docid: wznsjfbq

title: Surgical reconstruction for male-to-female sex reassignment.

text: BACKGROUND The primary challenge of male-to-female reassignment surgery is to create natural-appearing female genitalia with neovaginal dimensions adequate for intercourse, neoclitoris sensitivity, and minimal risk of complications. Surgical positioning is an important component of the procedure that successfully minimizes the risk of morbidity. OBJECTIVE We modified various vaginoplasty techniques to better position the urethral neomeatus in the proper anatomic location to minimize the chance for complications and enhance aesthetic satisfaction. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed data stored in a prospective database for 24 consecutive patients who underwent male-to-female gender reassignment at a German university clinic between January 2007 and March 2011. SURGICAL PROCEDURE First, orchiectomy and penile disassembly are performed with the patient in the supine position. Both corpora cavernosa are resected with the patient in the lithotomy position, and neovaginal construction is accomplished with the incorporation of the penile urethra into the penile shaft skin. The glans is preserved and resized to form the neoclitoris. The assembled neovagina is inverted, inserted into the expanded rectoprostatic space, and secured to the sacrospinous ligament. Scrotal skin is tailored to create the labia. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Complications and patient satisfaction with neovaginal depth, appearance, neoclitoral sensation, and capacity for sexual intercourse were evaluated. RESULTS AND LIMITATIONS The mean neovaginal depth was 11cm (range: 10-14cm); median follow-up was 39.7 mo (range: 19-69 mo). All patients reported satisfactory vaginal functionality. One patient noted stenosis after 4 yr that was histologically confirmed as lichen sclerosus. Neoclitoral sensation was good or excellent in 97% of patients; 33% reported regular intercourse. No major complications were observed. Because this is a retrospective review to describe a complex reconstructive surgery and illustrate these techniques in the accompanying intraoperative surgery-in-motion video, no control group was undertaken. CONCLUSIONS Gender reassignment can be performed with minimal complications using penile skin with incorporated penile urethra and intraoperative repositioning of the patient to achieve adequate neovaginal dimensions for intercourse and neoclitoral sensation.


title: Aboriginal artefacts on the continental shelf reveal ancient drowned cultural landscapes in northwest Australia.

text: This article reports Australia's first confirmed ancient underwater archaeological sites from the continental shelf, located off the Murujuga coastline in north-western Australia. Details on two underwater sites are reported: Cape Bruguieres, comprising > 260 recorded lithic artefacts at depths down to -2.4 m below sea level, and Flying Foam Passage where the find spot is associated with a submerged freshwater spring at -14 m. The sites were discovered through a purposeful research strategy designed to identify underwater targets, using an iterative process incorporating a variety of aerial and underwater remote sensing techniques and diver investigation within a predictive framework to map the submerged landscape within a depth range of 0-20 m. The condition and context of the lithic artefacts are analysed in order to unravel their depositional and taphonomic history and to corroborate their in situ position on a pre-inundation land surface, taking account of known geomorphological and climatic processes including cyclone activity that could have caused displacement and transportation from adjacent coasts. Geomorphological data and radiometric dates establish the chronological limits of the sites and demonstrate that they cannot be later than 7000 cal BP and 8500 cal BP respectively, based on the dates when they were finally submerged by sea-level rise. Comparison of underwater and onshore lithic assemblages shows differences that are consistent with this chronological interpretation. This article sets a foundation for the research strategies and technologies needed to identify archaeological targets at greater depth on the Australian continental shelf and elsewhere, building on the results presented. Emphasis is also placed on the need for legislation to better protect and manage underwater cultural heritage on the 2 million square kilometres of drowned landscapes that were once available for occupation in Australia, and where a major part of its human history must lie waiting to be discovered.


docid: eohpfdpq

title: Endoscopic vein harvest for infrainguinal arterial bypass.

text: BACKGROUND Endoscopic harvest of saphenous vein for infrainguinal arterial bypass decreases incision length and was initially documented to decrease wound complications without adversely affecting patency. However, recent studies have shown lower patency without a wound complication benefit. We sought to further define the wound complication and patency rates of endoscopic harvest compared with open harvest in infrainguinal arterial bypass procedures. METHODS Infrainguinal bypasses performed from 2000 to 2011 were analyzed. Only procedures using a single segment of great saphenous vein were included. Cases were grouped according to endoscopic or open harvest and were frequency-matched for body mass index and diabetes. Baseline characteristics were compared. Univariate and multivariate analysis was performed to determine correlation of baseline data and harvest method on wound complications and patency. RESULTS The study included 76 bypasses; 35 in the endoscopic harvest group and 41 in the open harvest group. Baseline characteristics between the endoscopic and open harvest groups were not significantly different, with the exception of mean age, which was older in the endoscopic harvest group, and carotid artery disease, which was more common in the open harvest group. There was no significant difference between endoscopic and open harvest in 30-day wound complication rates (29% vs 27%; P = .87) or in the other perioperative variables, aside from decreased narcotic use in the endoscopic harvest group (P = .01). Mean follow-up was 747 days. There was no significant difference in 3-year primary (47% vs 49%; P = .8), 3-year primary-assisted (88% vs 73%; P = .1), or secondary patency rates (92% vs 76%; P = .09) at 3 years between the endoscopic and open harvest groups. High body mass index improved primary patency in the endoscopic harvest group (P = .02), but had no effect on patency in the open harvest group (P = .15). Patients requiring hemodialysis had increased risk for loss of primary assisted patency in both groups (endoscopic, P = .02; open, P = .02) and decreased secondary patency in the open harvest group (P = .04). CONCLUSIONS Endoscopic and open harvest techniques for infrainguinal arterial bypass provide similar rates of wound complications and bypass patency, whereas hemodialysis negatively affects patency after both harvest methods. Endoscopic harvest is associated with the need for less perioperative narcotics, suggesting a potential benefit of endoscopic harvest that deserves further study.


title: COVID-19 and the Widening Gap in Health Inequity.

text: The coronavirus disease 2019 (COVID-19) pandemic has brought to light significant health inequities that have existed in our society for decades. Blacks, Hispanics, Native Americans, and immigrants are the populations most likely to experience disparities related to burden of disease, health care, and health outcomes. Increasingly, national and state statistics on COVID-19 report disproportionately higher mortality rates in blacks. There has never been a more pressing time for us to enact progressive and far-reaching changes in social, economic, and political policies that will shape programs aimed at improving the health of all people living in the United States.


title: Efficacy of Baska mask and Laryngeal mask airway supreme during positive pressure ventilation - A comparative study.

text: Background and Aims Supraglottic airway devices have several roles including maintenance of a clear upper airway during general anesthesia. We primarily compared the efficacy of Baska mask (BM) and laryngeal mask airway supreme (LMAS) for the rate of first time successful placement and the seal pressure. The secondary outcome measures included laryngopharyngeal morbidity and the correct positioning of the gastric port. Material and Methods A sample size of 30 was calculated in each study group. A total of 70 study participants were included in the statistical analysis of which 36 patients were in the BM group and 34 patients were in the LMAS group. Results The BM was successfully inserted in 28 patients (77.8%), whereas LMAS was successfully inserted in 33 patients (97.1%) in the first attempt (P = 0.028). The mean oropharyngeal seal pressure in the BM group was higher (33.28 ± 6.80 cm H2O) than compared to the LMAS group (27.47 ± 2.34 cm H2O) with a P value <0.001. There was no significant difference between the two groups in the incidence of postoperative laryngopharyngeal morbidity both in the immediate postoperative period (P = 0.479) and that seen 24 hours post operatively (P = 0.660). The nasogastric tube could easily be inserted in the entire study population. Conclusion From the present study, it is concluded that the BM creates a higher oropharyngeal seal pressure than the LMAS. However, the BM is more difficult to insert. The incidence of postoperative laryngopharyngeal morbidity is similar in both groups.


title: Lung Scintigraphy Imaging Features in a Young Patient With COVID-19.

text: A 31-year-old man developed diarrhea, fatigue, and intermittent fever for 2 weeks. The past few days he had experienced increasing dyspnea and dry cough. Ambulatory reverse transcriptase-polymerase chain reaction testing was positive for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Because of elevated D-dimer (1.5 mg/L), a lung scintigraphy (V/Q scan) was performed as SPECT/CT. Ventilation SPECT showed reduced ventilation with central nuclide deposition, whereas perfusion SPECT was inconspicuous, excluding pulmonary embolism. However, the low-dose CT revealed bilateral ground-glass opacities as previously described in COVID-19. This case highlights the procedure and findings of V/Q scanning (without embolism) in COVID-19.


title: Performance comparison of a new automated cuff pressure controller with currently available devices in both basic research and clinical settings.

text: BACKGROUND The management of tracheal tube cuff pressure in patients receiving mechanical ventilation is important for the prevention of ventilator-associated pneumonia. Currently, cuff pressure is intermittently monitored with a pressure gauge and adjusted when necessary in a routine practice. However, this method results in wide variations in pressure, and adequate management is difficult due to the spontaneous release of air from the cuff, which reduces cuff pressure. In order to continuously maintain a uniform cuff pressure, we developed a new automated cuff pressure controller and compared its properties with existing devices. METHODS The effectiveness of the new device was assessed with a model trachea/lung and tracheal tube by measuring cuff pressure while on mechanical ventilation. An electrically powered automatic cuff controller or manual cuff pressure control was used for comparison purposes. The effectiveness of the new device was also examined in patients receiving mechanical ventilation by continuously measuring cuff pressure for a 24-h period. RESULTS Cuff pressure was uniformly maintained with the new device. Moreover, in the clinical setting, variation in pressure from the set pressure was minimal with both the new device and existing device, relative to the intermittent monitoring method. This suggests that, as with the existing device, uniform cuff pressure management is possible with the new device. CONCLUSIONS Our results demonstrate the ability of the new cuff pressure controller to manage cuff pressure without the need of a power source, highlighting its potential utility in clinical settings.


10 Practical Steps in Laparoscopic Sacrohysteropexy.


title: Laparoscopic gastric ischemic conditioning prior to esophagogastrectomy: technique and review.

text: Esophagectomy can be associated with significant peri-operative morbidity such as leaks and strictures. Gastric ischemia as a result of gastric devascularization is one of the several contributing factors that may play a role in development of these complications. In an attempt to improve gastric tissue perfusion, a technique of gastric ischemic conditioning was proposed. For patients with esophageal cancer and at the time of laparoscopic staging, partial gastric devascularization is achieved by division of the left gastric vessels. Esophagectomy is subsequently performed several days after the gastric ischemic conditioning procedure. Our experience showed that preoperative ligation of left gastric vessels prior to esophagogastrectomy is technically feasible and safe and may decrease ischemic complications such as leaks and strictures.


title: Pathogenesis of morbidity after fast-track laparoscopic colonic cancer surgery.

text: AIM Analysis of the nature and time course of early complications after laparoscopic colonic surgery is required to allow rational strategies for their prevention and management. METHOD One hundred and four consecutive patients who underwent elective fast-track laparoscopic colonic cancer surgery were analysed prospectively from the Danish Colorectal Cancer Database, supplemented by data from the medical records. We studied in detail the time course of morbidity and reasons for prolonged stay (> 3 days). RESULTS Seventeen (16.3%) patients had one or more complications. Surgical complications occurred in 14 patients, of which four were preceded by medical complications. Three patients had only medical complications. Median length of stay was 3 days (range 1-44). CONCLUSION Further improvement of outcomes after fast-track laparoscopic colonic surgery might be obtained by improved surgical performance.


title: Early-elective single-incision laparoscopic sigmoidectomy for perforated diverticulitis using a totally reusable single-port device.

text: BACKGROUND Single-port access (SPA) is an emerging concept in minimally invasive colorectal surgery. The authors report their experience using SPA sigmoidectomy as an early-elective approach to complicated diverticulitis with paracolic abscess. METHODS Between September 2009 und April 2010, 4 patients underwent SPA sigmoidectomy for Hinchey-I diverticulitis using the reusable X-Cone device. RESULTS After a median time of antibiotic treatment of 8 days, SPA sigmoidectomy was performed successfully in all patients. The median operative time was 200 minutes (range, 187-221 minutes). No intraoperative or postoperative complications were recorded; the median postoperative hospital stay was 7 days (range, 5-7 days). No incisional hernias were observed at midterm follow-up (median, 11.5 months; range, 8-14 months). CONCLUSIONS When performed by an experienced laparoscopic surgeon, early-elective SPA sigmoidectomy is a feasible and safe approach to complicated diverticulitis. The reusability of the X-Cone device ensures that the costs of the procedure are not high.


title: Laparoscopic adnexectomy of suspect ovarian masses: surgical technique used to avert spillage.

text: Herein is described and evaluated a safe laparoscopic adnexectomy technique for retroperitoneal dissection of suspect ovarian masses including the underlying peritoneum fixed to the ovary. Adopting this technique in cases of suspect adnexal masses enables the reduction of spilling and ensures an intact specimen. Twenty-two consecutive patients with suspect adnexal masses 10 cm or smaller underwent laparoscopic adnexectomy. Patients with bilateral suspect ovarian masses that required bilateral adnexectomy were enrolled only if they were no longer of childbearing age. Laparoscopy was feasible in all patients. No tumor spillage occurred. In 5 patients (23.6%), minilaparotomy was required to extract the specimen. Mean (SD) operating time was 80 (35-160) minutes, and estimated blood loss was 50 (10-100) mL. No major intraoperative complications occurred. Median (range) postoperative stay was 1 (1-3) day. Definitive pathologic analysis revealed benign pathologic conditions in 18 patients (81.8%), an ovarian tumor with low malignant potential in 3 patients (13.7%), and ovarian cancer in 1 patient (4.5%) in whom findings at frozen-section analysis were inconclusive. Median (range) follow-up of malignant ovarian tumors and of tumors with low malignant potential was 27 (21-29) months. No recurrence or port-site metastasis developed during follow-up. The data are encouraging for adoption of this technique to avert spillage during laparoscopic management of suspect adnexal masses, especially those firmly adherent to the peritoneum. However, the procedure must be validated in a larger series of patients to standardize the technique.


Response to Comment on Cummings and Cohen. Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2. Diabetes Care 2016;39:924-933.


title: Mechanisms and consequences of positive-strand RNA virus recombination.

text: Genetic recombination in positive-strand RNA viruses is a significant evolutionary mechanism that drives the creation of viral diversity by the formation of novel chimaeric genomes. The process and its consequences, for example the generation of viruses with novel phenotypes, has historically been studied by analysis of the end products. More recently, with an appreciation that there are both replicative and non-replicative mechanisms at work, and with new approaches and techniques to analyse intermediate products, the viral and cellular factors that influence the process are becoming understood. The major influence on replicative recombination is the fidelity of viral polymerase, although RNA structures and sequences may also have an impact. In replicative recombination the viral polymerase is necessary and sufficient, although roles for other viral or cellular proteins may exist. In contrast, non-replicative recombination appears to be mediated solely by cellular components. Despite these insights, the relative importance of replicative and non-replicative mechanisms is not clear. Using single-stranded positive-sense RNA viruses as exemplars, we review the current state of understanding of the processes and consequences of recombination.


title: Surgical salvage of acquired lung lesions in extremely premature infants.

text: Acquired neonatal lung lesions including pneumatoceles, cystic bronchopulmonary dysplasia, and pulmonary interstitial emphysema can cause extrinsic mediastinal compression, which may impair pulmonary and cardiac function. Acquired lung lesions are typically managed medically. Here we report a case series of three extremely premature infants with acquired lung lesions. All three patients underwent aggressive medical management and ultimately required tube thoracostomies. These interventions were unsuccessful and emergency thoracotomies were performed in each case. Two infants with acquired pneumatoceles underwent unroofing of the cystic structure and primary repair of a bronchial defect. The third infant with pulmonary interstitial emphysema, arising from cystic bronchopulmonary dysplasia, required a middle lobectomy for severe and diffuse cystic disease. When medical management fails, tube thoracostomy can be attempted, leaving surgical intervention for refractory cases. Surgical options include oversewing a bronchial defect in the setting of a bronchopleural fistula or lung resection in cases of an isolated expanding lobe.


title: Evaluating the use of posterior oropharyngeal saliva in a point-of-care assay for the detection of SARS-CoV-2.

text: During the Coronavirus disease 2019 (COVID-19) pandemic, logistic problems associated with specimen collection limited the SARS-CoV-2 testing especially in the community. In this study, we assessed the use of posterior oropharyngeal saliva as specimens for the detection of SARS-CoV-2 in an automated point-of-care molecular assay. Archived nasopharyngeal swab (NPS) and posterior oropharyngeal saliva specimens of 58 COVID-19 patients were tested with the Xpert® Xpress SARS-CoV-2 assay. SARS-CoV-2 was detected in either NPS or saliva specimens of all patients. Among them, 84.5% (49/58) tested positive in both NPS and saliva, 10.3% (6/58) tested positive in NPS only, and 5.2% (3/58) tested positive in saliva only. No significant difference in detection rate was observed between NPS and saliva (McNemar's test p=0.5078). The detection rate was slightly higher for N2 (NPS 94.8% and Saliva 93.1%) than that of the E gene target (Saliva:89.7% vs 82.8%) on both specimen types. Significant earlier median Ct value was observed for NPS comparing to that of saliva on both E (26.8 vs 29.7, p=0.0002) and N2 gene target (29.3 vs 32.3, p=0.0002). The median Ct value of E gene target was significantly earlier than that of the N2 gene target for both NPS (26.8 vs 29.3, p<0.0001) and saliva (29.7 vs 32.3, p<0.0001). In conclusion, posterior oropharyngeal saliva and NPS were found to have similar detection rates in the point-of-care test for SARS-CoV-2 detection. Due to the easy collection of posterior oropharyngeal saliva, the use of saliva as an alternative specimen type for SARS-CoV-2 detection is recommended.


title: Novel treatment options in stage I non-small-cell lung cancer.

text: In the last 5 years, the current management of stage I non-small-cell lung cancer has been challenged due to novel surgical approaches and advances in radiation technology. The outcome after a sublobar resection is promising, especially for tumors less than 2 cm. Other treatment opportunities are available for high risk patients with comorbidity and impaired pulmonary function. Stereotactic ablative body radiotherapy is a good alternative treatment to surgery, especially in elderly and comorbid patients. However, randomized evidence comparing sublobar resection and stereotactic radiotherapy is presently lacking. The most recent development in radiotherapy is hadron therapy with a presumed reduced toxicity because of its peculiar physical and biological effects. Promising thermal and microwave ablative techniques are in development and have specific niche indications.


title: Antimicrobial-impregnated dressing combined with negative-pressure wound therapy increases split-thickness skin graft engraftment: a simple effective technique.

text: OBJECTIVE Immobilization and adequate surface contact to wounds are critical for skin graft take. Techniques such as the tie-over dressing, cotton bolster, and vacuum-assisted closure are used to address this, but each has its limitations. This study is designed to assess the effect of antimicrobial-impregnated dressing (AMD) combined with negative-pressure wound therapy (NPWT) on skin graft survival. DESIGN Retrospective case-control study PARTICIPANTS : Patients with chronic or contaminated wounds treated with split-thickness skin graft. A broad spectrum of wounds was included, from causes such as trauma, burns, chronic diabetic ulcers, and infection. INTERVENTIONS Antimicrobial-impregnated dressing, which contains 0.2% polyhexamethylene biguanide, with NPWT MAIN OUTCOME MEASURE:: Success of skin graft MAIN RESULTS : In the AMD group, all skin grafts achieved 100% take without secondary intervention. No infection or graft failure was observed in any patients, and no complications, such as hematoma or seroma formation, were noted, although in the control group partial loss of skin grafts was noted in 3 patients. Infection and inadequate immobilization were thought to be the main reasons. There were no hematoma or seroma formations in the control group. CONCLUSION Use of an AMD dressing with NPWT after split-thickness skin grafting can be an effective method to ensure good graft to wound contact and enhances skin graft take in chronic and contaminated wounds.


title: [Respiratory insurance in coronavirus-infected patients].

text: The coronavirus epidemic that is spreading around our world poses a number of challenges for healthcare workers. The virus is spread by droplet infection and has a high virulence, so any intervention that generates airway aerosol formation potentially endangers the health of those involved in care. Severe forms of coronavirus infection are associated with progressive respiratory failure, for the treatment of which early endotracheal intubation and invasive mechanical ventilation are essential. There is an increased risk of airway aerosol formation during intubation, resulting in a high risk of infection for care personnel. In addition to the above, difficult airway insurance is relatively common in these patients. The aim of our article is to provide a practice-oriented overview of the specialties of airway insurance in patients infected with coronavirus, with particular reference to aspects of infection control and patient safety. Orv Hetil. 2020; 161 (17): 696-703.


Meningococcal vaccination and Hajj pilgrimage.


title: [Source of the COVID-19 pandemic: ecology and genetics of coronaviruses (Betacoronavirus: Coronaviridae) SARS-CoV, SARS-CoV-2 (subgenus Sarbecovirus), and MERS-CoV (subgenus Merbecovirus).]

text: Since the early 2000s, three novel zooanthroponous coronaviruses (Betacoronavirus) have emerged. The first outbreak of infection (SARS) caused by SARS-CoV virus occurred in the fall of 2002 in China (Guangdong Province). A second outbreak (MERS) associated with the new MERS-CoV virus appeared in Saudi Arabia in autumn 2012. The third epidemic, which turned into a COVID-19 pandemic caused by SARS-CoV-2 virus, emerged in China (Hubei Province) in the autumn 2019. This review focuses on ecological and genetic aspects that lead to the emergence of new human zoanthroponous coronaviruses. The main mechanism of adaptation of zoonotic betacoronaviruses to humans is to changes in the receptor-binding domain of surface protein (S), as a result of which it gains the ability to bind human cellular receptors of epithelial cells in respiratory and gastrointestinal tract. This process is caused by the high genetic diversity and variability combined with frequent recombination, during virus circulation in their natural reservoir - bats (Microchiroptera, Chiroptera). Appearance of SARS-CoV, SARS-CoV-2 (subgenus Sarbecovirus), and MERS (subgenus Merbecovirus) viruses is a result of evolutionary events occurring in bat populations with further transfer of viruses to the human directly or through the intermediate vertebrate hosts, ecologically connected with bats. This review is based on the report at the meeting «Coronavirus - a global challenge to science» of the Scientific Council «Life Science» of the Russian Academy of Science: Lvov D.K., Alkhovsky S.V., Burtseva E.I. COVID-19 pandemic sources: origin, biology and genetics of coronaviruses of SARS-CoV, SARS-CoV-2, MERS-CoV (Conference hall of Presidium of RAS, 14 Leninsky Prospect, Moscow, Russia. April 16, 2020).


title: Translational profiling of dorsal root ganglia and spinal cord in a mouse model of neuropathic pain.

text: Acute pain serves as a protective mechanism, guiding the organism away from actual or potential tissue injury. In contrast, chronic pain is a debilitating condition without any obvious physiological function. The transition to, and the maintenance of chronic pain require new gene expression to support biochemical and structural changes within the pain pathway. The regulation of gene expression at the level of mRNA translation has emerged as an important step in the control of protein expression in the cell. Recent studies show that signaling pathways upstream of mRNA translation, such as mTORC1 and ERK, are upregulated in chronic pain conditions, and their inhibition effectively alleviates pain in several animal models. Despite this progress, mRNAs whose translation is altered in chronic pain conditions remain largely unknown. Here, we performed genome-wide translational profiling of dorsal root ganglion (DRG) and spinal cord dorsal horn tissues in a mouse model of neuropathic pain, spared nerve injury (SNI), using the ribosome profiling technique. We identified distinct subsets of mRNAs that are differentially translated in response to nerve injury in both tissues. We discovered key converging upstream regulators and pathways linked to mRNA translational control and neuropathic pain. Our data are crucial for the understanding of mechanisms by which mRNA translation promotes persistent hypersensitivity after nerve injury.


title: Structural and dynamic characterization of the interaction of the putative fusion peptide of the S2 SARS-CoV virus protein with lipid membranes.

text: The SARS coronavirus (SARS-CoV) envelope spike (S) glycoprotein, a Class I viral fusion protein, is responsible for the fusion between the membranes of the virus and the target cell. In the present work, we report a study of the binding and interaction with model membranes of a peptide pertaining to the putative fusion domain of SARS-CoV, SARS FP, as well as the structural changes that take place in both the phospholipid and the peptide molecules upon this interaction. From fluorescence and infrared spectroscopies, the peptide ability to induce membrane leakage, aggregation and fusion, as well as its affinity toward specific phospholipids, was assessed. We demonstrate that SARS FP strongly partitions into phospholipid membranes, more specifically with those containing negatively charged phospholipids, increasing the water penetration depth and displaying membrane-activity modulated by the lipid composition of the membrane. Interestingly, peptide organization is different depending if SARS FP is in water or bound to the membrane. These data suggest that SARS FP could be involved in the merging of the viral and target cell membranes by perturbing the membrane outer leaflet phospholipids and specifically interacting with negatively charged phospholipids located in the inner leaflet.


Toward Universal Deployable Guidelines for the Care of Patients With COVID-19.


title: [Prevention and control strategies and methods of novel coronavirus epidemic infection in department of otolaryngology head and neck surgery in hospital].

text: 2019新型冠状病毒（2019 novel coronavirus, 2019-nCoV）感染疫情形势严峻，初步调查显示，在抗击疫情一线，武汉市各大医院耳鼻咽喉头颈外科几乎都有医护感染发生。为了应对2019-nCoV疫情对医护人员院内感染防控的巨大挑战，本文结合武汉市某医院耳鼻咽喉头颈外科在这方面的实践经验及教训，分享在疫情中，耳鼻咽喉头颈外科防控院内感染的策略和方法，期望有助于保护医护人员，维持疫情中日常医疗工作的运行，快速遏制疫情的蔓延。.


title: Laparoscopic management of a giant hepatic cyst with fibrin glue fixation of the omentum.

text: Approximately 4.5% to 7% of the population will have simple hepatic cysts, but only 5% of these will require treatment. Drainage options include interventional, laparoscopic, and open techniques ranging from simple aspiration to liver resection. We present a case where a giant hepatic cyst was treated laparoscopically and omentum was fixed in the defect using fibrin glue to prevent recurrence. A 69-year-old female patient presented with a recurrent simple hepatic cyst after percutaneous aspiration had failed. Her symptoms were related to the size of the cyst. Laparoscopic drainage was performed with cyst wall excision. Omentum was fixed in the defect using fibrin glue. She was discharged after 24 hours without complication. There are many ways to treat nonparasitic liver cysts. The laparoscopic approach limits morbidity with excellent results. The use of fibrin glue to secure omentum in the defect is a simple technique to limit recurrence.


title: Enterovirus 71 suppresses interferon responses by blocking Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling through inducing karyopherin-α1 degradation.

text: Enterovirus 71 (EV71) has emerged as one of the most important enteroviruses since the eradication of poliovirus, and it causes severe neurological symptoms for which no effective antiviral drugs are available. Type I interferons (IFN) α/β have been used clinically as antiviral therapy as the first line of defense against virus infections successfully for decades. However, treatment with type I interferons has not been effective in patients with EV71 infection. In this study, we found that in cells pretreated with IFN-β, EV71 infection could still lead to a cytopathic effect, and the viral replication was not affected. The mechanism by which EV71 antagonizes interferon signaling, however, has been controversial. Our study indicated that EV71 infection did not inhibit phosphorylation of STAT1/2 induced by IFN-β stimulation, but p-STAT1/2 transport into the nucleus was significantly blocked. We showed that EV71 infection reduced the formation of STAT/karyopherin-α1 (KPNA1) complex upon interferon stimulation and that the virus down-regulated the expression of KPNA1, a nuclear localization signal receptor for p-STAT1. Using specific caspase inhibitors and siRNA for caspase-3, we demonstrated that EV71 infection induced degradation of cellular KPNA1 in a caspase-3-dependent manner, which led to decreased induction of interferon-inducible genes and IFN response. Viral 2A and 3C proteases did not degrade KPNA1, inhibit the activity of ISRE or suppress the transcription of interferon-inducible genes induced by IFN-β. Our study demonstrates a novel mechanism by which antiviral signaling is suppressed through degradation of KPNA1 by activated caspase-3 induced in an enteroviral infection.


title: Splanchnic-cerebral oxygenation ratio (SCOR) values in healthy term infants as measured by near-infrared spectroscopy (NIRS).

text: PURPOSE The splanchnic-cerebral oxygenation ratio (SCOR) is a measurement comparing regional tissue oxygen saturation of splanchnic organs and brain tissue. SCOR has been previously proposed as a marker of clinical conditions associated with gut ischemia. Our goal was to determine SCOR values in healthy neonates in their first and second days of life. METHODS Prospective observational study measuring SCOR in term neonates in the nursery using near-infrared spectroscopy (NIRS). RESULTS Forty-five subjects with a mean gestational age of 39.4 ± 1.3 weeks were included. Mean SCOR on the first day was 0.90 ± 0.16 and 0.97 ± 0.16 on the second day, p = 0.02 (n = 45). No correlation was found between SCOR and gestational age; however, we did find a positive correlation between hour of life and SCOR values (r = 0.28, r(2) = 0.08, p < 0.01, two tails); SCOR appears to stabilize by 36 h. CONCLUSIONS Our findings demonstrate SCOR values in healthy neonates consistent with those previously theorized and help to validate it as a diagnostic measure. In addition, we have demonstrated that SCOR values may normally be lower in infants during their first days of life, and this information may be helpful to clinicians using NIRS as a diagnostic tool.


title: Display of the human (pro)renin receptor on Bombyx mori nucleopolyhedrovirus (BmNPV) particles using Bm cells.

text: The human (pro)renin receptor (hPRR) was displayed on the surface of Bombyx mori nucleopolyhedrovirus (BmNPV) with and without fusion to glycoprotein 64 (GP64) of the BmNPV. hPRR1 is a native hPRR with an additional FLAG peptide sequence inserted between the signal peptide and prorenin-binding domain. hPRR2 has the prorenin-binding domain inserted between amino acid residues (81)Asp and (82)Pro of GP64. hPRR4 has the prorenin-binding domain inserted in (81)Asp and (320)Met of partially deleted GP64. Incorporation of hPRR was confirmed in recombinant BmNPV (rBmNPV) but not in cysteine protease-deleted rBmNPV. hPRR1 was observed in ER, but hPRR2 and hPRR4 were observed around the endoplasmic reticulum (ER) and in its periphery. rBmNPV-hPRR1 and -hPRR2, carrying hPRR1 and hPRR2 respectively, showed binding affinity to human renin, but rBmNPV-hPRR4 did not. The presence of hPRR4 of rBmNPV-hPRR4 was confirmed in western blotting under nonreducing conditions, suggesting that although hPRR4 was incorporated in rBmNPV-hPRR4, it behaved as a non-functional aggregate. This rBmNPV display system can also be used for analyzing a ligand-receptor interaction.


title: End-point disease investigation for virus strains of intermediate virulence as illustrated by flavivirus infections.

text: Viruses of intermediate virulence are defined as isolates causing an intermediate morbidity/mortality rate in a specific animal model system, involving specific host and inoculation parameters (e.g. dose and route). Therefore, variable disease phenotype may exist between animals that develop severe disease or die and those that are asymptomatic or survive after infection with these isolates. There may also be variability amongst animals within each of these subsets. Such potential variability may confound the use of time-point sacrifice experiments to investigate pathogenesis of this subset of virus strains, as uniformity in disease outcome is a fundamental assumption for time-course sacrifice experiments. In the current study, we examined the disease phenotype, neuropathology, neural infection and glial cell activity in moribund/dead and surviving Swiss white (CD-1) mice after intraperitoneal infection with various Australian flaviviruses, including West Nile virus (WNV) strains of intermediate virulence (WNVNSW2011 and WNVNSW2012), and highly virulent Murray Valley encephalitis virus (MVEV) isolates. We identified notable intragroup variation in the end-point disease in mice infected with either WNVNSW strain, but to a lesser extent in mice infected with MVEV strains. The variable outcomes associated with WNVNSW infection suggest that pathogenesis investigations using time-point sacrifice of WNVNSW-infected mice may not be the best approach, as the assumption of uniformity in outcomes is violated. Our study has therefore highlighted a previously unacknowledged challenge to investigating pathogenesis of virus isolates of intermediate virulence. We have also set a precedent for routine examination of the disease phenotype in moribund/dead and surviving mice during survival challenge experiments.


title: Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor.

text: BACKGROUND Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes. METHODS We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication. This disruption occurred during clival tumor surgery and required immediate sphenoidal sinus packing. Emergent angiography revealed continued petrous carotid artery extravasation, warranting emergent vessel repair or deconstruction for treatment. To preserve the vessel, we utilized a covered Jostent. Due to tortuosity and lack of optimal wall apposition, there was reduced, yet persistent extravasation from an endoleak after Jostent deployment that failed to resolve despite multiple angioplasties. Therefore, we used PEDs to divert the flow. RESULTS Flow diversion relieved the extravasation. The patient remained neurologically intact post-procedure. CONCLUSIONS This case demonstrates successful combined use of a covered stent and flow diverters to treat acute vascular injury resulting from transsphenoidal surgery. However, concerns remain, including the requirement of dual antiplatelet agents increasing postoperative bleeding risks, stent-related thromboembolic events, and delayed in-stent restenosis rates.


title: The impact of COVID-19 on small business outcomes and expectations.

text: To explore the impact of coronavirus disease 2019 (COVID-19) on small businesses, we conducted a survey of more than 5,800 small businesses between March 28 and April 4, 2020. Several themes emerged. First, mass layoffs and closures had already occurred-just a few weeks into the crisis. Second, the risk of closure was negatively associated with the expected length of the crisis. Moreover, businesses had widely varying beliefs about the likely duration of COVID-related disruptions. Third, many small businesses are financially fragile: The median business with more than $10,000 in monthly expenses had only about 2 wk of cash on hand at the time of the survey. Fourth, the majority of businesses planned to seek funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. However, many anticipated problems with accessing the program, such as bureaucratic hassles and difficulties establishing eligibility. Using experimental variation, we also assess take-up rates and business resilience effects for loans relative to grants-based programs.


docid: gabqxwhg

title: Flexor tenorrhaphy using absorbable suture materials.

text: BACKGROUND Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model. METHODS Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies. RESULTS Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates. CONCLUSIONS Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.


title: Behavioural interventions to treat drooling in children with neurodisability: a systematic review.

text: AIM To review the evidence for behavioural interventions to reduce drooling in children with neurodisability. METHOD A detailed search in eight databases sought studies that: (1) included participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling-related behaviour; and (3) used experimental designs. Two reviewers extracted data from full-text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N-of-1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied. RESULTS Of an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self-management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures' outcomes (drooling frequency and severity); three included activity outcomes (mouth drying, head control, eye contact, and vocalizations) and none assessed participation or quality of life. While each study reported positive effects of intervention, risk of bias was high. INTERPRETATION Low-level evidence suggests behavioural interventions may be useful for treatment of drooling in children with neurodisability. Well-designed intervention studies are urgently needed to determine effectiveness. WHAT THIS PAPER ADDS Behavioural interventions used to treat drooling included reinforcement, prompting, self-management, extinction, overcorrection, instruction, and fading. Interventions targeted body structures and function-level outcomes and activity-level outcomes. Low-level evidence supports the use of behavioural intervention to treat drooling.


title: Photoinduced antiviral carbon nanohorns.

text: Nanocarbons, such as carbon nanohorns (CNH) and carbon nanotubes, are materials of interest in many fields of science and technology because of their remarkable physical properties. We report here a novel approach for using NIR laser-driven CNH as an antiviral agent. NIR laser-driven functional CNH complexes could open the way to a new range of antiviral materials.


docid: ohnkujzv

title: Does Sensory Retraining Improve Sensation and Sensorimotor Function Following Stroke: A Systematic Review and Meta-Analysis.

text: Background: Reduced sensation is experienced by one in two individuals following stroke, impacting both the ability to function independently and overall quality of life. Repetitive activation of sensory input using active and passive sensory-based interventions have been shown to enhance adaptive motor cortical plasticity, indicating a potential mechanism which may mediate recovery. However, rehabilitation specifically focusing on somatosensory function receives little attention. Objectives: To investigate sensory-based interventions reported in the literature and determine the effectiveness to improve sensation and sensorimotor function of individuals following stroke. Methods: Electronic databases and trial registries were searched from inception until November 2018, in addition to hand searching systematic reviews. Study selection included randomized controlled trials for adults of any stroke type with an upper and/or lower limb sensorimotor impairment. Participants all received a sensory-based intervention designed to improve activity levels or impairment, which could be compared with usual care, sham, or another intervention. The primary outcomes were change in activity levels related to sensorimotor function. Secondary outcomes were measures of impairment, participation or quality of life. Results: A total of 38 study trials were included (n = 1,093 participants); 29 explored passive sensory training (somatosensory; peripheral nerve; afferent; thermal; sensory amplitude electrical stimulation), 6 active (sensory discrimination; perceptual learning; sensory retraining) and 3 hybrid (haptic-based augmented reality; sensory-based feedback devices). Meta-analyses (13 comparisons; 385 participants) demonstrated a moderate effect in favor of passive sensory training on improving a range of upper and lower limb activity measures following stroke. Narrative syntheses were completed for studies unable to be pooled due to heterogeneity of measures or insufficient data, evidence for active sensory training is limited however does show promise in improving sensorimotor function following stroke. Conclusions: Findings from the meta-analyses and single studies highlight some support for the effectiveness of passive sensory training in relation to sensory impairment and motor function. However, evidence for active sensory training continues to be limited. Further high-quality research with rigorous methods (adequately powered with consistent outcome measures) is required to determine the effectiveness of sensory retraining in stroke rehabilitation, particularly for active sensory training.


title: A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA).

text: INTRODUCTION Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision-bilateral axillary approach (BAA). PATIENTS AND METHODS We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery. We performed a propensity score-matched analysis to compare the BAA robotic thyroid surgery group (BAA group) with the conventional open thyroid surgery group (open group). RESULTS Mean operation time in the BAA group (129.7 min) was significantly longer than that in the open group (103.1 min) (p < 0.001). However, no significant differences in the mean number of metastatic lymph nodes (LNs), mean number of retrieved LNs, vocal cord palsy, hypoparathyroidism, and mean stimulated thyroglobulin level were observed between the two groups. There was no case of postoperative bleeding or chyle leak. Of the 51 patients who had undergone the BAA procedure, 27 patients answered the questionnaire. The mean scale, ranging from 0 to 10, at postoperative 1 day/2 weeks was as follows: voice change score, 3.0/1.6; swallowing difficulty score, 4.0/2.0; anterior neck pain score, 4.6/3.6; anterior neck numbness score, 5.4/4.3; right chest pain score, 3.8/2.1; left chest pain score, 3.6/2.3; right chest numbness score, 3.2/2.8; left chest numbness score, 2.4/2.7; right breast pain score, 0.9/0; left breast pain score, 1.2/0; right breast numbness score, 1.7/0; and left breast numbness score, 2.6/0, respectively. CONCLUSION BAA robotic thyroid surgery is a novel, safe, and feasible oncoplastic method, especially for patients who have fear of procedures around the nipple areolar complex.


title: Long non‑coding RNAs: novel links in respiratory diseases (review).

text: Long non‑coding RNAs (lncRNAs) represent a surprisingly novel field in mammalian transcriptome research. With the development of RNA sequencing technology and computational methods, lncRNAs have been demonstrated to have important roles in biological processes at the epigenetic, transcription and post‑transcriptional levels. In addition, the dysregulation of lncRNAs contributes to numerous diseases, including cancer and cardiovascular diseases. The present review discusses the important functions of lncRNAs in respiratory diseases, highlights the mechanistic roles which underlie lncRNAs in lung cancer as well as considers the current and future potential use of lncRNAs as novel biomarkers and therapeutic targets for the treatment of lung cancer.


title: Posterior circulation flow diversion: a single-center experience and literature review.

text: BACKGROUND Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. OBJECTIVE To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. METHODS A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. RESULTS We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%. CONCLUSIONS Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.


Managing COVID-19-Positive Maternal-Infant Dyads: An Italian Experience.


title: Noninvasive assessment of hemodynamic variables using near-infrared spectroscopy in patients experiencing cardiogenic shock and individuals undergoing venoarterial extracorporeal membrane oxygenation.

text: PURPOSE The relationship between near-infrared spectroscopy cerebral oximetry (CrSO2), peripheral oximetry (PrSO2) and hemodynamic variables is not fully understood. METHODS The relationship between CrSO2/PrSO2 and cardiac index (CI), systemic vascular resistance index (SVRI) and mean arterial pressure (MAP) in patients experiencing cardiogenic shock and those undergoing venoarterial extracorporeal membrane oxygenation (ECMO) was retrospectively analyzed; in patients on ECMO, total circulatory index (TCI) was calculated from the sum of CI and extracorporeal blood flow index. RESULTS In patients experiencing cardiogenic shock (n=10), significant correlations between PrSO2 values and CI (Spearman r=0.81; P<.0001), SVRI (r=-0.45; P<.0001), and MAP (r=0.58; P<.0001) were found. Significant correlations between CrSO2 and CI (r=0.55; P<.0001) and SVRI (r=-0.47; P<.0001), but not MAP, were observed. Linear regression analysis revealed that CI could be calculated using the following equation: CI=PrSO2/24.0. In patients on VA ECMO (n=12), significant correlations were found between PrSO2 and TCI (r=0.68; P<.0001), SVRI (r=-0.47; P<.0001), and MAP (r=0.27; P=.025). Significant correlations were also found between CrSO2 and TCI (r=0.68; P<.0001) and SVRI (r=-0.51; P<.0001), but not MAP. CONCLUSIONS Results of the present study suggest that CrSO2 and PrSO2 in particular can be used for noninvasive estimation and monitoring of global circulatory status in patients experiencing cardiogenic shock and individuals undergoing ECMO.


title: Good training allows excellent results for laparoscopic Nissen fundoplication even early in the surgeon's experience.

text: BACKGROUND Laparoscopic antireflux surgery is the gold standard for surgical treatment of gastroesophageal reflux disease (GERD), and a well-defined learning curve for the procedure has been described. This study aimed to assess whether the surgeon's experience has an effect on 1-year symptom scores and patient satisfaction. METHODS All the patients who underwent antireflux surgery were entered into a prospectively maintained database including 1-year postoperative symptom scores. The database was queried in June 2008 to identify patients who had been followed up for 1 year. To decrease variability, the patients with a large hiatal hernia (>5 cm), paraesophageal hernia, treatment with partial fundoplication, a required Collis gastroplasty, or treatment with a transthoracic procedure were excluded from the study. RESULTS From September 2003 to March 2007, 215 consecutive patients underwent primary antireflux surgery. Of these 215 patients, 158 (93 women with a mean age of 50.9 ± 13.6 years; range, 18-87 years) met the inclusion criteria and were divided into three groups: early group (9/2003-10/2004), mid group (10/2004-12/2005), and late group (12/2005-3/2007). Experience significantly decreased the mean operative time (P < 0.05) and the hospital stay (P < 0.05). Additionally, the number of patients who required reoperative intervention also decreased with experience. There was no difference in the patient-reported symptom scores at 1 year for heartburn (mean, 0.3 ± 0.7), regurgitation (mean, 0.1 ± 0.4), or dysphagia (mean, 0.3 ± 0.6) (P > 0.05 for each). However, chest pain (mean, 0.2 ± 0.4) was significantly improved with experience (P < 0.05). The overall patient-reported mean satisfaction was 9.0 ± 1.9 (P > 0.05, scale, 1-10), and 14.5% (19/131) of the patients reported use of acid suppression medications. CONCLUSIONS A high degree of 1-year symptom resolution and satisfaction can be achieved even early in a surgeon's experience provided there is adequate training and maintenance of strict adherence to technique.


Drug Repurposing for COVID-19: Ethical Considerations and Roadmaps.


Covid-19 and Health Care's Digital Revolution.


title: Human CD8⁺ and CD4⁺ T cell memory to lymphocytic choriomeningitis virus infection.

text: Although cellular immunity to acute lymphocytic choriomeningitis virus (LCMV) infection has been well characterized in experimental studies in mice, the T cell response to this virus in humans is incompletely understood. Thus, we analyzed the breadths, magnitudes, and differentiation phenotypes of memory LCMV-specific CD8(+) and CD4(+) T cells in three human donors displaying a variety of disease outcomes after accidental needle stick injury or exposure to LCMV. Although only a small cohort of donors was analyzed at a single time point postinfection, several interesting observations were made. First, we were able to detect LCMV-specific CD8(+) and CD4(+) T cell responses directly ex vivo at 4 to 8 years after exposure, demonstrating the longevity of T cell memory in humans. Second, unlike in murine models of LCMV infection, we found that the breadths of memory CD8(+) and CD4(+) T cell responses were not significantly different from one another. Third, it seemed that the overall CD8(+) T cell response was augmented with increasing severity of disease, while the LCMV-specific CD4(+) T cell response magnitude was highly variable between the three different donors. Next, we found that LCMV-specific CD8(+) T cells in the three donors analyzed seemed to undergo an effector memory differentiation program distinct from that of CD4(+) T cells. Finally, the levels of expression of memory, costimulatory, and inhibitory receptors on CD8(+) and CD4(+) T cell subsets, in some instances, correlated with disease outcome. These data demonstrate for the first time LCMV-specific CD8(+) and CD4(+) T cells in infected humans and begin to provide new insights into memory T cell responses following an acute virus infection.


title: Rapid Induction of Liver Regeneration for Major Hepatectomy (REBIRTH): A Randomized Controlled Trial of Portal Vein Embolisation versus ALPPS Assisted with Radiofrequency.

text: To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) ≤25% (or ≤35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.


title: Uninterrupted administration of edoxaban vs vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation: Rationale and design of the ELIMINATE-AF study.

text: Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF. The ELIMINATE-AF (Evaluation of Edoxaban Compared With VKA in Subjects Undergoing Catheter Ablation of Nonvalvular Atrial Fibrillation) trial is a multinational, multicenter, prospective, randomized, open-label, parallel-group, blinded-endpoint evaluation (PROBE) study to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients indicated for a dose reduction) vs vitamin K antagonists (VKA) in patients with nonvalvular AF undergoing catheter ablation (http://www.ClinicalTrials.gov: NCT02942576). A total of 560 patients are planned for randomization to edoxaban or VKA (2:1 ratio) to obtain 450 patients fully compliant with the protocol. Patients will complete 21 to 28 days of anticoagulation prior to the ablation and a 90-day post-ablation period. The primary efficacy endpoint is the composite of all-cause death, stroke, and major bleeding. The primary safety endpoint is major bleeding. A magnetic resonance imaging substudy will assess the incidence of silent cerebral lesions post-ablation. ELIMINATE-AF will define the efficacy and safety of edoxaban for uninterrupted oral anticoagulation during catheter ablation of AF.


Rectal diverticulum resection by stapler device.


title: Pandemic Paradox.

text: The COVID-19 crisis continues. Worldwide, there have been roughly 6.3 million cases and 380,000 deaths. In the United States, at the time of this writing, there were 106,200 deaths. As life has changed on many fronts, some predictable effects of the pandemic have occurred, including socioeconomic hardships, social isolation, and political unease. Although the intensity of the need for effective treatments and a vaccine is ongoing, other issues have arisen that were not widely anticipated in the early days of the pandemic. Several of these consequences have brought a focus on issues that are at the heart of oncology nursing.


title: A real-time policy dashboard can aid global transparency in the response to coronavirus disease 2019.

text: There has been great provision of open data across the coronavirus disease 2019 (COVID-19) pandemic response, with, for example, dashboards presenting real-time descriptions of new daily cases and risk factors. Transparency has been an important discussion point and there have been concerns and criticisms of governments for not publishing the evidence base that is informing their decision-making. A 'policy dashboard' could act as a hub to show the localised reasoning behind COVID-19 policy decisions and allow the global health community to provide further support to governments and international stakeholders.


title: Filling the Void: A Review of Intragastric Balloons for Obesity.

text: Endoscopic bariatric therapies are predicted to become much more widely used in North America for obese patients who are not candidates for bariatric surgery. Of all the endoscopic bariatric therapies, intragastric balloons (IGBs) have the greatest amount of clinical experience and published data supporting their use. Three IGBs are FDA approved and are now commercially available in the USA (Orbera, ReShape Duo, and Obalon) with others likely soon to follow. They are generally indicated for patients whose BMI ranges from 30 to 40 mg/kg2 and who have failed to lose weight with diet and exercise. IGBs have been shown to be safe, effective, and relatively straightforward to place and remove. Accommodative symptoms commonly occur within the initial weeks post-placement; however, major complications are rare. Gastric ulceration can occur in up to 10% of patients, while balloon deflation with migration and bowel obstruction occurs in <1% of patients. The effectiveness of the Orbera and ReShape Duo IGBs ranges from 25 to 50% EWL (excess weight loss) after 6 months of therapy. The use of IGBs is likely to grow dramatically in the USA, and gastroenterologists and endoscopists should be familiar with their indications/contraindications, efficacy, placement/removal, and complications.


title: Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery.

text: PURPOSE To explore the additional health care costs of incidental durotomies and cerebrospinal fluid (CSF) leaks after elective surgery for degenerative spinal disorders. METHODS Prospective, observational single-center study including all patients operated for a degenerative condition of the spine over a 13-month period. Incidental durotomies and cerebrospinal fluid leaks were registered prospectively and a detailed analysis of health care costs of each case was performed. RESULTS In total 239 patients were included; an incidental durotomy occured in ten patients and a postoperative cerebrospinal fluid leak occured in one patient causing significantly higher hospital costs, as well as significantly longer hospital stay and operation time. While the hospital costs increased by nearly 50% the hospitals reimbursement increased only by 21% and this resulted in an average financial loss of 730 per case. CONCLUSION Incidental durotomy or postoperative cerebrospinal fluid leak after elective surgery for degenerative spinal disorders causes significantly higher health care costs.


SARS-CoV-2, COVID-19 pandemic, "coronawar"… oops; something was forgotten. Cardiovascular disease is still here! The collateral damage.


title: Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience.

text: Total thyroidectomy makes up the majority of all thyroidectomy cases. Energy-based advanced vessel-sealing devices which were developed in recent years for the control of vascular pedicles allowed significant progress in thyroid surgery. This study is designed to compare the efficiency and safety of the two energy-based vessel-sealing devices (Ligasure™ LF1212 and Harmonic FOCUS(®)) in sutureless thyroidectomy. Two hundred and forty-five consecutive patients underwent sutureless total thyroidectomy. Patients were randomized for the Ligasure™ LF1212 (n = 126) or Harmonic FOCUS(®) (n = 119). The parameters of demographics, surgical indications, morbidity, incision length, duration of operation, weight of specimen, amount of drainage, postoperative pain, hospital stay, and histopathology of specimen were recorded. Mean duration of operation was 37.98 ± 14.98 min (16-92 min) and was significantly shorter for Harmonic FOCUS(®) (p < 0.001). Mean hospital stay was 1.09 ± 0.3 (1-3) days. Morbidity rate was 9.8 % in total, whereas no mortality was observed. In terms of morbidity rates, no significant difference was determined between the two groups (p = 0.476). In both groups, there was no need for extra analgesic application other than the routine given after surgery. According to our experience, sutureless thyroidectomy can be performed with low morbidity rates in secure and efficient way.


title: Clinical performance of the Luminex NxTAG CoV Extended Panel for SARS-CoV-2 detection in nasopharyngeal specimens of COVID-19 patients in Hong Kong.

text: In December 2019, the coronavirus disease 2019 (COVID-19) pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) was first reported in the Hubei Province of China and later spread all over the world. There was an urgent need of a high-throughput molecular testing for screening the COVID-19 patients in the community. The Luminex NxTAG CoV Extended Panel is a high-throughput FDA emergency use authorized molecular diagnostic assay for SARS-CoV-2 detection. This system targets three genes (ORF1ab, N and E gene) of SARS-CoV-2, ORF1ab region of SARS-CoV and ORF5 region of MERS-CoV.In this study, we evaluated the diagnostic performance of this system with nasopharyngeal swab specimens of 214 suspected COVID-19 patients in Hong Kong. The results were compared with our routine COVID-19 RT-PCR protocol with LightMix SarbecoV E-gene kit and an in-house RdRp/Hel RT-PCR assay. The NxTAG CoV Extended panel demonstrated a 97.8% sensitivity and 100% specificity to SARS-CoV-2 in nasopharyngeal specimens. On low viral load specimens, the sensitivity of the NxTAG panel could still maintain at 85.71%. High agreement was observed between the NxTAG panel and the routine COVID-19 RT-PCR protocol (kappa value = 0.98). Overall the E gene target of the NxTAG panel demonstrated the highest sensitivity among the three SARS-CoV-2 targets while the N gene targets demonstrated the least.In conclusion, the NxTAG CoV Extended Panel is simple to use and it has high diagnostic sensitivity and specificity to SARS-CoV-2 in nasopharyngeal specimens. we recommend this diagnostic system for high-throughput COVID-19 screening in the community.


title: Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients.

text: OBJECTIVES To define effectiveness and safety of CT-guided radiofrequency ablation (RFA) of renal tumours and prognostic indicators for treatment success. METHODS Patients with a single treatment of a solitary, biopsy-proven renal tumour with intent to cure over a 14-year period were included (n = 203). Probability of residual disease over time, complication rates and all-cause mortality were assessed in relation to multiple variables. RESULTS Mean tumour size was 2.5 cm (range 1.0-6.0). Mean follow-up was 34.1 months (range 1-131). There was an increase in likelihood of residual disease for tumours ≥3.5 cm (P < 0.05), clear cell subtype of renal cell carcinoma (P ≤ 0.005) and maximum treatment temperature ≤70 °C (P < 0.05). There was a decrease in likelihood of residual disease for exophytic tumours (P = 0.01) and no difference based on age, gender, tumour location or type of radio freqency (RF) electrode used. Major complications occurred in 3.9 %. Median post-treatment survival was 7 years for patients with tumours <4 cm, and 5-year overall survival was 80 %. Probability of minor complication increased with tumour size (P = 0.03), as did all-cause mortality (P = 0.005). CONCLUSIONS CT-guided RFA is safe and effective for early-stage renal cancer, particularly for exophytic tumours measuring <3.5 cm. Overall 5-year survival with tumours <4 cm is comparable to partial nephrectomy. KEY POINTS • Prognostic indicators for success of CT-guided RFA of renal tumours are reported. • Tumour size ≥3.5 cm confers an increased risk for residual tumour. • Clear cell renal cell carcinoma subtype confers increased risk for residual tumour. • Tmax <70 °C within the ablation zone confers increased risk for residual tumour. • Exophytic tumours have a lower probability of residual disease.


title: Arytenoid dislocation after uneventful endotracheal intubation: a case report.

text: Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation.


Letter by Cerase et al Regarding Article, "Temporary Emergency Guidance to US Stroke Centers During the COVID-19 Pandemic".


title: Metabolic Syndrome and Viral Pathogenesis: Lessons from Influenza and Coronaviruses.

text: Metabolic syndrome increases the risk of severe disease due to viral infection. Yet, few6 studies have assessed the pathogenesis of respiratory viruses in high-risk populations. Here, we summarize how metabolic dysregulation impairs immune responses and we define the role of metabolism during influenza and coronavirus infections. We also discuss the use of various in vitro, in vivo, and ex vivo models to elucidate the contribution of host factors to viral susceptibility, immunity, and disease severity.


title: Sustainable COVID-19 Mitigation: Wuhan Lockdowns, Health Inequities, and Patient Evacuation.

text: The world is urgently looking for ways to flatten the coronavirus disease 2019 (COVID-19) curve, and many governments have resorted to implementing strict lockdowns, as researchers show the effectiveness of China's approaches in containing the virus. However, this paper argues that the draconian lockdowns instituted in Wuhan, Hubei, China, may have actually contributed to intensifying patient surges and incapacitating local health systems. Medical aids were rushed to Hubei and new hospitals were rapidly built, however, the healthcare system was still unable to match the staggering increase of patients in the early stages of the lockdowns. The paper proposes using patient evacuation to enhance sustainable COVID-19 mitigation during lockdowns. It demonstrates that patients in Hubei could have been transported to other Chinese provinces where hospitals were under-utilized. This could have theoretically saved thousands of lives by reducing inequities between Hubei and the rest of China in healthcare capacity for treating COVID-19 patients.


title: Manual aspiration thrombectomy using the Penumbra catheter in patients with acute M1 occlusion: A single-center study.

text: PURPOSE The efficacy and safety of aspiration thrombectomy using Penumbra in acute occlusion of intracranial artery have been proved in many previous studies. Our study aimed to retrospectively assess the efficacy and safety of a manual aspiration thrombectomy using Penumbra in patients with M1 occlusion. MATERIALS AND METHODS We conducted a retrospective review of 70 patients who underwent manual aspiration thrombectomy using Penumbra catheters for treatment of M1 occlusion between January 2012 and December 2014. We evaluated immediate angiographic results and clinical outcomes through review of patient electronic medical records. RESULTS Male was the dominant sex in this study (M:F = 38:32) and median age was 72 (age range, 36-91). The rate of successful recanalization (TICI grade ≥2 b) was 91.4% (64/70). The successful recanalization rate by single Penumbra was 82.9% (58/70). Six patients were treated in combination with Solitaire stent. Median NIHSS score was 11 (range, 4-20) at admission and was 3 (range 0-23) at discharge. Favorable clinical outcomes (mRS score at three months ≤2) were seen in 42 patients (60%). Two patients were observed to have subarachnoid hemorrhage after the procedure. Another two patients died related to massive symptomatic hemorrhage, brain edema and herniation in the hospital. CONCLUSION Manual aspiration thrombectomy appears to be safe and is capable of achieving a high rate of successful recanalization and favorable clinical outcomes in patients with M1 occlusion.


title: Role of paravertebral block anaesthesia during percutaneous transhepatic thermoablation.

text: PURPOSE This paper discusses the technique and preliminary results of right thoracic paravertebral block (TPVB) for percutaneous thermal ablation of liver tumours. MATERIALS AND METHODS Between October 2011 and August 2012 we treated 36 lesions (25 hepatocellular carcinoma and 11 metastases) in 30 patients aged 47-85 years (mean 67.5). Patients received ultrasound (US)-guided injection of 7 ml of naropin 0.75 % in T7, T9 and T11 levels, below the costo-vertebral ligament, until we observed an anterior displacement of the parietal pleura. For the subcapsular lesions, a cervical right phrenic nerve block was associated. The level of analgesia was evaluated during and after the percutaneous procedures with the Numerical Rating Scale. Finally, we investigated statistical correlations between pain and lesions (histological type, site, dimensions), and ablation time and technique (microwave or radiofrequency ablation). RESULTS Technical success was achieved in all patients. Despite the correct anaesthetic diffusion during the ablation, 10 patients (33.3 %) reported medium/severe pain and intravenous sedation was required. Pain was not found to correlate with any variable. No complications were observed. CONCLUSIONS In most cases, TPVB is a safe and effective technique for conscious anaesthesia during percutaneous thermal ablation of liver tumours. Failures probably derive from left sympathetic and parasympathetic fibre stimulation. We recommend performing a TPVB in the presence of the anaesthetist.


title: Repurposing of well-known medications as antivirals: hydroxychloroquine and chloroquine; from HIV-1 infection to COVID-19.

text: INTRODUCTION Chloroquine (CQ) and hydroxychloroquine (HCQ), originally were prescribed for prevention or treatment of malaria, but now successfully are used in several rheumatologic diseases. In addition, in recent decades considering their immunomodulatory effects, high tolerably and low cost, they are evaluated for various viral infections from HIV to COVID-19. AREAS COVERED In this review we tried to summarize all available studies on HCQ and CQ efficacy for management of viral infections and the probable mechanisms of action. The data were collected by searching "Hydroxychloroquine", "Choloroquine", "Viral infection", and names of various viral infections in PubMed/MEDLINE, Scopus, and Google Scholar databases from commencement to June 2020. Out of 95 search results, 74 most relevant works were gathered. EXPERT OPINION HCQ/CQ showed acceptable efficacy in HIV especially as an adjuvant treatment beside routine HAART. However, for some viral infections such as ZIKA, EBOLA, SARS-CoV and MERS-CoV, human studies are lacking. In the COVID-19 pandemic, in vitro and preliminary human studies showed encouraging findings. However, later well-designed trials and retrospective studies with large sample size, not only reported non-significant efficacy but also showed more cardiac adverse reactions. Alkalinisation of acid vesicles is the most important mechanism of action.


title: The holistic 3M modality of drug delivery nanosystems for cancer therapy.

text: Cancer has become the leading cause of human death worldwide. There are many challenges in the treatment of cancer and the rapidly developing area of nanotechnology has shown great potential to open a new era in cancer therapy. This article, rather than being exhaustive, focuses on the striking progress in the drug delivery nanosystems (DDNS) for cancer therapy and selects typical examples to point out the emerging mode of action of DDNS from our perspective. Among the outstanding advances in DDNS for cancer therapy is the development of "multicomponent delivery systems", "multifunctional nanocarriers" and "multistage delivery systems". However, these represent only one aspect of DDNS research. In addition, nature is the best teacher and natural evolution pressure has meant that virions conform to the "multitarget, multistage and multicomponent" (3M) mode of action. Amazingly, traditional Chinese medicine (TCM), used for over 4000 years in China, also displays the same mode of action. Integrating the previous notable progress in nanoparticle technology, learned from the building mode of natural virions and the action concept of TCM, we propose an integrity-based 3M mode DDNS for cancer therapy: multitarget, multistage and multicomponent, which are not fragmented parts but an interconnected integrity. Based on the physiological multitarget and the pharmacokinetic multistage, multicomponent DDNS are rationally designed, where different components with individual specific functions act in a synergistic manner against each target at each disposition stage to maximize the targeted delivery effectiveness. In this article, we introduce each component of 3M DDNS in detail and describe some typical cases to realize the tumor-homing purposes.


title: Fixation Methods for Calcaneus Fractures: A Systematic Review of Biomechanical Studies Using Cadaver Specimens.

text: Calcaneal fractures are notoriously difficult to treat and wound complications occur often. However, owing to the rare nature of these fractures, clinical trials on this subject are lacking. Thus, biomechanical studies form a viable source of information on this subject. With our systematic review of biomechanical studies, we aimed to provide an overview of all the techniques available and guide clinicians in their choice of method of fracture fixation. A literature search was conducted using 3 online databases to find biomechanical studies investigating methods of fixation for calcaneal fractures. A total of 14 studies investigating 237 specimens were identified. Large diversity was found in the tested fixation methods and in the test setups used. None of the studies found a significant difference in favor of any of the fixation methods. All tested methods provided a biomechanically stable fixation. All the investigated methods of fixation for calcaneal fractures seem to be biomechanically sufficient. No clear benefit was found for locking plates in the fixation of calcaneal fractures; however, a subtle mechanical superiority might exist compared with nonlocking plates in the case of fractures in osteoporotic bone. Several of the techniques tested would be suitable for a minimal invasive approach. These should be investigated further in clinical trials.


title: Can wearing face masks in public affect transmission route and viral load in COVID-19?

text: The mandatory face mask wearing was implemented in the Czech Republic and Slovakia shortly after the COVID-19 outbreak in Central Europe. So far, the number of COVID-19-associated deaths per 100,000 individuals is far lower in these countries as compared with other neighbouring or close countries. The use of face masks in public may not protect the general public from contracting the virus, however, presumptively decreases the viral load and contributes to a favourable clinical outcome in COVID-19 disease. A certain time is required for antigen-specific T cells and B cells to fully develop. Obligatory face mask wearing in public favours the virus transmission through oral mucosa and/or conjunctival epithelium, which enables the adaptive immune responses to evolve. In the case of inhalation of high loads of SARS-CoV-2, the time for the development of fully protective adaptive immune responses seems to be insufficient. Then, a less specific and more damaging innate immune response prevails.


title: Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery: A Randomized Controlled Trial.

text: Fluid is usually restricted during thoracic surgery, and vasoactive agents are often administered to maintain blood pressure. One-lung ventilation (OLV) decreases arterial oxygenation; thus oxygen delivery to the brain can be decreased. In this study, we compared phenylephrine and dopamine with respect to maintaining cerebral oxygenation during OLV in major thoracic surgery.Sixty-three patients undergoing lobectomies were randomly assigned to the dopamine (D) or phenylephrine (P) group. The patients' mean arterial pressure was maintained within 20% of baseline by a continuous infusion of dopamine or phenylephrine. Maintenance fluid was kept at 5 mL/kg/h. The depth of anesthesia was maintained with desflurane 1MAC and remifentanil infusion under bispectral index guidance. Regional cerebral oxygen saturation (rScO2) and hemodynamic variables were recorded using near-infrared spectroscopy and esophageal cardiac Doppler.The rScO2 was higher in the D group than the P group during OLV (OLV 60 min: 71 ± 6% vs 63 ± 12%; P = 0.03). The number of patients whose rScO2 dropped more than 20% from baseline was 0 and 6 in the D and P groups, respectively (P = 0.02). The D group showed higher cardiac output, but lower mean arterial pressure than the P group (4.7 ± 1.0 vs 3.9 ± 1.2 L/min; 76.7 ± 8.1 vs 84.5 ± 7.5 mm Hg; P = 0.02, P = 0.02). Among the variables, age, hemoglobin concentration, and cardiac output were associated with rScO2 by correlation analysis.Dopamine was superior to phenylephrine in maintaining cerebral oxygenation during OLV in thoracic surgery.


docid: tnyjfljp

title: Editor's Introduction: The Postpandemic World.


title: Effect of gadolinium concentration on temperature change under magnetic field.

text: Gadolinium based contrast agents (GBCAs) were found to play a role in nephrogenic systemic fibrosis in patients with and without renal impairment. Therefore, preserving the structural stability of GBCAs to reduce their propensity to liberate Gd3+ is of utmost importance. This study evaluates the effect of gadolinium concentration of GBCAs on solution temperature under magnetic fields. It is hypothesized that presence of gadolinium will lead to temperature changes of its solutions under magnetic field, and this change will depend on concentration. In this study, GBCAs were diluted to concentrations of 0.6, 1.2, 1.8, 2.4 mMol/L. A 10mL preparation in pure water, simulated body fluid (SBF), and plasma was scanned at 3T following a soft tissue neck protocol, and their temperatures were measured. Findings revealed that concentration of GBCA had significant effect on temperature change in all dilution media. Type of commercially available GBCA had an effect only in SFB and plasma. Evaluation of correlation between conditional stability constant (Kcond) and temperature difference (ΔT) revealed that in water and SBF there exists a positive correlation between Kcond and temperature variation. Collectively, GBCAs can cause local temperature variations when administered into patients, and can affect dissociation of gadolinium from its chelates, which should be investigated in a further study.


docid: tnkynruo

title: Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair: an Unresolved Question.

text: PURPOSE The effectiveness of the concomitant repair of hiatal hernia (HHR) during laparoscopic sleeve gastrectomy (LSG) in reducing gastroesophageal reflux disease (GERD) symptoms is still unclear. The aim of this study is to assess the effect of concomitant HHR on postoperative GERD symptoms in our patient population. MATERIALS AND METHODS A retrospective review of patients who underwent LSG with or without HHR between 2011and 2014 was performed. Pre- and postoperative GERD symptoms were assessed at different time intervals until a maximum of 2 years after the surgery. RESULTS The study included 165 patients; 76 (46%) underwent LSG with concomitant HHR (group A) while the rest underwent only LSG (group B). Baseline GERD complaints were more prevalent in group A (61.8 vs 41.6%, p = 0.04), in which 44 patients (57.9%) had evidence of hiatal hernia on preoperative EGD. In the remaining 32 patients, it was diagnosed intraoperatively. GERD symptoms did not significantly differ between the two groups after years 1 and 2. GERD remission was observed in 21.3% of the 76 patients who underwent concomitant HHR (group A) and in 29.7% of those who did not (group B) while new-onset GERD symptoms were reported in 12 patients (41.4%) in group A and in 24 patients (46.2%) in group B. CONCLUSIONS Routine HHR at the time of LSG does not show an improvement in GERD symptoms. More prospective studies are needed to clarify the role of the routine dissection, identification, and repair of concomitant hiatal hernia during LSG.


title: Rapid On-Site Evaluation of Fine-Needle Aspiration by Non-Cytopathologists: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies for Adequacy Assessment.

text: OBJECTIVE Rapid on-site evaluation (ROSE) has been shown to improve adequacy rates and reduce needle passes. ROSE is often performed by cytopathologists who have limited availability and may be costlier than alternatives. Several recent studies examined the use of alternative evaluators (AEs) for ROSE. A summary of this information could help inform guidelines regarding the use of AEs. The objective was to assess the accuracy of AEs compared to cytopathologists in assessing the adequacy of specimens during ROSE. STUDY DESIGN This was a systematic review and meta-analysis. Reporting and study quality were assessed using the STARD guidelines and QUADAS-2. All steps were performed independently by two evaluators. Summary estimates were obtained using the hierarchal method in Stata v14. Heterogeneity was evaluated using Higgins' I2 statistic. RESULTS The systematic review identified 13 studies that were included in the meta-analysis. Summary estimates of sensitivity and specificity for AEs were 97% (95% CI: 92-99%) and 83% (95% CI: 68-92%). There was wide variation in accuracy statistics between studies (I2 = 0.99). CONCLUSIONS AEs sometimes have accuracy that is close to cytopathologists. However, there is wide variability between studies, so it is not possible to provide a broad guideline regarding the use of AEs.


title: Does transumbilical single incision laparoscopic adjustable gastric banding result in decreased pain medicine use? A case-matched study.

text: BACKGROUND We report on our initial experience of laparoscopic adjustable gastric banding performed through a single transumbilical incision of approximately 2.5 cm. All single incision bands were placed using the Covidien SILS Port™ and the Allergan Lap-Band(®). The purpose of the present study was to report on the analgesic use after single-incision laparoscopic surgery (SILS) adjustable gastric banding versus that after conventional laparoscopic gastric banding at a community hospital. METHODS A retrospective review of postoperative pain medication use and the time to return to work was conducted of 24 consecutive SILS adjustable gastric banding procedures compared with 24 traditional 5-incision laparoscopic adjustable gastric banding procedures. RESULTS The patients in both groups were evenly matched for age, body mass index, and co-morbidities. All patients were discharged home on postoperative day 1. No complications developed. The mean patient-controlled analgesia morphine use during hospitalization for the SILS group was 33 ± 19.22 mg versus 49 ± 23.78 mg in the traditional group (P <.05). The mean period of postoperative pain medication use for the SILS group was 2 days versus 5 days for the traditional group (P <.05). However, the mean period to return to work was 9.5 days for the SILS group versus 11 days for the traditional group (P = NS). CONCLUSION Transumbilical single-incision laparoscopic adjustable gastric banding with mechanical port fixation resulted in significantly decreased postoperative pain medication use compared with traditional laparoscopic gastric banding with suture fixation of the band port. Also, the patients tended to return to work earlier after SILS gastric banding.


title: Health care-acquired viral respiratory diseases.

text: Health care-associated viral respiratory infections, common among hospitalized children, also occur among adults and institutionalized persons and result in increased patient morbidity, mortality, and health care costs. Approximately 20% of patients with healthcare-associated pneumonia have viral respiratory infections, with 70% of these infections caused by adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus (RSV). These infections typically reflect the level of viral activity within the community. This article focuses on the epidemiology, transmission, and control of health care-associated RSV and influenza virus.


Publishing in the time of pandemic: Editorial policy of a dermatology journal during COVID-19.


title: Molecular diagnostic assays for detection of viral respiratory pathogens in institutional outbreaks.

text: Outbreaks of viral respiratory disease in institutions may be associated with high morbidity and mortality, depending upon the viral etiology and the age and immune status of the affected patients. Control of outbreaks may include isolation and/or cohorting, and prophylaxis or treatment with specific antiviral agents may be indicated, all dependent upon the specific cause of the outbreak. Conventional methods of viral diagnosis detect only a limited number of the viruses that are known to cause outbreaks. The availability of sensitive and specific molecular assays has facilitated rapid diagnosis of a wider range of viruses from respiratory outbreaks. Molecular methods have distinct advantages over conventional methods, including the ability to rapidly develop assays for emerging viruses and new variants of existing viruses. In addition, molecular testing allows rapid detection of resistance to antiviral agents or mutations leading to increased virulence. However, high-throughput molecular testing requires batch processes that may compromise the ability to respond quickly to urgent testing demands.


docid: dxoseidr

title: Timing and utility of ultrasound in diarrhea-associated hemolytic uremic syndrome: 7-year experience of a large tertiary care hospital.

text: The authors reviewed the clinical, laboratory, and imaging data from cases of diarrhea-associated hemolytic uremic syndrome (HUS D+), diagnosed at our institution, from 2001 to 2008. The timing and utility of ultrasonographic features of HUS D+ were analyzed. The aim of the study was to determine factors that could aid in the early diagnosis of this disease. A total of 13 children with HUS D+ were identified out of 23 patients with HUS diagnosed during this time period. Evidence of Escherichia coli 0157:H7 was found in 9 cases (70%). Ultrasound studies were ordered in 10 patients (71%), all of which showed renal sonographic findings compatible with HUS. Ultrasound was performed at a mean of 13 days after onset of the diarrhea. Of note, 2 patients whose ultrasounds were performed at the beginning of their diarrheal illness manifested ultrasonographic features suggestive of HUS when there was only a mild increase in serum creatinine and no decrease in hemoglobin or platelets, suggesting that ultrasonography can identify renal involvement early in the course of the disease before other systemic signs appear. Early renal ultrasound may be a useful adjunct in the initial evaluation in children with bloody diarrhea. Evidence of increased renal echogenicity in a patient with bloody diarrhea could aid in early recognition of HUS when other diagnoses such as intussusceptions are being entertained, potentially allowing early intervention.


title: Melatonin pharmacokinetics and dose extrapolation after enteral infusion in neonates subjected to hypothermia.

text: INTRODUCTION Neonates with hypoxic-ischemic encephalopathy (HIE) undergoing hypothermia may benefit from adjunctive therapy with melatonin. However, melatonin safety, pharmacokinetics (PK), and dosage in this sensitive population are still unknown. METHODS AND RESULTS This study assessed the PK and safety of melatonin enteral administration to neonates with HIE undergoing hypothermia. Melatonin was infused at 0.5 mg/kg in five neonates with HIE undergoing hypothermia. Infusion started 1 hour after the neonates reached the target temperature of 33.5°C. Blood samples were collected before and at selective times after melatonin infusion. Abdominal complications or clinically significant changes in patients' vital signs were not found during or after melatonin. The peak plasma concentration reached 0.25 µg/mL. The area under the curve in 24 hours was 4.35 µg/mL*h. DISCUSSION Melatonin half-life and clearance were prolonged, and the distribution volume decreased compared to adults. In silico simulation estimated that the steady state can be reached after four infusions. Hypothermia does not affect melatonin PK. In humans high blood concentrations with lower doses can be achieved compared to animal experimentation, although intravenous administration is advised in the neonate population. Our study is a preparatory step for future clinical studies aimed at assessing melatonin efficacy in HIE.