title: Effects of liposomal-curcumin on five opportunistic bacterial strains found in the equine hindgut - preliminary study.

text: BACKGROUND The horse intestinal tract is sensitive and contains a highly complex microbial population. A shift in the microbial population can lead to various issues such as inflammation and colic. The use of nutraceuticals in the equine industry is on the rise and curcumin is thought to possess antimicrobial properties that may help to minimize the proliferation of opportunistic bacteria. METHODS Four cecally-cannulated horses were utilized to determine the optimal dose of liposomal-curcumin (LIPC) on reducing Streptococcus bovis/equinus complex (SBEC), Escherichia coli K-12, Escherichia coli general, Clostridium difficile, and Clostridium perfringens in the equine hindgut without adversely affecting cecal characteristics. In the first study cecal fluid was collected from each horse and composited for an in vitro, 24 h batch culture to examine LIPC at four different dosages (15, 20, 25, and 30 g) in a completely randomized design. A subsequent in vivo 4 × 4 Latin square design study was conducted to evaluate no LIPC (control, CON) or LIPC dosed at 15, 25, and 35 g per day (dosages determined from in vitro results) for 9 days on the efficacy of LIPC on selected bacterial strains, pH, and volatile fatty acids. Each period was 14 days with 9 d for acclimation and 5 d withdrawal period. RESULTS In the in vitro study dosage had no effect (P ≥ 0.42) on Clostridium strains, but as the dose increased SBEC concentrations increased (P = 0.001). Concentrations of the E. coli strain varied with dose. In vivo, LIPC's antimicrobial properties, at 15 g, significantly decreased (P = 0.02) SBEC when compared to 25 and 35 g dosages. C. perfringens decreased linearly (P = 0.03) as LIPC dose increased. Butyrate decreased linearly (P = 0.01) as LIPC dose increased. CONCLUSION Further studies should be conducted with a longer dosing period to examine the antimicrobial properties of curcumin without adversely affecting cecal characteristics.


title: Low dose lung radiation therapy for pneumonia: an examination of historical dose distributions.

text: The novel coronavirus, SARS-CoV-2, that causes the COVID-19 disease currently has healthcare systems around the world dealing with unprecedented numbers of critically ill patients. One of the primary concerns associated with this illness is acute respiratory distress syndrome (ARDS) and the pneumonia that accompanies it. Historical literature dating back to the 1940s and earlier contains many reports of successful treatment of pneumonias with ionizing radiation. Although these were not randomized controlled trials, they do suggest a potential avenue for further investigation. Technical details in these reports however were limited. In this work we review the literature and identify details including nominal kilovoltage ranges, filtration, and focus-skin distances (FSDs). Using a freely available and benchmarked code, we generated spectra and used these as sources for Monte Carlo simulations using the EGSnrc software package. The approximate sources were projected through a radiologically anthropomorphic phantom to provide detailed dose distributions within a targeted lung volume (approximate right middle lobe). After accounting for the reported exposure levels, mean lung doses fell in a relatively narrow range: 30 - 80 cGy. Variation in patient dimensions and other details are expected to result in an uncertainty on the order of ± 20%. This result is consistent with the dose range expected to induce anti-inflammatory effects.


title: Three clinical cases of Anaplasma phagocytophilum infection in cats in Poland.

text: The purpose of this study was to describe Anaplasma phagocytophilum infection of three cats in Poland showing signs of fever, swollen and painful joints, pale mucous membranes and epistaxis. Morulae consistent with A phagocytophilum were present within the neutrophils of two of the cats. A polymerase chain reaction (PCR) was found targeting the 16S rRNA gene amplified DNA consistent with A phagocytophilum in the blood of all three cats. The sequence of the PCR product obtained showed 99.6-100% homology with the sequence of A phagocytophilum, gene number EU 090186 from Genbank. Applied therapy (including administration of tetracyclines for 3 weeks) resulted in a gradual clinical recovery.


title: Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity.

text: Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 hours and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.


title: Delivery of therapeutic protein for prevention of neurodegenerative changes: comparison of different CSF-delivery methods.

text: Injection of lysosomal enzyme into cisternal or ventricular cerebrospinal fluid (CSF) has been carried out in 11 lysosomal storage disorder models, with each study demonstrating reductions in primary substrate and secondary neuropathological changes, and several reports of improved neurological function. Whilst acute studies in mucopolysaccharidosis (MPS) type II mice revealed that intrathecally-delivered enzyme (into thoraco-lumbar CSF) accesses the brain, the impact of longer-term treatment of affected subjects via this route is unknown. This approach is presently being utilized to treat children with MPS types I, II and III. Our aim was to determine the efficacy of repeated intrathecal injection of recombinant human sulfamidase (rhSGSH) on pathological changes in the MPS IIIA dog brain. The outcomes were compared with those in dogs treated via intra-cisternal or ventricular routes. Control dogs received buffer or no treatment. Significant reductions in primary/secondary substrate levels in brain were observed in dogs treated via all routes, although the extent of the reduction differed regionally. Treatment via all CSF access points resulted in large reductions in microgliosis in superficial cerebral cortex, but only ventricular injection enabled amelioration in deep cerebral cortex. Formation of glutamic acid decarboxylase-positive axonal spheroids in deep cerebellar nuclei was prevented by treatment delivered via any route. Anti-rhSGSH antibodies in the sera of some dogs did not reduce therapeutic efficacy. Our data indicates the capacity of intra-spinal CSF-injected rhSGSH to circulate within CSF-filled spaces, penetrate into brain and mediate a significant reduction in substrate accumulation and secondary pathology in the MPS IIIA dog brain.


title: Reorganizing Cross-Sectional Interventional Procedures Practice During the Coronavirus Disease (COVID-19) Pandemic.

text: OBJECTIVE. The purpose of this article is to present strategies and guidelines that can be implemented in the performance of cross-sectional interventional procedures during the coronavirus disease (COVID-19) pandemic. CONCLUSION. Radiologists who perform cross-sectional interventional procedures can take several steps to minimize the risks to patients and radiology personnel, including screening referred patients to decide which procedures can be postponed, using appropriate personal protective equipment (PPE), minimizing the number of people involved in procedures, preserving PPE when possible, and applying proper room and equipment cleaning measures.


title: Public Health and Privacy in the Pandemic.

text: The fundamental ethical, legal, and policy challenge of public health is balancing public and individual interests, often conceptualized as the conflict between utilitarianism and libertarianism. During the COVID-19 (coronavirus disease 2019) pandemic, this struggle has involved the imposition of extraordinary levels of government-mandated social distancing to protect public health followed by impassioned efforts to lessen these constraints in the interests of individual liberty and economic renewal. (Am J Public Health. Published online ahead of print July 2, 2020: e1-e2. doi:10.2105/AJPH.2020.305849).


docid: umgpqqlc

title: SINGLE PORT LAPAROSCOPIC FALCIFORM LIGAMENT COLLECTION IN A CHEETAH (ACINONYX JUBATUS).

text: A single incision laparoscopic system (SILS) was used to remove the falciform ligament of an adult male cheetah (Acinonyx jubatus) during routine diagnostic liver biopsy. Adipose tissue isolated from the falciform ligament was used to establish a mesenchymal stem cell culture. The use of a SILS port for liver biopsy and falciform ligament collection allowed for a large amount of fat to be collected from a small surgical incision and rapid postoperative recovery. This case expands the use of the single incision laparoscopy surgical technique beyond reproductive sterilization procedures in large cats.


title: Successful Treatment of Mandibular Nonunion With Cortical Allograft, Cancellous Autograft, and Locking Titanium Miniplates in a Dog.

text: Discontinuities of the mandible can occur for a variety of reasons including primary pathology of bone, pathologic fracture secondary to periodontal disease, and segmental resection for the treatment of neoplasia. Surgical intervention is necessary in many cases to establish normal occlusion and normal mandibular function. Rigid stabilization and treatment of these defects can be challenging due to the limited availability of bone for fixation as well as limited soft tissue coverage. This case report describes successful treatment of a nonunion fracture using cortical allograft and locking titanium miniplates. Complete osseointegration and bone healing were achieved, allowing for complete return to normal occlusion and function.


title: Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study.

text: OBJECTIVE To assess urinary, sexual, and bowel function before and after laparoscopic bowel resection for rectosigmoid endometriosis. DESIGN Prospectively collected data regarding the function of the pelvic organs. SETTING Tertiary endometriosis referral unit, Aarhus University Hospital. SAMPLE A cohort of 128 patients who underwent laparoscopic bowel resection for endometriosis. METHODS The International Consultation on Incontinence Questionnaire (ICIQ), Sexual Function-Vaginal Changes Questionnaire (SVQ), and the Low Anterior Resection Syndrome (LARS) questionnaire were answered before and after surgery. Non-invasive urodynamic testing was performed. MAIN OUTCOME MEASURES Pre- and postoperative function of the pelvic organs was compared, and risk factors for improved/impaired function were identified. RESULTS A total of 96.1% of the women completed the 1-year follow-up. A significant decrease (P = 0.002) in bladder filling problems (F-score) was observed 1 year after surgery, primarily caused by a significant decrease in bladder pain (P = 0.0001). No change for urodynamic parameters was observed. A significant increase in overall sexual satisfaction (P = 0.0001) and decrease in worries about sexual life (P = 0.001) was seen 1 year after surgery. Frequency of defecation was significantly increased 1 year after surgery (P = 0.0001), but the overall bowel function measured by LARS score was unchanged. Patients with anastomotic leakage had a significantly higher risk (odds ratio, OR 5.40; P = 0.002) of increased incontinence problems (I-score) 1 year after surgery. CONCLUSION A significant and clinically relevant improvement in urinary and sexual function 1 year after laparoscopic bowel resection for endometriosis was found. Except for anastomotic leakage, this could be observed independent of any patient- or treatment-related factor. Apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection in endometriosis patients. TWEETABLE ABSTRACT Rectal resection for endometriosis does not impair urinary and sexual function 1 year after surgery.


title: Inhibition of Innate Immune Responses Is Key to Pathogenesis by Arenaviruses.

text: Mammalian arenaviruses are zoonotic viruses that cause asymptomatic, persistent infections in their rodent hosts but can lead to severe and lethal hemorrhagic fever with bleeding and multiorgan failure in human patients. Lassa virus (LASV), for example, is endemic in several West African countries, where it is responsible for an estimated 500,000 infections and 5,000 deaths annually. There are currently no FDA-licensed therapeutics or vaccines available to combat arenavirus infection. A hallmark of arenavirus infection (e.g., LASV) is general immunosuppression that contributes to high viremia. Here, we discuss the early host immune responses to arenavirus infection and the recently discovered molecular mechanisms that enable pathogenic viruses to suppress host immune recognition and to contribute to the high degree of virulence. We also directly compare the innate immune evasion mechanisms between arenaviruses and other hemorrhagic fever-causing viruses, such as Ebola, Marburg, Dengue, and hantaviruses. A better understanding of the immunosuppression and immune evasion strategies of these deadly viruses may guide the development of novel preventative and therapeutic options.


title: Comparison of the Pentax AirwayScope and McGrath MAC videolaryngoscope for endotracheal intubation in patients with a normal airway.

text: Various videolaryngoscopes (VLs) have been developed to provide a better laryngeal view and facilitate difficult intubations. The goal of this study was to compare 2 VLs, the Pentax AWS and the McGrath VL, with respect to intubation time and ease of intubation.One hundred forty patients aged 19 to 65 years (American Society of Anesthesiologists classification I or II), who required tracheal intubation for elective surgery, were randomly assigned to 1 of the 2 groups: the Pentax AWS (n = 70) or the McGrath VL (n = 70). The primary outcome was time to intubation (TTI) measured by a blind observer. The intubation difficulty scale (IDS), percentage of glottic opening (POGO) scale, glottic grade, use of optimal external laryngeal manipulation (OELM), and ease of intubation were also recorded.The Pentax AWS provided a better laryngeal view than the McGrath VL with respect to the Cormack-Lehane (CL) glottic grade (1/2a/2b) (63/7/0 vs 43/24/3, P < .001) and the POGO scale (median [interquartile range, IQR]) (100 [100-100] vs 100 [80-100], P < .001). The IDS was significantly lower in the Pentax AWS group compared with the McGrath VL group (median [IQR]) (0 [0-0] vs 0 [0-1], P < .001). However, the TTI was similar in both the Pentax AWS and McGrath VL groups (median [IQR]) (30 [27-34] vs 32 [27-35] seconds, P = .440). OELM and ease of intubation were also similar between the 2 groups.The Pentax AWS offered a superior laryngeal view compared with the McGrath VL. There was no significant difference in either the intubation time or ease of intubation using these 2 devices in patients with normal airways.


title: Heme oxygenase-1 promoter polymorphisms: do they modulate neonatal hyperbilirubinemia?

text: The role of genetic factors in the modulation of serum bilirubin levels and the pathophysiology of neonatal hyperbilirubinemia is being increasingly recognized. Heme oxygenase-1 (HO-1) is the rate-limiting enzyme by which heme is catabolized to biliverdin and thence to bilirubin, with the simultaneous release of equimolar quantities of ferrous iron (Fe3+) and carbon monoxide. Polymorphisms of the HO-1 gene promoter may modulate transcriptional activity, thereby augmenting or attenuating HO-1 expression with resultant modulation of the production of bilirubin. Few studies have related these polymorphisms to neonatal bilirubin metabolism and have reported conflicting results. In this clinical review, we surveyed the role of HO-1 gene promoter polymorphisms in the control of bilirubin production and further considered their role, if any, in the pathophysiology of neonatal hyperbilirubinemia.


docid: abuhuscb

title: Current discovery progress of some emerging anti-infective chalcones: Highlights from 2016 to 2017.

text: The anti-infective potentials of the natural products are very well known for centuries and are a part of traditional healing. The foremost therapeutic classes include flavones, isoflavones, flavonols, flavanones, flavanols, proanthocyanidins, anthocyanidins, chalcones, and aurones. The chalcone or 1,3-diphenyl-2E-propene-1-one represents the class of natural product which comprise of benzylideneacetophenone function; i.e. two aromatic moieties linked together by a α, β-unsaturated carbonyl bridge comprising of three-carbons. At present, chalcone is one of the privileged scaffolds that can be synthesized in the laboratory to derive different pharmacologically active compounds. This article is the continued form of the previously published work on anti-infective perspectives of chalcones (highlighted till 2015). The current work emphasizes on the discovery process of the chalcone in the period of 2016 to 2017 on malaria, trypanosomiasis, leishmaniasis, filaria, tuberculosis, netamodes, Human Immunodeficiency Virus (HIV), Tobacco Mosaic Virus (TMV), Severe Acute Respiratory Syndrome (SARS), and miscellaneous conditions. This review comprehensively focuses on the latest progress related with the anti-infective chalcones. The content includes the crucial structural features of chalcone scaffold including structure activity relationship(s) along with their plausible mechanism of action(s) from the duration Jan 2016 to Dec 2017. This literature will be of prime interest to medicinal chemists in getting ideas and concepts for better rational development of potential anti-infective inhibitors.


title: A case with coil embolization for ruptured aneurysm associated with fenestration of the posterior inferior cerebellar artery.

text: An 87-year-old man hospitalized for subarachnoid hemorrhage showed a ruptured aneurysm arising from fenestration of the posterior inferior cerebellar artery. Endovascular treatment was selected and the aneurysm and superior limb were embolized completely using three coils. Fenestration of the posterior cerebellar artery is exceedingly rare. In addition, we present a first case of aneurysm as fenestration of the posterior inferior cerebellar artery that was definitively identified as a cause of bleeding.


title: Benchmarks for the interpretation of esophageal high-resolution manometry.

text: BACKGROUND Competent interpretation of esophageal high-resolution manometry (HRM) is integral to a quality study. Currently, methods to assess physician competency for the interpretation of esophageal HRM do not exist. The aim of this study was to use formal techniques to (i) develop an HRM interpretation exam, and (ii) establish minimum competence benchmarks for HRM interpretation skills at the trainee, physician interpreter, and master level. METHODS A total of 29 physicians from 8 academic centers participated in the study: 9 content experts separated into 2 study groups-expert test-takers (n=7) and judges (n=2), and 20 HRM inexperienced trainees ("trainee test-taker"; n=20). We designed the HRM interpretation exam based on expert consensus. Expert and trainee test-takers (n=27) completed the exam. According to the modified Angoff method, the judges reviewed the test-taker performance and established minimum competency cut scores for HRM interpretation skills. KEY RESULTS The HRM interpretation exam consists of 22 HRM cases with 8 HRM interpretation skills per case: identification of pressure inversion point, hiatal hernia >3 cm, integrated relaxation pressure, distal contractile integral, distal latency, peristaltic integrity, pressurization pattern, and diagnosis. Based on the modified Angoff method, minimum cut scores for HRM interpretation skills at the trainee, physician interpreter, and master level ranged from 65-80%, 85-90% (with the exception of peristaltic integrity), and 90-95%, respectively. CONCLUSIONS & INFERENCES Using a formal standard setting technique, we established minimum cut scores for eight HRM interpretation skills across interpreter levels. This examination and associated cut scores can be applied in clinical practice to judge competency.


Virus Evolution: Current Research and Future DirectionsVirus Evolution: Current Research and Future Directions. S. C. Weaver, M. Dennison, M. Roossinck and M. Vignuzzi (editors). Caister Academic Press, Poole, UK. 2016. 366 pp. Paperback ISBN: 978-1-910190-23-4, Ebook ISBN: 978-1-910190-24-1. £159,


title: A Multi-institutional Study on the Mid-Term Outcomes of Single Anastomosis Duodeno-Ileal Bypass as a Surgical Revision Option After Sleeve Gastrectomy.

text: INTRODUCTION Recently, a single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has become increasingly popular for patients with BMI > 50 as a primary or staged surgery. Staging allows surgeons to do the sleeve gastrectomy (SG) first with the conversion only happening when a failure or technical challenge is identified. PURPOSE We present the mid-term outcomes of SADI bypass surgery after SG. METHOD A retrospective analysis was performed on a prospective database from four institutions. Ninety-six patients were identified from 2013 to 2018. Patients were divided into two groups: one had two-stage SADI because of insufficient weight loss, the second had planned two-stage SADI because of super obesity (BMI > 50 kg/m2). Incidence of complications was divided into < 30 days and > 30 days. RESULT Of 96 patients, 3 patients were completely lost to follow-up. The mean age was 44.8 ± 11.3 years. There were no deaths or conversion to open surgery. The postoperative early complication and late complication rate was 5.3% and 6.4% respectively. At 24 months, group 2 had higher %weight loss (WL) and change in BMI units compared to group 1 with statistically significant difference. The average WL and change in BMI for entire patient's population at 24 months after 2nd stage SADI was 20.5% and 9.4 units respectively. The remission rate for DM was 93.7% with or without the use of medication. CONCLUSION The two-stage approach to SADI-S appears technically simpler than a single compromised operation. However, this approach needs more patients to understand its limitations.


title: Guidance for anticoagulation management in venous thromboembolism during the coronavirus disease 2019 (COVID-19) pandemic in Poland: an expert opinion of the Section on Pulmonary Circulation of the Polish Cardiac Society.

text: The COVID -19 pandemic affects anticoagulantion not only for those infected with SARS-CoV-2, but also for most patients who require daily anticoagulant therapy and are facing substantial limitations in medical care these days. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has frequently been reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and hematological alterations. In the era of COVID-19 pandemic is strongly recommended for patients who require chronic anticoagulation to continue therapy to prevent thromboembolic events. To avoid regular and frequent blood tests and unnecessary exposure to SARS-CoV-2 during contacts with medical personnel DOACs should be strongly preferred whenever possible. Current evidence is insufficient to recommend routine pharmacological antithrombotic prophylaxis in all hospitalized patients with COVID-19. In COVID-19 patients suspected for VTE or in whom the diagnosis is confirmed parenteral therapy with LMWH should be initiated in the absence of contraindications. If heparin induced thrombocytopenia is suspected, nonheparin anticoagulants should be used such as bivalirudin or fondaparinux. When acute pulmonary embolism is confirmed, treatment should be guided by risk stratification as defined in the current guidelines.


title: Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.

text: OBJECTIVE To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? METHODS The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention. RESULTS AND RECOMMENDATIONS The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A).


title: The Pig: A Relevant Model for Evaluating the Neutrophil Serine Protease Activities during Acute Pseudomonas aeruginosa Lung Infection.

text: The main features of lung infection and inflammation are a massive recruitment of neutrophils and the subsequent release of neutrophil serine proteases (NSPs). Anti-infectious and/or anti-inflammatory treatments must be tested on a suitable animal model. Mice models do not replicate several aspects of human lung disease. This is particularly true for cystic fibrosis (CF), which has led the scientific community to a search for new animal models. We have shown that mice are not appropriate for characterizing drugs targeting neutrophil-dependent inflammation and that pig neutrophils and their NSPs are similar to their human homologues. We induced acute neutrophilic inflammatory responses in pig lungs using Pseudomonas aeruginosa, an opportunistic respiratory pathogen. Blood samples, nasal swabs and bronchoalveolar lavage fluids (BALFs) were collected at 0, 3, 6 and 24 h post-insfection (p.i.) and biochemical parameters, serum and BAL cytokines, bacterial cultures and neutrophil activity were evaluated. The release of proinflammatory mediators, biochemical and hematological blood parameters, cell recruitment and bronchial reactivity, peaked at 6h p.i.. We also used synthetic substrates specific for human neutrophil proteases to show that the activity of pig NSPs in BALFs increased. These proteases were also detected at the surface of lung neutrophils using anti-human NSP antibodies. Pseudomonas aeruginosa-induced lung infection in pigs results in a neutrophilic response similar to that described for cystic fibrosis and ventilator-associated pneumonia in humans. Altogether, this indicates that the pig is an appropriate model for testing anti-infectious and/or anti-inflammatory drugs to combat adverse proteolytic effects of neutrophil in human lung diseases.


title: Goal-Directed Resuscitative Interventions During Pediatric Interfacility Transport.

text: OBJECTIVES This article reports results of the first National Institutes of Health-funded prospective interfacility transport study to determine the effect of goal-directed therapy administered by a specialized pediatric team to critically ill children with the systemic inflammatory response syndrome. We hypothesized that goal-directed therapy during interfacility transport would decrease hospital length of stay, prevent multiple organ dysfunction, and reduce subsequent ICU interventions. DESIGN Before-and-after intervention trial. SETTING During interfacility transport of critically ill patients by a specialized pediatric transport team, back to a tertiary care children's hospital. PATIENTS Before-and-after intervention trial. DESIGN Interfacility pediatric transport patients, age 1 month to 17 years, with systemic inflammatory response syndrome. INTERVENTIONS Prospective data were collected on all pediatric interfacility transport patients with systemic inflammatory response syndrome transported by the Angel One Transport team at Arkansas Children's Hospital. A 10-month data collection period was followed by institution of a goal-directed resuscitation protocol. Data were subsequently collected for 10 additional months followed by comparison of pre- and postintervention groups. All transport personnel underwent training with didactics and high-fidelity simulation until mastery with goal-directed resuscitation was achieved. MEASUREMENTS AND MAIN RESULTS All transport patients were screened for systemic inflammatory response syndrome using established variables and 235 (123 preintervention and 112 postintervention) were enrolled. Univariate analysis revealed shorter hospital stay (11 ± 15 d vs 7 ± 10 d; p = 0.02) and fewer required therapeutic ICU interventions in the postintervention group (Therapeutic Intervention Scoring System-28 Scores, 19.4 ± 6.8 vs 17.3 ± 6.6; p = 0.04). ICU stay and prevalence of organ dysfunction were not statistically different. Multivariable analysis showed a 1.6-day (95% CI, 1.3-2.03; p = 0.02) decrease in hospital stay in the postintervention group. CONCLUSIONS This study suggests that goal-directed therapy administered by a specialized pediatric transport team has the potential to impact the outcomes of critically ill children. Findings from this study should be confirmed across multiple institutions, but have the potential to impact the clinical outcomes of critically ill children with systemic inflammatory response syndrome.


Seven days in medicine: 1-7 July 2020.


title: Use of a subcutaneous ureteral bypass device for treatment of bilateral proximal ureteral injury in a 9-month-old cat.

text: Case summary A 9-month-old male domestic longhair cat presented following iatrogenic ureteral trauma after an attempted laparoscopic ovariectomy. Prior to identifying that the cat was male, both ureters were transected approximately 4 mm from the renal pelves. Initial management involved a left-sided Boari flap neoureterocystostomy, cystonephropexy and right ureteronephrectomy. Thirty-six hours later, the cat developed uroabdomen due to leakage from the neoureterocystostomy site. At a tertiary referral institution, the ureter was reconstructed via end-to-end anastomosis and a left-sided subcutaneous ureteral bypass (SUB) device was placed in the event the anastomosis failed. Five weeks after SUB placement, the cat was dysuric and stranguric. A urine culture was negative and clinical signs were attributed to sterile cystitis secondary to device placement. Blood urea nitrogen (BUN) was 22 mg/dl and creatinine was 1.2 mg/dl. Contrast pyelography confirmed device patency, but no contrast was identified through the ureteral anastomosis. At 12 months, BUN and creatinine were 1.5 mg/dl and 25 mg/dl, respectively, and a subclinical urinary tract infection was identified (Enterococcus faecalis). Antibiotic therapy was not prescribed in order to prevent multidrug resistance. At 42 months, BUN was 38 mg/dl and creatinine was 2.0 mg/dl. The cat had occasional and intermittent signs of pollakiuria and stranguria but was otherwise doing well. Relevance and novel information To our knowledge, this is the first case report to describe the use of a SUB device for management of traumatic proximal ureteral injury in a cat with one kidney. The case outcome provides valuable information about the direct effect of the SUB device and the presence of chronic Enterococcus species infection on long-term renal function.


Evaluation of seven commercial SARS-CoV-2 RNA detection kits based on real-time polymerase chain reaction (PCR) in China.


title: Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals.

text: STUDY OBJECTIVE To determine whether shoulder and head elevation, such that the patient's ear lies at or higher than the sternum ("ramp"), improves laryngoscopic grade in adult patients of various body mass index (BMI) values. DESIGN Prospective, unblinded study, with patients and laryngoscopists acting as their own controls. SETTING Operating room of a university-affiliated hospital. PATIENTS 189 adult ASA physical status 1, 2, and 3 patients. INTERVENTIONS After performing a standard preoperative airway evaluation and inducing general anesthesia, the anesthetist performed and graded two laryngoscopies: one in the "ramp" position and one in the "sniff" position. MEASUREMENTS Patient BMI, Mallampati airway class, thyromental distance, neck circumference, cervical extension ability, Cormack and Lehane laryngoscopic grade for each laryngoscopy, subjective lifting force required, and need for external laryngeal pressure were recorded. MAIN RESULTS Use of the "ramp" provided significantly better or equal laryngoscopic views, relative to those with the "sniff" position, in the entire study population. CONCLUSIONS Shoulder and head elevation by any means that brings the patient's sternum onto the horizontal plane of the external auditory meatus maintains or improves laryngoscopic view significantly.


COVID-19 in Europe: Le roi est mort, vive le roi!


title: A review on histotechnology practices in COVID-19 pathology investigations.

text: COVID-19 disease in humans, caused by the novel SARS-CoV-2 virus, was first reported in the city of Wuhan, China in December 2019. This disease has quickly developed into a global pandemic, resulting in over 350,000 deaths worldwide and over 5 million confirmed infections in a matter of 6 months. Although the genome of this novel viral RNA was sequenced quickly and testing kits were manufactured to assist in combatting COVID-19, the diagnosis and treatment will remain relatively unsuccessful until the pathology of this disease is fully understood. Histotechnology plays an important role in understanding the pathology of many diseases, including COVID-19. The first postmortem biopsy of a COVID-19 patient was collected on 27 January 2020, and the pathology finding was published in mid-February 2020. Since then, more studies have been published in scientific literatures as the global outbreak continues. This mini-review summarizes the published articles in which histotechnology aspects were utilized with the intent to understand the pathology of COVID-19. In addition, it is anticipated there will be more molecular and immunohistochemical studies to further understand the mechanism of the disease in the near future.


title: Power injection of iodinated intravenous contrast material through acute and chronic hemodialysis catheters.

text: PURPOSE End-stage renal disease patients with hemodialysis catheters in need of contrast enhanced imaging studies often have limited peripheral venous access. In this study we aimed to determine pressures generated in hemodialysis catheters during power injection of computed tomography (CT) contrast media. METHODS Three different chronic hemodialysis catheters and two acute hemodialysis catheters were included in this study. All catheters were evaluated in vitro. A total volume of 120 cc of CT contrast material was injected at rate of 10 cc/s using a power injector. The catheters were connected to the power injector using a standard connecting tubing. Pressures were simultaneously measured in the power injector as well as in the hemodialysis catheters. RESULTS The maximal measured pressures during injection in the power injector averaged 338 PSI (SD ± 8.7 PSI). The maximal measured pressure in the dialysis catheters ranged between 9.17 and 21.2 PSI. Pressures averaged 14.02 PSI (SD ± 3.34 PSI). The average pressure in the power injector was over 23 times higher than the pressure recorded at the hemodialysis catheter. None of the catheters ruptured or deformed during testing. CONCLUSIONS Pressures measured in hemodialysis catheters during power injection are lower than currently believed and markedly lower than the pressures recorded in the power injector. Standard hemodialysis catheters are likely to be amenable to power contrast injection in hemodialysis patients who have limited venous access. In vivo studies are necessary to confirm these findings.


title: Absence of gastrointestinal pathogens in ileum tissue resected for necrotizing enterocolitis.

text: Necrotizing enterocolitis (NEC) is one of the most common gastrointestinal emergencies in premature infants and has been linked with viral antigens in as much as 40% of cases in single-center cohorts. We examined 28 tissue sections from surgically resected ileum from 27 preterm infants with NEC from 2 separate institutions for 15 common bacterial, viral, and parasitic gastrointestinal pathogens using multiplex reverse transcriptase polymerase chain reaction amplification and suspension array detection methods. We did not detect infectious enteritis pathogens in any of the NEC tissues and conclude that gastrointestinal pathogens are a rare cause of NEC.


title: Which Anesthesia Regimen Is Best to Reduce Morbidity and Mortality in Lung Surgery?: A Multicenter Randomized Controlled Trial.

text: BACKGROUND One-lung ventilation during thoracic surgery is associated with hypoxia-reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia-induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications. METHODS Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age. RESULTS Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71). CONCLUSIONS This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.


Northern Ireland disease surveillance report, July to September 2014.


title: The challenge of intracellular antibiotic accumulation, a function of fluoroquinolone influx versus bacterial efflux.

text: With the spreading of antibiotic resistance, the translocation of antibiotics through bacterial envelopes is crucial for their antibacterial activity. In Gram-negative bacteria, the interplay between membrane permeability and drug efflux pumps must be investigated as a whole. Here, we quantified the intracellular accumulation of a series of fluoroquinolones in population and in individual cells of Escherichia coli according to the expression of the AcrB efflux transporter. Computational results supported the accumulation levels measured experimentally and highlighted how fluoroquinolones side chains interact with specific residues of the distal pocket of the AcrB tight monomer during recognition and binding steps.


title: Recommendations in covid-19 times: a view for home care.

text: OBJECTIVE To suggest recommendations for the practice of Home Nursing in the context of COVID-19. METHOD Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. RESULTS Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. FINAL CONSIDERATIONS the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.


title: Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3.

text: UNLABELLED We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3-98), respectively. Using the Strickland criteria, 'excellent' or 'good' function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath-pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert's regime. LEVEL OF EVIDENCE III.


title: Mood disorders and non-celiac gluten sensitivity.

text: The association between gluten related disorders and psychiatric diseases has been firmly demonstrated. Non-celiac gluten sensitivity (NCGS) is a syndrome diagnosed in patients responsive to gluten-free diet after ruling out celiac disease and wheat allergy. The pathogenesis of neuro-psychiatric disorders in NCGS is unclear. An association between gluten and schizophrenia was described for the first time in 1950 by Bender et al. In the 1950's, Dicke noted that gluten-free diet improved mood in celiac patients. In 1970, Goldberg et al., in a study of 80 celiac patients, found that 34% of them showed minor affective disorders. Bipolar disorder patients show an increase of blood anti gliadin deamidated antibodies (IgG). The effect of diet and nutrition on autistic spectrum disorders has been investigated in the last two decades, particularly focusing on the symptoms of hyperactivity and attention. Toxoplasma gondii and other neurotropic pathogens as Influenzavirus and Coronavirus may be associated with mood disorders, probably secondary to an increased intestinal permeability. Abnormalities of host-microbiota interactions or of gut-microbiota composition have been associated with central nervous system disorders, such as autism, anxiety, depression and the integrity of intestinal microbiota may be considered a potential therapeutic goal to treat these conditions.


title: ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy.

text: BACKGROUND The development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization. METHODS 98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis. RESULTS The aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0-21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0-11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0-2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages. DISCUSSION The ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.


title: Simultaneous determination of eight active components in Houttuynia cordata injection and its quality control in productive process.

text: A simple, reliable and effective gas chromatography coupled with flame ionization detection method was developed for the simultaneous determination of eight components (α-pinene, β-pinene, myrcene, limonene, terpinen-4-ol, α-terpineol, bornyl acetate and methyl-n-nonylketone) in Chinese medicine Houttuynia cordata and its injection. The chromatographic separation of all eight components, including undecylene as internal standard was performed on a DB-1 column (30 m×0.25 mm, 0.25 μm). Excellent linear behaviors including herb and injection over the investigated concentration ranges were observed with the values of r(2) higher than 0.9990 for all analytes. Satisfactory intra-day and inter-day precisions were achieved with RSD less than 2% and the average recoveries for all analytes at three different concentrations obtained were in the range of 93.4-104.4%, with RSD ranging from 1.3 to 4.1%. The proposed method was successfully applied in the simultaneous determination of these active components in H. cordata and H. cordata injection (HCI), including the intermediate product of HCI in productive process, from different pharmaceutical factories and different production batches, indicating that the method in this paper was particularly suitable for the routine analysis of HCI and its quality control in productive process.


title: Endoscopic fixation of the rectum for rectal prolapse: a feasibility and survival experimental study.

text: BACKGROUND In recent years, there has been considerable interest in developing technology as well as techniques that could widen the therapeutic horizons of endoscopy. Rectal prolapse, a benign localized condition causing considerable morbidity, could be an excellent focus for new endoscopic therapies. The aim of this study was to assess the feasibility and safety of endoluminal fixation of the rectum to the anterior abdominal wall, after pushing it up inside the body, using an in vivo animal model. METHODS We performed an in vivo comparative surgical study in a porcine model, including laparoscopic mobilization of the rectum and posterior rectopexy (standard surgical method) or endoluminal tacking of the rectum. After proving feasibility in ex vivo and acute studies, we performed a survival study to evaluate the safety of endoluminal tacking of the mobilized rectum to the anterior abdominal wall. The main outcome measures were successful completion of the tasks, maintenance of the fixation, complications associated with the methods, and survival studies including histopathological examinations of the fixation sites. RESULTS There were two groups: laparoscopic rectopexy (8 animals) and endoluminal fixation of the rectum to the anterior abdominal wall (10 animals). There were no differences between these two groups in their postoperative recovery. The group with the endoluminal fixation was found to have adequate attachment of the rectum to the anterior abdominal wall (measured attachment pressure in the endoluminal group = 6.06 ± 0.52 ft-lb, in the control group = 4.86 ± 2.00 ft-lb) on both gross and microscopic evaluation. CONCLUSION Endoscopic fixation of the mobilized rectum is feasible and safe in this model and in the future may provide an effective alternative to current treatment options for rectal prolapse.


Developing Trust With Early Medical School Graduates During the COVID-19 Pandemic.


title: In vitro and in vivo effects of Houttuynia cordata on infectious bronchitis virus.

text: Avian infectious bronchitis virus (IBV), a coronavirus, causes infectious bronchitis leading to enormous economic loss in the poultry industry worldwide. Houttuynia cordata (Saururaceae) (HC) is a traditional Chinese medicine used in China. In the present study, the effect of HC on cell infection by IBV was determined using plaque assay and reverse transcription-polymerase chain reaction. The inhibitory effect of HC on IBV infection in ovo and in vivo was analysed using specific pathogen free (SPF) chicken embryos and chickens. Moreover, the effect of HC on cell apoptosis induced by IBV was investigated. Results showed that HC had more than 90% inhibition rate against IBV infection in Vero cells and chicken embryo kidney cells, and decreased more than 90% apoptotic cells caused by IBV. HC fully protected the SPF embryos, and had more than 50% protection rate in SPF chickens, against IBV challenge.


title: Whole body computed tomographic characteristics of skeletal and cardiac muscular metastatic neoplasia in dogs and cats.

text: Muscular metastatic neoplasia has been reported to be rare in domestic animals, however previous studies were based primarily on necropsy findings. The purpose of this retrospective study was to describe whole body computed tomography (CT) characteristics of confirmed muscular metastases in a cohort of dogs and cats presented for oncology evaluation. Medical records of 1201 oncology patients were reviewed. Included animals underwent pre and postcontrast whole body CT, and CT-guided tru-cut biopsy or fine needle aspiration of one or more metastatic lesions. Twenty-one dogs and six cats met inclusion criteria, representing 2.08% of all canine oncology patients and 3.1% of all feline oncology patients. Mean age was 9.6 years. Postcontrast CT characteristics included well-demarcated, oval-to-round lesions with varying enhancement patterns: ring enhancing (n = 16), heterogeneously enhancing (n = 8), or homogeneously enhancing (n = 5). Five animals showed concurrent and varying nodular patterns. In seven cases (five dogs and two cats), one single muscular nodule was observed. In 20 cases, two or more lesions were observed. In two cases, cardiac hypodense nodules were observed in the postcontrast CT, while appearing isodense in the precontrast study. Necropsy confirmed neoplasia in both of them. Locations of muscular metastases included epaxial/paraspinal muscles of the cervical, thoracic, and lumbar spine (n = 18), superficial muscles of the thoracic wall (n = 13), scapular/shoulder region (n = 3), hind limb (n = 3), and abdominal wall muscles (n = 1). Findings supported the use of pre and postcontrast whole body CT for oncologic staging in dogs and cats, especially for primary tumors characterized by a high metastatic rate.


title: Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2 Test.

text: Background. Nucleic acid amplification tests (NAATs) are the primary means of identifying acute infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accurate and fast test results may permit more efficient use of protective and isolation resources and allow for rapid therapeutic interventions.Methods. We evaluated the analytical and clinical performance characteristics of the Xpert® Xpress SARS-CoV-2 (Xpert) test, a rapid, automated molecular test for SARS-CoV-2. Analytical sensitivity and specificity/interference were assessed with infectious SARS-CoV-2, other infectious coronavirus species including SARS-CoV, and 85 nasopharyngeal swab specimens positive for other respiratory viruses including endemic human coronaviruses (hCoVs). Clinical performance was assessed using 483 remnant upper and lower respiratory specimens previously analyzed by standard of care (SOC) NAATs.Results. The limit of detection of the Xpert test was 0.01 plaque forming units (PFU)/mL. Other hCoVs, including Middle East Respiratory Syndrome coronavirus, were not detected by the Xpert test. SARS-CoV, a closely related species in the Sarbecovirus subgenus, was detected by a broad-range target (E) but was distinguished from SARS-CoV-2 (SARS-CoV-2-specific N2 target). Compared to SOC NAATs, the positive agreement of the Xpert test was 219/220 (99.5%) and the negative agreement was 250/261 (95.8%). A third tie-breaker NAAT resolved all but three of the discordant results in favor the Xpert test.Conclusions. The Xpert test provided sensitive and accurate detection of SARS-CoV-2 in a variety of upper and lower respiratory tract specimens. The high sensitivity and fast time to results of approximately 45 minutes may impact patient management.


title: Antibiotic use in the management of children with the common cold at a provincial hospital in Papua New Guinea: a point-prevalence study.

text: BACKGROUND Antibiotic prescribing for self-limiting viral infections such as the common cold or viral upper respiratory tract infection (URTI) is irrational and increases the risk of antibiotic resistance. However, such a practice is widespread and is likely to be as common in Papua New Guinea as in many other countries. METHODS In a cross-sectional descriptive study, children were recruited who had been diagnosed with a common cold or URTI by attending clinical staff-mostly nurses-in a provincial hospital's children's outpatient department using a standard definition. The frequency of antibiotic prescribing was determined and the clinical knowledge and practices of nurses, health extension officers, community health workers and doctors working in the children's outpatients department regarding the common cold and its management was assessed. RESULTS One hundred and eight children diagnosed with the common cold were enrolled; 89 (82.4%) were prescribed antibiotics. Children with fever on examination, those older than 12 months and those whose symptoms lasted ≥7 days were more likely to be prescribed antibiotics. Of the health workers surveyed, 95% knew that viruses were the cause of the common cold, but 30% thought that antibiotics were needed for treatment. CONCLUSIONS Although among healthcare workers, there was a gap between knowledge of aetiology and knowledge of appropriate management of the common cold, there was a larger apparent gap between that knowledge and practice. Findings from this study could be used to identify interventions promoting rational antibiotic use, targeting both health-care workers and the community.


title: Changes in tumour vessel density upon treatment with anti-angiogenic agents: relationship with response and resistance to therapy.

text: BACKGROUND We examine how changes in a surrogate marker of tumour vessel density correlate with response and resistance to anti-angiogenic therapy. METHODS In metastatic renal cancer patients treated with anti-angiogenic tyrosine kinase inhibitors, arterial phase contrast-enhanced computed tomography was used to simultaneously measure changes in: (a) tumour size, and (b) tumour enhancement (a surrogate marker of tumour vessel density) within individual lesions. RESULTS No correlation between baseline tumour enhancement and lesion shrinkage was observed, but a reduction in tumour enhancement on treatment was strongly correlated with reduction in lesion size (r=0.654, P<0.0001). However, close examination of individual metastases revealed different types of response: (1) good vascular response with significant tumour shrinkage, (2) good vascular response with stabilisation of disease, (3) poor vascular response with stabilisation of disease and (4) poor vascular response with progression. Moreover, contrasting responses between different lesions within the same patient were observed. We also assessed rebound vascularisation in tumours that acquired resistance to treatment. The amplitude of rebound vascularisation was greater in lesions that had a better initial response to therapy (P=0.008). INTERPRETATION Changes in a surrogate marker of tumour vessel density correlate with response and resistance to anti-angiogenic therapy. The data provide insight into the mechanisms that underlie response and resistance to this class of agent.


title: Single-incision laparoscopic colonic surgery.

text: AIM SILS is an area of growing interest in colorectal surgery. We report our preliminary experience of 13 consecutively selected patients undergoing colonic surgery using SILS. METHOD From July 2009 to January 2010, 13 patients (five men) of median age 56 (23-82) years and a body mass index (BMI) of 23.5 (18-30) kg/m(2) underwent colonic surgery. Procedures included subtotal colectomy (1), ileocolic resection (2), right colectomy (4) and sigmoidectomy for benign disease (6). Three instruments (including camera) were introduced through a single 2.5-cm port (SILS™ Port Multiple Instrument Access Port; Covidien Inc., Norwalk, Connecticut, USA) inserted at the umbilicus. RESULTS The median operating time was 150 (100-240) min, and the median size of the umbilical port incision was 32 (25-50) mm. There was no postoperative mortality and morbidity, and the median hospital stay was 6 (4-10) days. The cosmetic result was judged to be excellent in 12 of 13 patients who felt it to be better than expected. CONCLUSION This preliminary experience shows that SILS is technically feasible and safe for colonic resection.


title: The COVID-19 Pandemic and the Pathology of the Economic and Political Architecture in Cameroon.

text: This article examines the factors restricting an effective response to the COVID-19 pandemic in Cameroon. It argues that structural adjustment policies in the 1980s and 1990s as well as corruption and limited investment in recent times have severely weakened the country's health system. This article also emphasises the interconnection between poverty, slums, and COVID-19. This interconnection brings to the fore inequality in Cameroon. Arguably, this inequality could facilitate the spread of COVID-19 in the country. This article draws attention to the political forces shaping the response to the pandemic and contends that in some regions in the country, the lack of an effective response to the pandemic may not necessarily be due to a lack of resources. In so doing, it critiques the COVID-19 orthodoxy that focuses exclusively on the pathology of the disease and advocates "technical" solutions to the pandemic, while ignoring the political and socio-economic forces that shape the fight against the pandemic. At times, medical supplies and other forms of assistance may be available, but structural violence impairs access to these resources. Politics must be brought into the COVID-19 discourse, as it shapes the response to the pandemic.


title: A pilot study demonstrating a non-invasive method for the measurement of protein turnover in skin disorders: application to psoriasis.

text: BACKGROUND Previous studies of epidermal kinetics in psoriasis have relied on invasive biopsy procedures or the use of radioactive labels. We previously developed a non-invasive method for measuring keratin synthesis in human skin using deuterated water labeling, serial collection of tape strips and measurement of deuterium enrichment in protein by mass spectrometry. This powerful method can be applied to measure other skin proteins and lipids collected by tape stripping. Here, for the first time, we apply this technique to investigate the epidermal kinetics of psoriasis, the first step in defining a kinetic profile for normal skin versus activated or quiescent psoriatic skin. METHODS Psoriatic subjects were given (2)H2O orally as twice-daily doses for 16-38 days. Affected and unaffected skin was sampled by tape stripping and washing (modified Pachtman method). Proteins were isolated from the tape strips by a method that enriches for keratin. Turnover times were determined by gas chromatography/mass spectrometry. Kinetic data were compared to transepidermal water loss (TEWL). RESULTS Deuterium-labeled protein from lesional psoriatic skin appeared at the skin surface within 3-8 days of label administration, whereas labeled protein from non-lesional skin requires 10-20 days to appear. Psoriatic skin had similar rate of growth despite varying anatomic location. Proteins recovered from tape strips were identified by nanoscale liquid chromatography/tandem mass spectrometry. Isolated peptides were >98% from keratin in uninvolved skin and >72% keratin in psoriatic skin. Revealing that one-quarter of all newly synthesized proteins in psoriatic skin are antimicrobial defense and other immune-related proteins. TEWL values were greater in lesional than non-lesional skin, suggesting barrier compromise in psoriatic skin despite increased clinical thickness. CONCLUSIONS This simple, elegant, and non-invasive method for measuring epidermal protein synthesis, which can also be adapted to measure epidermal lipids, provides a metric that may reveal new insights into the mechanisms and dynamic processes underlying psoriasis and may also provide an objective scale for determining response to therapeutic agents in pre-clinical and clinical trials. This opens a pathway to the non-invasive study of kinetics of protein formation in psoriasis or other skin diseases.


title: Liquid Embolic Agents in Spectral X-Ray Photon-Counting Computed Tomography using Tantalum K-Edge Imaging.

text: The aim was to evaluate the potential of Spectral Photon-Counting Computed Tomography (SPCCT) to differentiate between liquid embolic agents and iodinated contrast medium by using tantalum-characteristic K-edge imaging. Tubes with a concentration series of tantalum and inserts with different concentrations of iodine were scanned with a preclinical SPCCT system. Tantalum density maps (TDM) and iodine density maps (IDM) were generated from a SPCCT acquisition. Furthermore, region-of-interest (ROI) analysis was performed within the tubes in the conventional CT, the TDM and IDM. TDM and IDM enable clear differentiation between both substances. Quantitative measurements of different tantalum concentrations match well with those of actually diluted mixtures. SPCCT allows for differentiation between tantalum and iodine and may enable for an improved follow-up diagnosis in patients after vascular occlusion therapy.


docid: arbhkenf

title: Treatment of Chytridiomycosis in Laboratory Axolotls (Ambystoma mexicanum) and Rough-skinned Newts (Taricha granulosa).

text: Chytridiomycosis is an infectious disease of amphibians caused by the fungal species Batrachochytrium dendrobatidis and B. salamandrivorans and has been implicated in the population decline of amphibian species worldwide. This case report describes a successful treatment protocol for chytridiomycosis in laboratory-maintained colonies of axolotls (Ambystoma mexicanum) and rough-skinned newts (Taricha granulosa). Over 12 mo, axolotls (n = 12) in a laboratory-reared colony developed multifocal erythematous dermatitis, mainly on the distal limbs and tails. Wild-caught newts handled by the same lab personnel were housed in an adjacent room and occasionally presented with abdominal distension and lethargy. Differentials included poor water quality, pathogen infection, parasitic infestation, and trauma. Antibiotic treatment of animals according to results of bacterial culture and sensitivity, combined with bleach disinfection of aquaria, did not resolve clinical signs. Skin swabs from clinically affected axolotls submitted for a newly available commercial screen were positive for B. dendrobatidis. Additional PCR and sequencing analysis revealed chytrid-positive animals among group-housed newts in 2 clinically unaffected aquaria and suspected PCR-positives for 2 affected newt aquaria and an additional axolotl. Axolotls with skin lesions (n = 2) and newts with abdominal distension and lethargy (n = 2) underwent experimental treatment with itraconazole submersion (0.002% to 0.0025%; 5 min daily for 10 d). This pilot treatment was well tolerated and led to clinical resolution. Subsequent itraconazole treatment of the entire colony led to regrowth of extremities and restoration of normal coloration among axolotls. During treatment, the facility was decontaminated, and additional biosecurity measures were developed. PCR results after the pilot treatment and subsequent full-colony treatments (at 1 wk, 1 mo, and 6 mo after treatment) were negative for the presence of B. dendrobatidis. Because chytridiomycosis is a reportable animal disease in our state, colonies officially remained quarantined until negative PCR results were obtained at least 6 mo after treatment.


title: Minimally invasive Ivor Lewis esophagectomy for esophageal cancer.

text: Esophageal cancer is the malignant tumor arising from the esophagus and has a poor prognosis. Squamous cell carcinoma and adenocarcinoma are the main subtypes of esophageal cancer with different risk factors. In the early stage, surgical resection is the most curative treatment modality. However, the procedure is considered an advanced and technically demanding surgery because esophageal cancer surgery includes esophagectomy, lymph node dissection, and a creation of esophageal conduit. Stomach is the commonest organ for the esophageal substitute. In open procedures, pulmonary complications and anastomotic failure are the most severe problems. Minimally invasive esophagectomy (MIE) has been introduced to decrease the postoperative pulmonary complications, but anastomotic failure remains a serious issue because of the extra-anatomical anastomosis between the esophagus and the conduit in the thorax or the neck.


docid: vzxlyzja

title: Use of a cyanoacrylate skin adhesive to reduce external ventricular drain infection rates.

text: UNLABELLED OBJECT.: Ventriculitis related to external ventricular drain (EVD) placement is a significant source of morbidity in neurological intensive care patients. Current rates of EVD-related infections range from 2% to 45% in the literature. The authors sought to determine if a 2-octyl cyanoacrylate adhesive would result in lower infection rate than standard semiocclusive dressings. METHODS The authors tracked ventriculitis rates via CSF cultures among 259 patients whose EVD sites were dressed with sterile semiocclusive dressings and underwent routine sterile dressing exchanges every 48 hours. They analyzed data obtained in an additional 113 patients whose EVD sites were dressed one time with a surgical adhesive, 2-octyl cyanoacrylate. RESULTS Ventriculitis rate in patients with standard bioocclusive dressings and wound care was 15.1%, whereas that in patients with a 2-octyl cyanoacrylate dressing was 3.54% (p = 0.002). Staphylococcus genus accounted for 79.5% of instances of ventriculitis among patients with bioocclusive dressings and routine wound care, whereas it accounted for 25.0% of the instances of ventriculitis among patients with a liquid polymer sealant dressing. A 90% reduction in Staphylococcus infection completely accounts for the observed effect (p = 0.04). CONCLUSIONS The one-time application of 2-octyl cyanoacrylate to EVD wounds and exit sites provided superior protection against EVD-related ventriculitis compared to conventional EVD-site wound care. Likely this protection results from a barrier to the entry of gram-positive skin flora along the EVD exit tract. The results should be validated in a randomized trial.


Correction.


Scientists in a time of COVID-19.


title: Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease.

text: OBJECTIVE The objectives of this study were to compare the results of radiofrequency ablation (RFA) and stripping for large-diameter varicose target veins for the period of 1 year, based on a composite end point; to analyze the pain severity on a digital rating scale for 7 days after RFA and stripping; and to detect the factors affecting the level of postoperative pain using the cluster analysis. METHODS This was a multicenter retrospective cohort study. Two groups, stripping ≥14 mm and RFA ≥14 mm, of 129 varicose vein disease patients underwent surgical treatment in three specialized clinics. We eliminated symptomatic pathologic reflux with RFA in 64 patients and with stripping in 65 patients. In the postoperative phase, we evaluated the pain level, subcutaneous hemorrhage, and paresthesia. A composite end point with four components was used to analyze the results. These were three clinical adverse effects of the intervention (pain, hemorrhage, and paresthesia) and the technical outcome 1 year after the surgical intervention. RESULTS The frequency of favorable outcomes was 20 (30.8%) in the stripping ≥14 mm group and 61 (95.3%) in the RFA ≥14 mm group (P < .0001). The odds ratio for a favorable outcome between the RFA and the stripping groups was 45.8 (95% confidence interval, 44.5-47.0). The pain clusters that were moderate were created by patients after stripping. These clusters show a link between the pain level on the one hand and an increased body mass index and large vein diameter on the other hand. CONCLUSIONS For large-diameter veins, RFA is superior to stripping in terms of favorable outcomes according to the composite end point chosen. Significant pain after stripping was linked to a large vein diameter and excess weight or adiposis.


We need more researchers in Women's History Month.


title: Technetium-99m complexes of l-arginine derivatives for targeting amino acid transporters.

text: Although relevant from the clinical point of view, radiotracers targeting cationic amino acid transporters are relatively unexplored and, in particular, no metal-based radiotracers are known. The rare examples of complexes recognized by amino acid transporters, namely by the Na+-independent neutral l-type amino acid transporter 1 (LAT1), are 99mTc(i)/Re(i) compounds. Herein, we describe conjugates comprising a pyrazolyl-diamine chelating unit and the cationic amino acid l-arginine (l-Arg) linked by a propyl (L1) or hexyl linker (L2), which allowed the preparation of stable complexes of the type fac-[99mTc(CO)3(k3-L)]+ (Tc1, L = L1; Tc2, L = L2) and of the respective surrogates Re1 and Re2. Interestingly, complex Tc2 exhibited moderate levels of time-dependent internalization in three human tumoural cell lines, with approximately 3% of total applied activity internalized, corresponding to 21% of the cell-associated activity. A putative mechanism of retention in the cytoplasm of cells could be the interaction of the complex with inducible nitric oxide synthase (iNOS), which is the enzyme responsible for the catalytic oxidation of l-Arg to citrulline and nitric oxide. However, the surrogate complex Re2 does not recognize iNOS, as demonstrated by the in vitro assays with purified iNOS and in studies with lipopolysaccharide(LPS)-activated macrophages. Preliminary mechanistic studies suggest that the internalization of Tc2 is linked to the cationic amino acid transporters, namely system y+. This finding might open the way towards the development of novel families of metal-based radiotracers for probing metabolically active cancer cells.


title: Different displacement of bioimpedance vector due to Ag/AgCl electrode effect.

text: BACKGROUND/OBJECTIVES Bioelectrical impedance vector analysis (BIVA) is increasingly used in clinical research to assess soft tissue hydration. It is known that physical characteristics of electrodes, such as low intrinsic impedance, low electrode/skin contact impedance and type of gel, affect the reliability of noninvasive bioimpedance assessments. The aim of this study was to determine the effect of intrinsic impedance of electrode on the bioimpedance vector displacement in RXc graph. SUBJECTS/METHODS The intrinsic impedance is measured in nine pregelled disposable Ag/AgCl electrodes usually used for bioimpedance measures. The BIVA method is performed on 35 healthy volunteers using a 50 kHz phase-sensitive bioimpedance analyzer (BIA 101 Anniversary) with the lowest intrinsic impedance electrode and highest. The individual bioimpedance vector is plotted on the bivariate normal interval of reference population. The differences in the mean bioimpedance vectors obtained with each electrode are plotted, with their 95% confidence ellipses, on the dRXc graph. The paired one-sample Hotelling's T2-test is used to compare the differences of the mean bioimpedance vectors. RESULTS We found large variability in intrinsic resistance (11-665 Ω) and reactance (0.25-2.5 Ω) values of the electrodes analyzed and significant displacement (P<0.05) of bioimpedance vector positions in healthy adults according to the paired one-sample Hotelling's T2-test. CONCLUSIONS A robust study of all physical characteristics of commercial Ag/AgCl electrodes is necessary to reach consensus on pregelled Ag/AgCl electrodes valid for bioimpedance measurement. This information will enable BIVA users to avoid systemic errors when performing BIVA assessments, specifically when these measurements are used for clinical interpretations.


title: Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update.

text: The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.


docid: zgrusvlr

title: Introduction of robot-assisted radical cystectomy within an established enhanced recovery programme.

text: OBJECTIVES To describe the implementation phase of a robot-assisted radical cystectomy (RARC) programme including side-effect profiles and impact on length of stay (LOS). PATIENTS AND METHODS In all, 114 consecutive patients (82% male) underwent RARC and urinary diversion between April 2013 and December 2015 [ileal conduit (97 patients) and orthotopic neobladder (17)]. Surgery was performed by two surgeons within a designated regional cancer centre. No exclusion criteria were applied. All patients were managed on the Exeter Enhanced Recovery Pathway (ERP) in a unit where embedded enhanced recovery practice was already established. Data were collected prospectively on the national cystectomy registry - the British Association of Urological Surgeons (BAUS) Complex Operations Dataset. RESULTS RARC was technically feasible in all but one case. The mean operating time was 3-5 h with an overall transfusion rate of 8.8%. There were higher-grade complications (Clavien-Dindo grade III-IV) in 18.4% of patients, with a 30-day mortality rate of 0.9%. The median (range) LOS after RARC was 7 (3-68) days, with a re-admission rate of 18.4%. CONCLUSIONS The present series shows that RARC can be safely implemented in a unit experienced in robot-assisted surgery (RAS). Case-selection in this setting is not deemed necessary. There are benefits in terms of lower transfusion rates and reduced LOS. The side-effect profile appears to differ from that of open RC, and despite the fact that complication rate is equivalent; 'technical' complications are over-represented in the RAS group. As such, they should improve with experience, recognition, and modification of surgical technique. ERPs can be safely applied to all patients undergoing RARC to maximise the benefits of minimally invasive surgery.


ISUOG Safety Committee Position Statement: safe performance of obstetric and gynecological scans and equipment cleaning in the context of COVID-19.


title: Pathogen microevolution in high resolution.

text: Microbial genomics has revolutionized infectious diseases and epidemiology research and is facilitating the tracking and containment of emerging biological threats. Among the most serious contemporary infectious agents are multiple antibiotic-resistant strains of the human pathogen Staphylococcus aureus, which present a formidable public health challenge that is no longer limited to hospitalized patients. To address key hypotheses regarding microbial strain evolution or virulence, conventional genotyping methods do not offer enough power to resolve minor changes between closely related strains. The application of next-generation high-throughput genotyping technologies, as illustrated in a recent analysis of a highly resistant S. aureus strain, can provide new clues about the geographical origin and intrahospital spread of important microbial pathogens.


[Examination of the Effects of Kinesiotape and IQ Tape on Neuromuscular Activity during Running, Stair Climbing and Drop Jumps].


title: Evaluation of a laparoscopically assisted ovariectomy technique in cats.

text: OBJECTIVE To describe a laparoscopically assisted ovariectomy (LAO) technique in the cat with a bipolar vessel sealing device (BVSD) or suture ligation and to compare the outcomes to open ovariohysterectomy (OO). STUDY DESIGN Randomized prospective study ANIMALS: Healthy, adult, sexually intact female cats (n = 30). METHODS Ten cats were assigned to each group: LAO with BVSD (group A), LAO with ligation (group B), and OO with ligation (group C). Surgical times and complications were assessed. Serum glucose and cortisol were measured prior to surgery and at 1, 2, 4, 6, 12, and 24 hours after surgery. Pain was scored by using an interactive visual analog scale (IVAS) at 0, 1, 2, 4, 6, 8, 12, 18, 24, 36, and 48 hours after surgery. Rescue analgesia was provided when IVAS score was 4 or more. Physiological and serum values and IVAS scores were compared among groups with area under the curve (AUC) by using a 1-way ANOVA. RESULTS Surgical time was shortest for group C (19.1 ± 5.2 minutes; P < .0002); there was no significant difference between groups A (27.7 ± 6.6 minutes) and B (33.2 ± 8.2 minutes). All procedures were completed successfully. No significant differences among groups were found in IVAS scores (P = .36), rescue analgesia (P = .22), glucose AUC (P = .53), or cortisol AUC (P = .27). CONCLUSION The LAO technique was accomplished as described in all cats with no complications or failures. Pain scores were not different from cats undergoing OO. LAO can be performed efficiently to maximize the benefits of minimally invasive surgery and is amenable to clinical practice.


title: Diversity and inclusion for the All of Us research program: A scoping review.

text: The All of Us Research Program (All of Us) is a national effort to accelerate health research by exploring the relationship between lifestyle, environment, and genetics. It is set to become one of the largest research efforts in U.S. history, aiming to build a national resource of data from at least one million participants. All of Us aims to address the need for more diversity in research and set the stage for that diversity to be leveraged in precision medicine research to come. This paper describes how the program assessed demographic characteristics of participants who have enrolled in other U.S. biomedical research cohorts to better understand which groups are traditionally represented or underrepresented in biomedical research. We 1) reviewed the enrollment characteristics of national cohort studies like All of Us, and 2) surveyed the literature, focusing on key diversity categories essential to the program's enrollment aims. Based on these efforts, All of Us emphasizes enrollment of racial and ethnic minorities, and has formally designated the following additional groups as historically underrepresented: individuals-with inadequate access to medical care; under the age of 18 or over 65; with an annual household income at or below 200% of the federal poverty level; who have a cognitive or physical disability; have less than a high school education or equivalent; are intersex; identify as a sexual or gender minority; or live in rural or non-metropolitan areas. Research accounting for wider demographic variability is critical. Only by ensuring diversity and by addressing the very barriers that limit it, can we position All of Us to better understand and tackle health disparities.


title: Baseline characteristics and outcomes of patients with COVID-19 admitted to intensive care units in Vancouver, Canada: a case series.

text: BACKGROUND Pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with high intensive care unit (ICU) mortality. We aimed to describe the clinical characteristics and outcomes of critically ill patients with coronavirus disease 2019 (COVID-19) in a Canadian setting. METHODS We conducted a retrospective case series of critically ill patients with laboratory-confirmed SARS-CoV-2 infection consecutively admitted to 1 of 6 ICUs in Metro Vancouver, British Columbia, Canada, between Feb. 21 and Apr. 14, 2020. Demographic, management and outcome data were collected by review of patient charts and electronic medical records. RESULTS Between Feb. 21 and Apr. 14, 2020, 117 patients were admitted to the ICU with a confirmed diagnosis of COVID-19. The median age was 69 (interquartile range [IQR] 60-75) years, and 38 (32.5%) were female. At least 1 comorbidity was present in 86 (73.5%) patients. Invasive mechanical ventilation was required in 74 (63.2%) patients. The duration of mechanical ventilation was 13.5 (IQR 8-22) days overall and 11 (IQR 6-16) days for patients successfully discharged from the ICU. Tocilizumab was administered to 4 patients and hydroxychloroquine to 1 patient. As of May 5, 2020, a total of 18 (15.4%) patients had died, 12 (10.3%) remained in the ICU, 16 (13.7%) were discharged from the ICU but remained in hospital, and 71 (60.7%) were discharged home. INTERPRETATION In our setting, mortality in critically ill patients with COVID-19 admitted to the ICU was lower than in previously published studies. These data suggest that the prognosis associated with critical illness due to COVID-19 may not be as poor as previously reported.


title: Organizational collaborative capacity in fighting pandemic crises: a literature review from the public management perspective.

text: Collaborative capacity serves for organizations as the capacity to collaborate with other network players. Organizational capacity matters as collaboration outcomes usually go beyond single-shot implementation efforts or a single-minded focus on either the vertical dimension of program or the horizontal component. This review article explores organizational collaborative capacities from the perspective of public management, in particular, network theory. By applying the 5 attributes of network theory-interdependence, membership, resources, information, and learning-to the explanation of collaborative capacity in fighting pandemic crises, I argue in some ways organizational collaborative capacity is very much like an organization in its own right. Studying collaborative capacity in the battle against pandemics facilitate our understanding of multisectoral collaboration in technical, political, and institutional dimensions, and greatly advances the richness of capacity vocabulary in pandemic response and preparedness.


title: Prevena™, negative pressure wound therapy applied to closed Pfannenstiel incisions at time of caesarean section in patients deemed at high risk for wound infection.

text: The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols.


title: DNA vaccines: ready for prime time?

text: Since the discovery, over a decade and a half ago, that genetically engineered DNA can be delivered in vaccine form and elicit an immune response, there has been much progress in understanding the basic biology of this platform. A large amount of data has been generated in preclinical model systems, and more sustained cellular responses and more consistent antibody responses are being observed in the clinic. Four DNA vaccine products have recently been approved, all in the area of veterinary medicine. These results suggest a productive future for this technology as more optimized constructs, better trial designs and improved platforms are being brought into the clinic.


title: Surgical technique for development of a clinically-representative ventral hernia repair infection rat model.

text: The animal model of infection following ventral hernia repair (VHR) has previously been utilized in exploring treatments and innovative therapies, such as implantation of biologic mesh imbedded with various anti-bacterial properties. The rat model has been utilized most commonly, but prior work has failed to recreate an adequately clinically representative model of infection following VHR. Additionally, there is lack of standardization of mesh infection severity across existing literature. Therefore, the aim of this paper is to describe the creation of a clinically representative VHR infection model utilizing an index procedure where a hernia defect is created followed by a VHR using biologic mesh and subsequent infectious agent inoculation. Additionally, we describe the development of a standardization index to quantify severity of mesh infection: the Mesh Infection Severity Index (MISI).•Our protocol involves two procedures, an index procedure where a hernia model is created, and a subsequent procedure where an infectious inoculant is introduced.•We describe the MISI, a standardization tool we hope will allow for ease of cross-institutional data assessment.•In summary, our protocol not only serves as a more clinically representative animal model, but also includes a novel metric to standardize mesh infection severity.


title: Transiliac Paraendograft Embolisation of Type 2 Endoleak: An Alternative Approach for Endoleak Management.

text: Selective transarterial catheterisation and translumbar sac puncture are well established techniques for the management of significant type 2 endoleaks. We report an additional technique for endovascular access to the endoleak sac through the space between the iliac endograft and artery wall.


title: Interrupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy: protocol for a systematic review and meta-analysis.

text: INTRODUCTION Radical prostatectomy is the mainstay of treatment for prostate cancer. The vesicourethral anastomosis is a critical step, which most likely impacts urinary continence and urethral stenosis. To date, it still remains unclear whether interrupted and continuous suturing for the anastomosis have different outcomes. Therefore, the aim of this systematic review and meta-analysis is to compare different suture techniques for vesicourethral anastomosis in terms of surgical and functional parameters. METHODS AND ANALYSIS A comprehensive literature search will be conducted covering MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. Studies comparing interrupted versus continuous suturing will be included in the analyses. No language restrictions will be applied. Screening, data extraction, statistical analysis and reporting will be done in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment will be performed with the help of the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle-Ottawa Scale for assessing quality of non-randomised studies. The quality of evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation. The primary outcome will be the time until removal of the urinary catheter. Secondary outcomes include rate of extravasation, length of hospital stay, time needed to perform the anastomosis, continence level at defined postoperative intervals and development of urethral strictures. Quantitative analysis will be calculated if meaningful. ETHICS AND DISSEMINATION In order to meet the highest ethical and methodological standards. we followed the PRISMA Protocol 2015 checklist. Each item was answered appropriately. For systematic reviews the ethical issues are strictly methodological as only data that were published earlier will be used. The full manuscript will be submitted to a peer-reviewed journal. Furthermore, the results will be presented on national and international congresses. TRIAL REGISTRATION NUMBER International prospective register of systematic reviews PROSPERO CRD42017076126.


title: Metabolic dysfunction associated fatty liver disease increases risk of severe Covid-19.

text: BACKGROUND AND AIMS Liver involvement is common in COVID-19. Elevated aspartate and alanine amino transaminase (AST/ALT) and borderline increase in serum bilirubin and serum alkaline phosphatase (ALP) are the commonest findings. Patients with associated co morbid conditions like obesity, cardiovascular disease, renal disease, malignancy, hypertension and old age are prone to develop severe disease. Limited data is available in patients with COVID-19 and metabolic dysfunction associated fatty liver disease (MAFLD).The aim of this review is to analyse the effect of MAFLD on severity of COVID-19. METHODS We systematically searched the PubMed database till May 20, 2020 and retrieved all the articles published on COVID-19 and fatty liver/MAFLD/NAFLD. RESULTS Limited studies done had shown four to six fold high risk of severe COVID-19 in patients with MAFLD. Patients with MAFLD and associated obesity, severe fibrosis and age <60 yrs are more prone to develop severe COVID-19. CONCLUSION MAFLD is associated with 4-6 fold increase in severity of COVID-19 compared to non MAFLD patients. Physician and hepatologist should follow these patients cautiously and preventive measures to be taken strictly in these high risk patients.


title: Lung sealant and morbidity after pleural decortication: a prospective randomized, blinded study.

text: OBJECTIVES Prolonged postoperative air leaks (AL) are a major cause of morbidity. Aim of this work was evaluating use of a Lung Sealant System (Pleuraseal, Covidien, Mansfield, MA, U.S.A.) in pleural decortications for empyema thoracis. METHODS From January 2008 to December 2008, 46 consecutive patients received pleural decortications for empyema thoracis. Post-procedural and malignancy-related empyemas were excluded. After hydro-pneumatic test and surgical correction of AL (until satisfaction), patients were assigned (23 per group) to Control or Sealant group. Control group underwent no additional interventions. In Sealant group, lung sealant was applied over AL areas. Following variables were measured daily: patients with AL; time to chest drainage (CD) removal; CD drainage volume at removal, postoperative length of hospital stay, postoperative C-reactive protein (CRP), and leukocyte counts. Personnel recording parameters were blinded to intervention. Two-tailed t-tests (normally distributed data) or Mann - Whitney U-test (not-normally distributed data) were used for evaluating significance of differences between group means or medians. Significance of any proportional differences in attributes were evaluated using Fisher's Exact Test. Statistical analysis was carried out using R-software (version 2.8.1). RESULTS Groups were similar regarding demographic and baseline characteristics. No patients were withdrawn from study; no adverse effects were recorded. There were no significative differences on CRP and leukocyte levels between two groups. Compared with the Control group, in Sealant group significantly fewer patients had AL (30 versus 78%, p = 0.012), and drains were inserted for a shorter time (medians, 3 versus 5 days, p = 0.05). Postoperative hospitalization time was shorter in Sealant group than in control group, but difference was not significant (0.7 days, p = 0.121). CONCLUSIONS Pleuraseal Lung Sealant System significantly reduces AL following pleural decortications for empyema and, despite of not-increased infectious indexes, is suitable for routinely use, even in procedures with contaminated pleura.


title: Inhibition of renin and the (pro)renin receptor system.

text: Renin is the rate-limiting step of the renin-angiotensin system (RAS) and can induce hypertension and cardiovascular diseases (CVDs) through the over-activated renin-angiotensin-converting enzyme (ACE)-angiotensin (Ang) II-Ang II type 1 receptor (AT(1)R) axis. Prorenin and renin bound to the (pro)renin receptor [(P)RR] not only increase the catalytic conversion of angiotensinogen (AGT) to Ang I, but also upregulate the expression of profibrotic genes. This review will discuss the inhibition of renin and the (P)RR system pharmacologically and nutritionally.


title: Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment.

text: PURPOSE Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. METHODS Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). RESULTS Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. CONCLUSION High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site.


title: COVID-19 on the Chest Radiograph: A Multi-Reader Evaluation of an AI System.

text: Background Chest radiography (CXR) may play an important role in triage for COVID-19, particularly in low-resource settings. Purpose To evaluate the performance of an artificial intelligence (AI) system for detection of COVID-19 pneumonia on chest radiographs. Methods An AI system (CAD4COVID-Xray) was trained on 24,678 CXR images including 1,540 used only for validation while training. The test set consisted of a set of continuously acquired CXR images (n=454) obtained in patients suspected for COVID-19 pneumonia between March 4th and April 6th 2020 in a single center (223 RT-PCR positive subjects, 231 RT-PCR negative subjects). The radiographs were independently analyzed by six readers and by the AI system. Diagnostic performance was performed by receiver operating characteristic curve analysis. Results For the test set, the mean age of the patients was 67.3 (+/-14.4) years (56% male). Using RT-PCR test results as the reference standard, the AI system correctly classified CXR images as COVID-19 pneumonia with an AUC of 0.81. The system significantly outperforms each reader (p < 0.001 using McNemar test) at their highest possible sensitivities. At their lowest sensitivities, only one reader can significantly outperform the AI system (p=0.04). Conclusions An AI system for detection of COVID-19 on chest radiographs was comparable to six independent readers.