title: Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years.

text: AIM To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days. MATERIALS AND METHODS The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27-88 years) underwent 1,843 RFA procedures. RESULTS The overall incidence rate of complications was 6.8% (125 cases). Major complications (n=36, 2%) included liver abscess (n=15, 0.8%), intraperitoneal bleeding (n=8, 0.4%), liver failure (n=5, 0.3%), variceal bleeding (n=3, 0.2%), haemothorax (n=2, 0.1%), cholecystitis (n=2, 0.1%), and bowel perforation (n=1, 0.1%). Among the minor complications (n=89, 4.8%), the most common was the post RFA syndrome accompanied by pain and fever (n=75, 4.1%). Other minor complications included significant pleural effusion (n=7, 0.4%), skin wound infection (n=4, 0.2%), and thermal injuries to the skin (n=3, 0.2%). Procedural infections significantly increased with tumour size (OR=1.379; 95% confidence interval [CI], 1.191-1.579; p<0.001), and multiple overlapping ablations (OR=1.118; 95% CI, 1.019-1.227, p=0.018). Thrombocytopenia (<50,000/μl), prothrombin time, and serum albumin level were significantly associated with post-RFA bleeding episodes (p=0.041, p=0.021, and p=0.003, respectively). The overall mortality rate was 0.3% (three cases of hepatic failure, two case of sepsis, and one case of renal failure). CONCLUSIONS RFA is a safe and effective local treatment for hepatocellular carcinoma. Careful selection of patients and appropriate RFA planning could decrease procedural mortality and morbidity.


title: What is the evidence for prophylactic antibiotic treatment in patients with systemic vasculitides?

text: PURPOSE OF REVIEW Microbial factors are supposed to play an inducing and/or reactivating role in many of the idiopathic systemic vasculitides. This review evaluates the evidence that microbes are involved in the etiopathogenesis of the disease focusing on possibilities for antimicrobial intervention. RECENT FINDINGS The clinical presentation of hepatitis B virus (HBV)-associated polyarteritis nodosa (PAN) is different from that of non-HBV-PAN and requires antiviral treatment. In hepatitic C virus (HCV)-associated autoimmune diseases, type 2 cryoglobulinemia is present in 52% of cases. Chronic nasal carriage of Staphylococcus aureus is related to endonasal activity of Wegener's granulomatosis and recurrent relapses, and prophylactic treatment with co-trimoxazole is effective in reducing relapse rate. SUMMARY Patients with PAN should be tested for HBV, and patients with type 2 cryoglobulinemia for HCV. When tested positive, antiviral treatment should be considered. Patients with Wegener's granulomatosis should be tested for nasal carriage of S. aureus, and prophylactic treatment with co-trimoxazole should be considered in case of persistent endonasal activity of Wegener's granulomatosis together with S. aureus carriage. The efficacy of S. aureus elimination for preventing relapses of Wegener's granulomatosis should be evaluated.


title: Single incision thoracoscopic lobectomy through a 2.5 cm skin incision.

text: Single incision thoracoscopic surgery (SITS) involves only one intercostal space with minimal skin incision, which means it can be the most minimally invasive technique up to date. We minimized the skin incision to a length of 2.5 cm to achieve the less chest wall trauma and the more cosmesis during SITS lobectomy for benign pulmonary disease. Four patients who had bronchiectasis [left lower lobe (LLL)], congenital lobar emphysema [left upper lobe (LUL)], aspergilloma [right upper lobe (RUL)], and hamartoma (RUL) were planned to undergo 2.5 cm SITS lobectomy. There were no conversion cases to multi-port video-assisted thoracic surgery (VATS) or thoracotomy. The mean operation time was 182±25 minutes. Chest drains were removed on postoperative day (POD) 2 in all patients. Three patients discharged on POD 3. One patient who discharged on POD 5 readmitted for delayed pleural effusion and treated with mini-tube insertion. There were no late complications or symptom relapses during the median follow-up of 13.5 months. A 2.5 cm SITS lobectomy can be alternative option for relatively young patients with benign lung disease.


The Nursing Shortage and the Future of Nursing Education Is in Our Hands.


Androgen-driven COVID-19 infection - is testosterone an enemy or a friend?


title: In vitro model to study the biomaterial-dependent reaction of macrophages in an inflammatory environment.

text: BACKGROUND Macrophages play an important role in the reaction to biomaterials, which sometimes have to be used in a surgical field at risk of contamination. The macrophage phenotype in reaction to biomaterials in an inflammatory environment was evaluated in both an in vivo and in vitro setting. METHODS In the in vivo setting, polypropylene (PP) biomaterial was implanted for 28 days in the contaminated abdominal wall of rats, and upon removal analysed by routine histology as well as immunohistochemistry for CD68 (marker for macrophages), inducible nitric oxide synthase (iNOS - a marker for proinflammatory M1 macrophages) and CD206 (marker for anti-inflammatory M2 macrophages). For the in vitro model, human peripheral blood monocytes were cultured for 3 days on biomaterials made from PP, collagen (COL), polyethylene terephthalate (PET) and PET coated with collagen (PET+COL). These experiments were performed both with and without lipopolysaccharide and interferon γ stimulation. Secretion of both M1- and M2-related proteins was measured, and a relative M1/M2 index was calculated. RESULTS In vivo, iNOS- and CD206-positive cells were found around the fibres of the implanted PP biomaterial. In vitro, macrophages on both PP and COL biomaterial had a relatively low M1/M2 index. Macrophages on the PET biomaterial had a high M1/M2 index, with the highest increase of M1 cytokines in an inflammatory environment. Macrophages on the PET+COL biomaterial also had a high M1/M2 index. CONCLUSION Macrophages in an inflammatory environment in vitro still react in a biomaterial-dependent manner. This model can help to select biomaterials that are tolerated best in a surgical environment at risk of contamination.


title: The Safety of Laparoscopic Sleeve Gastrectomy in Patients Receiving Chronic Anticoagulation Therapy: A Case-Matched Study.

text: BACKGROUND Obesity is linked to cardiac disorders with a relative risk of atrial fibrillation of 1.5 (requiring the use of chronic anticoagulation therapy, CAT). However, CAT is a known risk factor for postoperative bleeding after elective surgery. The primary objective of the present study was to evaluate the short- and long-term complications of laparoscopic sleeve gastrectomy (LSG) in patients receiving CAT. METHODS This is a retrospective analysis of a prospective database of CAT patients undergoing LSG between March 2004 and December 2012. This LSG-CAT group was matched 1:2 on preoperative data with patients not receiving CAT (LSG-control group). Primary efficacy criterion was the frequency of CAT-related complications. Secondary efficacy criteria were the major postoperative complications, frequency of revisional surgery, long-term CAT-related complications, and a change in the dose level of oral anticoagulants. RESULTS The LSG-CAT group consisted of 15 patients with a median age of 54 years (32-65). The LSG-control group consisted of 30 patients. Median operating time was 75 min in both groups (p = 0.33). Major complication rates in the LSG-CAT and LSG-control groups were 13.3 and 3.3 %, respectively (p = 0.20), with one case of postoperative bleeding in each group (6.7 and 3.3 %, p = 0.6); incidence of revisional surgery was 13.3 and 3.3 % (p = 0.2). There were no postoperative mortalities. After a median follow-up of 14 months (9-43), no changes in the dose level of oral anticoagulants were reported. CONCLUSIONS LSG in patients receiving CAT is not associated with CAT-specific complications. This surgical procedure enables good weight loss and does not require change in the dose level of oral anticoagulants.


docid: dsctmoou

title: Laparoscopic repair for recurrent parastomal hernia of an end stoma using the sandwich technique while preserving an ileal conduit: A case report.

text: INTRODUCTION Parastomal hernia is a common complication following stoma creation. The surgical approaches included local repair by suture, stoma relocation and mesh-based techniques; but none has been able to provide satisfactory results. PRESENTATION OF CASE A 60-year-old asian female was referred complaining of abdominal pain and constipation caused by recurrent parastomal hernia of an end stoma. She had undergone total cystectomy with creation of an ileal conduit at the age of 53 years, and laparoscopic sigmoid colostomy at the age of 55 years. Parastomal hernia of an end stoma had developed postoperatively, and she had undergone recreation of colostomy at the same place with fasciorrhaphy at the age of 59 years, but parastomal hernia recurred 6 months later because of split fascia sutures. Laparoscopic repair for recurrent parastomal hernia was conducted using the sandwich technique while preserving an ileal conduit. The patient has been followed postoperatively for more than 3 years without any sign of recurrence. DISCUSSION Although further cases are required to get definitive conclusions, we suppose that the laparoscopic sandwich technique can be useful for parastomal hernia. CONCLUSION We herein report a case of recurrent parastomal hernia treated laparoscopically while preserving an ileal conduit using the sandwich technique which combines the keyhole and Sugarbaker techniques. This is a quite rare case report of laparoscopic repair for recurrent parastomal hernia in a patient with an ileal conduit.


Screening for hearing loss in adults with CF: does it make sense?


title: The Unfolded Protein Response: Detecting and Responding to Fluctuations in the Protein-Folding Capacity of the Endoplasmic Reticulum.

text: Most of the secreted and plasma membrane proteins are synthesized on membrane-bound ribosomes on the endoplasmic reticulum (ER). They require engagement of ER-resident chaperones and foldases that assist in their folding and maturation. Since protein homeostasis in the ER is crucial for cellular function, the protein-folding status in the organelle's lumen is continually surveyed by a network of signaling pathways, collectively called the unfolded protein response (UPR). Protein-folding imbalances, or "ER stress," are detected by highly conserved sensors that adjust the ER's protein-folding capacity according to the physiological needs of the cell. We review recent developments in the field that have provided new insights into the ER stress-sensing mechanisms used by UPR sensors and the mechanisms by which they integrate various cellular inputs to adjust the folding capacity of the organelle to accommodate to fluctuations in ER protein-folding demands.


title: Exendin-4-based radiopharmaceuticals for glucagonlike peptide-1 receptor PET/CT and SPECT/CT.

text: UNLABELLED Strong overexpression of glucagonlike peptide-1 (GLP-1) receptors in human insulinoma provides an attractive target for imaging. The first clinical trials demonstrated that GLP-1 receptor SPECT/CT using [Lys(40)(Ahx [6-aminohexanoic acid]-DOTA-(111)In)NH(2)]-exendin-4 can localize hardly detectable insulinomas. However, [Lys(40)(Ahx-DOTA-(111)In)NH(2)]-exendin-4 imaging has drawbacks related to the use of (111)In in that it is costly and carries a relatively high radiation burden for the patient. The aim of this study was the preclinical evaluation of [Lys(40)(Ahx-DOTA-(68)Ga)NH(2)]-exendin-4 for PET/CT and [Lys(40)(Ahx-hydrazinonicotinamide [HYNIC]-(99m)Tc)NH(2)]-exendin-4 for SPECT/CT. METHODS Internalization, biodistribution, dosimetry, and imaging studies were performed in the Rip1Tag2 mouse model of pancreatic beta-cell carcinogenesis and compared with our gold standard [Lys(40)(Ahx-DOTA-(111)In)NH(2)]-exendin-4. Poly-glutamic acid and Gelofusine, a gelatin-based plasma expander, were used for renal uptake reduction studies. RESULTS The tumor uptake of [Lys(40)(Ahx-DOTA-(68)Ga)NH(2)]-exendin-4 was 205 +/- 59 percentage injected activity per gram of tissue at 4 h. Other GLP-1 receptor-positive organs showed more than 4.8 times lower radioactivity uptake. [Lys(40)(Ahx-HYNIC-(99m)Tc/ethylenediaminediacetic acid [EDDA])NH(2)]-exendin-4, compared with its (111)In- and (68)Ga-labeled sister compounds, showed significantly less tumor and organ uptake. The significantly lower tumor and organ uptake of [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH(2)]-exendin-4 did not result in inferior tumor-to-organ ratios or reduced image quality. All radiopeptides tested showed a high tumor-to-background ratio, resulting in the visualization of small tumors (maximum diameter between 1.0 and 3.2 mm) by SPECT and PET. The only exception was the kidneys, which also showed high uptake. This uptake could be reduced by 49%-78% using poly-glutamic acid, Gelofusine, or a combination of the 2. The estimated effective radiation dose was 3.7 muSv/MBq for [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH(2)]-exendin-4, which was 8 times less than that for [Lys(40)(Ahx-DOTA-(68)Ga)NH(2)]-exendin-4 and 43 times less than that for [Lys(40)(Ahx-DOTA-(111)In)NH(2)]-exendin-4. CONCLUSION These promising pharmacokinetic and imaging data show that [Lys(40)(Ahx-DOTA-(68)Ga)NH(2)]-exendin-4 and [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH(2)]-exendin-4 are suitable candidates for clinical GLP-1 receptor imaging studies.


Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19.


title: Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the Pipeline Embolization Device.

text: BACKGROUND There is wide variability in the reported incidence of perioperative thromboembolic (0-14%) and hemorrhagic (0-11%) complications after Pipeline Embolization Device (PED) procedures for cerebral aneurysm treatment, which could be partly due to differences in patient response to the P2Y12 receptor antagonist administered while the PED endothelializes. This study aims to identify an optimal pre-procedure P2Y12 reaction units (PRU) value range and determine the independent predictors of perioperative thromboembolic and hemorrhagic complications after PED procedures. METHODS We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, pre-procedure PRU value with VerifyNow, procedural variables and perioperative thromboembolic and hemorrhagic complications up to postoperative day 30 after PED procedures at our institution during an 8-month period. Perioperative complications were considered major if they caused a permanent disabling neurological deficit or death. Multivariate regression analysis was performed to identify independent predictors of perioperative complications in our cohort. RESULTS Forty-four patients underwent 48 PED procedures at our institution during the study period. There were eight thromboembolic and hemorrhagic perioperative complications in our cohort (16.7%), four of which were major (8.3%). A pre-procedure PRU value of <60 or >240 (p=0.02) and a technically difficult procedure (p=0.04) were independent predictors of all perioperative complications. A pre-procedure PRU value of <60 or >240 (p=0.004) and a history of hypertension (p=0.03) were independent predictors of major perioperative complications. CONCLUSIONS In our cohort, a pre-procedure PRU value of <60 or >240 was the strongest independent predictor of all and major perioperative thromboembolic and hemorrhagic complications after PED procedures.


title: Detection of Atrial Fibrillation from Single Lead ECG Signal Using Multirate Cosine Filter Bank and Deep Neural Network.

text: Atrial fibrillation (AF) is a cardiac arrhythmia which is characterized based on the irregsular beating of atria, resulting in, the abnormal atrial patterns that are observed in the electrocardiogram (ECG) signal. The early detection of this pathology is very helpful for minimizing the chances of stroke, other heart-related disorders, and coronary artery diseases. This paper proposes a novel method for the detection of AF pathology based on the analysis of the ECG signal. The method adopts a multi-rate cosine filter bank architecture for the evaluation of coefficients from the ECG signal at different subbands, in turn, the Fractional norm (FN) feature is evaluated from the extracted coefficients at each subband. Then, the AF detection is carried out using a deep learning approach known as the Hierarchical Extreme Learning Machine (H-ELM) from the FN features. The proposed method is evaluated by considering normal and AF pathological ECG signals from public databases. The experimental results reveal that the proposed multi-rate cosine filter bank based on FN features is effective for the detection of AF pathology with an accuracy, sensitivity and specificity values of 99.40%, 98.77%, and 100%, respectively. The performance of the proposed diagnostic features of the ECG signal is compared with other existing features for the detection of AF. The low-frequency subband FN features found to be more significant with a difference of the mean values as 0.69 between normal and AF classes.


title: Clitoral cyst in a bitch.

text: Clitoral cyst can be easily mistaken for a vaginal mass lesion and should be considered in the differential diagnosis for a female dog presenting with an anatomically abnormal external genital examination.


title: Cardiac-Gated En Face Doppler Measurement of Retinal Blood Flow Using Swept-Source Optical Coherence Tomography at 100,000 Axial Scans per Second.

text: PURPOSE To develop and demonstrate a cardiac gating method for repeatable in vivo measurement of total retinal blood flow (TRBF) in humans using en face Doppler optical coherence tomography (OCT) at commercially available imaging speeds. METHODS A prototype swept-source OCT system operating at 100-kHz axial scan rate was developed and interfaced with a pulse oximeter. Using the plethysmogram measured from the earlobe, Doppler OCT imaging of a 1.5- × 2-mm area at the optic disc at 1.8 volumes/s was synchronized to cardiac cycle to improve sampling of pulsatile blood flow. Postprocessing algorithms were developed to achieve fully automatic calculation of TRBF. We evaluated the repeatability of en face Doppler OCT measurement of TRBF in 10 healthy young subjects using three methods: measurement at 100 kHz with asynchronous acquisition, measurement at 100 kHz with cardiac-gated acquisition, and a control measurement using a 400-kHz instrument with asynchronous acquisition. RESULTS The median intrasubject coefficients of variation (COV) of the three methods were 8.0%, 4.9%, and 6.1%, respectively. All three methods correlated well, without a significant bias. Mean TRBF measured at 100 kHz with cardiac-gated acquisition was 40.5 ± 8.2 μL/min, and the range was from 26.6 to 55.8 μL/min. CONCLUSIONS Cardiac-gated en face Doppler OCT can achieve smaller measurement variability than previously reported methods. Although further validation in older subjects and diseased subjects is required, precise measurement of TRBF using cardiac-gated en face Doppler OCT at commercially available imaging speeds should be feasible.


title: Cerebral desaturation events in the beach chair position: correlation of noninvasive blood pressure and estimated temporal mean arterial pressure.

text: BACKGROUND Cerebral oximetry (rSO2) has emerged as an important tool for monitoring of cerebral perfusion during surgery. High rates of cerebral desaturation events (CDEs) have been reported during surgery in the beach chair position. However, correlations have not been made with blood pressure measured at the cerebral level. The purpose of this study was to examine the correlations between brachial noninvasive blood pressure (NIBP) and estimated temporal mean arterial pressure (eTMAP) during CDEs in the beach chair position. METHODS Fifty-seven patients underwent elective shoulder surgery in the beach chair position. Values for eTMAP, NIBP, and rSO2 were recorded supine (0°) after induction and when a CDE occurred in the 70° beach chair position. Twenty-six patients experienced 45 CDEs, defined as a 20% drop in rSO2 from baseline. RESULTS Median reduction in NIBP, eTMAP, and rSO2 from baseline to the CDE were 48.2%, 75.5%, and 33.3%, respectively. At baseline, there was a significant weak negative correlation between rSO2 and NIBP (rs = -0.300; P = .045) and no significant association between rSO2 and eTMAP (rs = -0.202; P = .183). During CDEs, there were no significant correlations between rSO2 and NIBP (rs = -0.240; P = .112) or between rSO2 and eTMAP (rs = -0.190; P = .212). No significant correlation between the decrease in rSO2 and NIBP (rs = 0.064; P = .675) or between rSO2 and eTMAP (rs = 0.121; P = .430) from baseline to CDE was found. CONCLUSION NIBP and eTMAP are unreliable methods for identifying a CDE in the beach chair position. Cerebral oximetry provides additional information to the values obtained from NIBP and eTMAP, and all should be considered independently and collectively.


title: Molecular Confirmation of Rocky Mountain Spotted Fever Epidemic Agent in Mexicali, Mexico.

text: Since 2008, a large epidemic of Rocky Mountain spotted fever has been emerging among humans and dogs in Mexicali, adjacent to the United States in Baja California, Mexico. We molecularly confirmed the causative agent; this information can be used to study the origin and dynamics of the epidemic.


title: Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model.

text: BACKGROUND The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective. METHODS A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources. RESULTS Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of euro 8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of euro 66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime. CONCLUSION Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.


docid: jhznfqtt

title: Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease.

text: Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient's overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD.


title: Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial.

text: PURPOSE Venous thromboembolism (VTE) is a frequent and serious problem in intensive care units (ICU). Anticoagulant treatments have demonstrated their efficacy in preventing VTE. However, when the bleeding risk is high, they are contraindicated, and mechanical devices are recommended. To date, mechanical prophylaxis has not been rigorously evaluated in any trials in ICU patients. METHODS In this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned 407 patients with a high risk of bleeding to receive intermittent pneumatic compression (IPC) associated with graduated compression stockings (GCS) or GCS alone for 6 days during their ICU stay. The primary endpoint was the occurrence of a VTE between days 1 and 6, including nonfatal symptomatic documented VTE, or death due to a pulmonary embolism, or asymptomatic deep vein thrombosis detected by ultrasonography systematically performed on day 6. RESULTS The primary outcome was assessed in 363 patients (89.2%). By day 6, the incidence of the primary outcome was 5.6% (10 of 179 patients) in the IPC + GCS group and 9.2% (17 of 184 patients) in the GCS group (relative risk 0.60; 95% confidence interval 0.28-1.28; p = 0.19). Tolerance of IPC was poor in only 12 patients (6.0%). No intergroup difference in mortality rate was observed. CONCLUSIONS With the limitation of a low statistical power, our results do not support the superiority of the combination of IPC + GCS compared to GCS alone to prevent VTE in ICU patients at high risk of bleeding.


docid: lfcctrgp

title: COVID-19 in Africa.


docid: dettywey

title: Prostasomes as a source of diagnostic biomarkers for prostate cancer.

text: New biomarkers are needed to improve the diagnosis of prostate cancer. Similarly to healthy cells, prostate epithelial cancer cells produce extracellular vesicles (prostasomes) that can be isolated from seminal fluid, urine, and blood. Prostasomes contain ubiquitously expressed and prostate-specific membrane and cytosolic proteins, as well as RNA. Both quantitative and qualitative changes in protein, mRNA, long noncoding RNA, and microRNA composition of extracellular vesicles isolated from prostate cancer patients have been reported. In general, however, the identified extracellular vesicle-associated single-marker molecules or combinations of marker molecules require confirmation in large cohorts of patients to validate their specificity and sensitivity as prostate cancer markers. Complications include variable factors such as prostate manipulation and urine flux, as well as masking by ubiquitously expressed free molecules and extracellular vesicles from tissues other than the prostate. Herein, we propose that the most promising methods include comprehensive combinational screening for (mutant) RNA in prostasomes that are immunoisolated with antibodies targeting prostate-specific epitopes.


title: Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis.

text: Background The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes. Methods A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders. Findings 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8). Interpretation Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.


title: Disseminated rhinovirus C8 infection with infectious virus in blood and fatal outcome in a child with repeated episodes of bronchiolitis.

text: We report a fatal case of acute lower respiratory tract disease with human rhinovirus C (HRV-C) as the unique cause in a 19-month-old girl with a history of repeated episodes of bronchiolitis. HRV-C type 8 nucleic acids were observed in respiratory, stool, and cerebrospinal fluid samples, and infectious virions were isolated from patient serum after inoculation onto reconstituted airway epithelia.


title: Early results of an endoscopic nipple-sparing mastectomy for breast cancer.

text: BACKGROUND Endoscopic mastectomy has been reportedly associated with smaller scars and greater patient satisfaction; however, few reports on this topic have been made. The purpose of this retrospective study was to examine the early results of endoscopic nipple-sparing mastectomy (E-NSM) and to investigate the safety of this procedure. METHODS Between January 2002 and December 2005, a total of 87 patients with breast cancer but without skin and nipple involvement, including two cases of bilateral breast cancer, underwent E-NSM. In case of bloody nipple discharge and suspicious extension near the nipple as assessed by magnetic resonance imaging, the major ducts within the nipple were cored (nipple coring). In other cases, nipple coring was not performed. RESULTS Of the 89 breasts in 87 patients, 42 had tumors of >2 cm and 80 were diagnosed as having invasive carcinoma. Lymph node involvement was observed in 36 procedures. The overall rate of nipple necrosis was 18% (16 of 89). The rate of nipple necrosis among the procedures with nipple coring was statistically higher than that among those without nipple coring (7 of 17, 41%, vs. 9 of 72, 13%) (P = .01). Nipple involvement was observed in 2.2% (2 of 89). After a median follow-up period of 52 months, distant metastasis was observed in nine cases; no local recurrences occurred in this series. CONCLUSIONS E-NSM is an oncologically safe procedure and an acceptable method in selected patients requiring a mastectomy. The higher rate of nipple necrosis may have been the result of a technical problem, indicating the need for continued improvement in nipple coring procedures.


title: Challenges and Future of Wireless Capsule Endoscopy.

text: In 2015, capsule endoscopy was introduced as the main investigation method for small bowel mucosal diseases, and its role in colonic diseases has been gradually revealed. Future challenges for capsule endoscopy, besides improvements of image quality and visualization of each part of the small bowel and colonic mucosa, include the development of gastric capsules, the capacity to perform histological examination of the mucosa, and maybe in the future, some capsule endoscopy-driven therapeutics. The aim of this review was to evaluate the clinical demands and feasibility of achieving the aforementioned objectives.


Domestic violence in the COVID-19 pandemic: a forensic psychiatric perspective.


title: Critical illness-associated diaphragm weakness.

text: Diaphragm weakness is highly prevalent in critically ill patients. It may exist prior to ICU admission and may precipitate the need for mechanical ventilation but it also frequently develops during the ICU stay. Several risk factors for diaphragm weakness have been identified; among them sepsis and mechanical ventilation play central roles. We employ the term critical illness-associated diaphragm weakness to refer to the collective effects of all mechanisms of diaphragm injury and weakness occurring in critically ill patients. Critical illness-associated diaphragm weakness is consistently associated with poor outcomes including increased ICU mortality, difficult weaning, and prolonged duration of mechanical ventilation. Bedside techniques for assessing the respiratory muscles promise to improve detection of diaphragm weakness and enable preventive or curative strategies. Inspiratory muscle training and pharmacological interventions may improve respiratory muscle function but data on clinical outcomes remain limited.


Diversifying medical school education to represent BAME backgrounds.


title: Network analyses in microbiome based on high-throughput multi-omics data.

text: Together with various hosts and environments, ubiquitous microbes interact closely with each other forming an intertwined system or community. Of interest, shifts of the relationships between microbes and their hosts or environments are associated with critical diseases and ecological changes. While advances in high-throughput Omics technologies offer a great opportunity for understanding the structures and functions of microbiome, it is still challenging to analyse and interpret the omics data. Specifically, the heterogeneity and diversity of microbial communities, compounded with the large size of the datasets, impose a tremendous challenge to mechanistically elucidate the complex communities. Fortunately, network analyses provide an efficient way to tackle this problem, and several network approaches have been proposed to improve this understanding recently. Here, we systemically illustrate these network theories that have been used in biological and biomedical research. Then, we review existing network modelling methods of microbial studies at multiple layers from metagenomics to metabolomics and further to multi-omics. Lastly, we discuss the limitations of present studies and provide a perspective for further directions in support of the understanding of microbial communities.


title: Is contralateral exploration justified in endoscopic total extraperitoneal repair of clinical unilateral groin hernias - A Prospective cohort study.

text: BACKGROUND Laparoscopic adult hernia repair has the clinical advantage of allowing the surgeon to explore asymptomatic contralateral inguinal hernia. We conduct a retrospective study to compare the occurrence of contralateral metachronous inguinal hernia (CMIH) after laparoscopic total extraperitoneal (TEP) repair with or without contralateral exploration. METHODS One hundred and fifty-one consecutive patients undergoing unilateral laparoscopic TEP repair during November 2007 to November 2012 were enrolled into groups with contralateral or no contralateral exploration. Preoperative, intraoperative, and postoperative factors were recorded then reviewed for analysis. The primary end-point was the occurrence of contralateral inguinal hernia. The patients were regularly interviewed postoperatively at outpatient clinics. RESULTS Finally, 68 patients in the exploration group and 46 in the non-exploration group were eligible for analysis. All demographic data, except age, was comparable between the two groups. Twenty-three of 68 (33.8%) in the exploration cohort had at least one occult contralateral inguinal hernia detected and repaired at the time of primary repair. In contrast to the high incidence (6/46, 13%) of CMIH in the non-exploration cohort, there was only one metachronous occurrence (1/68, 1.4%) after negative contralateral exploration at a median follow-up of longer than 3 yrs (p = 0.02). The peri-operative results were comparable between groups regarding operative time, analgesic requirements, complications, and chronic pain. CONCLUSIONS Simultaneous exploration and repair of the incidental defects on the contralateral inguinal region during laparoscopic TEP repair of unilateral inguinal hernia is recommended in selected patients based on its high safety and clinical effectiveness in preventing later CMIH.


title: Obturator neuropathy: an adverse outcome of a trans-obturator vaginal mesh to repair pelvic organ prolapse.

text: We report a case of obturator neuropathy induced by trans-obturator vaginal mesh surgery for symptomatic cystocele. Initial electromyography excluded genito-femoral and pudendal nerve deficiency. Typical clinical arguments for severe obturator neuropathy at physical examination led to vaginal revision surgery with hemi-resection of the mesh to the ischio-pubic branch. This fully relieved obturator-induced pain and reversed adductor muscle motor deficiency.


title: Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction.

text: AIMS Whether prasugrel plus bivalirudin is a superior strategy to unfractionated heparin plus clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has never been assessed in specifically designed randomized trials. METHODS AND RESULTS The Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 study is an investigator-initiated, randomized, open-label, multicentre trial, designed to test the hypothesis that in STEMI patients with planned primary PCI a strategy based on prasugrel plus bivalirudin is superior to a strategy based on clopidogrel plus heparin in terms of net clinical outcome. Owing to slow recruitment, the trial was stopped prematurely after enrolment of 548 of 1240 planned patients. At 30 days, the primary composite endpoint of death, myocardial infarction, unplanned revascularization of the infarct related artery, stent thrombosis, stroke, or bleeding was observed in 42 patients (15.6%) randomized to prasugrel plus bivalirudin and 40 patients (14.5%) randomized to clopidogrel plus heparin [relative risk, 1.09; one-sided 97.5% confidence interval (CI) 0-1.79, P = 0.680]. The composite ischaemic endpoint of death, myocardial infarction, unplanned revascularization of the infarct-related artery, stent thrombosis, or stroke occurred in 13 patients (4.8%) in the prasugrel plus bivalirudin group and 15 patients (5.5%) in the clopidogrel plus heparin group (relative risk, 0.89; 95% CI 0.40-1.96, P = 0.894). Bleeding according to the HORIZONS-AMI definition was observed in 38 patients (14.1%) in the prasugrel plus bivalirudin group and 33 patients (12.0%) in the clopidogrel plus heparin group (relative risk, 1.18; 95% CI 0.74-1.88, P = 0.543). Results were consistent across various subgroups of patients. CONCLUSION In this randomized trial of STEMI patients, we were unable to demonstrate significant differences in net clinical outcome between prasugrel plus bivalirudin and clopidogrel plus heparin. Neither the composite of ischaemic complications nor bleeding were favourably affected by prasugrel plus bivalirudin compared with a regimen of clopidogrel plus unfractionated heparin. However, the results must be interpreted in view of the premature termination of the trial. CLINICAL TRIAL REGISTRATION INFORMATION Unique identifier NCT00976092 (www.clinicaltrials.gov).


title: Outcomes of spot stenting versus long stenting after intentional subintimal approach for long chronic total occlusions of the femoropopliteal artery.

text: OBJECTIVES This study sought to compare the outcomes of spot stenting versus long stenting after intentional subintimal approach for long femoropopliteal chronic total occlusions (CTO). BACKGROUND The optimal stenting strategy following the subintimal recanalization of long femoropopliteal chronic total occlusions has not been investigated. METHODS A total of 196 limbs in 163 patients, implanted with bare nitinol stents after subintimal approach in long femoropopliteal occlusions (lesion length 25 ± 8 cm), were retrospectively analyzed. The primary patency was compared between spot stenting (n = 129) and long stenting (n = 67). RESULTS Baseline characteristics and immediate procedural results were similar between groups. Adjusted-primary patency (47% vs. 77%, p < 0.001) and adjusted-freedom from target lesion revascularization (52% vs. 84%, p < 0.001) at 2 years were significantly lower in the long stenting group than in the spot stenting group. The incidence of stent fracture, fracture type, and restenosis pattern did not differ between groups. Long stenting was an independent predictor of restenosis (hazard ratio [HR]: 2.0) along with other risk factors such as nonuse of clopidogrel (HR: 3.3) or cilostazol (HR: 2.2), small stent diameter (HR: 0.6), poor run-off (HR: 1.9), and post-procedural ankle-brachial index (HR: 0.1). Compared with spot stenting after adjustment using inverse probability of treatment weighting, long stenting, especially involving the P2 or P3 segment of the popliteal artery, was independently associated with 7.5-fold increases in restenosis risk (p < 0.001). CONCLUSIONS The primary patency was significantly higher with spot stenting than with long stenting following subintimal approach for long femoropopliteal chronic total occlusions. The risk of restenosis was especially higher when long stenting was extended to the distal popliteal artery.


title: Duodenal lengthening in an adult with ultra-short bowel syndrome. A case report.

text: BACKGROUND We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome. CASE REPORT A 25-year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation. Only a megaduodenum stump that reached as far as the third portion (30 cm of length) and the colon up to the hepatic flexure in the form of a mucous fistula was retained. A gastrostomy tube drained gastric and bilio-pancreatic secretions (output range: 2.5-4 liters/day). The time spent on parenteral nutrition (3 liters/day; 1500 calories/day) and I.V. fluid (1.5-2 liters/day) administration was 24 hours per day. The patient underwent duodenal lengthening and tapering with 7 sequential transverse applications (5 of 45 mm and 2 of 60 mm) of an endoscopic stapler on the anterior and posterior walls of the duodenum, respecting the pancreatic parenchyma and end-to-side duodeno-colonic anastomosis. The final duodenal length was 83 cm. The pre-lengthening citrulline level increased from 13.6 micromol/L to 21.6 micromol/L one year post-lengthening. After 24 month of follow-up, the time on a parenteral pump was shortened to 9 hours during the night. The volume and calorie requirements were also reduced by half. DISCUSSION Duodenal lengthening may be effective as part of the autologous intestinal reconstruction armamentarium in adults with short bowel syndrome.


title: Radical trachelectomy for cervical cancer: postoperative physical and emotional adjustment concerns.

text: OBJECTIVE To investigate the incidence of cervical stenosis and related emotional and sexual adjustment concerns in women treated with radical trachelectomy. METHODS Prospective data of 30 stage I cervical cancer patients enrolled in an ongoing study were evaluated in combination with a medical chart review. RESULTS Eight patients (27%) did not have any stenosis of the neo-cervix postoperatively; 10 (33%) had clinically notable stenosis not requiring neo-cervical dilation to allow adequate sampling; moreover, 12 (40%) had sufficient stenosis requiring a neo-cervical dilation procedure, which proved to be safe and useful. The majority of the dilation procedures (n=8) were conducted under local anesthesia in the office. At preoperative baseline survey, women reported a high rate of sexual inactivity. Fear of intercourse and dyspareunia were reported prior to surgery; however, trends of adjustment and improvement were noted over time postoperatively. Overall, fear of sexual activity tended to lessen if the degree of dyspareunia decreased over time. Postoperative dyspareunia decreased over time, which could have been associated with the mechanical stretching due to vaginal dilator use or dilating benefit of intercourse. CONCLUSION Postoperative concerns associated with radical trachelectomy may be greater than what has been reported in the literature; however, several adjustment trends were noted with intermediate/long-term follow-up. Office cervical dilation is a simple procedure, which is helpful in the management of neo-cervical stenosis. We are currently investigating the value of a physician checklist as a clinical care model to remind medical professionals to monitor and address important survivorship issues.


Pancreatic involvement in SARS-CoV-2: case report and living review.


title: Clinical management of COVID-19.

text: The novel coronavirus disease 2019 (COVID-19) with its early origin from Wuhan city in China has evolved into a global pandemic. Maximal precautionary measures and resources have been put forward by most nations in war footing to mitigate transmission and decrease fatality rates. This article was aimed to review the evidence on clinical management and to deal with the identification of high-risk groups, warning signs, appropriate investigations, proper sample collection for confirmation, general and specific treatment measures, strategies as well as infection control in the healthcare settings. Advanced age, cardiovascular disease, diabetes, hypertension and cancer have been found to be the risk factors for severe disease. Fever lasting for >five days with tachypnoea, tachycardia or hypotension are indications for urgent attention and hospitalization in a patient with suspected COVID-19. At present, reverse transcription-polymerase chain reaction (RT-PCR) from the upper respiratory tract samples is the diagnostic test of choice. While many drugs have shown in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are insufficient clinical data to promote or dissuade their usage. Among the currently available drugs, hydroxychloroquine and lopinavir/ritonavir may be considered for patients with severe COVID-19 infection, awaiting further clinical trials. Stringent droplet and contact precautions will protect healthcare workers against most clinical exposures to COVID-19.


title: Combined Hookwire and Methylene Blue Localization of Pulmonary Nodules: Analysis of 74 Patients.

text: OBJECTIVE Because of decreased tactile sensation with thoracoscopic approaches to biopsy, localization preoperatively and intraoperatively is important for successful biopsy. Our study evaluated the technique of combined computed tomography-guided hookwire and methylene blue localization. METHODS Seventy-five patients from November 2007 to August 2013 who underwent combined Hawkins hookwire and methylene blue localization of 76 total pulmonary nodules before video-assisted thoracic surgery-guided wedge resection were retrospectively reviewed. Multiple patient, nodule, and procedural characteristics were analyzed for correlation with successful wire localization and wire dislodgement. Successful wire localization was defined as absence of lesions requiring re-resection, wire dislodgement necessitating re-resection, or conversion to thoracotomy for localization. RESULTS Seventy-four patients were included in the study (75 pulmonary nodules - 1 patient had 2 lesions localized) and mean ± SD patient age was 65.8 ± 12.1 years and 50% were male. The mean ± SD largest nodule diameter was 14.6 ± 7.4 mm and 29.3% of these were subcentimeter pulmonary nodules. Increased age and history of malignancy were associated with malignant diagnoses (P = 0.037 and 0.009, respectively) Successful wire localization was present in 86.4% of patients. Lesions with lower mean distance to the pleura correlated with successful localization (P = 0.002). Wire dislodgement was present in 9.3% (7 patients) with 4 (5.3%) of these necessitating need for re-resection to establish pathologic diagnosis. Albeit wire dislodgement, 57.4% (4/7) still had successful thoracoscopic localization. CONCLUSIONS This study demonstrates that utilization of Hawkins hookwire in combination with methylene blue injection is an effective method to successfully localize pulmonary nodules for thoracoscopic wedge resection and should prompt further investigation for its utilization.


Editorial: Are we ready? Preparing nurses to respond to disasters and emerging infectious diseases.


title: Mobile Technology for Cognitive Assessment of Older Adults: A Scoping Review.

text: Background and Objectives The number of people diagnosed with dementia is rising appreciably as the population ages. In an effort to improve outcomes, many have called for facilitating early detection of cognitive decline. Increased use of mobile technology by older adults provides the opportunity to deliver convenient, cost-effective assessments for earlier detection of cognitive impairment. This article presents a review of the literature on how mobile platforms-smartphones and tablets-are being used for cognitive assessment of older adults along with benefits and opportunities associated with using mobile platforms for cognitive assessment. Research Design and Methods We searched MEDLINE, Web of Science, PsycInfo, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials in October 2018. This search returned 7,024 articles. After removing 1,464 duplicates, we screened titles and abstracts then screened full-text for those articles meeting inclusion and exclusion criteria. Results Twenty-nine articles met our inclusion criteria and were categorized into 3 groups as follows: (a) mobile versions of existing article or computerized neuropsychological tests; (b) new cognitive tests developed specifically for mobile platforms; and (c) the use of new types of data for cognitive assessment. This scoping review confirms the considerable potential of mobile assessment. Discussion and Implications Mobile technologies facilitate repeated and continuous assessment and support unobtrusive collection of auxiliary behavioral markers of cognitive impairment, thus allowing users to view trends and detect acute changes that have traditionally been difficult to identify. Opportunities include using new mobile sensors and wearable devices, improving reliability and validity of mobile assessments, determining appropriate clinical use of mobile assessment information, and incorporating person-centered assessment principles and digital phenotyping.


title: Analysis of photosynthetically active radiation under various sky conditions in Wuhan, Central China.

text: Observations of photosynthetically active radiation (PAR) and global solar radiation (G) at Wuhan, Central China during 2005-2012 were first reported to investigate PAR variability at different time scales and its PAR fraction (F(p)) under different sky conditions. Both G irradiances (I(g)) and PAR irradiances (I(p)) showed similar seasonal features that peaked in values at noon during summer and reached their lower values in winter. F(p) reached higher values during either sunrise or sunset; lower values of F p appeared at local noon because of the absorption effects of water vapor and clouds on long-wave radiation. There was an inverse relationship between clearness index (K(t)) and F(p); the maximum I(p) decreased by 22.3 % (39.7 %) when sky conditions changed from overcast to cloudless in summer (winter); solar radiation was more affected by cloudiness than the seasonal variation in cloudy skies when compared with that in clear skies. The maximum daily PAR irradiation (R(p)) was 11.89 MJ m⁻² day⁻¹ with an annual average of 4.85 MJ m⁻² day⁻¹. F p was in the range of 29-61.5 % with annual daily average value being about 42 %. Meanwhile, hourly, daily, and monthly relationships between R p and G irradiation (R g) under different sky conditions were investigated. It was discovered that cloudy skies were the dominated sky condition in this region. Finally, a clear-sky PAR model was developed by analyzing the dependence of PAR irradiances on optical air mass under various sky conditions for the whole study period in Central China, which will lay foundations for ecological process study in the near future.


Rules for scientific progress while living with the COVID-19 Pandemic: from 'benchside' to 'fireside.'


title: "We're Not Ready, But I Don't Think You're Ever Ready." Clinician Perspectives on Implementation of Crisis Standards of Care.

text: Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.


Can companion animals become infected with Covid-19?


title: Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases.

text: BACKGROUND This paper aims to retrospectively evaluate the feasibility, safety, and standardization for both consecutive primary and revisional SILS bariatric surgeries, and to analyze incisional hernia's prevalence, technical improvements, and limiting factors. METHODS A retrospective database review was undertaken involving, in Part I (Belgium), 290 consecutive SILS, including 80.68% primary bariatric surgeries, and 19.32% revisional gastric bypass, followed in Part II (Lebanon), by 40 selective primary SILS. Training for and standardization of the trans-umbilical technique was done for the operating room team, and was executed in part II. RESULTS The procedure of single incision was successfully completed in all of the 330 cases part I & part II. There was a need for additional salvage for one or two trocars in respectively 3.1% and 2.75% of the cases. There were no deaths or conversions in either group. Early complications included one medically healed fistula after revisional GB, and two secondary gastric and intestinal perforation requiring reoperations. Late surgical complications were: "3 patients (1.03%) in Part I and 2 (5%) in Part II suffered occlusions, requiring laparoscopic mesenteric defect's closure on an internal herniation." Twelve patients (4.1%) from part I and 5 (12.5%) in part II suffered an incisional hernia. CONCLUSION Selective SILS, when standardized, tends to be superior to consecutive SILS in terms of overall morbidity, operative time, and need for additional salvage trocars. Cost effectiveness and higher midterm rate of umbilical port site incisional hernia should be weighed against the beneficial cosmetic effect for the patient.


title: Utilization of a novel unidirectional knotless suture during minimal access procedures in pediatric surgery.

text: BACKGROUND The application of minimally invasive surgery (MIS) for advanced procedures in children is logical. However, the intracorporeal placement and tying of suture can be challenging, leading to prolonged anesthesia and morbidity. We describe our initial experience with the use of a novel unidirectional barbed knotless suture (V-LOC, Covidien, Mansfield, MA) that permits a safe and efficient advanced MIS reconstruction in infants and children. METHODS From August 2010 to February 2012, 11 infants and children underwent diaphragmatic reconstruction utilizing either the absorbable or the permanent V-LOC suture. Data retrieval included gender, weight, diagnosis, operative time, complications and follow up. RESULTS Thoracoscopic or laparoscopic repairs were carried out in all children. Two of the infants with congenital diaphragmatic hernia of Bochdalek (CDH) developed a recurrence at 4 and 6 months of age and required reoperation. There were no other complications or recurrence in the remaining 9 children, and there were no mortalities in the group. CONCLUSION This is the first study to evaluate the use of the unidirectional barbed knotless suture in pediatric surgery. We demonstrate that the use of the V-LOC barbed suture is an innovative, safe and time saving option for pediatric MIS. Prospective analysis with long-term follow-up is required to confirm these initial results and to ascertain if this novel approach can be utilized in other pediatric surgical conditions.


title: Retrieval of projectile foreign bodies from the paranasal sinuses and skull base.

text: BACKGROUND Penetrating trauma to the paranasal sinuses and skull base with retained foreign bodies represents a unique challenge for head and neck surgeons. Management of these injuries is complicated by associated injuries and the proximity to vital neurovascular structures. This study was designed to review the clinical experience with retained sinonasal and skull base projectile foreign bodies at a single academic tertiary care institution. METHODS A retrospective review of patients who suffered penetrating trauma to the head with retained metallic foreign bodies in the paranasal sinuses and/or skull base between January 2002 and August 2011 was performed at a single academic medical center. RESULTS There were 599 patients who suffered penetrating trauma to the head and neck, with 13 patients having retained metallic foreign bodies in the sinuses and/or skull base, mostly bullets or nails. Ten patients underwent urgent (n = 5) or delayed (n = 5) removal of foreign bodies accessible without compromise of adjacent structures either through an endoscopic or open approach. Three patients had multiple foreign bodies that were not removed. Three patients experienced traumatic cerebrospinal fluid fistula managed with either conservative measures (n = 2) or intraoperative repair at the time of foreign body retrieval (n = 1). All patients received prophylactic antibiotic coverage. No patients suffered infectious complications such as sinusitis from retained foreign bodies. CONCLUSION Although not all retained foreign bodies after penetrating trauma to the head require removal, those that are safely accessible and at risk for infectious complications should be recovered. The timing and approach of retrieval are dictated by the clinical scenario.


docid: pskksjfw

title: Does the human placenta express the canonical cell entry mediators for SARS-CoV-2?

text: The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 10 million people, including pregnant women. To date, no consistent evidence for the vertical transmission of SARS-CoV-2 exists. The novel coronavirus canonically utilizes the angiotensin-converting enzyme 2 (ACE2) receptor and the serine protease TMPRSS2 for cell entry. Herein, building upon our previous single-cell study (Pique-Regi, 2019), another study, and new single-cell/nuclei RNA-sequencing data, we investigated the expression of ACE2 and TMPRSS2 throughout pregnancy in the placenta as well as in third-trimester chorioamniotic membranes. We report that co-transcription of ACE2 and TMPRSS2 is negligible in the placenta, thus not a likely path of vertical transmission for SARS-CoV-2. By contrast, receptors for Zika virus and cytomegalovirus, which cause congenital infections, are highly expressed by placental cell types. These data show that the placenta minimally expresses the canonical cell-entry mediators for SARS-CoV-2.


title: Negative regulators of the RIG-I-like receptor signaling pathway.

text: Upon recognition of specific molecular patterns on microbes, host cells trigger an innate immune response, which culminates in the production of type I interferons, proinflammatory cytokines and chemokines, and restricts pathogen replication and spread within the host. At each stage of this response, there are stimulatory and inhibitory signals that regulate the magnitude, quality, and character of the response. Positive regulation promotes an antiviral state to control and eventually clear infection, whereas negative regulation dampens inflammation and prevents immune-mediated tissue damage. An overexuberant innate response can lead to cell and tissue destruction, and the development of spontaneous autoimmunity. The retinoic acid-inducible gene I (RIG-I)-like receptors (RLRs), RIG-I and melanoma differentiation-associated gene 5 (MDA5), belong to a family of cytosolic host RNA helicases that recognize distinct nonself RNA signatures and trigger innate immune responses against several RNA viruses by signaling through the essential adaptor protein mitochondrial antiviral signaling (MAVS). The RLR signaling pathway is tightly regulated to maximize antiviral immunity and minimize immune-mediated pathology. This review highlights contemporary findings on negative regulators of the RLR signaling pathway, with specific focus on the proteins and biological processes that directly regulate RIG-I, MDA5 and MAVS signaling function.


Traumatic abdominal wall hernia: Is the treatment strategy a real problem?


title: Complete Genome Sequence of a Porcine Epidemic Diarrhea Virus Isolated in Belgorod, Russia, in 2008.

text: We identified porcine epidemic diarrhea virus (PEDV) in stool samples from sick piglets in the Belgorod region of Russia. The complete coding genome sequence of 28,295 nucleotides (nt) of PEDV was generated. Compared to a prototype PEDV strain (DR13), an extreme number of mismatches in the S gene were revealed.


Thoughts during a COVID nightmare.


title: Diagnosis of co-morbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders.

text: OBJECTIVES To determine the prevalence of major depressive disorder (MDD) and other selected axis-I disorders among women with newly diagnosed, untreated endocrine disorders. METHODS Two hundred and eighteen consecutive women, aged 18-65, with newly diagnosed, untreated endocrine disorders were referred for potential diagnosis of co-morbid axis-I disorders with the use of the Structured Clinical Interview for Axis I-Patient Edition (SCID-P). The SCID-P was re-administered after 12 weeks. RESULTS At baseline, 64 (29.3%) women met criteria for at least one axis-I disorder. Women who were diagnosed with hyperthyroidism were more likely to meet criteria for generalized anxiety disorder and panic disorder than women without hyperthyroidism. Nine of 154 (5.8 %) women who did not meet criteria for an axis-I disorder at baseline met criteria for at least one axis-I disorder during follow-up. Among them, the presence of diabetes mellitus was statistically correlated with a higher probability of developing major depressive disorder at follow-up. CONCLUSIONS Although preliminary, our findings are consistent with previous studies and suggest an increased prevalence of MDD and other axis-I disorders among women with newly diagnosed endocrine disorders, providing further evidence suggesting that women with endocrine abnormalities may be at increased risk of depression and/or anxiety disorders.


title: Outcomes of nonpledgeted horizontal mattress suture technique for mitral valve replacement.

text: BACKGROUND Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. METHODS We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. RESULTS In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. CONCLUSION We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.


title: Cancer biomarker discovery via low molecular weight serum proteome profiling - Where is the tumor?

text: Time-course analyses of rapidly processed serum performed in parallel by SELDI and nanoscale LC-MS/MS have revealed the temporal correlation of several literature-based disease markers with ex vivo driven events such that their in vivo existence in healthy subjects is questionable. Identification by MS/MS reveals these putative biomarkers to be byproducts of the coagulation cascade and platelet activation and suggests plasmatic analysis may be preferred. In a pilot plasmatic study, a cohort of naïve prostate cancer (PCa) samples were uniformly distinguished from their age-matched controls (n = 20) on the basis of multiple peptidic components; most notably by a derivative of complement C(4) at 1863 m/z (GLEEELQFSLGSKINVK, C4(1353-1369) ). The fully tryptic nature of this and other putative PCa discriminants is consistent with the cleavage specificity of common blood proteases and questions the need for tumor-derived proteolytic activities as has been proposed. In light of the known correlation of disregulated hemostasis with malignant disease, we suggest the underlying differentiating phenomena in these types of analyses may lie in the temporal disparity of sample activation such that the case (patient) samples are preactivated while the control samples are not.


docid: etpczxst

title: Add to your learning experience as a histopathology professional: dealing with the SARS-Cov-2 pandemic and publications in this issue.


Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE.


docid: kloqlezv

title: The burden of seasonal respiratory infections on a national telehealth service in England.

text: Seasonal respiratory illnesses present a major burden on primary care services. We assessed the burden of respiratory illness on a national telehealth system in England and investigated the potential for providing early warning of respiratory infection. We compared weekly laboratory reports for respiratory pathogens with telehealth calls (NHS 111) between week 40 in 2013 and week 29 in 2015. Multiple linear regression was used to identify which pathogens had a significant association with respiratory calls. Children aged <5 and 5-14 years, and adults over 65 years were modelled separately as were time lags of up to 4 weeks between calls and laboratory specimen dates. Associations with respiratory pathogens explained over 83% of the variation in cold/flu, cough and difficulty breathing calls. Based on the first two seasons available, the greatest burden was associated with respiratory syncytial virus (RSV) and influenza, with associations found in all age bands. The most sensitive signal for influenza was calls for 'cold/flu', whilst for RSV it was calls for cough. The best-fitting models showed calls increasing a week before laboratory specimen dates. Daily surveillance of these calls can provide early warning of seasonal rises in influenza and RSV, contributing to the national respiratory surveillance programme.


title: Dynamic social representations of the 2009 H1N1 pandemic: Shifting patterns of sense-making and blame.

text: We investigate dynamics of public perceptions of the 2009 H1N1 influenza pandemic to understand changing patterns of sense-making and blame regarding the outbreak of emerging infectious diseases. We draw on social representation theory combined with a dramaturgical perspective to identify changes in how various collectives are depicted over the course of the pandemic, according to three roles: heroes, villains and victims. Quantitative results based on content analysis of three cross-sectional waves of interviews show a shift from mentions of distant collectives (e.g., far-flung countries) at Wave 1 to local collectives (e.g., risk groups) as the pandemic became of more immediate concern (Wave 2) and declined (Wave 3). Semi-automated content analysis of media coverage shows similar results. Thematic analyses of the discourse associated with collectives revealed that many were consistently perceived as heroes, villains and victims.


title: SARS-CoV-2; What We Know so far.

text: A recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected more than 1100000 (April 5, 2020) individuals worldwide and is spreading rapidly. The virus is reported to be derived from bats and the infection was first reported in China. Similar to the severe acute respiratory syndrome and the Middle East respiratory syndrome coronaviruses, it is responsible for respiratory tract infection. Real time polymerase chain reaction and radiography are the two main diagnostic methods. Guidelines from the Center for Disease Control and Prevention and the World Health Organization (WHO) should be followed for diagnostic and precautionary measures. Treatment of the infection is still not available; however, antivirals are under clinical trials.


title: Ventral hernias in morbidly obese patients: a suggested algorithm for operative repair.

text: With the rise in prevalence of obesity, most general surgeons will have to face the problem of the obese patient with an abdominal wall defect. Treatment of these bariatric patients raises unique challenges, and at this time there is still no consensus on the best treatment option. This study was performed in a high-volume bariatric and minimally invasive surgery center at a tertiary care facility in the USA. Twenty-eight morbidly obese patients treated at our facility between 2003 and 2008 were separated into four groups according to anatomic features and symptoms. Patients with the following characteristics were classified as having a favorable anatomy: body mass index not exceeding 50 kg/m(2), gynecoid body habitus, reducible hernias found in a central location, abdominal wall thickness less than 4 cm, and the defect's largest diameter not exceeding 8 cm. All other patients were classified as having an unfavorable anatomy. In this study, we report a systematic treatment approach for the morbidly obese patient presenting with a ventral hernia based on whether the hernia is symptomatic or asymptomatic, as well as the distinct characteristics of the hernia and body habitus features. We followed up on these patients postoperatively for at least 2 years, with a mean follow-up period of 30 months. Only a total of three hernia recurrences were observed. Successful treatment of ventral hernias in morbidly obese patients should be individualized based on the patient's symptoms and defined hernia characteristics.


title: Does central tympanic membrane perforation affect infrared tympanic thermometer measurements in adults?

text: Objective Infrared Tympanic Thermometer (ITT) is one of the most useful instruments for accurately measuring temperature. The effects of ear pathologies on ITT measurement remain unclear. The purpose of this study is to determine if tympanic membrane perforation (TMP) affects ITT measurements in adult patients. Material and methods A total of 90 adult patients with monaural central TMP were enrolled in this study. Patients were categorized into three subgroups according to perforation size (1-3 mm, 4-7 mm, and 8-10 mm). The tympanic temperatures of the affected and unaffected sites, and subgroups were compared with each other. Results This study contained 54 (60%) males and 36 (40%) females ranging from 20 to 58 years of age (mean age: 30.74 ± 9.61 years). The mean tympanic temperature of the side affected with TMP was 36.34oC ± 0.61oC. The mean tympanic temperature of the unaffected side with healthy and intact tympanic membrane was 36.33oC ± 0.6oC. The Pearson correlation score for the tympanic temperatures and the size of TMP was 0.22 which was not significant (r=-0.12). Conclusion TMP and perforation size do not affect ITT measurements in adult patients.


title: Acellular dermal matrix in the management of the burn patient.

text: Although the principles of burn management are still primarily focused on survival, as advances are realized in resuscitation, nutrition, and wound management, the functional and aesthetic outcomes following burn injury have become increasingly important. Acellular dermal matrix materials, which allow surgeons to minimize skin graft donor site morbidity in the process of repairing injured areas, play a role in addressing these important issues. Many favorable reports have been published, but they are generally characterized by small sample sizes, limited objective testing, and retrospective analysis. There does appear to be some evidence for ADM application in patient populations in whom donor site availability (those with massive burns) or morbidity (children, the elderly) is a concern, but more studies are needed. In this article, the authors discuss the current applications for ADM in burn management, review the existing literature, and present opportunities for future research.


title: Evaluation of a modified vaccinia virus Ankara (MVA)-based candidate pandemic influenza A/H1N1 vaccine in the ferret model.

text: The zoonotic transmissions of highly pathogenic avian influenza viruses of the H5N1 subtype that have occurred since 1997 have sparked the development of novel influenza vaccines. The advent of reverse genetics technology, cell-culture production techniques and novel adjuvants has improved the vaccine strain preparation, production process and immunogenicity of the vaccines, respectively, and has accelerated the availability of pandemic influenza vaccines. However, there is still room for improvement, and alternative vaccine preparations can be explored, such as viral vectors. Modified vaccinia virus Ankara (MVA), originally developed as a safe smallpox vaccine, can be exploited as a viral vector and has many favourable properties. Recently, we have demonstrated that an MVA-based vaccine could protect mice and macaques against infection with highly pathogenic influenza viruses of the H5N1 subtype. In the present study, recombinant MVA expressing the haemagglutinin (HA) gene of pandemic influenza A/H1N1 virus was evaluated in the ferret model. A single immunization induced modest antibody responses and afforded only modest protection against the development of severe disease upon infection with a 2009(H1N1) strain. In contrast, two immunizations induced robust antibody responses and protected ferrets from developing severe disease, confirming that MVA is an attractive influenza vaccine production platform.


title: A rare nonincisional lateral abdominal wall hernia.

text: A 68-year-old woman presented a rare lateral abdominal wall hernia. Three month before admission to Chungbuk National University Hospital, she found a large protruding mass measuring 8 cm in diameter in the midaxillary line just below the costal margin upon heavy coughing. She had no history of abdominal trauma, infection, or operation previously. The mass was easily reduced manually or by position change to left lateral decubitus. CT scan showed a defect of the right transversus abdominis muscle and internal oblique muscle at the right flank with omental herniation. Its location is different from that of spigelian hernia or lumbar hernia. The peritoneal lining of the hernia sac was smooth and there was no evidence of inflammation or adhesion. The hernia was successfully repaired laparoscopically using Parietex composite mesh with an intraperitoneal onlay mesh technique. The patient was discharged uneventfully and did not show any evidence of recurrence at follow-up visits.


docid: ecyreyif

title: The plague of Thebes, a historical epidemic in Sophocles' Oedipus Rex.

text: Sophocles, one of the most noted playwrights of the ancient world, wrote the tragedy Oedipus Rex in the first half of the decade 430-420 bc. A lethal plague is described in this drama. We adopted a critical approach to Oedipus Rex in analyzing the literary description of the disease, unraveling its clinical features, and defining a possible underlying cause. Our goals were to clarify whether the plague described in Oedipus Rex reflects an actual historical event; to compare it with the plague of Athens, which was described by Thucydides as occurring around the same time Sophocles wrote; and to propose a likely causative pathogen. A critical reading of Oedipus Rex and a comparison with Thucydides' history, as well as a systematic review of historical data, strongly suggests that this epidemic was an actual event, possibly caused by Brucella abortus.


title: Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections.

text: Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.


title: Clinical presentation of patients with Ebola virus disease in Conakry, Guinea.

text: BACKGROUND In March 2014, the World Health Organization was notified of an outbreak of Zaire ebolavirus in a remote area of Guinea. The outbreak then spread to the capital, Conakry, and to neighboring countries and has subsequently become the largest epidemic of Ebola virus disease (EVD) to date. METHODS From March 25 to April 26, 2014, we performed a study of all patients with laboratory-confirmed EVD in Conakry. Mortality was the primary outcome. Secondary outcomes included patient characteristics, complications, treatments, and comparisons between survivors and nonsurvivors. RESULTS Of 80 patients who presented with symptoms, 37 had laboratory-confirmed EVD. Among confirmed cases, the median age was 38 years (interquartile range, 28 to 46), 24 patients (65%) were men, and 14 (38%) were health care workers; among the health care workers, nosocomial transmission was implicated in 12 patients (32%). Patients with confirmed EVD presented to the hospital a median of 5 days (interquartile range, 3 to 7) after the onset of symptoms, most commonly with fever (in 84% of the patients; mean temperature, 38.6°C), fatigue (in 65%), diarrhea (in 62%), and tachycardia (mean heart rate, >93 beats per minute). Of these patients, 28 (76%) were treated with intravenous fluids and 37 (100%) with antibiotics. Sixteen patients (43%) died, with a median time from symptom onset to death of 8 days (interquartile range, 7 to 11). Patients who were 40 years of age or older, as compared with those under the age of 40 years, had a relative risk of death of 3.49 (95% confidence interval, 1.42 to 8.59; P=0.007). CONCLUSIONS Patients with EVD presented with evidence of dehydration associated with vomiting and severe diarrhea. Despite attempts at volume repletion, antimicrobial therapy, and limited laboratory services, the rate of death was 43%.


docid: qgdumvdy

title: DNA-encoded bispecific T cell engagers and antibodies present long-term antitumor activity.

text: Specific antibody therapy, including mAbs and bispecific T cell engagers (BiTEs), are important new tools for cancer immunotherapy. However, these approaches are slow to develop and may be limited in their production, thus restricting the patients who can access these treatments. BiTEs exhibit a particularly short half-life and difficult production. The development of an approach allowing simplified development, delivery, and in vivo production would be an important advance. Here we describe the development of a designed synthetic DNA plasmid, which we optimized to permit high expression of an anti-HER2 antibody (HER2dMAb) and delivered it into animals through adaptive electroporation. HER2dMAb was efficiently expressed in vitro and in vivo, reaching levels of 50 μg/ml in mouse sera. Mechanistically, HER2dMAb blocked HER2 signaling and induced antibody-dependent cytotoxicity. HER2dMAb delayed tumor progression for HER2-expressing ovarian and breast cancer models. We next used the HER2dMAb single-chain variable fragment portion to engineer a DNA-encoded BiTE (DBiTE). This HER2DBiTE was expressed in vivo for approximately 4 months after a single administration. The HER2DBiTE was highly cytolytic and delayed cancer progression in mice. These studies illustrate an approach to generate DBiTEs in vivo, which represent promising immunotherapies for HER2+ tumors, including ovarian and potentially other cancers.


Study on the cleaning effect of medical protective positive pressure air supply respirator during COVID-19.


docid: qxuymkjt

title: Community-acquired pneumonia guidelines: a global perspective.

text: Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide, and since 1993, guidelines for management have been available. The process, which first began in the United States and Canada, has now been implemented in numerous countries throughout the world, and often each geographic region or country develops locally specific recommendations. It is interesting to realize that guidelines from different regions often interpret the same evidence base differently, and guidelines differ from one country to another, even though the bacteriology of CAP is often more similar than different from one region to another. One of the unique contributions of the 2007 US guidelines is the inclusion of quality and performance measures. In addition, US guidelines emphasize management principles that differ from some of the principles in European guidelines because of unique epidemiological considerations. In addition, certain therapy principles apply in the United States that differ from those in other regions, including the need for all patients to receive routine therapy for atypical pathogens, the emergence of community-acquired methicillin-resistant Staphylococcus aureus in some patients following influenza, and the need for all patients admitted to the intensive care unit to receive at least two antimicrobial agents. In the future, as guidelines evolve, there will be an important place for regional guidelines, particularly if these guidelines can recommend locally specific strategies to implement guidelines, which if successful, can lead to improved patient outcomes.


Experiences and lesson strategies for cardiology from the COVID-19 outbreak in Wuhan, China, by 'on the scene' cardiologists.


docid: cqiccdfk

title: Novel coronavirus: Australian GPs raise concerns about shortage of face masks.


title: [Isolated peripheral facial paralysis in a patient with COVID-19].

text: Parálisis facial periférica aislada en un paciente con COVID-19.


title: Enterovesical Fistula Secondary to Transitional Cell Carcinoma of the Bladder.

text: Although fistulae between the urinary bladder and the gastrointestinal tract are not uncommon, those caused by carcinoma of the urinary bladder are rare. This report describes the case of an 85 years old male who was diagnosed with a mass involving the small bowel and the urinary bladder during the course of investigation for recurrent urinary tract infections. At laparotomy, the presence of an enterovesical fistula involving the ileum and bladder was confirmed. Histopathological examination of the resected mass showed poorly differentiated urothelial carcinoma. No early postoperative complications were encountered and postoperative cystography showed healing of the bladder without evidence of leakage. Due to the patient's age and comorbidities, no further oncological treatment was offered. Three months later the patient was readmitted to hospital with a severe pneumonia to which he succumbed.


title: Efficacy of Combining Proximal Balloon Guiding Catheter and Distal Access Catheter in Thrombectomy with Stent Retriever for Anterior Circulation Ischemic Stroke.

text: OBJECTIVE We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke. METHODS We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them. RESULTS The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ≥11 or National Institutes of Health Stroke Scale ≤1 at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ≤2) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group. CONCLUSION The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.


title: Surgical and Oncologic Outcomes of Laparoscopic Radical Nephrectomy for Non-Metastatic Renal Cancer in Long-Term Dialysis Patients.

text: This study aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) between patients undergoing dialysis for ≤240 and >240 months. Data from all dialysis patients with non-metastatic renal cell carcinoma (RCC) treated with LRN between 2008 and 2015 in our hospital were evaluated retrospectively. Patients were divided into two groups, shorter- and longer-term dialysis patients, according to the preoperative duration of dialysis (≤240 vs. >240 months). Of 174 patients, 58 (33.3%) were on longer-term dialysis. Perioperative minor complications were significantly more frequent in the longer-term dialysis patients (P = 0.03). There was no significant difference between the two groups in other perioperative outcomes. Patients on longer-term dialysis more frequently had pathologically advanced RCC (P = 0.009) with poorer prognosis (P = 0.005). LRN for RCC in longer-term dialysis patients appears to be safe and feasible; however, careful follow-up is needed because these patients tend to have poorer prognosis.


title: SARS-CoV-2 nsp13, nsp14, nsp15 and orf6 function as potent interferon antagonists.

text: The Coronavirus disease 2019 (COVID-19), which is caused by the novel SARS-CoV-2 virus, is now causing a tremendous global health concern. Since its first appearance in December 2019, the outbreak has already caused over 5.8 million infections worldwide (till 29 May 2020), with more than 0.35 million deaths. Early virus-mediated immune suppression is believed to be one of the unique characteristics of SARS-CoV-2 infection and contributes at least partially to the viral pathogenesis. In this study, we identified the key viral interferon antagonists of SARS-CoV-2 and compared them with two well-characterized SARS-CoV interferon antagonists, PLpro and orf6. Here we demonstrated that the SARS-CoV-2 nsp13, nsp14, nsp15 and orf6, but not the unique orf8, could potently suppress primary interferon production and interferon signaling. Although SARS-CoV PLpro has been well-characterized for its potent interferon-antagonizing, deubiquitinase and protease activities, SARS-CoV-2 PLpro, despite sharing high amino acid sequence similarity with SARS-CoV, loses both interferon-antagonising and deubiquitinase activities. Among the 27 viral proteins, SARS-CoV-2 orf6 demonstrated the strongest suppression on both primary interferon production and interferon signaling. Orf6-deleted SARS-CoV-2 may be considered for the development of intranasal live-but-attenuated vaccine against COVID-19.


title: Single-incision laparoscopic cholecystectomy with routine intraoperative cholangiography and common bile duct exploration via the umbilical port.

text: BACKGROUND Laparoscopic cholecystectomy currently is the gold standard technique for gallbladder removal. The use of routine intraoperative cholangiography (IOC) is widely practiced during conventional four-port laparoscopic cholecystectomy (4PLC) to confirm biliary anatomy and allow for immediate management of unexpected choledocholithiasis. Single-incision laparoscopic surgery (SILS) offers a more aesthetic technique for gallbladder removal and has been reported by several groups. However, no series to date have included routine IOC without a separate incision. This study aimed to demonstrate the feasibility of the SILS technique for cholecystectomy with routine IOC (LCIOC) and common bile duct (CBD) exploration as needed via the umbilical port. METHODS A database was prospectively completed for a series of 60 consecutive patients undergoing single-incision LCIOC via the umbilical port. Details of the patients, operations, indications, outcomes, and follow-up evaluation were included. RESULTS Of the 60 patients included in the database, 55 (91.7%) successfully underwent single-incision laparoscopic cholecystectomy (SILC), whereas the remaining five patients required conversion to 4PLC. No patient required conversion to open cholecystectomy (OC). Of the 55 successful SILC patients, 53 (88.3%) successfully received IOCs, 48 of which were normal. The remaining five IOCs demonstrated choledocholithiasis, four of which could be managed laparoscopically without the need for conversion to either 4PLC or OC. One patient required postoperative endoscopic retrograde cholangiopancreatography (ERCP). Complications included four wound infections (7.8%), one incisional hernia (2.0%), and one bile leak (3.2%). The operating time ranged from 35 to 180 min and decreased with experience. CONCLUSIONS This study represents the largest series to date of single-incision laparoscopic cholecystectomies with routine IOC via the umbilical port and is the first study to demonstrate that the laparoscopic management of choledocholithiasis during SILC is feasible.


Fail to prepare no more.


title: Technical refinement of mini-laparoscopic hernia repair in infants and children.

text: BACKGROUND In large, long-term series of laparoscopic pediatric groin hernia repairs, the recurrence rate is commonly higher compared with the open herniotomy. Thus, we refined our laparoscopic technique from a simple hernia sac ligation into combined posterior wall repair for pediatric groin hernias. METHODS Between March 2010 and March 2013, 41 consecutive infants and children with primary inguinal hernia were treated surgically with our refined mini-laparoscopic hernia technique. The mean patient age was 4.5 years. Before hernia repair, there were synchronous bilateral hernias in 4 (9.7 %), left inguinal hernias in 14 (34.2 %) and right inguinal hernias in 23 (56.1 %). The mini-laparoscopic hernia repair was carried out with three 3.5 mm trocar ports including 3 mm telescope and 3 mm instruments. RESULTS Totally 61 repairs were performed. The mean follow-up period was 12 months. The mean operation time was 45 min. None of the repaired groin hernias had a recurrence or procedure-related complication during the period of follow-up. None of them experienced a chronic pain postoperatively. To date there was no scrotal or testicular complication detected by regular ultrasonographic follow-up. CONCLUSIONS Our refined laparoscopic technique is a safe and effective method in the management of groin hernias in infants and children with a minimal early recurrence rate.


title: Quality of life and symptoms of depression in advanced heart failure patients and their partners.

text: PURPOSE OF REVIEW To provide an overview of factors related to quality of life and symptoms of depression in heart failure patients and their partners. Furthermore, to give an overview of interventions that can be effective in improving their quality of life and decrease depressive symptoms. RECENT FINDINGS Quality of life of patients with heart failure and their partners is poor compared with their age-matched peers from the general population and also compared with patients suffering from other chronic diseases. Furthermore, many heart failure patients are depressed. Depressive symptoms of patients and of their partners seem to be interrelated, making interventions complicated but needed. Although the number of studies that specifically target improvement of quality of life and depression in heart failure patients and their partners is still small, several interventions are known to improve quality of life, and these could be implemented in daily care. SUMMARY This review considers demographic and clinical factors that are related to quality of life and depressive symptoms and addresses interventions that can contribute to improvement of quality of life of heart failure patients and their partners and decrease depressive symptoms. Education on self-care management and physical exercise are important elements of disease management programs. A multidisciplinary care approach including optimizing medical therapy and optimal symptom management is advised, focusing both on the patient and the caregiver. Treatment and care should not only focus on heart failure, but also address the consequences of co-morbidities and the side-effects of therapies.


Covid-19: how coronavirus will change the face of general practice forever.


title: Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum.

text: We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.