title: Laparoendoscopic single-site myomectomy compared with conventional laparoscopic myomectomy: a multicenter, randomized, controlled trial.

text: OBJECTIVE To compare surgical outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs. conventional laparoscopic myomectomy (LM). DESIGN Multicenter, noninferiority, randomized, controlled trial. SETTING University hospitals. PATIENT(S) A total of 100 subjects with symptomatic uterine myomas were randomly assigned to either LESS-M or conventional LM. Surgical outcomes were comparatively assessed between the groups on the basis of the intention-to-treat principle. INTERVENTION(S) Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S) The time required for uterine defect suturing. RESULT(S) There were no differences in baseline demographics (age, body mass index, surgical indication, number of myomas, and size and location of the largest myoma) between the two groups. The suturing time (mean ± SD) was 21.9 ± 10.7 minutes (95% confidence interval 18.8-24.9 min) for the LESS-M group and 23.3 ± 12.4 minutes (95% confidence interval 19.8-26.9 min) for the conventional LM group, with no significant difference between the two groups. The other surgical outcomes, such as total operative time, operative blood loss, postoperative hemoglobin change, degree of surgical difficulty, postoperative pain scores, operative complication, and length of hospital stay, were similar between the two groups. Three subjects (6%) assigned to the LESS-M group underwent conventional LM because of difficulty in myoma enucleation and suturing, whereas no failure to intended procedure occurred in the conventional LM group (6% vs. 0). CONCLUSION(S) Laparoendoscopic single-site surgery is a feasible and safe treatment option for myomectomy that offers surgical outcomes comparable to those with conventional LM. CLINICAL TRIAL REGISTRATION NUMBER NCT01984632.


European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support.


title: The changing landscape of opioid prescribing: long-acting and extended-release opioid class-wide Risk Evaluation and Mitigation Strategy.

text: Prescriptions for opioid analgesics to manage moderate-to-severe chronic noncancer pain have increased markedly over the last decade, as have postmarketing reports of adverse events associated with opioids. As an unintentional consequence of greater prescription opioid utilization, there has been the parallel increase in misuse, abuse, and overdose, which are serious risks associated with all opioid analgesics. In response to these concerns, the Food and Drug Administration announced the requirement for a class-wide Risk Evaluation and Mitigation Strategy (REMS) for long-acting and extended-release (ER) opioid analgesics in April 2011. An understanding of the details of this REMS will be of particular importance to primary care providers. The class-wide REMS is focused on educating health care providers and patients on appropriate prescribing and safe use of ER opioids. Support from primary care will be necessary for the success of this REMS, as these clinicians are the predominant providers of care and the main prescribers of opioid analgesics for patients with chronic pain. Although currently voluntary, future policy will likely dictate that providers undergo mandatory training to continue prescribing medications within this class. This article outlines the elements of the class-wide REMS for ER opioids and clarifies the impact on primary care providers with regard to training, patient education, and clinical practice.


title: Functional characterization of a low-frequency V1937I variant in FASN associated with susceptibility to esophageal squamous cell carcinoma.

text: Metabolic reprogramming has been regarded as one of the core hallmarks of cancer and increased de novo fatty acid synthesis has been documented in multiple tumors including esophageal squamous cell carcinoma (ESCC). Our previous exome-wide analyses found a Val1937Ile variant (rs17848945) in the 34th exon of fatty acid synthase (FASN) that showed a strong association with the risk of ESCC. In this study, we performed a series of functional assays to investigate the biological functions underlying this variant in the development of ESCC. We demonstrated that FASN was upregulated in ESCC and both knockdown and knockout of FASN significantly inhibited ESCC cell proliferation, suggesting a tumor promoter role for this gene in ESCC. Furthermore, the results showed that overexpression of FASN[I] in the ESCC cells substantially enhanced cell proliferation, compared with overexpression of FASN[V], or the control vector. Intriguingly, we found that the FASN[I] variant can enhance the enzyme activity of FASN, and, thus, increase the amount of the FASN end-product, palmitate in the ESCC cells. We also observed elevated palmitate levels in the plasma of the FASN[I] genotype carriers among a total of 632 healthy Chinese adults. In conclusion, our results suggested that the FASN V1937I variant influenced ESCC cell proliferation and susceptibility by altering the catabolic activity of FASN on palmitate. These findings may highlight an important role of palmitate metabolism in the development of ESCC and may contribute to the personalized medicine of this disease.


title: Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation.

text: BACKGROUND Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices. METHODS We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken. RESULTS Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values. CONCLUSION Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought.


title: Usefulness of Parasternal Intercostal Muscle Ultrasound during Weaning from Mechanical Ventilation.

text: BACKGROUND The assessment of diaphragm function with diaphragm ultrasound seems to bring important clinical information to describe diaphragm work and weakness. When the diaphragm is weak, extradiaphragmatic muscles may play an important role, but whether ultrasound can also assess their activity and function is unknown. This study aimed to (1) evaluate the feasibility of measuring the thickening of the parasternal intercostal and investigate the responsiveness of this muscle to assisted ventilation; and (2) evaluate whether a combined evaluation of the parasternal and the diaphragm could predict failure of a spontaneous breathing trial. METHODS First, an exploratory evaluation of the parasternal in 23 healthy subjects. Second, the responsiveness of parasternal to several pressure support levels were studied in 16 patients. Last, parasternal activity was compared in presence or absence of diaphragm dysfunction (assessed by magnetic stimulation of the phrenic nerves and ultrasound) and in case of success/failure of a spontaneous breathing trial in 54 patients. RESULTS The parasternal was easily accessible in all patients. The interobserver reproducibility was good (intraclass correlation coefficient, 0.77 (95% CI, 0.53 to 0.89). There was a progressive decrease in parasternal muscle thickening fraction with increasing levels of pressure support (Spearman ρ = -0.61 [95% CI, -0.74 to -0.44]; P < 0.0001) and an inverse correlation between parasternal muscle thickening fraction and the pressure generating capacity of the diaphragm (Spearman ρ = -0.79 [95% CI, -0.87 to -0.66]; P < 0.0001). The parasternal muscle thickening fraction was higher in patients with diaphragm dysfunction: 17% (10 to 25) versus 5% (3 to 8), P < 0.0001. The pressure generating capacity of the diaphragm, the diaphragm thickening fraction and the parasternal thickening fraction similarly predicted failure or the spontaneous breathing trial. CONCLUSIONS Ultrasound assessment of the parasternal intercostal muscle is feasible in the intensive care unit and provides novel information regarding the respiratory capacity load balance. : WHAT WE ALREADY KNOW ABOUT THIS TOPIC: Ultrasound can be used to assess work (i.e., function) and weakness of the diaphragm. This can be helpful in predicting difficulty in weaning patients from mechanical ventilation.Patients who have weakness of the diaphragm may compensate with parasternal muscle activity. However, the feasibility of measuring parasternal intercostal muscle thickening with ultrasound and the ability of these measures to be combined with ultrasound evaluation of the diaphragm in order to predict ability to wean from mechanical ventilation has not been well explored. WHAT THIS ARTICLE TELLS US THAT IS NEW Parasternal intercostal muscle thickness can be measured with ultrasound with good interobserver reproducibility.Parasternal intercostal muscle thickening was responsive to the level of ventilator assistance and significantly higher (i.e., increased) in mechanically ventilated patients with diaphragm dysfunction.The pressure-generating capacity of the diaphragm, the diaphragm-thickening fraction, and the parasternal intercostal muscle-thickening fraction were all significantly associated with failure of a spontaneous breathing trial in mechanically ventilated patients.


title: The messages presented in online electronic cigarette promotions and discussions: a scoping review protocol.

text: INTRODUCTION Electronic cigarettes have become increasingly popular over the last 10 years. These devices represent a new paradigm for tobacco control offering smokers an opportunity to inhale nicotine without inhaling tobacco smoke. To date there are no definite conclusions regarding the safety and long-term health effects of electronic cigarettes; however, there is evidence that they are being marketed online as a healthier alternative to traditional cigarettes. This scoping review aims to identify and describe the breadth of messages (eg, health, smoking-cessation and price related claims) presented in online electronic cigarette promotions and discussions. METHODS AND ANALYSIS A scoping review will be undertaken adhering to the methodology outlined in The Joanna Briggs Institute Manual for Scoping Reviews. Six key electronic databases will be searched to identify eligible studies. Studies must be published in English between 2007 and 2017, examine and/or analyse content captured from online electronic cigarette promotions or discussions and report results for electronic cigarettes separately to other forms of tobacco delivery. Studies will be screened initially by title and abstract, followed by full-text review. Results of the search strategy will be reported in a PRISMA flow diagram and presented in tabular form with accompanying narrative summary. ETHICS AND DISSEMINATION The methodology consists of reviewing and collecting data from publicly available studies, and therefore does not require ethics approval. Results will be published in a peer reviewed journal and be presented at national/international conferences. Additionally, findings will be disseminated via social media and online platforms. Advocacy will be key to informing policy makers of regulatory and health issues that need to be addressed. REGISTRATION DETAILS The review was registered prospectively with The Joanna Briggs Institute Systematic Reviews database.


title: Sleep disturbances and suicidal ideation in sleep medical center patients.

text: OBJECTIVE The purpose of this investigation was two-fold: first, we examined associations between suicidal ideation, maladaptive sleep patterns and abnormal sleep behaviors in a sleep center population, an understudied population in the domain of suicide research; and then, we explored whether significant associations remained after accounting for the possible influence of depressive symptoms. METHOD Data were analyzed from intake information obtained from 1584 adult patients presenting at a community-based private sleep medical center. The sample was parsed into a Suicidal Ideation (SI) group (N=211) and No Suicidal Ideation (NSI) group (N=1373). Comparisons of these groups were made on measures of self-reported sleep complaints, habits, and behaviors, suicidal ideation, depressive symptoms, and associated psychopathology. RESULTS Approximately 13% of participants reported suicidal ideation. Clinically significant suicidal ideation was present in 4.5% of the sample. Compared to the NSI group, the SI group showed a pervasive pattern of significantly greater frequency or severity of sleep problems in areas of insomnia, nightmares and other parasomnia behaviors, poor sleep quality, and sleep-related psychophysiologic conditioning as well as worse sleep-related impairment and quality of life. Several relationships were significant after controlling for depressive symptoms. DISCUSSION Suicidal ideation was consistently associated with a broad array of sleep complaints, even when controlling for level of depressive symptoms. As these self-reported sleep disturbances are treatable sleep disorders, future research should examine the efficacy of sleep and behavioral medicine for reducing the risk of suicidal ideation.


title: Single-Center Experience With Lutonix Drug-Coated Balloons in Infrapopliteal Arteries.

text: PURPOSE To examine patient outcomes following the use of the Lutonix drug-coated balloon (DCB) in patients undergoing endovascular intervention in below-the-knee (BTK) arteries. METHODS A retrospective chart review identified 248 patients who were treated for symptomatic peripheral artery disease with the Lutonix DCB between May 2013 and October 2014. Forty patients were lost to follow-up, leaving 208 patients (mean age 74.1±9.7 years; 138 men) with evaluable data for outcome analysis. The patient cohort suffered from either severe claudication (38.6%) or critical limb ischemia (CLI; 61.4%) in 220 limbs. Almost two-thirds (140, 63.6%) of the 220 target lesions were total occlusions, and 37 (17.8%) of all patients had occlusion of all 3 BTK vessels before intervention. RESULTS Over a median 9-month follow-up, target lesion revascularization occurred in 15.9% of patients with an average time to first reintervention of 8 months. In total, 39 amputations were performed in 31 limbs. However, 17 of these amputations were preplanned minor amputations below the ankle; only 9 (4.1%) major amputations occurred corresponding to 6.6% of the CLI cohort. Freedom from the composite of death or major amputation was estimated as 92% and 85% at 6 and 12 months, respectively, by Kaplan-Meier analysis. In the full cohort, improvement of at least 1 Rutherford category was seen in 130 (59.1%) limbs after 1 year or at the last follow-up, with 104 (80.0%) of those limbs showing an improvement of ≥2 categories. CONCLUSION From this single-center experience, the Lutonix DCB shows therapeutic promise in a disease state where new treatment options are needed.


Interpretation of the association between frequency of self-reported medical errors and faculty supervision of anesthesiology residents.


title: Carotid sacrifice with a single Penumbra occlusion device: a feasibility study in a swine model.

text: INTRODUCTION Carotid sacrifice is a valuable tool in the treatment of select vascular lesions. Traditional coil embolization as the primary means of carotid sacrifice can be expensive, with high radiation exposure. We investigated the feasibility of a novel hybrid coil, the Penumbra occlusion device (POD), for carotid sacrifice in a swine model. METHODS A total of eight common carotid artery sacrifices were performed in fully heparinized pigs under fluoroscopic guidance. A single POD device was deployed within each vessel, and intermittent follow-up angiography was performed to assess flow. RESULTS Complete carotid occlusion was achieved in all cases with a single POD (time range 2-15 min) without any coil migration or intraprocedural complications. Once the anchor zone was stable, no distal migrations were observed during either proximal soft coil packing or during hand injected angiography. Complete occlusion was verified between 2 and 15 min following POD deployment. CONCLUSIONS Carotid artery sacrifice using a novel POD device is safe and effective, allowing for reduced radiation and material costs compared with any other described endovascular technique.


title: CCL20 induced by visfatin in macrophages via the NF-κB and MKK3/6-p38 signaling pathways contributes to hepatic stellate cell activation.

text: Chemokines interact with hepatic resident cells during inflammation and fibrosis. CC chemokine ligand (CCL) 20 has been reported to be important in inflammation and fibrosis in the liver. We hypothesized that visfatin, an adipocytokine, could play a role in hepatic fibrosis via CCL20. We investigated the effect of visfatin on CCL20 in THP-1 human promonocytic cells and examined the molecular mechanisms involved. Following treatment of THP-1 cells with visfatin, CCL20 expression and secretion were assessed. We assessed the intracellular signaling molecules IKK/NF-κB, JAK2/STAT3, MAPKs, and MKK3/6 by western blotting. We treated THP-1 cells with visfatin and signaling inhibitors, and examined CCL20 mRNA and protein levels. To investigate the effect of visfatin-induced CCL20 expression in hepatic stellate cells (HSCs), LX-2 cells were co-cultured with the culture supernatant of THP-1 cells with or without anti-CCL20 neutralizing antibodies, and fibrosis markers were examined by RT-PCR and immunoblotting. In THP-1 cells, visfatin increased the CCL20 mRNA and protein levels. visfatin increased the activities of the NF-κB, p38, and MLK3/6 signaling pathways but not those of the JAK2/STAT3 and ERK pathways. Visfatin treatment together with an NF-κB, p38, or MLK3 inhibitor reduced the mRNA and protein levels of CCL20. The visfatin-induced CCL20 increased the expression of fibrosis markers and CCR6 in HSCs. Following neutralization of CCL20, the levels of fibrosis markers and CCR6 were decreased. Visfatin increases the expression of CCL20 via the NF-κB and MKK3/6-p38 signaling pathways in macrophages, and visfatin-induced CCL20 expression promotes the fibrosis markers in HSCs.


title: Thrombocytopaenia in pregnancy: the importance of differential diagnosis during the COVID-19 pandemic.

text: Since the beginning of the COVID-19 pandemic, an optimal management of vulnerable patients, such as pregnant women, has been regarded as a challenge for healthcare professionals. Although thrombocytopaenia is considered a minor criterion for admission within an intensive care unit, a low platelet count has been observed in COVID-19 patients, including a pregnant woman, who developed severe pulmonary complications. Furthermore, thrombocytopaenia has been proposed as a potential biomarker in order to identify cases at high-risk complications. Nevertheless, thrombocytopaenia is a relatively frequent condition observed in pregnancy. In this context, a differential diagnosis is essential for the correct management of COVID-19 pregnant women.


title: A Hazard Analysis of Class I Recalls of Infusion Pumps.

text: BACKGROUND The adverse event report of medical devices is one of the postmarket surveillance tools used by regulators to monitor device performance, detect potential device-related safety issues, and contribute to benefit-risk assessments of these products. However, with the development of the related technologies and market, the number of adverse events has also been on the rise, which in turn results in the need to develop efficient tools that help to analyze adverse events monitoring data and to identify risk signals. OBJECTIVE This study aimed to establish a hazard classification framework of medical devices and to apply it over practical adverse event data on infusion pumps. Subsequently, it aimed to analyze the risks of infusion pumps and to provide a reference for the risk management of this type of device. METHODS The authors define a general hierarchical classification of medical device hazards. This classification is combined with the Trace Intersecting Theory to form a human-machine-environment interaction model. Such a model was applied to the dataset of 2001 to 2017 class I infusion pump recalls extracted from the Food and Drug Administration (FDA) website. This dataset does not include cases involving illegal factors. RESULTS The proposed model was used for conducting hazard analysis on 70 cases of class I infusion pump recalls by the FDA. According to the analytical results, an important source of product technical risk was that the infusion pumps did not infuse accurate dosage (ie, over- or underdelivery of fluid). In addition, energy hazard and product component failure were identified as the major hazard form associated with infusion pump use and as the main direct cause for adverse events in the studied cases, respectively. CONCLUSIONS The proposed human-machine-environment interaction model, when applied to adverse event data, can help to identify the hazard forms and direct causes of adverse events associated with medical device use.


title: Mobile tablet-based therapies following stroke: a systematic scoping review protocol of attempted interventions and the challenges encountered.

text: BACKGROUND Stroke is a growing global epidemic limiting the ability of millions to function independently due to post-stroke deficits and complications. Although specialized stroke rehabilitation improves the recovery of functional abilities, accessing rehabilitation services has become increasingly challenging as the number of stroke survivors continues to increase and rehabilitation resources remain scarce. Mobile tablet-based therapies (MTBTs) may be a resource-efficient platform for providing stroke rehabilitation services. The feasibility and challenges of offering MTBTs to stroke survivors should be well understood before expensive, large-scale clinical trials are undertaken to study treatment efficacy. METHOD A systematic scoping review will be conducted to describe attempted MTBTs following stroke and the challenges encountered by survivors and study staff. Studies of interest will evaluate MTBTs offered to adult stroke patients in response to post-stroke complications or deficits. Journal databases, gray literature sources, clinical trial registries, relevant organizational websites, and reference lists of eligible studies will be searched to identify suitable studies. Study characteristics, barriers to care, methodological challenges, patient-reported outcomes, and health outcomes will be extracted to describe MTBTs and understand the challenges encountered in context. Results will be presented using descriptive statistics, tables, figures, and narrative description to summarize the scope of the field. DISCUSSION Trends in MTBT feasibility and common challenges will be discussed to summarize major findings and highlight research gaps. Solutions to common challenges experienced by intervention participants and study staff will be proposed. Implications for the conduct of randomized clinical trials of MTBT efficacy and the appropriateness of a systematic review and meta-analysis of completed trials will be discussed. SYSTEMATIC REVIEW REGISTRATION: uO Research ( http://hdl.handle.net/10393/35696 ).


title: Transanal Total Mesorectal Excision: A Novel Approach to Rectal Surgery.

text: Less invasive approaches continue to be explored and refined for diseases of the colon and rectum. The current gold standard for the surgical treatment of rectal cancer, total mesorectal excision (TME), is a technically precise yet demanding procedure with outcomes measured by both oncologic and functional outcomes (including bowel, urinary, and sexual). To date, the minimally invasive approach to rectal cancer has not yet been perfected, leaving ample opportunity for rectal surgeons to innovate. Transanal TME has recently emerged as a safe and effective technique for both benign and malignant diseases of the rectum. While widespread acceptance of this surgical approach remains tempered at this time due to lack of long-term oncologic outcome data, short-term outcomes are promising and there is great excitement surrounding the promise of this technique.


docid: xjeymczf

title: Adaptation and evaluation of a monopolar electrosurgical triangle-tip knife for transendoscopic ventriculocordectomy in healthy horses.

text: OBJECTIVE To evaluate the efficacy and safety of a transendoscopic monopolar electrosurgical triangle-tip knife as instrumentation to perform unilateral ventriculocordectomy (VC) in healthy adult horses. STUDY DESIGN In vivo experimental study. STUDY POPULATION Nine horses donated for medical conditions unrelated to respiratory system. METHODS The triangle-tip knife was applied in contact fashion. Left VC was performed under standing sedation. Endoscopic images of the upper airway were graded for inflammation by 2 masked surgeons preoperatively and immediately, 24 hours and, in 2 cases, 7 and 14 days postoperatively. Four larynxes were examined for histological evidence of inflammation and collagen deposition at 24 hours (n = 2) and at 14 days (n = 2) after surgery. RESULTS Ventriculocordectomy was successfully performed in all horses. Endoscopic evidence of inflammation was scored as normal (preoperatively), mild (immediately postoperatively), mild (24 hours postoperatively), mild (7 days postoperatively), and normal (14 days postoperatively). According to histopathology, inflammation of the surgical site and ventricularis muscle was generally increased (variable is common and is present in most high-power fields) 24 hours and 14 days postoperatively. Fibrosis and collagen deposition also seemed increased at the surgical site 14 days postoperatively. CONCLUSION Ventriculocordectomy was successfully performed with an electrosurgical triangle-tip knife and resulted in acceptable short-term outcomes. CLINICAL SIGNIFICANCE The use of an electrosurgical triangle-tip knife alternative instrumentation may be offer an alternative option to perform VC in practices when diode laser is not available or is cost prohibitive. Longer term evaluation of the VC site is required to determine the effect on rima glottic cross-sectional area.


title: Landiolol for managing atrial fibrillation in post-cardiac surgery.

text: Landiolol is an intravenous ultra-short acting beta-blocker which has been used in Japan for many years to prevent and/or to treat post-operative atrial fibrillation following cardiac surgery. The drug is now available in Europe. This article is a systematic review of literature regarding the use of landiolol in that specific surgical setting.


title: Detection of nonstructural protein 6 in murine coronavirus-infected cells and analysis of the transmembrane topology by using bioinformatics and molecular approaches.

text: Coronaviruses encode large replicase polyproteins which are proteolytically processed by viral proteases to generate mature nonstructural proteins (nsps) that form the viral replication complex. Mouse hepatitis virus (MHV) replicase products nsp3, nsp4, and nsp6 are predicted to act as membrane anchors during assembly of the viral replication complexes. We report the first antibody-mediated Western blot detection of nsp6 from MHV-infected cells. The nsp6-specific peptide antiserum detected the replicase intermediate p150 (nsp4 to nsp11) and two nsp6 products of approximately 23 and 25 kDa. Analysis of nsp6 transmembrane topology revealed six membrane-spanning segments and a conserved hydrophobic domain in the C-terminal cytosolic tail.


title: Clinicopathological features of 11 suspected outbreaks of bovine adenovirus infection and development of a real-time quantitative PCR to detect bovine adenovirus type 10.

text: CASE HISTORY A retrospective study was conducted to investigate 11 outbreaks of presumptive fatal adenovirus infection diagnosed through two New Zealand diagnostic laboratories during 2014 and 2015. Outbreaks occurred in 6-12-month-old Friesian or Friesian cross cattle during autumn, winter and spring. Individual outbreaks were short in duration, with mortality rates ranging from 3/250 to 20/600 (1.2 to 3.3%). CLINICAL AND PATHOLOGICAL FINDINGS Clinical signs included severe diarrhoea, depression, recumbency, and death. Post-mortem examination revealed congestion and oedema of the alimentary tract and fluid to haemorrhagic intestinal contents. Histopathological lesions were characterised by congestion and haemorrhage of the alimentary tract mucosa, oedema of the submucosa, and mild interstitial inflammation in the kidneys. Large basophilic intranuclear inclusion bodies were identified in vascular endothelial cells of the alimentary tract in 11/11 cases and of the kidney in 8/9 cases. MOLECULAR TESTING A real-time quantitative PCR (qPCR) assay was designed to detect bovine adenovirus type 10 (BAdV-10) using hexon gene sequences available in GenBank. DNA extracted from a field case and confirmed by sequencing was used as a positive control. The qPCR had a reaction efficiency of 101% (R(2)=0.99) and the limit of detection was <10 DNA copies/reaction. The qPCR detected BAdV-10 in formalin-fixed paraffin-embedded (FFPE) tissue from 10/11 cases. DNA sequencing of PCR products from nine of these cases showed them to be identical to BAdV-10 sequences in GenBank. For the PCR-negative case, the PCR product had a hexon sequence 99% similar to bovine adenovirus Wic isolate Ma20-1, a close relative of BadV-10. DIAGNOSIS Bovine adenovirus type 10 was identified in FFPE tissues from cattle with histopathological evidence of adenovirus infection. CLINICAL RELEVANCE Bovine adenoviruses, and especially BAdV-10, should be considered in the differential diagnosis for acute enteric disease and death in young cattle. The qPCR detected BAdV-10 from FFPE tissue of cattle with suspected adenoviral infection diagnosed by histopathology. However results should be interpreted in light of clinical and pathological findings due to the possibility of adenovirus shedding by healthy cattle and the presence of pathogenic adenoviruses other than BAdV-10.


title: Strange Days.

text: As people around the globe grapple with the COVID-19 pandemic it is difficult to know what to write in this space. Given publication lags, academic periodicals like Medical Education are a terrible place for "news" at the best of times. Our recently started release of "Accepted Articles" ensures this editorial will be made public in days rather than months, but the current situation is changing for many of us by the hour. With no capacity to know the future, the only claim I can make with confidence is that things are different now, when you're reading this text, relative to when it was written.


A minimally invasive technique utilizing percutaneous and endoscopic rendezvous for successful treatment of a proximal bile leak following partial hepatectomy.


title: Removable and repositionable covered metal self-expandable stents for leaks after upper gastrointestinal surgery: experiences in a tertiary referral hospital.

text: BACKGROUND Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks. METHODS Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described. RESULTS Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation. CONCLUSIONS RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem.


title: The ICMR bulletin on targeted hydroxychloroquine prophylaxis for Covid-19: Need to interpret with caution.

text: The National Task Force for Covid-19 of the Indian Council of Medical Research (ICMR) in a bulletin dated March 21, 2020 recommended the use of hydroxychloroquine for prophylaxis in asymptomatic health care workers caring for suspected or confirmed patients and household contacts of confirmed patients. This is cause for concern with regard to bioethics and good clinical practice. The evidence for the efficacy of chloroquine and hydroxychloroquine is currently derived from open label trials and cell culture studies with no conclusive evidence available from randomised clinical trials. Hydroxychloroquine also carries contraindications in the case of conditions such as maculopathy, retinopathy and QTc prolongation and should be used with caution in vulnerable populations such as children, pregnancy, lactation and the elderly. Despite this, there has been a rush to procure and self-medicate with hydroxychloroquine, which has been addressed by the National Task Force. The WHO and the FDA have not found adequate evidence to recommend any specific medication for the treatment of Covid-19. While further evidence is awaited, including from trials registered with the FDA and the ICMR, it is recommended that the administration of hydroxychloroquine for chemo-prophylaxis be considered on a case by case basis with monitoring by a registered medical practitioner including electrocardiography (ECG). The potential for retinal and cardiac toxicity must also be borne in mind. It is further recommended that a public advisory regarding the need for caution in chemo-prophylaxis be made available in the public domain. Keywords: Coronavirus, Covid-19, SARS-CoV-2, hydroxychloroquine, chloroquine, chemoprophylaxis, bioethics, evidence- based medicine.


Epidemiological and clinical characteristics of a familial cluster of COVID-19.


title: Retrospective Review of 516 Implantations of Option Inferior Vena Cava Filters at a Single Health Care System.

text: PURPOSE To retrospectively evaluate the safety, efficacy, and retrievability of Option inferior vena cava (IVC) filters. MATERIALS AND METHODS All patients (N = 516; 247 women; mean age, 67.1 y ± 15.1; range, 19.5-101.6 y) who received an Option filter between August 2009 and March 2015 at a single health care system were analyzed. RESULTS The study duration was 68 months, with median clinical follow-up of 7.1 months (range, 1 d to 61.8 mo). During follow-up, 73 of 83 patients (88.0%) underwent successful filter retrieval, 153 died (including three after successful retrieval), and 293 remained alive with filters in situ. Seventeen cases of breakthrough pulmonary embolism (PE) occurred (3.4%). Among 323 patients with direct filter imaging, there were two cases of tilt > 15°, one case of filter deformity, 16 cases of intracaval migration > 2 cm, and no cases of filter fracture. There were six cases of caval occlusion, nine cases of thrombus trapped inside the filter, and 57 cases of limb penetration on computed tomography scans or radiographs of the IVC. Retrieval failures were attributed to filter tilt or tip embedment in the caval wall (n = 4), complete IVC thrombosis (n = 3), thrombus inside the filter (n = 2), or inability to disengage filter legs (n = 1). Recurrent deep vein thrombosis occurred in 34 patients, including 32 with filters in situ and two whose filters had been removed. CONCLUSIONS Most Option filters were left in situ for permanent indications. Rates of successful retrieval, device-related complications, and breakthrough PE were similar to those associated with other retrievable filters.


title: Laparoscopic approach for Wilms tumor.

text: INTRODUCTION Traditionally, radical nephrectomy for Wilms tumor has been performed through an open approach. Advances in minimally invasive surgery have led to the application of these techniques to malignant lesions, including Wilms tumor. We aim to present our experience with laparoscopic nephrectomy (LN) for Wilms tumor. PATIENTS AND METHODS Four patients with Wilms tumor were treated preoperatively with chemotherapy and afterwards underwent an LN and lymph node sampling. Four ports were placed and the tumors were removed without morcellation in an endoscopic bag through an incision by extending the umbilical or the suprapubic port site. RESULTS The average age at the time of surgery was 3 years and 7 months (range, 23 mo to 6 y). There were no intraoperative complications and the blood loss was minimal in all cases. The mean operative time was 125 minutes (range, 90 to 160 min). Among our patients, we had 2 stage IV and 2 stage I cases. The mean time of hospitalization was 3 days (range, 2 to 4 d). There were no long-term complications at the mean follow-up of 3 years and 6 months. CONCLUSIONS LN for Wilms tumor may be considered as an option in selected patients. Minimally invasive surgery allows the surgeon to follow all the oncologic principles required for surgical treatment of this neoplasm and provides the advantages of these techniques for cancer patients. Preoperative chemotherapy is essential to decrease tumor size and facilitate the dissection avoiding tumor rupture.


title: Prone position is associated with mild cerebral oxygen desaturation in elderly surgical patients.

text: PURPOSE A variety of hemodynamic and respiratory alterations accompany patients in the prone position; however the effect of the prone position on intraoperative cerebral saturation has not been studied. We sought to examine whether the incidence of cerebral oxygen desaturation in elderly patients (≥68 years of age) undergoing spine surgery in the prone position was more common than patients undergoing major surgery in the supine position. METHODS We performed a retrospective cohort study of 205 patients; 63 patients underwent surgery in the prone position and 142 in the supine position. Patients were evaluated for cerebral desaturation with bilateral cerebral oximetry. The primary predictor was position, secondary were: length of the surgery, incidence and duration of cerebral desaturation episodes at several thresholds, average time of Bispectral index below threshold of 45 in minutes, average electroencephalogram suppression ratio >0, amount of blood transfused, and the incidence of hypotension and hypertension. RESULTS Elderly spine surgery patients in the prone position were more than twice as likely to experience mild cerebral desaturation as patients in the supine position. Patients in the prone position had longer surgeries; however cerebral desaturation in the prone position was significantly more common even when adjusted for surgery time and the occurrence of intraoperative hypotension. CONCLUSION Cerebral desaturation is related to the prone position in elderly surgery patients. Future studies are necessary to determine whether this translates to a higher incidence of postoperative cognitive dysfunction and delirium.


COVID-19: From Epidemic to Pandemic.


title: Clinical, endoscopic, and histologic characteristics of lymphocytic esophagitis: a systematic review.

text: OBJECTIVE Lymphocytic esophagitis (LyE) is a novel, yet poorly described, clinicopathologic entity. The aim of this systematic review was to characterize the demographic, clinical, endoscopic, and histologic features of LyE in observational studies of adult and pediatric patients. DESIGN We searched the Embase, MEDLINE, and SCOPUS databases for relevant studies in 2018. Two authors reviewed and extracted data from studies that met the inclusion and exclusion criteria. RESULTS We identified 20 studies for analysis of demographic, clinical, and endoscopic features of LyE. The mean age ranged from 9 to 67 years. When pooled, there were 231 (52.7%) patients with LyE that were female. The most common presenting symptom was dysphagia reported in 191 (48.8%) patients. On endoscopy, most patients with LyE tended to have abnormal findings (69.0%), which included erosive esophagitis, multiple esophageal rings, linear furrows, and narrow-caliber esophagus. In the 31 studies used to assess the histologic definition, the cut-off number of intraepithelial lymphocytes (IELs) was reported in 16 (51.6%) studies, peripapillary IEL specification in 18 (58.1%) studies, and presence of spongiosis in 6 (19.4%) studies. CONCLUSION We identified a spectrum of demographic, clinical, and endoscopic findings characteristic of patients with LyE. A consensus on the diagnostic criteria of LyE is required.


title: [Clinical consideration and management of coronavirus disease 2019].

text: Coronavirus disease 2019 (COVID-19) outbreak in Wuhan city, Hubei province in December 2019 and the epidemic so rapidly happened within the whole country and abroad, raising serious problems and urgent concerns, such as: how to control most effectively human-to-human transmission? When does infection rate rise to its peak? What will eventually be the number of infected patients? How to make early diagnosis? What effective antiviral drugs are available? How to use the existing drugs to achieve the best effect? Can available drugs effectively improve the survival rate of critical patients? In view of the above questions, this article now puts forwards the corresponding suggestions and considerations from the perspective of clinical infectious diseases physician.


title: Prospective study evaluating the impact of severity of chronic pain on quality of life after inguinal hernioplasty.

text: PURPOSE The definition of chronic pain after inguinal hernioplasty and the methods of its assessment vary a great deal, which make it complicated to conduct meta-analyses. The primary aim of the present prospective study was to evaluate at which pain severity degree the quality-of-life scores will be reduced. METHOD A prospective study of patients operated for inguinal hernia was conducted. A pain questionnaire and a quality-of-life (QoL) questionnaire were completed. RESULTS Altogether, 370 patients were investigated and included in analysis. Of them, 33.8% experienced pain during different activities. Compared to the non-pain response group, significantly lower QoL scores for the Bodily pain domain were reported by patients who gave 1, 2, or 3 positive responses to the pain questionnaire. Patients with no pain as well as patients who gave 1 positive response to the pain questionnaire and whose VAS score was ≤20 had similar QoL scores for all domains. Patients who gave 1 positive response to the pain questionnaire and whose VAS score was >20, and patients who gave two or more positive responses to the pain questionnaire, showed significantly lower QoL scores in most of the domains compared with the non-pain group. When the patients who gave 1 positive response to the pain questionnaire and whose VAS score was ≤20 were excluded from the group of patients with pain, the rate of chronic pain was 19.7%. Considering the above result, the reduction in the rate of chronic pain from 33.8 to 19.7% was statistically significant. CONCLUSION Pain scores 20 mm or less on the VAS (0 to 100 mm) have no impact on the patients' quality of life. Uniform assessment methods of chronic pain should be developed to improve the quality of research.


title: Induction of Labor in an Intubated Patient With Coronavirus Disease 2019 (COVID-19).

text: BACKGROUND In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. CASE A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. CONCLUSION Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.


title: Safety and Efficacy of the Sofia (6F) PLUS Distal Access Reperfusion Catheter in the Endovascular Treatment of Acute Ischemic Stroke.

text: BACKGROUND Neuroendovascular intervention has become a key treatment option for acute ischemic stroke. The Sofia (6F) PLUS catheter was designed for neurovascular access for diagnostic or therapeutic interventions. OBJECTIVE To report the first series describing use of the Sofia PLUS intermediate/distal access reperfusion catheter in the treatment of acute ischemic stroke. METHODS In this retrospective study, 41 stroke cases were identified in which the catheter was utilized for thrombolysis/thrombectomy. Mean preprocedure National Institutes of Health Stroke Scale score was 16.5 ± 5.2 (range 4-29). Occluded vessels included the M1 segment, M2 segment, internal carotid artery terminus, cervical internal carotid artery, and basilar artery. RESULTS Successful positioning of the Sofia PLUS catheter near the occlusion site was achieved in 38 (92.7%) of 41 cases in which thrombectomy or thrombolysis was attempted using intraarterial tissue plasminogen activator, a direct aspiration first-pass technique, and/or stent retrieval. A postprocedure thrombolysis in cerebral infarction (TICI) score of 2b/3 was achieved in 37 of 41 cases. Of 15 cases where the Sofia PLUS was used for a direct aspiration first-pass technique, TICI 2b/3 was achieved in 11 (73.3%). In one case where intra-arterial tissue plasminogen activator was used as the only treatment modality, TICI 2a was achieved. No device-related or catheter-related complications were observed. The mean 7-d-postprocedure National Institutes of Health Stroke Scale score among the 39 survivors was 8.5 ± 7.3 (range 0-23). CONCLUSION Initial results with use of the Sofia (6F) PLUS for endovascular treatment of acute ischemic stroke have been encouraging. Experience with a larger series is warranted to further evaluate the safety and efficacy of this device and compare it with other reperfusion catheters.


docid: rwtvidiw

title: Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes.

text: Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and ΔNWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) ΔNWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization ( p < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered ΔNWU by 6.3% compared to LVO (95% confidence interval: 3.7-9.0, p < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.


title: SCALE: Skin Changes at Life's End: Final Consensus Statement: October 1, 2009.

text: PURPOSE To enhance the learner's competence with knowledge of Skin Changes at Life's End (SCALE). TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to: 1. Apply SCALE knowledge to patient care scenarios and documentation procedures. 2. Analyze the expert panel's 10 statements on Skin Changes at Life's End (SCALE).


title: Flagellin and pilin immunization against multi-drug resistant Pseudomonas aeruginosa protects mice in the burn wound sepsis model.

text: Pseudomonas aeruginosa is a formidable pathogen and a major threat to burn patients. Antimicrobial therapy is often unsuccessful because P. aeruginosa can develop multi-drug resistance; thus, immunotherapy and vaccine can be a rational alternative. Flagella and type IV pili have been identified as important virulence factors in the colonization and pathogenesis of P. aeruginosa in burn wound infections. Immunogenicity and efficacy of mixed recombinant full-length type b flagellin (r-b-flagellin) and recombinant PilA (r-PilA) as candidate vaccines were assessed by measuring humoral and cellular responses, using an experimental burned mouse model. Primary immunization with "r-b-flagellin+r-PilA" followed by two booster shots was sufficient to generate a robust humoral response, which was predominantly a Th2 response consisting mainly of subtype IgG1 and low levels of IgG2a. Analysis of the cytokine response among immunized mice showed an increased production of IL-4, INF-γ and IL-17 by splenocytes upon stimulation by "r-b-flagellin+r-PilA". Opsonophagocytosis assays confirmed the enhanced killing of bacteria by anti "r-b-flagellin+r-PilA" immune sera. These antibodies were also able to reduce bacterial load in the site of original infection into the liver and spleen of challenged mice. The reduction of systemic bacterial spread resulted in an increased survival rate of challenged immunized mice. In conclusion, immunization with "r-b-flagellin+r-PilA" proteins provides a better protective response against P. aeruginosa infection in the burn mouse model.


title: Minimally invasive surgery in childhood cancer: a challenging future.

text: INTRODUCTION Minimally invasive surgery (MIS) has emerged as an alternative to open approach for cancer diagnosis in children ∼20 years ago, but only recently for tumor resection. The purpose of this review is to update the use of MIS in pediatric oncological surgery over the past five years. METHODS The authors conducted a systematic review of papers published between 2009 and 2014 focusing on indications and results of the technique. RESULTS New indications in Wilms tumor, pheochromocytoma, and lung nodules have emerged, thanks to the growing use of MIS in benign urological and thoracic surgery with satisfactory results. Case control studies comparing MIS to open approach have been published for the first time in more classical indications such as neurogenic tumors, while robot-assisted procedure has shown concern in results about its early experience in solid tumors. CONCLUSION MIS is a promising method for removal of thoracic and abdominal malignancies as long as oncological principles are strictly followed. Long-term follow-up is mandatory to further delineate objective indications.


title: Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow.

text: BACKGROUND The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood. OBJECTIVE To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features. MATERIALS AND METHODS We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre- and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on the increase of the contralateral hemispheric CBF: stenosis grade (≥50% or <50%, according to the North American Symptomatic Carotid Endarterectomy Trial criteria); age; the presence of anterior and posterior communicating arteries; postoperative hyperperfusion on the stenotic side; and the presence of cerebral steal phenomenon during preoperative acetazolamide-challenge SPECT. RESULTS Following unilateral CAS, mean hemispheric CBF increased significantly on both sides: from 33.4±5.6 (mean ± SD) to 38.7±7.8 mL/min on the operated side (paired t test, p<0.001) and f35.4±5.4 to 39.2±7.2 mL/min on the contralateral side (p<0.001). In a general linear model, stenosis grade (≥50%) alone was significantly correlated with the increase of the CBF on the contralateral side (p=0.03). CONCLUSION Revascularization by CAS for unilateral carotid stenosis can increase hemispheric CBF on both sides. Increase of the contralateral CBF is correlated with stenosis grade (≥50%).


title: Initial experiences of laparoscopic intravesical detrusorraphy using the Politano-Leadbetter technique.

text: INTRODUCTION Minimally invasive laparoscopic surgical procedures are increasingly being used for the management of vesicoureteral reflux. OBJECTIVE We present our experience of the laparoscopic Politano-Leadbetter technique performed under pneumovesicum conditions, which allows an orthotopic ureteral location after vesicoureteral reflux correction. Our procedure recreates the new ureteric orifice in a normal anatomical position with potential less morbidity and better cosmesis. STUDY DESIGN Our series comprises ten cases. The three 5 mm ports were introduced through bladder wall under cystoscopic vision. A 5-0 monofilament traction suture was used and dissection was carried out. After the ureteral mobilization, the location of the new hiatus was selected in a straight line superior to the original orifice. Dissection of the submucosal tunnel was started from the new hiatus and advanced to the original hiatus and the ureter was gently drawn passed through the tunnel. The ureter was rolled up and muscle fibers were incised until ureter could freely move from the base of the new hiatus. Finally, after spatulation of the terminal part of the ureter, ureterovesical anastomosis was performed with intracorporeal suturing using 5-0 monofilament sutures. RESULTS The average operative time was 125 min, with an average of 93 min for unilateral and 133 min for bilateral reimplantation. Blood loss was minimal and drains were used selectively. Removal of urethral catheter was decided empirically after hematuria stopped. Mean catheterization time was 5.1 days. The mean postoperative hospital stay was 6.2 days. DISCUSSION This study had limitations: the small number of cases, follow-up period is relatively short and data on the pre-operative bladder capacity, catheter-related morbidity, pain control and cosmesis are lacking. But most cases showed positive clinical results including acceptable operating time and good resolution rate with minimal complication. Our Politano-Leadbetter transvesicoscopic ureteric reimplantation is safe and useful in the resolution of VUR, even though the laparoscopic ureteric reimplantation is technically demanding even for experienced pediatric surgeons. Considering the main advantages of endoscopic surgery, our new vesicoscopic technique could be an optional treatment to the open reimplantation and has merits because whole the procedure are performed within the bladder, so there is no risk of intraperitoneal organ injury. CONCLUSION Though the role of this new technique in the treatment of VUR remains to be determined, the technique could be an optional treatment to replace other surgical methods as a less invasive and effective therapeutic method.


Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients with Severe COVID-19 in Wuhan.


title: Histopathological effects of modern topical sealants on the liver surface after hepatectomy: an experimental swine study.

text: The present study aimed to determine the impact of different sealant materials on histopathological changes to the liver surface after liver resection. Thirty-six landrace pigs underwent left anatomical hemihepatectomy and were assigned to a histopathological control group (HPC, n = 9) with no bleeding control, a clinically simulated control group (CSC, n = 9) with no sealant but bipolar cauterization and oversewing of the liver surface, and two treatment groups (n = 9 each) with a collagen-based sealant (CBS) or a fibrinogen-based sealant (FBS) on resection surface. After postoperative day 6, tissue samples were histologically examined. There were no significant differences in preoperative parameters between the groups. Fibrin production was higher in sealant groups compared with the HPC and CSC groups (both p < 0.001). Hepatocellular regeneration in sealant groups was higher than in both control groups. A significantly higher regeneration was seen in the FBS group. Use of sealants increased the degree of fibrin exudation at the resection plane. Increased hepatocellular necrosis was seen in the CBS group compared with the FBS group. The posthepatectomy hepatocellular regeneration rate was higher in the FBS group compared with the CBS group. Randomized studies are needed to assess the impact of sealants on posthepatectomy liver regeneration in the clinical setting.


title: Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature.

text: INTRODUCTION There is an urgent need to identify patients at high risk during the ongoing coronavirus disease (COVID-19) pandemic. Whether a history of stroke is associated with increased severity of disease or mortality is unknown. METHOD We pooled studies from published literature to assess the association of a history of stroke with outcomes in patients with COVID-19. RESULTS A pooled analysis of 4 studies showed a ∼2.5-fold increase in odds of severe COVID-19. While a trend was observed, there was no statistically significant association of stroke with mortality in patients with COVID-19 infection. DISCUSSION Our findings are limited by a small number of studies and sample size. CONCLUSION There is a ∼2.5-fold increase in odds of severe COVID-19 illness with a history of cerebrovascular disease.


title: Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients.

text: BACKGROUND/AIMS As numbers of maintenance hemodialysis patients are growing, debilitating conditions of muscle wasting and atrophy are becoming some of the greatest concerns in end-stage renal disease patients. Exercise training has various potential benefits in terms of prevention of a sustained decline in functional status. This study aimed to evaluate the physical, psychological, laboratory, and dialysis-related effects of intradialytic exercise. METHODS We enrolled 22 patients from a hemodialysis center for a 6-month non-randomized prospective trial. Combination of aerobic exercise with bicycle ergometer and anaerobic exercise with elastic bands was conducted during hemodialysis. Data including physical fitness test results, dialysis-related measurements, and biochemical laboratory results were collected at baseline, 3, and 6 months. Depression and quality of life were assessed using Beck Depression Inventory and Short Form-36 health survey. RESULTS After exercise completion, there were significant improvements in back muscle power, forward and backward trunk flexibility, vertical jump, elbow flexion, sit to stand test, and 6-minute walk test (p < 0.05). No significant changes were observed in dry weight, blood pressure, Kt/V, and biochemical variables, except for intradialytic hypotension (p < 0.05). For depression, Beck Depression Inventory showed statistically significant enhancement (p < 0.05). Scores of Short Form-36 health survey did not show significant increase in each domain, except for bodily pain (p < 0.05). CONCLUSION Combined aerobic and anaerobic exercise training during dialysis was found to be effective on physical health status, intradialytic hypotension, and depression in terms of mental health. Therefore, the findings of the current study may provide an appropriate guidance for encouraging exercise by nephrologists.


docid: qrypsxlk

title: The VAC-Basket for Easy Fixation of Scrotal Skin Grafts.


title: Detection of Respiratory Viruses from ARTI Patients by xTAG RVP Fast v2 Assay and Conventional Methods.

text: Introduction Acute respiratory tract infections (ARTIs) are a major cause of morbidity and mortality in paediatric patients. Therefore, early detection of the viral aetiologies of ARTIs is essential for patient management and infection control. In this study, we evaluated the performance of a new multiplex polymerase chain reaction (PCR) assay (xTAG Respiratory Viral Panel [RVP] Fast v2) in the detection of respiratory viruses by comparing it with that of viral culture and direct immunofluorescence (IF) staining. Methods Nasopharyngeal swab and aspirate samples were collected prospectively from 199 patients who presented with ARTIs at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia during a 10-month period. The PCR assay was conducted in parallel with conventional culture and direct IF staining methods. Results The positive rate of the xTAG RVP Fast v2 assay (78.4%) in detecting respiratory viruses was higher than that of the viral isolation (7.5%) and direct IF (23.1%) methods. Using the xTAG RVP Fast v2 assay, human enterovirus/human rhinovirus (HEV/HRV) was the most frequently detected (46.2%). The xTAG RVP Fast v2 assay revealed mixed infection caused by two or three respiratory viruses in 40 specimens, and these were undetected by the viral isolation and direct IF methods. Conclusion The xTAG RVP Fast v2 assay was superior to conventional methods in the identification of common respiratory viruses, with higher sensitivity and shorter turnaround times for laboratory results.


title: Model-based iterative reconstruction in low-dose CT colonography-feasibility study in 65 patients for symptomatic investigation.

text: RATIONALE AND OBJECTIVES To compare image quality on computed tomographic colonography (CTC) acquired at standard dose (STD) and low dose (LD) using filtered-back projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction (MBIR) techniques. MATERIALS AND METHODS A total of 65 symptomatic patients were prospectively enrolled for the study and underwent STD and LD CTC with filtered-back projection, adaptive statistical iterative reconstruction, and MBIR to allow direct per-patient comparison. Objective image noise, subjective image analyses, and polyp detection were assessed. RESULTS Objective image noise analysis demonstrates significant noise reduction using MBIR technique (P < .05) despite being acquired at lower doses. Subjective image analyses were superior for LD MBIR in all parameters except visibility of extracolonic lesions (two-dimensional) and visibility of colonic wall (three-dimensional) where there were no significant differences. There was no significant difference in polyp detection rates (P > .05). Doses: LD (dose-length product, 257.7), STD (dose-length product, 483.6). CONCLUSIONS LD MBIR CTC objectively shows improved image noise using parameters in our study. Subjectively, image quality is maintained. Polyp detection shows no significant difference but because of small numbers needs further validation. Average dose reduction of 47% can be achieved. This study confirms feasibility of using MBIR in this context of CTC in symptomatic population.


title: Sociodemographic Determinants of Occupational Risks of Exposure to COVID-19 in Canada.

text: The activities performed by Canadian workers in some occupations may increase the risk of exposure to infectious diseases such as COVID-19. This research note explores how occupational exposure risks vary by labor force characteristics using publicly available Canadian data in combination with a data set providing information on the level of physical proximity and frequency of exposure to infections or diseases faced by workers in different occupations. The results show important sociodemographic differences. First, women work in occupations associated with significantly higher average risks of exposure to COVID-19 than men. This is driven by their overrepresentation in high-risk broad occupational categories such as health occupations. Second, older workers (65 years or more), a group vulnerable to COVID-19, appear to work in occupations requiring performing activities characterized by a lower level of physical proximity than their younger colleagues, with minimal differences in the frequency of exposure to diseases or infections. Finally, workers in low-income occupations are employed in occupations that put them at greater risk of exposure to COVID-19 than other workers. This is especially the case for women, immigrants, and members of visible minority groups in low-income occupations. More broadly, this research note provides insights into the health-related dimension of the literature on occupational tasks and labor market stratification.


title: The Modified Maquet Procedure (MMP) in Dogs: Technical Development and Initial Clinical Experience.

text: The literature about tibial tuberosity advancement surgery in dogs and humans informed the development of a version of the operation using a wedge-shaped implant of titanium foam. Computer-assisted drawing and stereolithography was used to create instruments and implants that were evaluated by cadaver surgery. A trial, involving 26 client-owned dogs with lameness due to cranial cruciate ligament failure, was started. Follow-up was done by clinical and radiographic examination after 4 wk and clinical examination again 6-11 mo after surgery. The titanium foam implant maintained tibial tuberosity advancement easily and effectively. The same major complication occurred in 2 of the first 6 cases before, a slightly modified technique was used to treat 20 dogs without complication. At mid-term follow-up (6-11 mo), 20/26 dogs (77%) had returned to full function, two dogs (7.7%) had acceptable function, two dogs (7.7%) could not be evaluated due to recent contra lateral modified Maquet procedure surgery, and two (7.7%) dogs had died for reasons unrelated to the study. This is the first clinical report of the use of titanium foam in veterinary orthopaedics. Modified Maquet procedure appears to be an effective treatment for lameness due to failure of the cranial cruciate ligament in dogs.


title: Assessing Intra-arterial Complications of Planning and Treatment Angiograms for Y-90 Radioembolization.

text: PURPOSE To report hepatic arterial-related complications encountered during planning and treatment angiograms for radioembolization and understand any potential-associated risk factors. MATERIALS AND METHODS 518 mapping or treatment angiograms for 180 patients with primary or metastatic disease to the liver treated by Yttrium-90 radioembolization between 2/2010 and 12/2015 were retrospectively reviewed. Intra-procedural complications were recorded per SIR guidelines. Patient demographics, indication for treatment, prior exposure to chemotherapeutic agents, operator experience, and disease burden were reviewed. Technical variables including type of radioembolic (glass vs. resin microspheres), indication for angiography (mapping vs. treatment), variant anatomy, and attempts at coil embolization were also assessed. RESULTS Thirteen (13/518, 2.5%) arterial-related complications occurred in 13 patients. All but two complications resulted during transcatheter coil embolization to prevent non-target embolization. Complications included coil migration (n = 6), arterial dissection (n = 2), focal vessel perforation (n = 2), arterial thrombus (n = 2), and vasospasm prohibiting further arterial sub-selection (n = 1). Transarterial coiling was identified as a significant risk factor of complications on both univariate and multivariate regression analysis (odds ratio 7.8, P = 0.004). Usage of resin microspheres was also a significant risk factor (odds ratio 9.5, P = 0.042). No other technical parameters or pre-procedural variables were significant after adjusting for confounding on multivariate analysis (P > 0.05). CONCLUSION Intra-procedural hepatic arterial complications encountered during radioembolization were infrequent but occurred mainly during coil embolization to prevent non-target delivery to extra-hepatic arteries.


title: Rapid Review: Nonsteroidal Anti-inflammatory Agents and Aminosalicylates in COVID-19 Infections.

text: In the current COVID-19 pandemic, there has been concern regarding the use of ibuprofen and other nonsteroidal anti-inflammatory agents by COVID-19 infected patients. Aminosalicylates (5-ASAs) are structurally similar and have anti-inflammatory functions that resemble those of nonsteroidal anti-inflammatory agents. Since 5-ASAs are a mainstay treatment for inflammatory bowel disease, the authors review the pharmacology of both classes of drugs and discuss the potential relevance of 5-ASAs in the ongoing discussion of medication use in patients infected with COVID-19.


Wearable Technology and Long-term Weight Loss.


title: Challenges and Priorities in Responding to COVID-19 in Inpatient Psychiatry.

text: This Open Forum focuses on specific challenges, contingency planning considerations, and downstream impacts of COVID-19 on inpatient psychiatric care. COVID-19 is a novel coronavirus that has been declared a pandemic. Challenges for inpatient psychiatry include risky close contact among staff and patients, space constraints, and structural barriers in care delivery. Nuanced considerations of five contingency planning strategies in response to COVID-19 are described, including COVID-19-specific precautions, visitor restrictions, physician workforce considerations, operational adjustments, and group therapy changes. Organized leadership and clear communication are identified as early priorities in pandemic response to minimize misinformation and address immediate challenges.


title: Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection.

text: OBJECTIVE To provide clinical management guidelines for novel coronavirus (COVID-19) in pregnancy. METHODS On February 5, 2020, a multidisciplinary teleconference comprising Chinese physicians and researchers was held and medical management strategies of COVID-19 infection in pregnancy were discussed. RESULTS Ten key recommendations were provided for the management of COVID-19 infections in pregnancy. CONCLUSION Currently, there is no clear evidence regarding optimal delivery timing, the safety of vaginal delivery, or whether cesarean delivery prevents vertical transmission at the time of delivery; therefore, route of delivery and delivery timing should be individualized based on obstetrical indications and maternal-fetal status.


title: Prospective evaluation of the routine use of a nasopharyngeal airway (Wendl Tube) during endoscopic propofol-based sedation.

text: BACKGROUND/AIMS Insertion of a nasopharyngeal airway (NPA) during endoscopic sedation is only recommended in the event of respiratory problems. We evaluated the safety and efficacy of routine insertion of an NPA during sedation in gastrointestinal (GI) endoscopy. METHODS Between July 2009 and April 2012, patients with colonoscopy or expected longer-lasting or therapeutic upper GI endoscopy were pseudo-randomized in a weekly alternating fashion to perform sedation (midazolam in combination with propofol) with or without NPA insertion. The primary outcome measure was respiratory depression (oxygen saturation <90%). Secondary measures included hypotension (systolic blood pressure <90 mm Hg), bradycardia (heart rate <40 beats/min) or nasopharyngeal damage after NPA insertion. RESULTS 216 (106 females, mean age 60.7 ± 9.65 years) were enrolled. Colonoscopy was performed in 131 patients and upper endoscopy in 85 patients. In 105 patients an NPA was used (intervention group). Five (4.7%) of those patients showed minor nasopharyngeal injury. Respiratory depression (13.5 vs. 1.9%, p = 0.002) and hypotension (11 vs. 5%, p = 0.09) occurred more frequently in the control than in the intervention group. CONCLUSION The routine placement of an NPA can reduce the frequency of hypoxemic events during endoscopic sedation with minor risks for nasopharyngeal injury.


title: Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women.

text: CONTEXT Few data are available on pregnancy outcomes in women with acromegaly. STUDY DESIGN This was a retrospective multicenter study. PATIENTS The study included 46 women with GH-secreting pituitary microadenomas (n = 7) or macroadenomas (n = 39). Their mean age was 31.7 yr (±4.5 yr). Incomplete transsphenoidal surgical resection (n = 39) and pituitary radiation (n = 14) had been performed, respectively, 2.9 ± 2.6 and 7.3 ± 4.2 yr before pregnancy. The patients were receiving dopamine agonists (n = 25) and/or somatostatin analogs (n = 14), and GH/IGF-I hypersecretion was controlled and uncontrolled in, respectively, 23 and 34 cases. Five pregnancies followed the fertility treatment. RESULTS Fifty-nine pregnancies resulted in 64 healthy babies. Gestational diabetes and gravid hypertension occurred in four (6.8%) and eight (13.6%) pregnancies, respectively, and both were more frequent when GH/IGF-I hypersecretion was not controlled before pregnancy. Visual field defects were diagnosed during pregnancy in four women, three of whom were diagnosed with acromegaly during the pregnancy. Seven women had isolated headache. Magnetic resonance imaging performed 3.9 ± 0.3 months after delivery showed that the size of the adenoma had increased in three cases, decreased in two cases, and remained stable in 22 cases. Seventeen women breast-fed with no complications. Four women gave birth to a small-for-gestational-age infant; all had received somatostatin analogs, alone or in combination with dopamine agonists, during pregnancy. The mean IGF-I level fell significantly during the first trimester in 12 cases (before conception 588 ± 207 ng/ml, first trimester 319 ± 126 ng/ml, P = 0.002), whereas the GH concentration did not change significantly. CONCLUSION The following conclusions were reached: 1) pregnancy in women with active or uncontrolled acromegaly may be associated with an increased risk of gestational diabetes and gravid hypertension; 2) pregnancy is occasionally associated with symptomatic enlargement of GH-secreting pituitary macroadenomas; 3) changes in serum GH and IGF-I concentrations are variable during pregnancy, indicating that routine monitoring is not mandatory if the pregnancy is uneventful; and 4) GH-suppressive treatment can be safely withdrawn after conception in most acromegalic women.


title: Spinal subdural hematoma following lumbar decompressive surgery: a report of two cases.

text: Spinal subdural hematoma (SSDH) following spine surgery is an extremely rare condition, with only three cases being reported in the literature. Unintended durotomy has been associated with SSDH due to alterations of pressures in the dural compartments. The objective of the present report was to report two rare cases of acute SSDH developed after lumbar decompressive surgery. In one of the patients, the diagnosis of SSDH was followed by urgent hematoma evacuation via durotomy due to the patient's worsening neurological symptoms. In the second patient, the SSDH was treated conservatively due to the absence of severe or progressive motor or sensory deficits. In conclusion, emergency evacuation via durotomy is the treatment of choice for patients with SSDH and neurologic impairment. Conservative management may be indicated in selected cases with absent motor and sensory deficits.


docid: kidijxpl

title: One Health: the small animal dimension.

text: Earlier this year, the World Small Animal Veterinary Association (WSAVA) established a One Health committee with the remit of positioning small companion animals in the global One Health framework. Here, Michael Day, the chairman of that committee, explains how companion animals fit within the One Health concept.


title: Chest CT features of the novel coronavirus disease (COVID-19).

text: A new type of coronavirus (2019-nCoV) is rapidly spreading worldwide and causes pneumonia, respiratory distress, thromboembolic events, and death. Chest computed tomography (CT) plays an essential role in the diagnosis of viral pneumonia, monitoring disease progression, determination of disease severity, and evaluating therapeutic efficacy. Chest CT can show important clues of 2019-nCoV disease (also known as COVID-19) in patients with an appropriate clinic. Prompt diagnosis of COVID-19 is essential to prevent disease transmission and provide close clinical observation of patients with clinically severe disease. Therefore, radiologists and clinicians should be familiar with the CT imaging findings of COVID-19 pneumonia. Herein we aimed to review the imaging findings of COVID-19 pneumonia and to examine the critical points to be considered for imaging in cases with COVID-19 suspicion.


title: Embolization followed by surgery for treatment of perimedullary arteriovenous fistula causing acute myelopathy.

text: BACKGROUND Perimedullary arteriovenous fistula (AVF) is rare. There are three subtypes, and the treatment strategies for each are different. Subtype B (multiple fistulas) can be treated by either embolization or surgery. On the basis of a case from our treatment experience, we propose a method for achieving optimal outcome while minimizing nerve injury. CASE DESCRIPTION A 51-year-old female was admitted to our hospital with acute myelopathy caused by a perimedullary AVF. Initially, we treated her by embolization using the chemical agent Onyx. Her symptoms improved immediately but gradually returned beginning 1 week later. Two months later, the symptoms had returned to pretreatment status, so we removed the fistulas surgically. Severe adhesions between nerve and occult venous varices were noted during the operation. Afterward, the patient's symptoms improved significantly. Histopathological sections showed an inflammatory reaction around the varices. CONCLUSIONS We initially considered several possible reasons for the return of symptoms: (a) Hypoperfusion of the spinal cord; (b) mass effect of the occult vein varices; (c) residual AVF or vascular remodeling resulting in recurrent cord hypertension; (d) Onyx-induced perivascular inflammation resulting in nerves adhering to each other and to occult venous varices. Clinical, surgical, and pathological findings ruled out the first three, leaving Onyx-induced perivascular inflammation as the probable reason. Given our treatment experience and the pros and cons of the two methods, we propose that initial embolization followed by surgery after 5 days to remove occult venous varices is the ideal strategy for treating perimedullary AVF of subtype B.


title: Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage.

text: BACKGROUND AND PURPOSE We developed and validated a simple algorithm to predict the risk of hematoma growth in acute spontaneous intracerebral hemorrhage (ICH) to better inform clinicians and researchers in their efforts to improve outcomes for patients. METHODS We analyzed data from the computed tomography substudies of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2, respectively). The study group was divided into a derivation cohort (INTERACT2, n=964) and a validation cohort (INTERACT1, n=346). Multivariable logistic regression was used to identify factors associated with clinically significant (≥6 mL) increase in hematoma volume at 24 hours after symptom onset. A parsimonious risk score was developed on the basis of regression coefficients derived from the logistic model. RESULTS A 24-point BRAIN score was derived from INTERACT2 (C-statistic, 0.73) based on baseline ICH volume (mL per score, ≤10=0, 10-20=5, >20=7), recurrent ICH (yes=4), anticoagulation with warfarin at symptom onset (yes=6), intraventricular extension (yes=2), and number of hours to baseline computed tomography from symptom onset (≤1=5, 1-2=4, 2-3=3, 3-4=2, 4-5=1, >5=0) predicted the probability of ICH growth (ranging from 3.4% for 0 point to 85.8% for 24 points) with good discrimination (C-statistic, 0.73) and calibration (Hosmer-Lemeshow P=0.82) in INTERACT1. CONCLUSIONS The simple BRAIN score predicts the probability of hematoma growth in ICH. This could be used to improve risk stratification for research and clinical practice. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.


Acute ischemic stroke and timing of treatment--reply.


Food in a time of COVID-19.


title: Use of rapid sampling microdialysis for intraoperative monitoring of bowel ischemia.

text: PURPOSE Intestinal ischemia is a major cause of anastomotic leak and death and remains a clinical challenge as the physician relies on several nonspecific signs, biologic markers, and radiologic studies to make the diagnosis. This study used rapid sampling online microdialysis to evaluate the biochemical changes occurring in a segment of human bowel during and after resection, and assessed for the feasibility and reproducibility of this technique in monitoring intestinal ischemia. METHODS A custom made, rapid sampling online microdialysis analyzer was used to monitor the changes in the bowel wall of specimens being resected intraoperatively. Two patients were recruited for the pilot study to optimize the analyzer and seven patients undergoing colonic resections were recruited for the data collection and analysis. RESULTS The concentration of glucose in the extracellular bowel wall fluid decreased transiently after division of individual feeding arteries followed by a rebound increase in the concentration back to baseline concentrations. After completion of resection, glucose concentrations continued to decrease while lactate concentrations increased constantly. CONCLUSION Rapid sampling microdialysis was feasible in the clinical environment. These results suggest that tissue responds to ischemic insult by mobilizing glucose stores which later decrease again, whereas lactate concentrations constantly increased.


title: A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma.

text: OBJECTIVES Prognosis for patients with locally advanced esophagogastric adenocarcinoma (EAC) is poor with surgery alone, and adjuvant therapy after open esophagectomy is frequently not tolerated. After minimally invasive esophagectomy (MIE); however, earlier return to normal function may render patients better able to receive adjuvant therapy. We examined whether primary MIE followed by adjuvant chemotherapy influenced survival compared with propensity-matched patients treated with neoadjuvant therapy. METHODS Patients with stage II or higher EAC treated with MIE (N = 375) were identified. Using 30 pretreatment covariates, propensity for assignment to either neoadjuvant followed by MIE (n = 183; 54%) or MIE as primary therapy (n = 156; 46%) was calculated, generating 97 closely matched pairs. Hazard ratios were adjusted for age, sex, body mass index, smoking, comorbidity, and final pathologic stage. RESULTS In propensity-matched pairs, adjusted hazard ratio for death did not differ significantly for primary MIE compared with neoadjuvant (hazard ratio, 0.83; 95% confidence interval, 0.60-1.16). Recurrence patterns were similar between groups and 65% of patients with IIb or greater pathologic stage received adjuvant therapy. Clinical staging was inaccurate in 37 out of 105 patients (35%) who underwent primary MIE (n = 18 upstaged and n = 19 downstaged). CONCLUSIONS Primary MIE followed by adjuvant chemotherapy guided by pathologic findings did not negatively influence survival and allowed for accurate staging compared with clinical staging. Our data suggest that primary MIE in patients with resectable EAC may be a reasonable approach, improving stage-based prognostication and potentially minimizing overtreatment in patients with early stage disease through accurate stage assignments. A randomized controlled trial testing this hypothesis is needed.


title: Single-stranded oligonucleotides can inhibit cytokine production induced by human toll-like receptor 3.

text: Toll-like receptor 3 (TLR3) can signal the production of a suite of cytokines and chemokines in response to double-stranded RNA (dsRNA) ligands or the dsRNA mimic poly(I-C). Using a human embryonic kidney 293T cell line to express human TLR3, we determined that poly(I-C)-induced signal could be significantly inhibited by single-stranded DNAs (ssDNAs), but not ssRNA or dsDNA. The ssDNA molecules that down-modulated TLR3 signaling did not affect TLR4 and do not require the hypomethylated CpG motif found in TLR9 ligands. The degree of modulation can be altered by the length, base sequence, and modification state of the ssDNAs. An inhibitory ssDNA was found to colocalize with TLR3 in transfected cells and in a cell line that naturally expresses TLR3. The inhibitory ssDNAs can compete efficiently with dsRNA for binding purified TLR3 ectodomains in vitro, while noninhibitory nucleic acids do not. The ssDNAs also decrease the levels of several cytokines produced by the human bronchial epithelial cell line BEAS-2B and by human peripheral blood mononuclear cells in response to poly(I-C) stimulation of native TLR3. These activities indicate that ssDNAs could be used to regulate the inflammatory response through TLR3.


docid: aqcxcsxn

title: U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016.


docid: qtvkkger

title: Management of sickle cell disease in patients undergoing cardiac surgery.

text: Sickle cell disease is a life-limiting inherited hemoglobinopathy that poses inherent risk for surgical complications following cardiac operations. In this review, we discuss preoperative considerations, intraoperative decision-making, and postoperative strategies to optimize the care of a patient with sickle cell disease undergoing cardiac surgery.


title: Residual Lesions on Capsule Endoscopy Is Associated with Postoperative Clinical Recurrence in Patients with Crohn's Disease.

text: BACKGROUND In order to optimize postoperative therapy in patients with Crohn's disease (CD), it is important to detect endoscopic recurrence preceding clinical recurrence. However, we have little knowledge about how high the rate of residual lesions is and whether these lesions have an influence on postoperative course or not. AIMS To assess residual lesions in small bowel immediately after surgery. METHODS Capsule endoscopy (CE) was performed immediately after surgery (< 3 months), and endoscopic activity was assessed using the Lewis score (LS) composed of the highest tertile score (in first, second, and third tertile) and the stenosis score (in whole small intestine). The relationship between these residual lesions and postoperative clinical recurrence was prospectively evaluated. RESULTS After assessing patency using a patency capsule, CE was performed in 25 patients. The mean LS was 751.3, and 84.0% (21/25) had endoscopic activity. These lesions were detected by preoperative examinations in 0% and by a serosal side view during surgery in 16.0%. Regarding the cumulative clinical recurrence rate according to endoscopic severity (normal, mild, and moderate-to-severe) immediately after surgery, no significant difference was found. However, comparing groups divided according to the highest tertile score, the cumulative clinical recurrence rate was significantly higher in the group with the highest third tertile score. Furthermore, patients with ulcers in the third tertile had a significantly higher recurrence rate. CONCLUSIONS Many cases with CD had endoscopic activity immediately after "curative" surgery. These residual lesions, especially in the distal small intestine, were associated with postoperative clinical recurrence.


title: Dose optimized chest CT for diagnosis of COVID-19 - Evaluation of the image quality and diagnostic impact.

text: OBJECTIVES The detection of COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) has varying sensitivity. CT of the chest can verify the infection in patients with clinical symptoms and a negative test result accelerating treatment and actions to prevent further contagion. However, CT employs ionizing radiation. The purpose of this study was to evaluate protocol settings, associated radiation exposure, image quality and diagnostic performance of a low-dose CT protocol in a university hospital setting. MATERIALS AND METHODS Chest-CT examinations were performed on a single scanner (Somatom Definition Edge, Siemens Healthineers, Germany) in 105 symptomatic patients (60 male, 45 female). Images were evaluated with regard to protocol parameters, image quality, radiation exposure and diagnostic accuracy. Serial RT-PCR served as the standard of reference. Based on this reference standard sensitivity, specificity, positive and negative predictive values of CT with 95% confidence interval were calculated. RESULTS The mean effective dose was 1.3 ± 0.4 mSv (0.7 - 2.9 mSv) for the patient cohort (mean age 66.6 ± 16.7 years (19-94 years), mean BMI 26.6 ± 5.3 kg/m² (16-46 kg/m²)). A sensitivity of 100 [95% CI: 82-100]%, a specificity of 78 [95% CI: 68-86]%, a positive predictive value of 50 [95% CI: 33-67]% and a negative predictive value of 100 [95% CI: 95-100]% were obtained. No COVID-19 diagnoses were missed by CT. Image noise did not strongly correlate with BMI or patient diameter and was rated as average. CONCLUSIONS We presented a robust imaging procedure with a chest CT protocol for confident diagnosis of COVID-19. Even for an overweight patient cohort, an associated radiation exposure of only 1.3 ± 0.4 mSv was achieved with sufficient diagnostic quality to exclude COVID-19.


The COVID-19 testing debacle.


title: Changes in Cerebral Oxygenation Associated with Intradialytic Blood Transfusion in Patients with Severe Anemia Undergoing Hemodialysis.

text: BACKGROUND Hemodialysis (HD) patients frequently suffer from severe anemia caused by various hemorrhagic disorders in addition to renal anemia. Intradialytic blood transfusion is sometimes performed; however, the cerebral oxygenation changes associated with this procedure remain unclear. METHODS Sixteen HD patients with severe anemia who required intradialytic blood transfusion were included (12 men and 4 women; mean age, 64.8 ± 9.8 years). Cerebral regional oxygen saturation (rSO2) was monitored using near-infrared spectroscopy, and cerebral fractional oxygen extraction (FOE) was calculated before and after HD. Twenty-five HD patients with well-maintained hemoglobin (Hb) levels were included as a control group. RESULTS Cerebral rSO2 values were significantly lower in HD patients with severe anemia than in the control group (42.4 ± 9.9 vs. 52.5 ± 8.5%, p = 0.001). Following intradialytic blood transfusion (385 ± 140 mL of concentrated red blood cells), Hb levels significantly increased (from 7.2 ± 0.9 to 9.1 ± 1.1 g/dL, p < 0.001), and cerebral rSO2 values significantly improved after HD (from 42.4 ± 9.9 to 46.3 ± 9.0%, p < 0.001). Cerebral FOE values before HD in patients with severe anemia were significantly higher than those in the control group (severe anemia, 0.56 ± 0.10; controls, 0.45 ± 0.08; p < 0.001). After HD with intradialytic blood transfusion, these values significantly decreased (0.52 ± 0.09 after HD versus 0.56 ± 0.10 before HD, p = 0.002). CONCLUSION HD patients with severe anemia represented cerebral oxygen metabolism deterioration, which could be significantly improved by intradialytic blood transfusion.


title: Ablative therapies in adrenal tumors: primary and metastatic.

text: A large number of adrenal tumors are now identified either incidentally or associated with a metastatic workup for cancer. While the vast majority of these lesions are benign, those that prove to be primary or secondary cancers are traditionally treated with surgical resection. A wide variety of alternative, less invasive therapies exist. One of these, thermal ablation, is examined herein.


title: Meeting the Transitional Care Needs of Older Adults with COVID-19.

text: Older adults with COVID-19 who survive hospitalizations and return to their homes confront substantial health challenges and an unpredictable future. While understanding of the unique needs of COVID-19 survivors is developing, components of the evidence-based Transitional Care Model provide a framework for taking a more immediate, holistic response to caring for these individuals as they moved back into the community. These components include: increasing screening, building trusting relationships, improving patient engagement, promoting collaboration across care teams, undertaking symptom management, increasing family caregiver care/education, coordinating health and social services, and improving care continuity. Evidence generated from rigorous testing of these components reveal the need for federal and state policy solutions to support the following: employment/redeployment of nurses, social workers, and community health workers; training and reimbursement of family caregivers; widespread access to research-based transitional care tools; and coordinated local efforts to address structural barriers to effective transitions. Immediate action on these policy options is necessary to more effectively address the complex issues facing these older adults and their family caregivers who are counting on our care system for essential support.


title: Management of Primary Nonresponders and Partial Responders to Tumor Necrosis Factor-α Inhibitor Induction Therapy among Patients with Crohn's Disease.

text: Induction therapy with tumor necrosis factor-α (TNF-α) inhibitors is highly effective for the treatment of Crohn's disease. However, there are primary nonresponders (PNR) of TNF-α inhibitors without clinical response during the induction period. In addition, there are partial responders (PR), who show some efficacy, but clinical remission is not achieved by induction therapy. To date, the definition and clinical management of PNR and PR have not been established. This report summarizes the opinions of 36 Japanese experts attending the Japan Round Table Discussion on IBD Meeting regarding how to determine PNR and PR of TNF-α inhibitors and how to manage these patients in clinical practice. PNR, who do not show any initial improvement of clinical symptoms and serum C-reactive protein (CRP) levels, require re-assessment of intestinal complications. PR can be determined either by clinical symptoms, serum CRP levels, or imaging results. PR need intensification of the treatment with TNF-α inhibitors either with or without optimization of immunomodulators. Optimization of initial TNF-α inhibitor therapy may improve long-term outcomes, but more evidence is required to improve the use of TNF-α inhibitors for the prevention and management of PNR and PR.