title: Defining competencies for safe thyroidectomy: An international Delphi consensus.

text: BACKGROUND Current methods for teaching and assessing competencies that characterize expert intraoperative performance are inconsistent, subjective, and lack standardization. This mixed-methods study was designed to define and establish expert consensus on the most important competencies required to perform a thyroidectomy safely. METHODS Cognitive task analyses for thyroidectomy were performed with semistructured interviews of experts in thyroid surgery. Verbal data were transcribed verbatim, coded, and categorized according to themes that were synthesized into a list of items. Once qualitative data reached saturation, 26 experts were invited to complete 2-round online Delphi surveys to rank each item on a Likert scale of importance (1-7). Consensus was predefined as a Cronbach's α ≥ 0.80. RESULTS Sixty items were synthesized from 5 interviews and categorized into 8 sections: preparation (n = 8), incision/exposure (n = 11), general considerations (n = 4), middle thyroid vein (n = 1), superior pole (n = 5), inferior pole (n = 5), posterolateral dissection (n = 19), and closure (n = 7). Eighteen (69%) experts from 3 countries participated in the Delphi survey. Consensus was achieved after 2 voting rounds (Cronbach's α = 0.95). Greatest weighted sections included "Superior Pole Dissection" and "Posterolateral Dissection." CONCLUSION Consensus was achieved on defining the most important competencies for safe thyroidectomy. This blueprint serves as the basis for instructional design and objective assessment tools to evaluate performance.


title: Transanal rectal foreign body removal using a SILS port.

text: Rectal foreign bodies are being detected more frequently, and their textures, sizes, shapes, and locations are critical considerations when removal and deciding on management plans. Many removal techniques have been described and various theories have been put forward to explain procedural mechanics. Here the authors report a case in which a transanal technique using a SILS port was successfully used.


Covid-19: Push to reopen schools risks new wave of infections, says Independent SAGE.


title: The use of a virtual patient to follow pleural pressure changes associated with therapeutic thoracentesis.

text: PURPOSE Influence of therapeutic thoracentesis on the pleural pressure (Pp) has been discussed in many clinical studies, however reasons of Pp changes are not precisely established. The aim of the study was to use a previously elaborated virtual cardiopulmonary patient (VP) in analysis of impact of physiological factors on Pp during the procedure. METHODS Simulations were performed on VP with default values of parameters for which VP simulated the respiratory system of the average 50-year-old healthy Polish woman according to spirometric examination. Alterations of Pp and the amplitude of Pp changes related to breathing (AP) were analyzed. Model parameters related to chosen factors were deviated from their default values to analyze the degree of their impact on Pp and AP. The analysis was based on and supported by our own clinical data. RESULTS The Pp and AP alteration intensity appeared to be most sensitive to the compliances of the rib cage and mediastinum, and the nonlinearity of the dependence between the recoil pressure and the lung volume: the lower the compliances and the higher the nonlinearity were, the deeper the Pp fall during the procedure and the bigger the AP increase were observed. CONCLUSIONS Experiments in silico are very useful in analyzing sophisticated physiological and medical problems. They made it possible to show which factors are particularly responsible for changes in Pp during thoracentesis. In the future, they may be useful in establishing objective conditions under which thoracentesis needs to be stopped.


The COVID-19 Pandemic: A Watershed Moment to Strengthen Food Security Across the US Food System.


title: Healthcare workers experience in dealing with Coronavirus (COVID-19) pandemic.

text: OBJECTIVES To analyze healthcare workers experiences in dealing with the Coronavirus (COVID-19) pandemic. Methods: An anonymous open web-based survey study was conducted among healthcare workers from the March 2020 to April 2020. A total of 24 relevant questions were asked based on participants' characteristics, obligations, and preparedness in healthcare workers in the event of COVID-19 pandemic. Results: Approximately 1036 healthcare workers participated in this study with high response rate. Out of all the participants, 70% were women, 52% belonged to the 26-34 year age range, 50% were nurses, 33.7% were clinicians, 74.3% agreed to work overtime, 93.1% understand why they should stay past their shift end, 97.7% thought that preventing illness among healthcare workers and providing safety to family members, nearly 94% thought that personal protective equipment (PPE) for employees will enhance their willingness to report to work. Approximately 89.3% express a desire for incentives and financial support for family members. Conclusion: We recommend that providing PPE, reducing psychological stress, financial support and safety to family members of healthcare workers will increase the willingness to report to work.


title: Anti-Coagulant and Anti-Platelet Therapy in the COVID-19 Patient: A Best Practices Quality Initiative Across a Large Health System.

text: The coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health care systems and physicians worldwide to attempt to provide the best care to their patients with an evolving understanding of this unique pathogen. This disease and its worldwide impact have sparked tremendous interest in the epidemiology, pathogenesis, and clinical consequences of COVID-19. This accumulating body of evidence has centered around case series and often empiric therapies as controlled trials are just getting underway. What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. Patients with underlying cardiovascular disease are also at higher risk for morbidity and mortality if infected. These patients are commonly treated with anticoagulation and/or antiplatelet medications and less commonly thrombolysis during hospitalization, potentially with great benefit but management of these medications can be difficult in potentially critically ill patients.In this paper, we review the current guidelines, consensus statements, and emerging evidence for a wide range of cardiovascular disease states with special focus on anticoagulant and antiplatelet therapy. Our goal is to provide guidance for treatment of the cardiovascular patient with COVID-19 in the face of a rapidly evolving understanding of this virus and its complications.Preamble:Anticoagulant and antiplatelet therapies are a major cause of inpatient morbidity and mortality. This is amplified in critically ill patients. COVID-19 patients present special challenges due to rapidly changing clinical status. In an effort to align practice patterns across a large health system (Jefferson Health 2,622 staffed inpatient beds and 319 intensive care unit (ICU) beds across 14 facilities), a task force was assembled to address the utilization of anti-thrombotic and anti-platelet therapy in COVID-19 positive or suspected patients. The task force incorporated experts in Cardiology, Vascular Medicine, Hematology, Vascular Surgery, Pharmacy, and Vascular Neurology. Current guidelines, consensus documents, and policy documents from specialty organizations were used to formulate health system recommendations. Our deliberations and treatment recommendations are summarized here.Objective:To provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19.


title: Acute carotid stenting for treatment of stuttering transient ischemic attacks after recent carotid endarterectomy.

text: Carotid endarterectomy (CEA) is the established standard to treat occlusive extracranial atherosclerotic carotid disease. Complications of CEA must be recognized and dealt with efficiently due to the potentially catastrophic neurologic sequelae. A 67-year-old African American man was transferred from an outside hospital for an acute stroke. He had initially presented with a small right frontal subcortical infarct and had undergone a right CEA 2 days prior to transfer. He had a fluctuating examination with left-sided hemiplegia to slight hemiparesis and inconsistent neglect. Head CT demonstrated a watershed infarct of the right hemisphere. CT angiography demonstrated high grade stenosis at the distal aspect of the CEA anastomosis. He was promptly taken for angiography and underwent acute stenting of the right internal carotid artery. This case demonstrates that carotid artery stenting is a safe management strategy for the treatment of complications associated with failed distal anastomosis during CEA.


Completeness of case ascertainment and availability of environmental data in Legionnaires' disease enhanced surveillance in England, 2012-2014.


title: Our Shared Vulnerability to Dangerous Pathogens.

text: The international community vastly underestimates the risk and scale of our shared vulnerability to fast moving pathogens. Ranging from SARS and novel influenzas to Ebola and Zika, the world seems to be caught off guard, despite the regularity of global health threats historically. More importantly, when governments and international institutions underestimate the threat, they also underinvest in preparedness. Failure to prepare has deep costs in human lives and economic productivity. Here, I offer a pathway to preparedness for, and rapid response to, infectious disease threats: robust and resilient national health systems; strong institutions capable of leading, particularly the World Health Organization; and investments in research and development. Overall, the world needs a strong system of laws and governance, ranging from the International Health Regulations through to norms of transparency and accountability. To secure our common future, the world needs sustained investment and leadership. I propose a 'security dividend', both financial and institutional, to remake the global health security system.


title: Resorbable mesh plate in the treatment of blow-out fracture might cause gaze restriction.

text: Selection of the material for the reconstruction of orbital floor defects is controversial. There are both autogenous and alloplastic materials, each having its own benefits and disadvantages. Resorbable mesh plate is one of the alloplastic implants. Although it has many advantages, the considerable complication related to the mesh is local inflammatory reaction along the infraorbital rim.We present a patient treated using resorbable mesh plate for the orbital floor fracture, in whom gaze restriction in the eye movements was detected because of some fibrotic bands passing through holes of the resorbable mesh.


title: Effect of Cutaneous Heat Pain on Corticospinal Excitability of the Tibialis Anterior at Rest and during Submaximal Contraction.

text: Previous studies have shown that pain can interfere with motor control. The neural mechanisms underlying these effects remain largely unknown. At the upper limb, mounting evidence suggests that pain-induced reduction in corticospinal excitability is involved. No equivalent data is currently available at the lower limb. The present study therefore examined the effect of thermal pain on the corticospinal drive to tibialis anterior (TA) at rest and during an isometric submaximal dorsiflexion. Transcranial magnetic stimulation was used to induce motor-evoked potentials (MEPs) in the TA at rest and during contraction in the presence or absence of cutaneous heat pain induced by a thermode positioned above the TA (51°C during 1 s). With similar pain ratings between conditions (3.9/10 at rest and 3.6/10 during contraction), results indicate significant decreases in MEP amplitude during both rest (-9%) and active conditions (-13%) (main effect of pain, p = 0.02). These results therefore suggest that cutaneous heat pain can reduce corticospinal excitability in the TA muscle and that such reduction in corticospinal excitability could contribute to the interference of pain on motor control/motor learning.


docid: atknevte

title: Screening for dysplasia with Lugol chromoendoscopy in longstanding idiopathic achalasia.

text: BACKGROUND Achalasia patients with longstanding disease are considered to be at risk for developing esophageal cancer. Endoscopic screening is not standardized and detection of dysplastic lesions is difficult, for which Lugol chromoendoscopy could be helpful. Aim was to evaluate the efficacy of screening for esophageal dysplasia and carcinoma in patients with longstanding achalasia using Lugol chromoendoscopy. METHODS In this cohort study achalasia patients underwent three-annual screening by Lugol chromoendoscopy between January 2000 and March 2016. Patients with low-grade dysplasia (LGD) underwent yearly screening, patients with high-grade dysplasia (HGD) or carcinoma were treated. RESULTS In total, 230 achalasia patients (144 male, median age 52 years (IQR 43-63) at first endoscopy) were included. Three patients (1.3%, 2 male, age 68 years (range 50-87)) developed esophageal squamous cell carcinoma (ESCC), without LGD at the preceding screening. Incidence rate for ESCC was 63 (95% CI 13-183) per 100 000 persons-years. LGD was observed in 4 patients (1.7%, 2 male, age 64 years (range 57-73)), without progression to HGD/ESCC during a follow-up of 9 (IQR 7-14) years. ESCC/LGD was diagnosed 30 (IQR 14-36) years after onset of symptoms and 22 (IQR 4-13) years after diagnosis. Lugol chromoendoscopy tripled the detection rate of suspected lesions (111 lesions white light versus 329 lesions Lugol), but only 8% was histopathological confirmed ESCC or LGD. CONCLUSION Achalasia patients with longstanding disease (>20 years) have an increased risk to develop esophageal dysplasia and carcinoma. Endoscopic screening using white light and Lugol chromoendoscopy does not accurately identify precursor lesions for ESCC and therefore cannot be systematically recommended.


title: Robotic surgery: new robots and finally some real competition!

text: PURPOSE For the last 20 years, the predominant robot used in laparoscopic surgery has been Da Vinci by Intuitive Surgical. This monopoly situation has led to rising costs and relatively slow innovation. This article aims to discuss the two new robotic devices for laparoscopic surgery which have received regulatory approval for human use in different parts of the world. MATERIALS A short description of the Senhance Surgical Robotic System and the REVO-I Robot Platform and their pros and cons compared to the Da Vinci system is presented. A discussion about the differences between the three robotic systems now in the market is presented, as well as a short review of the present state of robotic assistance in surgery and where we are headed.


title: Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis.

text: BACKGROUND The serum erythrocyte sedimentation rate and C-reactive protein level, as well as the synovial fluid white blood-cell count with differential, are commonly used tests for the diagnosis of periprosthetic joint infection; however, their utility for the diagnosis of periprosthetic joint infection in patients with inflammatory arthritis is unknown. METHODS Eight hundred and three patients undergoing 871 consecutive hip and knee arthroplasties (including sixty-one in patients with inflammatory arthritis and 810 in patients with noninflammatory arthritis) were prospectively evaluated for periprosthetic joint infection. The erythrocyte sedimentation rate, C-reactive protein level, and synovial fluid white blood-cell count with differential were obtained routinely. Receiver operating characteristic curves were used to establish optimal thresholds for the diagnosis of periprosthetic joint infection, and the area under the curve was calculated to determine the overall accuracy of these tests for patients with inflammatory compared with noninflammatory arthritis. RESULTS The utility of all serum and synovial tests for predicting chronic periprosthetic joint infection was similar for patients with noninflammatory and inflammatory arthritis. The optimal cutoffs in patients with noninflammatory and inflammatory arthritis were 32 and 30 mm/hr, respectively, for the erythrocyte sedimentation rate; 15 and 17 mg/L, respectively, for the C-reactive protein level; 3450/μL and 3444/μL, respectively, for the synovial fluid white blood-cell count; and 78% and 75%, respectively, for the differential. The areas under the curves were similar for the two groups (84.9% and 85.0%, respectively, for the erythrocyte sedimentation rate; 88.5% and 85.1%, respectively, for the C-reactive protein level; 94.5% and 93.8%, respectively, for the synovial fluid white blood-cell count, and 95.0% and 93.6%, respectively, for the differential). Finally, the sensitivities, specificities, negative predictive values, and positive predictive values for all tests were also comparable in both groups. The rate of periprosthetic joint infection was significantly higher following procedures in patients with inflammatory arthritis than following procedures in patients with noninflammatory arthritis (31% compared with 18%; p = 0.013). CONCLUSIONS The erythrocyte sedimentation rate, C-reactive protein level, and synovial fluid white blood-cell count with differential are useful for diagnosing periprosthetic joint infection in patients with inflammatory as well as noninflammatory arthritis, with similar optimal cutoff values and overall testing performance. The synovial fluid white blood-cell count and differential performed the best for the diagnosis of periprosthetic joint infection. Physicians evaluating patients with a failed or painful total hip or knee arthroplasty should not assume that elevation of the erythrocyte sedimentation rate, C-reactive protein level, and synovial fluid white blood-cell count with differential is secondary to inflammatory arthropathy; rather, elevation of these markers may indicate periprosthetic joint infection, and further evaluation for infection is warranted.


title: Corticosteroids for patients with acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials.

text: INTRODUCTION Acute respiratory distress syndrome (ARDS) is a rapidly progressing inflammatory lung disease with a high mortality rate without specific pharmacological therapy. OBJECTIVES We conducted a systematic review and meta-analysis on corticosteroid use in ARDS. METHODS A search of four medical literature databases was conducted. We retained randomized trials (RCTs) of corticosteroids in hospitalized adults with ARDS in a search up to February, 2020. Two reviewers identified eligible studies, independently extracted data, and assessed risk of bias. Authors assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS We included seven RCTs (n=851 patients). Corticosteroids reduced all-cause mortality (risk ratio [RR] 0.75, 95% CI: 0.59 to 0.95, p=0.02, moderate certainty) and duration of mechanical ventilation (mean difference [MD] -4.93 days, 95% CI: -7.81 days to -2.06 days, p<0.001, low certainty), and increased ventilator-free days (VFD) (MD 4.28 days, 95% CI: 2.67 days to 5.88 days, p<0.001, moderate certainty), when compared to placebo. Corticosteroids also increased the risk of hyperglycemia (RR 1.12%, 95% CI: 1.01 to 1.24, p=0.03, moderate certainty), and the effect on neuromuscular weakness was unclear (RR 1.30, 95% CI 0.80 to 2.11, p=0.28, low certainty). CONCLUSIONS These results suggest that systemic corticosteroids may potentially improve mortality, ventilator duration, and VFD in patients with ARDS. However, the studies included different corticosteroid classes and initiated the corticosteroid doses at different times, as well as different dosing regimens. Thus caution in the actual clinical application of these results is recommended.


title: Flow Instability Detected by High-Resolution Computational Fluid Dynamics in Fifty-Six Middle Cerebral Artery Aneurysms.

text: Recent high-resolution computational fluid dynamics (CFD) studies have detected persistent flow instability in intracranial aneurysms (IAs) that was not observed in previous in silico studies. These flow fluctuations have shown incidental association with rupture in a small aneurysm dataset. The aims of this study are to explore the capabilities and limitations of a commercial cfd solver in capturing such velocity fluctuations, whether fluctuation kinetic energy (fKE) as a marker to quantify such instability could be a potential parameter to predict aneurysm rupture, and what geometric parameters might be associated with such fluctuations. First, we confirmed that the second-order discretization schemes and high spatial and temporal resolutions are required to capture these aneurysmal flow fluctuations. Next, we analyzed 56 patient-specific middle cerebral artery (MCA) aneurysms (12 ruptured) by transient, high-resolution CFD simulations with a cycle-averaged, constant inflow boundary condition. Finally, to explore the mechanism by which such flow instabilities might arise, we investigated correlations between fKE and several aneurysm geometrical parameters. Our results show that flow instabilities were present in 8 of 56 MCA aneurysms, all of which were unruptured bifurcation aneurysms. Statistical analysis revealed that fKE could not differentiate ruptured from unruptured aneurysms. Thus, our study does not lend support to these flow instabilities (based on a cycle-averaged constant inflow as opposed to peak velocity) being a marker for rupture. We found a positive correlation between fKE and aneurysm size as well as size ratio. This suggests that the intrinsic flow instability may be associated with the breakdown of an inflow jet penetrating the aneurysm space.


title: Is There a Role for Measuring Synovial Biomarkers for Diagnosis of Infected Total Ankle Arthroplasty (TAA)?

text: RECOMMENDATION Based on the hip and knee arthroplasty literature, measuring synovial biomarkers may play a role in the diagnosis of infected total ankle arthroplasty (TAA). The diagnosis of periprosthetic joint infection (PJI) in the setting of a TAA can be confirmed with cultures, provided that a plausible pathogen is recovered in the context of a compatible clinical picture. In the absence of a positive culture, synovial biomarker analysis may help in establishing the diagnosis. LEVEL OF EVIDENCE Moderate. DELEGATE VOTE Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus).


title: Global Research Trends in Lithium Toxicity from 1913 to 2015: A Bibliometric Analysis.

text: Lithium salts have been used to treat psychiatric disorders since the 1940s and are currently used in prophylaxis and treatment of depression and bipolar disorder. Therefore, we conducted this study to assess lithium toxicity-related publications using bibliometric approaches from a health point of view to assess global research trends in the lithium toxicity field to offer guidance to future research in this field. The data were retrieved from the online version of Scopus database on 6 August 2016. All records with the term 'lithium' in the title were retrieved, and those related to lithium toxicity were evaluated. There were a total of 1241 publications related to lithium toxicity published from 1913 to 2016. Articles (971 or 78.2%) were the most common type, followed by letters (179 or 14.4%) and reviews (61 or 4.9%). The annual publication of articles increased slightly after 1950 and the total number of publications related to lithium toxicity fluctuated with three peaks occurred in 1978, 1985 and 2014. The USA was the predominant country (25.38%), followed by the UK (7.82%), France (6.85%) and Canada (3.55%). Denmark had the highest productivity of publication after standardization by gross domestic product and population size. The average number of citations per article was 9.24, and the h-index for all publications in the field of lithium toxicity was 46. The highest h-index value was achieved by the USA (31) followed by the UK (21) and Canada (13). The Lancet was the highest ranked journal with 27 articles, followed by American Journal of Psychiatry with 23 articles. This study provides a bibliometric analysis on the global research trends in lithium toxicity studies during 1913-2015. There has been a progressive increase in the number of publications related to lithium toxicity published in the last decade, and most of the studies related to lithium toxicity arose from the USA and the UK.


title: Clinical use of a cordless laparoscopic ultrasonic device.

text: OBJECTIVE On April 25, 2012, the first laparoscopic cordless ultrasonic device (Sonicision, Covidien, Mansfield, Massachusetts) was used in a clinical setting. We describe our initial experience. METHODS The cordless device is assembled with a reusable battery and generator on a base hand-piece. It has a minimum and maximum power setting controlled by a single trigger for both coagulation and cutting. A laparoscopic radical nephrectomy was performed on a 56-year-old man with a 7-cm right renal mass. A laparoscopic pelvic lymphadenectomy was performed in a 51-year-old man with high-risk prostate cancer. Data on surgical team satisfaction, operative time, number of activations, and times the laparoscope was removed as a result of plume were collected. RESULTS The surgical technician successfully assembled the device at the beginning of the cases with verbal instructions from the surgeon. Operative time for nephrectomy was 77 minutes, with 143 total activations (minimum = 86, maximum = 57). The operative time for the pelvic lymphadenectomy was 27 minutes, with 38 total activations (minimum = 27, maximum = 11). One battery was used in each case. The laparoscope was removed twice during the nephrectomy and once during the lymphadenectomy. Surgical staff satisfaction survey results revealed easier and faster assembly, more space in the operating room, ergonomic handle, and comparable cutting/coagulation, weight, and plume generation with other devices (Table 1). [Table: see text]. CONCLUSION The first clinical application of the pioneering cordless dissector was successfully performed, resulting in surgeons' perceptions of comparable results with other devices of easier and safer use and faster assembly.


title: Acute carotid artery stenting in symptomatic high-grade cervical carotid artery stenosis.

text: The safety and efficacy of emergency carotid artery stenting (CAS) for patients with acute ischemic stroke resulting from internal carotid artery stenosis are not established. In this retrospective study, we evaluated outcomes for CAS performed within 2 weeks of acute ischemic stroke for 16 patients treated between December 2009 and February 2014. Cases of internal carotid artery occlusion, internal carotid dissection, or intracranial major arterial trunk occlusion were excluded. Five patients were treated with CAS during the hyperacute phase (within 24 h of stroke onset), three in the advanced phase (within 24 h of stroke-in-evolution after admission), and eight in the acute phase (24 h to 2 weeks after onset). We evaluated modified Rankin scale (mRS) scores 90 days after CAS. For patients treated during the hyperacute phase without intravenous tissue-type plasminogen activator (IV-tPA), two had mRS scores of 2 and one had a score of 3. Two patients treated in the hyperacute phase with IV-tPA had scores of 5: one with symptomatic intracerebral hemorrhage and the other with acute brain swelling. For patients treated in the advanced phase, mRS scores were 1, 3, and 5; the patient with 5 had contralateral cerebral infarction. All patients treated in the acute phase had scores of 2 or lower. Patients treated with IV-tPA in advanced or acute phases had no severe post-CAS complications. CAS was effective and safe for treating ischemic stroke within 2 weeks of onset. However, IV-tPA treatment may be a risk factor for CAS treatment during the hyperacute phase.


title: Analysis of open and intracorporeal robotic assisted radical cystectomy shows no significant difference in recurrence patterns and oncological outcomes.

text: OBJECTIVES To report and compare early oncological outcomes and cancer recurrence sites among patients undergoing open radical cystectomy (ORC) and robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). METHODS AND MATERIALS A total of 184 patients underwent radical cystectomy for bladder cancer. ORC cases (n = 94) were performed between June 2005 and July 2014 while iRARC cases (n = 90) were performed between June 2011 and July 2014. Primary outcome was recurrence free survival (RFS). Secondary outcomes were sites of local and metastatic recurrence, cancer specific survival (CSS) and overall survival (OS). RESULTS Median follow-up for patients without recurrence was 33.8 months (interquartile range [IQR]: 20.5-45.4) for ORC; and 16.1 months (IQR: 11.2-27.0) for iRARC. No significant difference in age, sex, precystectomy T stage, precystectomy grade, or lymph node yield between ORC and iRARC was observed. The ORC cohort included more patients with≥pT2 (64.8% ORC vs. 38.9% iRARC) but fewer pT0 status (8.5% ORC vs.vs. 22.2% iRARC) due to lower preoperative chemotherapy use (22.3% ORC vs. 34.4% iRARC). Positive surgical margin rate was significantly higher in the ORC cohort (19.3% vs. 8.2%; P = 0.042). Kaplan-Meir analysis showed no significant difference in RFS (69.5% ORC vs. 78.8% iRARC), cancer specific survival (80.9% ORC vs. 84.4% iRARC), or OS (73.5% ORC vs.vs. iRARC 83.8%) at 24 months. Cox regression analysis showed RFS, cancer specific survival and OS were not influenced by cystectomy technique. No significant difference between local and metastatic RFS between ORC and iRARC was observed. CONCLUSION This study has found no difference in recurrence patterns or oncological outcomes between ORC and iRARC. Recurrent metastatic sites vary, but are not related to surgical technique.


title: Cardiac patient care during a pandemic: how to reorganise a heart failure unit at the time of COVID-19.

text: Still it was not absolutely the plague; the use of the word was prohibited, it was a pestilential fever, the adjective was preferred to the substantive, - then, not the true plague, - that is to say, the plague, but only in a certain sense, - and further, combined with poison and witchcraft. Such is the absurd trifling with which men seek to blind themselves, wilfully abstaining from a sound exercise of judgment to arrive at the truth. Alessandro Manzoni, The Betrothed.


COVID-19 Psychological Impact in 3109 Healthcare workers in Spain: The PSIMCOV Group.


title: Peptidase inhibitors in the MEROPS database.

text: The MEROPS website (http://merops.sanger.ac.uk) includes information on peptidase inhibitors as well as on peptidases and their substrates. Displays have been put in place to link peptidases and inhibitors together. The classification of protein peptidase inhibitors is continually being revised, and currently inhibitors are grouped into 67 families based on comparisons of protein sequences. These families can be further grouped into 38 clans based on comparisons of tertiary structure. Small molecule inhibitors are important reagents for peptidase characterization and, with the increasing importance of peptidases as drug targets, they are also important to the pharmaceutical industry. Small molecule inhibitors are now included in MEROPS and over 160 summaries have been written.


title: Detection of Brain Hypoxia Based on Noninvasive Optical Monitoring of Cerebral Blood Flow with Diffuse Correlation Spectroscopy.

text: BACKGROUND Diffuse correlation spectroscopy (DCS) noninvasively permits continuous, quantitative, bedside measurements of cerebral blood flow (CBF). To test whether optical monitoring (OM) can detect decrements in CBF producing cerebral hypoxia, we applied the OM technique continuously to probe brain-injured patients who also had invasive brain tissue oxygen (PbO2) monitors. METHODS Comatose patients with a Glasgow Coma Score (GCS) < 8) were enrolled in an IRB-approved protocol after obtaining informed consent from the legally authorized representative. Patients underwent 6-8 h of daily monitoring. Brain PbO2 was measured with a Clark electrode. Absolute CBF was monitored with DCS, calibrated by perfusion measurements based on intravenous indocyanine green bolus administration. Variation of optical CBF and mean arterial pressure (MAP) from baseline was measured during periods of brain hypoxia (defined as a drop in PbO2 below 19 mmHg for more than 6 min from baseline (PbO2 > 21 mmHg). In a secondary analysis, we compared optical CBF and MAP during randomly selected 12-min periods of "normal" (> 21 mmHg) and "low" (< 19 mmHg) PbO2. Receiver operator characteristic (ROC) and logistic regression analysis were employed to assess the utility of optical CBF, MAP, and the two-variable combination, for discrimination of brain hypoxia from normal brain oxygen tension. RESULTS Seven patients were enrolled and monitored for a total of 17 days. Baseline-normalized MAP and CBF significantly decreased during brain hypoxia events (p < 0.05). Through use of randomly selected, temporally sparse windows of low and high PbO2, we observed that both MAP and optical CBF discriminated between periods of brain hypoxia and normal brain oxygen tension (ROC AUC 0.761, 0.762, respectively). Further, combining these variables using logistic regression analysis markedly improved the ability to distinguish low- and high-PbO2 epochs (AUC 0.876). CONCLUSIONS The data suggest optical techniques may be able to provide continuous individualized CBF measurement to indicate occurrence of brain hypoxia and guide brain-directed therapy.


title: An experimental model of neonatal normocapnic hypoxia and resuscitation in Landrace/Large White piglets.

text: OBJECTIVE The aim of this study is to describe and evaluate an experimental model of neonatal normocapnic hypoxia and resuscitation. METHODS Ten male Landrace/Large White neonatal piglets were studied. Following anaesthesia and intubation, the animals were mechanically ventilated. Surgical procedures included catheterization of the right internal jugular vein and the carotid artery. After stabilization with 21% O(2), normocapnic hypoxia was induced by decreasing the inspired O(2) to 6-8%. When piglets developed bradycardia (heart rate < 60 beats/min), reoxygenation was initiated by administering 21% O(2). Arterial blood samples were taken during baseline, hypoxia and reoxygenation in order to measure interleukine-6 and interleukine-8. RESULTS Nine out of ten animals were successfully resuscitated (one of these required chest compressions and a dose of adrenaline) and one died despite resuscitation efforts. After returning to baseline haemodynamic values, euthanasia was performed using thiopental overdose. CONCLUSIONS Haemodynamic fluctuations at baseline, during normocapnic hypoxia and reoxygenation in Landrace/Large White piglets are comparable to that in human neonates, making the breed a favorable model of human neonatal hypoxia investigation.


title: Endoscopic solutions for weight loss.

text: PURPOSE OF REVIEW Gastroenterologists will likely play a critical role in the treatment of obesity and its comorbidities, as novel endoluminal approaches demonstrate their safety and efficacy over the coming years. Understanding the relative advantages and shortcomings of the endoscopic tools and procedures currently under investigation will provide the gastroenterologist with valuable insight into the future of endoscopic procedures for weight loss. RECENT FINDINGS Endoscopic restrictive procedures, intestinal sleeves, and intragastric balloons have demonstrated short-term efficacy in inducing weight reduction and in reversing the comorbidities of obesity with an acceptable risk profile. Several endoscopic tools have also demonstrated effectiveness as revisional tools for reversing weight gain after bariatric surgery. SUMMARY A plethora of endoscopic tools and procedures are under investigation for primary and revisional obesity management, and these may offer new weight loss options to a variety of different patient populations.


title: Adhesion prevention in ventral hernia repair: an experimental study comparing three lightweight porous meshes recommended for intraperitoneal use.

text: BACKGROUND In ventral hernia repair, when prosthetic material is placed intraperitoneally, it may lead to an inflammatory reaction resulting in adhesions between the mesh and abdominal viscera. Several meshes have been developed to minimize this process. In this experimental study, the ability of different combined meshes to attenuate the adhesion formation was examined. METHODS Three commercially available lightweight porous combined meshes were placed intraperitoneally to repair an abdominal wall defect in rats: DynaMesh-IPOM (PVDF + PP), TiMesh (titanium-coated filament PP) and C-QUR/FX (omega-3 fatty acid-coated filament PP). The DynaMesh-CICAT (PVDF) was implanted in the control group. Adhesion formation was macroscopically evaluated and scored after 7 and 21 days. RESULTS All animals except two presented intra-abdominal adhesions. None of the meshes examined in the study demonstrated to prevent adhesions. C-QUR/FX reduced adhesion formation at 7 days' follow-up compared with all other meshes but by 21 days this effect was diminished. Between 7 and 21 days adhesion extension significantly decreased for TiMesh. TAS did not show significant modifications between 7 and 21 days' follow-up for each mesh. CONCLUSIONS The combined porous meshes tested in the present study demonstrated to reduce but not to prevent the adhesion formation, even if with some differences. Combined porous meshes could be chosen instead of simple meshes for retro-rectus preperitoneal prosthetic ventral hernia repair.


docid: jpdeaefp

title: Mast cells in Canine parvovirus-2-associated enteritis with crypt abscess.

text: The role of mast cells (MCs) in allergic reactions and parasitic infections is well established. Their involvement in host immune response against bacterial and viral infections is reported. In this study, investigation is made to determine if MCs are associated with Canine parvovirus-2 (CPV-2)-induced enteritis with crypt abscess (ECA). Mast cell count (MCC) was made on toluidine blue-stained intestinal sections from a total of 34 dogs. These included 16 dogs exhibiting ECA positive for CPV-2 and negative for Canine distemper virus and Canine coronavirus by immunohistochemistry and fluorescent antibody test, 12 dogs with inflammatory bowel disease (IBD), and 6 non-ECA/non-IBD (control) dogs. The average total MCC per high-power field in ECA (40.8 ± 2.2) and IBD (24.7 ± 2.1) was significantly higher (P < .05) than in the control (3.4 ± 0.6). Although not significant (P > .05), MCC was also higher in ECA than in IBD. The present study for the first time has documented significantly increased MCs in CPV-2-associated ECA as was previously reported for IBD, showing that MCs may also play an important role in CPV-2-associated ECA. Further studies involving more CPV-infected dogs are recommended to substantiate the findings.


title: Cost-effectiveness of Continuous Positive Airway Pressure Treatment in Moderate-Severe Obstructive Sleep Apnea Syndrome.

text: INTRODUCTION The socioeconomic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) is considerable. The aim of this study was to evaluate the cost-effectiveness of treating OSAHS with continuous positive airway pressure (CPAP) and the impact of CPAP compliance. METHODS This was a retrospective, case-crossover study of 373 patients with OSAHS receiving CPAP. We compared changes in costs, Epworth score and health-related quality of life (EQ-5D questionnaires) between the year before treatment and the year after treatment. The incremental cost-effectiveness ratio (ICER) for the first year of treatment was estimated, and projections were made for the second year, using different effectiveness and cost scenarios. RESULTS The visual analog scale score for the EQ-5D questionnaire increased by 5 points and the Epworth score fell by 10 points during the year of CPAP treatment. Mean gain in quality-adjusted life years (QALY) was 0.05 per patient per year (P<.001): 0.07 among compliers and -0.04 among non-compliers. ICER was €51,147/QALY during the first year of CPAP treatment and €1,544/QALY during the second year. CONCLUSION CPAP treatment in patients with moderate-severe OSAHS improves the quality of life of compliant patients, and is cost-effective as of the second year.


title: Minimal invasive single-site surgery in colorectal procedures: Current state of the art.

text: BACKGROUND Minimally invasive single-site (MISS) surgery has recently been applied to colorectal surgery. We aimed to assess the current state of the art and the adequacy of preliminary oncological results. METHODS We performed a systematic review of the literature using Pubmed, Medline, SCOPUS and Web of Science databases. Keywords used were "Single Port" or "Single-Incision" or "LaparoEndoscopic Single Site" or "SILS™" and "Colon" or "Colorectal" and "Surgery". RESULTS Twenty-nine articles on colorectal MISS surgery have been published from July 2008 to July 2010, presenting data on 149 patients. One study reported analgesic requirement. The final incision length ranged from 2.5 to 8 cm. Only two studies reported fascial incision length. There were two port site hernias in a series of 13 patients (15.38%). Two "fully laparoscopic" MISS procedures with preparation and achievement of the anastomosis completely intracorporeally are reported. Future site of ileostomy was used as the sole access for the procedures in three studies. Lymph node harvesting, resection margins and length of specimen were sufficient in oncological cases. CONCLUSIONS MISS colorectal surgery is a challenging procedure that seems to be safe and feasible, but the existing clinical evidence is limited. In selected cases, and especially when an ileostomy is planned, colorectal surgery may be an ideal indication for MISS surgery leading to a no-scar surgery. Despite preliminary oncological results showing the feasibility of MISS surgery, we want to stress the need to standardize the technique and carefully evaluate its application in oncosurgery under ethical committee control.


Flow Diversion for the Treatment of an Unruptured Paraclinoid Carotid Artery Aneurysm.


title: Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review.

text: The aim of this article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on "clinical trials" and "randomised controlled trials". The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1), SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.


title: Single-Incision Pediatric Endosurgery Cholecystectomy Performed by Residents in Children with Sickle Cell Disease.

text: Introduction: Few centers worldwide have advanced single-incision pediatric endosurgery (SIPES) for pediatric age group. Up to our knowledge this is the first study assessing the safety of SIPES cholecystectomy in children with sickle cell disease (SCD) done by surgical residents. Aims: To determine the feasibility, safety, and expediency of SIPES cholecystectomy in children with SCD performed by surgical residents. Materials and Methods: Retrospective study of all SIPES cholecystectomies performed in our unit from April 1, 2011 to March 31, 2018. We compared the outcome of SIPES cholecystectomy done by fellows and residents. SIPES Covidien 5-12 mm port was inserted through umbilicus. Long 50 cm laparoscope, straight regular instruments, and transabdominal gallbladder traction suture were used in all patients. The cystic duct and artery were identified and divided. The gallbladder is then dissected off the liver and extracted from the abdomen through the port. Results: Forty-three SCD patients underwent SIPES cholecystectomy for 7 years. Mean HbS was 37.56%. Mean age was 10 years. Twenty-four cases (56%) and 19 (44%) were performed by 8 fellows and 10 residents, respectively. Nine other procedures were done simultaneously with cholecystectomy and were excluded from the mean operative time (MOT). The MOT for all cases was 85 minutes, 78 minutes for fellows and 94 minutes for residents (P value is <.001). One extra port was inserted in 2 patients at the beginning of the series. Conclusion: SIPES cholecystectomy in children with SCD is safe and feasible if done by residents under supervision. Stepwise training is essential in this challenging surgery. Involving residents with other SIPES procedures and hands-on minimally invasive surgery single port workshops help them in improving their skills.


Seven days in medicine: 5-11 Feb 2020.


Weighting evidence in MS: Obesity and neurodegeneration.


title: Development of novel entry inhibitors targeting emerging viruses.

text: Emerging viral diseases pose a unique risk to public health, and thus there is a need to develop therapies. A current focus of funding agencies, and hence research, is the development of broad-spectrum antivirals, and in particular, those targeting common cellular pathways. The scope of this article is to review screening strategies and recent advances in this area, with a particular emphasis on antivirals targeting the step of viral entry for emerging lipid-enveloped viruses such as Ebola virus and SARS-coronavirus.


title: Role of the Akt pathway in mRNA translation of interferon-stimulated genes.

text: Multiple signaling pathways are engaged by the type I and II IFN receptors, but their specific roles and possible coordination in the generation of IFN-mediated biological responses remain unknown. We provide evidence that activation of Akt kinases is required for IFN-inducible engagement of the mTOR/p70 S6 kinase pathway. Our data establish that Akt activity is essential for up-regulation of key IFN-alpha- and IFN-gamma-inducible proteins, which have important functional consequences in the induction of IFN responses. Such effects of the Akt pathway are unrelated to regulatory activities on IFN-dependent STAT phosphorylation/activation or transcriptional regulation. By contrast, they reflect regulatory activities on mRNA translation via direct control of the mTOR pathway. In studies using Akt1 and Akt2 double knockout cells, we found that the absence of Akt kinases results in dramatic reduction in IFN-induced antiviral responses, establishing a critical role of the Akt pathway in IFN signaling. Thus, activation of the Akt pathway by the IFN receptors complements the function of IFN-activated JAK-STAT pathways, by allowing mRNA translation of IFN-stimulated genes and, ultimately, the induction of the biological effects of IFNs.


title: Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: a near-infrared spectroscopy-based study.

text: OBJECTIVE The purpose of this study was to determine whether therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation measured by near-infrared spectroscopy. METHODS The study included 10 preterm infants at 34-40 weeks' corrected age. Oxyhaemoglobin (Oxy-Hb) concentration, heart rate (HR), arterial oxygen saturation (SaO2) and body movements were recorded during low-intensity sensory punctate stimulation for 1 s with and without therapeutic touch by a neonatal development specialist nurse. Each stimulation was followed by a resting phase of 30 s. All measurements were performed with the infants asleep in the prone position. RESULTS sensory punctate stimulus exposure significantly increased the oxy-Hb concentration but did not affect HR, SaO2 and body movements. The infants receiving therapeutic touch had significantly decreased oxy-Hb concentrations over time. CONCLUSIONS Therapeutic touch in preterm infants can ameliorate their sensory punctate stimulus response in terms of brain activation, indicated by increased cerebral oxygenation. Therefore, therapeutic touch may have a protective effect on the autoregulation of cerebral blood flow during sensory punctate stimulus in neonates.


title: Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative.

text: The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at centre and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%); 2 antibiotic prophylaxis before EUS-guided puncture of cystic lesions (key performance measure, at least 95%); 3 bile duct cannulation rate (key performance measure, at least 90%); 4 tissue sampling during EUS (key performance measure, at least 85%); 5 appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%); 6 bile duct stone extraction (key performance measure, at least 90%); 7 post-ERCP pancreatitis (key performance measure, less than 10%); and 8 adequate documentation of EUS landmarks (minor performance measure, at least 90%). This present list of quality performance measures for ERCP and EUS recommended by the ESGE should not be considered to be exhaustive; it might be extended in future to address further clinical and scientific issues.


title: The expanding realm of endovascular neurosurgery: flow diversion for cerebral aneurysm management.

text: The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden the endovascular therapeutic spectrum for varied aneurysm morphology.


title: A highly prevalent and genetically diversified Picornaviridae genus in South Asian children.

text: Viral metagenomics focused on particle-protected nucleic acids was used on the stools of South Asian children with nonpolio acute flaccid paralysis (AFP). We identified sequences distantly related to Seneca Valley virus and cardioviruses that were then used as genetic footholds to characterize multiple viral species within a previously unreported genus of the Picornaviridae family. The picornaviruses were detected in the stools of >40% of AFP and healthy Pakistani children. A genetically diverse and highly prevalent enteric viral infection, characteristics similar to the Enterovirus genus, was therefore identified substantially expanding the genetic diversity of the RNA viral flora commonly found in children.


title: Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study.

text: STUDY OBJECTIVE To evaluate risk of leakage and tissue dissemination associated with various contained tissue extraction (CTE) techniques. DESIGN In vitro study (Canadian Task Force classification: II-1). SETTING Academic hospital simulation laboratory. INTERVENTION Beef tongue specimens weighing 400 to 500 g were stained using 5 mL indigo carmine dye and morcellated under laparoscopic guidance within a plastic box trainer. CTE was performed via 3 different techniques: a stitch-sealed rip-stop nylon bag and multi-port approach; a one-piece clear plastic 50 × 50-cm isolation bag and multi-port approach; or a 1-piece clear plastic 50 × 50-cm isolation bag and single-site approach. Four trials of each CTE method were performed and compared with an open morcellation control. All bags were insufflated to within 10 to 25 mmHg pressure with a standard CO2 insufflator. Visual evidence of spilled tissue or dye was recorded, and fluid washings of the box trainer were sent for cytologic analysis. MEASUREMENTS AND MAIN RESULTS Blue dye spill was noted in only 1 of 12 CTE trials. Spillage was visualized from a seam in 1 of the 4 stitch-sealed rip-stop nylon bags before morcellation of the specimen. The only trial in which gross tissue chips were visualized in the box trainer after morcellation was the open morcellation control. However, cytologic examination revealed muscle cells in the open morcellation washings and in the washings from the trial with dye spill. Muscle cells were not observed at cytologly in any of the other samples. CONCLUSION CTE did not result in any leakage or tissue dissemination with use of the single-site or multi-port approach when using a 1-piece clear plastic 50 × 50-cm isolation bag. Further studies are needed to corroborate these findings in an in vivo context and to evaluate use of alternate bag options for specimen containment.


title: Prenatal exposure to organic pollutants in northwestern Spain using non-invasive matrices (placenta and meconium).

text: Human exposure to environmental organic pollutants (OPs) begins in the uterine life period by trans-placental transfer. Epidemiological studies have consistently demonstrated the vulnerability of human fetuses and infants to the effects of OPs because of their rapid growth and organ development, cell differentiation, and immaturity of metabolism. The aim of the present study was to evaluate the prenatal exposure to OPs characterized by different physicochemical properties using non-invasive biological samples (meconium and placenta). A total of 88 placenta and 53 meconium samples were collected in Ourense, a city located in northwestern Spain, at the delivery and after birth from mothers and their infants from the University Hospital of Ourense, respectively. Selective pressurized liquid extraction (SPLE) methodologies were used to determine the targeted OPs in the selected biological samples. Cleanup of extracts was performed by solid-phase extraction (SPE) using EZ-POP cartridges and detection by gas chromatography (GC) coupled to tandem mass spectrometry (QqQ-MS/MS). The targeted OPs were detected with the following mean level total concentration order polycyclic aromatic hydrocarbons (PAHs) > organophosphorus pesticides (OPPs) > non-dioxin like polychlorinated biphenyls (NDLPCBs) > pyrethroids (PYRs) > polybrominated diphenyl ethers (PBDEs) > dioxin like polychlorinated biphenyls (DLPCBs) > organochlorine pesticides (OCPs) for placenta and ΣNDLPCBs > ΣPAHs > ΣOCPs > ΣPYRs > ΣOPPs > ΣDLPCBs > ΣPBDEs for meconium, respectively. Significant correlations (p < .050) between the socio-demographic characteristics of the selected population (mother's parity, age, weight increase during pregnancy, place of living and smoking habits) and log transformed concentration of some of the targeted OPs (OCPs, PBDEs, PYRs, OPPs and PAHs) were detected. The results obtained shown the complementary information given by both biological samples selected. Nevertheless, additional research will be needed to gain an understanding of the trans-placental transfer of OPs, to choose the best biological matrix to evaluate the prenatal exposure to OPs in a correct way and to know their health implications.


Risk of COVID-19 in Patients With Cancer.


title: Impact of intravenous phenylephrine bolus administration on the nociceptive level index (NOL).

text: Recently, the nociceptive level index (NOL) was shown to more specifically and sensitively detect noxious stimuli during anesthesia, in comparison to previous methods that relied on such parameters as heart rate (HR) and mean blood pressure (MAP). An ongoing study (NCT#03410485) evaluates the intraoperative combination of both NOL and bispectral (BIS) indices to improve quality of recovery after colorectal surgery. Our ethical committee (REB approval #CER15083) initially agreed on an interim analysis of the data from the first 30 patients. More specifically, this present report analyzed all the intravenous phenylephrine (PE) boluses administered during anesthesia as part of our study protocol to see whether they had a significant impact on NOL values as well as other parameters: HR, MAP, BIS index. For this trial, remifentanil and phenylephrine were given in both groups based on a specific algorithm. All study parameters were recorded electronically. Our analysis for the present specific outcome evaluated NOL index for 30 s before the intravenous PE bolus (1 µg kg-1) was given and until 5 min afterwards. The average NOL values after PE bolus, as well as MAP, HR and BIS indices, were recorded and analyzed. A total of 178 events of PE boluses were identified for 28 patients (two were excluded). Median baseline NOL was 3 (1.8-8.3) CI 95% 5.7-8.7; post-PE bolus: 5.3 (2.7-9.9) (95% CI 6.6-8.9; Wilcoxon matched-pairs signed rank test (WMPSRT), P = 0.0003). When analyzing delta NOL (difference between pre- and post-PE bolus in NOL values) for each patient, the median delta NOL was 2.9 (1.2-6.1) (95% CI 3.6-5.5) with 95% of the subjects keeping a delta NOL under 10. MAP and HR values showed expected significant variations after PE bolus: a slight increase and slight decrease, respectively. BIS index values did not change after PE bolus. Our present results demonstrate that intravenous phenylephrine boluses of 1 µg kg-1 had the expected impact on hemodynamic parameters: a significant but very slight increase in MAP and decrease in HR, which might lack clinical relevance. Our report also demonstrates that these same phenylephrine boluses induce a statistically significant increase of the NOL index which does not seem to have much of a clinical relevance for the novel NOL index used to monitor intraoperative nociception as well as for the more classical BIS index for depth of anesthesia. Nevertheless, doses of intravenous PE bolus used in the present study (1 µg kg-1) might be regarded as smaller than more conventional ones (100-200 µg per bolus). Further studies need to be done with the latter doses.


title: Communication and social capital in the control of avian influenza: lessons from behaviour change experiences in the Mekong Region.

text: International development agencies, national governments, and nongovernmental organizations are increasingly collaborating with local civil society groups in mounting behaviour change communication (BCC) interventions. Even in countries with weakened civil societies, the social capital of local organizations can be a fundamental communication resource. The experience of three programmes in the Mekong Region that used BCC to prevent and control outbreaks of avian influenza bore out this finding. These programmes worked with the Vietnam Women's Union to mobilize local women as conduits for education; worked with the Centre d'Etude et de Developpement Agricole Cambodgien (CEDAC), in Cambodia, to educate and train village health promoters and model farmers; and worked with the Lao Journalists Association to educate and build skills among print and broadcast journalists to enhance avian influenza coverage. Collaborating with civil society organizations can enhance communication reach, trust, and local ownership, but poses many challenges, particularly institutional capacity. Our experience, nevertheless, holds promise for a measured approach that views social capital as a set of communication resources at the community level that can be mobilized to promote complex behaviours, particularly in a rapidly changing outbreak situation.


title: Aldolase C is a novel molecular marker for folliculo-stellate cells in rodent pituitary.

text: The anterior pituitary gland is composed of five types of hormone-producing cells and folliculo-stellate cells. Folliculo-stellate cells do not produce anterior pituitary hormones but they are thought to play important roles as stem cells, phagocytes, or supporting cells of hormone-producing cells in the anterior pituitary. S100β protein has been used as a folliculo-stellate cell marker in some animals, including rats. However, since no reliable molecular marker for folliculo-stellate cells has been reported in mice, genetic approaches for the investigation of folliculo-stellate cells in mice are not yet available. Aldolase C/Zebrin II is a brain-type isozyme and is a fructose-1,6-bisphosphate aldolase. In the present study, we first used immunohistochemistry to verify that aldolase C was produced in the anterior pituitary of rats. Moreover, using transgenic rats expressing green fluorescent protein under the control of the S100β gene promoter, we identified aldolase C-immunoreactive signals in folliculo-stellate cells and marginal cells located in the parenchyma of the anterior pituitary and around Rathke's cleft, respectively. We also identified aldolase C-expressing cells in the mouse pituitary using immunohistochemistry and in situ hybridization. Aldolase C was not produced in any pituitary hormone-producing cells, while aldolase C-immunopositive signal co-localized with E-cadherin- and SOX2-positive cells. Using post-embedding immunoelectron microscopy, aldolase C-immunoreactive products were observed in the cytoplasm of marginal cells and folliculo-stellate cells of the mouse pituitary. Taken together, aldolase C is a common folliculo-stellate cell marker in the anterior pituitary gland of rodents.


title: Unanswered questions in thrombolytic therapy for acute ischemic stroke.

text: This article reviews some of the current literature in support or against extension of the intravenous tissue plasminogen activator window, use of intra-arterial therapy or devices, as well alternative pharmacologic therapies that may extend the window for treatment of patients with acute ischemic stroke, with consideration of the relative risk of thrombolytic complications, factors for worse outcomes, and unclear stroke onset, as seen in patients with wake-up stroke. The issue of newer concomitant antithrombotic therapies as they affect the decision for acute ischemic stroke thrombolytic therapy is also explored.


title: Sydney contained in bag morcellation for laparoscopic myomectomy.

text: STUDY OBJECTIVE To demonstrate a new technique of contained in bag morcellation of a myoma after laparoscopic myomectomy. DESIGN Step-by-step explanation of the technique in a narrated video. INTERVENTION Contained In Bag Morcellation of myoma after laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS Recent controversy regarding the risk of disseminating occult leiomyosarcomatous tissue during morcellation means we need to revise our current approach to tissue extraction at laparoscopic myomectomy and morcellation in general. Herein we present a novel technique, conceived by Dr. Danny Chou, called the Sydney Contained In Bag Morcellation technique for laparoscopic myomectomy. In this technique an EndoCatch bag (EndoCatch II Auto Suture Specimen Retrieval Pouch; Covidien, Mansfield, MA) is introduced in the typical fashion, the myoma is retrieved, and the mouth of the bag is exteriorized onto the abdominal wall. A 12-mm trocar is then introduced within the bag, and pneumoperitoneum is created before introducing an optical balloon tip port (KII Balloon Blunt Tip System; Applied Medical, Rancho Santa Margarita, CA) and the power morcellator device. Morcellation is then performed within the bag, under direct vision. This technique may offer a safer approach to morcellation because the bowel is not within the morcellation field and there is lower risk of disseminating occult leiomyosarcomatous tissue during morcellation. Subsequent to the morcellation process, suctioning of the bag removes any aerosolized particles of myoma, further minimizing the risk of possible dissemination. CONCLUSION This technique may enable a minimally invasive approach to myomectomy to continue as a viable option in the era since the warning by the US Food and Drug Administration.


title: Repositioning of Cranial Bone Flaps Cut with a Diamond-Coated Threadwire Saw: 5-Year Experience with Cosmetic Cranioplasty without Fixation Devices.

text: Artificial fixation systems for cranial bone flaps have problems related to their materials and designs. We developed an alternative technique for supratentorial craniotomy that employs a diamond-coated threadwire saw (diamond T-saw), originally developed for spinal surgery, and reduces the bone gap for fitted bone flap fixation. The study subjects were 77 adults undergoing elective supratentorial craniotomy. After placing a burr hole at each corner of the craniotomy, we performed osteotomy between adjacent burr holes to approximately one-third of the length of the osteotomy with a craniotome; this leaves a bony bridge at each corner. The diamond T-saw was introduced between adjacent burr holes through the epidural space and a bridge was cut with reciprocating strokes. On closure, the bridge firmly supports the flap and only sutures are needed for fixation. Successful bone flap fixation was obtained in all followed-up cases. There were no technique-related complications such as dural laceration, flap displacement, or resorption. Our method is ideal for bone cuts in cosmetic cranioplasty; it is easy, safe, and inexpensive and avoids the need for flap fixation with artificial devices.


Preoperative physical fitness assessment, prehabilitation and surgical outcome - a video vignette.


title: European Hernia Society guidelines on prevention and treatment of parastomal hernias.

text: BACKGROUND International guidelines on the prevention and treatment of parastomal hernias are lacking. The European Hernia Society therefore implemented a Clinical Practice Guideline development project. METHODS The guidelines development group consisted of general, hernia and colorectal surgeons, a biostatistician and a biologist, from 14 European countries. These guidelines conformed to the AGREE II standards and the GRADE methodology. The databases of MEDLINE, CINAHL, CENTRAL and the gray literature through OpenGrey were searched. Quality assessment was performed using Scottish Intercollegiate Guidelines Network checklists. The guidelines were presented at the 38th European Hernia Society Congress and each key question was evaluated in a consensus voting of congress participants. RESULTS End colostomy is associated with a higher incidence of parastomal hernia, compared to other types of stomas. Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. Currently available classifications are not validated; however, we suggest the use of the European Hernia Society classification for uniform research reporting. There is insufficient evidence on the policy of watchful waiting, the route and location of stoma construction, and the size of the aperture. The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present. It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, a mesh without a hole is suggested in preference to a keyhole mesh when laparoscopic repair is performed. CONCLUSION An evidence-based approach to the diagnosis and management of parastomal hernias reveals the lack of evidence on several topics, which need to be addressed by multicenter trials. Parastomal hernia prevention using a prophylactic mesh for end colostomies reduces parastomal herniation. Clinical outcomes should be audited and adverse events must be reported.


title: Covid-19 emergency in prison: Current management and forensic perspectives.

text: The Covid-19 pandemic is currently a major worldwide public health problem. Contagion within prisons and in other custodial settings will need to be addressed promptly, but the management of preventive measures will be difficult due to overcrowding and inmates and officers' close physical contact. There may also be less access to care than in community settings. Accordingly, prisons are particularly vulnerable to outbreaks of infection, and in addition to the likely greater risks of contagion attention must be paid to the psychological problems that the pandemic can have on the prison population. Riots and episodes of violence have already taken place in various prisons. With the inevitable restrictions on social contact and family meetings, prisoners who already are at increased risk of mental illness and suicide are more susceptible to adverse psychological repercussions. From a forensic point of view, therefore, we stress the need for the development of a strong support network by mental health workers for the prison population.


title: Diclofenac topical solution compared with oral diclofenac: a pooled safety analysis.

text: BACKGROUND Topical nonsteroidal anti-inflammatory drug (NSAID) formulations, which produce less systemic exposure compared with oral formulations, are an option for the management of osteoarthritis (OA). However, the overall safety and efficacy of these agents compared with oral or systemic therapy remains controversial. METHODS Two 12-week, double-blind, double-dummy, randomized, controlled, multicenter studies compared the safety and efficacy profiles of diclofenac topical solution (TDiclo) with oral diclofenac (ODiclo). Each study independently showed that TDiclo had similar efficacy to ODiclo. To compare the safety profiles of TDiclo and ODiclo, a pooled safety analysis was performed for 927 total patients who had radiologically confirmed symptomatic OA of the knee. This pooled analysis included patients treated with TDiclo, containing 45.5% dimethyl sulfoxide (DMSO), and those treated with ODiclo. Safety assessments included monitoring of adverse events (AEs), recording of vital signs, dermatologic evaluation of the study knee, and clinical laboratory evaluation. RESULTS AEs occurred in 312 (67.1%) patients using TDiclo versus 298 (64.5%) of those taking ODiclo. The most common AE with TDiclo was dry skin at the application site (24.1% vs 1.9% with ODiclo; P < 0.0001). Fewer gastrointestinal (25.4% vs 39.0%; P < 0.0001) and cardiovascular (1.5% vs 3.5%; P = 0.055) AEs occurred with TDiclo compared with ODiclo. ODiclo was associated with significantly greater increases in liver enzymes and creatinine, and greater decreases in creatinine clearance and hemoglobin (P < 0.001 for all). CONCLUSIONS These findings suggest that TDiclo represents a useful alternative to oral NSAID therapy in the management of OA, with a more favorable safety profile.


title: Recent advances in self-expanding stents for use in the superficial femoral and popliteal arteries.

text: Significant advances have been made in femoropopliteal stent design and clinical outcomes during the past decade. Initial randomized studies demonstrated superiority of nitinol self-expanding stents to balloon angioplasty for treatment of moderate-length superficial femoral artery stenoses. During longer-term follow-up, first generation nitinol stents were hampered by high rates of stent fracture. A number of newer nitinol stent designs have been developed with improved conformability, greater radial strength and lower rates of long-term stent fracture. These newer stent designs have demonstrated superior primary patency and decreased restenosis for the treatment of moderate-length femoropopliteal lesions relative to historical benchmarks. Recent advances in drug-eluting nitinol stents have also offered treatment options for challenging lesion subsets including very long femoropopliteal lesions and for the treatment of in-stent restenosis. This article reviews recent advances and upcoming research in nitinol self-expanding stent technology for the treatment of superficial femoral and popliteal artery stenosis.


Conceived in the covid-19 crisis: impact of maternal stress and anxiety on fetal neurobehavioral development.


docid: vvxzlypd

title: CORRIGENDUM to Emergency Approval of Chloroquine and Hydroxychloroquine for Treatment of COVID-19 (updated to Emergency Authorization of Chloroquine and Hydroxychloroquine for Treatment of COVID-19).


title: Bedside adjustment of proportional assist ventilation to target a predefined range of respiratory effort.

text: OBJECTIVES During proportional assist ventilation with load-adjustable gain factors, peak respiratory muscle pressure can be estimated from the peak airway pressure and the percentage of assistance (gain). Adjusting the gain can, therefore, target a given level of respiratory effort. This study assessed the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors with the goal of targeting a predefined range of respiratory effort. DESIGN Prospective, multicenter, clinical observational study. SETTINGS Intensive care departments at five university hospitals. PATIENTS Patients were included after meeting simple criteria for assisted mechanical ventilation. INTERVENTIONS Patients were ventilated in proportional assist ventilation with load-adjustable gain factors. The peak respiratory muscle pressure, estimated in cm H2O as (peak airway pressure-positive end-expiratory pressure)×[(100-gain)/gain], was calculated from a grid at the bedside. The gain adjustment algorithm was defined to target a peak respiratory muscle pressure between 5 and 10 cm H2O. Additional recommendations were available in case of hypoventilation or hyperventilation. RESULTS Fifty-three patients were enrolled. Median time spent under proportional assist ventilation with load-adjustable gain factors was 3 days (interquartile range, 1-5). Gain was adjusted 1.0 (0.7-1.8) times per day, according to the peak respiratory muscle pressure target range in 91% of cases and because of hypoventilation or hyperventilation in 9%. Thirty-four patients were ventilated with proportional assist ventilation with load-adjustable gain factors until extubation, which was successful in 32. Eighteen patients required volume assist-controlled reventilation because of clinical worsening and need for continuous sedation. One patient was intolerant to proportional assist ventilation with load-adjustable gain factors. CONCLUSIONS This first study assessing the clinical feasibility of titrating proportional assist ventilation with load-adjustable gain factors in an attempt to target a predefined range of effort showed that adjusting the level of assistance to maintain a predefined boundary of respiratory muscle pressure is feasible, simple, and often sufficient to ventilate patients until extubation.


title: Re-irradiation in locally recurrent lung cancer patients.

text: PURPOSE Lung cancer remains one of the tumour diagnoses with high lethality, although innovative treatment approaches have yielded improvements in local control and survival rates. There is still no consensus on how to treat local relapse in patients after first-line treatments. Radiotherapy may be considered in this situation; however, data supporting its effectiveness are rare. The purpose of this retrospective analysis was to evaluate outcomes of patients re-irradiated for thoracic tumours in terms of overall survival (OS), local progression-free survival (LPFS), toxicity and dose-volume parameters. PATIENTS AND METHODS Sixty-two patients with locally recurrent previously irradiated lung cancer were analysed retrospectively (NSCLC n = 52, SCLC n = 10). Target volumes both in lung and mediastinum were re-irradiated with conventional three-dimensional or intensity-modulated radiotherapy techniques. Median overall dose of re-irradiation was 38.5 Gy (range 20-60 Gy) with a median single dose per fraction of 2 Gy (1.8-3.0 Gy). Clinical documents and treatment plans were evaluated. RESULTS Median follow-up was 8.2 months (range 0-27 months). OS following re-irradiation was 9.3 months (range: 0-27 months) and LPFS was 6.5 months (range: 0-24 months). OS and LPFS were not affected by histology, total dose or patient age and gender. OS was improved in patients whose re-irradiation volumes included less than two mediastinal lymph node stations (p = 0.016). Twelve patients suffered from pneumonitis ≥grade II (19%) and two from pneumonitis grade III. One patient presumably died from pneumonitis grade V. A slight decline in forced expiratory volume (FEV1) was detected in post-re-irradiation lung function testing. CONCLUSIONS Re-irradiation is an option for patients with tumour recurrence to control local progression and lower the symptom burden. Oncological outcome appears to be affected by size, location of mediastinal target volumes and lung function. Prospective clinical trials are warranted to substantiate the role of re-irradiation in recurrent lung cancer.


Laparoscopic Extraction of a Gastric Phytobezoar: A Different Approach.


title: Analysis of Transpulmonary Thermodilution Data Confirms the Influence of Renal Replacement Therapy on Thermodilution Hemodynamic Measurements.

text: BACKGROUND Transpulmonary thermodilution (TPTD) is used frequently in the intensive care unit to determine cardiac index (CI), intrathoracic blood volume index (ITBVI), and extravascular lung volume index (EVLWI). Renal replacement therapy (RRT) influences TPTD results, but the underlying mechanisms are not completely understood. We hypothesized that RRT blood flow induces errors in TPTD measurements. METHODS We analyzed TPTD data available from the PiCCO® plus hemodynamic measurement device on a personal computer using a proprietary Pulsion Medical Systems software. By using the dialysis catheter to inject the thermal indicator, 20 measurement series were performed in 12 intensive care unit patients determining CI, ITBVI, and EVLWI during RRT with the blood pump stopped, and at flows of 100 and 200 mL/min, respectively. RESULTS Data export was successful in 17 measurement series and showed a significant decrease in measured CI (6.5 ± 2.5 vs 5.4 ± 1.9 L/min/m, P < 0.001) and ITBVI (1358.8 ± 274.5 vs 1132.8 ± 218.3 mL/m, P < 0.001) with RRT and a significant increase in EVLWI (8.6 ± 4.4, 10.2 ± 4.5 mL/kg, P < 0.001). Blood temperature before and the temperature decrease after injection of the thermal indicator were unchanged by RRT. Mean transit time and downslope time of the thermodilution curve, however, were both increased with the RRT blood pump running (P ≤ 0.001). CONCLUSIONS Analysis of TPTD data shows that thermodilution curve forms are modified with RRT, resulting in an erroneous calculation of thermodilution-derived hemodynamic parameters.


title: Laparoscopic gastric electrical stimulation for medically refractory diabetic and idiopathic gastroparesis.

text: BACKGROUND Gastric electrical stimulator (GES) implantation is effective in certain patients with gastroparesis; however, laparotomy is often employed for placement. The aim of this study is to review outcomes of patients who underwent laparoscopic GES therapy for diabetic and idiopathic gastroparesis at a large referral center. METHODS Patients who underwent GES (Enterra Therapy System; Medtronic, Minneapolis, MN) implantation with subsequent interrogation and programming between March 2001 and November 2011 were analyzed. RESULTS A total of 113 patients underwent GES placement or revision during the study period. One hundred eleven patients underwent primary GES at our institution, while two patients underwent GES generator revision at our institution. Primary operations were completed laparoscopically in 110 of 111 cases, with one conversion to laparotomy due to severe adhesions. At a mean follow-up of 27 months (1-113), symptom improvement was achieved in 91 patients (80 %) and was similar for both the diabetic and idiopathic subgroups. Need for supplemental nutrition (enteral and/or parental) decreased in both groups. CONCLUSIONS GES placement is feasible using a laparoscopic approach. Medical refractory gastroparesis in the diabetic and idiopathic groups had significant symptom improvement with no difference between the two groups. Need for supplemental nutrition is decreased following GES.


title: [Evaluation of the emergency response strategies and measures on the epidemic of COVID-19 in Shenzhen, China].

text: Objectives: This study aimed to evaluate the effect of the strategies on COVID-19 outbreak control in Shenzhen, and to clarify the feasibility of these strategies in metropolitans that have high population density and strong mobility. Methods: The epidemic feature of COVID-19 was described by different phases and was used to observe the effectiveness of intervention. Hierarchical spot map was drawn to clarify the distribution and transmission risk of infection sources at different time points. The Susceptible-Exposed-Infectious-Asymptomatic-Recovered model was established to estimate case numbers without intervention and compare with the actual number of cases to determine the effect of intervention. The positive rate of the nucleic acid test was used to reflect the risk of human exposure. A survey on COVID-19 related knowledge, attitude and behaviors were used to estimate the abilities of personal protection and emergency response. Results: The epidemic of COVID-19 in Shenzhen experienced the rising, plateau and decline stage. The case number increased rapidly at the beginning, with short duration of peak period. Although the epidemic curve showed human-to-human transmission, the "trailing" was not obvious. From the spot map, during the intervention period, the source of infection was widely distributed. More cases and higher transmission risk were observed in areas with higher population density. After the effective intervention measures, both infection sources and the risk of transmission decreased. After compared with the estimated case numbers without intervention, actual number proved the COVID-19 control strategies were effective. The positive rate of nucleic acid test for high risk populations decreased and no new cases reported since February 16. Shenzhen citizens had high knowledge, attitude and behavior level, and high protection ability and emergency response. Conclusion: Although the response initiated by the health administration department played a key role at the early stage of the epidemic, it was not enough to contain the outbreak of COVID-19. The first-level emergency response initiated by provincial and municipal government was effective and ensured the start of work resumption after the Spring Festival. Metropolitans like Shenzhen can also achieve the goals of strategies and measures for containment and mitigation of COVID-19.


Foveal avascular zone (FAZ) assessment with optical coherence angiography in patients with multiple sclerosis.


title: Smartphone-based multiplex 30-minute nucleic acid test of live virus from nasal swab extract.

text: Rapid, sensitive and specific detection and reporting of infectious pathogens is important for patient management and epidemic surveillance. We demonstrated a point-of-care system integrated with a smartphone for detecting live virus from nasal swab media, using a panel of equine respiratory infectious diseases as a model system for corresponding human diseases such as COVID-19. Specific nucleic acid sequences of five pathogens were amplified by loop-mediated isothermal amplification on a microfluidic chip and detected at the end of reactions by the smartphone. Pathogen-spiked horse nasal swab samples were correctly diagnosed using our system, with a limit of detection comparable to that of the traditional lab-based test, polymerase chain reaction, with results achieved in ∼30 minutes.


US research community feels the impact of SARS.


title: A novel dual-covering method in video-assisted thoracic surgery for pediatric primary spontaneous pneumothorax.

text: BACKGROUND Primary spontaneous pneumothorax (PSP) generally occurs in young adults, whereas pediatric PSP is uncommon. It is difficult to source reliable data on pediatric PSP, the management of which is based on guidelines for adult PSP; however, the rate of recurrence after video-assisted thoracoscopic surgery (VATS) for pediatric PSP is reported to be higher. METHODS We reviewed retrospectively a collective total of 66 surgical cases of a first pneumothorax episode in 46 children under 16 years of age, who were treated at our hospital between February, 2005 and November, 2017. RESULTS The surgical cases were divided into two groups, depending on how the treated lesions were covered. In the dual-covering (DC) group, the PSP was covered by oxidized regenerated cellulose and polyglycolic acid (8 patients; 13 cases) and in the single-covering (SC) group, the PSP was covered by oxidized regenerated cellulose (38 patients; 53 cases). There was no incidence of recurrence after surgery in the DC group, but 17 cases (32.1%) of recurrence after surgery in the SC group. This difference was significant. CONCLUSION The DC method prevented the recurrence of PSP more effectively than the SC method after VATS in pediatric patients. Long-term follow-up after VATS for pediatric PSP is also important because of the risk of delayed recurrence.


title: Distinguishing between spiritual health and religious involvement as determinants of adolescent health in Canada and the Czech Republic.

text: Spiritual health is a topic of emergent interest; however, lack of a clear distinction between spiritual health and religious involvement makes it difficult to understand the potential role of spiritual health as a determinant of health. Analyses of such relationships that cross countries and cultures are rare. We therefore assessed whether differences exist between spiritual health and religious involvement and their respective associations with general indicators adolescent health. The study was based on the 2013/2014 Health Behaviour in School-aged Children study conducted in Canada (n = 10 761) and the Czech Republic (n = 4411). In both countries, we failed to identify strong or statistically significant associations between self-reported religiosity and adolescent health. In contrast, adolescents with higher spiritual health scores consistently reported enhanced levels of general health status. Study findings point to the importance of a strong sense of spiritual health as a protective determinant of adolescent health, and raise questions about religious involvement as protective to adolescent health outcomes.


Focus on "COVID Toes".


title: Adiposity and influenza-associated respiratory mortality: a cohort study.

text: BACKGROUND Obesity was first noted as a risk factor for severe illness associated with pandemic H1N1 infection in 2009, but the relationship between obesity and seasonal influenza remains unclear. METHODS We used data from a population-based cohort comprising 66 820 older (≥65 years) participants with a follow-up period from 1998 to 2012. The impact of influenza activity on respiratory mortality rates was estimated using a Cox proportional hazards model adjusted for comorbidities, meteorological factors, and other co-circulating respiratory viruses. We also tested whether the association of influenza with respiratory mortality varied with obesity and/or health status. As a control outcome, we similarly assessed the association of influenza with deaths from external causes, because these deaths should be unrelated to influenza. RESULTS Seasonal influenza activity was associated with higher respiratory mortality (hazard ratio [HR], 1.13 for influenza activity in the influenza season vs noninfluenza season; 95% confidence interval [CI], 1.05-1.22). The effect of seasonal influenza was 19% greater in obese individuals than normal-weight individuals (HR, 1.19; 95% CI, 1.01-1.42). The marginally significant and greater effect modification of obesity status on the association between seasonal influenza and respiratory mortality was also observed among older people in good health (HR, 1.35; 95% CI, .97-1.87). No such relations were observed for death from external causes. CONCLUSIONS Obesity aggravates the effect of seasonal influenza on respiratory mortality. Priority for influenza vaccine should be considered for obese older people to decrease the burden of influenza.


title: Rational use of face mask in a tertiary care hospital setting during COVID-19 pandemic: An observational study.

text: Masks play a role in the protection of health-care workers (HCWs) from acquiring respiratory infections, including coronavirus disease 2019 (COVID-19) in health-care settings. This observational study was conducted among 382 HCWs in a tertiary care setting over a period of 1 month. Descriptive analysis was done to assess the rational and recommended use of masks/respirators during COVID-19 pandemic using a structured observation checklist as a survey tool. A total of 374 HCWs were included, 64.9% of whom were using face masks rationally as mentioned per risk area categorization with a predominance of triple-layered mask during all 4 weeks. Overall, 64.1% used masks correctly. Clear guidelines and strategies can help to increase the compliance of HCWs with rational use of face masks.


docid: lzxppaoe

title: Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.

text: Importance The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. Objective To provide new and updated evidence-based recommendations for the prevention of SSI. Evidence Review A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized. Findings Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI. Conclusions and Relevance This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.


title: Quantitative analysis of changes in blood concentrations and 'presumed effect-site concentration' of sevoflurane during one-lung ventilation.

text: During one-lung ventilation, ventilation-perfusion mismatch decreases the arterial concentration of inhaled anaesthetics due to the arterial-to-venous concentration difference. This study tested the hypothesis that in humans, the 'presumed effect-site concentration' (taken as the mid-point between the arterial and superior jugular venous concentrations) of inhaled anaesthetic falls during one-lung (vs two-lung) ventilation. Four patients scheduled for elective prostatectomy (two-lung ventilation) and four patients for elective thoracotomy (one-lung ventilation) were randomly selected and assigned to receive sevoflurane (vaporiser-dial setting, 1.5%). Sevoflurane concentrations were measured periodically from radial artery and superior jugular vein (via a catheter advanced cephalad from the jugular vein). During one-lung ventilation, the end-expiratory sevoflurane concentration was stable at ∼1.3% but the mean (SD) presumed effect-site concentration declined initially from 58 (6.7) to 43 (4.7) μg.ml(-1) (p=0.011) before slowly recovering. A period of insufficient depth of anaesthesia is thus a risk during one-lung ventilation.


title: Single-incision laparoscopic adrenalectomy.

text: BACKGROUND The aim of this study was to compare outcome measures between conventional transabdominal laparoscopic adrenalectomy and single-incision laparoscopic adrenalectomy (SILA). METHODS Between January 2006 and April 2010, a total of 96 patients underwent laparoscopic adrenalectomy. Of these, 74 (77.1%) underwent conventional transabdominal laparoscopic adrenalectomy (group 1) and 22 (32.9%) underwent SILA (group 2). Age, sex ratio, tumor size, operating time, blood loss, postoperative visual analog pain scale (VAS) scores, and duration of hospitalization were compared between the two groups. RESULTS The mean ages of the patients in groups 1 and 2 were 43.4 ± 12.3 and 43.3 ± 10 years, respectively (P = 0.7). The female:male ratios in groups 1 and 2 were 1.6:1 and 4.5:1, respectively (P < 0.0001). The mean tumor size was significantly larger in group 1 than in group 2 (4.7 ± 1.5 vs. 3.34 ± 1.06 cm, respectively; P = 0.093). No significant difference was found between group 1 and group 2 with respect to the mean operating time (68.4 ± 20.8 vs. 63.9 ± 16.9 min, respectively; P = 0.36) or the level of intraoperative blood loss (38 ± 26.5 vs. 48.4 ± 62.4 ml, respectively; P = 0.26). The postoperative VAS score was significantly lower in group 2 than in group 1 (2.05 ± 0.57 and 3.28 ± 0.63, respectively; P < 0.0001). The length of hospital stay was significantly higher in group 1 than in group 2 (3.04 ± 1.2 and 2.45 ± 0.96 days, respectively; P = 0.04). CONCLUSION The findings of the present study suggest that SILA is as safe as conventional transabdominal laparoscopic adrenalectomy. Furthermore, SILA is associated with less pain and better cosmesis than the conventional laparoscopic procedure.