominal preperitoneal (TAPP) hernia repair via a single port.

text: INTRODUCTION To report our initial experience and outcome of 7 cases of single port laparoscopic transabdominal preperitoneal (TAPP) hernia repair. METHODS Between May 2009 and June 2010, 7 patients underwent single port TAPP hernia repair for inguinal hernia. The device was placed through a single 2 cm infraumbilical incision. Patients' demographics, hernia characteristics, operative time, conversion rate, intraoperative and postoperative complications, and recurrence were measured. Five patients had unilateral and 2 had bilateral hernias. RESULTS The mean operative time was 67 minutes (range: 36 to 111 min). None of the patients required any conversion to conventional TAPP. No intraoperative and postoperative complications were recorded and no recurrences have been recorded to the present with a median follow-up of 6 months (range: 2 to 8 mo). CONCLUSIONS Single port TAPP hernia repair is safe and feasible. Further study is needed to evaluate the benefits of this novel approach compared with the conventional laparoscopic approach.


title: Clinical challenges in isolation care.

text: OVERVIEW In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.


title: Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management.

text: PURPOSE The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA. METHODS This study was performed on surviving adult comatose patients after CA treated with TTM. The average scores of rSO2 was measured at 6h intervals for the first 2days and once a day for the following 3days with a NIRS device during TTM. The CPC scale was used to define the neurologic outcomes of patients. We compared the correlations of rSO2 values between good (CPC 1-2) and poor (CPC 3-5) neurologic outcomes in CA patients. RESULTS There was no statistically significant difference identified between the prognosis groups in terms of rSO2, CPR durations, hemoglobin values and admission body temperature (p>0.05). When the variation in rSO2 values over time is investigated, though there was no significant difference between the good and poor prognosis groups, it appeared to fall in the first 6h in both prognosis groups. The median NT-proBNP and lactate values were observed to be higher in the poor prognosis group. CONCLUSION There is no significant correlation between rSO2 values and neurologic outcomes. Multimodal monitoring methods may be useful and further studies with a larger patient population are necessary in this area.


title: Multicompartment polymer nanostructures with ratiometric dual-emission pH-sensitivity.

text: Pyrazine-labeled multicompartment nanostructures are shown to exhibit enhanced pH-responsive blue-shifted fluorescence emission intensities compared to their simpler core-shell spherical analogs. An amphiphilic linear triblock terpolymer of ethylene oxide, N-acryloxysuccinimide, and styrene, PEO(45)-b-PNAS(105)-b-PS(45), which lacks significant incompatibility for the hydrophobic block segments and undergoes gradual hydrolysis of the NAS units, underwent supramolecular assembly in mixtures of organic solvent and water to afford multicompartment micelles (MCMs) with a narrow size distribution. The assembly process was followed over time and found to evolve from individual polymer nanodroplets containing internally phase segregated domains, of increasing definition, and ultimately to dissociate into discrete micelles. Upon covalent cross-linking of the MCMs with pH-insensitive pyrazine-based diamino cross-linkers, pH-responsive, photonic multicompartment nanostructures (MCNs) were produced. These MCNs exhibited significant enhancement of overall structural stability, in comparison with the MCMs, and internal structural tunability through the cross-linking chemistry. Meanwhile, the complex compartmentalized morphology exerted unique pH-responsive fluorescence dual-emission properties, indicating promise in ratiometric pH-sensing applications.


Acute-on-chronic stress in the time of COVID-19: assessment considerations for vulnerable youth populations.


title: Immune responses of mice immunized by DNA plasmids encoding PCV2 ORF 2 gene, porcine IL-15 or the both.

text: Porcine circovirus type 2 (PCV2) is associated with many kinds of diseases including postweaning multisystemic wasting syndrome (PMWS). It affects the immune system of swine and causes huge epidemic losses every year. In our previous study, we provided evidence that DNA plasmid bearing porcine IL-15 (pVAX-pIL-15) might serve as an immune enhancer for DNA plasmid encoding porcine reproductive and respiratory syndrome virus GP5 gene. In this study, PCV2 open reading frame (ORF)2 gene was cloned into the eukaryotic expression vector pVAX, resulting in the plasmid pVAX-PCV2-ORF2. Transient expression of the plasmid in BHK-21 cells could be detected using immunofluorescence assay. Experimental mice were divided into 5 groups and immunized with PBS, pVAX, pVAX-pIL-15, pVAX-PCV2-ORF2 or pVAX-pIL-15 plus pVAX-PCV2-ORF2. The results showed that the mice co-inoculated with pVAX-PCV2-ORF2 plus pVAX-pIL-15 had higher humoral and cellular immune responses than the others. In addition, DNA plasmid bearing PCV2 ORF2 gene had a protective effect against challenge with PCV2 in mice which could be promoted with the utilization of pIL-15.


title: Successful Surgical Therapy of a Double Aortic Arch in a 10-Month-Old Mixed Breed Dog.

text: A 10-month-old female spayed mixed breed dog with a suspected vascular ring anomaly was presented for exercise intolerance and wheezing. Computed tomography (CT) revealed a double aortic arch. The smaller right aortic arch was successfully ligated via right 4th intercostal thoracotomy. The patient was discharged one day postoperatively and continued to have good outcome at recheck 3.5 weeks after surgery. This is the 4th documented case of double aortic arch with a successful outcome. Preoperative CT scan was vital in preoperative planning and should be strongly recommended in all cases of suspected vascular ring anomalies with atypical presentation.


title: Hemodialysis Arteriovenous Access Occlusion Using the Amplatzer Vascular Plug in Patients with Intractable Arm Edema.

text: OBJECTIVES Vascular occlusion of hemodialysis arteriovenous access (AVA) using an Amplatzer vascular plug (AVP; St. Jude Medical, St. Paul, MN, USA) is an arising and alternative practice in selected patients; however, few reported cases can be found in the literature. Herein, we report on our experience with endovascular treatment of complicated AVA. MATERIALS AND METHODS From September 2015 to December 2016, 3 patients at our clinic underwent an occlusion of hemodialysis AVA with 2 different Amplatzer vascular plugs: 2 patients with type II and 1 patient with type IV. Of these, 1 patient was treated for an autologous radiocephalic fistula, the second patient was treated for an autologous brachiocephalic fistula located at the elbow, and the third was, instead, treated for a radiocephalic forearm fistula. The reason for closing the AVA in all patients was due to the presence of dialysis-associated steal syndrome with critical hand ischemia and intractable ipsilateral edema. RESULTS All AVAs were treated using an AVP. No plug migration, access revascularization, persistent ischemia, nor other complications were observed. CONCLUSION This report suggests that the use of AVP for embolization of complicated AVA is a safe and reasonable alternative to open surgery in selected patients.


title: Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis.

text: BACKGROUND Whether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate. METHODS This study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI). Sensitivity analysis was performed by distinguishing between studies including dMTE patients eligible for IVT (IVT-E) or ineligible for IVT (IVT-IN). Primary outcome measures were functional independence (modified Rankin Scale≤2) and mortality at day 90, successful reperfusion, and symptomatic intracerebral hemorrhage. RESULTS Twenty studies, incorporating 5279 patients, were included. There was no evidence that rates of successful reperfusion differed in dMTE and IVT+MTE patients (sOR 0.93, 95% CI 0.68 to 1.28). In studies including IVT-IN dMTE patients, patients undergoing dMTE tended to have lower rates of functional independence and had higher odds for a fatal outcome as compared with IVT+MTE patients (sOR 0.78, 95% CI 0.61 to 1.01 and sOR 1.45, 95% CI 1.22 to 1.73). However, no such treatment group effect was found when analyses were confined to cohorts with a lower risk of selection bias (including IVT-E dMTE patients). CONCLUSION The quality of evidence regarding the relative merits of IVT+MTE versus dMTE is low. When considering studies with lower selection bias, the data suggest that dMTE may offer comparable safety and efficacy as compared with IVT+MTE. The conduct of randomized-controlled clinical trials seems justified.


title: Intraoperative awareness: from neurobiology to clinical practice.

text: Intraoperative awareness is defined by both consciousness and explicit memory of surgical events. Although electroencephalographic techniques to detect and prevent awareness are being investigated, no method has proven uniformly reliable. The lack of a standard intraoperative monitor for the brain likely reflects our insufficient understanding of consciousness and memory. In this review, the authors discuss the neurobiology of consciousness and memory, as well as the incidence, risk factors, sequelae, and prevention of intraoperative awareness.


title: Adjunctive visceral artery chimney in patients undergoing Zenith Fenestrated aortic repair.

text: OBJECTIVE Visceral artery chimneys have been employed as an adjunct to endovascular aneurysm repair (EVAR) to treat short-neck infrarenal and juxtarenal aortic aneurysms for more than two decades. With the widespread introduction of fenestrated endovascular aneurysm repair by the Food and Drug Administration-approved Zenith Fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) to the United States in 2012, clinicians gained the ability to apply the chimney technique to these custom devices for difficult anatomy. The purpose of this report was to demonstrate feasibility and to provide evidence on the performance of chimneys for the treatment of complex juxtarenal aneurysms that could not be adequately treated with ZFEN alone. METHODS A retrospective analysis was performed of a prospectively maintained institutional ZFEN database capturing 110 fenestrated endovascular aneurysm repairs from October 2012 to January 2018 to identify patients undergoing a concomitant visceral artery chimney. All patients with <12 months of follow-up were excluded from further analysis. Demographic, anatomic, intraoperative, perioperative, and follow-up characteristics were tabulated and analyzed. RESULTS Six patients met criteria and were included in this investigation. They were universally male with a mean age of 76.2 years at the time of ZFEN/chimney. Chimneys were placed in a total of six visceral arteries (n = 1 per patient) consisting of three renal arteries, two celiac arteries, and one accessory renal artery. Mean estimated blood loss and operative time were 283 mL and 298 minutes, respectively. Technical success was achieved in all cases. Two small type IA "gutter" endoleaks were detected early; both spontaneously resolved on follow-up. We observed no instances of chimney migration, stenosis, or thrombosis perioperatively or on follow-up. Two reinterventions were performed in these six patients; these consisted of a repeated renal stent for ostial stenosis at a main body fenestration and a common femoral artery endarterectomy and patch angioplasty for an access-related common femoral artery occlusion. CONCLUSIONS Use of ZFEN in conjunction with a singular chimney is safe, feasible, and durable in patients with difficult anatomy who do not meet instructions for use as demonstrated in this limited series.


title: Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs.

text: Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.


title: Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis.

text: OBJECTIVE We sought to summarize accuracy of physical examination, imaging, and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in diagnosis of necrotizing soft tissue infection (NSTI) in adults with a soft tissue infection clinically concerning for NSTI. SUMMARY OF BACKGROUND DATA NSTI is a life-threatening diagnosis. Delay to diagnosis and surgical management is associated with increased mortality. METHODS We searched 6 databases from inception through November 2017. We included English-language studies reporting diagnostic accuracy of testing or LRINEC Score. Outcome was NSTI confirmed by surgery or histopathology. Two reviewers screened all citations and extracted data independently. Summary measures were obtained from the Hierarchical Summary Receiver Operating Characteristic model. RESULTS From 2,290 citations, we included 23 studies (n = 5982). Of physical examination signs, pooled sensitivity and specificity for fever was 46.0% and 77.0% respectively, for hemorrhagic bullae 25.2% and 95.8%, and for hypotension 21.0% and 97.7%. Computed tomography (CT) had sensitivity of 88.5% and specificity of 93.3%, while plain radiography had sensitivity of 48.9% and specificity of 94.0%. Finally, LRINEC ≥ 6 had sensitivity of 68.2% and specificity of 84.8%, while LRINEC ≥ 8 had sensitivity of 40.8% and specificity of 94.9%. CONCLUSIONS Absence of any 1 physical examination feature (eg, fever or hypotension) is not sufficient to rule-out NSTI. CT is superior to plain radiography. LRINEC had poor sensitivity, and should not be used to rule-out NSTI. Given the poor sensitivity of these tests, a high clinical suspicion warrants early surgical consultation for definitive diagnosis and management.


title: Robotic radical cystectomy: where are we today, where will we be tomorrow?

text: While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non-muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade. The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy. While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up. This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.


title: Effect of positive end-expiratory pressure on ductal shunting and systemic blood flow in preterm infants with patent ductus arteriosus.

text: BACKGROUND Left to right (L-R) shunting through a patent ductus arteriosus (PDA) can reduce systemic and cerebral blood flow in preterm infants. To minimize this, the positive end-expiratory pressure (PEEP) is often raised to increase pulmonary vascular resistance and reduce L-R shunting. The effects of this maneuver on systemic and cerebral hemodynamics and oxygenation are not well documented. OBJECTIVE To compare the effects of different PEEP on the left ventricular output (LVO), superior vena cava (SVC) flow, LVO/SVC flow ratio, cerebral oxygenation (CrSO2) and gas exchange in mechanically ventilated preterm infants with PDA. METHODS Sixteen mechanically ventilated infants of 23-30 weeks' gestational age with L-R shunting through the PDA were studied. Ultrasound measurements of LVO and SVC flow, CrSO2, arterial oxygen saturation and transcutaneous CO2 tension (TcPCO2) obtained at PEEP of 2 and 8 cm H2O were compared with baseline values at 5 cm H2O. RESULTS There was a small but significant reduction in LVO and the LVO/SVC flow ratio at PEEP of 8 compared to 5 cm H2O. SVC flow and CrSO2 did not differ significantly. CONCLUSIONS Increasing PEEP to 8 cm H2O in ventilated preterm infants with a PDA produced a modest decrease in L-R ductal shunting as indicated by a lower LVO/SVC flow ratio. The higher PEEP did not have a significant effect on cerebral perfusion or oxygenation.


Skin-to-Skin Care and COVID-19.


title: Tuberculosis control: lessons for outbreak preparedness in correctional facilities.

text: Correctional facilities typically house large numbers of persons in close and crowded conditions for long periods. Clusters of communicable diseases ranging from simple viral upper respiratory infections to more serious threats, such as tuberculosis (TB), infections with methicillin-resistant Staphylococcus aureus, and influenza, often emerge in these surroundings. The recent H1N1 influenza pandemic highlights the importance of outbreak prevention and containment preparedness, particularly in congregate settings. In this commentary, the authors propose that the TB control model can provide valuable lessons for infection control practitioners to prepare for, identify, investigate, and control outbreaks of communicable diseases to prevent transmission in correctional facilities and to the surrounding community.


Conventional wisdom: unconventional virus.


OPERATIONAL RECOMMENDATIONS FOR THE ATTENTION AND PREVENTION OF SARS-COV-2 INFECTION AT INTERVENTIONAL BRONCHOSCOPY UNITS.


title: Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey.

text: A rapid cross-sectional survey was conducted across India among frontline allopathic doctors to know their prime concerns. Four hundred and five responses were received from 16 states and 3 union territories. Among doctors working in COVID-dedicated hospitals, 56.18% are formally trained for the same, and 40.5% of these are satisfied with the training. 47.3% of these have personal protective equipment (PPE) kits, 35.1% have no PPE kits, and 17.6% are not aware of their availability. 31.1% of doctors reported attending to COVID suspects without PPE. 58.1% of institutions have a dedicated task force, 20.3% do not, whereas 21.6% of doctors are not aware of such a task force. Only 21.6% of the participants consider their institution to be fully prepared for COVID. After performing COVID duties, 45.9% are being provided with an alternative place of stay, whereas only 16.2% have been quarantined. In non-COVID institutions, 82.4% of doctors are using protective gear, of these 35.2% procured them on their own.


docid: eewtvjen

title: Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding "Zoom Fatigue".


title: Are Females More Resistant to Extreme Neuromuscular Fatigue?

text: PURPOSE Despite interest in the possibility of females outperforming males in ultraendurance sporting events, little is known about the sex differences in fatigue during prolonged locomotor exercise. This study investigated possible sex differences in central and peripheral fatigue in the knee extensors and plantar flexors resulting from a 110-km ultra-trail-running race. METHODS Neuromuscular function of the knee extensors and plantar flexors was evaluated via transcranial magnetic stimulation (TMS) and electrical nerve stimulation before and after an ultra-trail-running race in 20 experienced ultraendurance trail runners (10 females and 10 males matched by percent of the winning time by sex) during maximal and submaximal voluntary contractions and in relaxed muscle. RESULTS Maximal voluntary knee extensor torque decreased more in males than in females (-38% vs -29%, P = 0.006) although the reduction in plantar flexor torque was similar between sexes (-26% vs -31%). Evoked mechanical plantar flexor responses decreased more in males than in females (-23% vs -8% for potentiated twitch amplitude, P = 0.010), indicating greater plantar flexor peripheral fatigue in males. Maximal voluntary activation assessed by TMS and electrical nerve stimulation decreased similarly in both sexes for both muscle groups. Indices of knee extensor peripheral fatigue and corticospinal excitability and inhibition changes were also similar for both sexes. CONCLUSIONS Females exhibited less peripheral fatigue in the plantar flexors than males did after a 110-km ultra-trail-running race and males demonstrated a greater decrease in maximal force loss in the knee extensors. There were no differences in the magnitude of central fatigue for either muscle group or TMS-induced outcomes. The lower level of fatigue in the knee extensors and peripheral fatigue in the plantar flexors could partly explain the reports of better performance in females in extreme duration running races as race distance increases.


title: Phospholipid Oxygen Microbubbles for Image-Guided Therapy.

text: In recent work, oxygen microbubbles (OMB) have been shown to oxygenate hypoxic tumors, increase radio-sensitivity and improve tumor control by radiation therapy. Compared to intra-tumoral injection, intravenous delivery of adjuvant agents such as OMBs for radiotherapy offers an attractive means of achieving true theranostic function in a minimally invasive manner via contrast-enhanced ultrasound (CEUS), while reducing the risk of injury, infection or displacing tumor cells. However, short intravascular circulation times with conventional DSPC-lipid OMBs may lead to premature off-target dissolution of OMBs with an associated reduction in tumoral oxygen delivery. Prior work on microbubble stability and gas exchange suggests that increasing phospholipid acyl-chain length of the encapsulating shell and OMB size may increase circulation persistence, delivery and dissolved oxygen content. In the following studies, we investigate the effect of two phospholipid shell compositions, DSPC (C18:0) and DBPC (C22:0), as well as three size distributions (0.5-2 µm, 2-10 µm and polydisperse) on OMB circulation persistence utilizing CEUS in the kidneys of live C57B1/6 male and female mice, six weeks of age. DBPC OMB formulations demonstrated increased circulation half-lives versus DSPC formulations (2.4 ± 1.0 vs. 0.6 ± 0.5 s, p<0.01 for 2-10 µm), as well as an increased maximum intensity by over tenfold (p<0.01). Size-dependent effects remained consistent across both formulations with larger 2-10 µm microbubbles demonstrating significantly increased half-lives (2.4 ± 1.0 vs. 0.3 ± 0.2 s, p < 0.01) compared to smaller 0.5-2 µm formulations of DBPC. These studies indicate that DBPC 2-10 µm OMBs may be improved adjuvant agents for radiotherapy with significant potential for CEUS interrogation.


title: Safe transection of aberrant arteries associated with pulmonary sequestrations.

text: BACKGROUND Video-assisted thoracoscopic surgery (VATS) lobectomy is increasingly used for pulmonary sequestration; however, there are few descriptions of safe handling of the aberrant artery. Here we clarify the safe handling of an aberrant artery using a clinical review and an experimental model. METHODS We retrospectively reviewed the records of patients who underwent lobectomy for pulmonary sequestration with aberrant arteries at the Nippon Medical School between January 2008 and December 2010. This was supplemented by an experimental pressure test using vessels obtained from pigs. RESULTS We identified four patients with aberrant arteries that were successfully occluded via either stapling. In the experimental model, we divided pig vessels into small-diameter (S) and large-diameter (L) groups. The 1.0-mm-high staples were stronger in the S group than in the L group (p = 0.028). In the L group, the 2.0-mm-high staples were stronger than the 1.0-mm staples (p = 0.015). Leakage from the staple line was associated with a poorer B-shape of inserted staples. CONCLUSIONS The techniques described in this report are useful in successful minimally invasive transection of an aberrant artery (other than very thin vessels) when resecting a pulmonary sequestration by stapler only. A detailed investigation should be performed to determine the most appropriate stapler or cartridge.


title: Pathogenesis of Thromboembolism and Endovascular Management.

text: Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.


docid: pvyomwqa

title: The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery.

text: Background Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients. Methods Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given. Results There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS. Conclusion SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.


title: Niti CAR 27 Versus a Conventional End-to-End Anastomosis Stapler in a Laparoscopic Anterior Resection for Sigmoid Colon Cancer.

text: PURPOSE The Niti CAR 27 (ColonRing) uses compression to create an anastomosis. This study aimed to investigate the safety and the effectiveness of the anastomosis created with the Niti CAR 27 in a laparoscopic anterior resection for sigmoid colon cancer. METHODS In a single-center study, 157 consecutive patients who received an operation between March 2010 and December 2011 were retrospectively assessed. The Niti CAR 27 (CAR group, 63 patients) colorectal anastomoses were compared with the conventional double-stapled (CDS group, 94 patients) colorectal anastomoses. Intraoperative, immediate postoperative and 6-month follow-up data were recorded. RESULTS There were no statistically significant differences between the two groups in terms of age, gender, tumor location and other clinical characteristics. One patient (1.6%) in the CAR group and 2 patients (2.1%) in the CDS group experienced complications of anastomotic leakage (P = 0.647). These three patients underwent a diverting loop ileostomy. There were 2 cases (2.1%) of bleeding at the anastomosis site in the CDS group. All patients underwent a follow-up colonoscopy (median, 6 months). One patient in the CAR group experienced anastomotic stricture (1.6% vs. 0%; P = 0.401). This complication was solved by using balloon dilatation. CONCLUSION Anastomosis using the Niti CAR 27 device in a laparoscopic anterior resection for sigmoid colon cancer is safe and feasible. Its use is equivalent to that of the conventional double-stapler.


The Value and Ethics of Using Technology to Contain the COVID-19 Epidemic.


docid: aholnesl

title: Mesh expansion as the cause of bulging after abdominal wall hernia repair.

text: BACKGROUND Recurrence is the most important complication of abdominal wall reconstruction. It is possible the repair itself is intact, but bulging or expansion of mesh causes recurrent swelling's of the abdominal wall. CASE SUMMARY In this report, we present bulging of a polyester mesh due to central pore expansion. DISCUSSION Repetitive stress and variations in intra-abdominal pressure can change tensile strength and stretches mesh materials. CONCLUSION A swelling after abdominal wall repair can be caused by bulging of the mesh. A progressive bulging might be the result of failure of the mesh implant due to elongation. Mesh characteristics should be considered when choosing a feasible and suitable mesh for abdominal wall reconstruction. Clinical distinction between recurrent hernia and mesh bulging is difficult but therapeutically irrelevant in symptomatic patients.


title: Ephedrine and phenylephrine induce opposite changes in cerebral and paraspinal tissue oxygen saturation, measured with near-infrared spectroscopy: a randomized controlled trial.

text: While the effects of phenylephrine (PE) and ephedrine (E) on cerebral oxygen saturation (rScO2) already has been studied, the effect on paraspinal oxygen saturation (rSpsO2) is still unexplored. This study aims to assess the effect of PE and E on rScO2 and rSpsO2, measured with near-infrared spectroscopy. A randomized 4-treatment cross-over trial was designed in 28 patients under BIS-titrated anaesthesia with sevoflurane. If MAP decreased more than 20% from baseline, incremental doses of PE and/or E were given according to the randomization (group I: E-PE-E, group II: PE-E-PE, group III: E-E-E, group IV: PE-PE-PE). rScO2 and rSpsO2 on T3-T4, T9-T10 and L1-L2 were recorded. Differences in rSO2 (post-pretreatment) within each group were analyzed with paired Student's t test. Differences in effects of PE and E on rScO2 and rSpsO2 were analyzed with linear mixed-modelling. Following PE administration, rScO2 decreased significantly (- 2.7% ± 3.5), while it remained stable following E (- 0.6% ± 3.6). Contrastingly, rSpsO2 at T3-T4, T9-T10 and L1-L2 slightly increased following PE (0.4% ± 2.5, 0.7% ± 2.0 and - 0.1% ± 1.4, respectively), while it decreased after E administration (- 1.3% ± 3.4%, - 0.7% ± 2.6% and - 1.3% ± 2.7%, respectively). Compared to E, PE administration was associated with a significant decrease in rScO2 (- 2.1%, 95% CI [- 3.1%, - 1.2%], p < 0.001). In contrast, compared to PE, E was associated with a significant decrease in rSpsO2 at T3-T4, T9-T10 and L1-L2 (- 2.0%, 95% CI [- 2.8, - 1.1], p < 0.001; - 1.4%, 95% CI [- 2.4%, - 0.4%], p = 0.006; and - 1.5%, 95% CI [- 2.3%, - 0.8%], p < 0.001, respectively). An opposite effect on rScO2 and rSpsO2 was observed after bolus administration of PE and E.


title: Duodenal stump leak following a duodenal switch: A case report.

text: INTRODUCTION Duodenal switch (DS) is a superior choice for surgical weight loss in the super obese patient population. However, there is an associated risk of adverse events following a DS procedure including vitamin deficiencies, bleeding, obstruction, stricture, and leakage. PRESENTATION OF CASE A 37-year-old female with body mass index of 67kg/m(2) and multiple comorbidities underwent a Da Vinci-assisted, laparoscopic, one-stage, single-anastomosis DS procedure. On postoperative day 11, the patient developed persistent nausea, fatigue, and severe abdominal pain. She underwent diagnostic laparoscopy and was found to have hemoperitoneum, which was evacuated, but active bleeding source was not identifiable. Three days later, the patient underwent exploratory laparotomy, for bleeding with duodenal stump blowout. DISCUSSION Duodenal stump blowout is the result from increased pressure caused by distal obstruction with the back up of duodenal contents. Anastomotic leakage/blow-out following surgery when suspected, should be individualized and management strategy should be implemented according to the size of the leak, extent of the abscess, and status of the patient. CONCLUSION Duodenal stump leaks must be diagnosed as early as possible, and treated appropriately with operative intervention. Regardless of the operative technique the key to appropriate treatment is stabilize the patient, repair the duodenal stump, and adequate drainage.


title: Single-incision (with multi-input single-port) laparoscopic colorectal procedures: Early results.

text: OBJECTIVE Single incision laparoscopic surgery (SILS) is a "scar-less" new surgical technique which has been gaining popularity over recent years. In comparison to conventional multiport laparoscopic surgery, SILS is introduced as a less invasive method. This technique has also been applied to colorectal surgery. The aim of the presenting study is to investigate the applicability of SILS and report short term results. MATERIAL AND METHODS We evaluated prospectively collected data of 24 patients who had been operated with "Single Incision Laparoscopic Colon Resection (SILCR)" in our clinic between June 2011-June 2013. Informed consent was obtained from all patients before surgery. Patient data such as ASA and BMI values, need for additional surgery, tumors, number of lymph nodes resected, length of hospital stay, length of surgery, timing of flatus, time to start oral feeding and complications were recorded. RESULTS SILCR was performed in 24 patients. In 13 patients, SILCR was performed for cancer treatment. There was no need for extra ports, conversion to open surgery and stoma creation was also not necessary. Drain was placed in 4 patients. Overall complication rate was 12.5%. The mean number of lymph nodes in 13 patients who underwent SILCR for tumor was found to be 23 (14-33). The mean operative time and length of hospital stay was 177 minutes (110-363) and 5.35 days (4-11) respectively. Anastomotic leakage was not seen in any of the patients. In one patient, urinoma formation due to ureteral leakage was seen which resulted from thermal injury. CONCLUSION When we compare other series with almost the same number of patients' reported SILS results in the literature, we believe that we could draw conclusions from our data. SILS appears to have comparable results to conventional multiport laparoscopic surgery in the hands of experienced surgeons. It seems advantegous as it can be done with conventional laparoscopic instruments in a "scar-less" manner. Prospective randomized trials are necessary to define the benefits of one procedure over the other.


title: Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up.

text: OBJECTIVE To compare the oncological outcomes of laparoscopic radical nephroureterectomy (LNU) vs open NU (ONU) for upper urinary tract transitional cell carcinoma (TCC). PATIENTS AND METHODS Between July 1999 and January 2003, we performed 70 LNUs and 70 ONUs for TCC of the upper urinary tract. ONU was reserved for patients with previous abdominal surgery or with severe cardiac and/or pulmonary problems. Demographic data, tumour staging and histological grading and rates of metastasis were recorded and compared. RESULTS For LNU and ONU the mean operative durations were 240 min and 190 min, respectively. The definitive pathology showed a high incidence of tumour stage pT2 G2 in both LNU and ONU groups. The median follow-up was 60 months. In the LNU group, the 5-year disease-free survival (DFS) was 75%: 100% for pTa, 88% for pT1, 78% for pT2, and 35% for pT3 (P < 0.001). In the ONU group, the 5-year DFS was 73% (LNU vs ONU, P = 0.037): 100% for pTa, 89% for pT1, 75% for pT2 and 31% for pT3 (P < 0.001). CONCLUSION The results of our long-term controlled study support the use of LNU as an effective alternative to ONU in the therapy of upper urinary tract urothelial cancer.


title: What is the effect of bodily illusions on corticomotoneuronal excitability? A systematic review.

text: BACKGROUND This systematic review aimed to summarise and critically appraise the evidence for the effect of bodily illusions on corticomotoneuronal excitability. METHODS Five databases were searched, with two independent reviewers completing study inclusion, risk of bias, transcranial magnetic stimulation (TMS) reporting quality, and data extraction. Included studies evaluated the effect of an illusion that altered perception of the body (and/or its movement) on excitability of motor circuitry in healthy, adult, human participants. Studies were required to: use TMS to measure excitability and/or inhibition; report quantitative outcomes (e.g., motor evoked potentials); compare the illusion to a control or active comparison condition; evaluate that an illusion had occurred (e.g., measured illusion strength/presence). RESULTS Of 2,257 studies identified, 11 studies (14 experiments) were included, evaluating kinaesthetic illusions (n = 5), a rubber hand illusion (RHI) paradigm (n = 5), and a missing limb illusion (n = 1). Kinaesthetic illusions (induced via vision/tendon vibration) increased corticomotoneuronal excitability. Conflicting effects were found for traditional, visuotactile RHIs of a static hand. However, embodying a hand and then observing it move ("self-action") resulted in decreased corticomotoneuronal excitability and increased silent period duration (a measure of Gamma-Aminobutynic acid [GABA]B-mediated intracortical inhibition in motor cortex), with the opposite occurring (increased excitability, decreased inhibition) when the fake hand was not embodied prior to observing movement ("other-action"). Visuomotor illusions manipulating agency had conflicting results, but in the lower risk study, illusory agency over movement resulted in a relative decrease in corticomotoneuronal excitability. Last, an illusion of a missing limb reduced corticomotoneuronal excitability. CONCLUSION While evidence for the effect of bodily illusions on corticomotoneuronal excitability was limited (only 14 experiments) and had a high risk of bias, kinaesthetic illusions and illusions of embodying a hand (and seeing it move), had consistent effects. Future investigations into the role of embodiment and the illusion strength on corticomotoneuronal excitability and inhibition are warranted.


Cervical artery dissection in a young patient with Rubinstein-Taybi syndrome.


Safety fears over drug hyped to treat the coronavirus spark global confusion.


title: Effective Wavelength Range in Photobiomodulation for Tooth Movement Acceleration in Orthodontics: A Systematic Review.

text: Objective: The present systematic review aims to establish an effective range of low-level laser therapy wavelengths to accelerate tooth movement in orthodontic treatments. Materials and methods: The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane randomized controlled trials (RCTs). The protocol (CRD42019117648) was registered in PROSPERO. Results: According to PRISMA guidelines and after applying the inclusion criteria, nine RCTs were included. Three blind reviewers independently assessed the methodological quality and evidence level of selected articles. Evidence level classification was established according to the recommendations of SIGN 50 (Scottish Intercollegiate Guidelines Network 2012) and was high quality being ++, acceptable +, low quality -, unacceptable -, reject 0. Conclusions: The majority of RCTs related to accelerating the tooth movement in orthodontic treatments are ideally between 780 and 830 nm wavelengths. The average increase in speed movement calculated as a percentage of the control group in nine studies is 24%. Further studies are necessary to establish the exact dosimeter in photobiomodulation during orthodontic movement.


docid: wpkeqmfq

title: Using Virtual Environments to Improve Real-World Motor Skills in Sports: A Systematic Review.

text: In many settings, sports training can be difficult to organize, logistically complicated and very costly. Virtual environments (VE) have garnered interest as a tool to train real-world sports skills due to the realism and flexibility that they can deliver. A key assumption of VE-based training is that the learned skills and experiences transfer to the real world, but do they? Using PRISMA guidelines, this systematic review evaluated the available evidence regarding the transfer of motor skills from VE training to real-world sporting contexts. The initial search identified 448 articles, but only 4 of these articles met basic criteria necessary to assess real-world transfer. Key factors regarding the study design, learner characteristics and training environment of these studies are considered. In a relatively new area of research, the findings from these 4 articles are encouraging and provide initial support for the notion that skills training in a VE can improve real-world performance in sports. However, for a wider uptake of VEs in sports training, it is important that more research demonstrates real-world transfer. Study design recommendations are suggested for researchers, developers or trainers who are considering demonstrating real-world transfers from virtual to real-world environments.


title: COVID-19 Pandemic: What Can the West Learn From the East?

text: Differences in public health approaches to control the coronavirus disease 2019 (COVID-19) pandemic could largely explain substantial variations in epidemiological indicators (such as incidence and mortality) between the West and the East. COVID-19 revealed vulnerabilities of most western countries' healthcare systems in their response to the ongoing public health crisis. Hence, western countries can possibly learn from practices from several East Asian countries regarding infrastructures, epidemiological surveillance and control strategies to mitigate the public health impact of the pandemic. In this paper, we discuss that the lack of rapid and timely community-centered approaches, and most importantly weak public health infrastructures, might have resulted in a high number of infected cases and fatalities in many western countries.


title: Comprehensive characterization of mainstream marijuana and tobacco smoke.

text: Recent increases in marijuana use and legalization without adequate knowledge of the risks necessitate the characterization of the billions of nanoparticles contained in each puff of smoke. Tobacco smoke offers a benchmark given that it has been extensively studied. Tobacco and marijuana smoke particles are quantitatively similar in volatility, shape, density and number concentration, albeit with differences in size, total mass and chemical composition. Particles from marijuana smoke are on average 29% larger in mobility diameter than particles from tobacco smoke and contain 3.4× more total mass. New measurements of semi-volatile fractions determine over 97% of the mass and volume of the particles from either smoke source are comprised of semi-volatile compounds. For tobacco and marijuana smoke, respectively, 4350 and 2575 different compounds are detected, of which, 670 and 536 (231 in common) are tentatively identified, and of these, 173 and 110 different compounds (69 in common) are known to cause negative health effects through carcinogenic, mutagenic, teratogenic, or other toxic mechanisms. This study demonstrates striking similarities between marijuana and tobacco smoke in terms of their physical and chemical properties.


docid: oquhgthb

title: Choices.

text: We need to make choices on a daily basis in our practice of medical oncology. In regular times, these choices are evidence-based and backed by science. However, during emergency situations like the current COVID pandemic, these choices are not just tougher to make, but come with the added burden of inadequate evidence to base them on. We attempt to discuss the various issues involved in making difficult choices.