title: Revised sleeve gastrectomy (re-sleeve).

text: BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions. OBJECTIVES To evaluate the safety and the efficiency of revisional sleeve gastrectomy (ReSG). SETTING Private hospital. METHODS From October 2008 to October 2014, 61 patients underwent ReSG. All patients with failure after primary LSG underwent radiologic evaluation, and an algorithm of treatment was proposed. RESULTS Sixty-one patients (54 women, 7 men; mean age 40.8 yr) with a body mass index (BMI) of 39.4 kg/m² underwent ReSG. The primary LSG was performed for mean BMI of 46.2 kg/m² (range 35.4-77.9). The mean interval time from the primary LSG to ReSG was of 37.5 months (9-80 mo). The indication for ReSG was insufficient weight loss in 28 patients (45.9%), weight regain in 29 patients (47.5%), and gastroesophageal reflux disease (GERD) in 4 patients. In 42 patients the gastrografin swallow results were interpreted as primary dilation and in the remaining 19 cases as secondary dilation. The computed tomography (CT) scan volumetry was obtained in 38 patients with mean gastric volume of 436.3 cc (275-1056 cc). All cases were completed by laparoscopy with no intraoperative incidents. The mean operative time was 39 minutes (range 29-70 min) and the mean hospital stay was 3.5 days (range 3-16 d). One perigastric hematoma and 2 cases of gastric stenosis were recorded. The mean BMI decreased to 29.2 kg/m(2) (range 20.2-37.5); the mean percentage of excess weight loss (%EWL) was 58.5% (±25.3) (P<.0004) for a mean follow-up of 20 months (range 6-56 mo). CONCLUSION The ReSG may be a valid option for failure of primary LSG. Further prospective clinical trials are required to compare the outcomes of ReSG with those of laparoscopic Roux-en-Y gastric bypass or duodenal switch for weight loss failure after LSG.


title: Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents.

text: INTRODUCTION Intracranial aneurysms in distal locations are sometimes difficult to treat due to their branching locations and the presence of blister-like or very wide-necked aneurysms. Braided intracranial stents, including flow diverters (FDs) and low-profile braided intracranial stents (LPBSs) may provide additional advantages, due to their flow-diverting properties. Areas covered: The use of FDs in off-label, distal intracranial locations has been increasing with promising outcomes and has given rise to the LPBS, which has less flow-diverting properties, allowing for easier use in distal branching sites through 0.017' microcatheters. These devices have shifted the interest from the aneurysm's sac filling to the regional remodeling through the effect of flow diversion. The purpose of this article is to discuss their functionality, safety, performance, and perspectives through a critical review of important publications of the last 11.5 years (January 2007 to July 2018) on the use of these devices at and beyond the circle of Willis. Expert opinion: FDs modify the regional anatomy thus careful pre-procedural consideration of the regional hemodynamic equilibrium is mandatory, as well as effective antiplatelet regimen. LPBSs provide moderate flow-diversion effect, which may be an advantage, especially for very distal and small aneurysms.


title: PET with the 89Zr-labeled transforming growth factor-β antibody fresolimumab in tumor models.

text: UNLABELLED Transforming growth factor-β (TGF-β) promotes cancer invasion and metastasis and is therefore a potential drug target for cancer treatment. Fresolimumab, which neutralizes all mammalian active isoforms of TGF-β, was radiolabeled with (89)Zr for PET to analyze TGF-β expression, antibody tumor uptake, and organ distribution. METHODS (89)Zr was conjugated to fresolimumab using the chelator N-succinyldesferrioxamine-B-tetrafluorphenol. (89)Zr-fresolimumab was analyzed for conjugation ratio, aggregation, radiochemical purity, stability, and immunoreactivity. (89)Zr-fresolimumab tumor uptake and organ distribution were assessed using 3 protein doses (10, 50, and 100 μg) and compared with (111)In-IgG in a human TGF-β-transfected Chinese hamster ovary xenograft model, human breast cancer MDA-MB-231 xenograft, and metastatic model. Latent and active TGF-β1 expression was analyzed in tissue homogenates with enzyme-linked immunosorbent assay. RESULTS (89)Zr was labeled to fresolimumab with high specific activity (>1 GBq/mg), high yield, and high purity. In vitro validation of (89)Zr-fresolimumab showed a fully preserved immunoreactivity and long (>1 wk) stability in solution and in human serum. In vivo validation showed an (89)Zr-fresolimumab distribution similar to IgG in most organs, except for a higher uptake in the liver in all mice and higher kidney uptake in the 10-μg group. (89)Zr-fresolimumab induced no toxicity in mice; it accumulated in primary tumors and metastases in a manner similar to IgG. Both latent and active TGF-β was detected in tumor homogenates, whereas only latent TGF-β could be detected in liver homogenates. Remarkably high (89)Zr-fresolimumab uptake was seen in sites of tumor ulceration and in scar tissue, processes in which TGF-β is known to be highly active. CONCLUSION Fresolimumab tumor uptake and organ distribution can be visualized and quantified with (89)Zr-fresolimumab PET. This technique will be used to guide further clinical development of fresolimumab and could possibly identify patients most likely to benefit.


title: Esophageal Inlet Patch: An Under-Recognized Cause of Symptoms in Children.

text: OBJECTIVES To determine the incidence of inlet patch (IP) and to assess the clinical and pathological features, role of the diagnostic workup in treatment decision making, efficacy of medical and endoscopic therapy, and natural history in a pediatric population. STUDY DESIGN Consecutive patients aged <18 years (n = 1000) undergoing esophagogastroduodenoscopy were enrolled prospectively. Biopsy specimens were obtained from IPs and the proximal and distal esophagus, stomach, and duodenum. Multichannel intraluminal impedance and pH monitoring (MII-pH) was performed in all symptomatic patients. Symptomatic patients were treated with proton pump inhibitors for 8 weeks, and IP ablation by argon plasma coagulation (APC) was performed in unresponsive patients. RESULTS The endoscopic incidence of IP was 6.3%, with a cumulative missing rate of 5.8%. Thirty-five of the 63 patients (56%) were asymptomatic, 11 (17%) had symptoms clearly related to the underlying digestive disorder, and 17 (27%) had chronic IP-related symptoms. MII-pH was positive in 10 of the 28 symptomatic patients. All 17 patients with IP-related symptoms were unresponsive to proton pump inhibitors and were treated with APC, and all had achieved complete remission by the 3-year follow-up. Patients with underlying disorders were successfully treated with medical therapy, and asymptomatic patients remained symptom-free, with no endoscopic or histological changes seen at the 3-year follow-up. CONCLUSION IP is an under-recognized cause of symptoms in children with unexplained esophageal and respiratory symptoms. MII-pH and bioptic sampling are needed to exclude entities mimicking IP symptoms and to direct therapy. APC is safe and effective for treating IP-related symptoms.


Commentary: A review of long-term corneal preservation techniques: Relevance and renewed interests in the COVID-19 era.


title: Retrograde semi-retrieval technique for combined stentriever plus aspiration thrombectomy in acute ischemic stroke.

text: The endovascular treatment of acute ischemic stroke has become a standard procedure. The combination of multiple neuroendovascular devices provides more possibilities for the improvement of the thrombectomy technique. We describe a modified retrieval technique using a distal intracranial catheter (DIC) for the semi-retrieval of stentriever during the thrombectomy procedure. The retrograde semi-retrieval technique involves completely unfolding the stent retriever by pulling a Navien catheter and the partial re-sheath of a retrievable stent forming a tapered configuration by pushing the Navien catheter, which results in the thrombi being embedded into the strut, securing the clot within the stent and there being a shorter distance for the clot to travel. This technique may lessen the occurrence of thrombus fragmentation and injury to the vessel wall. The retrograde semi-retrieval technique is an optional thrombectomy technique that may improve the efficiency of this procedure in the treatment of acute ischemic stroke.


Do psychotropic drugs used during COVID-19 therapy have an effect on the treatment process?


title: Cerebral autoregulation and activity after propofol for endotracheal intubation in preterm neonates.

text: BACKGROUND Despite increasing use of propofol in neonates, observations on cerebral effects are limited. AIM To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. METHODS Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. RESULTS After intubation with a median propofol dose of 1 (0.5-4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. CONCLUSIONS Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.


title: β-TrCP is dispensable for Vpu's ability to overcome the CD317/Tetherin-imposed restriction to HIV-1 release.

text: BACKGROUND The cellular transmembrane protein CD317/BST-2/HM1.24/Tetherin restricts HIV-1 infection by physically tethering mature virions to the surface of infected cells. HIV-1 counteracts this restriction by expressing the accessory protein Vpu, yet the mechanism of this antagonism is incompletely understood. β-TrCP is the substrate recognition domain of an E3 ubiquitin ligase complex that interacts with the di-serine motif S52/S56 in the cytoplasmic tail of Vpu to target the CD4 receptor for proteasomal degradation. Recently, it has been suggested that β-TrCP is also critically involved in Vpu's ability to overcome the CD317-mediated virion release block. RESULTS To test this model, we analyzed the consequences of several experimental strategies to interfere with the Vpu-β-TrCP protein-protein interaction. Under these conditions, we studied effects of Vpu on expression and localization of CD317 and CD4, as well as on its ability to promote HIV-1 release. Our results demonstrate a strict requirement for Vpu's di-serine motif for degradation of CD4 and also CD317, reduction of cell surface exposure of CD317, and HIV-1 release enhancement. We further show a critical role of β-TrCP2, but not of the structurally related β-TrCP1 isoform, for Vpu-mediated degradation of both receptors. Most importantly, Vpu remained active in downregulating CD317 from the cell surface and in overcoming the HIV-1 release restriction in β-TrCP-depleted cells. CONCLUSIONS These results demonstrate that β-TrCP is not strictly required for Vpu's ability to counteract the CD317-imposed virion release block and support the relevance of cell surface down-modulation of the restriction factor as a central mechanism of Vpu antagonism. Moreover, we propose the existence of a critical, yet to be identified cellular factor that interacts with Vpu via its di-serine motif to alter the trafficking of the restriction factor.


Experimental studies investigating the pathophysiology of nephrogenic systemic fibrosis; what did we learn so far?


title: Diurnal Variations of Air-Soil Exchange of Semivolatile Organic Compounds (PAHs, PCBs, OCPs, and PBDEs) in a Central European Receptor Area.

text: Concentrations of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs), and polybrominated diphenyl ethers (PBDEs) in air and soil, their fugacities, and the experimental soil-air partitioning coefficient (KSA) were determined at two background sites in the Gt. Hungarian Plain in August 2013. The concentrations of the semivolatile organic compounds (SOCs) in the soil were not correlated with the organic carbon content but with two indirect parameters of mineralization and aromaticity, suggesting that soil organic matter quality is an important parameter affecting the sorption of SOCs onto soils. Predictions based on the assumption that absorption is the dominant process were in good agreement with the measurements for PAHs, OCPs, and the low chlorinated PCBs. In general, soils were found to be a source of PAHs, high chlorinated PCBs, the majority of OCPs and PBDEs, and a sink for the low chlorinated PCBs and γ-hexachlorocyclohexane. Diurnal variations in the direction of the soil-air exchange were found for two compounds (i.e., pentachlorobenzene and p,p'-dichlorodiphenyldichloroethane), with volatilization during the day and deposition in the night. The concentrations of most SOCs in the near-ground atmosphere were dominated by revolatilization from the soil.


title: Gynandroblastoma with a Juvenile Granulosa Cell Component in an Adolescent: Case Report and Literature Review.

text: BACKGROUND Gynandroblastoma is an extremely rare ovarian sex cord tumor with malignant potential. CASE An 18-year-old adolescent experienced intermittent vaginal bleeding. A year later, a right adnexal mass with a heterogeneous imaging appearance was identified. Laparoendoscopic single-site ovarian tumorectomy was performed. A histopathological examination showed gynandroblastoma composed of juvenile granulosa and Sertoli-Leydig cells. Because the tumor was upstaged to stage Ic because of cyst rupture during surgery, three cycles of adjuvant chemotherapy with carboplatin and paclitaxel were added. Three years after surgery, no signs of recurrence have been noted. SUMMARY AND CONCLUSION The present findings can help clinicians make an accurate preoperative imaging diagnosis of gynandroblastoma with a juvenile granulosa cell component and plan an adequate treatment strategy for this rare, potentially malignant neoplasm.


title: [Effect of convalescent plasma and immunoglobulin on patients with severe acute respiratory syndrome: a systematic review].

text: OBJECTIVE To systematically review evidence for the effect of convalescent plasma and immunoglobulin on treatment of severe acute respiratory syndrome (SARS), and further provide advice on the treatment of coronavirus disease 2019 (COVID-19). METHODS Clinical studies of convalescent plasma and immunoglobulin in the treatment of SARS were collected from a variety of databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang, and CBM from November 2002 to March 2020. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias based on the national institute for health and clinical excellence case series quality scale, and systematically evaluated the results. RESULTS A total of 10 clinical studies, including 212 patients, were eventually included. There were 4 case series studies, 5 case reports and 1 case-control study. Most studies were with low or very low quality. The systematic analysis showed that 107 patients administered convalescent plasma and 16 patients used immunoglobulin during the treatment of SARS. Forty-nine patients were definitely not treated with the above two methods, and the remaining 40 patients were not reported clearly. The treatment of convalescent plasma and immunoglobulin could both improve the symptoms and reduce the mortality (12 died), and most SARS patients got better, while 11 SARS patients who did not receive the above therapies died. CONCLUSIONS Convalescent plasma and immunoglobulin were effective on relieving symptoms of SARS patients. However, due to low quality and lacking of control group, convalescent plasma and immunoglobulin should be used with caution to treat COVID-19 patients.


Coronavirus diaries: to be a scientist.


title: Laparoscopic hybrid NOTES liver resection for metastatic colorectal cancer.

text: BACKGROUND Abdominal wound extraction site continues to be a major source of morbidity after laparoscopic-assisted surgery. METHODS A 59-year-old African American woman with a past history of T3N2M1 colon cancer, who underwent laparoscopic sigmoid colectomy and wedge liver resection (segment IV A) followed by adjuvant chemotherapy was our subject for this study. Twelve months later, she was found to have a positron emission tomography positive liver lesion of 6.5 cm at the left lateral liver segment. A combined laparoscopic-transvaginal approach was used. Four 5-mm trocars were used. The liver parenchyma was divided using the harmonic scalpel, whereas the left hepatic vein was transected using the laparoscopic transvaginal vascular stapler. The specimen was placed in an endobag and extracted transvaginally. The specimen size was 14×8×3.5 cm and that of the lesion was 6.5×5.7×4 cm. The patient was discharged on postoperative day 2. RESULTS Operative time was 120 minutes and blood loss was minimal. The patient was discharged on postoperative day 2. No postoperative complications were found after 30 days. CONCLUSIONS Laparoscopic-assisted natural orifice transluminal endoscopic surgery results in quicker recovery, less postoperative pain, and potential wound-related complications. This technique is safe and effective with excellent aesthetic results. (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A54).


title: Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a case report.

text: BACKGROUND External ventricular drain (EVD) placement temporarily provides cerebrospinal fluid (CSF) diversion and is indicated in patients with aneurysmal subarachnoid hemorrhage (aSAH) to relieve hydrocephalus. METHODS Case report. RESULTS A 56-year-old woman was admitted to our hospital with aSAH complicated by acute hydrocephalus. An EVD was placed and set to 15 mmHg. After nearly 72 h, she clinically deteriorated. A computed tomography (CT) perfusion scan showed hypoperfusion in the watershed regions in both hemispheres and CT angiogram showed mild segmental arterial narrowings. After the EVD was lowered to 5 mmHg, the radiologic perfusion abnormalities and clinical symptoms resolved. CONCLUSIONS We postulate a mechanism by which CSF diversion could decrease the risk of delayed cerebral ischemia after aSAH: CSF drainage at low levels of intracranial pressure (e.g., 5 mmHg) could improve blood flow in the microcirculation, and thus improve tissue perfusion.


title: First demonstration of resolution of an infundibulum by direct treatment of the arterial wall with Pipeline flow-diverting stent.

text: INTRODUCTION Infundibula are symmetrical funnel-shaped widening, measuring more than 3 mm at its base with the branch artery arising from its apex. The pathological significance of this entity remains controversial. Although a relatively common appearance in otherwise normal angiograms, they have occasionally been described to progress into saccular aneurysms or directly rupture. METHODS/RESULTS We describe the first case of a disappearing infundibulum after a flow diverting stent was deployed across the infundibulum during the treatment of an adjacent aneurysm. CONCLUSIONS We concur in the view that infundibula are at least pre-pathological lesions that may in certain circumstances require consideration for treatment. Our case for the first time offers a potential treatment option for such situations.


title: Care Status of the ALS Patients With Long-Term Use of Tracheostomy Tube.

text: OBJECTIVE To evaluate the care status of the amyotrophic lateral sclerosis (ALS) patients with long-term use of tracheostomy tube by caregivers of ALS patients. METHODS A survey was conducted in the form of questionnaires to ALS patients and their caregivers. All measurements were performed by two visiting nurses. For statistical analysis, SPSS ver. 22.0 and Mann-Whitney U test on non-normal distribution were used. RESULTS In total, 19 patients (15 males and 4 females) and their caregivers participated in the survey. In the case of patients, the average duration of care was 5.9±3.7 years, and the mean periods of illness and tracheostomy were 5.3±3.2 years and 3.0±2.6 years, respectively. Replacement intervals were 14 days in 11 patients, 7 days in 4 patients, 28 days in 2 patients, and 21 days in 1 patient. One patient was unable to provide an accurate replacement interval. Eighteen (99%) caregivers had experience of adding volume to a cuff without pressure measure in the following instances: due to patients' needs in 7 cases, air leakage in 7 cases, and no reason in 4 cases. Mean pressure of tracheostomy cuff was 40±9.4 cmH2O, and air volume of tracheostomy cuff was 6.7±3.2 mL, but real mean volume was 7.0±2.9 mL. The number of suctioning for airway clearance was a mean 27.5±18.2 times a day. CONCLUSION According to this survey, we notice that almost all the patients and caregivers had an erroneous idea about cuff volume and pressure. Moreover, education and long-term professional care of tracheostomy cannot be overemphasized in this manner.


docid: taffvnvo

title: Single-incision laparoscopic resection of ovarian masses in children: a preliminary report.

text: PURPOSE Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. METHODS We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. RESULTS Six patients were identified with mean age of 14 years. Imaging studies showed cystic masses ranging 4-6 cm in five patients, and 20 cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75 min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37 h. Narcotic use averaged 9.9 mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. CONCLUSIONS Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.


docid: gvtpzxjg

title: Infants born very preterm react to variations of the acoustic environment in their incubator from a minimum signal-to-noise ratio threshold of 5 to 10 dBA.

text: INTRODUCTION Very early preterm infants (VPIs) are exposed to unpredictable noise in neonatal intensive care units. Their ability to perceive moderate acoustic environmental changes has not been fully investigated. RESULTS Physiological values of the 598 isolated sound peaks (SPs) that were 5-10 and 10-15 dB slow-response A (dBA) above background noise levels and that occurred during infants' sleep varied significantly, indicating that VPIs detect them. Exposure to 10-15 dBA SPs during active sleep significantly increased mean heart rate and decreased mean respiratory rate and mean systemic and cerebral oxygen saturations relative to baseline. DISCUSSION VPIs are sensitive to changes in their nosocomial acoustic environment, with a minimal signal-to-noise ratio (SNR) threshold of 5-10 dBA. These acoustic changes can alter their well-being. METHODS In this observational study, we evaluated their differential auditory sensitivity to sound-pressure level (SPL) increments below 70-75 dBA equivalent continuous level in their incubators. Environmental (SPL and audio recording), physiological, cerebral, and behavioral data were prospectively collected over 10 h in 26 VPIs (GA 28 (26-31) wk). SPs emerging from background noise levels were identified and newborns' arousal states at the time of SPs were determined. Changes in parameters were compared over 5-s periods between baseline and the 40 s following the SPs depending on their SNR thresholds above background noise.


docid: xqmhqfpk

title: Stabilization of mobile pulmonary nodules during radiofrequency ablation.

text: OBJECTIVE Lung tumors can exhibit a high degree of mobility during insertion of radiofrequency applicators owing to both respiratory motion and the inherent characteristics of pulmonary parenchyma. The purpose of this report is to describe a technique used to secure lung tumors during insertion of a radiofrequency applicator. CONCLUSION As experience with percutaneous imaging-guided radiofrequency ablation increases, technical challenges become increasingly apparent. A technique whereby a mobile pulmonary tumor is anchored prior to placement of the ablation electrode is one method of overcoming such a challenge.


title: Nanostructured Mineral Coatings Stabilize Proteins for Therapeutic Delivery.

text: Proteins tend to lose their biological activity due to their fragile structural conformation during formulation, storage, and delivery. Thus, the inability to stabilize proteins in controlled-release systems represents a major obstacle in drug delivery. Here, a bone mineral inspired protein stabilization strategy is presented, which uses nanostructured mineral coatings on medical devices. Proteins bound within the nanostructured coatings demonstrate enhanced stability against extreme external stressors, including organic solvents, proteases, and ethylene oxide gas sterilization. The protein stabilization effect is attributed to the maintenance of protein conformational structure, which is closely related to the nanoscale feature sizes of the mineral coatings. Basic fibroblast growth factor (bFGF) released from a nanostructured mineral coating maintains its biological activity for weeks during release, while it maintains activity for less than 7 d during release from commonly used polymeric microspheres. Delivery of the growth factors bFGF and vascular endothelial growth factor using a mineral coated surgical suture significantly improves functional Achilles tendon healing in a rabbit model, resulting in increased vascularization, more mature collagen fiber organization, and a two fold improvement in mechanical properties. The findings of this study demonstrate that biomimetic interactions between proteins and nanostructured minerals provide a new, broadly applicable mechanism to stabilize proteins in the context of drug delivery and regenerative medicine.


title: COVID-19, Australia: Epidemiology Report 4 (Reporting week ending 19:00 AEDT 22 February 2020).

text: This is the fourth epidemiological report for coronavirus disease 2019 (COVID-19), reported in Australia as at 19:00 Australian Eastern Daylight Time [AEDT] 22 February 2020. It includes data on COVID-19 cases diagnosed in Australia, the international situation and a review of current evidence.


title: Current situation of COVID-19 in northern Cyprus.

text: Background The public health burden of the novel coronavirus disease 2019 (COVID-19) is expected to increase and urgent strict measures by decision-makers is critical for the containment of the novel coronavirus (SARS-CoV-2) outbreak worldwide. Aims This study aimed to give a real-time analysis of COVID-19 presence in northern Cyprus. Methods All official SARS-CoV-2 positive cases were tracked and reported in terms of the origin, nationality, and transmission routes. Preventive measures taken after the first reported case were analyzed for their effectiveness as control strategies. Results The index case of SARS-CoV-2 in northern Cyprus was identified as a female German tourist. First local case had travel history from the United Kingdom after which local transmission occurred. Rapid and strict containment measures have currently delayed a peak in observed cases. Conclusions Rapid implementation of social-distancing measures, good hygiene measures and travel/gathering bans in northern Cyprus has been effective in controlling the outbreak.


"Abandoned" Nursing Homes Continue to Face Critical Supply and Staff Shortages as COVID-19 Toll Has Mounted.


title: Comparing the impact of two concurrent infectious disease outbreaks on The Netherlands population, 2009, using disability-adjusted life years.

text: In 2009 two notable outbreaks, Q fever and the novel influenza A(H1N1)pdm09, occurred in The Netherlands. Using a composite health measure, disability-adjusted life years (DALYs), the outbreaks were quantified and compared. DALYs were calculated using standardized methodology incorporating age- and sex-stratified data in a disease progression model; years lost due to disability and years of life lost were computed by outcome. Nationally, influenza A(H1N1)pdm09 caused more DALYs (24 484) than Q fever (5797). However, Q fever was 8·28 times more severe [497 DALYs/1000 symptomatic cases (DP1SC)] than A(H1N1)pdm09 (60 DP1SC). The A(H1N1)pdm09 burden is largely due to mortality while the Q fever burden is due primarily to long-term sequelae. Intervention prioritization for influenza should support patients in a critical condition while for Q fever it should target immediate containment and support for patients with long-term sequelae. Burden estimates provide guidance for focusing intervention options during outbreaks of infectious diseases.


title: Monitored anesthesia care for great saphenous vein stripping surgery with target controlled infusion of propofol and remifentanil: a prospective study.

text: BACKGROUND The aim of this study was to determine the appropriate target concentrations at the effect site of propofol and remifentanil when deep sedation was achieved by monitored anesthesia care (MAC) anesthesia and related respiratory depression during vein stripping surgery for varicose veins. METHODS In total, 51 adult patients who were scheduled for varicose vein stripping surgery were sedated with propofol and remifentanil during the surgery, after administration of midazolam. Target concentrations at the effect site of the two drugs were changed based on the patient's status. Respiratory support was applied in the order of oxygen supply, chin lift, and assisted mask ventilation. Target concentrations at the effect site of propofol and remifentanil, the need for respiratory support, and a six-point rating scale satisfaction score were the outcome measurements. RESULTS Only one patient did not require oxygen, eight patients needed oxygen alone, 22 patients required use of the chin lift technique, and 20 patients were assisted with mask ventilation. There was no significant difference in the target concentration of propofol or remifentanil between the patients who required mask ventilation and those who did not. Fifty of the 51 patients reported a satisfaction score of 6. CONCLUSIONS Although MAC using low target concentrations of propofol and remifentanil during vein stripping surgery was satisfactory to patients, close observation regarding the need for respiratory assistance was necessary.


title: Brain Oxygenation During Thoracoscopic Repair of Long Gap Esophageal Atresia.

text: BACKGROUND Elongation and repair of long gap esophageal atresia (LGEA) can be performed thoracoscopically, even directly after birth. The effect of thoracoscopic CO2-insufflation on cerebral oxygenation (rScO2) during the consecutive thoracoscopic procedures in repair of LGEA was evaluated. METHODS Prospective case series of five infants, with in total 16 repetitive thoracoscopic procedures. A CO2-pneumothorax was installed with a pressure of maximum 5 mmHg and flow of 1 L/min. Parameters influencing rScO2 were monitored. For analysis 10 time periods of 10' during surgery and in the perioperative period were selected. RESULTS Median gestational age was 35+3 [range 33+4 to 39+6] weeks; postnatal age at time of first procedure 4 [2-53] days and time of insufflation 127[22-425] min. Median rScO2 varied between 55 and 90%. Transient outliers in cerebral oxygenation were observed in three patients. In Patient 2 oxygenation values below 55% occurred during a low MABP and Hb < 6 mmol/L. The rScO2 increased after erythrocytes transfusion. Patient 5 also showed a rScO2 of 50% with a Hb <6 mmol/L during all procedures, except for a substantial increase during a high paCO2 of 60 mmHg. Patient 4 had a rScO2 > 85% during the first procedure with a concomitant high FiO2 > 45%. All parameters recovered during the surgical course. CONCLUSIONS This prospective case series of NIRS during consecutive thoracoscopic repair of LGEA showed that cerebral oxygenation remained stable. Transient outliers in rScO2 occurred during changes in hemodynamic or respiratory parameters and normalized after interventions of the anesthesiologist. This study underlines the importance of perioperative neuromonitoring and the close collaboration between pediatric surgeon, anesthesiologist and neonatologist.


title: Single-port laparoscopic parastomal hernia repair with modified sugarbaker technique.

text: INTRODUCTION Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. MATERIALS AND METHODS All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, "inline" and "chopsticks" to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. RESULTS Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m(2) did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm(2) with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. CONCLUSION Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care.


Covid-19: Clinicians must be able to access all test results, pathologists say.


title: Time-Dependent Computed Tomographic Perfusion Thresholds for Patients With Acute Ischemic Stroke.

text: BACKGROUND AND PURPOSE Among patients with acute ischemic stroke, we determine computed tomographic perfusion (CTP) thresholds associated with follow-up infarction at different stroke onset-to-CTP and CTP-to-reperfusion times. METHODS Acute ischemic stroke patients with occlusion on computed tomographic angiography were acutely imaged with CTP. Noncontrast computed tomography and magnectic resonance diffusion-weighted imaging between 24 and 48 hours were used to delineate follow-up infarction. Reperfusion was assessed on conventional angiogram or 4-hour repeat computed tomographic angiography. Tmax, cerebral blood flow, and cerebral blood volume derived from delay-insensitive CTP postprocessing were analyzed using receiver-operator characteristic curves to derive optimal thresholds for combined patient data (pooled analysis) and individual patients (patient-level analysis) based on time from stroke onset-to-CTP and CTP-to-reperfusion. One-way ANOVA and locally weighted scatterplot smoothing regression was used to test whether the derived optimal CTP thresholds were different by time. RESULTS One hundred and thirty-two patients were included. Tmax thresholds of >16.2 and >15.8 s and absolute cerebral blood flow thresholds of <8.9 and <7.4 mL·min(-1)·100 g(-1) were associated with infarct if reperfused <90 min from CTP with onset <180 min. The discriminative ability of cerebral blood volume was modest. No statistically significant relationship was noted between stroke onset-to-CTP time and the optimal CTP thresholds for all parameters based on discrete or continuous time analysis (P>0.05). A statistically significant relationship existed between CTP-to-reperfusion time and the optimal thresholds for cerebral blood flow (P<0.001; r=0.59 and 0.77 for gray and white matter, respectively) and Tmax (P<0.001; r=-0.68 and -0.60 for gray and white matter, respectively) parameters. CONCLUSIONS Optimal CTP thresholds associated with follow-up infarction depend on time from imaging to reperfusion.


title: Plasma intestinal fatty acid-binding protein levels correlate with morphologic epithelial intestinal damage in a human translational ischemia-reperfusion model.

text: BACKGROUND AND AIM Intestinal fatty acid-binding protein (I-FABP) is a useful marker in the detection of intestinal ischemia. However, more insight into the test characteristics of I-FABP release is needed. This study aimed to investigate the relationship between plasma I-FABP levels and the severity of ischemic mucosal injury, and define the clinical usefulness of systemic I-FABP following ischemia. METHODS In a human experimental model, 6 cm of the jejunum, to be removed for surgical reasons, was selectively exposed to either 15, 30, or 60 minutes of ischemia (I) followed by 30 and 120 minutes of reperfusion (R). Blood and tissue was sampled at all time points. Arteriovenous (V-A) concentration differences of I-FABP were measured. Tissue sections were stained with hematoxylin/eosin, and villus height was measured to score epithelial damage. RESULTS Histologic analysis showed only minor reversible intestinal damage following 15 I and 30 I; however, severe irreversible epithelial damage was observed in the jejunum exposed to 60 I. I-FABP V-A differences paralleled the degree of tissue damage over time [7.79 (± 1.8) ng/mL, 128.6 (± 44.2) ng/mL, 463.3 (± 139.8) ng/mL for 15 I, 30 I and 60 I, respectively]. A good correlation was found between histologic epithelial damage and V-A I-FABP (r=-0.82, P<0.001). Interestingly, systemic I-FABP levels were significantly increased after 60 I of this short small intestinal segment. CONCLUSIONS This study demonstrates the relationship between the duration of ischemia and the extent of tissue damage, which is reflected by I-FABP V-A plasma levels. In addition, systemic I-FABP levels appear valuable in detecting irreversible intestinal ischemia-reperfusion damage.


title: Spontaneous diaphragmatic rupture following robotic prostatectomy.

text: Robotic surgery is an established therapy for localised prostate cancer and is replacing conventional laparoscopic prostatectomy in developed countries. Port-site hernia is a recognised, albeit small, risk following laparoscopic or robotic surgery. We report a case of spontaneous rupture of the right hemidiaphragm following robotic prostatectomy.


title: The use of composite meshes in laparoscopic repair of abdominal wall hernias: are there differences in biocompatibily?: experimental results obtained in a laparoscopic porcine model.

text: INTRODUCTION In recent years, laparoscopic repair of abdominal wall hernias has become increasingly established in routine clinical practice thanks to the myriad advantages it confers. Apart from the risk of intestinal damage following adhesiolysis, to date no information is available on the best way of preventing the formation of new adhesions in the vicinity of the implanted meshes. Numerous experimental investigations, mainly conducted on an open small-animal model, have demonstrated the advantages of coating meshes, inter alia with absorbable materials, compared with uncoated polypropylene meshes. In our established laparoscopic porcine model we set about investigating three of these meshes, which are already available on the market. MATERIALS AND METHODS In total, 18 domestic pigs underwent laparoscopic surgery and three different composite meshes were tested in each case on six animals (Dynamesh IPOM, Proceed, Parietene Composite). At 4 months, postmortem diagnostic laparoscopy was carried out, followed by full-wall excision of the specimens. Planimetric analysis was conducted to investigate the size of the entire surface area and the extent of adhesions. Histological investigations were performed on five sections for each specimen. These focused on the partial volumes of inflammatory cells, the proliferation marker Ki67, apoptotic index, inflammatory cell marker CD68 and transforming growth factor beta (TGF-beta) as a marker of the extracellular matrix. RESULTS A similar value of 14% was obtained for shrinkage of Dynamesh IPOM and Parietene Composite, while Proceed showed a 25% reduction in its surface area. Markedly lower values of 12.8% were obtained for Parietene Composite in respect of adhesions to the greater omentum, compared with 31.7% for Proceed and 33.2% for Dynamesh IPOM (p = 0.01). Overall, Parietene Composite performed best in the histological and immunhistochemistry tests. CONCLUSIONS On the whole, all composite meshes showed evidence of good biocompatibility. However, none of the coatings was completely able to prevent adhesions. Coating of polypropylene meshes with collagen appears to confer significant advantages compared with other coatings.


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title: Effect of paroxetine on left ventricular remodeling in an in vivo rat model of myocardial infarction.

text: Left ventricular (LV) remodeling following a myocardial infarction (MI) involves formation of reactive oxygen species (ROS). Paroxetine, a selective serotonin reuptake inhibitor, has an antioxidant effect in the vascular wall. We investigated whether paroxetine reduces myocardial ROS formation and LV remodeling following a MI. In a total of 32 Wistar rats, MI was induced by a 30-min ligation of the left anterior descending artery followed by 7- or 28-day reperfusion. During the 28 days of reperfusion, LV remodeling was evaluated by magnetic resonance imaging (MRI) and echocardiography (n = 20). After 28 days of reperfusion, the susceptibility to ventricular tachycardia was evaluated prior to sacrifice and histological assessment of myocyte cross-sectional area, fibrosis, and presence of myofibroblasts. Myocardial ROS formation was measured with dihydroethidium after 7 days of reperfusion in separate groups (n = 12). Diastolic LV volume, evaluated by MRI (417 ± 60 vs. 511 ± 64 µL, p < 0.05), and echocardiography (515 ± 80 vs. 596 ± 83 µL, p < 0.05) as well as diastolic LV internal diameter evaluated with echocardiography (7.2 ± 0.6 vs. 8.1 ± 0.7 mm, p < 0.05) were lower in the paroxetine group than in controls. Furthermore, myocyte cross-sectional area was reduced in the paroxetine group compared with controls (277 ± 26 vs. 354 ± 23 mm3, p < 0.05) and ROS formation was reduced in the remote myocardium (0.415 ± 0.19 normalized to controls, p < 0.05). However, no differences in the presence of fibrosis or myofibroblasts were observed. Finally, paroxetine reduced the susceptibility to ventricular tachycardia (induced in 2/11 vs. 6/8 rats, p < 0.05). Paroxetine treatment following MI decreases LV remodeling and susceptibility to arrhythmias, probably by reducing ROS formation.


title: Expert Recommendations for Prevention, Treatment and Care of Oral Ulcers and Other Mucosal Diseases during the Coronavirus Outbreak.

text: In December 2019, some new and unexplained cases of pneumonia were found in Wuhan, Hubei province, China, and were later named as coronavirus disease 2019 by the World Health Organisation. The number of cases increased rapidly, and the virus spread continuously. Tens of thousands of medical staff throughout the country have since rushed to Wuhan to provide intensive medical treatment. Due to high levels of stress and work intensity, insufficient sleep and a lack of access to water after entering the isolation ward, staff may suffer from oral mucosal ulcers and other oral mucosal diseases. Police officers, community workers, family members in quarantine and even patients with mild coronavirus 2019, as well as those who have previously had oral mucosal disease, have also reported experiencing discomfort as a result of stress-induced oral mucosal disorders, such as recurrent aphthous ulcers, chronic cheilitis and oral lichen planus. This article will offer some suggestions for the prevention, treatment and care of the above-mentioned oral mucosal diseases during the fight against coronavirus 2019, focusing on measures to deal with the oral mucosal damage caused in response to stress.


SARS-CoV-2 RT-PCR: at least 2 viral targets are needed.


Flow Diversion for Giant Intracranial Aneurysms: Problem or Panacea?


title: Intra-arterial treatment of acute ischemic stroke: the continued evolution.

text: OPINION STATEMENT The devastation caused by acute ischemic strokes is evident in every intensive care unit across the world. Although there is no doubt that progress has been made in treatment, it has been slow to come. With the emergence of new technologies in imaging, thrombolysis and endovascular intervention, the treatment modalities of acute ischemic stroke will enter a new era. In this review, we present the concept of the seven evolutionary phases in the treatment of acute ischemic stroke to date.


title: Mechanical strain to maxillary incisors during direct laryngoscopy.

text: BACKGROUND While most Direct laryngoscopy leads to dental injury in 25-39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP). METHODS A mannequin head designed to teach and test intubation was instrumented with eight single axis strain gauges placed on the four maxillary incisors: four on the facial or front surface of the incisors and four on the lingual or back, near the insertion of the incisor in the gums to measure bending strain as well as compression. Anesthesiology faculty, residents, and certified registered nurse anesthetists intubated with Macintosh and Miller blades with and without APP. Using strain-time curves, the maximum strain, strain rate, and strain time integral were calculated. RESULTS Across the 92 subjects, strain varied 8-12 fold between the 25th and 75th percentiles for all four techniques, but little by experience, while strain rate and strain integral varied 6-13 fold and 15-26 fold, respectively, for the same percentiles. Intubators who had high strain values with one blade tended to have high strains with the other blade with and without the APP (all pairwise correlation rho = 0.42-0.63). CONCLUSIONS Strain varies widely by intubator and that the use of the APP reduces strain rate which may decrease the risk of or the severity of dental injury.


COVID-19 and Underinvestment in the Health of the US Population.


title: Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs.

text: BACKGROUND Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti-inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. OBJECTIVES To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. ANIMALS Eleven client-owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. METHODS Retrospective review of medical records. RESULTS Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P = .04) and larger change in serum creatinine concentration from baseline (P = .02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. CONCLUSIONS AND CLINICAL IMPORTANCE We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high-dose NSAID ingestion.


Concerns regarding self-treatment of burns during COVID-19 lockdown.


COVID-19 spotlights medical diagnostics.


title: Restoration of glycemic control in patients with type 2 diabetes mellitus after bariatric surgery is associated with reduction in microparticles.

text: BACKGROUND Microparticles bud from cellular elements during inflammation and are associated with the vascular dysfunction related to type 2 diabetes mellitus. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Our objectives were to determine the effect of bariatric surgery on the microparticle concentration and to correlate these changes with clinical parameters in a multispecialty group practice. METHODS We studied 14 obese subjects with type 2 diabetes mellitus 2 weeks before and 1 and 12 months after bariatric surgery. Of the 14 patients, 9 underwent Roux-en-Y gastric bypass and 5 gastric restrictive surgery. RESULTS At 1 month after surgery, the body mass index had decreased by ∼10%, glycemic control had improved dramatically (P < .01), and a >60% reduction in endothelial and platelet microparticles and C-reactive protein levels (P < .05) had occurred. The tissue factor microparticles had decreased by 40% (P = .1). At 12 months after surgery, the body mass index had decreased by ∼20%, glycemic control was maintained (P < .01), and a >50% reduction in monocyte microparticles compared with before surgery was found. The reduction in monocyte microparticles 1 month after surgery was strongly associated with the reduction in hemoglobin A1c (P < .05). The reduction in monocyte microparticles 12 months after surgery correlated strongly with the reduction in body mass index (P < .05). CONCLUSION The reduction in microparticles after bariatric surgery in patients with type 2 diabetes mellitus reflects an attenuation of inflammation, and this mechanism might contribute to normalization of glycemic control.


docid: kfsmdcpx

title: Cytokine Storm Drugs Move from CAR T to COVID-19.

text: Early reports suggest that tocilizumab, an IL6 receptor-blocking antibody used to manage toxicities associated with chimeric antigen receptor T-cell therapy, may help control cytokine storms in people infected with COVID-19. Preliminary data from randomized trials are less clear-cut.


title: Chloroquine-induced QTc prolongation in COVID-19 patients

text: BACKGROUND: In the battle against the SARS-CoV‑2 pandemic, chloroquine has emerged as a new potential therapeutic option for the treatment of infected patients. A safety consideration for the application of chloroquine is its QTc-prolonging potential. Thus far, no data are available on the QTc-prolonging potential of chloroquine in COVID-19 patients. OBJECTIVE: To assess the degree of chloroquine-induced QTc prolongation in hospitalised COVID-19 patients. METHODS: A baseline electrocardiogram (ECG) and ECGs recorded during chloroquine treatment were retrospectively collected in patients suspected of having COVID-19. The QTc interval was calculated by computerised and manual interpretation. Baseline and follow-up QTc intervals were compared using the paired samples t-test. RESULTS: A total of 95 patients had a baseline ECG recording and at least one ECG recording during chloroquine therapy. Chloroquine treatment resulted in a mean QTc prolongation of 35 ms (95% CI 28–43 ms) using computerised interpretation and 34 ms (95% CI 25–43 ms) using manual interpretation. No torsade de pointes was observed during chloroquine treatment. After manual review, 22 patients (23%) had a QTc interval exceeding 500 ms during chloroquine treatment. None of these patients had a prolonged QTc interval prior to the initiation of chloroquine treatment. CONCLUSIONS: Chloroquine significantly prolongs the QTc interval in a clinically relevant matter. This highlights the need for ECG monitoring when prescribing chloroquine to COVID-19 patients.


docid: wurxdrtx

title: Laparoscopic Repair of a Large Paraesophageal Hernia with Migration of the Stomach into the Mediastinum Creating an Upside-Down Stomach.

text: Upside-down stomach is a relatively rare type of a large paraesophageal hernia characterized by the migration of the stomach into the posterior mediastinum. Upside-down stomach is prone to severe complications and therefore surgery is recommended even in asymptomatic patients. A 62-year-old male presented with frequent abdominal pain with nausea and vomiting that persisted for one year. The patient was obese with fatty liver and was treated medically for gastroesophageal reflux disease (GERD) for 4 years. On upper gastrointestinal CT study a level-IV paraesophageal hernia was detected with upside-down stomach, and he was referred for elective surgery. Laparoscopic surgery included reduction of the stomach into the abdominal cavity followed by dissection of the paraesophageal membrane and hernia sac. The hiatal defect was closed using a wound closure device and nonabsorbable sutures. The defect closure was reinforced using Physiomesh tucked anteriorly and sutured posteriorly to the diaphragm. Follow-up was uneventful and the patient is free of complaints. The results of this surgical intervention support previous reports that laparoscopic repair with the use of biological mesh in the setting of large paraesophageal hernia should be favorably considered.


title: Diagnostic and Management Implications of Basic Science Advances in Barrett's Esophagus.

text: OPINION STATEMENT Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC), a cancer that has increased in the Western world by nearly sixfold over the past three decades and is associated with a dismal 5-year survival rate (<20 %) especially when detected at a symptomatic state. Given the dramatic rise in EAC incidence and poor outcomes, much attention has focused on screening and surveillance in BE with a goal of identifying curable lesions and improving outcomes in patients with EAC. The limitations of current screening and surveillance strategies provide the necessary impetus to improve diagnostic accuracy and risk stratification of patients with BE. Biomarkers have the potential to predict risk of progression to cancer, identify patients most likely to respond to endoscopic eradication therapies, and ultimately influence patient management and outcomes. The goal of identifying such a biomarker or panel of biomarkers ready for clinical application remains elusive. This review highlights the recent advances in the field of biomarkers. It is increasingly being recognized that a single biomarker is suboptimal in accurate clinical risk stratification of individuals at highest risk for progression to cancer and an ideal risk stratification tool should include a panel of biomarkers in conjunction with clinical and endoscopic factors. Finally, we review advances in our screening strategies with use of Cytosponge, transnasal endoscopy, and tethered capsule endomicroscopy and surveillance strategies with use of advanced imaging techniques. Feasibility of these novel technologies for large population screening and surveillance needs to be assessed in future trials.


docid: ygedcwut

title: Protocol for recombinant RBD-based SARS vaccines: protein preparation, animal vaccination and neutralization detection.

text: Based on their safety profile and ability to induce potent immune responses against infections, subunit vaccines have been used as candidates for a wide variety of pathogens. Since the mammalian cell system is capable of post-translational modification, thus forming properly folded and glycosylated proteins, recombinant proteins expressed in mammalian cells have shown the greatest potential to maintain high antigenicity and immunogenicity. Although no new cases of SARS have been reported since 2004, future outbreaks are a constant threat; therefore, the development of vaccines against SARS-CoV is a prudent preventive step and should be carried out. The RBD of SARS-CoV S protein plays important roles in receptor binding and induction of specific neutralizing antibodies against virus infection. Therefore, in this protocol, we describe novel methods for developing a RBD-based subunit vaccine against SARS. Briefly, the recombinant RBD protein (rRBD) was expressed in culture supernatant of mammalian 293T cells to obtain a correctly folded protein with proper conformation and high immunogenicity. The transfection of the recombinant plasmid encoding RBD to the cells was then performed using a calcium phosphate transfection method with some modifications. Compared with the lipid transfection method, this modified calcium phosphate transfection method is cheaper, easier to handle, and has the potential to reach high efficacy once a transfection complex with suitable size and shape is formed. Finally, a SARS pseudovirus neutralization assay was introduced in the protocol and used to detect the neutralizing activity of sera of mice vaccinated with rRBD protein. This assay is relatively safe, does not involve an infectious SARS-CoV, and can be performed without the requirement of a biosafety-3 laboratory. The protocol described here can also be used to design and study recombinant subunit vaccines against other viruses with class I fusion proteins, for example, HIV, respiratory syncytial virus (RSV), Ebola virus, influenza virus, as well as Nipah and Handra viruses. In addition, the methods for generating a pseudovirus and subsequently establishing a pseudovirus neutralization assay can be applied to all these viruses.


Challenges for NHS hospitals during covid-19 epidemic.


title: Prospective study of safety and effectiveness in the use of radiofrequency ablation for incompetent great saphenous vein ≥12 mm.

text: OBJECTIVE The objective of this study was to assess the outcomes of radiofrequency ablation (RFA) in incompetent great saphenous vein (GSV) according to its diameter. METHODS This was a prospective single-center study including all patients treated with RFA from September 2014 to December 2015. The sample was divided according to the maximum GSV diameter measured on duplex ultrasound scan (A, <12 mm; B, ≥12 mm). Second-generation catheters (ClosureFast; Covidien, Mansfield, Mass) and tumescent anesthesia were used. Clinical stage (according to Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification), quality of life (measured by the 14-item Chronic Venous Insufficiency Questionnaire), and pain on visual analog scale were recorded before the procedure and during follow-up. Technical success was defined as GSV occlusion on duplex ultrasound scan. Safety was defined as incidence and type of adverse events at 10 days, 1 month, 6 months, and 12 months. RESULTS There were 257 patients included, 183 (71%) with GSV diameter <12 mm and 74 (29%) with GSV diameter ≥12 mm. Mean GSV diameter was 8 ± 2 mm (4-11 mm) and 14 ± 2 mm (12-21 mm), respectively. Before the procedure, although a tendency toward greater clinical severity was observed in group B, no significant differences were found in the percentage of patients in C4 and C5 categories (A, 10%; B, 22%), median pain perception (A, 40; B, 39), or median quality of life value on the 14-item Chronic Venous Insufficiency Questionnaire scale (A, 27; B, 27). The rate of GSV occlusion at 1 month (n = 221) was 97% in group A and 100% in group B (P = .325); at 6 months (n = 158), it was 97% and 98%, respectively (P > .999); and at 12 months (n = 90), it was 99% and 96% (P = .481). There was a significant improvement in pain and quality of life in both groups, without differences between them. Finally, no differences between groups were found in terms of adverse events. Paresthesias were the most frequent event (A, 4%; B, 5%; P = NS), which disappeared during follow-up in half of the cases. Regarding major adverse events, there was only one case of deep venous thrombosis in group B. CONCLUSIONS RFA is safe and effective for the treatment of GSV ≥12 mm at midterm.


title: Tibiofemoral joint contact area and stress after single-bundle anterior cruciate ligament reconstruction with transtibial versus anteromedial portal drilling techniques.

text: BACKGROUND During single-bundle ACLR, femoral tunnel location plays an important role in restoring the intact knee mechanisms, whereas malplacement of the tunnel was cited as the most common cause of knee instability. The objective of this study is to evaluate, objectively, the tibiofemoral contact area and stress after single-bundle (SB) anterior cruciate ligament reconstruction (ACLR) with femoral tunnel positions drilled by transtibial (TT) or anteromedial (AM) portal techniques. METHODS Seven fresh human cadaveric knees underwent ACLR by the use of TT or AM portal techniques in a randomized order. These specimens were reused for ACL-R (TT and AM). The tibiofemoral contact area and stresses were gauged by an electronic stress-sensitive film inserted into the joint space. The knee was under the femoral axial compressive load of 1000 N using a biomechanics testing machine at 0°, 10°, 20°, and 30° of flexion. Three conditions were compared: (1) intact ACL, (2) ACLR by the use of the TT method, and (3) ACLR by the use of the AM portal method. RESULTS Compared with AM portal ACL-reconstructed knees, a significantly decreased tibiofemoral contact area on the medial compartment was detected in the TT ACL-reconstructed knees at 20°of knee flexion (P = .047). Compared with the intact group, the TT ACLR group showed a higher mean stress at 20° and 30° of flexion on the medial compartments (P = .001, P = .003, respectively), while the AM portal ACLR group showed no significant differences at 30° of flexion (P = .073). The TT ACLR group also showed a higher mean maximum stress at 20° of flexion on the medial compartments (P = .047), while the AM portal ACLR group showed no significant differences at this angle(P = .319). DISCUSSION The alternation of the tibiofemoral joint contact area and stress in reconstructed knees may be caused by the mismatch of the tibiofemoral joint during knee movement procedures compared with intact knees. CONCLUSIONS SB ACLR by the use of the AM portal method and TT method both alter the tibiofemoral contact area and stress when compared with the intact knee. When compared with the TT technique, ACLR by the AM portal technique more closely restores the intact tibiofemoral contact area and stress at low flexion angles.


title: Adapting to a global pandemic through live virtual delivery of a cancer collaborative trial group conference: the TROG 2020 experience.

text: INTRODUCTION The global COVID-19 pandemic forced the cancellation of the TROG 2020 face to face Annual Scientific Meeting (ASM). It was instead delivered as a live virtual meeting with six days of planning. Here we report the participants' experience of this live virtual meeting. METHOD Participants were invited to complete custom developed, pre and post meeting surveys to assess their expectations of and satisfaction with the live virtual format. Speakers and moderators were also invited to complete a custom developed satisfaction survey. The working parties of TROG (head neck/skin, genitourinary, breast and lung) were also sampled. RESULTS In total, 188/273 (69%) registered participants logged in to the live virtual meeting. The online engagement for each of the oral sessions ranged from 53-66%. There were 102 and 57 responders to the online pre and post meeting surveys, respectively. The majority of pre meeting responders indicated a significant level of employer support to attend the virtual meeting. Post meeting satisfaction exceeded pre meeting expectations ('very much' and 'quite a bit'; 86% v 54%; p<0.0001). The majority indicated they would be 'quite a bit' or 'very much' interested in future live virtual meetings. CONCLUSION The TROG 2020 ASM was conducted as a live virtual meeting. Participant satisfaction and future interest in a live virtual meeting was high, indicating this is a viable platform for other CCTG's faced with the decision to deliver virtual content at times of global public health threats.


title: Incidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars.

text: INTRODUCTION Hypertrophic burn scars may generate significant morbidity, due to intense pruritus, persistent dysesthesias, and contracture. Although treatment with pulsed dye laser and fractional CO2 laser may improve symptoms, incidence of secondary wound complications is not well known. We examined the adverse event profile of laser therapies for the treatment of hypertrophic burn scars. METHODS We performed a descriptive, retrospective, 6-month study of all patients who underwent laser therapies, at an accredited regional burn center, to improve the vascularity, texture, thickness, and stiffness of symptomatic burn scars. Data regarding skin type, mechanism, area treated, and laser parameters were collected. Main outcome measures included pigmentation changes, blistering, rash, infection. χ analysis and Student t test were used to evaluate associations between variables. RESULTS A total of 95 patients underwent 163 treatment sessions (mean, 2.7 sessions/patient) with pulsed dye laser (71%), CO2 laser (22%), and other lasers (7%). Forty-one adverse events were recorded: hyperpigmentation (2%), hypopigmentation (12%), mild blistering (27%), pain (37%), rash (7%), fever (10%), and infection (2%). Patients with scald burns were more likely to develop blistering, rash, and fever after treatment (all P < 0.05). Higher Fitzpatrick skin type was associated with hypopigmentation and blistering, whereas CO2 laser was associated with increased postoperative pain (all P < 0.05) CONCLUSIONS Despite the frequent occurrence of pain and mild blistering after laser treatment of hypertrophic burn scars, major adverse effects were exceedingly rare, with improvement noted in all patients. Patients with higher Fitzpatrick skin types must be handled with care, to avoid complications of blistering and hypopigmentation.


title: Local tumour progression after percutaneous ablation of colorectal liver metastases according to RAS mutation status.

text: BACKGROUND Percutaneous ablation is a common treatment for colorectal liver metastasis (CLM). However, the effect of rat sarcoma viral oncogene homologue (RAS) mutation on outcome after ablation of CLMs is unclear. METHODS Patients who underwent image-guided percutaneous ablation of CLMs from 2004 to 2015 and had known RAS mutation status were analysed. Patients were evaluated for local tumour progression as observed on imaging of CLMs treated with ablation. Multivariable Cox regression analysis was performed to determine factors associated with local tumour progression-free survival. RESULTS The study included 92 patients who underwent ablation of 137 CLMs. Thirty-six patients (39 per cent) had mutant RAS. Rates of local tumour progression were 14 per cent (8 of 56) for patients with wild-type RAS and 39 per cent (14 of 36) for patients with mutant RAS (P = 0·007). The actuarial 3-year local tumour progression-free survival rate after percutaneous ablation was worse in patients with mutant RAS than in those with wild-type RAS (35 versus 71 per cent respectively; P = 0·001). In multivariable analysis, negative predictors of local tumour progression-free survival were a minimum ablation margin of less than 5 mm (hazard ratio (HR) 2·48, 95 per cent c.i. 1·31 to 4·72; P = 0·006) and mutant RAS (HR 3·01, 1·60 to 5·77; P = 0·001). CONCLUSION Mutant RAS is associated with an earlier and higher rate of local tumour progression in patients undergoing ablation of CLMs.


title: Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial.

text: IMPORTANCE Barrett esophagus containing low-grade dysplasia is associated with an increased risk of developing esophageal adenocarcinoma, a cancer with a rapidly increasing incidence in the western world. OBJECTIVE To investigate whether endoscopic radiofrequency ablation could decrease the rate of neoplastic progression. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial that enrolled 136 patients with a confirmed diagnosis of Barrett esophagus containing low-grade dysplasia at 9 European sites between June 2007 and June 2011. Patient follow-up ended May 2013. INTERVENTIONS Eligible patients were randomly assigned in a 1:1 ratio to either endoscopic treatment with radiofrequency ablation (ablation) or endoscopic surveillance (control). Ablation was performed with the balloon device for circumferential ablation of the esophagus or the focal device for targeted ablation, with a maximum of 5 sessions allowed. MAIN OUTCOMES AND MEASURES The primary outcome was neoplastic progression to high-grade dysplasia or adenocarcinoma during a 3-year follow-up since randomization. Secondary outcomes were complete eradication of dysplasia and intestinal metaplasia and adverse events. RESULTS Sixty-eight patients were randomized to receive ablation and 68 to receive control. Ablation reduced the risk of progression to high-grade dysplasia or adenocarcinoma by 25.0% (1.5% for ablation vs 26.5% for control; 95% CI, 14.1%-35.9%; P < .001) and the risk of progression to adenocarcinoma by 7.4% (1.5% for ablation vs 8.8% for control; 95% CI, 0%-14.7%; P = .03). Among patients in the ablation group, complete eradication occurred in 92.6% for dysplasia and 88.2% for intestinal metaplasia compared with 27.9% for dysplasia and 0.0% for intestinal metaplasia among patients in the control group (P < .001). Treatment-related adverse events occurred in 19.1% of patients receiving ablation (P < .001). The most common adverse event was stricture, occurring in 8 patients receiving ablation (11.8%), all resolved by endoscopic dilation (median, 1 session). The data and safety monitoring board recommended early termination of the trial due to superiority of ablation for the primary outcome and the potential for patient safety issues if the trial continued. CONCLUSIONS AND RELEVANCE In this randomized trial of patients with Barrett esophagus and a confirmed diagnosis of low-grade dysplasia, radiofrequency ablation resulted in a reduced risk of neoplastic progression over 3 years of follow-up. TRIAL REGISTRATION trialregister.nl Identifier: NTR1198.


title: IMPACT OF COMORBIDITIES IN MEXICAN SARS-COV-2-POSITIVE PATIENTS: A RETROSPECTIVE ANALYSIS IN A NATIONAL COHORT.

text: Background The coronavirus disease 2019 outbreak is a significant challenge for health-care systems around the world. Objective The objective of the study was to assess the impact of comorbidities on the case fatality rate (CFR) and the development of adverse events in patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Mexican population. Materials and methods We analyzed the data from 13,842 laboratory-confirmed SARS-CoV-2 patients in Mexico between January 1, 2020, and April 25, 2020. We investigated the risk of death and the development of adverse events (hospitalization, pneumonia, orotracheal intubation, and intensive care unit [ICU] admission), comparing the number of comorbidities of each patient. Results The patient mean age was 46.6 ± 15.6 years, 42.3% (n = 5853) of the cases were women, 38.8% of patients were hospitalized, 4.4% were intubated, 29.6% developed pneumonia, and 4.4% had critical illness. The CFR was 9.4%. The risk of hospitalization (odds ratio [OR] = 3.1, 95% confidence interval [CI]: 2.7-3.7), pneumonia (OR = 3.02, 95% CI: 2.6-3.5), ICU admission (OR = 2, 95% CI: 1.5-2.7), and CFR (hazard ratio = 3.5, 95% CI: 2.9-4.2) was higher in patients with three or more comorbidities than in patients with 1, 2, or with no comorbidities. Conclusions The number of comorbidities may be a determining factor in the clinical course and its outcomes in SARS-CoV-2-positive patients.


title: A comparison of the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia for awake fibreoptic intubation.

text: We compared the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia administered via the working channel during awake fibreoptic tracheal intubation in 96 patients undergoing elective surgery. Patients who received topical anaesthesia via the atomiser, compared with boluses via the fibreoptic scope, reported a better median (IQR [range]) level of comfort: 1 (1-3 [1-10]) vs. 4 (2-6 [1-10]), p < 0.0001; experienced a reduced total number of coughs: 6 (3-10 [0-34]) vs. 11 (6-13 [0-25]), p = 0.0055; and fewer distinct coughing episodes: 7% vs. 27% respectively, p = 0.0133. The atomiser technique was quicker: 5 (3-6 [2-12]) min vs. 6 (5-7 [2-15]) min, p = 0.0009; and required less topical lidocaine: 100 mg (100-100 [80-160]) vs. 200 mg (200-200 [200-200]), p < 0.0001. Four weeks after nasal intubation, the incidence of nasal pain was less in the atomiser group compared with the control group (8% vs. 50%, p = 0.0015). We conclude that the atomiser was superior to bolus application for awake fibreoptic tracheal intubation.


Innovation and Knowledge Sharing Can Transform COVID-19 Infection Prevention Response.


title: Enucleation or exenteration in two dogs with previous parotid duct transposition: parotid duct ligation versus reverse parotid duct transposition.

text: Two dogs with previous parotid duct transpositions presented with unrelated ocular disease. In both cases, ophthalmic examination revealed the need for enucleation or exenteration. In case 1, systemic coccidioidomycosis was diagnosed with panuveitis and secondary glaucoma of the left eye. In this case, the parotid duct was ligated at the time of enucleation to stop salivary secretions. This dog encountered morbidity in the form of a sialocele that did not resolve for 11 months. In case 2, ultrasound and computed tomography revealed a discrete mass within the left medial orbit that was suspected to arise from the nictitating membrane. A combination of exenteration and parotid duct transposition reversal was performed to avoid morbidity associated with ligation of the parotid duct. The dog encountered no complications from this novel procedure. This case report represents the first report of re-routing a transposed parotid duct from the ventral conjunctival sac back to the mouth at the time of enucleation or exenteration in the dog.


Part 7: CPR techniques and devices: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.


title: Preserving Access: A Review of Stroke Thrombectomy during the COVID-19 Pandemic.

text: Thrombectomy for large-vessel-occlusion stroke is a highly impactful treatment. The spread of coronavirus 19 (COVID-19) across the United States and the globe impacts access to this crucial intervention through widespread societal and institutional changes. In this document, we review the implications of COVID-19 on the emergency care of large-vessel occlusion stroke, reviewing specific infection-control recommendations, available literature, existing resources, and expert consensus. As a population, patients with large-vessel occlusion stroke face unique challenges during pandemics. These are broad in scope. Responses to these challenges through adaptation of stroke systems of care and with imaging, thrombectomy, and postprocedural care are detailed. Preservation of access to thrombectomy must be prioritized for its public health impact. While the extent of required changes will vary by region, tiered planning for both escalation and de-escalation of measures must be a part of each practice. In addition, preparations described serve as templates in the event of future pandemics.


title: Toward a unified field of study: longevity, regeneration, and protection of health through meditation and related practices.

text: The orientation of this volume and the Longevity and Optimal Health: Integrating Eastern and Western Perspectives conference is that there is abundant evidence in the scientific and medical literatures that the diligent practice of certain yoga-meditational regimens can lead to a spectrum of health enhancements, ranging from modest to profound, and that these can be investigated in a scientifically rigorous fashion. This overview will summarize these possibilities regarding improved human longevity, regeneration, and protection of health and serve to introduce the perspectives of conference participants from all of the traditions represented.


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title: Commentary: Addressing Inequities in the Era of COVID-19: The Pandemic and the Urgent Need for Critical Race Theory.


title: Endovascular treatment results and risk factors for complications of body and extremity arteriovenous malformations.

text: OBJECTIVE The objective of this study was to investigate the factors associated with the complication rate and treatment outcomes of arteriovenous malformations (AVMs) during a 20-year period. METHODS This was a retrospective study of 306 patients (135 men, 171 women; mean age, 30.8 years) with body and extremity AVMs who were treated between 1996 and 2017. A total of 913 sessions of endovascular treatment were performed. Patients were divided into two decades of the study period to compare complications and clinical results. Group 1 comprised 107 patients treated in the first decade of the study period, and group 2 comprised 199 patients treated in the last decade. AVMs were classified according to the angiographic findings. Complication rates, number of treatment sessions, and treatment results were compared between the two groups. RESULTS Minor complication (group 1, 20.1%; group 2, 18.5%) and major complication (group 1, 3.1%; group 2, 4.1%) rates were similar between groups (P = .79). The mean number of treatment sessions in group 1 and group 2 was 4.2 and 2.3, respectively, indicating a 45% reduction in treatment sessions (P < .0001). The treatment failure rate decreased from 9.3% in group 1 to 1.5% in group 2 (P = .04). The clinical success rate was 54.2% in group 1 and 64.3% in group 2 (P = .10). CONCLUSIONS With an accumulation of AVM treatment experience, the number of treatment sessions and the rate of treatment failures were significantly reduced.


How can I feel less isolated from colleagues?


title: Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review.

text: BACKGROUND Convalescent plasma and hyperimmune immunoglobulin may reduce mortality in patients with viral respiratory diseases, and are currently being investigated in trials as potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks is required. OBJECTIVES: To continually assess, as more evidence becomes available, whether convalescent plasma or hyperimmune immunoglobulin transfusion is effective and safe in treatment of people with COVID-19. SEARCH METHODS We searched the World Health Organization (WHO) COVID-19 Global Research Database, MEDLINE, Embase, Cochrane COVID-19 Study Register, Centers for Disease Control and Prevention COVID-19 Research Article Database and trial registries to identify completed and ongoing studies on 4 June 2020. SELECTION CRITERIA We followed standard Cochrane methodology. We included studies evaluating convalescent plasma or hyperimmune immunoglobulin for people with COVID-19, irrespective of study design, disease severity, age, gender or ethnicity. We excluded studies including populations with other coronavirus diseases (severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS)) and studies evaluating standard immunoglobulin. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. To assess bias in included studies, we used the Cochrane 'Risk of bias' tool for randomised controlled trials (RCTs), the Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool for controlled non-randomised studies of interventions (NRSIs), and the assessment criteria for observational studies, provided by Cochrane Childhood Cancer for non-controlled NRSIs. MAIN RESULTS: This is the first living update of our review. We included 20 studies (1 RCT, 3 controlled NRSIs, 16 non-controlled NRSIs) with 5443 participants, of whom 5211 received convalescent plasma, and identified a further 98 ongoing studies evaluating convalescent plasma or hyperimmune immunoglobulin, of which 50 are randomised. We did not identify any completed studies evaluating hyperimmune immunoglobulin. Overall risk of bias of included studies was high, due to study design, type of participants, and other previous or concurrent treatments. Effectiveness of convalescent plasma for people with COVID-19 We included results from four controlled studies (1 RCT (stopped early) with 103 participants, of whom 52 received convalescent plasma; and 3 controlled NRSIs with 236 participants, of whom 55 received convalescent plasma) to assess effectiveness of convalescent plasma. Control groups received standard care at time of treatment without convalescent plasma. All-cause mortality at hospital discharge (1 controlled NRSI, 21 participants) We are very uncertain whether convalescent plasma has any effect on all-cause mortality at hospital discharge (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.61 to 1.31; very low-certainty evidence). Time to death (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma prolongs time to death (RCT: hazard ratio (HR) 0.74, 95% CI 0.30 to 1.82; controlled NRSI: HR 0.46, 95% CI 0.22 to 0.96; very low-certainty evidence). Improvement of clinical symptoms, assessed by need for respiratory support (1 RCT, 103 participants; 1 controlled NRSI, 195 participants) We are very uncertain whether convalescent plasma has any effect on improvement of clinical symptoms at seven days (RCT: RR 0.98, 95% CI 0.30 to 3.19), 14 days (RCT: RR 1.85, 95% CI 0.91 to 3.77; controlled NRSI: RR 1.08, 95% CI 0.91 to 1.29), and 28 days (RCT: RR 1.20, 95% CI 0.80 to 1.81; very low-certainty evidence). Quality of life No studies reported this outcome. Safety of convalescent plasma for people with COVID-19 We included results from 1 RCT, 3 controlled NRSIs and 10 non-controlled NRSIs assessing safety of convalescent plasma. Reporting of adverse events and serious adverse events was variable. The controlled studies reported on adverse events and serious adverse events only in participants receiving convalescent plasma. The duration of follow-up varied. Some, but not all, studies included death as a serious adverse event. Grade 3 or 4 adverse events (13 studies, 201 participants) The studies did not report the grade of adverse events. Thirteen studies (201 participants) reported on adverse events of possible grade 3 or 4 severity. The majority of these adverse events were allergic or respiratory events. We are very uncertain whether or not convalescent plasma therapy affects the risk of moderate to severe adverse events (very low-certainty evidence). Serious adverse events (14 studies, 5201 participants) Fourteen studies (5201 participants) reported on serious adverse events. The majority of participants were from one non-controlled NRSI (5000 participants), which reported only on serious adverse events limited to the first four hours after convalescent plasma transfusion. This study included death as a serious adverse event; they reported 15 deaths, four of which they classified as potentially, probably or definitely related to transfusion. Other serious adverse events reported in all studies were predominantly allergic or respiratory in nature, including anaphylaxis, transfusion-associated dyspnoea, and transfusion-related acute lung injury (TRALI). We are very uncertain whether or not convalescent plasma affects the number of serious adverse events. AUTHORS' CONCLUSIONS We are very uncertain whether convalescent plasma is beneficial for people admitted to hospital with COVID-19. For safety outcomes we also included non-controlled NRSIs. There was limited information regarding adverse events. Of the controlled studies, none reported on this outcome in the control group. There is only very low-certainty evidence for safety of convalescent plasma for COVID-19. While major efforts to conduct research on COVID-19 are being made, problems with recruiting the anticipated number of participants into these studies are conceivable. The early termination of the first RCT investigating convalescent plasma, and the multitude of studies registered in the past months illustrate this. It is therefore necessary to critically assess the design of these registered studies, and well-designed studies should be prioritised. Other considerations for these studies are the need to report outcomes for all study arms in the same way, and the importance of maintaining comparability in terms of co-interventions administered in all study arms. There are 98 ongoing studies evaluating convalescent plasma and hyperimmune immunoglobulin, of which 50 are RCTs. This is the first living update of the review, and we will continue to update this review periodically. These updates may show different results to those reported here.


title: Febrile Respiratory Illness Associated with Human Adenovirus Type 55 in South Korea Military, 2014-2016

text: An outbreak of febrile respiratory illness associated with human adenovirus (HAdV) occurred in the South Korea military during the 2014-15 influenza season and thereafter. Molecular typing and phylogenetic analysis of patient samples identified HAdV type 55 as the causative agent. Emergence of this novel HAdV necessitates continued surveillance in military and civilian populations.


title: Risk Evaluation and Mitigation Strategies (REMS) for extended-release and long-acting opioid analgesics: considerations for palliative care practice.

text: Prescription opioid analgesics are an essential treatment option for patients with moderate to severe pain. Over the last decade the increased medical use of these agents has contributed to a public health epidemic of abuse, addiction, and overdose-related deaths. These medications remain mainstays in both primary care and pain management practices. As palliative services are incorporated at earlier stages of the disease process and the number of individuals with chronic illness increases, palliative care specialists may encounter an increasing number of patients with opioid abuse and addiction problems. Extended-release (ER) and long-acting (LA) opioid formulations are administered to patients with moderate to severe chronic pain requiring around-the-clock analgesia. Given the large quantity of active ingredient contained within some dosage strengths, this medication class is associated with serious risks when taken improperly. In response to growing reports of abuse and overdose deaths, the US Food and Drug Administration (FDA) announced the need for a risk mitigation strategy for the entire class of medication. The class-wide Risk Evaluation and Mitigation Strategy (REMS) for ER/LA opioids will emphasize prescriber training and patient education to ensure that the therapeutic benefits outweigh the risks of addiction, unintentional overdose, and death. As primary care, pain management, and palliative care clinicians often encounter patients who require ER/LA opioids, an understanding of the suggested requirements and potential impact of this regulation is essential.


title: Malnutrition, enamel defects, and early childhood caries in preschool children in a sub-urban Nigeria population.

text: OBJECTIVES The study tried to determine if malnutrition (underweight, stunting, wasting, overweight) and enamel defects (enamel hypoplasia, hypomineralized second molar, amelogenesis imperfecta, fluorosis) were associated with early childhood caries (ECC). The study also examined whether malnutrition was associated with the presence of enamel defects in 0-5-year-old children. METHODS The study was a secondary analysis of primary data of a cross-sectional study assessing the association between maternal psychosocial health and ECC in sub-urban Nigerian population collected in December 2018 and January 2019. One hundred and fifty nine children were recruited. Exploratory variables were malnutrition and enamel defects. The outcome variables were the prevalence of ECC in 0-2-year-old, 3-5-year-old, and 0-5-year-old children. Multivariable Poisson regression analysis was used to determine the associations, and socioeconomic status, oral hygiene status, and frequency of in-between-meals sugar consumption were adjusted for. The adjusted prevalence ratios, 95% confidence intervals, and p values were calculated. RESULTS The prevalence of ECC was 2.1% in 0-2-year-old children and 4.9% in 3-5-year-old children. In adjusted models, underweight, stunting, and wasting/overweight were not significant risk indicators for ECC in either age group. 0-2-year-old children who had amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 3-5-year-old children who had hypoplasia (p = 0.004), amelogenesis imperfecta (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. 0-5-year-old children with hypoplasia (p<0.001) and fluorosis (p<0.001) were more likely to have ECC than were children who did not have these lesions. There were significant associations between various types of malnutrition and various types of enamel defects. CONCLUSION Although different types of malnutrition were associated with enamel defects, and enamel defects were associated with ECC, malnutrition was not associated with ECC. Further studies are needed to clarify the association between malnutrition and genetically and toxin-induced enamel defects.


title: The coronavirus nucleocapsid protein is dynamically associated with the replication-transcription complexes.

text: The coronavirus nucleocapsid (N) protein is a virion structural protein. It also functions, however, in an unknown way in viral replication and localizes to the viral replication-transcription complexes (RTCs). Here we investigated, using recombinant murine coronaviruses expressing green fluorescent protein (GFP)-tagged versions of the N protein, the dynamics of its interactions with the RTCs and the domain(s) involved. Using fluorescent recovery after photobleaching, we showed that the N protein, unlike the nonstructural protein 2, is dynamically associated with the RTCs. Recruitment of the N protein to the RTCs requires the C-terminal N2b domain, which interacts with other N proteins in an RNA-independent manner.


title: Heavy viewing: emergent frames in contemporary news coverage of obesity.

text: In the last 10 years, rising rates of obesity in the United States have drawn significant and increasing public attention from various quarters, which has led to commensurately increased news coverage of the issue. A handful of scholars to date have examined how obesity has been "framed" in the news, given that news framing of issues has proven effects on cultural and political attitudes, practices, and policies as regards the subject of coverage. Consistent with these studies, this qualitative framing analysis assesses how obesity is framed in more recent mainstream news coverage. Framing patterns identified in this analysis represent a notable departure from those identified in earlier studies, specifically as relevant to troubling the individual/environmental attribution binary that historically has characterized public discourse around obesity, in particular, and health more broadly. These findings signal important shifts for contemporary cultural attitudes toward obesity and, accordingly, public health policies designed to redress the issue. Further, the findings suggest a reconsideration and elaboration of established tenets of framing theory.


title: Is increased carer knowledge of the health care system associated with decreased preventable hospitalizations for people in the community diagnosed with dementia? A systematic review protocol.

text: BACKGROUND People living with dementia (PLWD) are admitted to hospital twice as often as those without dementia, for ambulatory care sensitive conditions (ACSC) that could have been managed in ambulatory and primary care settings. PLWD are at greater risk of poor outcomes during and following hospital admission. Compared to those without dementia, they are almost twice as likely to die in hospital and two to three times more likely to experience an adverse event. Although some hospitalizations are clinically necessary, there may be a proportion related to ACSC that could be potentially avoided with additional support and education for PLWD and their carers. This study aims to assess the effectiveness of interventions focused on reducing avoidable hospitalization for PLWD by supporting carers to manage the health care needs of the PLWD, via improved awareness and understanding of health and the healthcare system. METHOD Scientific and gray literature will be searched using a combination of keywords pertaining to dementia, caregivers, education, and support. Included studies will involve community-dwelling PLWD and caregivers, with interventions aimed at improving carer's understanding of the healthcare system and ability to manage the caregiving role. The primary outcome will be hospitalization related to the PLWD and secondary outcomes will be carer burden, stress, wellbeing, and quality of life. All study designs will be considered. Data from included studies will be analyzed using descriptive statistics and content analysis. If the data permits, we will perform a meta-analysis and subgroup analyses, related to the intervention and participant characteristics. DISCUSSION This review will provide a comprehensive picture of the knowledge available on the subject and identify knowledge gaps in existing literature. The findings may highlight the lack of existing interventions for PLWD and their carers who live in the community and will help stakeholders to identify needs and develop programs targeted to carers and care recipients that prevent avoidable hospitalization for PLWD. SYSTEMATIC REVIEW REGISTRATION PROSPERO number: 49655 .