title: Vesicourethral anastomosis using V-Loc™ barbed suture during robot-assisted radical prostatectomy.

text: In Europe, localized prostate cancer (PCa) is increasingly treated by robot-assisted radical prostatectomy. This minimally invasive procedure is technically evolving, with benefits to both the patient and surgeon. One of the final steps of the operation is the formation of a watertight vesicourethral anastomosis (VUA). A suboptimal anastomosis can lead to serious consequences, including acute urinary leak, ileus, prolonged hospitalization and catheterization, urethral stricture, and urinary incontinence. It is therefore highly desirable to develop a simple, reproducible and dependable technique for VUA formation. We report a VUA formation technique using a unidirectional barbed suture (3-0 V-LocTM 180 absorbable suture, Covidien, Dublin, Ireland).


Fair Allocation of Scarce Medical Resources in the Time of Covid-19.


title: Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial.

text: BACKGROUND Diagnostic and interventional procedures are often facilitated by moderate procedure-related sedation. Many studies support the overall safety of this sedation; however, adverse cardiovascular and respiratory events are reported in up to 70% of these procedures, more frequently in very young, very old, or sicker patients. Monitoring with pulse oximetry may underreport hypoventilation during sedation, particularly if supplemental oxygen is provided. Capnometry may result in false alarms during sedation when patients mouth breathe or displace sampling devices. Advanced monitor use during sedation may allow event detection before complications develop. This 2-part pilot study used advanced monitors during planned moderate sedation to (1) determine incidences of desaturation, low respiratory rate, and deeper than intended sedation alarm events; and (2) determine whether advanced monitor use is associated with fewer alarm events. METHODS Adult patients undergoing scheduled gastroenterology or interventional radiology procedures with planned moderate sedation given by dedicated sedation nurses under the direction of procedural physicians (procedural sedation team) were monitored per standard protocols (electrocardiography blood pressure, pulse oximetry, and capnometry) and advanced monitors (acoustic respiratory monitoring and processed electroencephalograpy). Data were collected to computers for analysis. Advanced monitor parameters were not visible to teams in part 1 (standard) but were visible to teams in part 2 (advanced). Alarm events were defined as desaturation-SpO2 ≤92%; respiratory depression, acoustic respiratory rate ≤8 breaths per minute, and deeper than intended sedation, indicated by processed electroencephalograpy. The number of alarm events was compared. RESULTS Of 100 patients enrolled, 10 were excluded for data collection computer malfunction or consent withdrawal. Data were analyzed from 90 patients (44 standard and 46 advanced). Advanced had fewer total alarms than standard (Wilcoxon-Mann-Whitney = 2.073, P = 0.038; Wilcoxon-Mann-Whitney odds, 1.67; 95% confidence interval [CI], 1.04-2.88). Similar numbers of standard and advanced had ≥1 alarm event (Wald difference, -10.2%; 95% CI, -26.4% to 7.0%; P = 0.237). Fewer advanced patients had ≥1 respiratory depression event (Wald difference, -22.1%; 95% CI, -40.9% to -2.4%; P = 0.036) or ≥1 desaturation event (Wald difference, -24.2%; 95% CI, -42.8% to -3.6%; P = 0.021); but there was no significant difference in deeper than intended sedation events (Wald difference, -1.38%; 95% CI, -20.21% to 17.49%; P = 0.887). CONCLUSIONS Use of advanced monitoring parameters during planned moderate sedation was associated with fewer alarm events, patients experiencing desaturation, and patients experiencing respiratory depression alarm events. This pilot study suggests that further study into the safety and outcome impacts of advanced monitoring during procedure-related sedation is warranted.


title: A two-year prospective study of small poultry flocks in Ontario, Canada, part 1: prevalence of viral and bacterial pathogens.

text: In Ontario, within the past few years, there has been a marked increase in the number of non-commercial poultry flocks (referred to as "small flocks"). Small poultry flocks may act as a reservoir of avian and zoonotic pathogens, given the flocks' limited access to veterinary services, inadequate biosecurity practices, and increased risk of contact with wild birds. Despite these potential risks, there is a scarcity of data concerning the prevalence of poultry and zoonotic pathogens among these flocks. To assess the baseline prevalence of bacterial and viral infectious pathogens, prospective surveillance of small flock postmortem submissions to the Animal Health Laboratory was conducted over a 2-y period. With the owner's consent, a postmortem examination and pre-set tests for infectious agents were conducted. A total of 160 submissions, mainly chickens (84%), were received. Among bacterial pathogens, Brachyspira spp., Mycoplasma synoviae, Campylobacter spp., Mycoplasma gallisepticum, and Salmonella spp. were detected in 37%, 36%, 35%, 23%, and 3% of tested submissions, respectively. Among viral pathogens, infectious bronchitis virus, fowl adenovirus, infectious laryngotracheitis virus, avian reovirus, and infectious bursal disease virus were detected in 39%, 35%, 15%, 4%, and 1% of submissions, respectively. We detected non-virulent avian avulavirus 1 from two chickens in a single submission, and low-pathogenic H10N8 influenza A virus from a single turkey submission. Our study provides baseline prevalence of viral and bacterial pathogens circulating in Ontario small flocks and may help animal and human health professionals to educate small flock owners about disease prevention.


title: Regulation of tryptophan 2,3-dioxygenase by HOXA10 enhances embryo viability through serotonin signaling.

text: Tryptophan 2,3-dioxygenase (TDO) is expressed in endometrium and catabolizes tryptophan, a precursor in the biosynthesis of serotonin. Tryptophan metabolism is an important mechanism for regulation of serotonin levels. Preimplantation mouse embryos are known to express serotonin receptors, specifically the 5-HT1D and 5-HT7 serotonin receptor subtypes. Here we demonstrate that Hoxa10 regulates endometrial TDO expression and improves embryo viability through increased serotonin production. Transfection of pcDNA-Hoxa10 to the murine uterus increased total TDO expression. In vitro, epithelial cell TDO expression was decreased after transfection with Hoxa10. Decreased glandular TDO in response to HOXA10 may augment serotonin production by increasing tryptophan availability. Conversely, stromal TDO expression increased with constitutive Hoxa10 expression. In mice, epithelial serotonin was increased in response to constitutive expression of Hoxa10. Embryo quality was impaired after treatment with Hoxa10 antisense. Blockade of serotonin receptors 1D and 7 also resulted in impaired embryo development, indicating an essential role for Hoxa10 induction of TDO and subsequent serotonin production in embryo development. Transfection of pcDNA-TDO also decreased the number of T cells in the endometrial stroma. We have shown a novel mechanism by which HOXA10 regulates endometrial TDO expression. In the endometrial stroma, HOXA10 increases TDO mRNA, which may increase tryptophan catabolism, allowing for immune tolerance at the time of embryo implantation. In endometrial glands, HOXA10 decreases TDO mRNA leading to increased serotonin that in turn acts to promote normal embryo development.


title: [COVID-19: Variable symptoms in mild course: olfactory loss and increased resting heart rate].

text: HISTORY A 56-year-old, previously healthy male and long distance runner noticed short episodes of parosmia, followed by anosmia. Few days later, he monitored an increase in his resting heart rate. This was followed by a dry cough, fatigue, and myalgia. At the same time, symptoms occurred in all four family members. CLINICAL FINDINGS The patient had a dry cough. The medical examination was normal. Heart rate was 60/min, sinus rhythm, body temperature 36.6 °C. Complete anosmia was present. The RT-PCR for SARS-CoV-2 from a deep pharyngeal swab was positive in all five family members. THERAPY AND COURSE Symptoms were present for almost two weeks. All family members had anosmia, that started earlier and lasted longer than the other symptoms, and myalgia. Reduced taste sensation, fatigue, dry cough and sore throat were present in four of five persons. Shortness of breath at rest or gastrointestinal symptoms were absent. Four affected persons had sleep disturbances in the later course of the disease. None of the affected persons had raised temperature at any time during the disease. Specific medical or drug treatment was not necessary. All patients made full recoveries without signs of organ dysfunction, and with full restitution of physical strength. DISCUSSION We describe a family of 5 previously healthy persons with a mild course of COVID-19 disease. The symptoms and course are described in detail. Anosmia can precede other symptoms by several days and can indicate an early phase of infection. An increase in resting heart rate can occur in the absence of raised temperature or fever. The symptoms and course are discussed in the context of the ongoing pandemic, and efforts to control infection chains.


Shortcomings in India's first national attempt at universal healthcare through publicly funded health insurance.


title: Clinical Characteristics and Outcomes of 74 Patients With Severe or Critical COVID-19.

text: BACKGROUND The outbreak of the coronavirus disease (COVID-19) has led to a major concern and caused a pandemic globally. The goal of this study was to clarify the clinical characteristics of recovery and death in patients with severe or critical COVID-19. MATERIALS AND METHODS In this retrospective single-center study, clinical data were collected from 74 severe or critical COVID-19 patients in Wuhan Fourth Hospital between Jan. 25th and Feb. 26th, 2020. All patients were divided into a recovery group or a death group according to clinical outcomes, and the differences between the groups were compared. RESULTS Of the 74 patients enrolled in the study, 48 (64.9%) were severe cases and 26 (35.1%) were critical cases. Sixty (81.1%) patients were recovered and 14 (18.9%) died. Compared with recovery patients, patients in the death group were older, and had higher incidences of hypertension, coronary disease and dyspnea at admission. Laboratory tests for lactate dehydrogenase, creatine kinase, myoglobin, brain natriuretic peptide and D-dimer indicated higher levels in the death group. The PaO2:FiO2 ratio and minimum SpO2 were lower in the death group, and a higher proportion of these patients received noninvasive mechanical ventilation, invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. CONCLUSIONS Elderly patients with comorbidities are at higher risk of severe COVID-19 or death. Patients with a low blood gas index and poor coagulation function at admission had a high mortality rate. For such patients, comprehensive treatment should be performed as soon as possible to improve the prognosis and reduce mortality.


title: Respiratory viral detection in the paranasal sinuses of patients with cystic fibrosis.

text: BACKGROUND Pulmonary colonization with antibiotic-resistant organisms in patients with cystic fibrosis (CF) is often preceded by upper-airway infections. Although there is a well-described relationship between pulmonary respiratory viral infections and overall disease progression of CF, the pathogenicity of respiratory viral infections in the paranasal sinuses of patients with CF remains unknown. With recent advances in respiratory virus detection techniques, this study sought to detect the presence of respiratory viruses in the paranasal sinuses of patients with CF in comparison with healthy controls and to correlate the viral presence with clinical measures of sinonasal disease. METHODS This prospective individual cohort study compared 24 patients with CF with 14 healthy controls. Basic demographics, clinical measures of disease and respiratory viral screens (commercial multiplex) obtained directly from the paranasal sinuses were compared between the two groups. RESULTS Respiratory viruses were detected in 33% of patients with CF (8/24) compared with 0% of the healthy controls (0/14) (p = 0.017). Respiratory viruses were only detected during the winter months, and the most commonly identified were influenza A and human rhinovirus strains. There was no statistical difference in the 22-Item Sino-Nasal Outcome Test (SNOT-22) scores (p = 0.93) or modified Lund-Kennedy scores (p = 0.74) between patients with CF with a positive viral test and those without a positive result. CONCLUSIONS Respiratory viral detection is more commonly detected in the paranasal sinuses of patients with CF compared with healthy controls. Although respiratory viral presence did not correlate with a worse clinical severity of sinonasal disease, these findings may provide insight into the pathophysiology of CF and open new avenues for potential targeted therapy.


title: High-volume bariatric surgery in a single center: safety, quality, cost-efficacy and teaching aspects in 2,000 consecutive cases.

text: BACKGROUND Obesity surgery is the most effective treatment for morbid obesity and the fastest growing area in surgery. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard procedure in many countries. Optimization of the treatment process is important in order to keep the morbidity rate down and cost of treatment as low as possible. METHODS In September 2005, we established a bariatric surgery program. Until December 2010, 2,000 patients underwent LRYGB. Clinical pathways were established, with focus on safety, fast-track methodology and training of surgeons. Time recordings from all parts of the treatment, as well as clinical outcome, were prospectively registered. RESULTS Time consumption for the total procedure in the operating theater was reduced from 102 to 54 min (P < 0.001). With only 11 min turnover between patients, the total time for one patient has been reduced to 65 min, enabling us to perform six operations in a single operating theater during ordinary daytime. Early complication rate was 2.8%, and mean hospital stay was 2.3 days. We were able to double the patients treated in 2010 compared to 2007 with only 10% increase in staff. Three surgeons were trained during the period into fully qualified senior bariatric surgeons. CONCLUSIONS Multimodal evidence-based care within the fast-track methodology and routine time recordings was successful in order to increase the production volumes and reduce costs, without compromising the safety or quality for the patients. This kind of approach may be transferred to other types of standardized surgery.


title: Inactivation of hantaviruses by N-ethylmaleimide preserves virion integrity.

text: Thiol groups of cysteine residues are crucial for the infectivity of various enveloped viruses, but their role in the infectivity of viruses of the family Bunyaviridae has thus far not been studied. This report shows that thiol groups are essential to the infectivity of hantaviruses. Alkylation of the thiol functional groups using the membrane-permeable compound N-ethylmaleimide (NEM) and membrane-impermeable compound 5,5'-dithio-bis-(2-nitrobenzoic acid) (DTNB) showed NEM to be a highly effective inactivator of Puumala and Tula hantaviruses. The NEM-inactivated hantavirus maintained the buoyant density of the wild-type virus. Furthermore, the antigenicity of glycoproteins and the cell attachment capacity of virions were retained at NEM concentrations that totally abolished virus infectivity. These results signified preservation of virion integrity following inactivation with NEM, making chemically inactivated virions valuable research antigens. It was demonstrated with biotin-conjugated maleimide, a mechanistic analogue of NEM, that all the structural proteins of hantavirus were sensitive towards thiol alkylation. In contrast to hantaviruses, NEM did not abolish Uukuniemi phlebovirus infectivity to the same extent. This indicates differences in the use of free thiols in virus entry among members of the family Bunyaviridae.


docid: ubxaexqv

title: How should data on airborne transmission of SARS-CoV-2 change occupational health guidelines?


title: COVID-19 emergency in the cruise's ship: a case report of conjunctivitis.

text: Little is known about the Covid-19 transmission through ocular tissue, and more research needs to be carried out in order to confirm its ability to infect ocular tissue and its pathogenic mechanisms. Covid-19 may be detected in the tears and conjunctival secretions in novel coronavirus pneumonia patients with conjunctivitis. This case report shows a severe viral conjunctivitis in a patient diagnosed with Covid-19 on the Diamond Princess ship, characterized by both red, irritated and swollen eyes, with transparent serous secretions, conjunctival chemosis, pseudomembranes of fibrin and inflammatory cells on the tarsal conjunctiva accompanied by preauricular lymph nodes and enlarged submaxillaries.


title: Acute Ischemic Stroke with Very Early Clinical Improvement: A National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Trials Exploratory Analysis.

text: BACKGROUND A high proportion of patients excluded from recombinant tissue plasminogen activator (rt-PA) treatment because of rapid improvement occurring before treatment decision had incomplete recovery. The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trials dataset allows for systematic analyses of very early postrandomization improvement (VEPRIM) in stroke severity as a National Institutes of Health Stroke Scale (NIHSS) score was available for all subjects enrolled in the study at baseline (NIHSSB) and at 2 hours after randomization (NIHSS2H). We explored various definitions of VEPRIM to characterize predictive values for clinical outcomes. METHODS Post hoc analyses of the NINDS rt-PA Stroke Trials were conducted. VEPRIM was defined as the difference between the NIHSSB and the NIHSS2H scores using 3 approaches: raw, percent, and normalized change. We assessed the association between VEPRIM and 3-month favorable outcome (mRS score of 0-1), symptomatic intracerebral hemorrhage (sICH), and death. RESULTS In the 624 subjects, every VEPRIM definition was independently associated with an increased probability of favorable outcome: for each unit of change within the VEPRIM definitions, there were 2%-24% (all P < .05) relative increased probability of favorable outcome, 2%-15% (all P < .05) decreased likelihood of death, and 2%-13% (all P < .05) decreased likelihood of sICH. Adjusting for NIHSSB and prestroke mRS scores, there was a significant rt-PA treatment effect for improvement seen for all 3 VEPRIM definitions. CONCLUSIONS VEPRIM predicted favorable outcomes independent of definition and treatment arm. Patients with VEPRIM by any definition, while doing better than patients without VEPRIM, also derived increased clinical benefit when treated with rt-PA compared to placebo. Even with VEPRIM, a substantial percentage of patients had unfavorable outcomes.


docid: vpgexjvv

title: Solidarity in response to COVID-19 outbreak in the Eastern Mediterranean Region.

text: The coronavirus disease 2019 (COVID-19) outbreak that began in Wuhan, Hubei Province, China in late 2019 has spread globally within a few months. The Director General of the World Health Organization (WHO) declared the COVID-19 outbreak to be a public health emergency of international concern (PHEIC) after the second meeting of the IHR (2005) Emergency Committee on 30 January 2020. On 12 March 2020, the outbreak of COVID-19 was characterized as a pandemic.


Re: "a novel cautery instrument for on-site fenestration of aortic stent-grafts: a feasibility study of 18 patients".


docid: zrlqzbss

title: Dietary recommendations during the COVID-19 pandemic.

text: Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals. The majority of documents encouraged the consumption of fruits, vegetables, and whole grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system. Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected. There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.


title: Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke.

text: BACKGROUND Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the covid-19 pandemic. The extent of covid-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. CASE DESCRIPTION We present two patients with covid-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to covid-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. CONCLUSION Our report shows that patients' CSF may be devoid of viral particles even when they test positive for covid-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus' nervous tissue tropism and should be examined in future studies.


title: Resuming elective surgical activity after the COVID-19 wave: what the patients need to know.

text: As COVID-19 outbreak enters its second phase of lockdown ease, healthcare plans involve elective surgery re-establishment to provide essential life-saving care. Patients are increasingly requesting information about their facility's readiness for safely performing surgery. This information should be open and transparent including patient's education with objective data regarding the state of the pandemic in the country and the control measures undertaken by the facility.


title: A comparison of substrate oxidation during prolonged exercise in men at terrestrial altitude and normobaric normoxia following the coingestion of 13C glucose and 13C fructose.

text: This study compared the effects of coingesting glucose and fructose on exogenous and endogenous substrate oxidation during prolonged exercise at altitude and sea level, in men. Seven male British military personnel completed two bouts of cycling at the same relative workload (55% Wmax) for 120 min on acute exposure to altitude (3375 m) and at sea level (~113 m). In each trial, participants ingested 1.2 g·min-1 of glucose (enriched with 13C glucose) and 0.6 g·min-1 of fructose (enriched with 13C fructose) directly before and every 15 min during exercise. Indirect calorimetry and isotope ratio mass spectrometry were used to calculate fat oxidation, total and exogenous carbohydrate oxidation, plasma glucose oxidation, and endogenous glucose oxidation derived from liver and muscle glycogen. Total carbohydrate oxidation during the exercise period was lower at altitude (157.7 ± 56.3 g) than sea level (286.5 ± 56.2 g, P = 0.006, ES = 2.28), whereas fat oxidation was higher at altitude (75.5 ± 26.8 g) than sea level (42.5 ± 21.3 g, P = 0.024, ES = 1.23). Peak exogenous carbohydrate oxidation was lower at altitude (1.13 ± 0.2 g·min-1) than sea level (1.42 ± 0.16 g·min-1, P = 0.034, ES = 1.33). There were no differences in rates, or absolute and relative contributions of plasma or liver glucose oxidation between conditions during the second hour of exercise. However, absolute and relative contributions of muscle glycogen during the second hour were lower at altitude (29.3 ± 28.9 g, 16.6 ± 15.2%) than sea level (78.7 ± 5.2 g (P = 0.008, ES = 1.71), 37.7 ± 13.0% (P = 0.016, ES = 1.45). Acute exposure to altitude reduces the reliance on muscle glycogen and increases fat oxidation during prolonged cycling in men compared with sea level.


docid: tfkggdpv

title: Letter by Weir Regarding Article, "Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2".


title: Comparing Angiographic Devascularization with Histologic Penetration after Preoperative Tumor Embolization with Onyx: What Indicates an Effective Procedure?

text: BACKGROUND AND PURPOSE To assess Onyx (Covidien, Irvine, California, United States) efficacy as a preoperative embolic agent for neoplasms of the head, neck, and spine, and to compare angiographic and histologic evidence of tumor penetration as predictors of intraoperative blood loss. MATERIALS AND METHODS Retrospective analysis of preoperative Onyx embolization procedures for treatment of head, neck, and spine tumors from 2009 to 2011. Patient demographics and information relating to the embolization procedure and operation were recorded. Measures of Onyx efficacy included intraoperative blood loss and length of surgery. Angiographic and histologic penetration, in addition to percentage of tumor devascularization, were assessed as predictors of efficacy. RESULTS A total of 22 patients with 17 head or neck and 5 spinal lesions underwent trans-arterial preoperative Onyx embolization. Good angiographic penetration was reported in 41% of tumors and central histologic penetration in 59%, with mean tumor devascularization of 85.3% (standard deviation [SD]: 12.6%). There was no relationship between angiographic and histologic Onyx penetrance. Mean surgical blood loss was 1342 mL (SD: 1327 mL), and length of surgery was 289 minutes (SD: 162 minutes). Neither angiographic, nor histologic Onyx penetration predicted intraoperative blood loss (p = 0.38 and p = 0.32, respectively) or surgical length (p = 0.62 and 0.90, respectively). Devascularization was not associated with blood loss (p = 0.62), but it was a negative predictor of surgical length (p = 0.013). CONCLUSIONS Preoperative Onyx embolization of head, neck, and spine tumors is capable of deep histologic tumor penetration, even when not visualized on angiography. The lack of association between measures of procedural adequacy suggests that using angiographic devascularization as a measure of procedural efficacy may be of limited utility.


title: Lateral canthal surgery.

text: The lateral canthus is a delicate and complicated three-dimensional structure with function relevant to the health of the ocular surface. Dysfunction of the lateral canthus, due to aging changes or iatrogenic trauma, results in ocular morbidity ranging from chronic irritation to tearing to recalcitrant keratopathy. From an aesthetic standpoint, symmetric, normally positioned lateral canthi are cornerstones of youthful periorbital appearance, disruption of which leads to cosmetically significant deformity or asymmetry. Reconstruction of the lateral canthus is important in the rehabilitation of the aging eyelid and an unfortunate necessity after failed lateral canthal surgery. The common methods for improving or maintaining position, tone, and shape of the lower eyelid and lateral canthus use tightening or shortening the lower eyelid horizontally, keeping the canthal angle in an appropriate vertical level, and hugging the ocular surface. Many techniques have been described for the reconstruction of the lateral canthus in functional conditions or for aesthetic purposes. These methods have met with varying success. In this article, we begin with a discussion of the anatomy and physiology of the lateral canthus, followed by clinical examples of lateral canthal abnormalities and underlying pathophysiologies. A review of surgical options for the lateral canthus is presented with concluding remarks on postoperative complications.


title: Sutureless enterostomy for extremely low birth weight infants.

text: OBJECTIVE In recent years, improved survival rates of extremely low birth weight infants (ELBWIs) have led to an increasing number of enterostomy performed for those with meconium obstruction of prematurity (MOP)1,2, spontaneous intestinal perforation (SIP)3,4. To prevent serious stoma-related complications such as stoma side perforation, prolapse, fall and surgical site infection, we introduce our new "sutureless enterostomy" technique. METHODS We present the procedures in detail. We reviewed the medical records of twelve patients who underwent "sutureless enterostomy" in our neonatal intensive care unit from 2007 to 2013. Patient attributes, surgery-related items, stoma-related complications and outcomes were investigated. RESULTS Mean birth weight was 671±158g (mean±S.D.). Six cases of MOP, three cases of SIP and three cases of NEC were diagnosed. Mean operative time was 75±35min (mean±S.D.) None of them presented any of early stoma-related complications (necrosis, fall, and surgical site infection). However the parastomal hernia occurred in one patient as late complication. Three deaths occurred postoperatively as a result of exacerbations of their conditions. CONCLUSIONS Based on our preliminary observations, our new "sutureless enterostomy" was done safely and reduced the risk of stoma-related complications. It may be an ideal procedure for the ELBWI with MOP or SIP.


title: Long-term outcomes after pediatric splenectomy.

text: BACKGROUND Splenectomy is performed frequently for various and primarily hematologic indications in children and adolescents. We analyzed the long-term outcome after splenectomy (median, 8.7 years) focusing on sepsis, portal vein thrombosis (PVT), and retained accessory spleen. METHODS In total, 141 consecutive children after open (n = 89; 63%) or laparoscopic (n = 52; 37%) splenectomy from 1991 to 2010 were followed up through nationwide registries for septic infections, PVT, and causes of death. Sixty-six patients (58% of survivors) answered a structured questionnaire on infections, abdominal symptoms, and general health, and 64 (laparoscopic n = 26, open n = 38) consented to ultrasonography of the portal venous system. RESULTS Median operation age was 8.8 years (range, 1.0-22). Reoperations were required for bleeding after open procedures (n = 1) and retained accessory spleen after laparoscopic procedures (n = 3). Postsplenectomy sepsis occurred after a median of 1.7 years (range, 0.2-5.9) in 11 patients (8%), of whom 10 had an underlying immunodeficiency. No cases of PVT were observed, although the median portal vein flow was 1,130 mL/min (range, 440-2200) and diameter was 9.9 mm (range, 7-15) at a median follow-up of 9.5 years (range, 2.0-22) after splenectomy. Twenty-seven patients (19%) died after 8.7 years (0.03-23.00). The most common cause of death was the underlying malignancy (n = 15), with sepsis being an additional cause of death in 5 patients. CONCLUSION Postsplenectomy sepsis was associated almost exclusively with an underlying immunodeficiency with a high mortality rate. No PVT was observed. The overall risk of retained accessory spleen was around 7%, and was slightly greater after laparoscopic operation.


title: The decisive role of the patient-side surgeon in robotic surgery.

text: INTRODUCTION Minimally invasive technology literature is mainly concerned about the feasibility of the robotic procedures and the performance of the console surgeon. However, few of these technologies could be applied without a well-trained team. Our goal was to demonstrate that robotic surgery depends more on the patient-side assistant surgeon's abilities than has been previously reported. METHODS In our department, 280 interventions in digestive, thoracic, and gynecological surgery were performed since the acquisition of the robotic equipment. There are three teams trained in robotic surgery with three console surgeons and four certified patient-side surgeons. Four more patient-side assistants were trained at our center. Trocar placement, docking and undocking of the robot, insertion of the laparoscopic instruments, and hemostatic maneuvers with various devices were quantified and compared. RESULTS Assistants trained by using animal or cadaver surgery are more comfortable with the robotic instruments handling and with docking and undocking of the robot. Assistants who finalized their residency or attend their final year are more accurate with the insertion of the laparoscopic instrument to the targeted organ and more skillful with LigaSure or clip applier devices. Interventions that require vivid participation of the assistants have shorter assistant-depending time intervals at the end of the learning curve than at the beginning. CONCLUSIONS Robotic surgery is a team effort and is greatly dependant on the performance of assistant surgeons. Interventions that have the benefit of a trained team are more rapid and secure.


title: Tumor Necrosis Factor Alpha-Induced Recruitment of Inflammatory Mononuclear Cells Leads to Inflammation and Altered Brain Development in Murine Cytomegalovirus-Infected Newborn Mice.

text: Congenital human cytomegalovirus (HCMV) infection is a significant cause of abnormal neurodevelopment and long-term neurological sequelae in infants and children. Resident cell populations of the developing brain have been suggested to be more susceptible to virus-induced cytopathology, a pathway thought to contribute to the clinical outcomes following intrauterine HCMV infection. However, recent findings in a newborn mouse model of the infection in the developing brain have indicated that elevated levels of proinflammatory mediators leading to mononuclear cell activation and recruitment could underlie the abnormal neurodevelopment. In this study, we demonstrate that treatment with tumor necrosis factor alpha (TNF-α)-neutralizing antibodies decreased the frequency of CD45+ Ly6Chi CD11b+ CCR2+ activated myeloid mononuclear cells (MMCs) and the levels of proinflammatory cytokines in the blood and the brains of murine CMV-infected mice. This treatment also normalized neurodevelopment in infected mice without significantly impacting the level of virus replication. These results indicate that TNF-α is a major component of the inflammatory response associated with altered neurodevelopment that follows murine CMV infection of the developing brain and that a subset of peripheral blood myeloid mononuclear cells represent a key effector cell population in this model of virus-induced inflammatory disease of the developing brain.IMPORTANCE Congenital human cytomegalovirus (HCMV) infection is the most common viral infection of the developing human fetus and can result in neurodevelopmental sequelae. Mechanisms of disease leading to neurodevelopmental deficits in infected infants remain undefined, but postulated pathways include loss of neuronal progenitor cells, damage to the developing vascular system of the brain, and altered cellular positioning. Direct virus-mediated cytopathic effects cannot explain the phenotypes of brain damage in most infected infants. Using a mouse model that recapitulates characteristics of the brain infection described in human infants, we have shown that TNF-α plays a key role in brain inflammation, including recruitment of inflammatory mononuclear cells. Neutralization of TNF-α normalized neurodevelopmental abnormalities in infected mice, providing evidence that virus-induced inflammation is a major component of disease in the developing brain. These results suggest that interventions limiting inflammation associated with the infection could potentially improve the neurologic outcome of infants infected in utero with HCMV.


title: Children's (in)visibility in social vulnerability and the impact of the novel coronavirus (COVID-19).

text: OBJECTIVE To examine the impact of the infection by the novel coronavirus on Brazilian children in situation of social vulnerability based on the Millennium Sustainable Development Goals. METHOD Reflective study based on discursive formulation in three aspects: principles of the objectives and goals for the millennium sustainable development; impact of the pandemic on the health of children and their families living in social vulnerability; and the role of pediatric nursing in the care provided - limits and challenges. RESULTS In January 2020, the news of COVID 19 is released as a pandemic. In Brazil, children and families are still without access to basic rights, thereby increasing their risks of social vulnerability because of the quarantine. The nursing field has an important role in monitoring children and their families, offering guidance in search for solutions and preventing contamination. CONCLUSION There are still challenges to be overcome by the children and their families in situations of vulnerability against COVID-19.


title: Coronavirus disease 2019: reassembly attack of coronavirus.

text: There have been three major global outbreaks of acute respiratory disease caused by coronavirus in the last two decades. The ongoing Coronavirus Disease 2019 (COVID-19) first emerged in Wuhan, China, is the most dangerous, which spread to 163 countries and 6 continents and caused a major public health emergency worldwide. The outbreak is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) originated from bats, which spreads rapidly from human to human. As of 17 March 2020, there have been 179,112 confirmed cases and 7426 deaths worldwide, with a mortality rate of 4.1%. There is currently no effective treatment or approved vaccine, so isolating the source of infection and blocking the routes of transmission is important. In this article, we summarized the worldwide epidemic trend of COVID-19 and discussed its epidemiological characteristics, prevention and control measures. We hope this article could provide experience and help for global epidemic prevention and control.


Mortality, Admissions, and Patient Census at SNFs in 3 US Cities During the COVID-19 Pandemic.


Risk of infection after the Nepal earthquake.


title: Biosafety for dental patients during dentistry care after COVID-19: A review of the literature.

text: The world is currently changing due to COVID-19, and the field of dentistry is no stranger to this. The care of patients in the dental office involves very strict biosafety protocols, and patients must be aware of the protection barriers implemented to allow satisfactory, safe dental care. The purpose of this study was to synthesize and analyze the management of the current biosafety standards for dental patients since the arrival of the COVID-19 pandemic. A bibliographic search of the main sources of information including MEDLINE (via PubMed), Scopus, Science Direct, SCIELO and Google Scholar was carried out. Articles published without language restriction, systematic reviews, literature reviews and observational studies were included. We identified the biosafety measures which must be taken before, during and after dental practice following the arrival of COVID-19, The main measures include telephone triage, temperature taking on arrival at the office, the organization of the waiting room, washing hands before entering the office, knowing the auxiliary radiographic exams of choice and what type of treatment can be performed, albeit with restrictions. In conclusion, dental patients must comply with all the biosafety measures established by international protection standards and implemented by dentists before, during and after dental practice, in order to reduce the possibility of COVID-19 infection.


docid: kmcrpuvi

title: Increased Epicardial Adipose Tissue Volume Correlates With Cardiac Sympathetic Denervation in Patients With Heart Failure.

text: RATIONALE It has been reported that epicardial adipose tissue (EAT) may affect myocardial autonomic function. OBJECTIVE The aim of this study was to explore the relationship between EAT and cardiac sympathetic nerve activity in patients with heart failure. METHODS AND RESULTS In 110 patients with systolic heart failure, we evaluated the correlation between echocardiographic EAT thickness and cardiac adrenergic nerve activity assessed by (123)I-metaiodobenzylguanidine ((123)I-MIBG). The predictive value of EAT thickness on cardiac sympathetic denervation ((123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score) was tested in a multivariate analysis. Furthermore, catecholamine levels, catecholamine biosynthetic enzymes, and sympathetic nerve fibers were measured in EAT and subcutaneous adipose tissue biopsies obtained from patients with heart failure who underwent cardiac surgery. EAT thickness correlated with (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score, but not with left ventricular ejection fraction. Moreover, EAT resulted as an independent predictor of (123)I-MIBG early and late heart:mediastinum ratio and single-photon emission computed tomography total defect score and showed a significant additive predictive value on (123)I-MIBG planar and single-photon emission computed tomography results over demographic and clinical data. Although no differences were found in sympathetic innervation between EAT and subcutaneous adipose tissue, EAT showed an enhanced adrenergic activity demonstrated by the increased catecholamine levels and expression of catecholamine biosynthetic enzymes. CONCLUSIONS This study provides the first evidence of a direct correlation between increased EAT thickness and cardiac sympathetic denervation in heart failure.


title: Exhaled droplets due to talking and coughing.

text: Respiratory infections can be spread via 'contact' with droplets from expiratory activities such as talking, coughing and sneezing, and also from aerosol-generating clinical procedures. Droplet sizes predominately determine the times they can remain airborne, the possibility of spread of infectious diseases and thus the strategies for controlling the infections. While significant inconsistencies exist between the existing measured data on respiratory droplets generated during expiratory activities, a food dye was used in the mouth during measurements of large droplets, which made the expiratory activities 'unnatural'. We carried out a series of experiments using glass slides and a microscope as well as an aerosol spectrometer to measure the number and size of respiratory droplets produced from the mouth of healthy individuals during talking and coughing with and without a food dye. The total mass of respiratory droplets was measured using a mask, plastic bag with tissue and an electronic balance with a high precision. Considerable subject variability was observed and the average size of droplets captured using glass slides and microscope was about 50-100 microm. Smaller droplets were also detected by the aerosol spectrometer. More droplets seemed to be generated when a food dye was used.


title: Nasogastric tube, temperature probe, and bougie stapling during bariatric surgery: a multicenter survey.

text: BACKGROUND An adverse event in laparoscopic bariatric surgery that has not received much scrutiny involves tube/probe stapling or suturing during gastrectomy or gastroenterostomy. METHODS A retrospective analysis was performed using a questionnaire sent to all bariatric surgeons (n = 43) in Israel. RESULTS Eight surgeons reported on 17 cases in which intraoperative nasogastric/orogastric tube (n = 8), temperature probe (n = 6), or bougie stapling (n = 3) was identified. Laparoscopic sleeve gastrectomy was performed in 14 patients and laparoscopic gastric bypass in 3 patients. The patient demographics, operative details, and postoperative results are reported. CONCLUSION Tube/probe complications can occur during laparoscopic bariatric surgery but are seldom reported. However, they can be associated with significant morbidity. The treatment options are dependent on the situation. More importantly, prevention strategies must include constant communication with the anesthesiologist and removal or relocation of a tube before stapling or suturing.


title: Human Washington University Polyomavirus in Patients with Respiratory Tract Infection in Kuwait.

text: OBJECTIVE To determine Washington University (WU) polyomavirus strains circulating among hospitalized patients with respiratory tract infections (RTI) in Kuwait. MATERIALS AND METHODS Samples from 459 hospitalized children and adult RTI patients were screened for respiratory viruses by polymerase chain reaction from April 2013 to April 2016. The VP2 gene from WU virus (WUV)-positive samples was sequenced and subjected to phylogenetic analysis. RESULTS Of the 459 hospitalized RTI patients, 18 (3.9%) patients were positive for WUV infection. WUV infection was common among children aged ≤11 years (9 patients, 50%). Among the 18 WUV-infected hospitalized patients, viral co-infection was detected in 9 patients (50%). The most common viruses associated with mixed infection were respiratory syncytial virus and human rhinovirus (2 patients, 11.1% each). Of the 18 WUV-infected patients, 4 were sequenced and subjected to phylogenetic analysis. The circulating strains belong to type Ia and IIIb. CONCLUSION This study enabled us to detect WUV among hospitalized RTI patients. Co-infection with other respiratory viruses was notable. Two circulating WUV genotypes (Ia and IIIb) were identified among hospitalized RTI patients in Kuwait.


title: The Impact of Heller Myotomy on Integrated Relaxation Pressure in Esophageal Achalasia.

text: BACKGROUND A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients. METHODS We prospectively collected data on achalasia patients who underwent HRM between 2009-2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy RESULTS One hundred thirty-nine consecutive achalasia patients (M:F = 72:67) represented the study population. All the patients had 100% simultaneous waves but 11 had an IRP < 15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4-35] vs 7.1 [IQR 4.4-9.8]; p < 0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18-33] vs 6 [IQR 3-11]; p < 0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score. CONCLUSIONS This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.


title: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review.

text: Importance The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2. Objective To evaluate currently reported pediatric cases of SARS-CoV-2 infection. Evidence Review An extensive search strategy was designed to retrieve all articles published from December 1, 2019, to March 3, 2020, by combining the terms coronavirus and coronavirus infection in several electronic databases (PubMed, Cochrane Library, and CINAHL), and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Retrospective cross-sectional and case-control studies, case series and case reports, bulletins, and national reports about the pediatric SARS-CoV-2 infection were included. The risk of bias for eligible observational studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Findings A total of 815 articles were identified. Eighteen studies with 1065 participants (444 patients were younger than 10 years, and 553 were aged 10 to 19 years) with confirmed SARS-CoV-2 infection were included in the final analysis. All articles reflected research performed in China, except for 1 clinical case in Singapore. Children at any age were mostly reported to have mild respiratory symptoms, namely fever, dry cough, and fatigue, or were asymptomatic. Bronchial thickening and ground-glass opacities were the main radiologic features, and these findings were also reported in asymptomatic patients. Among the included articles, there was only 1 case of severe COVID-19 infection, which occurred in a 13-month-old infant. No deaths were reported in children aged 0 to 9 years. Available data about therapies were limited. Conclusions and Relevance To our knowledge, this is the first systematic review that assesses and summarizes clinical features and management of children with SARS-CoV-2 infection. The rapid spread of COVID-19 across the globe and the lack of European and US data on pediatric patients require further epidemiologic and clinical studies to identify possible preventive and therapeutic strategies.


title: Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms.

text: We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.


title: No-incision (NOTES) versus single-incision (single-port) surgery for access to sites of peritoneal carcinomatosis: a back-to-back animal study.

text: BACKGROUND Preoperative radiological diagnosis and evaluation of limited peritoneal carcinomatosis (PC) is suboptimal. Triangle laparoscopy is considered a noncarcinologic option due to the risk of tumoral spreading through the lateral ports into the abdominal wall muscles. Open surgery is therefore often needed to characterize PC. A minimally invasive approach would be progress. METHODS We aimed to compare access rates to elective sites of PC using natural orifice transluminal endoscopic surgery (NOTES) with those using single-port laparoscopic surgery (SPLS). Sixteen acute experiments were performed in a live porcine model. Back-to-back NOTES and SPLS standardized peritoneoscopy were conducted in a cross-over design. Access rates to 11 elective sites of PC were considered as end points based on operators' consensus and necropsy verification. RESULTS Access to the targets was successful in 89 % with NOTES and 80 % with SPLS (p = 0.27). NOTES and SPLS achieved a 100 % access rate to the diaphragmatic domes and paracolic gutters, to the splenic area, to the pelvic floor, and to the trigonal bladder (p > 0.99). Access rates of NOTES versus SPLS to other elective sites of PC were the following: mesentery root (94 % vs. 0 %, p < 0.001), inferior mesenteric vein origin (88 % vs. 0 %, p < 0.001), inferior vena cava (88 % vs. 75 %, p = 0.85), and hepatic pedicle (8 % vs. 100 %, p < 0.001). CONCLUSIONS Both transgastric NOTES and SPLS provided quick and easy access to most elective sites of PC, except for the mesenteric vessel root (better achieved by NOTES) and the hepatic pedicle (better achieved by SPLS). Both techniques could be improved or combined to overcome their specific drawbacks.


Changes in the interaction of ophthalmologists and ophthalmic industry during and after COVID-19 lockdown: A perspective.


title: Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences.

text: OBJECTIVE This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC). DESIGN This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) - the co-occurrence of physical and psychiatric health problems - are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors. RESULTS Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to 'Psychiatric Only' health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women. CONCLUSION These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.


title: Single port robotic radical cystectomy with intracorporeal urinary diversion: a case series and review.

text: The da Vinci single port surgical system (SP) is the newest iteration of robotic technology, which combines the camera and all instruments into a single port. Robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion has classically been a difficult operation. Here we describe our technique for RARC with the SP and review our initial outcomes and data in the literature. Four patients at our institution underwent single port robotic assisted radical cystectomy with intracorporeal ileal conduit using the da Vinci SP surgical system. Operative steps were performed as described. Perioperative outcomes were reviewed. All patients successfully underwent the procedure without intraoperative complications. The average operative time was 270 minutes with an EBL of 250 cc. The average nodal harvest was 12.5. The average length of stay was 5.5 days. There was one 30-day Clavien Grade II complication and no additional 90-day complications. With our initial experience with the da Vinci surgical system, radical cystectomy with intracorporeal urinary diversion can be performed safely and quickly with the right technique. Our outcomes are similar to other initially published data. Further study is necessary to determine the additional benefits and clinical outcomes.


title: Operating room greening initiatives - the old, the new, and the way forward: A narrative review.

text: Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.


title: Astrocyte-derived CXCL10 drives accumulation of antibody-secreting cells in the central nervous system during viral encephalomyelitis.

text: Microbial infections of the central nervous system (CNS) are often associated with local accumulation of antibody (Ab)-secreting cells (ASC). By providing a source of Ab at the site of infection, CNS-localized ASC play a critical role in acute viral control and in preventing viral recrudescence. Following coronavirus-induced encephalomyelitis, the CNS accumulation of ASC is chemokine (C-X-C motif) receptor 3 (CXCR3) dependent. This study demonstrates that CNS-expressed CXCR3 ligand CXCL10 is the critical chemokine regulating ASC accumulation. Impaired ASC recruitment in CXCL10(-/-) but not CXCL9(-/-) mice was consistent with reduced CNS IgG and κ-light chain mRNA and virus-specific Ab. Moreover, the few ASC recruited to the CNS in CXCL10(-/-) mice were confined to the vasculature, distinct from the parenchymal localization in wild-type and CXCL9(-/-) mice. However, neither CXCL9 nor CXCL10 deficiency diminished neutralizing serum Ab, supporting a direct role for CXCL10 in ASC migration. T cell accumulation, localization, and effector functions were also not affected in either CXCL9(-/-) or CXCL10(-/-) mice, consistent with similar control of infectious virus. There was also no evidence for dysregulation of chemokines or cytokines involved in ASC regulation. The distinct roles of CXCL9 and CXCL10 in ASC accumulation rather coincided with their differential localization. While CXCL10 was predominantly expressed by astrocytes, CXCL9 expression was confined to the vasculature/perivascular spaces. These results suggest that CXCL10 is critical for two phases: recruitment of ASC to the CNS vasculature and ASC entry into the CNS parenchyma.


title: Palliative Care Team Involvement in Patients With COVID-19 in New York City.

text: BACKGROUND With the highest number of cases in the world as of April 13, 2020, New York City (NYC) became the epicenter of the global coronavirus disease 2019 (COVID-19) pandemic. The data regarding palliative team involvement in patients with COVID-19, however, remains scarce. We aimed to investigate outcomes of palliative team involvement for the patients with COVID-19 in NYC. METHODS Consecutive 225 patients with confirmed COVID-19 requiring hospitalization in our urban academic medical center in NYC were analyzed. Patients were divided into 2 groups, those with a palliative care consult (palliative group: 14.2% [n = 32]) versus those with no palliative care consult (no palliative group: 85.8% [n = 193]). RESULTS The palliative group was older and had more comorbidities. During the hospital course, the palliative group had more intensive care unit stays, rapid response team activations, and more use of vasopressors (P < .05). Patients with palliative care had higher rates of invasive mechanical ventilation than those without (46.9% vs 10.4%, P < .001). Cardiopulmonary resuscitation was performed in 12 patients (6.5% vs 5.2%, P = .77) and death rate was 100% in both subsets. Notably, initial code status was not different between the 2 groups, however, code status at discharge was significantly different between them (P < .001). The rate of full code decreased by 70% in the palliative group and by 47.5% in the no palliative care group from admission to the time of death. CONCLUSIONS Critically ill patients hospitalized for COVID-19 benefit from palliative team consults by helping to clarify advanced directives and minimize futile resuscitative efforts.


title: Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis.

text: PURPOSE To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. METHODS A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. RESULTS The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). CONCLUSION Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.


title: Robot-assisted partial nephrectomy with intracorporeal renal hypothermia using ice slush: step-by-step technique and matched comparison with warm ischaemia.

text: OBJECTIVES To outline our step-by-step technique for intracorporeal renal cooling during robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS Patient selection was performed during a preoperative clinic visit. Cases where we estimated during preoperative assessment that warm ischaemia time would be >30 min, as determined by whether the patient had a complex renal mass, were selected. The special equipment required for this procedure includes an Ecolab Hush Slush machine (Microtek Medical Inc., Columbus, MS, USA) a Mon-a-therm needle thermocouple device (Covidien, Mansfield, MA, USA) and six modified 20-mL syringes. Patients are arranged in a 60° modified flank position with the operating table flexed slightly at the level of the anterior superior iliac spine. For the introduction of a temperature probe and ice slush, an additional 12-mm trocar is placed along the mid-axillary line beneath the costal margin. Modified 10/20 mL syringes are prefilled with ice slush for instillation via an accessory trocar. Peri-operative and 6-month functional outcomes in the cold ischaemia group were compared with those of a cohort of patients who underwent RAPN with warm ischaemia in a 2:1 matched fashion. Matching was performed based on preoperative estimated glomerular filtration rate (GFR), ischaemia time and RENAL nephrometry score. RESULTS Strategies for successful intracorporeal renal cooling include: (i) placement of accessory port directly over the kidney; (ii) uniform ice consistency and modified syringes; (iii) sequential clamping of renal artery and vein; (iv) protection of the neighbouring intestine with a laparoscopic sponge; and (v) complete mobilization of the kidney. Kidney temperature is monitored via a needle thermocoupler device, while core body temperature is concurrently monitored via an oesophageal probe in real time. Renal function was assessed by serum creatinine level, estimated GFR (eGFR) and mercaptoacetyltriglycine (MAG-3) renal scan, peri-operatively and at 6-month follow-up. In the separate matched analysis, cold ischaemia during RAPN was found to be associated with a 12.9% improvement in preservation of postoperative eGFR. No difference was seen in either group at 6-month follow-up. CONCLUSIONS We conclude that RAPN with intracorporeal renal hypothermia using ice slush is technically feasible and may improve postoperative renal function in the short term. Our technique for intracorporeal hypotheramia is cost-effective, simple and highly reproducible.


docid: cpiaztqi

title: Non-intubated thoracoscopic surgery for lung cancer in patients with impaired pulmonary function.

text: Background Patients with impaired lung function or chronic obstructive pulmonary disease (COPD) are considered high-risk for intubated general anesthesia, which may preclude them from surgical treatment of their lung cancers. We evaluated the feasibility of non-intubated video-assisted thoracoscopic surgery (VATS) for the surgical management of lung cancer in patients with impaired pulmonary function. Methods From August 2009 to June 2015, 28 patients with impaired lung function (preoperative forced expiratory volume in 1 second <70% of the predicted value) underwent non-intubated VATS using a combination of thoracic epidural anesthesia or intercostal nerve block, and intra-thoracic vagal block with target-controlled sedation. Results Eighteen patients had primary lung cancers, 4 had metastatic lung cancers, and 6 had non-malignant lung tumors. In the patients with primary lung cancer, lobectomy was performed in 4, segmentectomy in 3 and wedge resection in 11, with lymph node sampling adequate for staging. One patient required conversion to intubated one-lung ventilation because of persistent wheezing and labored breathing. Five patients developed air leaks more than 5 days postoperatively while subcutaneous emphysema occurred in 6 patients. Two patients developed acute exacerbations of pre-existing COPD, and new-onset atrial fibrillation after surgery occurred in 1 patient. The median duration of postoperative chest tube drainage was 3 days while the median hospital stay was 6 days. Conclusions Non-intubated VATS resection for pulmonary tumors is technically feasible. It may be applied as an alternative to intubated general anesthesia in managing lung cancer in selected patients with impaired pulmonary function.


title: Structure and functional relevance of a transcription-regulating sequence involved in coronavirus discontinuous RNA synthesis.

text: Transmissible gastroenteritis coronavirus (TGEV) genomic RNA transcription generates 5'- and 3'-coterminal subgenomic mRNAs. This process involves a discontinuous step during the synthesis of minus-sense RNA that is modulated by transcription-regulating sequences located at the 3' end of the leader (TRS-L) and also preceding each viral gene (TRS-Bs). TRSs include a highly conserved core sequence (CS) (5'-CUAAAC-3') and variable flanking sequences. It has been previously proposed that TRS-Bs act as attenuation or stop signals during the synthesis of minus-sense RNAs. The nascent minus-stranded RNA would then be transferred by a template switch process to the TRS-L, which acts as the acceptor RNA. To study whether the TRS-L is structured and to determine whether this structure has a functional impact on genomic and subgenomic viral RNA synthesis, we have used a combination of nuclear magnetic resonance (NMR) spectroscopy and UV thermal denaturation approaches together with site-directed mutagenesis and in vivo transcriptional analyses. The results indicated that a 36-nucleotide oligomer encompassing the wild-type TRS-L forms a structured hairpin closed by an apical AACUAAA heptaloop. This loop contains most of the CS and is isolated from a nearby internal loop by a short Watson-Crick base-paired stem. TRS-L mutations altering the structure and the stability of the TRS-L hairpin affected replication and transcription, indicating the requirement of a functional RNA hairpin structure in these processes.


title: Hybrid laparoscopic versus open pylorus-preserving pancreatoduodenectomy: retrospective matched case comparison in 80 patients.

text: PURPOSE We compared the outcome of hybrid laparoscopic pylorus-preserving pancreatoduodenectomy (lapPPPD) and open PPPD (oPPPD) in a retrospective case-matched study. METHODS Patients operated from 2010 to 2013 by lapPPPD were matched 1:1 for age, sex, histopathology, American Society of Anesthesiologists category and body mass index to oPPPD patients operated from 1996 to 2013. RESULTS Patients eligible for lapPPPD are a risk group due to a high rate of soft pancreata. Complication rate and mortality were comparable to oPPPD. There was a significantly reduced transfusion requirement and a trend towards shorter operation time, less delayed gastric emptying, and reduced hospital stay. The main reason for conversion was portal venous tumor adhesion. Patient selection changed and operation time and hospital stay decreased with the surgeons' experience. CONCLUSION In selected patients, a hybrid laparoscopic technique of pancreatoduodenectomy is feasible with complication rates comparable to the open procedure. There seem to be advantages in terms of transfusion requirement, operation time, and hospital stay.


title: [Screening for novel coronavirus related conjunctivitis among the patients with corona virus disease-19].

text: Objective: Screening for novel coronavirus related conjunctivitis among the patients with coronavirus disease-19. Methods: Prospective series case study. Eighty-one patients diagnosed as coronavirus disease-19 in Guangxi Zhuang Autonomous Region People's Hospital were enrolled with ophthalmological consultation screening for novel coronavirus related conjunctivitis, including the inquiring of eye symptoms and checking for conjunctivitis-related signs. Conjunctival swab novel coronavirus nucleic acid test was performed on patients with clinical manifestation of conjunctivitis. Results: Only 3 of the 81 patients (3.70%) complained of eye discomfort, which appeared on the day 16.67±9.29 after the diagnosis of coronavirus disease-19. The eye signs did not meet the characteristics of viral conjunctivitis. Bilateral conjunctival swab novel coronavirus nucleic acid tests were negative. There was no evidence to support the diagnosis of novel coronavirus related conjunctivitis. Screening of clinical symptoms and signs of conjunctivitis in the remaining 78 patients showed no significant abnormalities. Conclusions: There wasn't any novel coronavirus related conjunctivitis in 81 patients with coronavirus disease-19.(Chin J Ophthalmol, 2020, 56:).


title: Negative pressure wound therapy facilitates closure of large congenital abdominal wall defects.

text: The degree of viscero-abdominal disproportion often makes single-stage reduction difficult in large abdominal wall defects, without risking respiratory or hemodynamic compromise. As a consequence, clinicians have adopted a number of different methods to control these defects. Repair may be in the neonatal period, or later in life. Delayed repairs require epithelialization of the gastroschisis or omphalocele. Definitive repair may be in single or multiple stages. This paper describes four children in whom negative pressure wound therapy (NPWT) was used to facilitate closure of these complex defects.


title: Edaravone reduces oxidative stress and intestinal cell apoptosis after burn through up-regulating miR-320 expression.

text: BACKGROUND Intestinal mucosa barrier dysfunction after burn injury is an important factor for causing mortality of burn patients. The current study established a burn model in rats and used a free radical scavenger edaravone (ED) to treat the rats, so as to investigate the effect of edaravone on intestinal mucosa barrier after burn injury. METHODS Anesthetized rats were subjected to 40% total body surface area water burn immediately, followed by treatment with ED, scrambled antagomir, or antagomiR-320. Intestinal mucosa damage was observed by hematoxylin-eosin staining and graded by colon mucosal damage index (CMDI) score. The contents of total sulfhydryl (TSH), superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) were determined by spectrophotometry. Cell apoptosis, protein relative expression,and the in situ expressions of p-Akt and p-Bad were detected by flow cytometry, Western blotting and immunohistochemistry, respectively. The miR-320 expression was determined by quantitative real-time polymerase chain reaction. RESULTS ED alleviated intestinal mucosal damage caused by burn injury, down-regulated the levels of MDA, cytochrome C, cleaved caspase-9 and cleaved caspase-3, but up-regulated the levels of TSH, SOD, CAT and Bcl-2. We also found that ED could reduce oxidative stress, inhibit cell apoptosis, increase the expressions of p-Akt, p-Bad and miR-320, and decrease PTEN expression. PTEN was predicted to be the target gene for miR-320, and cell apoptosis could be promoted by inhibiting miR-320 expression. CONCLUSION ED regulates Akt/Bad/Caspase signaling cascade to reduce apoptosis and oxidative stress through up-regulating miR-320 expression and down-regulating PTEN expression, thus protecting the intestinal mucosal barrier of rats from burn injury.


title: Radiofrequency ablation for the treatment of lung neoplasm.

text: Lung cancer is the most common cause of cancer-related mortality in the USA. Surgical resection is the standard treatment for resectable disease; however, a significant percentage of patients with otherwise resectable lung cancer may have other comorbidities, precluding surgical resection. In patients with Stage I non-small-cell lung cancer, conventional external-beam radiotherapy is typically offered as treatment in medically inoperable, high-risk patients with reported 5-year survival rates of 10-30%. An emerging technology in the treatment of lung tumors is radiofrequency ablation, which is a thermal ablative technique and may be applicable in high-risk patients with lung cancer. In this article we will review the principles of radiofrequency ablation, the common devices in use, the experimental background, the results of 'ablate and resect' studies and the clinical experience with radiofrequency ablation in the treatment of lung neoplasm.


title: Transanal minimally invasive surgery (TAMIS): applications beyond local excision.

text: Transanal minimally invasive surgery (TAMIS) is a new technique for the local excision of rectal neoplasia. This platform employs ordinary laparoscopic instruments to achieve high-quality local excision. The TAMIS platform, however, is quite versatile. Described here are applications of TAMIS beyond local excision, ranging from repair of a rectourethral fistula to reverse proctectomy.


title: Human La protein interaction with GCAC near the initiator AUG enhances hepatitis C Virus RNA replication by promoting linkage between 5' and 3' untranslated regions.

text: Human La protein has been implicated in facilitating the internal initiation of translation as well as replication of hepatitis C virus (HCV) RNA. Previously, we demonstrated that La interacts with the HCV internal ribosome entry site (IRES) around the GCAC motif near the initiator AUG within stem-loop IV by its RNA recognition motif (RRM) (residues 112 to 184) and influences HCV translation. In this study, we have deciphered the role of this interaction in HCV replication in a hepatocellular carcinoma cell culture system. We incorporated mutation of the GCAC motif in an HCV monocistronic subgenomic replicon and a pJFH1 construct which altered the binding of La and checked HCV RNA replication by reverse transcriptase PCR (RT-PCR). The mutation drastically affected HCV replication. Furthermore, to address whether the decrease in replication is a consequence of translation inhibition or not, we incorporated the same mutation into a bicistronic replicon and observed a substantial decrease in HCV RNA levels. Interestingly, La overexpression rescued this inhibition of replication. More importantly, we observed that the mutation reduced the association between La and NS5B. The effect of the GCAC mutation on the translation-to-replication switch, which is regulated by the interplay between NS3 and La, was further investigated. Additionally, our analyses of point mutations in the GCAC motif revealed distinct roles of each nucleotide in HCV replication and translation. Finally, we showed that a specific interaction of the GCAC motif with human La protein is crucial for linking 5' and 3' ends of the HCV genome. Taken together, our results demonstrate the mechanism of regulation of HCV replication by interaction of the cis-acting element GCAC within the HCV IRES with human La protein.


Inducing senescence sensitizes pancreatic tumours to therapies.


docid: tdipcgah

title: Standing diagnostic and therapeutic equine abdominal surgery.

text: The widespread use of laparoscopy in equine surgery has increased interest in the standing approach to a wide range of procedures typically regarded as feasible only through a ventral midline incision. Although a commonly cited benefit of standing surgery relates to avoiding costs of general anesthesia and risks associated with it, some procedures and horses are not suitable candidates for standing abdominal procedures. Some procedures, such as nephrectomy, colostomy, and closure of the nephrosplenic space, are not only suitable for standing surgery but are performed more easily and more safely through this approach than with general anesthesia.


title: Clinical outcomes and quality of life associated with the use of a biosynthetic mesh for complex ventral hernia repair: analysis of the "Italian Hernia Club" registry.

text: With the development of newer meshes and approaches to hernia repair, it is currently difficult to evaluate their performances while considering the patients' perspective. The aim of the study was to assess the clinical outcomes and quality of life consequences of abdominal hernia repairs performed in Italy using Phasix and Phasix ST meshes through the analysis of real-world data to support the choice of new generation biosynthetic meshes. An observational, prospective, multicentre study was conducted in 10 Italian clinical centres from May 2015 to February 2018 and in 15 Italian clinical centres from March 2018 to May 2019. The evaluation focused on patients with VHWG grade II-III who underwent primary ventral hernia repair or incisional hernia intervention with a follow-up of at least 18 months. Primary endpoints included complications' rates, and secondary outcomes focused on patient quality of life as measured by the EuroQol questionnaire. Seventy-five patients were analysed. The main complications were: 1.3% infected mesh removal, 4.0% superficial infection requiring procedural intervention, 0% deep/organ infection, 8.0% recurrence, 5.3% reintervention, and 6.7% drained seroma. The mean quality of life utility values ranged from 0.768 (baseline) to 0.967 (36 months). To date, Phasix meshes have proven to be suitable prostheses in preventing recurrence, with promising outcomes in terms of early and late complications and in improving patient quality of life.


docid: vvhettvk

title: Managing Persistent Hypoxemia: what is new?

text: Mechanical ventilation is the standard life-support technique for patients with severe acute respiratory failure. However, some patients develop persistent and refractory hypoxemia because their lungs are so severely damaged that they are unable to respond to the application of high inspired oxygen concentration and high levels of positive end-expiratory pressure. In this article, we review current knowledge on managing persistent hypoxemia in patients with injured lungs.


title: Clinical Validity of Serum Antibodies to SARS-CoV-2: A Case-Control Study.

text: BACKGROUND The clinical utility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies remains undefined. OBJECTIVE To determine the clinical validity and utility of SARS-CoV-2 antibodies. DESIGN Case-control study. SETTING First month of testing for coronavirus disease 2019 (COVID-19) by using a nucleic acid amplification test (NAAT) on nasopharyngeal swabs at the Johns Hopkins Hospital, Baltimore, Maryland (11 066 persons). PARTICIPANTS Of the 11 066 tested persons, 115 (1%) were hospitalized adults investigated for COVID-19. Clinical record review was performed to classify them into a COVID-19 case group (n = 60) or a non-COVID-19 control group (n = 55). The laboratory control groups comprised 513 persons not tested by NAAT: 160 healthy laboratory employees, 101 persons positive for IgG antibodies against Epstein-Barr virus capsid antigen, 215 positive for thyroperoxidase antibody, and 37 positive for rheumatoid factor. MEASUREMENTS Serum IgG and IgA antibodies against SARS-CoV-2 spike protein were detected by using enzyme-linked immunosorbent assay. RESULTS Sensitivity and specificity of the SARS-CoV-2 IgG assay were 0.976 (95% CI, 0.928 to 0.995) and 0.988 (CI, 0.974 to 0.995), respectively, when performed 14 days or later after symptom onset, but sensitivity decreased at earlier time points. Immunoglobulin G developed rapidly and was sustained at high levels throughout follow-up (up to 58 days). Antibodies to SARS-CoV-2 predicted the odds of developing acute respiratory distress syndrome, which increased by 62% (CI, 48% to 81%; P < 0.001) for every 2-fold increase in IgG. Of 11 066 NAAT-tested patients, 457 were repeatedly NAAT-negative, and serum samples were obtained for 18 such patients: 6 COVID-19 case patients and 12 non-COVID-19 control patients. Antibodies were present in 5 of 6 case patients and none of the 12 control patients (P = 0.001). LIMITATIONS The study was retrospective and performed at a single-center; the sample was small; follow-up was limited; and selection bias may have occurred. CONCLUSION Antibodies to SARS-CoV-2 demonstrate infection when measured at least 14 days after symptom onset, associate with clinical severity, and provide valuable diagnostic support in patients who test negative by NAAT but remain clinically suspicious for COVID-19. PRIMARY FUNDING SOURCE Clinical Immunology Laboratory, Department of Pathology, Johns Hopkins Hospital.


Clinical Significance of Viral Detection in Critically Ill Patients. More Questions Than Answers.


Budgeting for covid-19: changing the narrative and narrating the change.


title: Aspirin Is as Effective as and Safer Than Warfarin for Patients at Higher Risk of Venous Thromboembolism Undergoing Total Joint Arthroplasty.

text: BACKGROUND There is continued controversy regarding the optimal venous thromboembolism (VTE) prophylaxis, particularly for total joint arthroplasty (TJA) patients at higher risk. The purpose of this study was to compare the efficacy of aspirin (ASA) to warfarin in patients with higher risk of VTE. METHODS This retrospective study examined 30,270 patients who received ASA or warfarin for VTE prophylaxis after TJA. Using a previously developed risk stratification model, patients were classified into low or high VTE risk categories. Postoperative 90-day VTE, periprosthetic joint infection (PJI), gastrointestinal complications, and mortality were recorded. RESULTS The incidences of VTE, PJI, and mortality were higher in patients receiving warfarin compared to ASA. In multivariate analysis, warfarin was an independent risk factor for VTE, PJI, and mortality in the higher risk VTE patients (P < .001). There was no significant difference in gastrointestinal complications between groups. CONCLUSION Our study demonstrates that ASA is as effective as and safer than warfarin for VTE prophylaxis after TJA, even in patients at higher risk of VTE.


title: Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke.

text: PURPOSE Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. METHODS Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment. RESULTS One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success. The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. CONCLUSION In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases. In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.


title: Adult murine hippocampal neurogenesis is inhibited by sustained IL-1β and not rescued by voluntary running.

text: Acute neuroinflammation reduces adult hippocampal neurogenesis but the role of chronic neuroinflammation, which may be more representative of ongoing processes in CNS disorders, remains relatively unknown. Interleukin-1β (IL-1β) is a pro-inflammatory cytokine that has been shown to acutely impair neurogenesis. To further investigate the relationship between sustained IL-1β expression and adult neurogenesis, a mouse model with an IL-1β excisionally activated transgene, IL-1β(XAT), was utilized. Upon exposure to Cre recombinase, IL-1β overexpression in this model results in chronic neuroinflammation, which persists up to 12 months and causes glial activation, cellular recruitment, and deficits in learning and memory. We hypothesized that adult neurogenesis would be reduced by sustained hippocampal IL-1β overexpression and rescued by voluntary running, which has been shown to enhance neurogenesis. Hippocampal inflammation in the IL-1β(XAT) model severely impaired doublecortin (DCX) positive cells at 1 and 3 months after IL-1β induction. Furthermore, BrdU labeling demonstrated a shift in cell lineage from neuronal to astroglial in the context of sustained hippocampal IL-1β overexpression. Deletion of the IL-1 receptor prevented the decrease in DCX(+) cells. Voluntary running did not attenuate the effects of IL-1β expression demonstrated by DCX staining. These results suggest that chronic neuroinflammation severely impairs adult hippocampal neurogenesis and voluntary running is not beneficial as a therapy to rescue these effects.


title: The use of urea for the treatment of onychomycosis: a systematic review.

text: Background Onychomycosis, a fungal infection affecting the nail plate, is a common condition often requiring prolonged treatment regimens, with low success rates. Urea is one treatment option, which is thought to improve the efficacy of topical and oral antifungal agents. Despite a theoretical basis for the use of urea for the treatment of onychomycosis, the evidence-base for this treatment has not been systematically reviewed. Aim The purpose of this study was to conduct a systematic literature review to determine the efficacy and safety of urea as a monotherapy and as adjunct therapy, compared to other treatment regimens for onychomycosis. Method A systematic literature search of ten electronic databases was conducted. Only studies that used microscopy and culture or other validated laboratory-based testing method to confirm the presence of a fungal infection before treatment were included. The outcome measures assessed were efficacy (defined in terms of mycological, clinical and complete cure) and safety (defined as self-reported adverse events). Results The systematic search yielded 560 unique studies for review. Of these, only six were eligible for inclusion. All studies were observed to have methodological concerns, most studies consisted of small sample sizes and were difficult to compare given heterogeneity in outcome measures and follow-up time. Despite this, a trend was observed to suggest that urea, when added to topical or oral antifungal treatment regimens, improved efficacy of the treatment. Conclusion This review suggests that topical urea, as an adjunct to topical and oral antifungal treatment regimens, may improve the efficacy of treatment. However, further research is needed.


title: A review of available prosthetics for ventral hernia repair.

text: OBJECTIVE To review mesh products currently available for ventral hernia repair and to evaluate their efficacy in complex repair, including contaminated and reoperative fields. BACKGROUND Although commonly referenced, the concept of the ideal prosthetic has never been fully realized. With the development of newer prosthetics and approaches to the ventral hernia repair, many surgeons do not fully understand the properties of the available prosthetics or the circumstances that warrant the use of a specific mesh. METHODS A systematic review of published literature from 1951 to June of 2009 was conducted to identify articles relating to ventral hernia repairs and the use of prosthetics in herniorrhaphy. RESULTS Important differences exist between the synthetics, composites, and biologic prosthetics used for ventral hernia repair in terms of mechanics, cost, and the ideal situation in which each should be used. CONCLUSIONS The use of synthetic mesh remains an appropriate solution for most ventral hernia repairs. Laparoscopic ventral hernia repair has created a niche for both expanded polytetrafluoroethylene and composite mesh, as they are suited to intraperitoneal placement. Preliminary studies have demonstrated that the newer biologic prosthetics are reasonable options for hernia repair in contaminated fields and for large abdominal wall defects; however, more studies need to be done before advocating the use of these biologics in other settings.


The Pitch Invader-COVID-19 Canceled the Game: What Can Science Do for Us, and What Can the Pandemic Do for Science?


title: Early anticoagulation therapy for severe burns complicated by inhalation injury in a rabbit model.

text: The aim of the present study was to determine the effects of early anticoagulation treatment on severe burns complicated by inhalation injury in a rabbit model. Under anesthetization, an electrical burns instrument (100˚C) was used to scald the backs of rabbits for 15 sec, which established a 30% III severe burns model. Treatment of the rabbits with early anticoagulation effectively improved the severe burns complicated by inhalation injury‑induced lung injury, reduced PaO2, PaCO2 and SPO2 levels, suppressed the expression of tumor necrosis factor‑α, interleukin (IL)‑1β and IL‑6, and increased the activity of IL‑10. In addition, it was found that early anticoagulation treatment effectively suppressed the activities of caspase‑3 and caspase‑9, upregulated the protein expression of vascular endothelial growth factor (VEGF) and decreased the protein expression of protease‑activated receptor 1 (PAR1) in the severe burns model. It was concluded that early anticoagulation treatment affected the severe burns complicated by inhalation injury in a rabbit model through the upregulation of VEGF and downregulation of PAR1 signaling pathways. Thus, early anticoagulation is a potential therapeutic option for severe burns complicated by inhalation injury.


title: Efficacy of using a hydrodebrider and of citric acid/zwitterionic surfactant on a Staphylococcus aureus bacterial biofilm in the sheep model of rhinosinusitis.

text: BACKGROUND Biofilms in chronic rhinosinusitis (CRS) patients are associated with recalcitrant disease patterns. Citric acid/zwitterionic surfactant (CAZS) has been shown to have significant efficacy at in vitro biofilm eradication. Unique hydrodebrider systems have been shown to have effective antibiofilm efficacy. The aim of this study was to evaluate the efficacy of the CAZS/hydrodebrider treatment on Staphylococcus aureus biofilms in the sheep model of CRS. METHODS Forty-two sheep frontal sinuses were inoculated with S. aureus, followed by 7 days of biofilm growth. Sinuses were randomized to one of nine treatment groups: control, hydrodebrider with saline or CAZS (killed on day 0 or day 7 posttreatment), CAZS, or saline flush (killed on day 0 or day 7 posttreatment). Confocal scanning laser microscopy (CSLM) was used to confirm extent of biofilm reduction. Samples of each sinus were taken, assessing cilia morphology using electron microscopy. RESULTS A mean of 37.22 ± 9.65% of control (no treatment) CSLM images taken showed biofilms. Both CAZS flush and CAZS/hydrodebrider treatments showed initial improvements in biofilms but biofilm regrowth followed treatment, 14.74 ± 9.58% to 18.91 ± 12.14% and 15.60 ± 13.92% to 24.70 ± 3.66%, respectively (p > 0.05). Saline/hydrodebrider treatments showed a nonsignificant improvement in biofilm treatment, which was maintained, 18.34 ± 11.85% to 12.04 ± 10.28% (p > 0.05). Cilial morphology grade was significantly worse in the CAZS treatment groups (p < 0.05). CONCLUSION CAZS solution (with and without a hydrodebrider system) can significantly adversely affect cilia morphology. The hydrodebrider system, when combined with saline, may be a useful treatment adjunct for mucosal biofilms.


docid: eaqxifxu

title: Antivirals for COVID-19.

text: Drugs targeting RNA respiratory viruses has resulted in few effective therapies, highlighting challenges for antivirals to treat COVID-19. Several antivirals are being investigated for symptomatic COVID-19 but no definitive data support their clinical use. Remdesivir, with good in vitro activity against SARS-CoV2, appeared to result in favorable outcomes for hospitalized patients in a compassionate use series with shortened time to recovery and a modest decrease in mortality. Currently, remdesivir is available in phase III clinical trials, the compassionate use program, and eventually through the emergency use authorization. A randomized controlled trial of lopinavir/ritonavir demonstrated no apparent clinical or virologic benefit and drug-drug interactions and side effects further limit its utility. Antivirals to treat influenza (oseltamivir) have limited activity against SARS-CoV-2, but favipiravir and umifenovir, influenza antivirals available internationally, have distinct viral targets and require further investigation. Antivirals with evidence of clinical activity must be studied as treatment and prophylaxis for those at high risk for severe COVID-19.


Covid-19: Contact tracing requires ending the hostile environment.


title: Emerging applications of proteomics in hip and knee arthroplasty.

text: Total hip and knee arthroplasties are commonly performed orthopedic procedures that involve a complex interaction between the prosthetic device and its surrounding biological environment. Recent developments in the field of proteomics have enabled a better understanding of these interactions in patients with a total joint arthroplasty and have the potential to lead to development of novel diagnostic and therapeutic modalities that may improve the care of these patients, particularly those who have developed complications of wear, osteolysis, loosening and periprosthetic joint infection. This article reviews several of the areas of active research that are occurring at the intersection of the fields of proteomics and total joint arthroplasty.


Assessment of Ciliary Beat Pattern: Variability in Healthy Control Subjects Has Implications for Use as Test for Primary Ciliary Dyskinesia.