title: Meniscal repair: the newest fixators.

text: The surgical techniques and associated devices for meniscus repair have improved over time, spurred in part by the clear recognition of the benefits of meniscal preservation and in part by the introduction of ultra-high-molecular weight polyethylene containing sutures. The desires for more minimally invasive techniques that decrease the risks of neurovascular injury and articular cartilage excoriation have seen 1 device generation after another introduced and improved upon. The current generation of meniscal repair all-inside devices are easier to use, limit the presence of material on the meniscal surface, and are self-adjusting and suture based. Although the speed of meniscus fixation device development places increasingly useful devices in surgeons' hands, clinical evidence of their effectiveness lag behind.


title: Mechanical thrombectomy with the Solitaire AB stent for treatment of acute basilar artery occlusion: A single-center experience.

text: Basilar artery occlusion (BAO) remains one of the most devastating subtypes of ischemic stroke, and prognosis is poor if early recanalization is not achieved. The purpose of this study was to evaluate the safety and technical feasibility of mechanical thrombectomy with the Solitaire AB stent (Covidien, Irvine, CA, USA) for the treatment of acute BAO through a single-center experience. Twenty-one patients with acute BAO were treated with mechanical thrombectomy with the Solitaire AB stent device between 1st September 2011 and 1st December 2014. Recanalization was assessed using the Thrombolysis in Cerebral Infarction (TICI) scale system. Clinical outcome was established at discharge by The National Institute of Health Stroke Scale (NIHSS), and the mean time from symptom onset to recanalization determined. Authors had access to identifying information during or after data collection. The clinical status of patients on admission was severe, with a mean NIHSS score of 25.57±5.20 (range: 16-38), and the number of patients with TICI 2b or 3 was 0. The mean time from symptom onset to recanalization was 579.00±188.78min (range: 360-960min). At 3-month follow-up, eight (38.1%) patients had a good clinical outcome. At follow-up, the trial of ORG 10172 in acute stroke treatment (TOAST) classification was large-vessel atherosclerosis in 13 patients (61.9%), cardioembolic in seven patients (33.3%), and undetermined in one patient (4.8%). In our series, application of the Solitaire AB stent retriever in acute BAO resulted in a high recanalization rate without procedural complications, and with good clinical outcome. Further prospective trials are needed to confirm the potential clinical benefit of this treatment approach.


title: IL-1 receptor antagonist therapy mitigates placental dysfunction and perinatal injury following Zika virus infection.

text: Zika virus (ZIKV) infection during pregnancy causes significant adverse sequelae in the developing fetus, and results in long-term structural and neurologic defects. Most preventive and therapeutic efforts have focused on the development of vaccines, antivirals, and antibodies. The placental immunologic response to ZIKV, however, has been largely overlooked as a target for therapeutic intervention. The placental inflammatory response, specifically IL-1β secretion and signaling, is induced by ZIKV infection and represents an environmental factor that is known to increase the risk of perinatal developmental abnormalities. We show in a mouse model that maternally administrated IL-1 receptor antagonist (IRA; Kineret, or anakinra), following ZIKV exposure, can preserve placental function (by improving trophoblast invasion and placental vasculature), increase fetal viability, and reduce neurobehavioral deficits in the offspring. We further demonstrate that while ZIKV RNA is highly detectable in placentas, it is not correlated with fetal viability. Beyond its effects in the placenta, we show that IL-1 blockade may also directly decrease fetal neuroinflammation by mitigating fetal microglial activation in a dose-dependent manner. Our studies distinguish the role of placental inflammation during ZIKV-infected pregnancies, and demonstrate that maternal IRA may attenuate fetal neuroinflammation and improve perinatal outcomes.


title: Acute stroke intervention.

text: Ischemic strokes will make up most (>80%) of the three-quarters of a million strokes that will occur in Americans this year. Reperfusion therapy is the fundamental strategy for the treatment of acute ischemic stroke. Reperfusion therapy may be accomplished noninvasively (intravenous thrombolysis) or invasively with catheter-based treatments (intra-arterial thrombolysis, thrombectomy, or angioplasty). Currently, a large majority of patients with acute ischemic stroke do not receive any form of reperfusion therapy owing to their delayed presentation (>3 hours) and lack of skilled man power for on-demand endovascular treatment. Paradoxically, improved success rates for reperfusion have been reported with the newer thrombectomy catheters, called "stentreivers." An option for broadening access for patients who need endovascular therapy would be to use interventional cardiologists with carotid stent experience who can help to provide 24 × 7 × 365 coverage.


title: Unusual presentation of trocar site hernia after Roux-en-Y gastric bypass: case report.

text: INTRODUCTION The exponential increase of bariatric surgery has resulted in a new diagnostic field of postoperative complications. One of the possibly serious complications is trocar site hernia. CASE REPORT We present a rare case of trocar site hernia, in particular herniation of the blind loop of the jejunojejunostomy in a patient previously operated for laparoscopic gastric bypass. CONCLUSION In patients with intermittent epigastric pain and regurgitation or nausea after RYGB, the differential diagnosis should include internal herniation and cholecystitis. Besides that, incarcerated trocar site hernia should also be considered. If obstructive symptoms are lacking, this might indicate Richter's hernia or herniation of the blind loop of the jejunojejunostomy. Due to the vague symptoms and the potentially late presentation, diagnosis can be challenging. However, this is a dangerous complication possibly leading to bowel strangulation and perforation, requiring urgent surgical repair.


title: Catheter-based therapies for deep vein thrombosis.

text: The basic treatment of deep vein thrombosis (DVT) over the past several decades has consisted of anticoagulation only, with inferior vena cava filtration for those who either failed or could not tolerate anticoagulation. Until recently no randomized trials had studied the efficacy of thrombolysis in DVT despite advances in techniques and technologies for endovascular clot removal. This article is a review of the current evidence on catheter-based therapies for patients with DVT. Technical considerations to improve outcome as well as optimal patient selection are discussed.


title: Peptide-receptor radionuclide therapy for endocrine tumors.

text: Peptide-receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs is a promising option for the treatment of somatostatin-receptor-positive endocrine tumors. Treatment with somatostatin analogs labeled with (111)In, (90)Y or (177)Lu can result in symptomatic improvement, although tumor remission is seldom achieved with (111)In-labeled analogs. In this Review, the findings of several studies on the use of PRRT for endocrine tumors are evaluated. Large variation in the antitumor effects of (90)Y-octreotide was reported between studies: an objective response (> or =50% tumor regression) was achieved in 9-33% of patients. After treatment with (177)Lu-octreotate, an objective response was achieved in 29% of patients and a minor response (25-50% tumor regression) was achieved in 16% of patients; stable disease was present in 35% of patients. Treatment with (177)Lu-octreotate resulted in a survival benefit of several years and markedly improved quality of life. Serious, delayed adverse effects were rare after PRRT. Although randomized, clinical trials have not yet been performed, data on the use of PRRT compare favorably with those from other treatment approaches, such as chemotherapy. If these results can be replicated in large, controlled trials, PRRT might become the preferred option in patients with metastatic or inoperable gastroenteropancreatic neuroendocrine tumors.


title: Rationale for the fundamental use of surgical Energy™ (FUSE) curriculum assessment: focus on safety.

text: BACKGROUND Almost all surgical procedures involve the use of devices that apply energy to tissue. Adverse events can occur if the devices are not used appropriately. The SAGES' Fundamental Use of Surgical Energy™ (FUSE) program will include a curriculum and certification examination to address this safety issue. The aim of this study was to determine the self-perceived knowledge of practicing surgeons related to energy-based devices and identify areas to emphasize in the assessment component of FUSE. METHODS Psychometric experts led the test development process. During a 2-day retreat, a multidisciplinary group defined 63 test objectives assessing the knowledge and skills required to use energy-based surgical instruments safely (job task analysis). A survey was sent to a sample of 103 SAGES leaders and others in the test target audience to determine the number of items to use for the certification examination. Participants rated each objective for frequency, relevance, and importance on a 1-7 scale with the means used to create a weighted scale. The survey also included five self-assessment questions. RESULTS Fifty surveys were completed; only 28 % of respondents considered themselves "experts." The most common source of knowledge was "industry sales representative or course" (42 %). The highest weighted topic was "Prevention of Adverse Events with Electrosurgery." The highest-rated objectives (>6 out of 7) were "Identify various mechanisms whereby electrosurgical injuries may occur," "Identify patient protection measures for setup and settings for the electrosurgical unit," and "Identify circumstances, mechanisms, and prevention of dispersive electrodes-related injury." CONCLUSIONS Although basic and advanced energy-based devices are commonly used, training has been largely dependent upon industry representatives or industry-sponsored courses. Few surgeons consider themselves experts in the mechanisms of action and the appropriate and safe use of energy-based surgical devices. Competencies that emphasize electrosurgical safety were viewed as most important for the FUSE certification examination.


Society for Vascular Medicine (SVM) Leaders Respond to the COVID-19 Crisis.


title: Surgical treatment for isolated atrial fibrillation: minimally invasive vs. classic cut and sew maze.

text: OBJECTIVE We sought to compare outcomes after two surgical approaches for the treatment of atrial fibrillation (AF): a minimally invasive, staged hybrid approach combining surgery with catheter ablation, [Hybrid Maze (HM)] and the classic cut and sew Maze (CM). METHODS From April 2004 to March 2010, 63 stand-alone AF procedures were performed by two surgeons at a single center and followed up for ≥6 months. CM was offered to all patients. After July 2007, patients were also prospectively offered a two-stage HM: stage 1 = a beating heart bipolar radiofrequency pulmonary vein isolation and left atrial appendage ligation; stage 2 = transvenous catheter ablation connecting the pulmonary veins to each other and the mitral annulus when AF was present after stage 1. Outcomes were compared between 25 HM and 38 CM using χ or Fisher exact test analysis. RESULTS Postoperatively, there was no difference in 30-day mortality (0%), complications (4% HM vs. 18% CM), or median length of stay (5 days). At last follow-up, 88% of HM and 95% of CM were free from AF; 80% of HM and 90% of CM were free from AF and antiarrhythmic medication (P ≥ 0.3). Twenty-nine percent of HM required a subsequent catheter ablation (stage 2) when compared with 8% of the CM patients (P = 0.04). Freedom from AF and antiarrhythmic medication at 1 year was 52% for the HM and 87.5% for the CM (P = 0.004). CONCLUSIONS In AF patients reluctant to undergo a CM but willing to undergo subsequent catheter ablation, a minimally invasive approach is a reasonable strategy. Because pulmonary vein isolation alone may be sufficient in two-thirds of patients and delayed reconnection is common, an interval two-stage hybrid approach may prove preferable over a one-stage combined hybrid approach; however, successful sinus restoration may take longer with this approach.


title: Chemotherapy-induced peripheral neurotoxicity (CIPN): what we need and what we know.

text: Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the most frequent and severe long-term side effects of cancer chemotherapy. Preclinical and clinical studies have extensively investigated CIPN searching for effective strategies to limit its severity or to treat CIPN-related impairment, but the results have been disappointing. Among the reasons for this failure are methodological flaws in both preclinical and clinical investigations. Their successful resolution might provide a brighter perspective for future studies. Among the several neurotoxic chemotherapy drugs, oxaliplatin may offer a clear example of a methodological approach eventually leading to successful clinical trials. However, the same considerations apply to the other neurotoxic agents and, although frequently neglected, also to the new "targeted" agents.


title: Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council

text: Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A beta-hemolytic streptococcal (GAS) tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture. Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice, because it is cost-effective, has a narrow spectrum of activity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides. The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention). The recommended duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxis, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals. This report updates the 1995 statement by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. It includes new recommendations for the diagnosis and treatment of GAS pharyngitis, as well as for the secondary prevention of rheumatic fever, and classifies the strength of the recommendations and level of evidence supporting them.


title: Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters.

text: Endovascular intervention using traditional neurovascular stents and densely braided flow diverters (FDs) have become the preferred treatment strategies for traditionally challenging intracranial aneurysms. Modeling stent and FD deployment in patient-specific aneurysms and its flow modification results prior to the actual intervention can potentially predict the patient outcome and treatment optimization. We present a clinically focused, streamlined virtual stenting workflow that efficiently simulates stent and FD treatment in patient-specific aneurysms based on expanding a simplex mesh structure. The simplex mesh is generated using an innovative vessel-specific initialization technique, which uses the patient's parent artery diameter to identify the initial position of the simplex mesh inside the artery. A novel adaptive expansion algorithm enables the acceleration of deployment process by adjusting the expansion forces based on the distance of the simplex mesh from the parent vessel. The virtual stenting workflow was tested by modeling the treatment of two patient-specific aneurysms using the Enterprise stent and the Pipeline Embolization Device (commercial FD). Both devices were deployed in the aneurysm models in a few seconds. Computational fluid dynamics analyses of pre- and post-treatment aneurysmal hemodynamics show flow reduction in the aneurysmal sac in treated aneurysms, with the FD diverting more flow than the Enterprise stent. The test results show that this workflow can rapidly simulate clinical deployment of stents and FDs, hence paving the way for its future clinical implementation.


title: Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics.

text: BACKGROUND : Diagnostic criteria for bronchiolitis are variable. OBJECTIVE : To study how the risk factors for recurrent wheezing and asthma vary by different definitions of bronchiolitis. METHODS : Viral etiology and atopic characteristics were studied in 259 hospitalized wheezing children (median age, 14 months; range, 0-36 months). The data were analyzed according to age (<6, <12, <24 and <36 months) and whether they had a history or no history of a previous wheezing episode. Sixteen viruses were detected by conventional and molecular methods. Atopic characteristics included the presence of eczema, specific and total IgE responses, blood eosinophil count, and modified asthma predictive index. RESULTS : Evidence of respiratory virus infection was found in 93% of the cases and allergic sensitization in 26% of the cases. Rhinovirus infections and atopic characteristics (sensitization, blood eosinophil count, and modified asthma predictive index) increased by age and were significantly more common in children with recurrent wheezing episodes than in first-time wheezers in age categories of <24 and <36 months (P < 0.05 for all). CONCLUSIONS : In children with bronchiolitis, 2 clinical factors, age and number of previous wheezing episodes, are linked to inflammatory (atopy-related factors) and virologic risk factors of asthma (rhinovirus-associated disease). According to current US and UK guidelines, bronchiolitis includes wheezing children <24 months of age. Our observations suggest that the clinical definition should include only children with their first episode of wheezing.


title: Clinical and CT imaging features between the first nucleic acid-negative and first nucleic acid-positive COVID-19 patients.

text: OBJECTIVES To investigate the role of chest CT for the diagnostic work-up for patients with suspected infection of coronavirus disease 2019 (COVID-19). METHODS The clinical data and imaging findings of the first nucleic acid-negative COVID-19 patients were analyzed and compared with the first nucleic acid-positive patients. RESULTS Compared with the first nucleic acid-positive patients, the onset time of the first nucleic acid-negative patients was shorter [(3.58±2.94) d], but the diagnosis was longer [(3.92±3.66) d]. There were no significant differences in the characteristics of the clinical data and radiological findings between the 2 groups (P>0.05). CONCLUSION Chest CT examination is important to avoid COVID-19 missed diagnosis due to false negative nucleic acid.


title: Robotic-assisted minimally invasive central pancreatectomy: technique and outcomes.

text: BACKGROUND Central pancreatectomy is a definitive treatment for low-grade tumors of the pancreatic neck that preserves pancreatic and splenic function at the potential expense of postoperative pancreatic fistula. We analyzed outcomes after robot-assisted central pancreatectomy (RACP) to reexamine the risk-benefit profile in the era of minimally invasive surgery. METHODS Retrospective analysis of nine RACP performed between August 2009 through June 2010 at a single institution. RESULTS The average age of the cohort was 64 (range 18-75 years) with six women (67 %). Indications for surgery included: five benign cystic neoplasm and four pancreatic neuroendocrine tumor. Median operative time was 425 min (range 305-506 min) with 190 ml median blood loss (range 50-350 ml) and one conversion to open due to poor visualization. Median tumor size was 3.0 cm (range 1.9-6.0 cm); all patients achieved R0 status. Pancreaticogastrostomy was performed in seven cases and pancreaticojejunostomy in two. The median length of hospital stay was 10 days (range 7-19). Two clinically significant pancreatic fistulae occurred with one requiring percutaneous drainage. No patients exhibited worsening diabetes or exocrine insufficiency at the 30-day postoperative visit. CONCLUSIONS RACP can be performed with safety and oncologic outcomes equivalent to published open series. Although the rate of pancreatic fistula was high, only 22 % had clinically significant events, and none developed worsening pancreatic endocrine or exocrine dysfunction.


title: Sudden deafness and tuning fork tests: towards optimal utilisation.

text: The tuning fork tests have been under attack since their first use in clinical examination. However, the tuning fork is small and fits into every white coat, and tuning fork tests for hearing are easy, accurate and inexpensive. They should be used in patients with an acute unilateral hearing loss if an electric audiometer is not available. After more than 100 years, the tuning fork is not obsolete; tuning fork tests are a very useful if used correctly and for the appropriate indication.


title: Mapping the peer-reviewed literature on accommodating nurses' return to work after leaves of absence for mental health issues: a scoping review.

text: BACKGROUND The complexity of nursing practice increases the risk of nurses suffering from mental health issues, such as substance use disorders, anxiety, burnout, depression, and posttraumatic stress disorder (PTSD). These mental health issues can potentially lead to nurses taking leaves of absence and may require accommodations for their return to work. The purpose of this review was to map key themes in the peer-reviewed literature about accommodations for nurses' return to work following leaves of absence for mental health issues. METHODS A six-step methodological framework for scoping reviews was used to summarize the amount, types, sources, and distribution of the literature. The academic literature was searched through nine electronic databases. Electronic charts were used to extract code and collate the data. Findings were derived inductively and summarized thematically and numerically. RESULTS Academic literature is scarce regarding interventions for nurses' return to work following leaves of absence for mental health issues, and most focused on substance use concerns. Search of the peer-reviewed literature yielded only six records. The records were primarily quantitative studies (n = 4, 68%), published between 1997 and 2018, and originated in the United States (n = 6, 100%). The qualitative thematic findings addressed three major themes: alternative to discipline programs (ADPs), peer support, and return to work policies, procedures, and practices. CONCLUSIONS While the literature supports alternative to discipline programs as a primary accommodation supporting return to work of nurses, more on the effectiveness of such programs is required. Empirical evidence is necessary to develop, maintain, and refine much needed return to work accommodations for nurses after leaves of absence for mental health issues.


title: Quality of life in people with epidermolysis bullosa: a systematic review.

text: PURPOSE Individuals with epidermolysis bullosa (EB) present with various clinical manifestations of different severities that affect quality of life (QoL). This systematic review synthesizes the current evidence about the QoL of individuals with EB. METHODS We included observational studies with people of all age groups, both sexes, and any EB type. Studies with qualitative methodology, chapters of books, meeting proceedings, and abstracts were excluded. RESULTS In this study, 12 articles comprising 745 individuals were included. More than half of the articles observed lower QoL in individuals with recessive dystrophic EB (RDEB) or junctional EB (JEB). Three articles indicated that EB affected QoL more in women than in men, and one article identified that children with EB suffered more than adults with the disease. Pain was frequently reported. Seven articles identified difficulty in sports, two identified a need for bathing assistance, and three identified eating difficulties. Additionally, participants reported that family relationships and friendships were affected, and they experienced feelings of anxiety and depression. Some of the instruments used evaluated QoL in general dermatologic conditions, and one was specific to EB. CONCLUSION QoL is more affected in people who have RDEB and JEB. Regarding sex and age, women and children need special care in their monitoring. It is necessary that guidelines on pain management be more disseminated and put into practice. Future studies should use standardized specific instruments to assess the QoL in EB individuals, while considering the particularities of the different age groups.


title: Robot-assisted intracorporeal formation of the ileal neobladder.

text: We are celebrating the 10th anniversary of robot-assisted laparoscopic radical cystectomy (RARC) with urinary diversion (UD), and it seems that this operation is successfully following the footsteps of robot-assisted laparoscopic radical prostatectomy. Until now, approximately 1000 RARCs have been recorded; of them, only 102 were performed totally intracorporeally with a formation of an ileal neobladder. Despite the small numbers, morbidity and functional outcomes seem to be acceptable, when compared with the gold standard-the open procedure. It is imperative that in a challenging procedure such as this, the console surgeon follow a standardized protocol of all surgical steps to ensure the optimal results. In this article, we are sharing Karolinska's experience and discuss all perioperative issues along with ways of dealing with tricky cases.


title: A 24-month evaluation of a percutaneous osseointegrated limb-skin interface in an ovine amputation model.

text: Percutaneous osseointegrated (OI) prostheses directly connect an artificial limb to the residual appendicular skeleton via a permanently implanted endoprosthesis with a bridging connector that protrudes through the skin. The resulting stoma produces unique medical and biological challenges. Previously, a study using a large animal amputation model indicated that infection could be largely prevented, for at least a 12-month period, but the terminal epithelium continued to downgrow. The current study was undertaken to test the longer-term efficacy of this implant construct to maintain a stable skin-implant interface for 24 months. Using the previously successful amputation and implantation surgical procedure, a total of eight sheep were fitted with a percutaneous OI prosthesis. Two animals were removed from the study due to early complications. Of the remaining six sheep, one (16.7%) became infected at 15-months post-implantation and five remained infection-free for the intended 24 months. The histological data of the remaining animals further confirmed the grossly observable epithelial downgrowth. Albeit a receding interface, it was clear that all animals that survived to the end of the study had residual fibrous soft-tissue ingrowth into, and debris within, the exposed titanium porous-coated surface. Overall, the data demonstrated that the porous coated subdermal barrier offered initial protection against infection. However, the fibrous skin attachment was continuously lysed over time by the down-growing epithelium.


title: Doxapram Treatment and Diaphragmatic Activity in Preterm Infants.

text: BACKGROUND Doxapram is a treatment option for severe apnea of prematurity (AOP). However, the effect of doxapram on the diaphragm, the main respiratory muscle, is not known. OBJECTIVES To investigate the effect of doxapram on diaphragmatic activity measured with transcutaneous electromyography of the diaphragm (dEMG). METHODS A pilot study was conducted in a tertiary neonatal intensive care unit. Diaphragmatic activity was measured from 30 min before up to 3 h after the start of doxapram treatment. dEMG parameters were compared to baseline (5 min before doxapram treatment) and at 15, 60, 120 and 180 min after the start of doxapram infusion. RESULTS Eleven preterm infants were included with a mean gestational age of 25.5 ± 1.2 weeks and birth weight of 831 ± 129 g. The amplitudedEMG, peakdEMG and tonicdEMG values did not change in the 3 h after the start of doxapram infusion compared to baseline. Clinically, the number of apnea episodes in the 24 h after doxapram treatment decreased significantly. CONCLUSION Doxapram infusion does not alter diaphragmatic activity measured with transcutaneous dEMG in preterm infants with AOP, indicating that its working mechanism is primarily on respiratory drive and not on respiratory muscle activity.


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title: Binodal, wireless epidermal electronic systems with in-sensor analytics for neonatal intensive care.

text: Existing vital sign monitoring systems in the neonatal intensive care unit (NICU) require multiple wires connected to rigid sensors with strongly adherent interfaces to the skin. We introduce a pair of ultrathin, soft, skin-like electronic devices whose coordinated, wireless operation reproduces the functionality of these traditional technologies but bypasses their intrinsic limitations. The enabling advances in engineering science include designs that support wireless, battery-free operation; real-time, in-sensor data analytics; time-synchronized, continuous data streaming; soft mechanics and gentle adhesive interfaces to the skin; and compatibility with visual inspection and with medical imaging techniques used in the NICU. Preliminary studies on neonates admitted to operating NICUs demonstrate performance comparable to the most advanced clinical-standard monitoring systems.


title: Neutrophil extracellular traps in COVID-19.

text: In severe cases of coronavirus disease 2019 (COVID-19), viral pneumonia progresses to respiratory failure. Neutrophil extracellular traps (NETs) are extracellular webs of chromatin, microbicidal proteins, and oxidant enzymes that are released by neutrophils to contain infections. However, when not properly regulated, NETs have potential to propagate inflammation and microvascular thrombosis - including in the lungs of patients with acute respiratory distress syndrome. While elevated levels of blood neutrophils predict worse outcomes in COVID-19, the role of NETs has not been investigated. We now report that sera from patients with COVID-19 (n = 50 patients, n = 84 samples) have elevated levels of cell-free DNA, myeloperoxidase(MPO)-DNA, and citrullinated histone H3 (Cit-H3); the latter two are highly specific markers of NETs. Highlighting the potential clinical relevance of these findings, cell-free DNA strongly correlated with acute phase reactants including C-reactive protein, D-dimer, and lactate dehydrogenase, as well as absolute neutrophil count. MPO-DNA associated with both cell-free DNA and absolute neutrophil count, while Cit-H3 correlated with platelet levels. Importantly, both cell-free DNA and MPO-DNA were higher in hospitalized patients receiving mechanical ventilation as compared with hospitalized patients breathing room air. Finally, sera from individuals with COVID-19 triggered NET release from control neutrophils in vitro. In summary, these data reveal high levels of NETs in many patients with COVID-19, where they may contribute to cytokine release and respiratory failure. Future studies should investigate the predictive power of circulating NETs in longitudinal cohorts, and determine the extent to which NETs may be novel therapeutic targets in severe COVID-19.


title: Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy.

text: STUDY DESIGN Prospective cross-sectional study. OBJECTIVES To investigate the timing of deep vein thrombosis (DVT) onset secondary to spinal cord injury without anticoagulant therapies. SETTING Spinal Cord Injury Center in Hokkaido, Japan. METHODS Between November 2012 and June 2013, patients with spinal cord injury who were admitted to our hospital within 1 day after the injury and treated surgically within 24 h underwent a neurological examination, leg vein ultrasonography and D-dimer test 1, 3, 7, 14 and 28 days after surgery. All patients received treatment with intermittent pneumatic compression and elastic stockings, but without any anticoagulant. RESULTS DVT developed in 12 patients (11 men and 1 women), with a mean age of 62.2 years (range, 41-80 years; mean age of total sample, 63.2 years (range, 25-78 years)), all distal to the popliteal vein. DVT occurred more often with a more severe paralysis (66.3%, AIS A and B). The median (± standard error) length of time from the operation to DVT detection was 7.5±2.2 days. The mean D-dimer level upon DVT detection was 14.6±11.8 μg ml(-1), with no significant differences between those who developed DVT and those who did not at any of the time points. CONCLUSION These results suggest that DVT can develop at the very-acute stage of spinal cord injury and the incidence increases with a more severe paralysis. DVT detection was more reliable with ultrasonography, which should be used with DVT-preventive measures, beginning immediately after the injury, for the management of patients with spinal cord injury.


title: COVID-19 Pandemic Spurs Policy Changes Benefiting Older Adults.

text: This article reviews recent federal and state policy changes in response to the COVID-19 pandemic that affect health care and quality of life for older adults. Specific regulations and guidelines issued at the state and federal level have increased access and provided additional funding for essential services and supports. Many of these changes are temporary and have the potential to improve care beyond the immediate crisis. This period of greater flexibility offers the opportunity to accrue evidence on quality and access to influence sustained change. [Journal of Gerontological Nursing, 46(6), 19-23.].


Annals On Call - Clinical Reasoning and COVID-19 Part 2.


title: Neurocognitive functioning in adult WHO grade II gliomas: impact of old and new treatment modalities.

text: In the treatment of patients with low-grade glioma, there still is controversy on how surgical intervention, radiation therapy, and chemotherapy contribute to an ameliorated progression-free survival, overall survival, and treatment-related neurotoxicity. With the ongoing changes in treatment options for these patients, neurocognitive functioning is an increasingly important outcome measure, because neurocognitive impairments can have a large impact on self-care, social and professional functioning, and consequently, health-related quality of life. Many factors contribute to neurocognitive outcome, such as direct and indirect tumor effects, seizures, medication, and oncological treatment. Although the role of radiotherapy has been studied extensively, the adverse effects on neurocognitive function of other treatment-related factors remain elusive. This holds for both resective surgery, in which the use of intraoperative stimulation mapping has a high potential benefit concerning survival and patient functioning, and the use of chemotherapy that might have some interesting new applications, such as the facilitation of total resection for initially primary or recurrent diffuse low-grade glioma tumors. This article will discuss these treatment options in patients with low-grade glioma and their potential effects on neurocognitive functioning.


title: Abuse-deterrent formulations: part 2: commercial products and proprietary technologies.

text: INTRODUCTION Increased misuse and abuse of prescription pain medications has driven extensive research and development to produce what are best known as abuse-deterrent formulations (ADFs). The ADFs are intended to prevent, impede or discourage physical and chemical tampering while still being able to provide safe and accurate delivery of an abusable medication for therapeutic benefit. AREAS COVERED This review primarily focuses on patents and company literature regarding the formulations, manufacturing and physiochemical properties of abuse-deterrent compositions. Also included are journal articles with relevance to the development of these novel technologies. Particular attention is given to oral dosage forms with applications found in prescription drug products, over-the-counter medications and proprietary technologies in development. Overall, the formulations of 14 drug products, 2 meth-resistant cold products and 17 pharmaceutical proprietary technologies are explored in detail. EXPERT OPINION Despite the introduction of a wide range of formulation and technology interventions with different deterrence potential, the progression of these technologies seems to be moving from inhibiting only one type of abuse to stopping multiple types of tampering methods. Information on inherent strengths and weaknesses of various formulations can be utilized in the development of more robust and resistant ADF in the future.


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title: COVID-19 online surveys need to follow standards and guidelines: Comment on "Does COVID-19 pandemic affect sexual behaviour? A cross-sectional, cross-national online survey" and "Binge watching behavior during COVID 19 pandemic: A cross-sectional, cross-national online survey".


title: Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers.

text: BACKGROUND AND PURPOSE Successful recanalization after endovascular stroke therapy (EVT) did not translate into a good clinical outcome in randomized trials. The goal of the study was to identify the predictors of a good outcome after mechanical thrombectomy with stent retrievers. METHODS A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We evaluated the influence of risk factors for stroke, baseline NIHSS score, Alberta Stroke Program Early CT (ASPECT) score, recanalization rate, onset-to-recanalization and onset-to-groin puncture time, and glucose levels at admission on good outcomes. The number of stent passes during procedure and symptomatic hemorrhage rate were also recorded. A modified Rankin Scale (mRS) score of 0-2 at 90 days was considered as a good outcome. RESULTS From January 2011 to 2014, 70 consecutive patients with an acute ischemic stroke underwent EVT with stent retrievers. The absence of a medical history of diabetes was associated with good outcomes. Apart from diabetes, the baseline demographic and clinical characteristics of patients were similar between subjects with poor outcome versus those with good outcomes. Median time from onset to recanalization was significantly shorter in patients with good outcomes 245 (IQR: 216-313 min) compared with poor outcome patients (315 (IQR: 240-360 min); P = 0.023). Symptomatic intracranial hemorrhage was observed in eight (21.6%) of 37 patients with poor outcomes and no symptomatic hemorrhage was seen in patients with good outcomes (P = 0.006). In multivariate stepwise logistic regression analysis, a favorable ASPECT score (ASPECT > 7) and successful recanalization after EVT were predictors of good outcomes. Every 10-year increase was associated with a 3.60-fold decrease in the probability of a good outcome at 3 months. The probability of a good outcome decreases by 1.43-fold for each 20 mg/dL increase in the blood glucose at admission. CONCLUSION To achieve a good outcome after EVT with stent retrievers, quick and complete recanalization and better strategies for patient selection are warranted. We need randomized trials to identify the significance of tight blood glucose control in clinical outcome during or after EVT.


docid: hdbnbgik

title: Covid-19: Doctors feel shut out of plans for dealing with backlog of missed care.


Covid-19: healthcare and politics are inexorably intertwined.


title: Advanced Chronic Venous Insufficiency.

text: INTRODUCTION Intervention for advanced chronic venous insufficiency is considered an appropriate standard of care. However, outcomes vary among patients who present in advanced clinical stages of disease. The main objectives of this study were to determine whether racial disparity exists at initial presentation and response to intervention. METHODS A retrospective database was created to include all radiofrequency ablation procedures performed by a single surgeon from January 14, 2009, through May 25, 2011. Demographics, clinical traits, race, procedure, and outcomes were analyzed. Stepwise model selection reduced candidate baseline factors to a final parsimonious model, which was analyzed using analysis of variance. RESULTS The database consisted of 300 patients with a predominant female (n = 215, 85%) base and 85 (15%) males, with a mean age distribution of 53 years. The mean body mass index was 30.2. Racial distribution revealed Asian (n = 9, 3.3%), Pacific Islander (n = 1, 0.4%), African American (n = 37, 13.6%), and Caucasian (CAU, n = 225, 82.7%). African Americans presented with more advanced clinical stages than the CAU group-C2: African American 21.6%, CAU 36.7%; C4: African American 35%, CAU 24.3%; and C6: African American 35.1%, CAU 7.5%. African Americans demonstrated a higher preoperative venous clinical severity score (VCSS) than their CAU counterparts. Postprocedural decrease in VCSS score was lower in African Americans than their CAU counterparts. CONCLUSION African American patients present with more advanced venous insufficiency than CAUs. Postprocedural analysis reveals not only slower ulcer healing times but also higher ulcer recurrence rates.


title: Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure.

text: BACKGROUND Corneal endothelial transplantation has become the gold standard for the treatment of corneal endothelial dysfunctions, replacing full thickness transplantation, known as penetrating keratoplasty. Corneal endothelial transplantation has been described using two different techniques: Descemet's membrane endothelial keratoplasty (DMEK) and Descemet's stripping automated endothelial keratoplasty (DSAEK). Both are still performed worldwide. OBJECTIVES To compare the effectiveness and safety of Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for the treatment of corneal endothelial failure in people with Fuch's endothelial dystropy (FED) and pseudophakic bullous keratopathy (PBK). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 7); MEDLINE Ovid; Embase Ovid; LILACS BIREME; the ISRCTN registry; ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the search was 11 August 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised paired, contralateral-eye studies in any setting where DMEK was compared with DSAEK to treat people with corneal endothelial failure. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results, assessed trial quality and extracted data using the standard methodological procedures expected by Cochrane. Our primary outcome was best corrected visual acuity (BCVA) measured in logarithm of the Minimum Angle of Resolution (logMAR). Secondary outcomes were endothelial cell count, graft rejection, primary graft failure and graft dislocation. We graded the risk of bias of non-randomised studies (NRSs) using ROBINS-I. MAIN RESULTS We did not identify any RCTs but found four non-randomised studies (NRSs) including 72 participants (144 eyes), who had received DSAEK in the first eye followed by DMEK in the fellow eye. All the studies included adult participants where there was evidence of FED and endothelial failure requiring a corneal transplant for the treatment of visual impairment. We did not find any studies that included PBK. The trials were published between 2011 and 2015, and we assessed them as high risk of bias due to potential unknown confounding factors since DSAEK preceded DMEK in all participants. Two studies reported results at 12 months, one at 6 months, and one between 6 and 24 months. At one year, using DMEK in cases of endothelial failure may result in better BCVA compared with DSAEK (mean difference (MD) -0.14, 95% confidence interval (CI) -0.18 to -0.10 logMAR, 4 studies, 140 eyes, low-certainty evidence). None of the participants had severe visual loss (BCVA of 1.0 logMAR or more; very low-certainty evidence). Regarding endothelial cell count data (4 studies, 134 eyes) it is hard to draw any conclusions since two studies suggested no difference and the other two reported that DMEK provides a higher cell density at one year (very low-certainty evidence). No primary graft failure and only one graft rejection were recorded over four studies (144 eyes) (very low-certainty evidence). The most common complications reported were graft dislocations, which were recorded in one or two out of 100 participants with DSAEK but were more common using DMEK, although this difference could not be precisely estimated (risk ratio (RR) 5.40, 95% CI 1.51 to 19.3; 4 studies, 144 eyes, very low-certainty evidence). AUTHORS' CONCLUSIONS This review included studies conducted on people with corneal endothelium failure due to FED for whom both DMEK and DSAEK can be considered, and found low-certainty evidence that DMEK provides some advantage in terms of final BCVA, at the cost of more graft dislocations needing 're-bubbling' (very low-certainty of evidence).


title: Intraventricular hemorrhage after dural fistula embolization.

text: BACKGROUND AND OBJECTIVES Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. CASE REPORT A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. CONCLUSION Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.


title: Severe refractory thrombocytopenia in a woman positive for coronavirus disease 2019 with lupus and antiphospholipid syndrome.

text: The coronavirus disease 2019 (COVID-19) pandemic has created new challenges that necessitate prompt responses in unexpected clinical situations. Multiple extrapulmonary manifestations and complications of COVID-19 have already been described, but only scattered data are present on immunologic manifestations. We present a case of severe refractory thrombocytopenia in a 51-year-old woman with a history of long-standing systemic lupus erythematosus and antiphospholipid syndrome who presented with hemoptysis in the setting of COVID-19 infection. The patient failed to respond to initial treatment with intravenous immunoglobulin, high-dose steroids, and platelet transfusion, but responded to eltrombopag, with prompt improvement of a platelet count. The current case report provides clinical data of relevance to the largely unexplored question of the immunologic complications of COVID-19 in patients with a pre-existing inflammatory state.


title: Transanal minimally invasive surgery: a giant leap forward.

text: BACKGROUND Our novel approach is a hybrid between transanal endoscopic microsurgery (TEM) and single-port laparoscopy that we have termed TransAnal Minimally Invasive Surgery (TAMIS). We report the clinical application of this technique and present preliminary data that show TAMIS to be an effective tool for resection of both malignant and benign lesions of the rectum. METHODS Over a 3-month period (May-July 2009) all patients with rectal lesions who were candidates for conventional transanal excision were offered the option to undergo TAMIS resection. Patients with biopsy-proven malignant lesions were required to undergo endorectal ultrasound preoperatively to determine tumor stage. To perform TAMIS, a single-incision laparoscopic surgery port (SILS Port, Covidien) is introduced into the anal canal by applying steady manual pressure. Once seated in position, endoscopic access to the rectal vault is gained and pneumorectum is established. With this access, ordinary laparoscopic instruments, including graspers, thermal energy devices, and needle drives, are used to perform the transanal excisions. RESULTS Six patients, aged 43-85 years old (mean = 59.8), underwent TAMIS resection of rectal lesions. The average distance from the anal verge was 9.3 cm and the mean tumor diameter confirmed by pathology measured 2.93 cm. There were no conversions from TAMIS to conventional transanal excision. While the average operating time was 86 min, four of the six TAMIS resections (67%) were completed in less than 1 h. The mean set-up time was only 1.9 min and this may be one reason that the mean operative time was considerably less than the average operative time for TEM surgery (120-140 min). In short-term follow-up, there was no morbidity or mortality observed. CONCLUSIONS TAMIS is a feasible alternative to TEM, providing its benefits at a fraction of the cost.


title: Effectiveness of ultrasound-guided radiofrequency ablation in the treatment of 36 renal cell carcinoma tumours compared with published results of using computed tomography guidance.

text: This study aimed to analyse the outcomes of ultrasound (US) guided radiofrequency ablation (RFA) in patients with renal lesions and to compare our outcomes with published results of ablations carried out when using computed tomography (CT) guidance. This retrospective study evaluated RFA of 36 renal tumours in 32 patients (M = 21, F = 11). The mean patient age was 70 years (range, 39-89 years). Ablations were performed by using either multi-tined applicators or cooled and/or cluster applicators under US guidance. Applicator size varied from 2-5 cm, depending on the size of the index tumour. Conscious sedation was administered by an anesthetist. Follow-up imaging by using contrast-enhanced CT was performed 1, 3, 6, and 12 months after RFA, and yearly thereafter. The mean tumour follow-up time was 12 months (range, 1-35 months). The mean tumour size was 2.7 cm (range, 1-5 cm). Primary effectiveness was achieved in 31 cases (86.1%), with patients in 5 cases (11.1%) demonstrating residual disease. Three patients had repeated sessions, which were technically successful. The remaining 2 patients were not re-treated because of patient comorbidities. As a result, secondary effectiveness was achieved in 34 patients (94.4%). In 1 patient, a new lesion developed in the same kidney but remote from the 2 prior areas of treatment. Hydrodissection was performed in 3 patients (8.3%), manipulation or electrode repositioning in 11 patients (30.6%), and ureteric cooling in 1 patient (2.8%). Minor and major complications occurred in 3 (8.3%) and 3 (8.3%) patients, respectively. Correlation coefficients were calculated for distance from skin to tumour and risk of complication as well as compared with primary and secondary effectiveness. This study demonstrates that US-guided RFA is an effective treatment for renal lesions, with rates of effectiveness and complication rates comparable with published CT-guided RFA results.


title: Quality of life and menstruation in adolescents.

text: PURPOSE OF REVIEW Menstrual problems are known to be common amongst teenagers, but adequate recognition of the impact this may have on the adolescent and appropriate interventions that are focussed on the needs of the adolescents are limited. RECENT FINDINGS To date, the impact of menstrually related problems on the quality of life of adolescents has been poorly studied. Although some studies report on the impact of, in particular, dysmenorrhoea on school absenteeism, less is known about the impact on psychosocial functioning. For other menstrual problems, even less is known. It is increasingly recognized that understanding the impact on quality of life is an important measure to better understand the impact of the health problem and also to ensure the optimal delivery of patient-centred healthcare. This review will explore the current tools available for assessment of quality of life in adolescents and then focus on the specific menstrual problems (dysmenorrhoea, heavy menses, oligo/amenorrhoea) and what is known about their impact on the general well being of young women. SUMMARY Cultural differences in the presentation and impact of menstrual problems appear to be present with a greater impact on psychosocial functioning found with particularly oligo/amenorrhoea. There is clearly room for further study to explore and then optimize care.


title: A pilot study of laparoscopic gastric pull-up by using the natural orifice translumenal endoscopic surgery technique: a novel procedure for treating long-gap esophageal atresia (type a).

text: AIM This study aimed to develop a novel procedure for treating long-gap pure esophageal atresia. This procedure, which entails the combined use of laparoscopy and natural orifice translumenal endoscopic surgery (NOTES), would enable primary repair without cervical and thoracic incisions and prevent postoperative gastroesophageal reflux disease (GERD). METHODS Nonsurvival experiments were conducted in 9 pigs to study the technical feasibility. The procedure comprised the following: (1) creation of the disease model by laparoscopic resection of the lower esophagus; (2) laparoscopic fundoplication, complete mobilization of the stomach, and enlargement of the esophageal hiatus; (3) formation of a peroral transesophageal entry site into either the postmediastinum or the right thoracic cavity followed by fashioning a tunnel to the peritoneal cavity; (4) gastric pull-up by using both laparoscopy and NOTES; (5) esophagoesophageal anastomosis using BraceBar™, a prototype of the double T-bar suturing device (Olympus Medical Systems Co., Tokyo, Japan). RESULTS Laparoscopic procedures were performed without complications. The postmediastinal tunnel was successfully created three times with a complication of pleural injury. However, gastric pull-up via this route could not be completed due to porcine anatomical reasons. Gastric pull-up through the right thoracic route was achieved five times in six attempts. Two disorientations and a hemorrhagic death occurred during the procedures. CONCLUSIONS This study showed that combined use of laparoscopy and NOTES enabled gastric pull-up without cervical and thoracic incisions. Our method has the potential of lowering the incidence of GERD and enabling primary repair of this disease.


How the coronavirus pandemic slashed carbon emissions - in five graphs.


Possible method for the production of a Covid-19 vaccine.


title: Communicable disease outbreaks: What is a case?

text: This second article in a series on communicable disease outbreaks focuses on case definitions, testing and early phases of a public health response.


title: Utilizing Google Trends to Assess Worldwide Interest in Irritable Bowel Syndrome and Commonly Associated Treatments.

text: BACKGROUND Examining the prevalence of irritable bowel syndrome (IBS) across regions has been challenging given significant methodological heterogeneity. AIMS We aimed to perform a uniform assessment of the global burden of IBS using data from Google Trends, a novel, online tool. METHODS Google Trends measures popularity of a search term in a given week compared to popularity of all search terms in that week, calculated as relative search volume (RSV). We compiled data on the popularity of IBS and its treatments across 173 countries between 2014 and 2018. We compared Google Trends popularity for IBS with prior epidemiological prevalence data, while controlling for gross domestic product (GDP) per capita and physician density. RESULTS Of the 173 countries with Google Trends data, 137 countries also had data for GDP per capita and physician density. Worldwide popularity of IBS as a search topic increased from 79 to 89 (13% increase by RSV) over the 5-year period between 2014 and 2018. Country-specific change in IBS RSV ranged from - 35% (Nigeria) to + 64% (Pakistan). There was poor correlation between the Google Trends data and prior epidemiological data (0.08, Pearson correlation, p = 0.64). Popularity of the low-FODMAP diet increased the most among 8 common therapies (RSV 41 to 89, 117% increase). CONCLUSIONS Google Trends is a novel tool that can complement traditional epidemiological methods in gastrointestinal disease. Future research is needed to assess its utility and accuracy as a measure of disease burden across different gastrointestinal diseases.


title: Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement.

text: INTRODUCTION Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement. OPERATIVE APPROACH There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution. DISCUSSION This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach.


docid: zqsfakaa

title: Funders Support Mental Health Care: COVID-19 And Before.


title: Interstitial pneumonitis and myelosuppression associated to mitomycin C urinary tract instillations: A case report.

text: Mitomycin C as a treatment for superficial bladder carcinomas and upper urinary tract tumours has been linked to local adverse events. Systemic toxicity has been documented for just a very few cases. This report presents a case of interstitial pneumonitis accompanied by myelosuppression in a 74-year-old patient after receiving the fifth administration of mitomycin C through a ureteral catheter as a treatment for left kidney pyelocaliceal urothelial carcinoma. Therefore, suspecting mitomycin C toxicity, urinary tract instillations were discontinued, and intravenous filgrastim and methylprednisolone were initiated. Currently, after five months since the last mitomycin C urinary tract instillation, the patient is still receiving filgrastim and corticosteroids. A moderate effort dyspnoea persists despite interstitial pulmonary infiltrates have presented a very important reduction. Pancytopenia has also persisted. Blood count and lung function monitoring would be appropriate in patients undergoing mitomycin C instillations, especially in those with established prior lung disease.


title: Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019.

text: Importance Recipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression. Objective To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19. Design, Setting, and Participants This case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included. Interventions Heart transplant and a confirmed diagnosis of COVID-19. Main Outcomes and Measures The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19. Results Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization. Conclusions and Relevance In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.


Overview & Summary: Emerging Global Health Concerns: How Nurses Respond


title: Abdominal scar characteristics as a predictor of cervical stenosis after abdominal radical trachelectomy.

text: To investigate whether abdominal scar characteristics could predict the occurrence of cervical stenosis after abdominal radical trachelectomy (ART), we conducted a retrospective study and investigated the relationship between abdominal scar characteristics and the occurrence of cervical stenosis in patients one year after undergoing ART. The abdominal scars were evaluated using the Vancouver Scar Scale (VSS). Seventy-two participants were enrolled in the study, including 15 (20.8%) women with cervical stenosis, and 57 (79.2%) without stenosis. Results showed that the mean abdominal scar score assessed by VSS was higher in patients with cervical stenosis (7, range: 1-10) compared to those without stenosis (4, range: 0-9) (P = 0.001). Incidence rates of cervical stenosis increased with the VSS score. For women with VSS scores of 0 to 4, 5, 6, 7, 8, 9 and 10, respectively, the occurrences of cervical stenosis were 6.1%, 16.7%, 16.7%, 27.3%, 37.5%, 50% and 100%. The cutoff point of VSS score was 7 according to the receiver operating characteristic (ROC) curve. Fourteen of the 15 stenosis happened either in patients without anti-stenosis tools (Foley catheters or tailed intrauterine devices) placed during the surgery or after the devices were removed. Our results demonstrated that VSS is an effective approach to assess the presence of cervical stenosis after ART. Women who have an abdominal scar with a VSS score > 7 have a high risk of developing isthmic stenosis without anti-stenosis tools in place.


docid: yzyaanor

title: Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review.

text: INTRODUCTION Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery. METHODS We conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal. RESULTS Our search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes. CONCLUSIONS Despite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.


title: The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer.

text: OBJECTIVE The aim of this study was to show the safety and feasibility of single-port laparoscopic surgery (SPLS) by comparing its short-term outcomes with those following conventional laparoscopic surgery. SUMMARY BACKGROUND DATA Single-port laparoscopic surgery maximizes the advantages of laparoscopic surgery, and therefore it can be an ultimate attainment of laparoscopic surgery. However, no comparative study has addressed its role in colorectal cancer. METHODS Prospectively collected data of patients who had undergone either conventional laparoscopic surgery (n = 106) or SPLS (n = 73) for colorectal cancer between March 2006 and May 2010 were analyzed retrospectively. The short-term outcomes of these 2 operative modalities were compared. RESULTS Of the 179 study subjects, 103 (57.5%) had colon cancer and 76 (42.5%) had rectal cancer. Various operative methods, from right hemicolectomy to abdominoperineal resection, were used according to location through either conventional laparoscopic or SPLS approach. In its comparison, mean surgical time was greater in the SPLS group (255 vs 276 minutes, P < 0.008). Acquired length of sufficient surgical margins and the number of harvested lymph nodes were comparable. Postoperative recovery was faster in the SPLS group, in terms of shorter time duration before first flatus (SPLS vs conventional laparoscopic surgery; 2.5 ± 1.2 vs 3.2 ± 1.8 days, P = 0.004), earlier initiation of free oral fluids (1.8 ± 2.2 vs 2.6 ± 1.7 days, P = 0.000) and of a solid diet (4.2 ± 2.9 vs 6.5 ± 2.7 days, P = 0.000), less frequent usage of parenteral narcotics (2.2 ± 3.2 vs 3.5 ± 4.0 times, P = 0.029), and shorter hospital stay (9.6 ± 9.6 vs 15.5 ± 9.8 days, P = 0.000). CONCLUSION This study shows that SPLS is both safe and feasible in colorectal cancer, and that it has equivalent or better short-term outcomes than conventional laparoscopic surgery. Accordingly, the authors conclude that SPLS can be an alternative to conventional laparoscopic surgery for colorectal cancer.


title: Use of TaqMan Array card for the detection of respiratory viral pathogens in children under 5 years old hospitalised with acute medical illness in Ballabgarh, Haryana, India.

text: Historical specimens collected from hospitalized children were tested for the following 13 viruses: influenza A and B; respiratory syncytial virus (RSV); parainfluenza viruses 1-3; human metapneumovirus; rhinovirus; coronaviruses 229E, OC43, NL63 and HKU1 and Adenovirus using monoplex real-time reverse transcriptase polymerase chain reaction (rRT-PCR). They were retested using TaqMan Array Card (TAC), a micro-fluidic system, capable of simultaneous multi-pathogen testing, to evaluate its sensitivity and specificity against monoplex rRT-PCR. TAC showed high sensitivity (71%-100%) and specificity (98%-100%) for these viruses in comparison to monoplex rRT-PCR. Multi-specimen detection with high sensitivity and specificity makes TAC a potentially useful tool for both surveillance and outbreak investigations.


title: Spontaneous thrombosis of the main draining vein revealing an unruptured brain arteriovenous malformation.

text: Haemorrhage is the most frequent revealing condition of brain arteriovenous malformations (bAVMs). We report a rare case of unruptured parietal bAVM revealed by spontaneous thrombosis of the main draining vein, responsible for a focal neurological deficit. The bAVM was embolized in emergency conditions; complete regression of the neurological symptoms was observed within five days after the embolization. Potential mechanisms of such spontaneous thrombosis of the bAVM's main drainage pathway as well as an exhaustive review of the literature concerning this rare revealing condition are presented and discussed.


title: Antiviral activity of geneticin against dengue virus.

text: The aminoglycoside, geneticin (G418), was recently shown to have antiviral activity against bovine viral diarrhea virus (BVDV). Since BVDV, dengue virus (DENV) and yellow fever virus (YFV) all belong to the Flaviviridae family, it seemed possible that a common step in their life cycle might be affected by this aminoglycoside. Here it is shown that geneticin prevented the cytopathic effect (CPE) resulting from DENV-2 infection of BHK cells, in a dose-dependent manner with an 50% effective concentration (EC(50)) value of 3+/-0.4microg/ml. Geneticin had no detectable effect on CPE caused by YFV in BHK cells. Geneticin also inhibited DENV-2 viral yield with an EC(50) value of 2+/-0.1microg/ml and an EC(90) value of 20+/-2microg/ml. With a CC(50) value of 165+/-5microg/ml, the selectivity index of anti-DENV activity of geneticin in BHK cells was established to be 66. Furthermore, 25microg/ml of geneticin nearly completely blocked plaque formation induced by DENV-2, but not YFV. In addition, geneticin, inhibited DENV-2 viral RNA replication and viral translation. Gentamicin, kanamycin, and the guanidinylated geneticin showed no anti-DENV activity. Neomycin and paromomycin demonstrated weak antiviral activity at high concentrations. Finally, aminoglycoside-3'-phosphotransferase activity of neomycin-resistant gene abolished antiviral activity of geneticin.


title: Histologic and biomechanical evaluation of crosslinked and non-crosslinked biologic meshes in a porcine model of ventral incisional hernia repair.

text: BACKGROUND The objective of this study was to evaluate the biomechanical characteristics and histologic remodeling of crosslinked (Peri-Guard, Permacol) and non-crosslinked (AlloDerm, Veritas) biologic meshes over a 12 month period using a porcine model of incisional hernia repair. STUDY DESIGN Bilateral incisional hernias were created in 48 Yucatan minipigs and repaired after 21 days using an underlay technique. Samples were harvested at 1, 6, and 12 months and analyzed for biomechanical and histologic properties. The same biomechanical tests were conducted with de novo (time 0) meshes as well as samples of native abdominal wall. Statistical significance (p < 0.05) was determined using 1-way analysis of variance with a Fisher's least significant difference post-test. RESULTS All repair sites demonstrated similar tensile strengths at 1, 6, and 12 months and no significant differences were observed between mesh materials (p > 0.05 in all cases). The strength of the native porcine abdominal wall was not augmented by the presence of the mesh at any of the time points, regardless of de novo tensile strength of the mesh. Histologically, non-crosslinked materials showed earlier cell infiltration (p < 0.01), extracellular matrix deposition (p < 0.02), scaffold degradation (p < 0.05), and neovascularization (p < 0.02) compared with crosslinked materials. However, by 12 months, crosslinked materials showed similar results compared with the non-crosslinked materials for many of the features evaluated. CONCLUSIONS The tensile strengths of sites repaired with biologic mesh were not impacted by very high de novo tensile strength/stiffness or mesh-specific variables such as crosslinking. Although crosslinking distinguishes biologic meshes in the short-term for histologic features, such as cellular infiltration and neovascularization, many differences diminish during longer periods of time. Characteristics other than crosslinking, such as tissue type and processing conditions, are likely responsible for these differences.


title: Predictor-Response Analysis of Fiber Optic Enzymatic Biosensors Constructed with Nonmodified E. coli BL21 (DE3) pGELAF+ Sensing 1,2-Dichloroethane.

text: Biosensor technology can lack methods to iteratively validate system outputs (i.e., signals) concomitantly with the development of mathematical models. We evaluated a nonmodified fiber optic enzymatic biosensor (FOEB-Escherichia coli BL21 (DE3) pGELAF+) sensing dichloroethane with a predictor-response statistical form. The linear regression technique applied with MATLAB functions correlated FOEB parameters to sensing responses that could be used to identify system characteristics and interactions. A FOEB specific metric (i.e. normalized sensitivity) is shown to be significant as a mixed sensing correlation metric suggesting that similar development parameters could be related to engineering design paradigms for biosensor (or whole cell biosensor) systems.


title: Peroxide-based oxygen generating topical wound dressing for enhancing healing of dermal wounds.

text: Oxygen generating biomaterials represent a new trend in regenerative medicine that aims to generate and supply oxygen at the site of requirement, to support tissue healing and regeneration. To enhance the healing of dermal wounds, we have developed a highly portable, in situ oxygen generating wound dressings that uses sodium percarbonate (SPO) and calcium peroxide (CPO) as chemical oxygen sources. The dressing continuously generated oxygen for more than 3 days, after which it was replaced. In the in vivo testing on porcine full-thickness porcine wound model, the SPO/CPO dressing showed enhanced wound healing during the 8 week study period. Quantitative measurements of wound healing related parameters, such as wound closure, reepithelialization, epidermal thickness and collagen content of dermis showed that supplying oxygen topically using the SPO/CPO dressing significantly accelerated the wound healing. An increase in neovascularization, as determined using Von Willebrand factor (vWF) and CD31 staining, was also observed in the presence of SPO/CPO dressing. This novel design for a wound dressing that contains oxygen generating biomaterials (SPO/CPO) for supplying topical oxygen, may find utility in treating various types of acute to chronic wounds.


China AIDS policy implementation: reversing the HIV/AIDS epidemic by 2015.


title: Laboratory diagnostics within a modular hospital at the time of Coronavirus disease 2019 (COVID-19) in Wuhan.

text: An outbreak of the so-called Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), has been spreading rapidly nationwide in China since December 2019. Wuhan, Hubei Province, is the hardest-hit region, with a rise in confirmed cases and its hospitals overwhelmed. On 2nd February, 2020, Wuhan began to build a modular hospital to treat patients caught with mild illness. The mobile modular hospital is mainly composed of medical modules, technical support modules, ward units, living support units and transportation capacity under field conditions, and there are complete equipment and specialized personnel to treat patients. Due to the severity and particularity of SARS-CoV-2, taking granted from lessons learnt from mobile modular hospitals, we use the existing large venues to construct a new fixed modular hospital. As patients need to be treated and tested, it is important to develop a clinical laboratory in the modular hospital and ensure biosafety. The construction of a clinical laboratory in the modular hospital is faced with problems such as time pressure, limited site selection, high level of biosafety, lack of experience and so forth. This paper mainly discusses how to construct the clinical laboratory in the modular hospital quickly and safely and put it into use to provide testing service for patients under various limited conditions.


title: A Systematic Review of Recent Methodological Approaches for Using Ecological Momentary Assessment to Examine Outcomes in U.S. Based HIV Research.

text: PURPOSE OF REVIEW In recent years, researchers have been adopting and using ecological momentary assessment (EMA) methods via technology devices for real-time measurement of exposures and outcomes in HIV research. To assess and critically evaluate how EMA methods are currently being used in HIV research, we systematically reviewed recent published literature (October 2017-October 2019) and searched select conference databases for 2018 and 2019. RECENT FINDINGS Our searches identified 8 published articles that used EMA via smartphone app, a handheld Personal Digital Assistant, and web-based survey programs for real-time measurement of HIV-related exposures and outcomes in behavioral research. Overall trends include use of EMA and technology devices to address substance use, HIV primary prevention (e.g., condom use and preexposure prophylaxis), and HIV treatment (medication adherence). This review supports the use of EMA methods in HIV research and recommends that researchers use EMA methods to measure psychosocial factors and social contexts and with Black and Latinx samples of gay and bisexual men, transgender women, and cisgendered women to reflect current HIV disparities in the U.S.A.


title: Potent Inhibition of HIV-1 Replication in Resting CD4 T Cells by Resveratrol and Pterostilbene.

text: HIV-1 infection of resting CD4 T cells plays a crucial and numerically dominant role during virus transmission at mucosal sites and during subsequent acute replication and T cell depletion. Resveratrol and pterostilbene are plant stilbenoids associated with several health-promoting benefits. Resveratrol has been shown to inhibit the replication of several viruses, including herpes simplex viruses 1 and 2, papillomaviruses, severe acute respiratory syndrome virus, and influenza virus. Alone, resveratrol does not inhibit HIV-1 infection of activated T cells, but it does synergize with nucleoside reverse transcriptase inhibitors in these cells to inhibit reverse transcription. Here, we demonstrate that resveratrol and pterostilbene completely block HIV-1 infection at a low micromolar dose in resting CD4 T cells, primarily at the reverse transcription step. The anti-HIV effect was fully reversed by exogenous deoxynucleosides and Vpx, an HIV-1 and simian immunodeficiency virus protein that increases deoxynucleoside triphosphate (dNTP) levels. These findings are consistent with the reported ability of resveratrol to inhibit ribonucleotide reductase and to lower dNTP levels in cells. This study supports the potential use of resveratrol, pterostilbene, or related compounds as adjuvants in anti-HIV preexposure prophylaxis (PrEP) formulations.


title: New Surgical Technologies Could Facilitate Surgical Hemostasis in Hemophilic Patients.

text: BACKGROUND It's assumed that surgery in haemophilia can be accomplished these days safely. AIM The aim of this study was to investigate the influence of new surgical technologies in the perioperative management and outcome of surgical procedures in haemophiliacs. METHODS Two patients with mild haemophilia A underwent surgery (laparoscopic appendectomy and inguinal hernia repair). In both patients, the replacement therapy, with factor VIII, started 30 min before surgery. We used the available surgical technologies and techniques with a proven value in the best clinical practice, to achieve proper and permanent hemostasis. Postoperatively, the replacement therapy and thromboembolic prophylaxis was continued according to the international guidelines for the management of haemophilia. RESULTS The operative and post-operative periods were uneventful. No significant differences were found in the operation time in our hemophilic patients versus non-hemophilic patients. Significant differences related to the hospital stay duration were found in both patients compared with controls, due to the necessary replacement therapy. CONCLUSION With new surgical technologies, proper and permanent hemostasis can be achieved, without prolonging the operation time.


title: Genetic heterogeneity and recombination in canine noroviruses.

text: Alphatronlike (genogroup IV [GIV]) noroviruses (NoVs) have been recently identified in carnivores. By screening a collection of 183 fecal samples collected during 2007 from dogs with enteric signs, the overall NoV prevalence was found to be 2.2% (4/183). A unique strain, Bari/91/07/ITA, resembled GIV.2 NoVs in its ORF1 (polymerase complex), while it was genetically unrelated in its full-length ORF2 (capsid gene) to GIV animal and human NoVs (54.0 to 54.4% amino acid identity) and to any other NoV genogroup (<54.7% amino acid identity). It displayed the highest identity (58.1% amino acid identity) to unclassified human strain Chiba/040502/04/Jp. Interestingly, the very 5' end of ORF2 of the canine virus matched short noroviral sequences (88.9% nucleotide identity and 98.9% amino acid identity) identified from oysters in Japan, indicating that similar viruses may be common environmental contaminants.


title: Optical coherence tomography angiography indicates associations of the retinal vascular network and disease activity in multiple sclerosis.

text: BACKGROUND Patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) may show alterations of retinal layer architecture as measured by optical coherence tomography. Little is known about changes in the retinal vascular network during MS. OBJECTIVE To characterize retinal vessel structures in patients with MS and CIS and to test for associations with MS disease activity. METHOD In all, 42 patients with MS or CIS and 50 healthy controls underwent retinal optical coherence tomography angiography (OCT-A) with analysis of the superficial and deep vascular plexuses and the choriocapillaries. We tested OCT-A parameters for associations with retinal layer volumes, history of optic neuritis (ON), and the retrospective disease activity. RESULTS Inner retinal layer volumes correlated positively with the density of both the superficial and deep vascular plexuses. Eyes of MS/CIS patients with a history of ON revealed reduced vessel densities of the superficial and deep vascular plexuses as compared to healthy controls. Higher choriocapillary vessel densities were associated with ongoing inflammatory disease activity during 24 months prior to OCT-A examination in MS and CIS patients. CONCLUSION Optic neuritis is associated with rarefaction of the superficial and deep retinal vessels. Alterations of the choriocapillaries might be linked to disease activity in MS.


Re-embedding catheter technique at the discontinuation of peritoneal dialysis.


docid: pqmomaed

title: Sub-angiographic peripheral emboli in high resolution DWI after endovascular recanalization.

text: BACKGROUND AND AIM To analyze the incidence of peripheral emboli after successful mechanical thrombectomy (MT) of intracranial large vessel occlusions (LVO). METHODS We performed a prospective analysis of patients with intracranial LVO who underwent successful MT and received a 1.5 T MRI including diffusion-weighted imaging (DWI) in standard- and high-resolution as well as susceptibility-weighted imaging (SWI) on the day following the intervention. Reperfusion grade was assessed on post-thrombectomy digital subtraction angiography (DSA) using the expanded thrombolysis in cerebral infarction (eTICI) scale. Punctuate DWI lesions distal to the DWI core lesion were classified as peripheral emboli. DWI lesions outside the primary affected vascular territory were classified as emboli into new territories. Additionally, SWI and post-thrombectomy DSA were analyzed and correlated to findings on DWI. RESULTS Twenty-eight patients undergoing successful MT met the inclusion criteria. In 26/28 patients (93%), a total of 324 embolic lesions were detected in DWI representing 2.1% of the cumulated ischemic core volume. 151 peripheral emboli were detected in standard-resolution DWI, 173 additional emboli were uncovered in high-resolution DWI. Eight out of nine patients with an eTICI 3 reperfusion had embolic lesions (29 DWI lesions). 9.6% (31/324) of peripheral emboli were observed in vascular territories not affected by the LVO. SWI lesions were observed in close proximity to 10.2% (33/324) of DWI lesions. CONCLUSIONS Peripheral emboli are frequent after MT even after complete reperfusion. These emboli occur rather in the vascular territory of the occluded vessel than in other territories. A large proportion of peripheral emboli is only detected by high-resolution DWI.


title: Effects of different immunization protocols and adjuvant on antibody responses to inactivated SARS-CoV vaccine.

text: Severe acute respiratory syndrome (SARS) is a deadly and highly infectious disease caused by SARS Coronavirus (SARS-CoV). Inactivated SARS-CoV has been explored as a vaccine against SARS-CoV; however, current knowledge of inactivated SARS-CoV vaccine is quite limited. We attempted to investigate the effects of different immunization protocols and adjuvant on the antibody responses to inactivated SARS-CoV vaccine. With an intraperitoneal (IP) immunization protocol, inactivated SARS-CoV alone induced significant amounts of SARS-CoV-specific IgG antibodies in sera and a small quantity of SARS-CoV-specific IgA antibodies in the genital tract and feces, but failed to induce any detectable SARS-CoV-specific IgA antibodies in sera, saliva, lung, and intestine, and the addition of CpG ODN 2006 had only a marginal effect on antibody production. In contrast, with an intranasal (IN) immunization protocol, inactivated SARS-CoV alone failed to induce any detectable SARS-CoV-specific IgA antibodies in sera, saliva, lung, and intestine, except for a small quantity of IgA antibodies in fecal extracts and the genital tract, along with IgG antibodies in sera, but when given with adjuvant CpG ODN 2006, inactivated SARS-CoV induced significant amounts of SARS-CoV-specific IgG antibodies in sera, and a detectable amount of SARS-CoV-specific IgA antibodies in sera and all tested mucosal secretions and tissues (i.e., saliva, the genital tract, fecal extract, lung, and intestine). On a neutralization assay, neutralizing activity with the IP immunization protocol was detected in sera and mucosal secretions (from the saliva and genital tract), but sera from the IN protocol failed to show any neutralizing activity. Our study demonstrated that inactivated SARS-CoV vaccine is promising, and our data provide a sound foundation for the development of an effective inactivated SARS-CoV vaccine.


title: DESC1 and MSPL activate influenza A viruses and emerging coronaviruses for host cell entry.

text: The type II transmembrane serine protease (TTSP) TMPRSS2 cleaves and activates the influenza virus and coronavirus surface proteins. Expression of TMPRSS2 is essential for the spread and pathogenesis of H1N1 influenza viruses in mice. In contrast, H3N2 viruses are less dependent on TMPRSS2 for viral amplification, suggesting that these viruses might employ other TTSPs for their activation. Here, we analyzed TTSPs, reported to be expressed in the respiratory system, for the ability to activate influenza viruses and coronaviruses. We found that MSPL and, to a lesser degree, DESC1 are expressed in human lung tissue and cleave and activate the spike proteins of the Middle East respiratory syndrome and severe acute respiratory syndrome coronaviruses for cell-cell and virus-cell fusion. In addition, we show that these proteases support the spread of all influenza virus subtypes previously pandemic in humans. In sum, we identified two host cell proteases that could promote the amplification of influenza viruses and emerging coronaviruses in humans and might constitute targets for antiviral intervention. Importance: Activation of influenza viruses by host cell proteases is essential for viral infectivity and the enzymes responsible are potential targets for antiviral intervention. The present study demonstrates that two cellular serine proteases, DESC1 and MSPL, activate influenza viruses and emerging coronaviruses in cell culture and, because of their expression in human lung tissue, might promote viral spread in the infected host. Antiviral strategies aiming to prevent viral activation might thus need to encompass inhibitors targeting MSPL and DESC1.


title: Perioperative neurocognitive functions in patients with neuroepithelial intracranial tumors.

text: PURPOSE This study aimed to assess perioperative neurocognitive functions in patients with surgery for intracranial neuroepithelial tumors. METHODS Seventy-one patients [38 male, 33 female, mean age 47.2 years (range 18 to 81)] with surgery for an intracranial neuroepithelial tumor were included in this prospective single-center study. Mini-mental status examination (MMSE) and extensive neurocognitive testing (divided into the categories attention, memory, and executive functions and adjusted for age, sex, and education) were performed pre-(t0) and early postoperatively (t1). Part of the patient cohort (n = 32) also underwent neurocognitive testing during follow-up (t2). The Karnofsky Performance Status Scale (KPS) was used to assess patients' functional independence. Patients' quality of life was recorded by the Short Form 36 (SF 36) pre- and postoperatively in a part of the patient cohort. Pre- and postoperative comparisons were performed using the Wilcoxon-test for paired samples. Post hoc Bonferroni correction was performed to adjust for multiple testing. To assess the influence of risk factors on neurocognitive functions, Spearman correlations and the chi-squared test were performed. Subgroup analyses for patients with low-grade and high-grade tumors were performed. RESULTS Postoperative deterioration was observed in 5 of 39 subtests of extensive neurocognitive testing in all 3 categories, whereas no improvement was shown. Patients with WHO Grade I tumors showed no deterioration of cognitive functions. Patients with WHO Grade II and III tumors showed significantly worse results in the executive functions category patients with WHO Grade IV tumors showed deterioration in the attention category. Significantly worse functional independence was recorded postoperatively and during follow-up (P < 0.001). Patients reported poorer physical health (SF 36, P = 0.001) at t1, whereas mental health did not differ significantly (P = 0.480). Risk factors for postoperative deterioration of cognition are low KPS scores, postoperative radiotherapy and tumor location in the temporal lobe. CONCLUSIONS After surgery on an intracranial neuroepithelial tumor, early postoperative deterioration of neurocognitive functions, functional independence and physical health occur. Similar results were also shown during follow-up suggesting that these effects are not only due to postoperative systemic factors or fatigue. This knowledge might improve perioperative surveillance of neurocognitive functions.


title: Exploring the potential of civic engagement to strengthen mental health systems in Indonesia (IGNITE): a study protocol.

text: Background Indonesia has the highest rate of years of life lost to disability or early death from Schizophrenia than any other country in the world. More than 90% of people with mental illness do not get any treatment and tens of thousands of people with psychosis are illegally detained ('pasung') in the family home. Civic engagement, a core part of the recent World Health Organisation global strategy, has the potential to address some of these challenges through the development of person-centered models of care. The aim of the study is to develop a testable systems level, culturally appropriate, civic engagement framework for use in Jakarta and Bogor, Indonesia to strengthen local mental health services. Methods A mixed methods study underpinned by a realist approach will be undertaken across four phases in two study sites in Indonesia (Jakarta and Bogor). Phase 1 will explore the use of civic engagement across South East Asia by conducting a systematic review of existing evidence. By surveying 300 mental health professionals, phase 2 will identify the stakeholders, the sources of collaboration and the evidence used by professionals in decision making within local mental health systems and identify potential opportunities for civic engagement within the system. In order to explore the potential use of civic engagement within Indonesian mental health services and identify priorities for a culturally appropriate framework, phase 3 will undertake two focus groups with participants with experience of psychosis or caring for someone with psychosis (n = 20-30). Professionals and other key decision makers in a range of roles across the system at a national (n = 5) and local level (n = 10-15/site) will also take part in semi-structured interviews. Phase 4 will co-produce a civic engagement framework for use in Indonesia by synthesising evidence from phases 1-3 collaboratively with key stakeholders. Discussion Civic engagement is a potential way in which health services in low and middle income countries can address the burden of mental health conditions through the development of person-centred models of care. However, such approaches are underexplored in Indonesia. This study will work with local stakeholders to design a testable civic engagement framework for use in mental health services in Indonesia.