title: A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair.

text: BACKGROUND Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach. METHODS Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic result, were prospectively collected. RESULTS All LESS TEP procedures were completed successfully without conversion to standard laparoscopic or open surgery. A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 standard TEP operations. The mean operative time was significantly shorter in the standard TEP series (61.8 ± 26.0 vs. 70.9 ± 23.8 min, p = 0.04). Other perioperative parameters, including the length of hospital stay, time until return to full activity, complication rate, pain score, and cosmetic result, were all comparable between the two techniques. CONCLUSION Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. However, based on our evidence, we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the standard TEP technique for inguinal hernias.


title: Early postmortem brain MRI findings in COVID-19 non-survivors.

text: OBJECTIVES The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuro-invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. METHODS In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. RESULTS Among the 62 patients who died from COVID-19 from 31/03/2020 to 24/04/2020 at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical micro- and macro-bleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent), and nonspecific deep white matter changes (one decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. CONCLUSIONS Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.


title: EUS-guided tissue acquisition in the study of the adrenal glands: Results of a nationwide multicenter study.

text: BACKGROUND There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. METHODS This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. RESULTS A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. CONCLUSIONS EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.


Duration of SARS-CoV-2 viral shedding during COVID-19 infection.


title: Pharmaco-mechanical thrombectomy for early thrombus removal.

text: OBJECTIVES To review the current literature on the outcomes of pharmaco-mechanical thrombectomy (PMT) for early thrombus removal in patients with venous thromboembolism (VTE). METHODS We searched the MEDLINE database and performed a manual search of the references of selected articles to select reports reporting the outcomes of PMT alone and PMT compared to catheter-direct thrombolysis (CDT). Outcomes of interest included clot lysis rate, incidence of pulmonary embolism, major bleeding, recurrent deep vein thrombosis, number of venograms needed and amount of lytic utilized. RESULTS We found nine articles that reported outcomes of PMT. Three devices were utilized for PMT, the Angiojet, Trellis and Helix. Different thrombolytics were used to facilitate thrombus removal including urokinase, reteplase, tecneteplase, and tissue plasminogen activator (t-PA). Complete and partial thrombus removal were achieved in up to 84% and 64% and 81% and 59% of the limbs treated with PMT and CDT alone, respectively. Data on PE and bleeding risk after PMT compared to CDT are scarce. The duration of the thrombolysis process, amount of lytics and number of venograms were substantially reduced in the patients who had PMT compared to those who underwent CDT alone. Two articles evaluated the obstacles that limit the indication of PMT in patients with VTE. CONCLUSION VTE is a prevalent burden in Western societies. The rationale of early thrombus is to reduce valvular damage and improve venous patency in order to reduce the risk of PTS. PMT is a feasible, safe and faster alternative to expedite the thrombolysis process in patients with VTE.


title: Reliability of lithium dilution cardiac output in anaesthetized sheep.

text: BACKGROUND Cardiac output (CO) measurement with lithium dilution (COLD) has not been fully validated in sheep using precise ultrasonic flow probe technology (COUFP). Sheep generate important cardiovascular research models and the use of COLD has become more popular in experimental settings. METHODS Ultrasonic transit-time perivascular flow probes were surgically implanted on the pulmonary artery of 13 sheep. Paired COLD readings were taken at six time points, before and after implantation of a left ventricular assist device (LVAD) and compared with COUFP recorded just after lithium injection. RESULTS The mean COLD was 5.7 litre min(-1) (range 3.8-9.6 litre min(-1)) and mean COUFP 5.9 litre min(-1) (range 4.0-9.2 litre min(-1)). The bias (standard deviation) was 0.3 (1.0) litre min(-1) [5.1 (16.9)%] and limits of agreement (LOA) were -1.7 to 2.3 litre min(-1) (-28.8 to 39.0%) with a percentage error (PE) of 34.4%. Data to assess trending [rate (95% confidence intervals)] included a 78 (62-93)% concordance rate in the four-quadrant plot (n=27). In the half moon polar plot (n=19), the mean polar angle was +5°, the radial LOA were -49 to +35° and 68 (47-89)% of data points fell within 22.5° of the mean polar angle. Both tests indicated moderate to poor trending ability. CONCLUSION COLD is not precise when evaluated against COUFP in sheep based on the statistical criteria set, but the results are comparable with previously published animal studies.


title: Keeping an eye on COVID-19: Ophthalmic care and triage for general practitioners.

text: The ability of general practitioners to triage ophthalmic conditions appropriately is critical in our fight against COVID-19.


title: The coronavirus pandemic and Holocaust survivors in Israel.

text: Holocaust survivors in Israel and abroad appear to be especially vulnerable to COVID-19 because of their early life history, advanced age, and associated health conditions. And although some survivors may experience retraumatization because of the pandemic, others appear to be especially resilient. We encourage a strength-based approach when working with survivors to foster resilience and effective coping in this uncertain time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


docid: dkxjllcx

title: Uniportal subxiphoid video-assisted thoracoscopic thymectomy.

text: With a uniportal subxiphoid video-assisted thoracoscopic surgery (VATS) thymectomy, the thymus is not accessed through the ribs, which avoids intercostal nerve damage. Furthermore, compared to a VATS thymectomy via the lateral chest, decreased use of postoperative analgesics (lower doses and shorter duration), decreased blood loss, and shorter surgical duration and hospital stay have been reported. Here we report our surgical method and solutions for a uniportal subxiphoid VATS thymectomy. A uniportal subxiphoid VATS thymectomy is indicated for patients with myasthenia gravis and anterior mediastinal tumors who do not require surgical suturing. The operator stands between the patient's legs and the scopist stands to the right of the patient to operate the camera scope. To begin with, a 3-cm transverse incision was made along Langer's lines 1 cm caudal below the xiphoid process. The CO2 insufflation is performed in the mediastinum at 8 mmHg. The pericardial adipose tissue and thymus are detached from the pericardium in an anterior manner from the bilateral phrenic nerves. The resected thymus is placed in a pouch in the mediastinum and removed from the body through the subxiphoid incision. The subxiphoid approach is highly beneficial for the patient in that it results in superior esthetic outcomes considering that there is no sternotomy and no intercostal nerve damage; thus, it is a surgical procedure that surgeons should learn.


title: Best Practices for Healthcare Facility and Regional Stockpile Maintenance and Sustainment: A Literature Review.

text: Preparing for mass casualty incidents is essential to maximizing community resilience. Many US-based organizations and regions have developed stockpiles of medications, supplies, and equipment for mass casualty incident preparedness. The Centers for Disease Control and Prevention (CDC) assess and manage federally stockpiled materials, but hospitals, healthcare systems, and regional organizations are responsible for maintaining locally owned caches. The CDC has protocols for assessing and managing the Strategic National Stockpile, but no such guidance exists for local or geographical/regional stockpiles. This article outlines best practices and recommendations identified in the literature related to maintaining and sustaining a local or regional stockpile. Recommendations are provided on the timing and procedures for assessing, inventorying, storing, managing, tracking, and deploying materials stockpiled on site, in a trailer, or in a warehouse. In addition, alternative approaches for maintaining a local or regional cache, such as vendor- or user-managed inventory methods, are addressed. Management of local or regional caches requires an investment in infrastructure and training but is necessary to ensure the integrity of stockpiled medication and supplies and to enable rapid and appropriate activation during a mass casualty incident. Hospitals, healthcare systems, businesses, academic institutions, public health agencies, organizations, and regions can use the recommendations here to develop protocols or policies to properly manage their existing stockpiles, which should minimize costs related to damaged supplies.


title: Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage.

text: The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.


title: Interorganizational Coordination and Collaboration During the 2015 MERS-CoV Response in South Korea.

text: OBJECTIVES This study examined the way organizations were involved in the response to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV, MERS) outbreak that occurred in Korea in 2015. DATA AND METHODS We collected organizational network data through a content analysis of online news articles and the government's white paper. Social network analysis was used to analyze the key organizations and their connections in crucial response tasks. RESULTS Three national health authorities (Central MERS Management Headquarters [CMMH], Korea Centers for Disease Control [KCDC], Ministry of Health and Welfare [MOHW]) led the response. CMMH, which did not appear in the government's response plans, played a significant role in all 3 networks. KCDC also was involved in all 3 networks, but was most prominent in the laboratory testing network. MOHW appeared only in the patient management network. Each health authority coordinated and collaborated with distinctive types of organizations in the networks, but unclear lines of responsibilities also were found. CONCLUSIONS The study demonstrated that the roles and responsibilities of health authorities at the national level were fragmented and lacked clarity. Public health emergency preparedness must consider carefully the way to establish collaborative response systems.


Men's health: COVID-19 pandemic highlights need for overdue policy action.


title: Long-term quality of life and nutrition status of the aboral pouch reconstruction after total gastrectomy for gastric cancer: a prospective multicenter observational study (CCOG1505).

text: BACKGROUND Several efforts have been made to alleviate harms and symptoms after gastrectomy for gastric cancer. We previously conducted a randomized controlled trial (CCOG1101) to compare quality of life (QOL) and nutritional status between Roux-en-Y (RY) and aboral pouch (AP) reconstructions for up to 1 year after total gastrectomy. However, long-term outcomes after AP reconstruction remain unclear. METHODS A prospective multicenter observational study was conducted to compare QOL, body composition, and nutritional indicators between the RY and AP reconstructions at 5 years after surgery among patients who were enrolled in the CCOG1101 trial. QOL was assessed by the PGSAS-37 questionnaires as well as the EORTC QLQ-C30 and STO22. RESULTS Sixty patients (31 for RY and 29 for AP) were recruited for analysis. There were no significant differences in baseline and perioperative characteristics between the two groups. No significant differences were found in the EORTC QLQ-C30 global health status and functional scales. Regarding symptom scales in the QLQ-C30 and STO22, a more favorable score for the diarrhea scale was observed in the AP group. Diarrhea was also the only item in the PGSAS-37 questionnaires in which significant benefit of AP was observed. Body weight and lean body mass continued to decrease throughout the postoperative 5 years in both groups. None of the conventional nutritional indicators using the serum samples showed significant difference between the two groups. CONCLUSIONS Long-term observation suggested little benefit of AP reconstruction after total gastrectomy other than in alleviating diarrhea.


docid: ysonjtib

title: Advancing Marksman into contralateral vertebral artery in the treatment of intradural vertebral artery dissecting aneurysm with Pipeline.

text: Unruptured vertebral arteries dissecting aneurysms have a benign clinical course. The most common symptoms compromise headache, neck pain, dizziness and vomiting. The optimal endovascular treatment option remains controversial. Reconstructive techniques have many advantages over deconstructive ones since the advent of flow diverters such as the Pipeline embolization device (PED). Here, we present a case successfully treated with a PED through a combination of the radial access and advancement of the Marksman catheter into the contralateral vertebral artery due to the special angio-architecture of the patient.


title: Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus.

text: BACKGROUND Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown. METHODS Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated. RESULTS The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001). CONCLUSIONS In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.


title: Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device.

text: BACKGROUND Platelet function testing is controversial and not well studied in patients with neurovascular disease. OBJECTIVE To evaluate the performance of thromboelastography (TEG) as a platelet function test in neurovascular patients treated with the Pipeline embolization device (PED). METHODS A prospective protocol was instituted for platelet function testing in patients undergoing repair of intracranial aneurysms with the PED. All patients received dual antiplatelet therapy (DAT) and their response to both P2Y12 inhibitors and aspirin was quantified with TEG. Each patient's DAT induction strategy was tailored based on the percentage ADP-induced and percentage arachidonic acid-induced platelet inhibition reported by TEG. Data collected included clinical presentation, aneurysm characteristics, treatment details, and periprocedural events. Patients were followed up clinically and/or angiographically at 30 days, 6 months, and 1 year. RESULTS Thirty-four PED procedures were performed on 31 patients. TEG results altered the DAT strategy in 35% of patients. Technical success with the Pipeline placement was 100%. Two patients had minor strokes and five had transient ischemic attacks (TIAs). There have been no hemorrhagic complications. No patient had permanent neurologic deficits. Six of eight (75%) of patients with thromboembolic/TIA events were ADP-induced hyporesponders by TEG. Our 6- and 12-month angiographic occlusion rates were 78.9% and 89.5%, respectively. The 19 major branches covered by the PED that were assessed by follow-up imaging have all remained patent. CONCLUSIONS Platelet function testing with TEG altered our DAT induction strategy in a significant number of cases. No hemorrhagic or disabling thromboembolic complications were seen in this series. Future studies should compare methods of platelet function testing and, possibly, no platelet function testing in neurovascular patients undergoing flow diversion and/or stent-assisted treatment of intracranial aneurysms.


title: Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study).

text: OBJECTIVE Non-randomised studies suggest that endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM), but EMR might be more cost-effective and safer. This trial compares the clinical outcome and cost-effectiveness of TEM and EMR for large rectal adenomas. DESIGN Patients with rectal adenomas ≥3 cm, without malignant features, were randomised (1:1) to EMR or TEM, allowing endoscopic removal of residual adenoma at 3 months. Unexpected malignancies were excluded postrandomisation. Primary outcomes were recurrence within 24 months (aiming to demonstrate non-inferiority of EMR, upper limit 10%) and the number of recurrence-free days alive and out of hospital. RESULTS Two hundred and four patients were treated in 18 university and community hospitals. Twenty-seven (13%) had unexpected cancer and were excluded from further analysis. Overall recurrence rates were 15% after EMR and 11% after TEM; statistical non-inferiority was not reached. The numbers of recurrence-free days alive and out of hospital were similar (EMR 609±209, TEM 652±188, p=0.16). Complications occurred in 18% (EMR) versus 26% (TEM) (p=0.23), with major complications occurring in 1% (EMR) versus 8% (TEM) (p=0.064). Quality-adjusted life years were equal in both groups. EMR was approximately €3000 cheaper and therefore more cost-effective. CONCLUSION Under the statistical assumptions of this study, non-inferiority of EMR could not be demonstrated. However, EMR may have potential as the primary method of choice due to a tendency of lower complication rates and a better cost-effectiveness ratio. The high rate of unexpected cancers should be dealt with in further studies.


title: Protecting health care workers from tuberculosis in China: a review of policy and practice in China and the United States.

text: Tuberculosis causes >1.7 million deaths worldwide each year and is frequently transmitted in hospitals. Outbreaks of multidrug-resistant tuberculosis have led to illness and death among health care workers (HCWs) in many countries. Some countries, such as the United States, implemented occupational health policies that substantially reduced tuberculosis rates among HCWs. Inadequate tuberculosis infection control in China may contribute to its high burden of tuberculosis and multidrug-resistant tuberculosis, which are both the second highest worldwide. Occupational health policies in China for tuberculosis control can be strengthened. We reviewed the development and content of tuberculosis infection control policies in the United States and China. Sources included published academic literature, Chinese Ministry of Health policies, US government agency reports, legal databases, personal observations of hospitals, review of internet discussion sites, and discussions with HCWs and health care and law experts. In the United States, slow acceptance of the tuberculosis problem in HCWs resulted in decades of inaction. Tuberculosis infection control policies, based mostly on expert opinion, were implemented only after tuberculosis resurged in the 1980s. Effective evidence-based policies were developed only after multiple cycles of policy implementation, evaluation and revision. These policies have now substantially reduced occupational tuberculosis. In China, tuberculosis has not been formally recognized as an occupational disease, and data regarding the burden in HCWs are sparse. Vagueness of current labour laws and suboptimal alignment of infection control authority and expertise result in varied and sometimes absent protection of HCWs against tuberculosis. Formal evaluations of occupational tuberculosis policies have not been reported. By collecting data on its current HCW tuberculosis burden and infection control practices, refining policies, continually evaluating its policies based on accumulated evidence and rapidly identifying unsuspected tuberculosis cases, China can develop a more comprehensive strategy to ensure the health of HCWs and reduce transmission of tuberculosis and multidrug-resistant tuberculosis.


title: Predictive value of self-reported patient information for the identification of lumbar spinal stenosis.

text: BACKGROUND To our knowledge, no objective criterion has been identified for the diagnosis of lumbar spinal stenosis (LSS) and no study has evaluated the predictive value of self-reported patient information for the identification of LSS. OBJECTIVE To develop and validate a prediction rule for the identification of LSS based on self-reported patient information alone. METHODS Prospective derivation study using a coefficient-based multivariable logistic regression scoring method with internal validation with primary care clinics and orthopaedic departments of medical centres, as well as university and other hospitals. Participants were consecutive patients with primary symptoms of pain or numbness in the lower extremities. Physician-diagnosed LSS was the MAIN OUTCOME MEASURE RESULTS Of 468 patients included in the analysis, 47.3% were diagnosed with LSS and divided into derivation and validation sets. The following items were retained at the conclusion of the derivation process: age (<60, 60-70 and >70), duration of symptoms over 6 months, symptom improvement when bending forward, symptom improvement when bending backward, symptom exacerbation while standing up, intermittent claudication and urinary incontinence. To derive a risk score for each patient, integer-based scores were assigned and summed. In the validation data sets, prevalence of LSS in patients from the first to fourth risk score quartile were 13.3%, 47.6%, 55.2% and 65.5%, respectively. Further, the likelihood ratio in the low-risk category was 0.154. CONCLUSIONS We developed a prediction rule for the identification of LSS based on self-reported patient information alone. Further, the likelihood ratio in the low-risk category was sufficiently low. This rule may be used for screening of LSS.


title: Staged-volume radiosurgery for large arteriovenous malformations: a review.

text: Stereotactic radiosurgery is an effective management strategy for properly selected patients with arteriovenous malformations (AVMs). However, the risk of postradiosurgical radiation-related injury is higher in patients with large AVMs. Multistaged volumetric management of large AVMs was undertaken to limit the radiation exposure to the surrounding normal brain. This strategy offers a promising method for obtaining high AVM obliteration rates with minimal normal tissue damage. The use of embolization as an adjunctive method in the treatment of large AVMs remains controversial. Unfortunately, staged-volume radiosurgery (SVR) has a number of potential pitfalls that affect the outcome. The aim of this article is to highlight the role of SVR in the treatment of large AVMs, to discuss the outcome comparing it to other treatment modalities, and to discuss the potential improvement that could be introduced to this method of treatment.


title: Progressive deconstruction: a novel aneurysm treatment using the pipeline embolization device for competitive flow diversion: case report.

text: BACKGROUND AND IMPORTANCE A variety of deconstructive and reconstructive therapies have been used to treat intracranial aneurysms. The Pipeline embolization device (PED) has become a quite successful option to treat aneurysms, while reconstructing and remodeling the parent vessel. We report a case of off-label PED use, where a flow diverter was placed across the parent vessel of a giant intracranial aneurysm in a novel deconstructive strategy. CLINICAL PRESENTATION A 40-year-old man with a giant, slow-flow aneurysm of the distal middle cerebral artery (MCA) was treated with the placement of a PED across the vessel containing the aneurysm after superselective test balloon occlusion of that vessel failed. PED was successfully deployed in a competing MCA branch across the origin of the MCA branch supplying the giant aneurysm. The patient continued dual-antiplatelet therapy for 5 months and aspirin monotherapy thereafter. Follow-up angiography, performed 6 months after treatment, demonstrated complete and asymptomatic thrombosis of the aneurysm and its parent MCA branch. A collateral pial and leptomeningeal network developed, reconstructing the distal branches of the occluded MCA branch. After 18 months, the patient remains neurologically intact. CONCLUSION This appears to be the first description of progressive deconstruction for aneurysm treatment by using PED. Despite not tolerating acute vessel occlusion with superselective test balloon occlusion, the patient was asymptomatic following long-term occlusion with PED secondary to the growth of pial and leptomeningeal collateral networks.


title: The care of pregnant women during the COVID-19 pandemic - response of a large health system in metropolitan New York.

text: The rapid progression of the coronavirus disease 2019 (COVID-19) outbreak presented extraordinary challenges to the US health care system, particularly straining resources in hard hit areas such as the New York metropolitan region. As a result, major changes in the delivery of obstetrical care were urgently needed, while maintaining patient safety on our maternity units. As the largest health system in the region, with 10 hospitals providing obstetrical services, and delivering over 30,000 babies annually, we needed to respond to this crisis in an organized, deliberate fashion. Our hospital footprint for Obstetrics was dramatically reduced to make room for the rapidly increasing numbers of COVID-19 patients, and established guidelines were quickly modified to reduce potential staff and patient exposures. New communication strategies were developed to facilitate maternity care across our hospitals, with significantly limited resources in personnel, equipment, and space. The lessons learned from these unexpected challenges offered an opportunity to reassess the delivery of obstetrical care without compromising quality and safety. These lessons may well prove valuable after the peak of the crisis has passed.


docid: hlkpvrhg

title: B Cells, Viruses, and the SARS-CoV-2/COVID-19 Pandemic of 2020.


Long-term Pulmonary Consequences of Coronavirus Disease 2019 (COVID-19): What We Know and What to Expect.


title: Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial.

text: IMPORTANCE Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION trialregister.nl Identifier: NTR1804.


title: Detection of respiratory viruses and Legionella spp. by real-time polymerase chain reaction in patients with community acquired pneumonia.

text: We conducted a study on throat swabs obtained from a group of hospitalized patients with community acquired pneumonia (CAP). Throat swab specimens from 242 adults admitted to hospital with CAP were tested. In total, 1 or more aetiological agents were identified by real-time PCR in 55 (23%) patients. The most frequently detected pathogens were coronavirus (17%), parainfluenza virus (6%) and influenza virus (4%). Overall, viral pathogens were identified by conventional techniques in 7 (2%) patients, and real-time PCR in 50 (21%) patients (p<0.0001). The diagnostic yield increased from 137 cases (57% of patients using conventional microbiological assays) to 158 cases (65% of patients using real-time PCR assays and conventional microbiological assays; p=0.06). A significantly higher percentage of mortality was present in patients with a mixed bacterial and viral infection. L. pneumophila PCR was positive in only 3 out of 11 cases (27%) of Legionnaires' disease (LD). This study demonstrates that real-time PCR can increase the number of microbiological detections of respiratory pathogens, mainly as a result of detection of respiratory viruses.


title: Complex retrieval of fractured, embedded, and penetrating inferior vena cava filters: a prospective study with histologic and electron microscopic analysis.

text: PURPOSE To evaluate clinical outcomes, characterize adherent tissue, and analyze inferior vena cava (IVC) filter fractures in patients undergoing complex retrieval for management of filter-related complications. To elucidate mechanisms of filter fracture by radiographic and electron microscopic (EM) evaluation. MATERIALS AND METHODS Over 2.5 years, 50 consecutive patients with fractured and/or penetrating filter components were prospectively enrolled into a single-center study. There were 19 men and 31 women (mean age, 42 y; range, 15-73 y). All patients underwent complex filter retrieval after failure of standard methods, and retrieval indications along with resultant clinical outcomes were evaluated. Specimens with adherent tissue underwent histologic analysis, and all fractured components were studied with EM. RESULTS Retrieval was successful in all 50 cases (mean implantation, 815 d; range, 20-2,599 d) among the following filters: G2X (n = 23),G2 (n = 9), Eclipse (n = 3), Recovery (n = 4), ALN (n = 1), Celect (n = 7), OptEase (n = 2), and Simon Nitinol (n = 1). Mean indwell time in fractured filters (n = 31) was 1,082 days, versus 408 days in nonfractured filters (n = 19; P = .00169). Neointimal hyperplasia/fibrosis was seen in 46 of 48 specimens with adherent tissue (96%). Among 61 fractured components from conical filters, 35 had extravascular penetration whereas 26 remained intravascular (11 free-floating in IVC, 15 embolized centrally), and EM revealed fracture modes of high-cycle fatigue (n = 53), overload (n = 6), and indeterminate (n = 2). Following retrieval, previously prescribed lifelong anticoagulation was discontinued in 30 of 31 patients (97%). Filter-related symptoms from IVC occlusion, component embolization, and penetration-induced abdominal pain, duodenal injury, and/or small-bowel volvulus were alleviated in all 26 cases (100%). There were no long-term complications at a mean follow-up of 371 days (range, 67-878 d). CONCLUSIONS The risk of filter fracture increases after 408 days (ie,>1 y) of implantation and is associated with symptomatic extravascular penetration and/or intravascular embolization. Complex methods can be used to safely remove these devices, alleviate filter-related morbidity, and allow cessation of anticoagulation.


title: Forced arterial suction thrombectomy with the penumbra reperfusion catheter in acute basilar artery occlusion: a retrospective comparison study in 2 Korean university hospitals.

text: BACKGROUND AND PURPOSE A performance of forced arterial suction thrombectomy was not reported for the treatment of acute basilar artery occlusion. This study compared revascularization performance between intra-arterial fibrinolytic treatment and forced arterial suction thrombectomy with a Penumbra reperfusion catheter in patients with acute basilar artery occlusion. MATERIALS AND METHODS Fifty-seven patients with acute basilar artery occlusion were treated with intra-arterial fibrinolysis (n = 25) or forced arterial suction thrombectomy (n = 32). Baseline characteristics, successful revascularization rate, and clinical outcomes were compared between the groups. RESULTS Baseline characteristics, the frequency of patients receiving intravenous recombinant tissue plasminogen activator, and mean time interval between symptom onset and femoral puncture did not differ between groups. The forced arterial suction thrombectomy group had a shorter procedure duration (75.5 minutes versus 113.3 minutes, P = .016) and higher successful revascularization rate (88% versus 60%, P = .017) than the fibrinolysis group. Fair outcome, indicated by a modified Rankin Scale 0-3, at 3 months was achieved in 34% of patients undergoing forced arterial suction thrombectomy and 8% of patients undergoing fibrinolysis (P = .019), and the mortality rate was significantly higher in the fibrinolysis group (25% versus 68%, P = .001). Multiple logistic regression analysis identified the forced arterial suction thrombectomy method as an independent predictor of fair outcome with adjustment for age, sex, initial NIHSS score, and the use of intravenous recombinant tissue plasminogen activator (odds ratio, 7.768; 95% CI, 1.246-48.416; P = .028). CONCLUSIONS In acute basilar artery occlusion, forced arterial suction thrombectomy demonstrated a higher revascularization rate and improved clinical outcome compared with traditional intra-arterial fibrinolysis. Further clinical trials with the newer Penumbra catheter are warranted.


title: Navien catheter experience in neuroendovascular interventions.

text: Purpose Advancements in catheter technology have allowed for greater flexibility and trackability. We report 265 consecutive, single-center neurointerventional cases using the Navien guide catheter. Materials and methods Retrospective analysis was performed of consecutive intracranial endovascular procedures utilizing the Navien catheter. Data collected included procedure type, catheters, guide catheter position, cervical access artery tortuosity grade and complications. Results The 5 French catheter was used in 130 cases. The 6 French catheter was used in 135 cases. Access was via the internal carotid artery in 204, external carotid artery in 10, and vertebral artery in 51 cases. Catheter tip position was in the petrous segment of the internal carotid artery in 36.6% (97/265), distal cervical internal carotid artery in 13.9% (37/265), cavernous internal carotid artery in 10.2% (27/265), proximal or mid cervical internal carotid artery in 5.6% (15/265), supraclinoid internal carotid artery in 0.8% (2/265), and intradural vertebral artery in 0.8% (2/265) of cases. Catheter position was not determined in 18.9% (50/265) of cases. Proximal vessel tortuosity (grade B or C) was present in 98 cases (37%), and the catheter was tracked distal to the tortuosity in 93% (91/98) of these cases. The overall success rate without catheter complication was 97% (258/265). The Navien was replaced by another catheter in 1.9% (5/265) of cases. There was one cervical artery dissection (0.4%) and one severe vasospasm (0.4%) necessitating Navien removal. Conclusions The Navien guide catheter provided distal access support for neuroendovascular interventions in nearly all cases, including cases with proximal artery tortuosity, with a low rate of catheter-related complications.


Transcaval retrograde transcatheter aortic valve replacement for patients with no other access: first-in-man experience with CoreValve.


Biosafety in surgical pathology in the era of SARS-Cov2 pandemia. A statement of the Italian Society of Surgical Pathology and Cytology.


docid: lffsqxtx

title: [EMCAM (Multiple Sclerosis Autonomous Community of Madrid) document for the management of patients with multiple sclerosis during the SARS-CoV-2 pandemic].

text: INTRODUCTION The current SARS-CoV-2 pandemic is forcing neurologists to carry out a series of adaptations in the management of multiple sclerosis. Neurologists must weigh up the need to start or continue disease-modifying treatments against the risk of infection, the risk of complications from the infection, and the risk of multiple sclerosis activity. Since this is an unprecedented situation, most decisions are being made on the basis of a theoretical approach and the criteria of each neurologist. AIMS The aim of this study is conduct a literature search to collect available evidence on the relationship between disease-modifying therapies in multiple sclerosis and SARS-CoV-2 infection. This evidence, together with the experience of the authors in the management of patients with multiple sclerosis during the pandemic, will make it possible to offer some proposals for the treatment and follow-up of patients in this epidemiological context. DEVELOPMENT After the literature search and our experience in the management of patients, a number of proposals for treatment are established for each drug, which must necessarily be individualised for each patient, since, in these exceptional circumstances, their peculiarities can affect the prognosis. CONCLUSIONS The neurologist should be aware of current evidence to assess the risk-benefit of starting, maintaining and stopping disease-modifying therapies in multiple sclerosis during the pandemic.


title: Subcutaneous Ustekinumab Provides Clinical Benefit for Two-Thirds of Patients With Crohn's Disease Refractory to Anti-Tumor Necrosis Factor Agents.

text: BACKGROUND & AIMS Ustekinumab, a human monoclonal antibody against the p40 subunit of interleukins-12 and -23, is effective in inducing and maintaining remission in patients with luminal Crohn's disease (CD). We assessed the efficacy and safety of subcutaneous ustekinumab in patients with anti-tumor necrosis factor (anti-TNF) refractory CD. METHODS We performed a retrospective observational study, collecting data from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif on 122 consecutive patients with active CD refractory to anti-TNF therapy who received at least 1 subcutaneous injection of ustekinumab from March 2011 to December 2014, in 20 tertiary centers in Europe. Subjects were followed for at least 3 months. The primary outcome was clinical benefit, defined as reductions in symptoms and biochemical markers of CD and complete weaning from steroids, without surgery or immunosuppressant therapies. RESULTS Seventy-nine patients (65%) had a clinical benefit within 3 months of receiving ustekinumab. Concomitant immunosuppressant therapy at study inclusion increased the odds for a clinical benefit from ustekinumab (odds ratio, 5.43; 95% confidence interval, 1.14-25.77; P = .03). Over a median follow-up period of 9.8 months (interquartile range, 5.3-14.5 months), the cumulative probabilities that patients maintained the clinical benefit for 6 and 12 months after introduction of ustekinumab were 93% and 68%, respectively. CONCLUSIONS Almost two-thirds of patients with CD refractory to at least 1 anti-TNF agent receive clinical benefit from ustekinumab therapy, not requiring steroids for up to 12 months afterward. While awaiting results from ongoing trials, ustekinumab can be considered for use in these patients.


title: A critical appraisal of the quality of critical care pharmacotherapy clinical practice guidelines and their strength of recommendations.

text: OBJECTIVE Clinical practice guideline (CPG) quality assessment is important before applying their recommendations. Determining whether recommendation strength is consistent with supporting quality of evidence is also essential. We aimed to determine quality of critical care pharmacotherapy CPGs and to assess whether high quality evidence supports strong pharmacotherapy recommendations. METHODS MEDLINE (1966-February 2008), EMBASE (1980-February 2008), National Guideline Clearinghouse (February 2008) and personal files were searched to identify CPGs. Four appraisers evaluated each guideline using the appraisal of guidelines, research and evaluation (AGREE) instrument. AGREE assesses 23 items in six domains that include scope/purpose, stakeholder involvement, rigor of development, clarity, applicability and editorial independence. Standardized domain scores (0-100%) were determined to decide whether to recommend a guideline for use. One appraiser extracted strong pharmacotherapy recommendations and supporting evidence quality. RESULTS Twenty-four CPGs were included. Standardized domain scores were clarity [69% (95% confidence interval (CI) 62-76%)], scope/purpose [62% (95% CI 55-68%)], rigor of development [51% (95% CI 42-60%)], editorial independence [39% (95% CI 26-52%)], stakeholder involvement [32% (95% CI 26-37%)] and applicability [19% (95% CI 12-26%)]. The proportion of guidelines that could be strongly recommended, recommended with alterations and not recommended was 25, 37.5 and 37.5%, respectively. High quality evidence supported 36% of strong pharmacotherapy recommendations. CONCLUSION Variation in AGREE domain scores explain why one-third of critical care pharmacotherapy CPGs cannot be recommended. Only one-third of strong pharmacotherapy recommendations were supported by high quality evidence. We recommend appraisal of guideline quality and the caliber of supporting evidence prior to applying recommendations.


title: Personal Protective Equipment in the coronavirus pandemic: training with Rapid Cycle Deliberate Practice.

text: OBJECTIVE to discuss the application of Rapid Cycle Deliberate Practice for attire and unattire training in the context of COVID-19 and structure a practical guide to the application at this juncture. METHODS this methodological study described theoretical and practical aspects of the application of a simulation strategy as a technological training tool. An application guide was constructed from the search for evidence from the main health authority bodies in Brazil. RESULTS maximizing time in Deliberate Practice, feedback with evidence and psychological security are the principles of this strategy. The dynamic involves repetition and feedback. The application guide presents the sequence of actions for attire and unattire. FINAL CONSIDERATIONS coping with this pandemic requires appropriate use of personal protective equipment. The authors suggest the Rapid Cycle Deliberate Practice as a technological educational tool for attire/unattire, since it encourages mastery performance.


Dilemmas in resuscitation of COVID-19 patients based on current evidence.


title: Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques.

text: BACKGROUND Single-incision laparoscopic surgery (SILS) has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V) in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V). PATIENTS AND METHODS A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. RESULTS No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28) in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25). All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. CONCLUSION The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.


title: UV inactivation and resistance of rotavirus evaluated by integrated cell culture and real-time RT-PCR assay.

text: Rotaviruses are double-stranded RNA viruses which are among the most resistant waterborne enteric viruses to UV disinfection. An integrated cell culture and real-time RT-PCR (ICC real-time RT-PCR) assay was developed to detect the infectivity of rotaviruses in water, which uses real-time RT-PCR to detect RNA produced by infectious rotaviruses during replication in host cells. Detection of rotaviral RNA in host cells provides direct evidence of the presence of infectious rotavirus rather than just the presence of rotavirus RNA. Using this newly developed method, the inactivation and resistance of rotavirus to UV treatments at various doses was evaluated. With an initial concentration of 2 x 10(4)PFU/ml simian rotavirus (SA11), a first-order linear relationship was obtained at UV dose range of 0-120 mJ cm(-2), and the inactivation rate constant was estimated to be 0.0343 cm(2) mJ(-1) (R(2)=0.966). The dose-inactivation curve tailed off and reached plateau as the UV dose increased from 120 to 360 mJ cm(-2), indicating resistance phenomena of sub-populations of SA11 at very high UV doses. A maximal reduction of 4.8 log(10) was observed. Through parallel comparison with traditional culture assay, the ICC real-time RT-PCR method demonstrated more effective, sensitive and faster infectivity detection of rotavirus and, the results reveal that rotaviruses are more resistant to UV irradiation than previously reported with traditional cell culture assays.


title: The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study.

text: OBJECTIVE Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. METHODS Seventy two women with uncomplicated term pregnancies were randomized to spinal (n=37) or general anesthesia (n=35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. RESULTS Maternal (0.99 ± 0.19 vs. 0.80 ± 0.27) and fetal (1.00 ± 0.21 vs. 0.70 ± 0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r=0.31; P=0.008), parity (r=0.25; P=0.028), and fetal birth weight (r=0.23, P=0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r=0.29, P=0.012). CONCLUSION Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested.


title: Correlation between age and weight loss after bariatric surgery.

text: BACKGROUND Conflicting evidence exists regarding age as a predictive factor in excess weight loss after bariatric surgery. The objective of this cross-sectional study is to evaluate differences in excess BMI loss (%EBMIL) 1 year after surgery in patients older and younger than 45 years. METHODS Adult obese patients fulfilling selection criteria underwent either Roux-en-Y gastric bypass or sleeve gastrectomy and were grouped according to age < and ≥45 years with follow-up at least 1 year. Both groups were compared in terms of excess BMI loss (%EBMIL) and other clinical outcomes. Possible relationship between %EBMIL, age, surgical technique, and presence of comorbidities such as diabetes mellitus, hypertension (HT), and dyslipidemia (DL) was searched. RESULTS Three hundred thirty-seven patients (72.5 % female), 196 (50.1 %) younger than 45 years and 141 (49.9 %) with age ≥45 years. There was significant difference between age group and %EBMIL 12 months after surgery (p < 0.001), showing better results in younger patients. No differences were found in terms of gender, preoperative body mass index (BMI), surgical technique, nor presence of DL. Using multiple regression, we found significant interaction effect between age group (p < 0.001), presence of HT (p = 0.001), and %EBMIL at follow-up. CONCLUSIONS Patients younger than 45 years lose greater amount of excess BMI than older patients after bariatric surgery. This tendency might be useful as a preoperative weight loss predictor in bariatric patients.


title: Patented small molecule inhibitors of p53-MDM2 interaction.

text: The interaction between p53 and murine double minute 2 (MDM2) provides an attractive drug target in oncology. Small molecule inhibitors of this interaction have not only provided strong evidence for blocking the protein-protein interaction, but are also extremely useful as biological probes and ultimately as novel therapeutics. Here, a comprehensive review of the patented small molecule inhibitors of the p53-MDM2 interaction are provided. These inhibitors are divided into eight classes of compounds that include cis-imidazolines, benzodiazepines, fused indoles, substituted piperazines, substituted piperidines, aryl boronic acids, spiro-indoles, and alpha-helix mimetic compounds. The best documented class of compounds, cis-imidazolines (e.g., Nutlins) are selective and potent inhibitors of the p53-MDM2 interaction, and selected examples exhibit potency in the nanomolar range. Nutlins induce apoptosis in p53 wild-type cells and show in vivo efficacy in mice xenograft models. Additional strategies briefly discussed in this review, and which are under current exploration in targeting the p53 pathway, include the inhibition of MDM2-mediated p53 ubiquitylation and restoration of DNA-binding activity of mutant p53 protein using small molecules.


title: Venous thromboembolism prophylaxis in patients undergoing abdominal or pelvic surgery for cancer--a real-world, prospective, observational French study: PRéOBS.

text: INTRODUCTION Data on the epidemiology and prevention of venous thromboembolism in patients undergoing abdominal or pelvic cancer surgery in real practice are limited. The primary objective of this observational study was to describe the thromboprophylactic strategy implemented in routine practice. The main secondary objective was to assess the incidence of outcomes. MATERIALS AND METHODS Patients admitted to public or private hospitals for abdominal or pelvic cancer surgery were included between November 2009 and November 2010; endoscopic route for surgery was the only exclusion criterion. Study outcomes were recorded at hospital discharge and at routine follow-up (generally 9±3weeks). RESULTS 2380 patients (mean±SD age: 66.4±11.6years, women: 36.8%) admitted to hospital for abdominal (47.8%), urological (41%), or gynaecological (11.2%) cancer surgery were included in the analysis. Of these, 2179 had data available at study end. Perioperative antithrombotic prophylaxis, consisting mainly of low-molecular-weight heparin, was given to 99.5% of patients. At hospital discharge, thromboprophylaxis was continued in 91.7% of patients, 57.4% receiving a 4-6week prophylaxis. This management strategy was associated with an overall venous thromboembolic event rate of 1.9%, 34.7% of events occurring after discharge. Incidences of fatal bleeding, bleeding in a critical organ and bleeding necessitating re-intervention were 0.1%, 0.3% and 1.7%, respectively. Overall mortality was 1.5%. CONCLUSIONS Thromboprophylaxis is routinely used in French patients undergoing major cancer surgery. For more than a third of patients, however, treatment duration did not comply with best-practice recommendations, which might explain the non-negligible rate of thromboembolic complications still observed in this patient population.


title: First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China.

text: INTRODUCTION China has a very high tuberculosis (TB) burden. The interferon-gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. OBJECTIVES To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. METHODS A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross-sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self-administered questionnaire. RESULTS The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045-2.723, P = .0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. CONCLUSIONS Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.


Saline vs contrast infusion during optical coherence tomography imaging of peripheral percutaneous intervention.


title: Efficacy evaluation of a protocol for safe hip surgery (total hip arthroplasty).

text: OBJECTIVE To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. METHODS Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. RESULTS Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). CONCLUSION The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure.


title: Regionalization of the stretch reflex in the human vastus medialis.

text: KEY POINTS Regionalization of the stretch reflex, i.e. the notion that the activation of 1a afferents from a muscle region influences only the activation of motor units in the same region, has been demonstrated previously in animals but not in humans. Mechanical stretches applied to regions of vastus medialis as close as 10 mm apart resulted in recruitment of motor units localized topographically with respect to the location of the mechanical stretch. Stretch reflexes are regionalized in the human vastus medialis. The human spinal cord has the neuromuscular circuitry to preferentially activate motoneurones innervating muscle fibres located in different regions of the vastus medialis. ABSTRACT The localization of motor unit territories provides an anatomical basis to suggest that the CNS may have more independence in motor unit recruitment and control strategies than what was previously thought. In this study, we investigated whether the human spinal cord has the neuromuscular circuitry to independently activate motor units located in different regions of the vastus medialis. Mechanical taps were applied to multiple locations in the vastus medialis (VM) in nine healthy individuals. Regional responses within the muscle were observed using a grid of 5 × 13 surface EMG electrodes. The EMG amplitude was quantified for each channel, and a cluster of channels showing the largest activation was identified. The spatial location of the EMG response was quantified as the position of the channels in the cluster. In a subset of three participants, intramuscular recordings were performed simultaneously with the surface EMG recordings. Mechanical taps resulted in localized, discrete responses for each participant. The spatial location of the elicited responses was dependent on the location of the tap (P < 0.001). Recordings with intramuscular electrodes confirmed the regional activation of the VM for different tap locations. Selective stimulation of 1a afferents localized in a region of the VM results in reflex recruitment of motor units in the same region. These findings suggest that the human spinal cord has the neuromuscular circuitry to modulate spatially the motoneuronal output to vastus medialis regions, which is a neuroanatomical prerequisite for regional activation.


title: Superficial dermal melanocytosis of the elderly: an exceptional occurrence?

text: The development of flat pigmented lesions on chronically sun-damaged (CSD) skin of the face may represent the clinical manifestation of a wide variety of hyperplastic/neoplastic melanocytic proliferations. We report the exceptional case of an acquired pigmented patch occurring on CSD skin, histopathologically characterized by diffuse hyperplasia of dendritic/spindled melanocytes in the superficial dermis within a widened band of actinic elastosis. This lesion was associated with a small focus of early invasive lentigo maligna melanoma (LMM). We demonstrate the melanocytic nature of the population of dermal pigmented cells by means of single and double immunohistochemical staining for melanocytic and histiocytic markers. The biologic significance of the focus of LMM within the hyperpigmented lesion (whether random collision phenomenon or causally related occurrence), as well as the pathogenesis of the whole dermal lesion are difficult to elucidate. Our case emphasizes the need for a better understanding of the pathophysiology of so-called dermal melanocytes.


title: SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

text: The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008-2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.


docid: stcgbwod

title: Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study.

text: OBJECTIVE To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on fasting and meal-stimulated release of the gut hormones ghrelin, pancreatic polypeptide (PP), peptide-YY (PYY), glucagon-like peptide-1 (GLP-1), and amylin and of the adipocytokine leptin. BACKGROUND Mounting evidence suggests that the mechanisms of weight loss and the improvement in glucose metabolism seen after LSG are related not only to gastric restriction but also to neurohormonal changes. METHODS : Fasting and postprandial levels at 60 and 120 minutes after a standard test meal of the above peptides and glucose metabolism indices were evaluated in 15 consecutive morbidly obese (MO) subjects before and 6 and 12 months after LSG. As study controls, 15 lean subjects matched for age and sex were also assessed. RESULTS Body mass index values notably decreased at 6 and 12 months (P < 0.01), postoperatively. In addition, an overall improvement of the glycemic profile of MO patients was noted. After LSG, markedly decreased fasting and postprandial levels of ghrelin, amylin, and leptin were observed. A significant postprandial increase of PYY and GLP-1 levels was also noted postoperatively. Interestingly, significantly increased levels of PP were noted only at 60 minutes postprandially after LSG. CONCLUSIONS LSG markedly improved glucose homeostasis and generated significant changes in ghrelin, PP, PYY, GLP-1, amylin, and leptin levels. These multiple hormonal actions may have several beneficial effects on the underlying mechanism of weight loss, demonstrating that LSG could be more than just a restrictive bariatric operation.


title: Dose-dependent reversal of KCC2 hypofunction and phenobarbital-resistant neonatal seizures by ANA12.

text: Neonatal seizures have an incidence of 3.5 per 1000 newborns; while hypoxic-ischemic encephalopathy (HIE) accounts for 50-60% of cases, half are resistant to 1st-line anti-seizure drugs such as phenobarbital (PB). Tyrosine receptor kinase B (TrkB) activation following ischemic injury is known to increase neuronal excitability by downregulation of K-Cl co-transporter 2 (KCC2); a neuronal chloride (Cl-) co-transporter. In this study, three graded doses of ANA12, a small-molecule selective TrkB antagonist, were tested in CD1 mice at P7 and P10 following induction of neonatal ischemia by a unilateral carotid ligation. The PB loading dose remained the same in all treatment groups at both ages. Evaluation criteria for the anti-seizure efficacy of ANA12 were: (1) quantitative electroencephalographic (EEG) seizure burden and power, (2) rescue of post-ischemic KCC2 and pKCC2-S940 downregulation and (3) reversal of TrkB pathway activation following ischemia. ANA12 significantly rescued PB resistant seizures in a dose-dependent manner at P7 and improved PB efficacy at P10. Additionally, female pups responded better to lower doses of ANA12 compared to males. ANA12 significantly reversed post-ischemic KCC2 downregulation and TrkB pathway activation at P7 when PB alone was inefficacious. Rescuing KCC2 hypofunction may be critical for preventing emergence of refractory seizures.


title: Evaluation of a Safety Awareness Group Program for Adults With Intellectual Disability.

text: Using a participatory research approach, we enlisted 12 U.S. Centers for Independent Living (CILs) to recruit and enroll 170 adults with intellectual disability (ID) to be randomized to either The Safety Class, an abuse prevention group program, or usual care. Participants were asked to complete pre, post, and 3-month follow-up questionnaires. CIL staff members facilitated the eight-session, interactive program. Quantitative and qualitative findings suggest that participation in a brief safety program may improve safety protective factors among men and women with ID. The Safety Class serves as one model for delivering an abuse prevention and education intervention to adults with significant safety needs but extremely limited access to relevant community resources.


Coinfection of SARS-CoV-2 and multiple respiratory pathogens in children.


title: Strengthening Local Food Systems in Times of Concomitant Global Crises: Reflections From Chile.

text: The COVID-19 pandemic is superimposed on the existing challenges of obesity, undernutrition, and climate change. Currently, Chile is still facing the worst drought on record, which will continue to negatively affect agriculture. In Chile, COVID-19 also comes on top of a social crisis that began on October 18, 2019, and was driven by the cumulative effects of an economic system established by former dictator Augusto Pinochet that deregulated markets and privatized social security.1 As of March 26, 2020, Chile, already in a state of catastrophe, had reached 1300 confirmed cases of COVID-19, which catalyzed a total lockdown for the counties with the greatest concentration of cases. As in the rest of the world, in Chile COVID-19 has affected the national food system-which has been observed but mostly not yet documented. (Am J Public Health. Published online ahead of print May 14, 2020: e1-e3. doi:10.2105/AJPH.2020.305711).


title: Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients.

text: RATIONALE Measured at intensive care unit admission (ICU), the predictive value of neutrophil gelatinase-associated lipocalin (NGAL) for severe acute kidney injury (AKI) is unclear. OBJECTIVES To assess the ability of plasma and urine NGAL to predict severe AKI in adult critically ill patients. METHODS Prospective-cohort study consisting of 632 consecutive patients. MEASUREMENTS AND MAIN RESULTS Samples were analyzed by Triage immunoassay for NGAL expression. The primary outcome measure was occurrence of AKI based on Risk-Injury-Failure (RIFLE) classification during the first week of ICU stay. A total of 171 (27%) patients developed AKI. Of these 67, 48, and 56 were classified as RIFLE R, I, and F, respectively. Plasma and urine NGAL values at ICU admission were significantly related to AKI severity. The areas under the receiver operating characteristic curves for plasma and urine NGAL were for RIFLE R (0.77 ± 0.05 and 0.80 ± 0.04, respectively), RIFLE I (0.80 ± 0.06 and 0.85 ± 0.04, respectively), and RIFLE F (0.86 ± 0.06 and 0.88 ± 0.04, respectively) and comparable with those of admission estimated glomerular filtration rate (eGFR) (0.84 ± 0.04, 0.87 ± 0.04, and 0.92 ± 0.04, respectively). Plasma and urine NGAL significantly contributed to the accuracy of the "most efficient clinical model" with the best four variables including eGFR, improving the area under the curve for RIFLE F prediction to 0.96 ± 0.02 and 0.95 ± 0.01. Serial NGAL measurements did not provide additional information for the prediction of RIFLE F. CONCLUSIONS NGAL measured at ICU admission predicts the development of severe AKI similarly to serum creatinine-derived eGFR. However, NGAL adds significant accuracy to this prediction in combination with eGFR alone or with other clinical parameters and has an interesting predictive value in patients with normal serum creatinine.


title: The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review.

text: BACKGROUND Respiratory viruses spread in humans across wide geographical areas in short periods of time, resulting in high levels of morbidity and mortality. We undertook a systematic review to assess the evidence that air, ground and sea mass transportation systems or hubs are associated with propagating influenza and coronaviruses. METHODS Healthcare databases and sources of grey literature were searched using pre-defined criteria between April and June 2014. Two reviewers screened all identified records against the protocol, undertook risk of bias assessments and extracted data using a piloted form. Results were analysed using a narrative synthesis. RESULTS Forty-one studies met the eligibility criteria. Risk of bias was high in the observational studies, moderate to high in the reviews and moderate to low in the modelling studies. In-flight influenza transmission was identified substantively on five flights with up to four confirmed and six suspected secondary cases per affected flight. Five studies highlighted the role of air travel in accelerating influenza spread to new areas. Influenza outbreaks aboard cruise ships affect 2-7% of passengers. Influenza transmission events have been observed aboard ground transport vehicles. High heterogeneity between studies and the inability to exclude other sources of infection means that the risk of influenza transmission from an index case to other passengers cannot be accurately quantified. A paucity of evidence was identified describing severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus transmission events associated with transportation systems or hubs. CONCLUSION Air transportation appears important in accelerating and amplifying influenza propagation. Transmission occurs aboard aeroplanes, at the destination and possibly at airports. Control measures to prevent influenza transmission on cruise ships are needed to reduce morbidity and mortality. There is no recent evidence of sea transport accelerating influenza or coronavirus spread to new areas. Further investigation is required regarding the roles of ground transportation systems and transport hubs in pandemic situations.


docid: ebllnqpb

title: Laparoscopic pylorus-preserving pancreatic head resection and hybrid open reconstruction via pancreatogastrostomy.

text: INTRODUCTION Laparoscopic pancreatic surgery is ambitious and should only be performed in institutions with expert knowledge in pancreatic surgery. METHODS Whereas pancreatic tail resection is routinely and safely performed in several institutions, the laparoscopic resection of the pancreatic head is only performed by a handful of surgeons. RESULTS In this article, we present our hybrid approach with complete laparoscopic pylorus-preserving pancreatic head resection and successive reconstruction via a small retrieval incision, which might combine the advantages of the laparoscopic resection with the safety of an open and routine pancreatic anastomosis.


title: Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review.

text: INTRODUCTION Death due to opioid overdose was declared a public health crisis in Canada in 2015. Traditionally, patients who have overdosed on opioids that are managed by emergency medical services (EMS) are treated with the opioid antagonist naloxone, provided ventilatory support and subsequently transported to hospital. However, certain EMS agencies have permitted patients who have been reversed from opioid overdose to refuse transport, if the patient exhibits capacity to do so. Evidence on the safety of this practice is limited. Therefore, our intent was to examine the available literature to determine mortality and serious adverse events within 48 hours of EMS treat and release due to suspected rebound opioid toxicity after naloxone administration. METHODS A systematic search was performed on 11 May 2017 in PubMed, Cochrane Central, Embase and CINHAL. Studies that reported on the outcome of patients treated with prehospital naloxone and released at the scene were included. Analyses for incidence of mortality and adverse events at the scene were conducted. Risk of bias and assessment of publication bias was also done. RESULTS 1401 records were screened after duplicate removal. Eighteen full-text studies were reviewed with seven selected for inclusion. None were found to be high risk of bias. In most studies, heroin was the source of the overdose. Mortality within 48 hours was infrequent with only four deaths among 4912 patients ﴾0.081%﴿ in the seven studies. Only one study reported on adverse events and found no incidence of adverse events from their sample of 71 released patients. CONCLUSION Mortality or serious adverse events due to suspected rebound toxicity in patients released on scene post-EMS treatment with naloxone were rare. However, studies involving longer-acting opioids were rare and no study involved fentanyl.


title: KLF5 is involved in regulation of IFITM1, 2, and 3 genes during H5N1 virus infection in A549 cells.

text: The interferon-induced transmembrane (IFITM) proteins usually protect cells from many virus infections by viral entry and replication. Thus, the present study aimed to identification novel regulation factors of IFITM genes. Our data showed up-regulation of IFITM1, IFITM2, and IFITM3 genes in A549 by H5N1 virus infection. However, IFITM1 was not affected, IFITM2 and IFITM3 increases expression following different concentration H5N1 virus infection in HEK293T cells. This is the first time to find differences of IFITM1 transcription in different cells with the H5N1 virus infection. Moreover, experiments showed that H5N1 virus promotes expression of KLF4 and KLF5 in both A549 and HEK293T cells, but H5N1 virus NS1, M1, NP or PB2 alone has no obvious effect on transcription of KLF5. Overexpression of KLF5 increases transcription of IFITM1, IFITM2, and IFITM3 in A549 cells, however, it does not affect transcription of IFITM1, IFITM2, and IFITM3 in HEK293T cells. In addition, results for the first time displayed that KLF4 can up-regulate expression of IFITM5 in both A549 and HEK293T cells. In conclusion, we revealed KLF5 is involved in transcription of IFITM1, 2, and 3 thus making it a potential therapeutic activator in the future to treat viral infections through promoting the innate immune response.


Maintaining stereotactic radiosurgical treatments during Covid-19 outbreak: the case of the Gamma Knife Unit in Brescia - Italy.


docid: qsjzcxqp

title: Learning the lessons from 1000 robot-assisted radical prostatectomy procedures.


title: Viral Acute Respiratory Illnesses in Young Infants Increase the Risk of Respiratory Readmission.

text: BACKGROUND Respiratory viruses cause acute respiratory illness (ARI) in early childhood, but their effect on subsequent ARI admissions is not fully understood. This study aimed to determine the association between initial ARI admission because of viruses including human rhinovirus (HRV), respiratory syncytial virus (RSV), human adenovirus (HAdV) and human metapneumovirus (hMPV) and the risk of ARI readmission in children. METHODS Clinical information and nasopharyngeal swab samples were collected from children <2 years old at their initial ARI admission in Nha Trang, Vietnam, from January 2007 to April 2012. The incidence of ARI readmission during the follow-up period (initial admission to 5 years of age) was compared between children with and without 1 of 13 respiratory viruses (influenza virus A, influenza virus B, RSV, hMPV, parainfluenza virus-1, parainfluenza virus-2, parainfluenza virus-3 and parainfluenza virus-4, HRV, human coronavirus-229E, human coronavirus-OC43, HAdV and human bocavirus) at initial admission. RESULTS A total of 1941 children were enrolled in the study. Viruses were detected in 1254 (64.6%) children at enrollment; HRV, RSV, HAdV and hMPV were detected in 499 (25.7%), 439 (22.6%), 156 (8.0%) and 47 (2.4%) children, respectively. During the follow-up period (4572.7 person-years), 277 children were readmitted with ARI. Virus-related ARI initial admission was associated with an increased risk of ARI readmission for children who were initially admitted before 6 months of age (adjusted rate ratio, 1.6; 95% confidence interval: 1.1-2.5). HAdV (4.6; 1.8-11.9), hMPV (20.4; 6.2-66.9) and HRV (1.6; 1.0-2.4) were independently associated with the outcome. These associations were not observed for children whose initial admission occurred after 6 months of age. CONCLUSIONS HAdV-, hMPV- and HRV-related initial ARI admissions, when occurring during early infancy, increased the risk of subsequent ARI-related readmission.


title: Phase I trial of 90Y-DOTATOC therapy in children and young adults with refractory solid tumors that express somatostatin receptors.

text: UNLABELLED The purpose of this study was to conduct a phase I trial of (90)Y-DOTATOC to determine the dose-toxicity profile in children and young adults with somatostatin receptor-positive tumors. METHODS A 3 × 3 design was used to determine the highest tolerable dose of (90)Y-DOTATOC, with administered activities of 1.11, 1.48, and 1.85 GBq/m(2)/cycle given in 3 cycles at 6-wk intervals. An amino acid infusion was coadministered with the radiopharmaceutical for renal protection. Eligibility criteria included an age of 2-25 y, progressive disease, a positive lesion on (111)In-diethylenetriaminepentaacetic acid-D-Phe(1)-octreotide scanning, a glomerular filtration rate of 80 mL/min/1.73 m(2) or more, bone marrow cellularity of 40% or more or stored autologous hematopoietic stem cells, 60% or more on the Lansky Play Scale, and informed consent. RESULTS Seventeen subjects (age, 2-24 y) received at least 1 dose of (90)Y-DOTATOC; diagnoses included neuroblastoma, embryonal and astrocytic brain tumors, paraganglioma, multiple endocrine neoplasia IIB, and neuroendocrine tumors. No dose-limiting toxicities and no individual dose reductions due to renal or hematologic toxicity were noted. No complete responses were observed; 2 subjects experienced partial response, 5 had minor responses, 6 experienced stable disease, 2 had progressive disease, and 2 withdrew. CONCLUSION Peptide receptor radionuclide therapy with (90)Y-DOTATOC is safe in children and young adults and demonstrated a 12% partial response plus 29% minor response rate in patients with somatostatin receptor-positive tumors. No dose-limiting toxicities were observed. The recommended phase II dosing is 3 cycles of 1.85 GBq/m(2)/dose of (90)Y-DOTATOC coadministered with amino acids.


docid: ltgvntit

title: Advanced esophageal cancer in patients who underwent radiofrequency ablation for barrett esophagus with high-grade dysplasia.

text: OBJECTIVE We sought to evaluate clinicopathologic features of patients who underwent esophageal surgery after radiofrequency ablation (RFA) treatment using the HALO system for Barrett esophagus (BE) with high-grade dysplasia (HGD). METHODS We evaluated patients from our hospital database who underwent esophagectomy from August 2006 to January 2012 after previously receiving RFA for BE. Information on demographics, time between RFA and surgery, indications for surgery, and final esophageal pathology was collected. RESULTS In our study, we selected 102 patients who underwent esophagectomy. Five patients had a history of RFA for BE with HGD. Three patients were referred because of persistent HGD despite RFA, and all three patients had HGD in the esophagectomy specimen. Two patients presented with a benign diagnosis (esophageal perforation and leiomyoma), and both of these patients had pathologic stage T3N2M0 adenocarcinoma of the esophagus in the resected specimen. One of these patients had normal mucosa overlying carcinoma in the muscularis propria and adventitia. The patients with stage T3N2M0 cancer did not have pre-RFA endoscopic ultrasound, first treatment of RFA with HALO, or surveillance endoscopic biopsy every 3 months. CONCLUSIONS Radiofrequency ablation for BE with HGD may mask underlying esophageal cancer. Patients who are counseled to undergo RFA for HGD should be aware that RFA could lead to delayed diagnosis and delayed treatment of invasive esophageal cancer without careful patient selection, appropriate RFA use, and close surveillance.


title: Optimal care and design of the tracheal cuff in the critically ill patient.

text: Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure.


title: Role of Changes in State of Bound Water and Tissue Stiffness in Development of Age-Related Diseases.

text: An essential effect of environmental stiffness on biological processes in cells at present is generally accepted. An increase in arterial stiffness with advanced age has been reported in many publications. The aim of the present review is to summarize current information about possible chemical reactions and physical processes that lead to tissue stiffening and result in age-related diseases in order to find methods that can prevent or retard time-dependent tissue stiffening. The analysis of published data shows that bound water acts as a plasticizer of biological tissues, a decrease in bound water content results in an increase in biological tissue stiffness, and increased tissue stiffness leads to NF-kB activation and triggered actin polymerization-NF-kB activation is associated with age-related diseases. It can be suggested that changes in bound water content through changing tissue stiffness can affect cellular processes and the development of pathologies related to aging. Both age-related diseases and COVID-19 may be associated with tight-junction disruption and increased tissue stiffness and permeability.


title: In-vitro examination of the biocompatibility of fibroblast cell lines on alloplastic meshes and sterilized polyester mosquito mesh.

text: INTRODUCTION The use of alloplastic implants for tissue strengthening when treating hernias is an established therapy worldwide. Despite the high incidence of hernias in Africa and Asia, the implantation of costly mesh netting is not financially feasible. Because of that various investigative groups have examined the use of sterilized mosquito netting. The animal experiments as well as the clinical trials have both shown equivalent short- and long-term results. The goal of this paper is the comparison of biocompatibility of human fibroblasts on the established commercially available nets and on sterilized polyester mosquito mesh over a period of 12 weeks. MATERIALS AND METHODS Three commercially available plastic mesh types and a gas-sterilized mosquito polyethylenterephtalate (polyester) mesh were examined. Human fibroblasts from subcutaneous healthy tissue were used. Various tests for evaluating the growth behavior and the cell morphology of human fibroblasts were conducted. The semi-quantitative (light microscopy) and qualitative (scanning electron microscopy) analyses were performed after 1 week and then again after 12 weeks. The cell proliferation and cytotoxicity of the implants were investigated with the help of the 5'-bromo-2'-deoxyuridine (BrdU)-cell proliferation test and the LDH-cytotoxicity test. The number of live cells per ml was determined with the Bürker counting chamber. In addition, analyses were made of the cell metabolism (oxidative stress) by measuring the pH value, hydrogen peroxide, and glycolysis. RESULTS After 12 weeks, a proliferation of fibroblasts on all mesh is documented. No mesh showed a complete apoptosis of the cells. This qualitative observation could be confirmed quantitatively in a biochemical assay by marking the proliferating cells with BrdU. The biochemical analysis brought the proof that the materials used, including the polyester of the mosquito mesh, are not cytotoxic for the fibroblasts. The vitality of the cells was between 94 and 98%. The glucose metabolism as well as the pH value of the fibroblasts showed no significant differences between the tested meshes. The examination of the oxidative stress via measurement of the H2O2 concentration showed values in the normal range for the commercially alloplastic meshes and the mosquito mesh. CONCLUSIONS Our examination showed no significant difference with regard to biocompatibility between the officially approved and cost-intensive meshes and the sterilized (autoclaved) mosquito mesh. Due to the proven strength and stability of the mosquito mesh and their proven compatibility, the implantation of the sterilized mosquito mesh in additional in vivo studies must be considered. A wide-scale and cost-effective treatment of hernias could thus be guaranteed, not only in Third World countries.


title: A survey of rodent-borne pathogens carried by wild-caught Norway rats: a potential threat to laboratory rodent colonies.

text: Unintentional infection of laboratory rodents can compromise scientific research as well as the health of the animals and animal handlers. The source of contamination often is unknown, but may be introduced by wild rats from surrounding environments. To determine whether rats in Baltimore, Maryland, USA carry infectious agents commonly found in laboratory rodent colonies, we live-trapped 162 rats during 2005 to 2006 and screened them for a panel of viruses, bacteria and parasites. Antibodies against rat coronavirus/sialodacryoadenitis virus (91.7%), Mycoplasma pulmonis (72.9%), cilia-associated respiratory bacillus (52.1%), rat parvovirus/rat minute virus (29.2%), Kilham rat virus (10.4%), Toolan's H-1 virus (10.4%), Sendai virus (4.2%) and Theiler's mouse encephalomyelitis virus (4.2%), were detected in wild-caught Norway rats. Antibodies against reovirus and pneumonia virus of mice were not detected in wild Norway rats. Endoparasites, including Nippostrongylus braziliensis (71.6%), Rodentolepis nana or Hymenolepis diminuta (34.4%), Hetarakis spumosa (24.1%) and Trichuris muris (14.8%), as well as ectoparasites (14.8%), were identified in wild-caught rats. The risk of pathogen transmission from wild-caught rats to laboratory colonies needs to be mitigated by minimizing exposures rather than assuming wild animals represent a minimal hazard.


title: Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits.

text: INTRODUCTION Our recent prospective randomized controlled trial (NCT01660048) comparing single-incision laparoscopic (SIL) totally extraperitoneal (TEP) and multi-incision inguinal herniorraphy confirmed safety, efficacy and benefits of single-incision approach. This study (NCT01883115) aimed to assess safety, efficacy and cost effectiveness of telescopic extraperitoneal dissection. METHODS Patients with inguinal/femoral hernias from February 2013 to February 2014 undergoing SILTEP herniorraphy with telescopic dissection were compared with patients who had previously undergone SILTEP herniorraphy with balloon dissection. Costs of different ports/trocars were analysed. RESULTS There were 102 patients in telescopic compared to 51 in balloon dissection group; these had no significant differences in age, sex, body mass index, American Society of Anesthesiologists and pre-op visual analogue scores. Telescopic vs. balloon showed: post-operative pain-day one 2.5 vs. 2.5; p = 0.90, day seven 0 vs. 0; p = 0.02 (0 vs. 1; p < 0.01 for bilateral hernias); operation times-unilateral 48.0 vs. 48.0 min; p = 0.88 and bilateral 70.0 vs. 65.0 min; p = 0.66, length of hospital stay 1.0 vs. 1.0 day, analgesic intake (dextropropoxyphene) 6.0 vs. 6.0 tablets; p = 0.95, return to work/normal physical activities 7.0 vs. 7.0 days; p = 0.46 and cosmetic scar scores 24.0 vs. 24.0, respectively. There was no conversion to open surgery/need for additional ports in either group. Median scar length for telescopic group was 13.0 mm. Costs of disposable ports/trocars for telescopic and balloon groups were US$480 and $720, respectively. There were no morbidities/recurrences with follow-up of 2-36 months. CONCLUSIONS Telescopic extraperitoneal dissection during SILTEP inguinal herniorraphy represents a safe and efficient alternative with potential cost savings compared to balloon dissection.


title: Management of hospital wastewaters: the case of the effluent of a large hospital situated in a small town.

text: Hospitals are the main source of pharmaceutical compounds (PhCs) released into the environment. Generally, their discharges are co-treated with domestic wastewaters, resulting in a decrement of the recalcitrant compound concentrations in the final effluent due to water dilution. However, as many PhCs resist normal treatments, pollutant load does not change. This paper compares the chemical characteristics of hospital and domestic wastewaters on the basis of an experimental investigation for macro-pollutants and literature data for PhCs. A membrane biological reactor pilot plant fed by a hospital effluent is tested in order to evaluate the feasibility of treating these kinds of wastewaters with membrane systems. The paper then presents the possible scenarios in the management of the effluent of a large hospital situated in a small town. In particular, it reports on a case study of designing a (new) treatment plant for the effluent of the 900 bed hospital in Ferrara, Northern Italy, located on the outskirts of the town. Finally, costs for the intervention are given.


title: Indirect skin sign of COVID-19 days: striae rubrae.

text: During COVID-19 pandemic, an increase was observed in stress-related dermatological diseases and COVID-19 related rash, while a significant decrease was observed in cosmetological outpatient applications. However, one month after the COVID-19 outbreak began, we observed a rapid increase especially individuals under 20 years of age diagnosed with stria rubrae in dermatology outpatient clinics. The number of patients diagnosed with striae rubrae was four times higher than last month (0.1% vs 0.4%). In order to prevent the rapid spread of the COVID-19 epidemic, the closure of schools, the transition to online education and the curfew imposed under the age of 20 caused a change in lifestyle and diet in young people. The incidence of striae rubrae due to rapid weight gain increased. If not heeded, COVID-19 pandemic can cause striae rubrae pandemic.