title: Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar.

text: There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study. Median follow-up time was 25 (6-30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia. Impact statement What is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction. What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar. What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.


title: Optimization of IGF-1R SPECT/CT imaging using 111In-labeled F(ab')2 and Fab fragments of the monoclonal antibody R1507.

text: The insulin-like growth factor 1 receptor (IGF-1R) is a potential new target for the treatment of breast cancer. Patients with breast cancer lesions that express IGF-1R may benefit from treatment with anti-IGF-1R antibodies. IGF-1R expression can be visualized using radiolabeled R1507, a monoclonal antibody directed against IGF-1R. However, antibodies clear slowly from the circulation, resulting in low tumor-to-background ratios early after injection. Therefore, we aimed to accelerate targeting of IGF-1R using radiolabeled R1507 F(ab')2 and Fab fragments. In vitro, immunoreactivity, binding affinity and internalization of R1507 IgG, F(ab')2 and Fab were determined using the triple negative IGF-1R-expressing breast cancer cell line SUM149. In vivo, pharmacokinetics of (111)In-labeled R1507 IgG, F(ab')2 and Fab were studied in mice bearing subcutaneous SUM149 xenografts. SPECT/CT images were acquired and the biodistribution was measured ex vivo. The in vitro binding characteristics of radiolabeled R1507 IgG and F(ab')2 were comparable, whereas the affinity of Fab fragments was significantly lower (Kd: 0.6 nM, 0.7 nM and 3.0 nM for R1507 IgG, F(ab')2 and Fab, respectively). Biodistribution studies showed that the maximum tumor uptake of (111)In-R1507 IgG, F(ab')2 and Fab was 31.8% ID/g (72 h p.i.), 10.0% ID/g (6 h p.i.), and 1.8% ID/g (1 h p.i.), respectively. However, maximal tumor-to-blood ratios for F(ab')2 (24 h p.i.: 7.5) were more than twice as high as those obtained with R1507 (72 h p.i.: 2.8) and Fab (6 h p.i.: 2.8). Injection of an excess of unlabeled R1507 significantly reduced tumor uptake, suggesting that the uptake of R1507 IgG and F(ab')2 was specific for IGF-1R, while the major fraction of the tumor uptake of Fab was nonspecific. IGF-1R-expressing xenografts were visualized with (111)In-F(ab')2 SPECT/CT as early as 6 h p.i., while with R1507 IgG, the tumor could be visualized after 24 h. No specific targeting was observed with (111)In-Fab. (111)In-F(ab')2 fragments showed improved targeting of IGF-1R expressing tumors. Tumor-to-blood ratios were twice as high as those obtained with (111)In-R1507, and adequate tumor targeting on SPECT/CT images was observed as early as 6 h p.i. For individualization and optimization of IGF-1R targeted therapy, (111)In-F(ab')2 may be the tracer of choice.


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

text: The growth of eye banking in India was showing positive trends until the nation was hit by unprecedented times as a result of the COVID-19 pandemic. The impact of this has led to a downward spiraling in eye banking activities globally. Several measures had to be implemented to tide over the crisis and strategies planned for future to prepare for the needs of corneal transplantation. While eye banks in India have been practicing short- term and intermediate storage preservation media, there is a definite need to evolve other methods of very long-term preservation. This review discusses various methods of long term corneal preservation, their relevance and applications in the present times. We reviewed relevant medical literature in English from PUBMED with the key words "Corneal preservation", "Cryopreservation", "Glycerol preservation", Gamma Irradiation", "Eye Banking" ,"COVID-19".


docid: wahuruva

title: Court to hear clinical negligence case after remote trial is deemed "undesirable".


title: Serum Neurofilament Light Chain Levels Are Associated with Clinical Characteristics and Outcome in Patients with Cervical Artery Dissection.

text: BACKGROUND Serum neurofilament light chain (sNfL) levels represent a promising marker of neuroaxonal injury. They are elevated in several neurological conditions, but their importance in cerebrovascular diseases remains unclear. In a proof of concept study, we compared sNfL levels with clinical characteristics and outcome in patients with cervical artery dissection (CeAD). METHODS A total of 49 non-traumatic CeAD patients were included. sNfL levels were measured by high-sensitivity electrochemiluminescence immunoassay. Levels were compared with regard to (i) type of presenting symptoms (local symptoms only (n = 8), transient ischemic attack (TIA; n = 10) or ischemic stroke (n = 31)), (ii) stroke severity quantified by National Institute of Health Stroke Scale (NIHSS), (iii) time interval between onset of symptoms and blood sampling and (iv) 3-month outcome as measured by the modified Rankin Scale score. Analyses were performed using univariate and multivariate linear and ordinal regression models. RESULTS CeAD patients presenting with stroke had significantly higher sNfL levels (median 108.9 pg/ml, interquartile range (37.8-427.7)) than patients with TIA (16.4 pg/ml (8.7-36.3), p = 0.002) or local symptoms (23.4 pg/ml (17.8-30.8), p = 0.0007). Among stroke patients, sNfL levels were positively associated with both NIHSS (p = 0.0002) and time between stroke onset and serum sampling (p = 1.9 × 10-6). Higher sNfL levels were associated with unfavorable outcome at 3 months (OR 4.67, 95% CI 1.69-12.95, p = 0.003). However, this association lost significance after adjustment for NIHSS. The highest sNfL level was observed in a TIA patient who had ischemic stroke 1 day after serum sampling for sNfL measurement. CONCLUSION sNfL levels were increased in CeAD patients presenting with stroke, correlated with clinical severity and were influenced by the time point of blood sampling. The prognostic meaning of sNfL in CeAD deserves further testing.


Change in the face of the COVID-19 pandemic: shaping plastic surgery services of the future.


docid: csjyipiy

title: Acute Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients.

text: OBJECTIVES Acute Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp) is a prospective multicenter study assessing the efficacy and safety of the pREset stent retriever for the treatment of intracranial vessel occlusion. Determination of the effect of transfer status on clinical outcome was a secondary objective. METHODS Efficacy was measured by recanalization success (Thrombolysis in Cerebral Infarction score ≥2b) and favorable clinical outcome at 90 days (modified Rankin Scale 0-2). Intracranial hemorrhage (ICH) and death at 90 days were safety measures. The outcome of directly admitted (DAP) and transferred (TP) patients was investigated using multivariable regression models. RESULTS Four study centers included 100 patients (mean age 68.3 years, median National Institutes of Health Stroke Scale score 15). Recanalization success was achieved in 84.4% after a mean of 1.7 passes. ICH was detected in 14.0%, with 2.0% being symptomatic. At 90 days, 62.5% of the patients had a favorable outcome and 7.3% died. TP had longer occlusion times (289 vs 180 minutes, p<0.001) and a lower rate of favorable outcome (58.0% vs 78.4%, p=0.046) than DAP. Multivariable regression revealed occlusion time as the critical determinant (OR=0.963, 95% CI 0.931 to 0.997, p=0.032), whereas transfer status itself showed no significant association (OR=0.565, CI 0.133 to 2.393, p=0.438). CONCLUSIONS pREset proved to be safe and effective for the treatment of acute intracranial vessel occlusion. Increased occlusion time impaired clinical outcome in TP. TRIAL REGISTRATION NUMBER NCT02437409; Results.


title: Rapid Large-Scale COVID-19 Testing During Shortages.

text: The Coronavirus disease 2019 (COVID-19) pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has resulted in economic and social lockdowns in most countries all over the globe. Early identification of infected individuals is regarded as one of the most important prerequisites for fighting the pandemic and for returning to a 'New Normal'. Large-scale testing is therefore crucial, but is facing several challenges including shortage of sample collection tools and of molecular biological reagents, and the need for safe electronic communication of medical reports. We present the successful establishment of a holistic SARS-CoV-2 testing platform that covers proband registration, sample collection and shipment, sample testing, and report issuing. The RT-PCR-based virus detection, being central to the platform, was extensively validated: sensitivity and specificity were defined as 96.8% and 100%, respectively; intra-run and inter-run precision were <3%. A novel type of sample swab and an in-house-developed RNA extraction system were shown to perform as good as commercially available products. The resulting flexibility guarantees independence from the current bottlenecks in SARS-CoV-2 testing. Based on our technology, we offered testing at local, national, and global levels. In the present study, we report the results from approx. 18,000 SARS-CoV-2 tests in almost 10,000 individuals from a low-frequency SARS-CoV-2 pandemic area in a homogenous geographical region in north-eastern Germany for a period of 10 weeks (21 March to 31 May 2020). Among the probands, five SARS-CoV-2 positive cases were identified. Comparative analysis of corresponding virus genomes revealed a diverse origin from three of the five currently recognized SARS-CoV-2 phylogenetic clades. Our study exemplifies how preventive SARS-CoV-2 testing can be set up in a rapid and flexible manner. The application of our test has enabled a safe maintenance/resume of critical local infrastructure, e.g., nursing homes where more than 5000 elderlies and caretakers got tested. The strategy outlined by the present study may serve as a blueprint for the implementation of large-scale preventive SARS-CoV-2 testing elsewhere.


title: Thoracoscopic completion right lower lobectomy after anteromedial basilar segmentectomy in early-stage lung cancer.

text: This report describes the surgical management of a male patient with early-stage lung cancer who underwent thoracoscopic completion right lower lobectomy after previously undergoing sublobar resection for multifocal ground glass nodules of the lung. Perioperative considerations associated with the management of dense pulmonary hilar adhesions and the techniques used are discussed.


title: COVID-19: Measures to prevent hospital contagion. What do urologists need to know?

text: A new outbreak of respiratory infection caused by the novel coronavirus in late December 2019 in China caused standards of medical care to change not only for related areas but for the entire healthcare system, and when the WHO declared COVID-19 a pandemic new strategies of patient care had to be defined initially to optimize resources to confront the pandemic and then to protect healthcare personnel. As urologists, we must be involved in these new standards, since without an effective vaccine the risk of contagion is high; thus, the purpose of this review is to have orientation on the measures urologists should take in their everyday clinical practice.


title: [Rethinking public health education and public health workforce development in China].

text: During the fighting against novel coronavirus disease epidemic, both the public health education and public health workforce of China have exposed important challenges. The present review discusses dilemmas and weakness that relate to the position of public health education in the higher education system, public health education system, curriculum system, teaching methods, practice-based teaching, training of highly qualified personnel in public health, public health teachers, remuneration and non-monetary honorable rewards for the public health workforce. Suggestions are also proposed for each of the challenges.


Rereading Arrowsmith in the COVID-19 Pandemic.


title: Assessment of public health events through International Health Regulations, United States, 2007-2011.

text: Under the current International Health Regulations, 194 states parties are obligated to report potential public health emergencies of international concern to the World Health Organization (WHO) within 72 hours of becoming aware of an event. During July 2007-December 2011, WHO assessed and posted on a secure web portal 222 events from 105 states parties, including 24 events from the United States. Twelve US events involved human influenza caused by a new virus subtype, including the first report of influenza A(H1N1)pdm09 virus, which constitutes the only public health emergency of international concern determined by the WHO director-general to date. Additional US events involved 5 Salmonella spp. outbreaks, botulism, Escherichia coli O157:H7 infections, Guillain-Barré syndrome, contaminated heparin, Lassa fever, an oil spill, and typhoid fever. Rapid information exchange among WHO and member states facilitated by the International Health Regulations leads to better situation awareness of emerging threats and enables a more coordinated and transparent global response.


IR of Iran National Mobilization against COVID-19 Epidemic.


docid: lzlraihj

title: Animal models of colitis-associated carcinogenesis.

text: Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders that affect individuals throughout life. Although the etiology and pathogenesis of IBD are largely unknown, studies with animal models of colitis indicate that dysregulation of host/microbial interactions are requisite for the development of IBD. Patients with long-standing IBD have an increased risk for developing colitis-associated cancer (CAC), especially 10 years after the initial diagnosis of colitis, although the absolute number of CAC cases is relatively small. The cancer risk seems to be not directly related to disease activity, but is related to disease duration/extent, complication of primary sclerosing cholangitis, and family history of colon cancer. In particular, high levels and continuous production of inflammatory mediators, including cytokines and chemokines, by colonic epithelial cells (CECs) and immune cells in lamina propria may be strongly associated with the pathogenesis of CAC. In this article, we have summarized animal models of CAC and have reviewed the cellular and molecular mechanisms underlining the development of carcinogenic changes in CECs secondary to the chronic inflammatory conditions in the intestine. It may provide us some clues in developing a new class of therapeutic agents for the treatment of IBD and CAC in the near future.


title: Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial.

text: To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p<0.01). Pain scores had also reduced significantly at seven days (p<0.01), but not at 48hours, and patients had lower levels of food impaction (p<0.01) and less severe symptoms (p=0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.


docid: vleqeype

title: The missing 'P' in pain management: how the current opioid epidemic highlights the need for psychiatric services in chronic pain care.

text: OBJECTIVE The prevalence of opioid therapy for chronic noncancer pain has increased dramatically in recent years, with a parallel increase in opioid abuse, misuse and deaths from accidental overdose. We review epidemiological and clinical data that point to the important roles psychiatric disorders have in the use and abuse of opioids in patients with chronic pain. METHOD We conducted literature searches on the PubMed with the key phrases "chronic pain" and "opioid therapy" and selected those articles on the epidemiology of comorbidity between chronic pain and psychiatric disorders, the trends in long-term opioid therapy and the clinical trials that involved using opioid therapy for chronic pain or for mental health disorders. We then thoroughly reviewed the bibliography of all relevant articles to identify additional papers to be included in the present review. RESULTS Chronic pain is highly comorbid with common psychiatric disorders. Patients with mental health and substance abuse disorders are more likely to receive long-term opioid therapy for chronic pain and more likely to have adverse outcomes from this therapy. Although opioids may exert brief antidepressant and anxiolytic effects in some patients with depression or anxiety, there is scant evidence for long-term benefit from opioid treatment of psychiatric disorders. CONCLUSIONS Opioids may be used in current clinical practice as the de facto and only psychiatric treatment for patients with chronic pain, despite little evidence for sustained benefit. The opioid epidemic thus reflects a serious unmet need for better recognition and treatment of common mental health problems in patients with chronic pain. Psychiatry is the missing P in chronic pain care.


title: [Clinical features and outcome of treatment for novel coronavirus pneumonia: a meta-analysis].

text: Objective: To investigate the clinical features and outcome of treatment for novel coronavirus pneumonia. Methods: Literature on novel coronavirus pneumonia was retrieved from PubMed and EMBASE databases. The relevant data was extracted and a meta-analysis was performed using StatsDirect statistical software V.2.8.0 to calculate the combined odds ratio. Results: Seven studies were included, consisting of 1594 cases. The meta-analysis result showed that the most common clinical symptoms of the novel coronavirus pneumonia were fever (91.6%) and cough (64.5%), followed by dyspnea (32.8%) and sputum (28.1%). Headache (10.5%), sore throat (11.2%), hemoptysis (3.2%), diarrhea (6.6%) and the other symptoms were relatively rare. Aspartate aminotransferase (29%), alanine transaminase (22.7%), and total bilirubin (11.7%) levels were elevated, except for serum albumin levels (80.4%). The common therapeutic agents used were antibiotics (87.7%), antiviral drugs (75.5%), and glucocorticoids (26.6%), while antifungal agents (7.7%) were used in few. Mechanical ventilation (13.4%), extracorporeal membrane oxygenation (1.9%), and continuous renal replacement therapy (3.8%) were used in severe cases. The rate of mortality in hospital was 7.7%, respectively. Heterogeneity between studies was significant; however, subgroup and sensitivity analysis had failed to identify clear sources of heterogeneity. Conclusion: Fever, cough and liver dysfunction are the main clinical manifestations of this disease and the mortality rate is low.


title: Comparison of forced-air warming systems in prevention of intraoperative hypothermia.

text: In this study, we aimed to compare the effects of forced-air warming upper body blankets and forced-air warming underbody blankets on intraoperative hypothermia in patients who were planned to undergo open abdominal surgical operations in which extensive heat loss occurs. This prospective and randomized study included 92 patients who would undergo lower abdominal surgery under general anesthesia. Patients were randomized by closed envelope method and divided into two groups. Group I (n:46) included the patients who would receive warming with forced-air warming upper body blanket, and Group II (n:46) consisted of the patients who received warming with forced-air warming underbody blanket. Central body temperature was recorded by measuring with a temperature probe placed in distal esophagus. Demographic data, amount of fentanyl, crystalloid and blood products used, duration of operation, type of operation, hemodynamic parameters, shivering and thermal damage information were recorded. There was not any statistically significant difference among the patients in terms of demographic data, amount of fentanyl, crystalloid and blood products used, duration and type of operation and hemodynamic parameters. No difference was found between the groups in terms of body temperatures (Group I:36.1 °C, Group II:36.3 °C, respectively) (P > 0.05). Forced air warming underbody blanket can be as effective as forced-air warming upper body blankets in preventing intraoperative hypothermia. They can be alternative in cases where use of forced-air warming upper body blankets is not feasible.


title: Computer-based cognitive interventions for mild cognitive impairment and dementia in older adults: protocol for a systematic review of published studies and meta-analysis.

text: BACKGROUND A growing number of older adults experience mild cognitive impairment (MCI) and dementia. Recent technological advances allow for traditional cognitive interventions to be administered via computers and other devices. The aim of the proposed systematic review and meta-analyses is to determine the efficacy of computerised cognitive interventions for MCI and dementia in older adults. METHODS We will systematically search electronic databases and reference lists to identify randomised controlled trials. We will include studies that examine the use of computer-based cognitive interventions for adults aged over 60 with MCI or dementia. Primarily outcomes are global and domain-specific cognitive function. Secondary outcomes are attitudes (usability, understandability, acceptability of the intervention), mood and quality of life. Risk of bias will be assessed. Finally, the summary effect sizes will be reported. DISCUSSION This systematic review will summarise existing high-quality primary studies on computerised-cognitive interventions for MCI and dementia. Results from this review will provide the basis for future research in developing computer-based interventions for this population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016050236.


title: Risk Factors for Transmission of Middle East Respiratory Syndrome Coronavirus Infection During the 2015 Outbreak in South Korea

text: BACKGROUND. Transmission heterogeneity was observed during the 2015 Korean outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Only 22 of 186 cases transmitted the infection, and 5 super-spreading events caused 150 transmissions. We investigated the risk factors for MERS-CoV transmission. METHODS. Epidemiological reports were used to classify patients as nonspreaders, spreaders, or those associated with a super-spreading event (5 or more transmissions). Logistic regression analyses were used to evaluate the factors for MERS-CoV transmission. RESULTS. Compared to nonspreaders, spreaders exhibited a longer interval from symptom onset to isolation (7 days vs 3 days) and more frequent pre-isolation pneumonia diagnoses (68.2% vs 17.1%). Spreaders also exhibited higher values for pre-isolation contacts (149 vs 17.5), pre-isolation hospitalization (68.2% vs 16.5%), and emergency room (ER) visits (50% vs 7.3%). Spreaders exhibited lower cycle thresholds for the upE and ORF1a genes (22.7 vs 27.2 and 23.7 vs 27.9, respectively). In multivariate analysis, transmission was independently associated with the cycle threshold (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.75–0.96) and pre-isolation hospitalization or ER visits (OR, 6.82; 95% CI, 2.06–22.84). The super-spreading events exhibited higher values for pre-isolation contacts (777 vs 78), pre-isolation ER visits (100% vs 35.3%), and doctor shopping (100% vs 47.1%) compared to non-super-spreading events. CONCLUSIONS. These findings indicate that transmission is determined by host infectivity and the number of contacts, whereas super-spreading events were determined by the number of contacts and hospital visits. These relationships highlight the importance of rapidly enforcing infection control measures to prevent outbreaks.


title: Comparison of costs for three hypothetical alternative kitchen waste management systems.

text: Urban water and waste management continues to be a major challenge, with the Earth's population projected to rise to 9 billion by 2050, with 70% of this population expected to live in cities. A combined treatment of wastewater and the organic fraction of municipal solid waste offers opportunities for improved environmental protection and energy recovery, but the collection and transport of organic wastes must be cost effective. This study compares three alternative kitchen waste collection and transportation systems for a virtual modern urban area with 300,000 residents and a population density of 10,000 persons per square kilometre. Door-to-door collection, being the standard practice in modern urban centres, remains the most economically advantageous at a cost of 263 euros per tonne of kitchen waste. Important drawbacks are the difficult logistics, increased city traffic, air and noise pollution. The quieter, cleaner and more hygienic vacuum transport of kitchen waste comes with a higher cost of 367 euros per tonne, mainly resulting from a higher initial investment cost for the system installation. The third option includes the well-known use of under-sink food waste disposers (often called garbage grinders) that are connected to the kitchen's wastewater piping system, with a total yearly cost of 392 euros per tonne. Important advantages with this system are the clean operation and the current availability of a city-wide sewage conveyance pipeline system. Further research is recommended, for instance the application of a life cycle assessment approach, to more fully compare the advantages and disadvantages of each option.


Coronavirus Disease 2019-An Impetus for Resident Education Reform?


title: COVID-19: Healthy environmental impact for public safety and menaces oil market.

text: COVID-19 seems as global emergency, by infectious virus, caused respiratory illness like having symptoms of flue, sickness, headache, and difficulty in breathing. Within months the world has been transformed into new order, thousands of people died and many more are fallen ill due to COVID-19 outbreak. China was the first country to see the outbreak and the first country to control it. However, the disease has broken out in Europe, the Middle East, the United States and other places. The United States has the highest number of cases in the world.


title: Comparative effectiveness of carotid revascularization therapies: evidence from a National Hospital Discharge Database.

text: BACKGROUND AND PURPOSE Clinical equipoise of carotid revascularization therapies remains controversial. We sought to determine whether adverse outcomes after carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) were similar using propensity score-matched analysis of retrospective data from a large hospital discharge database. METHODS All CEA and CAS cases were identified from the 2006 to 2011 Premier Perspective Database and subjected to 1:1 propensity score matching using 33 clinical covariates associated with carotid revascularization. A primary composite end point of peri- or postoperative mortality, stroke, or acute myocardial infarction and a modified composite end point excluding acute myocardial infarction were used to compare our findings with recent prospective controlled trials. Multivariate regression and Cox-proportional hazard ratio survival analysis were performed to compare revascularization therapy outcomes. RESULTS After 1:1 propensity score matching, 24 004 (12 002 CEA and CAS) asymptomatic and 3506 (1753 CEA and CAS) symptomatic procedures were included. The risk of the primary composite end point was significantly higher after CAS than CEA in both asymptomatic (odds ratio, 1.40 [1.19-1.65]; P<0.0001) and symptomatic (odds ratio=2.31 [1.78-3.00]; P<0.0001) presentations, irrespective of age (P=0.28) or sex (P=0.35). Similar findings were observed using the modified composite end point for both asymptomatic (odds ratio, 1.49 [1.25-1.78]; P<0.0001) and symptomatic (odds ratio, 3.02 [2.25-4.07]; P<0.0001) presentations. Acute myocardial infarction risk was not significantly different between revascularization therapies, regardless of clinical presentation (P=0.71 and 0.24). CONCLUSIONS Among individuals undergoing carotid artery revascularization from a large sample of US hospitals, CAS was associated with higher risk of perioperative mortality, stroke, and unfavorable discharges compared with CEA for all ages and clinical presentations.


COVID-19: Perspectives and Reflections from Africa.


COVID-19 and the Drug Repurposing Tsunami.


The Practice of Wearing Surgical Masks during the COVID-19 Pandemic.


title: Electrothermal bipolar coagulation decreases the rate of red blood cell transfusions for pelvic exenterations.

text: BACKGROUND We evaluated whether electrothermal bipolar coagulation (Ligasure) for pelvic exenterations decreases operative morbidity. METHODS All cases of pelvic exenterations, for all malignancies, performed at Moffitt Cancer Center from 1999 to 2008, were identified through retrospective review of medical records. Estimated blood loss (EBL), transfusion, operative time, hospital stay, and complications were compared between Ligasure cases and non-Ligasure cases. RESULTS Seventy-five patients underwent identified. Ligasure was used in 29/75 (39%) cases and standard techniques in 46/75 (61%) cases. Primary malignancy was gynecologic in 31/75(40%) cases (18/29, 62% Ligasure cases, 13/46, 26% non-Ligasure cases). Patients undergoing gynecologic exenteration received fewer intraoperative packed red blood cell (PRBC) transfusions in the Ligasure group (mean = 2.8 U), compared to the non-Ligasure group (mean = 3.8 U; P < 0.0001). The EBL was less for Ligasure cases (1,815 ml vs. 2,205 ml; P = 0.4). For all patients, Ligasure cases had lower mean transfusion (2.7 U vs. 3.2 U; P = 0.32), and EBL (1,662 ml vs. 1,843 ml; P = 0.5). The mean operating time was similar (492 min vs. 502 min). There were no cases of re-operation for hemorrhage in either group. CONCLUSIONS Use of electrothermal bipolar coagulation for gynecologic exenterative surgery is associated with significantly lower blood transfusions, and may decrease blood loss and transfusion in non-gynecologic exenterative surgery.


title: Pediatric Endoscopy in the Era of Coronavirus Disease 2019: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper

text: The delivery of endoscopic care is changing rapidly in the era of Coronavirus Disease 2019 (COVID-19). The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Endoscopy and Procedures Committee has formulated this statement to offer practical guidance to help standardize endoscopy services for pediatric patients with the aim of minimizing COVID-19 transmission to staff, patients, and caregivers and to conserve personal protective equipment (PPE) during this critical time. Appropriate use of PPE is essential to minimize transmission and preserve supply. Pediatric endoscopic procedures are considered at high risk for COVID-19 transmission. We recommend that all pediatric endoscopic procedures are done in a negative pressure room with all staff using proper airborne, contact, and droplet precautions regardless of patient risk stratification. This includes appropriate use of a filtering face-piece respirator (N95, N99, FFP2/3, or PAPR), double gloves, facial protection (full visor and/or face shield), full body water-resistant disposable gown, shoe covers and a hairnet. In deciding which endoscopic procedures should proceed, it is important to weigh the risks and benefits to optimize healthcare delivery and minimize risk. To inform these decisions, we propose a framework for stratifying procedures as emergent (procedures that need to PROCEEED), urgent (PAUSE, weigh the benefits and risks in deciding whether to proceed) and elective (POSTPONE procedures). This statement was based on emerging evidence and is meant as a guide. It is important that all endoscopy facilities where pediatric procedures are performed follow current recommendations from public health agencies within their jurisdiction regarding infection prevention and control of COVID-19.


Super-rotating the venusian atmosphere.


title: A novel HIV-1 gp41 tripartite model for rational design of HIV-1 fusion inhibitors with improved antiviral activity.

text: OBJECTIVES During HIV-1 fusion process, the N-terminal heptad repeat (NHR) of the HIV-1 glycoprotein 41 (gp41) interacts with the C-terminal heptad repeat (CHR) to form the fusion active six-helix bundle, thus being an effective target for the design of CHR peptide-based HIV-1 fusion inhibitors. To overcome the limitations of the simplified helix wheel model of six-helix bundle, we herein developed a novel HIV-1 gp41 NHR-CHR-NHR tripartite model for the rational design of HIV-1 fusion inhibitors with improved antiviral activities. DESIGN Based on the crystal structure of six-helix bundle, we evaluated the NHR-binding properties of each residue in CHR. In this new tripartite model, CHR residues were divided into three groups: major binding, nonbinding, and assistant binding sites. METHODS Eight CHR peptides were designed and synthesized to confirm the validity of the tripartite model. Their affinities to NHR and inhibitory activities were analyzed. RESULTS In this tripartite model, replacements in assistant binding sites either increased or decreased the inhibition of HIV-1 infection. We identified three peptides with mutations of the residues in CHR at the assistant binding sites in our tripartite model but nonbinding sites in the helical wheel model. These mutant peptides had anti-HIV-1 activity up to 26-fold more potent than that of C34, a CHR peptide designed on the basis of the helix wheel model. CONCLUSION These data verified the superiority and validity of our new tripartite model for the rational design of HIV-1 fusion inhibitors. This approach can be adapted for designing viral fusion inhibitors against other enveloped viruses with class I membrane fusion protein.


title: Utility of CT perfusion scanning in patient selection for acute stroke intervention: experience at University at Buffalo Neurosurgery-Millard Fillmore Gates Circle Hospital.

text: Computed tomography perfusion scanning generates physiological flow parameters of the brain parenchyma, allowing differentiation of ischemic penumbra and core infarct. Perfusion maps, along with the National Institutes of Health Stroke Scale score, are used as the bases for endovascular stroke intervention at the authors' institute, regardless of the time interval from stroke onset. With case examples, the authors illustrate their perfusion-based imaging guidelines in patient selection for endovascular treatment in the setting of acute stroke.


title: For-Profit Hospitals Out of Business? Financial Sustainability During the COVID-19 Epidemic Emergency Response.

text: This perspective argues that for-profit hospitals will be heavily affected by epidemic crises, including the current coronavirus disease 2019 (COVID-19) outbreak. Policy-makers should be aware that for-profit hospitals in particular are likely to face financial distress. The suspension of all non-urgent elective surgery and the relegation of market-based mechanisms that determines the allocation and compensation of care puts the financial state of these hospitals at serious risk. We identify three organisational factors that determine which hospitals might be most affected (ie, care-portfolio, size and whether it is private equity [PE]-owned). In addition, we analyse contextual factors that could explain the impact of financial distress among for-profit hospitals on the wider healthcare system.


title: Epidemiology, health systems and stakeholders in rheumatic heart disease in Africa: a systematic review protocol.

text: INTRODUCTION Rheumatic heart disease (RHD) is a chronic disease affecting the heart valves, secondary to group A streptococcal infection (GAS) and subsequent acute rheumatic fever (ARF). However, RHD cure and preventative measures are inextricably linked with socioeconomic development, as the disease mainly affects children and young adults living in poverty. In order to address RHD, public health officials and health policymakers require up-to-date knowledge on the epidemiology of GAS, ARF and RHD, as well as the existing enablers and gaps in delivery of evidence-based care for these conditions. We propose to conduct a systematic review to assess the literature comprehensively, synthesising all existing quantitative and qualitative data relating to RHD in Africa. METHODS AND ANALYSIS We plan to conduct a comprehensive literature search using a number of databases and reference lists of relevant articles published from January 1995 to December 2015. Two evaluators will independently review and extract data from each article. Additionally, we will assess overall study quality and risk of bias, using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme criteria for quantitative and qualitative studies, respectively. We will meta-analyse estimates of prevalence, incidence, case fatality and mortality for each of the conditions separately for each country. Qualitative meta-analysis will be conducted for facilitators and barriers in RHD health access. Lastly, we will create a list of key stakeholders. This protocol is registered in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42016032852. ETHICS AND DISSEMINATION The information provided by this review will inform and assist relevant stakeholders in identifying key areas of intervention, and designing and implementing evidence-based programmes and policies at the local and regional level. With slight modifications (ie, to the country terms in the search strategy), this protocol can be used as part of a needs assessment in any endemic country.


title: Using arterial pressure waveform analysis for the assessment of fluid responsiveness.

text: Predicting the effects of volume expansion on cardiac output and oxygen delivery is of major importance in different clinical scenarios. Functional hemodynamic parameters based on pulse waveform analysis, which are relying on the effects of mechanical ventilation on stroke volume and its surrogates, have been shown to be reliable predictors of fluid responsiveness during anesthesia and intensive care unit treatment, as demonstrated by several clinical studies and meta-analyses. However, different limitations of these parameters have to be considered when they are used in clinical practice. Today, they can be continuously and automatically monitored by a variety of commercially available devices. These parameters have been introduced into the concept of perioperative fluid management and hemodynamic optimization - an approach that may positively impact postoperative patients' outcomes. In this article, technical aspects of the assessment of the functional hemodynamic parameters derived from pulse waveform analysis are summarized, emphasizing their advantages, limitations and potential applications, primarily in a perioperative setting in order to improve patient outcome.


title: Covid-19 chemoprophylaxis: Ethics of prevention based on anecdotal evidence.

text: The ongoing pandemic of Covid-19 caused by the SARS-CoV-2 virus has infected more than 6 million all over the world and has caused more than 3.8 lakh fatalities till date(1) Health workers are the frontline responders and are exposed to a plethora of health hazards. Recently, an advisory by the Indian Council of Medical Research for the use of hydroxychloroquine as post-exposure prophylaxis was hailed as an outstanding initiative for the protection of healthcare workers and high risk contacts of patients. But the evidence of effectiveness available is only from in vitro studies and non-randomised control trials of insufficient sample size. Several ongoing large scale clinical trials are focused on the same research questions, the preliminary results of which are still awaited. The present study discusses the ethics of the introduction of therapeutic or preventive interventions based on limited available evidence during the ongoing pandemic of Covid-19..


title: [En defensa del pensamiento de Ramón Carrillo: "La libertad en todas las formas es un derecho del pueblo"].

text: In the midst of the COVID-19 pandemic, images of a potential new banknote that may be introduced in Argentina have circulated, which depict Ramón Carrillo (the country's first Minister of Public Health) and Cecilia Grierson (the country's first female physician). In response, the Embassies of world powers such as the United Kingdom and Israel have released statements defaming Ramón Carrillo. The National University of Lanús expresses its support for the public health expert who taught us the importance of training physicians in public health, and that the true problem is not disease at an individual level, but rather that health must be addressed in collective terms.


Fast and frugal innovations in response to the COVID-19 pandemic.


title: Regulation by S-nitrosylation of protein post-translational modification.

text: Protein post-translational modification by S-nitrosylation conveys a ubiquitous influence of nitric oxide on signal transduction in eukaryotic cells. The wide functional purview of S-nitrosylation reflects in part the regulation by S-nitrosylation of the principal protein post-translational modifications that play a role in cell signaling, including phosphorylation, acetylation, ubiquitylation and related modifications, palmitoylation, and alternative Cys-based redox modifications. In this minireview, we discuss the mechanisms through which S-nitrosylation exerts its broad pleiotropic influence on protein post-translational modification.


title: Long-term results of giant hiatal hernia mesh repair and antireflux laparoscopic surgery for gastroesophageal reflux disease.

text: BACKGROUND The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates. The most debated issue is the risk of complications related to the use of the prosthesis, which are thought to be the cause of higher dysphagia. PATIENTS AND METHODS From January 2004 to December 2007, 198 consecutive patients underwent laparoscopic fundoplication for gastroesophageal reflux disease (GERD) with or without hiatal hernia. Fifty patients (25.3%) presented a giant hiatal hernia, defined as a hiatal defect over 5 cm. These 50 patients underwent primary simple suture of the crura and additional reinforcement with a Crurasoft mesh (Bard). Hiatal hernia or GERD symptoms recurrence, dysphagia, and mesh-related complications were investigated. RESULTS Of the 50 patients undergoing mesh repair, there were 32 women and 18 men with a mean age of 63.2 years. Conversion rate was 2%. Intraoperative complications rate was 6%, all of them laparoscopically managed. Postoperative complications occurred in 1 patient (2%). Mortality rate was 2%. Median postoperative stay was 3 days. Median follow-up was 62 months. Two percent of the patients presented wrap migration, and 4% presented dysphagia. Six percent of cases presented recurrence of GERD manifestations. There have been no complications related to the use of the mesh. CONCLUSIONS Laparoscopic antireflux surgery with a prosthetic mesh in cases of giant hiatal hernia is an effective and safe procedure, reducing the rate of postoperative hernia recurrence during long-term follow-up. The incidence of mesh-related complications is very low.


title: Synthetic sutures: Clinical evaluation and future developments.

text: Today's sutures are the result of a 4000-year innovation process with regard to their materials and manufacturing techniques, yet little has been done to enhance the therapeutic value of the suture itself. In this review, we explore the historical development, regulatory database and clinical literature of sutures to gain a fuller picture of suture advances to date. First, we examine historical shifts in suture manufacturing companies and review suture regulatory databases to understand the forces driving suture development. Second, we gather the existing clinical evidence of suture efficacy from reviewing the clinical literature and the Food and Drug Administration database in order to identify to what extent sutures have been clinically evaluated and the key clinical areas that would benefit from improved suture materials. Finally, we apply tissue engineering and regenerative medicine design hypotheses to suture materials to identify routes by which bioactive sutures can be designed and passed through regulatory hurdles, to improve surgical outcomes. Our review of the clinical literature revealed that many of the sutures currently in use have been available for decades, yet have never been clinically evaluated. Since suture design and development is industry driven, incremental modifications have allowed for a steady outflow of products while maintaining a safe regulatory position and limiting costs. Until recently, there has been little academic interest in suture development, however the rise of regenerative medicine strategies is shifting the suture paradigm from an inert material, which mechanically approximates tissue, to a bioactive material, which also actively promotes cell-directed repair and a positive healing response. These materials hold significant therapeutic potential, but could be associated with an increased regulatory burden, cost, and clinical evaluation compared with current devices.


title: Does vitamin D deficiency increase the severity of COVID-19?

text: The severity of coronavirus 2019 infection (COVID-19) is determined by the presence of pneumonia, severe acute respiratory distress syndrome (SARS-CoV-2), myocarditis, microvascular thrombosis and/or cytokine storms, all of which involve underlying inflammation. A principal defence against uncontrolled inflammation, and against viral infection in general, is provided by T regulatory lymphocytes (Tregs). Treg levels have been reported to be low in many COVID-19 patients and can be increased by vitamin D supplementation. Low vitamin D levels have been associated with an increase in inflammatory cytokines and a significantly increased risk of pneumonia and viral upper respiratory tract infections. Vitamin D deficiency is associated with an increase in thrombotic episodes, which are frequently observed in COVID-19. Vitamin D deficiency has been found to occur more frequently in patients with obesity and diabetes. These conditions are reported to carry a higher mortality in COVID-19. If vitamin D does in fact reduce the severity of COVID-19 in regard to pneumonia/ARDS, inflammation, inflammatory cytokines and thrombosis, it is our opinion that supplements would offer a relatively easy option to decrease the impact of the pandemic.


Simple 'Rule-of-6' predicts severe COVID-19 disease.


Undergraduate medical education and Covid-19: engaged but abstract.


title: Nitric oxide inhalations in bronchiolitis: A pilot, randomized, double-blinded, controlled trial.

text: AIM The aims of this pilot study were to determine safety, tolerability (primary outcome) and efficacy (secondary outcome) of high-dose inhaled nitric oxide for the treatment of infants with moderately severe bronchiolitis. METHODS This was a pilot, double-blinded, randomized controlled study (phase IIa). Intermittent inhalations of nitric oxide 160 ppm for 30 min or oxygen/air (control) were given 5 times/day to hospitalized infants (2-11 months) with acute bronchiolitis. Oxygen saturation, methemoglobin, and nitric dioxide (NO2 ) levels and vital signs were monitored. RESULTS Forty-three infants were enrolled. Baseline characteristics were comparable in both study groups. Mean clinical score, comprised of four components: respiratory rate, use of accessory muscles, wheezes and crackles, and % room-air oxygen saturation, was 7.86 (±1.1) and 8.09 (±1.2) in the NO and control groups, respectively, consistent with moderate severity. The overall frequency of adverse events was similar between the groups. Repeated nitric oxide inhalations did not result in increased inhaled NO2 levels or cumulative effect on methemoglobin levels. Secondary outcomes of efficacy were measured by length of hospitalization (LOS) in hours: LOS did not differ between groups. However, in a post-hoc analysis of a subgroup of infants hospitalized for >24 h (n = 24), the median LOS was shorter in the nitric oxide (41.9 h) than in the control group (62.5 h) (P = 0.014). CONCLUSION Our study was unable to detect a difference in side effects using intermittent high-dose nitric-oxide inhalation or supportive treatment alone, in infants with moderate bronchiolitis. Preliminary efficacy outcomes are encouraging.


title: The European Society of Thoracic Surgeons lung metastasectomy project.

text: Resection of metastases in the lung from a wide range of primary sites has become a routine part of the daily clinical practice of a thoracic surgeon. The European Society of Thoracic Surgeons brought together an international group of surgeons in 2006. The initial intention for this Lung Metastasectomy Working Group was to evaluate the evidence and to generate guidance. It rapidly became clear that although there was great experience in performing this surgery, the belief in its benefit relied on clinical case series and registry reports. Evidence fell well short of Evidence Based Medicine standards and robust guidance could not be produced on this basis. This supplement of the Journal of Thoracic Oncology brings together the findings and conclusions of the group under three headings. The first section covers generic issues such as imaging and the technical aspects of pulmonary metastasectomy. The second deals with specific cancer types in which pulmonary metastasectomy is more frequently performed. The third addresses the way forward to get better evidence for this practice.


docid: sgbdomoy

title: 68Ga-labelled exendin-3, a new agent for the detection of insulinomas with PET.

text: PURPOSE Insulinomas are neuroendocrine tumours derived from pancreatic beta-cells. The glucagon-like peptide 1 receptor (GLP-1R) is expressed with a high incidence (>90%) and high density in insulinomas. Glucagon-like peptide 1 (GLP-1), the natural ligand of GLP-1R, is rapidly degraded in vivo. A more stable agonist of GLP-1R is exendin-3. We investigated imaging of insulinomas with DOTA-conjugated exendin-3 labelled with (68)Ga. METHODS Targeting of insulinomas with [Lys(40)(DOTA)]exendin-3 labelled with either (111)In or (68)Ga was investigated in vitro using insulinoma tumour cells (INS-1). [Lys(40)((111)In-DTPA)]Exendin-3 was used as a reference in this study. In vivo targeting was investigated in BALB/c nude mice with subcutaneous INS-1 tumours. PET imaging was performed using a preclinical PET/CT scanner. RESULTS In vitro exendin-3 specifically bound and was internalized by GLP-1R-positive cells. In BALB/c nude mice with subcutaneous INS-1 tumours a high uptake of [Lys(40)((111)In-DTPA)]exendin-3 in the tumour was observed (33.5 +/- 11.6%ID/g at 4 h after injection). Uptake was specific, as determined by coinjection of an excess of unlabelled [Lys(40)]exendin-3 (1.8 +/- 0.1%ID/g). The pancreas also exhibited high and specific uptake (11.3 +/- 1.0%ID/g). High uptake was also found in the kidneys (144 +/- 24%ID/g) and this uptake was not receptor-mediated. In this murine tumour model optimal targeting of the GLP-1R expressing tumour was obtained at exendin doses < or =0.1 microg. Remarkably, tumour uptake of (68)Ga-labelled [Lys(40)(DOTA)]exendin-3 was lower (8.9 +/- 3.1%ID/g) than tumour uptake of (111)In-labelled [Lys(40)(DTPA)]exendin-3 (25.4 +/- 7.2%ID/g). The subcutaneous tumours were clearly visualized by small-animal PET imaging after injection of 3 MBq of [Lys(40)((68)Ga-DOTA)]exendin-3. CONCLUSION [Lys(40)((68)Ga-DOTA)]Exendin-3 specifically accumulates in insulinomas, although the uptake is lower than that of [Lys(40)((111)In-DTPA)]exendin-3. Therefore, [Lys(40)((68)Ga-DOTA)]exendin-3 is a promising tracer to visualize insulinomas with PET.


title: Most commonly isolated viruses in asthma exacerbation and their correlation with eosinophil and total serum immunoglobulin E levels.

text: BACKGROUND Asthma exacerbations are still a cause of hospitalization at the Emergency Department. The triggers of asthma exacerbations include allergens and infections -mostly viral-. The objective of this study was to establish the relationship between viruses detected during an asthma exacerbation and eosinophil and serum immunoglobulin E (IgE) levels in pediatric patients. POPULATION AND METHODS Cross-sectional. analytical study. Children aged 5-15 years seen at the Pediatric Emergency Department with an asthma exacerbation in the period between March 2013 and February 2016 were included. Viral ribonucleic acid was extracted from nasopharyngeal aspirates using the CLART Pneumo Vir kit. Eosinophil levels were measured in peripheral blood and total IgE levels, in serum. Eosinophilia was defined as a count ≥ 0.4 x 103/ mm3 and high IgE. as a level ≥ 350 IU/L. The Pearson's correlation was carried out. A value of p ≤ 0.05 was considered significant. RESULTS Out of 211 children with asthma exacerbation, a virus was isolated in 20%. The most commonly isolated viruses were rhinovirus. enterovirus, and respiratory syncytial virus. A correlation of 0.89 was established between eosinophil and total serum IgE levels in children with asthma exacerbation and rhinovirus, with a p value of 0.0001. CONCLUSIONS Rhinovirus, enterovirus, and respiratory syncytial virus were the most common viruses in asthma exacerbations in children younger than 15 years. A correlation was established between eosinophil and IgE levels in the presence of rhinovirus.


title: Label-free quantitative phosphoproteomic analysis reveals differentially regulated proteins and pathway in PRRSV-infected pulmonary alveolar macrophages.

text: Porcine reproductive and respiratory syndrome virus (PRRSV) is an important pathogen of swine worldwide and causes significant economic losses. Through regulating the host proteins phosphorylation, PRRSV was found to manipulate the activities of several signaling molecules to regulate innate immune responses. However, the role of protein phosphorylation during PRRSV infection and the signal pathways responsible for it are relatively unknown. Here liquid chromatography-tandem mass spectrometry for label-free quantitative phosphoproteomics was applied to systematically investigate the global phosphorylation events in PRRSV-infected pulmonary alveolar macrophages. In total, we identified 2125 unique phosphosites, of which the phosphorylation level of 292 phosphosites on 242 proteins and 373 phosphosites on 249 proteins was significantly altered at 12 and 36 h pi, respectively. The phosphoproteomics data were analyzed using ingenuity pathways analysis to identify defined canonical pathways and functional networks. Pathway analysis revealed that PRRSV-induced inflammatory cytokines production was probably due to the activation of mitogen-activated protein kinase and NF-κB signal pathway, which were regulated by several protein kinases during virus infection. Interacting network analysis indicated that altered phosphoproteins were involved in cellular assembly and organization, protein synthesis, molecular transport, and signal transduction in PRRSV infected cells. These pathways and functional networks analysis could provide direct insights into the biological significance of phosphorylation events modulated by PRRSV and may help us elucidate the pathogenic mechanisms of PRRSV infection.


title: Minimizing the Number of Urological Complications After Kidney Transplant: A Comparative Study of Two Types of External Ureteral Stents.

text: OBJECTIVES The aim of this study was to evaluate the effects of 2 types of external ureteral stents on the number of urological complications after kidney transplant. MATERIALS AND METHODS Data were retrospectively collected from 366 consecutive transplants performed between January 2013 and January 2015 in our hospital, in which an external ureteral stent was placed during surgery and removed after 9 days. Urological complications were defined as urinary leakage or ureteral stenosis requiring percutaneous nephrostomy placement. RESULTS A total of 197 patients received a straight stent with 2 larger side holes (type A; 8F "Covidien" tube; Covidien, Dublin, Ireland) and 169 patients received a single J stent with 7 smaller side holes (type B; 7F "Teleflex" single J stent; Teleflex Medical, Athlone, Ireland). We found a significantly higher number of percutaneous nephrostomy placements with type A stents, with 34 (17%) versus 16 (9%) in type B (P = .030). Reason for percutaneous nephrostomy placement, occurrence of stent dysfunction, and need for early removal (< 8 days) were equal in both groups (P = .397), whereas incidence of rejection and urinary tract infection were higher in type B stent group. Patient and graft survival did not differ between the groups. CONCLUSIONS Use of the type B stent was associated with less urological complications compared with the type A stent.


title: Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study.

text: OBJECTIVE A study was undertaken to evaluate clinical and procedural factors associated with outcome and recanalization in endovascular stroke treatment (EVT) of basilar artery (BA) occlusion. METHODS ENDOSTROKE is an investigator-initiated multicenter registry for patients undergoing EVT. This analysis includes 148 consecutive patients with BA occlusion, with 59% having received intravenous thrombolysis prior to EVT. Recanalization (defined as Thrombolysis in Cerebral Infarction [TICI] score 2b-3) and collateral status (using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral grading system) were assessed by a blinded core laboratory. Good (moderate) outcome was defined as a modified Rankin Scale score of 0 to 2 (0-3) assessed after at least 3 months (median time to follow-up = 120 days). RESULTS Thirty-four percent had good and 42% had moderate clinical outcome; mortality was 35%. TICI 2b-3 recanalization was achieved by 79%. Age, hypertension, National Institutes of Health Stroke Scale scores, collateral status, and the use of magnetic resonance imaging prior to EVT predicted clinical outcome, the latter 3 remaining independent predictors in multivariate analysis. Independent predictors of recanalization were better collateral status and the use of a stent retriever. However, recanalization did not significantly predict clinical outcome. INTERPRETATION Beside initial stroke severity, the collateral status predicts clinical outcome and recanalization in BA occlusion. Our data suggest that the use of a stent retriever is associated with high recanalization rates, but recanalization on its own does not predict outcome. The role of other modifiable factors, including the choice of pretreatment imaging modality and time issues, warrants further investigation.


title: Reconstructing influenza incidence by deconvolution of daily mortality time series.

text: We propose a mathematically straightforward method to infer the incidence curve of an epidemic from a recorded daily death curve and time-to-death distribution; the method is based on the Richardson-Lucy deconvolution scheme from optics. We apply the method to reconstruct the incidence curves for the 1918 influenza epidemic in Philadelphia and New York State. The incidence curves are then used to estimate epidemiological quantities, such as daily reproductive numbers and infectivity ratios. We found that during a brief period before the official control measures were implemented in Philadelphia, the drop in the daily number of new infections due to an average infector was much larger than expected from the depletion of susceptibles during that period; this finding was subjected to extensive sensitivity analysis. Combining this with recorded evidence about public behavior, we conclude that public awareness and change in behavior is likely to have had a major role in the slowdown of the epidemic even in a city whose response to the 1918 influenza epidemic is considered to have been among the worst in the U.S.


Disclosure.


THE COVID-19 Pandemic: Overview and Integrative Health Approaches.


title: Estimation of Arterial Carbon Dioxide Based on End-Tidal Gas Pressure and Oxygen Saturation.

text: Arterial blood gas (ABG) analysis is the traditional method for measuring the partial pressure of carbon dioxide. In mechanically ventilated patients a continuous noninvasive monitoring of carbon dioxide would obviously be attractive. In the current study, we present a novel formula for noninvasive estimation of arterial carbon dioxide. Eighty-one datasets were collected from 19 anesthetized and mechanically ventilated pigs. Eleven animals were mechanically ventilated without interventions. In the remaining eight pigs the partial pressure of carbon dioxide was manipulated. The new formula (Formula 1) is PaCO₂ = PETCO₂ + k(PETO₂ - PaO₂) where PaO₂ was calculated from the oxygen saturation. We tested the agreements of this novel formula and compared it to a traditional method using the baseline PaCO₂ - ETCO₂ gap added to subsequently measured, end-tidal carbon dioxide levels (Formula 2). The mean difference between PaCO₂ and calculated carbon dioxide (Formula 1) was 0.16 kPa (±SE 1.17). The mean difference between PaCO₂ and carbon dioxide with Formula 2 was 0.66 kPa (±SE 0.18). With a mixed linear model excluding cases with cardiorespiratory collapse, there was a significant difference between formulae (p < 0.001), as well as significant interaction between formulae and time (p < 0.001). In this preliminary animal study, this novel formula appears to have a reasonable agreement with PaCO₂ values measured with ABG analysis, but needs further validation in human patients.


title: Coronavirus diversity, phylogeny and interspecies jumping.

text: The SARS epidemic has boosted interest in research on coronavirus biodiversity and genomics. Before 2003, there were only 10 coronaviruses with complete genomes available. After the SARS epidemic, up to December 2008, there was an addition of 16 coronaviruses with complete genomes sequenced. These include two human coronaviruses (human coronavirus NL63 and human coronavirus HKU1), 10 other mammalian coronaviruses [bat SARS coronavirus, bat coronavirus (bat-CoV) HKU2, bat-CoV HKU4, bat-CoV HKU5, bat-CoV HKU8, bat-CoV HKU9, bat-CoV 512/2005, bat-CoV 1A, equine coronavirus, and beluga whale coronavirus] and four avian coronaviruses (turkey coronavirus, bulbul coronavirus HKU11, thrush coronavirus HKU12, and munia coronavirus HKU13). Two novel subgroups in group 2 coronavirus (groups 2c and 2d) and two novel subgroups in group 3 coronavirus (groups 3b and 3c) have been proposed. The diversity of coronaviruses is a result of the infidelity of RNA-dependent RNA polymerase, high frequency of homologous RNA recombination, and the large genomes of coronaviruses. Among all hosts, the diversity of coronaviruses is most evidenced in bats and birds, which may be a result of their species diversity, ability to fly, environmental pressures, and habits of roosting and flocking. The present evidence supports that bat coronaviruses are the gene pools of group 1 and 2 coronaviruses, whereas bird coronaviruses are the gene pools of group 3 coronaviruses. With the increasing number of coronaviruses, more and more closely related coronaviruses from distantly related animals have been observed, which were results of recent interspecies jumping and may be the cause of disastrous outbreaks of zoonotic diseases.


title: Electrical biosensors and the label free detection of protein disease biomarkers.

text: Electrical detection methodologies are likely to underpin the progressive drive towards miniaturised, sensitive and portable biomarker detection protocols. In being easily integrated within standard electronic microfabrication formats, and developing capability in microfluidics, the facile multiplexed detection of a range of proteins in a small analytical volume becomes entirely feasible with something costing just a few thousand pounds and benchtop or handheld in scale. In this review, we focus on recent important advances in label free assays of protein using a number of electrical methods, including those based on electrochemical impedance spectroscopy (EIS), amperometry/voltammetry, potentiometry, conductometry and field-effect methods. We introduce their mechanistic features and examples of application and sensitivity. The current state of the art, real world applications and challenges are outlined.


title: Disclosure at #SAGES2018: An analysis of physician-industry relationships of invited speakers at the 2018 SAGES national meeting.

text: BACKGROUND Financial conflicts of interest (COI) have been shown to affect the interpretation of scientific findings. Publications with unreported COI tend to be more favorable to industry. Since 2014 industry payments to United States (US) physicians are publicly reported in the Open Payments Database (OPD). Several studies show high levels of unreported COI in medical literature; however, there is no research examining COI reporting at surgical conferences. We hypothesized that compliance with the COI disclosure requirement would be high at the 2018 SAGES meeting. However, we expected to find significant discrepancy between speaker-reported and OPD-reported COI. A secondary aim was to characterize the amount, source, and variation in industry payments to invited speakers. METHODS We reviewed all available presentations from SAGES 2018 as recorded and publicly available on YouTube™ for the presence of COI disclosure and the disclosed industry relationships. For US physicians we searched the OPD and recorded all industry payments > $500. We compared the self-disclosed COI for each speaker with OPD records. Presentation topics were divided into ten groups to determine which topics received the most funding. RESULTS Of the 526 invited presentations, 479 (91%) videos were available. Disclosures were reported by 414 presenters (86.4%). There were 420 unique presenters of which 315 were listed in the OPD. Speaker-reported disclosures were fully concordant with the OPD in 38.3% (121/315) of cases with 39% (123/315) under-reporting disclosures. Of presenters listed in OPD, the median payment was $992 ($0-$374,502) with a total of $6,389,097 paid in 2017. SAGES speakers failed to disclose $2,049,535 worth of industry payments with an average undisclosed payment of $16,662.88 (± $40,733.19). The largest financial contributor was Intuitive Surgical with $1,981,169 paid. Among topics, robotics and hernia received the most funding with $2,593,925 (40.6%) and $2,591,671 (40.5%) paid, respectively. CONCLUSIONS Overall compliance with SAGES disclosure rules is high. There remains a discrepancy between speaker- and industry-reported disclosures, including a number of undisclosed payments, some of which are substantial. Adjustments to disclosure rules to include the relative amount of compensation may be warranted.


title: Correlation between antibiotic consumption and resistance of Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009.

text: OBJECTIVES This study investigated the correlation between antibiotic consumption and antimicrobial resistance in Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009. METHODS Disc susceptibility data of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus spp., Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia and other non-fermentative Gram-negative bacilli causing healthcare-associated infections were evaluated. Data on annual patient-days and annual consumption (defined daily doses per 1000 patient-days) of extended-spectrum cephalosporins, β-lactam/β-lactamase inhibitor combinations, carbapenems, aminoglycosides and ﬂuoroquinolones were analysed. RESULTS The trend of total consumption of extended-spectrum cephalosporins, β-lactam/β-lactamase inhibitor combinations, carbapenems, aminoglycosides and fluoroquinolones significantly increased between 2000 and 2003 and remained stable between 2004 and 2009. The decreasing use of gentamicin and amikacin in recent years was associated with increasing susceptibility of E. coli, E. cloacae, S. marcescens and P. aeruginosa to gentamicin, as well as increasing susceptibility of P. aeruginosa to amikacin. The use of piperacillin/tazobactam was positively correlated with the prevalence of piperacillin/tazobactam-resistant E. coli and S. maltophilia. In contrast, the use of cefotaxime and piperacillin/tazobactam was negatively correlated with the prevalence of cefotaxime-resistant E. coli and piperacillin/tazobactam-resistant S. maltophilia, respectively. The consumption of fluoroquinolones was positively correlated with the rates of ciprofloxacin-resistant E. coli, piperacillin/tazobactam-resistant P. aeruginosa and ceftazidime-resistant S. maltophilia. CONCLUSIONS The relationship between antibiotic prescription and the rates of resistance for Gram-negative bacteria is complicated; every type of antimicrobial agent or even individual agent can have distinct associations with different pathogens.


title: Safety, Dosimetry, and Tumor Detection Ability of 68Ga-NOTA-AE105: First-in-Human Study of a Novel Radioligand for uPAR PET Imaging.

text: The overexpression of urokinase-type plasminogen activator receptors (uPARs) represents an established biomarker for aggressiveness in most common malignant diseases, including breast cancer (BC), prostate cancer (PC), and urinary bladder cancer (UBC), and is therefore an important target for new cancer therapeutic and diagnostic strategies. In this study, uPAR PET imaging using a 68Ga-labeled version of the uPAR-targeting peptide (AE105) was investigated in a group of patients with BC, PC, and UBC. The aim of this first-in-human, phase I clinical trial was to investigate the safety and biodistribution in normal tissues and uptake in tumor lesions. Methods: Ten patients (6 PC, 2 BC, and 2 UBC) received a single intravenous dose of 68Ga-NOTA-AE105 (154 ± 59 MBq; range, 48-208 MBq). The biodistribution and radiation dosimetry were assessed by serial whole-body PET/CT scans (10 min, 1 h, and 2 h after injection). Safety assessment included measurements of vital signs with regular intervals during the imaging sessions and laboratory blood screening tests performed before and after injection. In a subgroup of patients, the in vivo stability of 68Ga-NOTA-AE105 was determined in collected blood and urine. PET images were visually analyzed for visible tumor uptake of 68Ga-NOTA-AE105, and SUVs were obtained from tumor lesions by manually drawing volumes of interest in the malignant tissue. Results: No adverse events or clinically detectable pharmacologic effects were found. The radioligand exhibited good in vivo stability and fast clearance from tissue compartments primarily by renal excretion. The effective dose was 0.015 mSv/MBq, leading to a radiation burden of 3 mSv when the clinical target dose of 200 MBq was used. In addition, radioligand accumulation was seen in primary tumor lesions as well as in metastases. Conclusion: This first-in-human, phase I clinical trial demonstrates the safe use and clinical potential of 68Ga-NOTA-AE105 as a new radioligand for uPAR PET imaging in cancer patients.


title: The hypothalamic-pituitary-adrenal axis and serotonin abnormalities: a selective overview for the implications of suicide prevention.

text: Suicidal behavior and mood disorders are one of the world's largest public health problems. The biological vulnerability for these problems includes genetic factors involved in the regulation of the serotonergic system and stress system. The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that regulates the body's response to stress and has complex interactions with brain serotonergic, noradrenergic and dopaminergic systems. Corticotropin-releasing hormone and vasopressin act synergistically to stimulate the secretion of ACTH that stimulates the biosynthesis of corticosteroids such as cortisol from cholesterol. Cortisol is a major stress hormone and has effects on many tissues, including on mineralocorticoid receptors and glucocorticoid receptors in the brain. Glucocorticoids produce behavioral changes, and one important target of glucocorticoids is the hypothalamus, which is a major controlling center of the HPA axis. Stress plays a major role in the various pathophysiological processes associated with mood disorders and suicidal behavior. Serotonergic dysfunction is a well-established substrate for mood disorders and suicidal behavior. Corticosteroids may play an important role in the relationship between stress, mood changes and perhaps suicidal behavior by interacting with 5-HT1A receptors. Abnormalities in the HPA axis in response to increased levels of stress are found to be associated with a dysregulation in the serotonergic system, both in subjects with mood disorders and those who engage in suicidal behavior. HPA over-activity may be a good predictor of mood disorders and perhaps suicidal behavior via abnormalities in the serotonergic system.


title: Outcomes of stapler repair with anastomosis for stoma prolapse.

text: PURPOSE The published data on the outcomes of an operative repair for stoma prolapse are limited. This study aimed to clarify the long-term outcomes of stapler repair with anastomosis for stoma prolapse. METHODS Twenty-four patients (15 men, median age 64 years, range 33-88 years) undergoing 25 stapler repairs with anastomosis were prospectively registered, and their medical records were retrospectively reviewed. RESULTS The median length of prolapse was 10 cm (range 5-22). Stoma prolapse repair was performed by means of 16 loop colostomies, four end colostomies, three loop ileostomies, and one end ileostomy. A stapler was used 4.6 times on average (range 4-8). The average operative time and bleeding were 40.8 (range 15-75) min and 40 (range 0-214) mL, respectively. No mortality and morbidity were observed after surgery. A recurrence of stoma prolapse was reported in only one of 25 repairs (4%) at the proximal limb of loop ileostomy during a median follow-up period of 1 year (range 1-120 months). However, a new stoma prolapsed in one untreated limb of loop stoma. CONCLUSIONS Stapler repair with anastomosis is a safe and minimally invasive treatment option for stoma prolapse with a low recurrence. However, the effectiveness of reparing stoma prolapse on the proximal limb of loop ileostomy might be limited.


title: Role of Contrast in MR Imaging.

text: Magnetic resonance (MR) contrast agents have been widely used over the last 3 decades in routine clinical practice. Paul Lauterbur recognized the presence of these contrast agents, which act as paramagnetic catalysts that accelerate the T1 relaxation process. The first MR contrast agent to be approved for clinical use was in 1988, and since then, it is estimated that 200 million doses have been administered worldwide. These contrast agents have diverse clinical as well as research applications, involving almost all the body organs. This review will cover some existing as well as many new applications that have emerged over the last few decades. MR imaging now has the potential of being used to monitor enzymatic activity, gene expression, metal ion homeostasis, and cell death in vivo. In future, newer contrast agents will develop and become commercially available, expanding the current clinical applications of MR contrast media.


docid: mwebrcqb

title: Conscious Sedation Versus General Anesthesia for the Treatment of Cerebral Aneurysms with Flow Diversion: A Matched Cohort Study.

text: INTRODUCTION Flow diversion has become a popular treatment option for a variety of cerebral aneurysms. We sought to compare conscious sedation and general anesthesia for flow diverter placement in a matched cohort study. METHODS Patients who underwent flow diverter placement under conscious sedation were matched on the basis of age, sex, American Society of Anesthesiologists classification, aneurysm location, and aneurysm size to patients who received general anesthesia. RESULTS Seventy patients undergoing flow diverter placement under conscious sedation were matched to 70 patients using general anesthesia. There were no statistically significant differences in gender, age, pretreatment modified Rankin Scale scores, or American Society of Anesthesiologists class. Aneurysms were located primarily in the internal carotid artery (87.1%) and posterior circulation (11.4%). Maximal aneurysm diameter and history of aneurysm rupture did not differ between the 2 groups. Duration of flow diverter placement was significantly longer in the general anesthesia group. The number of flow diverters placed was also higher in the general anesthesia group. Complete occlusion was achieved in 75% of aneurysms treated under conscious sedation and 82.4% under general anesthesia. Good functional outcome at last follow-up was recorded in 97.1% of cases of conscious sedation and 96.8% of cases of general anesthesia. The rate of thromboembolic and hemorrhagic neurologic complications was comparable between both groups. CONCLUSIONS Placement of a flow diverter can be safely performed under conscious sedation and is associated with reduced procedure length. The ideal candidate is cooperative, requires an intervention that is not too complex, and has an experienced operator performing the intervention.


COVID-19 and the practice of rheumatology in Africa: big changes to services from the shockwave of a pandemic.


title: Prospective randomized assessment of acquisition and retention of SILS skills after simulation training.

text: BACKGROUND Skills in single-incision laparoscopic surgery (SILS) are difficult to acquire. Simulation training leads to skill acquisition but circumstances about skill deterioration are unclear. The aim of this study was to evaluate skill acquisition and retention after single-incision laparoscopic simulation training. METHODS From October 2013 to January 2014, 30 surgically naive participants underwent a SILS training curriculum and completed two validated tasks (peg transfer, precision cutting) with subsequent testing to assess acquisition of skills (baseline testing, BT). The participants were randomized into two groups and skill retention testing (RT) was measured after 4 weeks (group A) or 12 weeks (group B). Task completion was measured in time with penalties for inaccurate performance. RESULTS A SILS training curriculum was established. 90 % of the participants completed the training successfully and reached the required levels of proficiency. Comparison of BT and RT revealed significantly better RT performances for peg transfer and precision cutting in group A (P < 0.05). These effects were not seen for RT in group B. Evaluating the RT performance of both groups, group A showed a non-significant trend for improved peg transfer and precision cutting compared to group B. CONCLUSION A proficiency-based training curriculum for acquisition of basic SILS skills was successfully established in our department. The results of this study indicate that acquired SILS skills are well retained for a short period without training (4 weeks) but a longer non-training period (12 weeks) resulted in a significant loss of acquired skills. For enhancement of surgical skills, specialised SILS training curricula could be developed for novices and inexperienced surgeons; however, continuous training is essential to maintain these acquired skills.


title: Cytomegalovirus-mediated activation of pyrimidine biosynthesis drives UDP-sugar synthesis to support viral protein glycosylation.

text: Human cytomegalovirus (HCMV) induces numerous changes to the host metabolic network that are critical for high-titer viral replication. We find that HCMV infection substantially induces de novo pyrimidine biosynthetic flux. This activation is important for HCMV replication because inhibition of pyrimidine biosynthetic enzymes substantially decreases the production of infectious virus, which can be rescued through medium supplementation with pyrimidine biosynthetic intermediates. Metabolomic analysis revealed that pyrimidine biosynthetic inhibition considerably reduces the levels of various UDP-sugar metabolites in HCMV-infected, but not mock-infected, cells. Further, UDP-sugar biosynthesis, which provides the sugar substrates required for glycosylation reactions, was found to be induced during HCMV infection. Pyrimidine biosynthetic inhibition also attenuated the glycosylation of the envelope glycoprotein B (gB). Both glycosylation of gB and viral growth were restored by medium supplementation with either UDP-sugar metabolites or pyrimidine precursors. These results indicate that HCMV drives de novo-synthesized pyrimidines to UDP-sugar biosynthesis to support virion protein glycosylation. The importance of this link between pyrimidine biosynthesis and UDP-sugars appears to be partially shared among diverse virus families, because UDP-sugar metabolites rescued the growth attenuation associated with pyrimidine biosynthetic inhibition during influenza A and vesicular stomatitis virus infection, but not murine hepatitis virus infection. In total, our results indicate that viruses can specifically modulate pyrimidine metabolic flux to provide the glycosyl subunits required for protein glycosylation and production of high titers of infectious progeny.


title: Single incision laparoscopic splenectomy in a 5-year-old with hereditary spherocytosis.

text: BACKGROUND Single incision laparoscopic surgery (SILS) is an emerging technique that has been used as an approach for appendectomy, cholecystectomy, and splenectomy. We describe the technique of single incision laparoscopic splenectomy for hypersplenism in a 5-year-old boy with spherocytosis. CASE REPORT The patient required blood transfusions for anemia secondary to hypersplenism. His spleen measured 9.8 cm in cranio-caudal length on ultrasound. SILS splenectomy was performed through a 2-cm umbilical incision by using 3 ports. The splenic attachments were taken down using an electrosurgical sealing and cutting device, and the hilum was transected with an endosurgical stapler. The spleen was placed in an endosurgical bag, morcellated, and removed from the abdomen via the umbilical incision without complications. Operative time was 84 minutes; blood loss was minimal. CONCLUSION SILS splenectomy is feasible in pediatric patients. More experience is needed to assess advantages and disadvantages compared with the standard laparoscopic approach.


docid: tjpamkum

title: Development of a test system to evaluate procedures for decontamination of respirators containing viral droplets.

text: The aim of this study was to develop a test system to evaluate the effectiveness of procedures for decontamination of respirators contaminated with viral droplets. MS2 coliphage was used as a surrogate for pathogenic viruses. A viral droplet test system was constructed, and the size distribution of viral droplets loaded directly onto respirators was characterized using an aerodynamic particle sizer. The sizes ranged from 0.5 to 15 mum, and the sizes of the majority of the droplets were the range from 0.74 to 3.5 mum. The results also showed that the droplet test system generated similar droplet concentrations (particle counts) at different respirator locations. The test system was validated by studying the relative efficiencies of decontamination of sodium hypochlorite (bleach) and UV irradiation with droplets containing MS2 virus on filtering facepiece respirators. It was hypothesized that more potent decontamination treatments would result in corresponding larger decreases in the number of viable viruses recovered from the respirators. Sodium hypochlorite doses of 2.75 to 5.50 mg/liter with a 10-min decontamination period resulted in approximately 3- to 4-log reductions in the level of MS2 coliphage. When higher sodium hypochlorite doses (> or =8.25 mg/liter) were used with the same contact time that was used for the dilute solutions containing 2.75 to 5.50 mg/liter, all MS2 was inactivated. For UV decontamination at a wavelength of 254 nm, an approximately 3-log reduction in the level of MS2 virus was achieved with dose of 4.32 J/cm(2) (3 h of contact time with a UV intensity of 0.4 mW/cm(2)), while with higher doses of UV irradiation (> or =7.20 J/cm(2); UV intensity, 0.4 mW/cm(2); contact times, > or =5 h), all MS2 was inactivated. These findings may lead to development of a standard method to test decontamination of respirators challenged by viral droplets.


title: A prospective clinical trial comparing Biobrane(®) Dressilk(®) and PolyMem(®) dressings on partial-thickness skin graft donor sites.

text: INTRODUCTION In a single-center, prospective, randomized clinical trial three different configured wound dressings Biobrane(®), Dressilk(®) and PolyMem(®) were compared with each other regarding objective and subjective healing parameters and cost efficiency. METHODS 28 burn patients received surgical treatment with split-thickness skin grafting, while utilizing Biobrane(®), Dressilk(®) and PolyMem(®) as a single bound donor site wound dressing in all patients. Following a standardized case report form, we monitored several parameters such as pain, transparency of the dressing, active bleeding, exudation and inflammation by using the Verbal Rating Scale 1-10 through out. RESULTS With regard to re-epithelialization, pain and acute bleeding all three dressings were equivalent. Dressilk(®) and Biobrane(®) presented clearly superior to PolyMem(®) in both wound assessment and in the reduction of mild inflammation and exudation. High subjective satisfaction rates were reported with Dressilk(®) and Biobrane(®) dressings in regard to comfort and mobility. During the continuous monitoring period Biobrane(®) outperformed Dressilk(®) by providing higher wound transparency rates and offering a better level of wound control during the entire study period. Regarding their cost efficiency, PolyMem(®) and Dressilk(®) are clearly superior to Biobrane(®). CONCLUSION The "ideal" wound dressing maximizes patients' comfort while reducing pain and the risk of pulling off migrating epidermal cells from the wound surface. In addition reliable wound status evaluation (minimizing complications), an increase of treatment cost value efficacy, and reduced hospitalization rates should be provided. Dressilk(®) and Biobrane(®) were favored by patients and surgeons for providing an effective and safe healing environment, with overall low complication rates with respect to infection and exudation. Regarding cost-effectiveness PolyMem(®) and Dressilk(®) presented superior to Biobrane(®).


title: Can medicinal mushrooms have prophylactic or therapeutic effect against COVID-19 and its pneumonic superinfection and complicating inflammation?

text: Medicinal mushrooms have documented effects against different diseases, including infections and inflammatory disorders. The related Basidiomycota Agaricus blazei Murill (AbM), Hericium erinaceus (HE) and Grifola frondosa (GF) have been shown to exert antimicrobial activity against viral agents, Gram positive and Gram negative bacteria, and parasites in vitro and in vivo. Since the mechanism is immunomodulatory and not antibiotical the mushrooms should be active against multi-drug resistant microbes as well. Moreover, since these Basidiomycota also have anti-inflammatory properties, they may be suited for treatment of the severe lung inflammation that often follows COVID-19 infection. An AbM-based mushroom extract (AndosanTM ), also containing HE and GF, has been shown to significantly reduce bacteremia and increase survival in mice with pneumococcal sepsis, and to improve symptoms and quality of life in IBD patients via an anti-inflammatory effect. Hence, such mushroom extracts could have prophylactic or therapeutic effect against the pneumonic superinfection and severe lung inflammation that often complicates COVID-19 infection. Here, we review antimicrobial and anti-inflammatory properties of AbM, HE and GF mushrooms, which could be used for the battle against COVID-19.


title: CT-guided radiofrequency ablation following high-dose chemotherapy of a liver-metastasizing pancreatoblastoma with tumor thrombus in the portal vein.

text: Pancreatoblastoma is a rare neoplasm encountered most commonly in infants and young children. Unresectable or metastatic tumors have a poor prognosis despite adjuvant chemotherapy or radiotherapy. We report the successful use of CT-guided radiofrequency ablation subsequent to intensive chemotherapy in an 8-year-old girl with liver-metastasizing pancreatoblastoma and with right and segment 4 portal vein tumor thrombosis. She has been in remission for 3 years.


COVID-19 Lockdown and Mental Health: Why We Must Look Into Oncology Units.


title: Long term complications and rehabilitation of COVID-19 patients.

text: With the ongoing pandemic of COVID-19 having caught the world almost unaware millions of people across the globe are presently grappling to deal with its acute effects . Our previous experience with members of the same corona virus family (SARS and MERS) which have caused two major epidemics in the past albeit of much lower magnitude , has taught us that the harmful effect of such outbreaks are not limited to acute complications alone .Long term cardiopulmonary, glucometabolic and neuropsychiatric complications have been documented following these infections .In the given circumstance it is therefore imperative to keep in mind the possible complications that may occur after the acute phase of the disease subsides and to prepare the healthcare system for such challenges.


title: Peer support opportunities across the cancer care continuum: a systematic scoping review of recent peer-reviewed literature.

text: OBJECTIVE Evidence suggests peer support (PS) is as an effective strategy for enhancing prevention and control of chronic and infectious diseases, including cancer. This systematic scoping review examines the range and variety of interventions on the use of PS across the cancer care continuum. METHOD We used a broad definition of PS to capture a wide-range of interventions and characterize the current status of the field. Literature searches were conducted using PubMed, SCOPUS, and CINAHL to identify relevant articles published from January 2011 to June 2016. We screened the title and abstracts of 2087 articles, followed by full-text screening of 420 articles, resulting in a final sample of 242 articles of which the most recent 100 articles were reviewed (published June 2014 to May 2016). RESULTS A number of the recent intervention studies focused on breast cancer (32%, breast cancer only) or multiple cancer sites (23%). Although the interventions spanned all phases of the cancer care continuum, only 2% targeted end-of-life care. Seventy-six percent focused on clinical outcomes (e.g., screening, treatment adherence) and 72% on reducing health disparities. Interventions were primarily phone-based (44%) or delivered in a clinic setting (44%). Only a few studies (22%) described the impact of providing PS on peer supporters. CONCLUSION PS appears to be a widely used approach to address needs across the cancer care continuum, with many opportunities to expand its reach.


title: Patient Perspectives on Audio-Only Virtual Prenatal Visits Amidst the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic.

text: OBJECTIVE To evaluate patient satisfaction after integration of audio-only virtual visits into a pre-existing prenatal care schedule within a large, county-based system during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS We implemented audio-only prenatal virtual visits in response to the SARS-CoV-2 pandemic within a large, county-based prenatal care system serving predominantly women with low socioeconomic status and limited resources. Using a four-question telephone survey, we surveyed a cross-section of patients who had opted to participate in virtual visits to assess their level of satisfaction surrounding audio-only visits. In addition, average clinic wait times and attendance rates by visit type were examined. RESULTS From March 17 to May 31, 2020, more than 4,000 audio-only virtual prenatal visits were completed in our system. After implementation, the percentage of visits conducted through the virtual platform gradually rose, with nearly 25% of weekly prenatal visits being performed through the virtual platform by the month of May. Clinic wait times trended downward after implementation of virtual visits (P<.001). On average, 88% of virtual prenatal visits were completed as scheduled, whereas only 82% of in-person visits were attended (P<.001). Hospital administration attempted to contact 431 patients who had participated in at least one virtual visit to assess patient satisfaction; 283 patients were reached and agreed to participate (65%). Ninety-nine percent of respondents reported that their needs were met during their audio-only virtual visits. The majority of patients preferred a combination of in-person and virtual visits for prenatal care, and patients reported many benefits with virtual visits. CONCLUSION Audio-only virtual prenatal visits-as a complement to in-person prenatal visits-have specific and distinct advantages compared with video-enabled telehealth in a vulnerable population of women and offer a viable option to increase access to care.


Older Clinicians and the Surge in Novel Coronavirus Disease 2019 (COVID-19).


docid: ksmieodk

title: The Andes hantavirus NSs protein is expressed from the viral small mRNA by a leaky scanning mechanism.

text: The small mRNA (SmRNA) of all Bunyaviridae encodes the nucleocapsid (N) protein. In 4 out of 5 genera in the Bunyaviridae, the smRNA encodes an additional nonstructural protein denominated NSs. In this study, we show that Andes hantavirus (ANDV) SmRNA encodes an NSs protein. Data show that the NSs protein is expressed in the context of an ANDV infection. Additionally, our results suggest that translation initiation from the NSs initiation codon is mediated by ribosomal subunits that have bypassed the upstream N protein initiation codon through a leaky scanning mechanism.


Risk of COVID-19 infection in workplace settings and the use of personal protective equipment.