title: Chronic otitis media surgery and re-operation risk factor analysis: A nationwide retrospective cohort study of 18 895 patients.

text: CONCLUSION Patients with risk factors including younger age, mastoiditis, external ear disease, treatment by older surgeons, and concomitant mastoidectomy should receive detailed management to minimize the probability of re-operation for chronic otitis media (COM). OBJECTIVES Although COM remains a common ear disease requiring surgical intervention, its re-operation risks are less well-documented. This study aimed to compare patients with COM who underwent re-operation and those patients with no re-operation, and identify the risks of re-operation. METHOD This retrospective cohort study analyzed the trend of COM surgery from 1999-2009, and identified the re-operation risks of 18 895 patients with COM who underwent surgery from 2002-2006 using the National Health Insurance Research Database in Taiwan. RESULTS Among the study population, 129 patients underwent revision surgery during a 5.5 ± 1.5 year follow-up period. A univariate logistic regression analysis showed that the re-operation rate was significantly higher in patients under 18 years of age, those with mastoiditis, disorders of external ear, treatment by surgeons of 50-64 years of age, use of a very high volume surgeon, and combined surgery with mastoidectomy. A multivariate analysis further limited the re-operation risk factors to younger patients, those with mastoiditis, external ear disorders, treatment by older surgeons, and concomitant mastoidectomy.


title: Effects of exposure to Bovine viral diarrhoea virus 1 on risk of bovine respiratory disease in Australian feedlot cattle.

text: Viruses play a key role in the complex aetiology of bovine respiratory disease (BRD). Bovine viral diarrhoea virus 1 (BVDV-1) is widespread in Australia and has been shown to contribute to BRD occurrence. As part of a prospective longitudinal study on BRD, effects of exposure to BVDV-1 on risk of BRD in Australian feedlot cattle were investigated. A total of 35,160 animals were enrolled at induction (when animals were identified and characteristics recorded), held in feedlot pens with other cattle (cohorts) and monitored for occurrence of BRD over the first 50days following induction. Biological samples collected from all animals were tested to determine which animals were persistently infected (PI) with BVDV-1. Data obtained from the Australian National Livestock Identification System database were used to determine which groups of animals that were together at the farm of origin and at 28days prior to induction (and were enrolled in the study) contained a PI animal and hence to identify animals that had probably been exposed to a PI animal prior to induction. Multi-level Bayesian logistic regression models were fitted to estimate the effects of exposure to BVDV-1 on the risk of occurrence of BRD. Although only a total of 85 study animals (0.24%) were identified as being PI with BVDV-1, BVDV-1 was detected on quantitative polymerase chain reaction in 59% of cohorts. The PI animals were at moderately increased risk of BRD (OR 1.9; 95% credible interval 1.0-3.2). Exposure to BVDV-1 in the cohort was also associated with a moderately increased risk of BRD (OR 1.7; 95% credible interval 1.1-2.5) regardless of whether or not a PI animal was identified within the cohort. Additional analyses indicated that a single quantitative real-time PCR test is useful for distinguishing PI animals from transiently infected animals. The results of the study suggest that removal of PI animals and/or vaccination, both before feedlot entry, would reduce the impact of BVDV-1 on BRD risk in cattle in Australian feedlots. Economic assessment of these strategies under Australian conditions is required.


title: Emergence of novel nephropathogenic infectious bronchitis viruses currently circulating in Chinese chicken flocks.

text: The emergence of novel infectious bronchitis viruses (IBVs) has been reported worldwide. Between 2011 and 2014, eight IBV isolates were identified from disease outbreaks in northeast China. In the current study we analysed the S1 gene of these eight IBV isolates in addition to the complete genome of five of them. We confirmed that these isolates emerged through the recombination of LX4 and Taiwan group 1 (TW1) viruses at two switch sites, one was in the Nsp 16 region and the other in the spike protein gene. The S1 gene in these viruses exhibited high nucleotide similarity with TW1-like viruses; the TW1 genotype was found to be present in southern China from 2009. Pathogenicity experiments in chickens using three of the eight virus isolates revealed that they were nephropathogenic and had similar pathogenicity to the parental viruses. The results of our study demonstrate that recombination, coupled with mutations, is responsible for the emergence of novel IBVs.


title: COVID-19 with cystic features on computed tomography: A case report.

text: RATIONALE The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia. PATIENT CONCERNS A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit. DIAGNOSES Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall. INTERVENTIONS The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment. OUTCOMES At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department. LESSONS COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.


A Saudi family with sickle cell disease presented with acute crises and COVID-19 infection.


title: Nurses: Courageous, Committed, and Fed Up.

text: The COVID-19 pandemic is a watershed moment for nurses.


title: A comparison of a deterministic and stochastic model for hepatitis C with an isolation stage.

text: We formulate a deterministic epidemic model for the spread of Hepatitis C containing an acute, chronic and isolation class and analyse the effects of the isolation class on the transmission dynamics of the disease. We calculate the basic reproduction number R(0) and show that for R(0)≤1, the disease-free equilibrium is globally asymptotically stable. In addition, it is shown that for a special case when R(0)>1, the endemic equilibrium is locally asymptotically stable. Furthermore, an analogous stochastic epidemic model for Hepatitis C is formulated using a continuous time Markov chain. Numerical simulations are used to estimate the mean, variance and probability distributions of the discrete random variables and these are compared to the steady-state solutions of the deterministic model. Finally, the expected time to disease extinction is estimated for the stochastic model and the impact of isolation on the time to extinction is explored.


title: Mayo Clinic approaches to meet United States Pharmacopeia <797> requirements for facility design and environmental controls of nuclear pharmacy.

text: UNLABELLED According to the United States Pharmacopeia (USP) General Chapter <797> (USP <797>), "Pharmaceutical Compounding-Sterile Preparations," the compounding facility must be physically designed and environmentally controlled to minimize airborne contamination from contacting critical sites. The goal of the project was to evaluate the appropriateness and effectiveness of our approaches in meeting <797> requirements. METHODS USP <797> standards, radiation safety concerns, and work-flow patterns were the focal points in our assessment of 4 laboratories: 2 nuclear pharmacy laboratories that engage in preparing sterile (low-, medium-, and high-risk levels), nonsterile, or possible hazardous radioactive drugs and 2 other laboratories in which only low-risk-level preparations are involved. RESULTS Each laboratory was constructed with a physically separated International Organization for Standardization Class 7 anteroom and clean room to allow us to maintain an appropriate air quality, a consistent operation, and a desirable flexibility. An isolated area within the laboratory was designated for preparing nonsterile products. Higher air change per hour was used in the areas with higher traffic or smaller space. Lead-lined biological safety cabinets (BSCs) were segregated and used depending on the risk category of the preparations. In 1 laboratory, the exhaust flow for the BSC was too great, and a lead-lined compounding aseptic containment isolator (CACI) was installed. Air in the BSC and CACI was 100% exhausted to the atmosphere. 99Mo/99mTc generators were placed in the negative-pressure clean room to ensure a more efficient operation and cleaner air environment. Clean-room equipment (i.e., keyboards, printers, and telephones) was installed, and refrigerators or freezers and the central-processing unit of each computer were placed outside clean room. CONCLUSION Our wide-range preparations of sterile, nonsterile, or potential hazardous radiopharmaceuticals, coupled with the limited space of each laboratory and existing antiquated mechanical systems, presented a challenge. Nevertheless, we successfully remodeled each nuclear pharmacy laboratory to meet USP <797> requirements for facility design and environmental controls.


title: Obatoclax Inhibits Alphavirus Membrane Fusion by Neutralizing the Acidic Environment of Endocytic Compartments.

text: As new pathogenic viruses continue to emerge, it is paramount to have intervention strategies that target a common denominator in these pathogens. The fusion of viral and cellular membranes during viral entry is one such process that is used by many pathogenic viruses, including chikungunya virus, West Nile virus, and influenza virus. Obatoclax, a small-molecule antagonist of the Bcl-2 family of proteins, was previously determined to have activity against influenza A virus and also Sindbis virus. Here, we report it to be active against alphaviruses, like chikungunya virus (50% effective concentration [EC50] = 0.03 μM) and Semliki Forest virus (SFV; EC50 = 0.11 μM). Obatoclax inhibited viral entry processes in an SFV temperature-sensitive mutant entry assay. A neutral red retention assay revealed that obatoclax induces the rapid neutralization of the acidic environment of endolysosomal vesicles and thereby most likely inhibits viral fusion. Characterization of escape mutants revealed that the L369I mutation in the SFV E1 fusion protein was sufficient to confer partial resistance against obatoclax. Other inhibitors that target the Bcl-2 family of antiapoptotic proteins inhibited neither viral entry nor endolysosomal acidification, suggesting that the antiviral mechanism of obatoclax does not depend on its anticancer targets. Obatoclax inhibited the growth of flaviviruses, like Zika virus, West Nile virus, and yellow fever virus, which require low pH for fusion, but not that of pH-independent picornaviruses, like coxsackievirus A9, echovirus 6, and echovirus 7. In conclusion, obatoclax is a novel inhibitor of endosomal acidification that prevents viral fusion and that could be pursued as a potential broad-spectrum antiviral candidate.


title: The role of ORF3 accessory protein in replication of cell-adapted porcine epidemic diarrhea virus (PEDV).

text: The ORF3 accessory protein has been shown to impede reverse genetics of cell-culture-adapted porcine epidemic diarrhea virus (PEDV). Its absence or truncated variants are also associated with viral attenuation in vivo. Here, three ORF3 variants (ORF3NP12, ORF3NP14 and ORF3RB14) and their truncated counterparts were investigated for their regulatory role in recovery of cell-adapted PEDV in vitro. We demonstrate that ORF3NP12, but not the truncated form, can inhibit recovery of reverse-genetics-derived PEDV when expressed in trans. When testing with other RNA viruses, ORF3 was found to inhibit rescue of porcine respiratory and reproductive syndrome virus (PRRSV), but not of influenza virus. Interestingly, results from mutagenesis of ORF3NP12 suggest that F81 and M167 are responsible for impairing PEDV rescue in vitro. By changing specific residues of ORF3, the recombinant PEDV bearing the modified ORF3NP12 can be productively propagated in VeroE6-APN cells. These results may provide mechanistic insights into ORF3-mediated inhibition of PEDV replication in new host cells.


Twists and turns in the war with infectious disease.


title: Assessment and Management of Anorexia Nervosa during COVID-19.

text: Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with Anorexia Nervosa require regular clinical review. However, during the current pandemic, face to face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.


title: Early detection and visualization of human adenovirus serotype 5-viral vectors carrying foot-and-mouth disease virus or luciferase transgenes in cell lines and bovine tissues.

text: Recombinant replication-defective human adenovirus type 5 (Ad5) vaccines containing capsid-coding regions from foot-and-mouth disease virus (FMDV) have been demonstrated to induce effective immune responses and provide homologous protective immunity against FMDV in cattle. However, basic mechanisms of Ad5-FMDV vaccine function including virus tropism, transgene expression, and antigen presentation, remain incompletely understood. The current study characterized the dynamics of Ad5 viral vector (Ad5-FMDV-A24 and Ad5-luciferase) infection in cell lines and early post-inoculation vector-host interactions in cattle. Adenovirus dissemination was described utilizing novel rPCR, rRT-PCR, luminometry, and immunomicroscopy techniques. In vitro infection of human and bovine cells with both Ad5 vectors resulted in dose-dependent detection of vector DNA, mature mRNA transcripts, and transgene-encoded proteins. Subsequent to intramuscular inoculation of cattle, Ad5 and transgene products were detected at the injection sites of all animals at all time-points examined (6, 24, and 48 hpi). Microscopically, injection sites were characterized by marked infiltrates of interstitium consisting of predominantly large mononuclear cells. Immunomicroscopy indicated these cells infrequently contained adenovirus and/or transgenic proteins and were phenotypically consistent with antigen-presenting cells (macrophages and dendritic cells). Vector DNA and mature mRNA transcripts were first detected at the draining and local lymph nodes as early as 6 hpi and systemically at 24 hpi. These results provide novel insights for understanding Ad5-mediated immunity against FMDV using novel techniques that will contribute to ongoing efforts for the improvement of future Ad-FMDV vaccine platforms.


title: Bilateral endoclose approach for the stabilization of the bar in pectus repair.

text: BACKGROUND Mini-invasive repair of pectus excavatum with Nuss technique is the preferred technique in most centers. One of the most important technical points for the final result is the stabilization of the bar, usually obtained by one or more stabilizers and few stitches fixing the bar to some ribs. Our aim is to show how to get the bar more stable by passing bilaterally some stitches around the bar and the ribs close to it. By a right thoracoscopy and a 30-degree optic, we are able to pass the stitches bilaterally by using an Endoclose needle (Covidien Ltd., Hamilton HM, Bermuda). The left hemithorax is visualized from the right side, pushing the optic through the mediastinum following the bar and staying just below it. MATERIALS AND METHODS We have operated on 230 patients in two centers. We have used only one stabilizer in more than 90% of the patients. In all patients, we have passed four absorbable stitches on the right side, using an Endoclose needle. In the last 45 cases, we have adopted bilateral fixation of the bar by the Endoclose needle. RESULTS The maneuver takes only around 10 minutes. We did not have complications related to that maneuver. We did not observe destabilization of the bar in those cases. The overall destabilization rate was 1.3%. CONCLUSIONS We suggest this technique to give the bar more stability on both sides. We think the use of a bilateral stabilizer can be avoided.


title: Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh.

text: BACKGROUND Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure. METHODS A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence. RESULTS Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p = 0.01), current smoking status (p = 0.05) and hernia side [p = 0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1 ± 37.1 min vs. 76.8 ± 32.9, p < 0.0001). No cases were converted to open. Average follow-up was 21.6 ± 23.8 months. Ninety-three percent of closure patients had documented resolution of pre-operative pain versus 94.0% of non-closure (p = 0.81). The closure group experienced a higher percentage of post-operative complications, though this did not reach significance (5.5 vs. 2.3%; p = 0.36). Compared to the closure group, the non-closure groups experienced similar post-operative pain (3.6 vs. 1.2%; p = 0.24) and recurrence rate (1.8 vs. 4.0%; p = 0.68). There were no bowel obstructions, surgical site infections, unplanned readmissions, or unplanned re-operations. CONCLUSIONS Equivalent patient outcomes were seen for both procedure types post-operatively and during follow-up. Operative times were significantly shorter for non-closure patients. Larger study population and longer follow-up is necessary to evaluate true long-term complication rates in flap non-closure.


title: Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial.

text: IMPORTANCE Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease. OBJECTIVE To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen. DESIGN, SETTING, AND PARTICIPANTS A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013. The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada. A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were randomized after completion of neoadjuvant therapy to laparoscopic or open resection. INTERVENTIONS Standard laparoscopic and open approaches were performed by the credentialed surgeons. MAIN OUTCOMES AND MEASURES The primary outcome assessing efficacy was a composite of circumferential radial margin greater than 1 mm, distal margin without tumor, and completeness of total mesorectal excision. A 6% noninferiority margin was chosen according to clinical relevance estimation. RESULTS Two hundred forty patients with laparoscopic resection and 222 with open resection were evaluable for analysis of the 486 enrolled. Successful resection occurred in 81.7% of laparoscopic resection cases (95% CI, 76.8%-86.6%) and 86.9% of open resection cases (95% CI, 82.5%-91.4%) and did not support noninferiority (difference, -5.3%; 1-sided 95% CI, -10.8% to ∞; P for noninferiority = .41). Patients underwent low anterior resection (76.7%) or abdominoperineal resection (23.3%). Conversion to open resection occurred in 11.3% of patients. Operative time was significantly longer for laparoscopic resection (mean, 266.2 vs 220.6 minutes; mean difference, 45.5 minutes; 95% CI, 27.7-63.4; P < .001). Length of stay (7.3 vs 7.0 days; mean difference, 0.3 days; 95% CI, -0.6 to 1.1), readmission within 30 days (3.3% vs 4.1%; difference, -0.7%; 95% CI, -4.2% to 2.7%), and severe complications (22.5% vs 22.1%; difference, 0.4%; 95% CI, -4.2% to 2.7%) did not differ significantly. Quality of the total mesorectal excision specimen in 462 operated and analyzed surgeries was complete (77%) and nearly complete (16.5%) in 93.5% of the cases. Negative circumferential radial margin was observed in 90% of the overall group (87.9% laparoscopic resection and 92.3% open resection; P = .11). Distal margin result was negative in more than 98% of patients irrespective of type of surgery (P = .91). CONCLUSIONS AND RELEVANCE Among patients with stage II or III rectal cancer, the use of laparoscopic resection compared with open resection failed to meet the criterion for noninferiority for pathologic outcomes. Pending clinical oncologic outcomes, the findings do not support the use of laparoscopic resection in these patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00726622.


title: The Importance of Health Informatics in Public Health During the COVID-19 Pandemic.

text: The COVID-19 pandemic became a challenge to all the health care systems across the world causing at places collapse of the healthcare systems and endangering the healthcare professionals and consequently the public health. One powerful tool for the healthcare systems and the policy makers is Health Informatics. This brief article presents the challenges faced by Health Informatics in supporting healthcare professionals and public health authorities in the world.


title: Is gamma loop dysfunction related to bilateral inhibition in anterior knee pain?

text: INTRODUCTION The potential relationship between bilateral quadriceps inhibition in individuals with unilateral anterior knee pain (AKP) and gamma loop dysfunction is examined in this study. METHODS Twelve individuals with unilateral AKP and 10 healthy controls were recruited. Quadriceps voluntary activation (%VA) was quantified using a triggered interpolated twitch technique. Gamma loop function was assessed through knee extension maximum voluntary isometric contractions before and after 20 minutes of 50-Hz patellar tendon vibration. RESULTS The AKP group exhibited 5.7% lower %VA bilaterally compared with controls (P = 0.039, Cohen d = 0.79). After prolonged vibration, both groups exhibited an average 8.5% reduction in knee extension force in each limb (P < 0.001, Cohen d = 0.85). CONCLUSIONS Significant force reductions after vibration suggest that gamma loop dysfunction was not seen in either control or AKP participants. Bilateral quadriceps inhibition in the AKP group does not appear to be associated with gamma loop dysfunction.


title: Neuroanesthesiology Update.

text: We provide a synopsis of innovative research, recurring themes, and novel experimental findings pertinent to the care of neurosurgical patients and critically ill patients with neurological diseases. We cover the following broad topics: general neurosurgery, spine surgery, stroke, traumatic brain injury, monitoring, and anesthetic neurotoxicity.


Optical Coherence Tomography Guidance during Peripheral Vascular Intervention.


title: Erector spinae plane and intra thecal opioid (ESPITO) analgesia in radical nephrectomy utilising a rooftop incision: novel alternative to thoracic epidural analgesia and systemic morphine: a case series.

text: Background Open radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes. Methods Five patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complications Results Five adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery. Conclusion The novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.


title: Laparoscopic CBD exploration using a V-shaped choledochotomy.

text: BACKGROUND Laparoscopic common bile duct exploration (LCBDE) is a treatment modality for choledocholithiasis. The advantages of this technique are that it is less invasive than conventional open surgery and it permits single-stage management; however, other technical difficulties limit its use. The aim of this article is to introduce our novel technique for LCBDE, which may overcome some of the limitations of conventional LCBDE. Since December 2013, ten patients have undergone LCBDE using a V-shaped choledochotomy (V-CBD). After the confluence of the cystic duct and the CBD were exposed, a V-shaped incision was made along the medial wall of the cystic duct and the lateral wall of the common hepatic duct, which comprise two sides of Calot's triangle. The choledochoscope was inserted into the lumen of the CBD through a V-shaped incision, and all CBD stones were retrieved using a basket or a Fogarty balloon catheter or were irrigated with saline. After CBD clearance was confirmed using the choledochoscope, the choledochotomy was closed with the bard absorbable suture material known as V-loc. RESULTS The diameter of the CBD ranged from 8 to 30 mm, and the mean size of the stones was 11.6 ± 8.4 mm. The mean operative time was 97.8 ± 30.3 min, and the mean length of the postoperative hospital stay was 6.0 ± 4.6 days. All patients recovered without any postoperative complications, except for one patient who developed postoperative pancreatitis. No conversions to laparotomy were observed, and there were no recurrent stones and no need of T-tube insertion. CONCLUSIONS This report suggests that our novel technique, known as V-CBD, may represent a feasible and straightforward procedure for treating choledocholithiasis, especially when the CBD is not dilated.


title: Mental Health Policy in the Era of COVID-19.

text: The response to the global COVID-19 pandemic has important ramifications for mental health systems and the patients they serve. This article describes significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. These extraordinary advances provide an unprecedented opportunity to evaluate the effects of mental health policies that may be adopted in the post-COVID-19 era in the United States.


title: Inhomogeneity of lung parenchyma during the open lung strategy: a computed tomography scan study.

text: RATIONALE The open lung strategy aims at reopening (recruitment) of nonaerated lung areas in patients with acute respiratory distress syndrome, avoiding tidal alveolar hyperinflation in the limited area of normally aerated tissue (baby lung). OBJECTIVES We tested the hypothesis that recruited lung areas do not resume elastic properties of adjacent baby lung. METHODS Twenty-five anesthetized, mechanically ventilated pigs were studied. Four lung-healthy pigs served as controls and the remaining 21 were divided into three groups (n = 7 each) in which lung injury was produced by surfactant lavage, lipopolysaccharide infusion, or hydrochloride inhalation. Computed tomography scans, respiratory mechanics, and gas exchange parameters were recorded under three conditions: at baseline, during lung recruitment maneuver, and at end-expiration and end-inspiration when ventilating after an open lung protocol. MEASUREMENTS AND MAIN RESULTS During recruitment maneuver and open lung protocol, the gas volume entering the insufficiently aerated compartment was 96% (75-117%) and 48% (41-63%) (median [interquartile range]) of the functional residual capacity measured before and at zero end-expiratory pressure, respectively. Nonetheless, the volume of hyperinflated lung increased during both recruitment maneuver (by 1-28% of total lung volume; P < 0.01) and open lung protocol ventilation at end-inspiration (by 1-15% of total lung volume; P < 0.01). Regional elastance of recruited lung tissue was consistently higher than that of the baby lung regardless of the ARDS model (P < 0.01). CONCLUSIONS Alveolar recruitment is not protective against hyperinflation of the baby lung because lung parenchyma is inhomogeneous during ventilation with the open lung strategy.


title: Chimney and periscope grafts to facilitate endovascular treatment of aortic transection in a patient with aberrant right subclavian artery.

text: PURPOSE To report the use of parallel grafts to extend the proximal landing zone for stent-graft repair of aortic transection involving an aberrant right subclavian artery (ARSA). CASE REPORT A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month after the initial injury in good condition. Imaging follow-up at 10 months showed a stable repair, patent parallel grafts, and no complications. CONCLUSION TEVAR with chimney and periscope grafts proved to be a safe and quick treatment for a patient requiring ARSA repair in acute aortic transection. This technique maintained blood flow to the ARSA and LSA in a totally endovascular approach, which could be very valuable in transection cases where bypass surgery to supra-aortic branches is compromised or deemed challenging due to thoracic wall and/or neck trauma. Parallel grafting can be a valuable tool to address any acute aortic pathology as it can be performed with off-the-shelf devices.


title: Lateral circumflex femoral artery false aneurysm as a complication of intertrochanteric hip fracture with displaced lesser trochanter.

text: We present a patient who suffered an unstable intertrochanteric hip fracture and underwent osteosynthesis with a trochanteric nail. During the postoperative period, he presented a pseudoaneurysm of the lateral circumflex branch of the deep femoral artery secondary to a displaced fracture of the lesser trochanter. With the suspected diagnosis due to indirect clinical and radiological signs and confirmation by Doppler ultrasound and computed tomography angiography, a transverse arterial embolization with resolution of the symptoms was carried out. The pseudoaneurysm of the deep femoral artery or its branches is a very rare complication after intertrochanteric hip fractures, which must be taken into account in the late appearance of edema and hematoma in the thigh and evidence of medial and superior displacement of the lesser trochanter. The diagnosis is confirmed by CT angiography and the treatment by percutaneous arterial embolization has good results without the need of excising the lesser trochanter.


title: Techniques in distal access of wide-necked giant intracranial aneurysms during treatment with flow diversion.

text: BACKGROUND Accessing the normal distal vessel in treatment of wide-necked giant intracranial aneurysms with flow diversion can be difficult. CASE DESCRIPTION Through illustrative cases, the authors present several useful techniques in distal access of wide-necked giant aneurysms during flow diversion treatment. Obtaining an optimal projection that separates the outflow limb from the aneurysm is most critical. Each of the three techniques described enabled the distal access to giant intracranial aneurysms during treatment with flow diversion. CONCLUSION The looped-around technique, balloon-assisted technique, and retrograde access are valuable strategies in crossing the aneurysm if direct distal access cannot be obtained.


title: First in vivo visualization of MRI-visible IPOM in a rabbit model.

text: BACKGROUND Application of a mesh in presence of pneumoperitoneum may cause deformation or wave formation when gas is released. Moreover, mesh shrinkage during subsequent wound healing cannot be detected in vivo without invasive diagnostics. Using MRI-visible polyvinylidene fluoride (PVDF) mesh, the extend of mesh deformation and shrinkage could be objectified by MRI for the first time. MATERIALS AND METHODS Laparoscopic intraperitoneal onlay mesh (IPOM) implantation was performed in 10 female rabbits using ferro-oxide loaded PVDF meshes. MRI measurements were performed postoperatively at days 1 and 90. After three-dimensional reconstruction of all MRI images the total surface and the effective surface of the implanted mesh were explored and calculated computer-assisted. RESULTS In all cases, the mesh could be identified in MRI. The subsequent three-dimensional reconstruction always allowed a calculation of the mesh area. In relation to the original size of the used textile implant, we found neither a significant reduction of the effective mesh surface after release of the pneumoperitoneum at day 1 after laparoscopic surgery nor a significant change of the total surface of this large pore mesh by the end of the observation period. CONCLUSIONS In vivo investigation of mesh surface via MRI could exclude a significant initial reduction of the effective mesh surface after release of pneumoperitoneum, in this IPOM rabbit model. A further subsequent shrinkage of these large pore PVDF meshes could be excluded, as well. Imaging of MRI-visible IPOM mesh turned out to be a sufficient tool to objectify mesh configuration and position in vivo.


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title: A series of complications after paraesophageal hernia repair with the used of Timesh: a case report.


title: Latest advances in advanced diagnostic and therapeutic pulmonary procedures.

text: Over the past 15 years, patients with a myriad of pulmonary conditions have been diagnosed and treated with new technologies developed for the pulmonary community. Advanced diagnostic and therapeutic procedures once performed in an operating theater under general anesthesia are now routinely performed in a bronchoscopy suite under moderate sedation with clinically meaningful improvements in outcome. With the miniaturization of scopes and instruments, improvements in optics, and creative engineers, a host of new devices has become available for clinical testing and use. A growing community of pulmonologists is doing comparative effectiveness trials that test new technologies against the current standard of care. While more research is needed, it seems reasonable to provide an overview of pulmonary procedures that are in various stages of development, testing, and practice at this time. Five areas are covered: navigational bronchoscopy, endobronchial ultrasound, endoscopic lung volume reduction, bronchial thermoplasty, and pleural procedure. Appropriate training for clinicians who wish to provide these services will become an area of intense scrutiny as new skills will need to be acquired to ensure patient safety and a good clinical result.


title: Clinical History of the Theranostic Radionuclide Approach to Neuroendocrine Tumors and Other Types of Cancer: Historical Review Based on an Interview of Eric P. Krenning by Rachel Levine.

text: In nuclear medicine, the term theranostics describes the combination of therapy and diagnostic imaging. In practice, this concept dates back more than 50 years; however, among the most successful examples of theranostics are peptide receptor scintigraphy and peptide receptor radionuclide therapy of neuroendocrine tumors. The development of these modalities through the radiolabeling of somatostatin analogs with various radionuclides has led to a revolution in patient management and established a foundation for expansion of the theranostic principle into other oncology indications. This article provides a review of the evolution and development of the theranostic radionuclide approach to the management of neuroendocrine tumors, as described by the inventor of this technique, Eric P. Krenning, in an interview with Rachel Levine.


title: Consensus conference: multimodality management of early- and intermediate-stage non-small cell lung cancer.

text: Surgery is the mainstay of treatment in early- and intermediate-stage non-small cell lung cancer (NSCLC), yet recurrences are frequent. Studies have documented the benefits of chemotherapy administered after resection, but a number of questions remain regarding how overall outcomes can be further improved. To provide the oncology community with direction on these issues, a consensus conference of leading experts in the NSCLC field was held at the Fifth Annual Atlanta Lung Cancer Symposium on October 25-27, 2007. The available scientific literature is presented and when such literature is lacking, clinical experience is provided to support the following conclusions. Preoperative staging should be done in accordance with the National Comprehensive Cancer Network guidelines, but endoscopic fine needle aspiration of enlarged mediastinal nodes can be used, and if histology is positive for malignancy, mediastinoscopy can be avoided. Neoadjuvant systemic therapy is not generally recommended but can be considered to downstage an unresectable patient. There is currently no role for preoperative radiation or chemoradiation. Adjuvant systemic therapy is not recommended for stage IA and IB patients; however, adverse prognostic factors are acceptable reasons to consider adjuvant systemic therapy in the latter. Adjuvant systemic therapy is recommended for stage IIA, IIB, and IIIA patients, consistent with recent American Society of Clinical Oncology guidelines. A cisplatin-based regimen should be started within 60 days after surgery, but if relatively contraindicated, carboplatin is an acceptable alternative. Adjuvant radiation therapy is not recommended for N0 and N1 patients, but is used in N2 patients to decrease local recurrence.


title: Care of acute coronary syndromes during the health contingency due to a SARS-CoV-2 outbreak.

text: The communications accumulated in the last weeks make it clear that there is no agreement to define the best treatment strategy in patients with acute coronary syndrome (SICA). In patients presenting with an acute myocardial infarction with ST-segment elevation (IAMCESST), it has been suggested to favor fibrinolysis (FL) over primary percutaneous coronary intervention (PCI), reserving ICP for cases of failed FL1,2; however, some societies have maintained the indication of the ICPp as the repercussion method of choice3. In SICAs without ST segment elevation (SICASESST) the recommendations are very similar, favoring medical treatment over percutaneous coronary intervention in this subgroup of patients1. Several companies consider the contagion status, particularly in the SICASESST, to decide which repercussion follow3. Anticipating that the epidemiological curve in Mexico will be similar to that observed in most countries, we recommend continuing the care of patients with SICA, the catheterization rooms must maintain their operation.


title: Chemical composition, antimicromicrobial activity and insecticidal activity against the lesser mealworm Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae) of Origanum vulgare L. ssp. hirtum (Link) and Artemisia dracunculus L. essential oils.

text: BACKGROUND Essential oils (EOs) from Artemisia dracunculus L. and Origanum vulgare L. ssp. hirtum were obtained and the qualitative and quantitative chemical composition of the extracts was investigated. The insecticidal activity of EOs against the larval stages of Alphitobius diaperinus (Panzer) was studied. Moreover, the antimicrobial activity of these oils against pathogens transmitted by this pest was also investigated. RESULTS The obtained results indicate the possibility of using Greek oregano EO with a high content of carvacrol as a feed additive in poultry nutrition. The use of the Greek oregano oil at 1% (w/w) dose showed stronger reduction of body weight gain of stage IV larvae. Their body mass was only 10.92% of the control. Moreover, EOs from O. vulgare strongly inhibited the growth of tested bacterial strains as well as Candida albicans. CONCLUSION Greek oregano EO may be a good alternative to antibiotic growth promoters and coccidiostats whose use in feeding farm animals has been prohibited since January 2006 under European Union directives. The introduction of O. vulgare L. ssp. hirtum EO into the premises of farm and poultry houses may help to improve sanitary conditions and control of the lesser mealworm inhabiting these buildings. © 2017 Society of Chemical Industry.


Tattooing: more than skin deep.


title: Associations Between Anxiety and Adherence to Antiretroviral Medications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

text: Untreated mental health disorders among people living with HIV (PLHIV) may prevent low- and middle-income countries (LMICs) from achieving the UNAIDS 90-90-90 targets. Anxiety disorders may be associated with decreased adherence to antiretroviral therapy (ART). We sought to review and meta-analyze studies estimating associations between anxiety and ART adherence in LMICs. We searched PubMed, PsychINFO, CINAHL and EMBASE for relevant studies published before July 18, 2018. We defined anxiety as reported anxiety scores from screening questionnaires or having a clinical diagnosis of an anxiety disorder, and poor ART adherence as missed doses, poor visit attendance, or scores from structured adherence questionnaires. We used a random effects model to conduct a meta-analysis for calculating a pooled odds ratio, and conducted sensitivity analyses by time on ART, anxiety evaluation method, and study region. From 472 screened manuscripts, thirteen studies met our inclusion criteria. Eleven studies were included in the meta-analysis. PLHIV who reported anxiety had 59% higher odds of poor ART adherence compared with those who did not report anxiety disorder (pooled odds ratio [pOR]: 1.59, 95% confidence interval [CI] 1.29-1.96, p < 0.001). When excluding PLHIV who initiated ART within 6 months, reported anxiety remained strongly associated with poor ART adherence (pOR: 1.61, 95% CI 1.18-2.20, p = 0.003). Among PLHIV in LMICs, reported anxiety was associated with poor ART adherence. This association persisted after the ART initiation period. Increased resources for mental health may be important for achieving virologic suppression in LMICs.


docid: gifnvuad

title: Prevalence and Clinical Profile of Human Salivirus in Children with Acute Gastroenteritis in Northern Italy, 2014-2015.

text: OBJECTIVE Human Salivirus (SalV) has been associated with gastroenteritis on all continents. METHODS This paper presents the real-time RT-PCR assay for the detection of SalV in clinical fecal samples collected from 192 hospitalized children with acute gastroenteritis in Piedmont, Italy. RESULTS The most commonly detected virus was Norovirus genogroup II (GII) (33.8%), followed by Rotavirus (21.3%), Sapovirus (10.9%), Parechovirus (8%), Norovirus GI (6.7%), and Adenovirus (1%). PCR detected SalV in 1 (0.5%) subject. CONCLUSIONS Our data show that the detection rate of SalV in diarrheal children (0.5%) is lower than that observed in other countries, where it is reported in diarrheal children in 8.6-1.2% of patients.


title: Breaking America's dependence on imported molybdenum.

text: Approximately 9 million nuclear cardiology studies performed each year in the U.S. use technetium-99m, which is produced from the decay of molybdenum-99. The fragility of the worldwide technetium-99m supply chain has been underscored by current shortages caused by an unplanned shutdown of Europe's largest reactor. The majority of the U.S. supply derives from a reactor in Canada that is nearing the end of its lifespan and whose planned replacements have been cancelled recently. In this article, the clinical importance of technetium-99m and our tenuous dependence on the foreign supply of molybdenum are addressed, along with potential measures that may be taken to ensure that America's supply chain remains unbroken.


title: Urea-based recirculation validation of the symmetrical palindrome catheter.

text: BACKGROUND High blood flow and low recirculation rates are central for adequate haemodialysis. A new symmetrical tip has been invented promising efficient haemodialysis even if the ports are reversed. OBJECTIVE To evaluate access recirculation of the 'palindrome' catheter and to report initial experiences in a clinical setting. MATERIAL AND METHODS After implantation of the new catheter in 20 patients (male: 14; female: 6; mean age 72 ± 12.2), access recirculation was evaluated using the urea-based recirculation test. After 30 minutes of haemodialysis, ultrafiltration was stopped and arterial and venous samples were taken. Afterwards, the blood flow rate was reduced to 120 ml/min. Another systemic arterial blood sample was taken 10 seconds after the blood pump was switched off. RESULTS All 20 interventions were performed successfully without complications. The average recirculation rate was 8.1% with a median of 2.5% ranging from 0 to 85.8%. Recirculation rates under 5% were measured in 13 patients and more than 10% recirculation were found in two patients. The median of days between catheter implantation and recirculation assessment was the day following implantation. CONCLUSION The new symmetrical catheter presented low recirculation rates in a clinical setting. Since there is just a single tip, fluoroscopic placement in the right atrium is facilitated.


title: Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1000 patients.

text: BACKGROUND Single-port laparoscopic sleeve gastrectomy (SPSG) is performed routinely in our department as an alternative to a conventional laparoscopic approach. OBJECTIVES The aim of this study was to report our surgical results and follow-up outcome after SPSG. SETTING Department of Digestive Minimally Invasive Surgery, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, France. METHODS Data from consecutive patients who underwent SPSG in our institution between August 2010 and July 2015 were prospectively collected and retrospectively analyzed. Patients with more than 1-year follow-up were included in our analysis for weight loss and co-morbidity. RESULTS A total of 1000 patients underwent SPSG during the study period. Median body mass index was 42.6 kg/m² (range: 33.8-84.6 kg/m²). Median operative time was 112 minutes (range: 50-360 min) and decreased over the years. Completion of the procedure required introduction of an extraport in 78 patients (7.8%). Postoperative mortality and morbidity rates were .1% and 8.1%, respectively. Relaparoscopy and/or endoscopic treatment were required to treat intra-abdominal bleeding in 24 patients (2.4%) and staple-line leakage in 28 patients (2.8%). Five hundred forty-six patients were considered for 1-year follow-up evaluation. Mean excess weight loss was 69% after 1 year and 62.2% after 2 years. Incisional hernia from the trocar site occurred in 20 (3.7%) patients. CONCLUSION Sleeve gastrectomy can be routinely performed using a single-incision laparoscopic technique with equivalent outcomes of surgical morbidity and weight loss compared with conventional laparoscopic surgery. Prospective comparative studies are necessary to assess the potential benefits of this minimally-invasive approach.


title: H7N9 and other pathogenic avian influenza viruses elicit a three-pronged transcriptomic signature that is reminiscent of 1918 influenza virus and is associated with lethal outcome in mice.

text: UNLABELLED Modulating the host response is a promising approach to treating influenza, caused by a virus whose pathogenesis is determined in part by the reaction it elicits within the host. Though the pathogenicity of emerging H7N9 influenza virus in several animal models has been reported, these studies have not included a detailed characterization of the host response following infection. Therefore, we characterized the transcriptomic response of BALB/c mice infected with H7N9 (A/Anhui/01/2013) virus and compared it to the responses induced by H5N1 (A/Vietnam/1203/2004), H7N7 (A/Netherlands/219/2003), and pandemic 2009 H1N1 (A/Mexico/4482/2009) influenza viruses. We found that responses to the H7 subtype viruses were intermediate to those elicited by H5N1 and pdm09H1N1 early in infection but that they evolved to resemble the H5N1 response as infection progressed. H5N1, H7N7, and H7N9 viruses were pathogenic in mice, and this pathogenicity correlated with increased transcription of cytokine response genes and decreased transcription of lipid metabolism and coagulation signaling genes. This three-pronged transcriptomic signature was observed in mice infected with pathogenic H1N1 strains such as the 1918 virus, indicating that it may be predictive of pathogenicity across multiple influenza virus strains. Finally, we used host transcriptomic profiling to computationally predict drugs that reverse the host response to H7N9 infection, and we identified six FDA-approved drugs that could potentially be repurposed to treat H7N9 and other pathogenic influenza viruses. IMPORTANCE Emerging avian influenza viruses are of global concern because the human population is immunologically naive to them. Current influenza drugs target viral molecules, but the high mutation rate of influenza viruses eventually leads to the development of antiviral resistance. As the host evolves far more slowly than the virus, and influenza pathogenesis is determined in part by the host response, targeting the host response is a promising approach to treating influenza. Here we characterize the host transcriptomic response to emerging H7N9 influenza virus and compare it with the responses to H7N7, H5N1, and pdm09H1N1. All three avian viruses were pathogenic in mice and elicited a transcriptomic signature that also occurs in response to the legendary 1918 influenza virus. Our work identifies host responses that could be targeted to treat severe H7N9 influenza and identifies six FDA-approved drugs that could potentially be repurposed as H7N9 influenza therapeutics.


title: COVID-19-Hospitalized Patients in Karnataka: Survival and Stay Characteristics.

text: The information on the clinical course of coronavirus disease 2019 (COVID-19) and its correlates which are essential to assess the hospital care needs of the population are currently limited. We investigated the factors associated with hospital stay and death for COVID-19 patients for the entire state of Karnataka, India. A retrospective-cohort analysis was conducted on 445 COVID-19 patients that were reported in the publicly available media-bulletin from March 9, 2020, to April 23, 2020, for the Karnataka state. This fixed cohort was followed till 14 days (May 8, 2020) for definitive outcomes (death/discharge). The median length of hospital stay was 17 days (interquartile range: 15-20) for COVID-19 patients. Having severe disease at the time of admission (adjusted-hazard-ratio: 9.3 (3.2-27.3);P < 0.001) and being aged ≥ 60 years (adjusted-hazard-ratio: 11.9 (3.5-40.6);P < 0.001) were the significant predictors of COVID-19 mortality. By moving beyond descriptive (which provide only crude information) to survival analyses, information on the local hospital-related characteristics will be crucial to model bed-occupancy demands for contingency planning during COVID-19 pandemic.


title: Evaluation of the COVID19 ID NOW EUA Assay

text: • ID NOW EUA SARS-CoV-2 assay had an overall agreement of 78.7% when compared to the standard of care reference methods. • ID NOW had a sensitivity of 71.7% and specificity of 100%. • All the false-negative results occurred with weakly positive samples, with reference method C(T) values ≥35.


Conducting rapid qualitative research to support sex workers' health and social needs in the face of COVID-19: capitalising on stakeholder networks from the HIV response in Singapore to drive policymaking.


title: Fifteen-month duration of immunity for the serovar Grippotyphosa fraction of a tetravalent canine leptospirosis vaccine.

text: Forty-four specific pathogen-free beagles, median age 65 days, received two subcutaneous doses of either a commercially available, five-way combination vaccine or the same vaccine in combination with a tetravalent Leptospira bacterin (Canicola, Grippotyphosa, Icterohaemorrhagiae, Pomona). They were subsequently challenged with a pathogenic strain L kirschneri serovar Grippotyphosa 470 days following completion of the vaccination protocol. Titres of agglutinating serum antibodies were determined at various time points before and after both vaccination and challenge, along with postchallenge reisolation of the challenge organisms from blood and urine, and evaluation of renal histopathology. Clinical signs of generalised leptospirosis were not observed in any of the dogs after challenge. In order to demonstrate efficacy, leptospirosis was defined as having at least one positive urine sample and a positive renal histopathology score; or, in the absence of renal pathology, multiple positive urine samples. Leptospiremia was not demonstrated in any of the vaccinated dogs versus 27 per cent of the controls; leptospiruria was noted in 5 per cent of the vaccinates compared with 76 per cent of controls; and renal lesions were observed in 15 per cent of the vaccinates and 65 per cent controls. Using these criteria, the vaccine was able to significantly prevent leptospirosis (P=0.0001) in the vaccinated animals. This study establishes duration of immunity of at least 15 months for the prevention of disease and renal excretion of leptospires for the Leptospira serovar Grippotyphosa fraction of a quadrivalent Leptospira vaccine.


title: A comparative assessment of irrigation and drainage characteristics for commercially available urethral catheters.

text: Introduction We aimed to investigate irrigation and drainage characteristics of commercially available urethral catheters and determined which catheter offers the best flow characteristics. Material and methods Twelve different commercially available urethral catheters from three companies (Bard™, Rusch™ and Dover™) were investigated to compare their irrigation and drainage properties. Irrigation port, drainage port and overall cross-sectional areas for a 24Fr 3-way catheter was measured and compared. The maximum (Qmax) and average (Qavg) irrigation and drainage flow rates for each catheter was measured for 20-40 seconds using uroflowmetry. The primary endpoint was to determine which catheter offers optimal irrigation and drainage parameters. Results Overall cross-sectional area, irrigation port cross-sectional area, and drainage port cross-sectional area differed significantly for each 24Fr 3-way catheter assessed (p <0.001). The 24Fr 3-way Rusch Simplastic™ catheter consistently demonstrated the greatest maximal flow rate (Qmax: 5 ±0.3 ml/s) and average flow rate (Qavg: 4.6 ±0.2 ml/s) for irrigation. The 24Fr 3-way Dover™ catheter provided the greatest drainage properties (Qmax: 19.7 ±2 ml/s; Q avg: 15.9 ±5 ml/s). In the setting of continuous bladder irrigation, the 24Fr 3-way Rusch Simplastic™ catheter provided the highest irrigation rates (Qmax: 6.6 ±1.8 ml/s; Q avg: 4.6 ±0.9 ml/s). Conclusions Three-way catheters demonstrate significant differences in their irrigation and drainage characteristics. The type of catheter selected should be based on the appropriate prioritization of efficient bladder irrigation versus efficient bladder drainage.


title: CB1 cannabinoid receptor-mediated plasticity of GABAergic synapses in the mouse insular cortex.

text: The insular cortex plays pivotal roles in taste learning. As cellular mechanisms of taste learning, long-term potentiation (LTP) at glutamatergic synapses is well studied. However, little is known about long-term changes of synaptic efficacy at GABAergic synapses in the insular cortex. Here, we examined the synaptic mechanisms of long-term plasticity at GABAergic synapses in layer V pyramidal neurons of the mouse insular cortex. In response to a prolonged high-frequency stimulation (HFS), GABAergic synapses displayed endocannabinod (eCB)-mediated long-term depression (LTDGABA). When cannabinoid 1 receptors (CB1Rs) were blocked by a CB1R antagonist, the same stimuli caused LTP at GABAergic synapses (LTPGABA) which was mediated by production of nitric oxide (NO) via activation of NMDA receptors. Intriguingly, NO signaling was necessary for the induction of LTDGABA. In the presence of leptin which blocks CB1 signaling, the prolonged HFS caused LTPGABA which was mediated by NO signaling. These results indicate that long-term plasticity at GABAergic synapses in the insular cortex can be modulated by combined effects of eCB and NO signaling. These forms of GABAergic synaptic plasticity in the insular cortex may be crucial synaptic mechanisms in taste learning.


title: Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study.

text: BACKGROUND Splenic flexure cancer (SFC), identified as tumors raised in the distal transverse colon and proximal descending colon, accounts for 2 to 5% of all surgically treated colorectal cancers. Despite the fact that the laparoscopic approach has become the gold standard for many colorectal procedures, it has never been extensively investigated in SFC due to lack of an agreed consensus on the appropriate operative procedure. The aim of this multicenter retrospective study is to evaluate the oncologic value of laparoscopic segmental resection with complete mesocolic excision (CME) for cancer located in the splenic flexure. METHODS All data of consecutive patients who had undergone laparoscopic resection with CME for SFC from January 2005 to December 2017 at five different tertiary centers were retrospectively analyzed. The Kaplan-Meier (KM) test was used to assess the overall survival (OS) and the disease-free survival (DFS) rates after surgery. Univariate Cox regression was used to explore the association between OS and other independent factors. RESULTS Recurrence was observed in 13 (11.6%) patients and a significant association between disease stage and recurrence (P < 0.001) was found with a higher proportion of stage IV patients in the recurrence group (46.1% vs. 7.1%). During a median follow-up of 43 months (range 12-149), 13 deaths occurred, all of them due to disease progression. KM curves for all stages showed an estimated survival rate of 51% at 148 months. CONCLUSION Laparoscopic segmental resection with CME appears to be an oncologically safe and effective procedure for treatment of SFC and may be considered as a standard surgical method for elective management of the disease. In the future, routine lymph node mapping could be used to confirm this hypothesis.


title: Prostate-supplying arteriogram created by multidetector-row CT during pelvic arteriography: contribution to the treatment strategy of prostatic artery embolization for prostatic hyperplasia.

text: We describe an 85-year-old man suffering lower urinary tract symptoms, who underwent prostatic artery embolization (PAE) based on a prostate-supplying arteriogram created with multidetector-row computed tomography during pelvic arteriography. This arteriogram was synthesized from a background bone volume-rendered (VR) image, an aorta-pelvic artery VR image, and a prostate-supplying artery VR image. Because the bone background VR image is combined with the aorta-pelvic artery VR image, the prostate-supplying arteriogram can simultaneously show the pelvic branch arteries present on the ventral side, inside, and the dorsal side of the pelvic bone. It showed that the left prostatic artery supplied the urethra at the outlet of the urinary bladder. PAE of the left prostatic artery was performed with catheter navigation based on the prostate-supplying arteriogram. There was marked relief of the lower urinary tract symptoms at the 12-month follow-up.


title: Psychophysical Olfactory Tests and Detection of COVID-19 in Patients With Sudden Onset Olfactory Dysfunction: A Prospective Study.

text: OBJECTIVE To investigate the coronavirus disease 2019 (COVID-19) status of patients with initial sudden olfactory anosmia (ISOA) through nasopharyngeal swabs for reverse transcription-polymerase chain reaction (RT-PCR) analysis and to explore their olfactory dysfunctions with psychophysical olfactory evaluation. METHODS A total of 78 ISOA patients were recruited from April 6, 2020, to April 10, 2020, through a public call of University of Mons (Mons, Belgium). Patients benefited from nasopharyngeal swabs and fulfilled the patient-reported outcome questionnaire. Among them, 46 patients performed psychophysical olfactory evaluation using olfactory identification testing. Based on the duration of the ISOA, 2 groups of patients were compared: patients with olfactory dysfunction duration ≤12 days (group 1) and those with duration >12 days (group 2). RESULTS In group 1, 42 patients (87.5%) had a positive viral load determined by RT-PCR and 6 patients (12.5%) were negative. In group 2, 7 patients (23%) had a positive viral load and 23 patients (77%) were negative. The psychophysical olfactory evaluation reported that anosmia and hyposmia occurred in 24 (52%) and 11 (24%) patients, respectively. Eleven patients were normosmic. The viral load was significantly higher in patients of group 1 compared with those of group 2. CONCLUSIONS Coronavirus disease 2019 was detected in a high proportion of ISOA patients, especially over the first 12 days of olfactory dysfunction. Anosmia is an important symptom to consider in the detection of COVID-19 infection.


Another Enchantment From ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study): Are Savings and Safety More Salutary Than Efficacy?


title: Glutathione-Capped Ag2S Nanoclusters Inhibit Coronavirus Proliferation through Blockage of Viral RNA Synthesis and Budding.

text: Development of novel antiviral reagents is of great importance for the control of virus spread. Here, Ag2S nanoclusters (NCs) were proved for the first time to possess highly efficient antiviral activity by using porcine epidemic diarrhea virus (PEDV) as a model of coronavirus. Analyses of virus titers showed that Ag2S NCs significantly suppressed the infection of PEDV by about 3 orders of magnitude at the noncytotoxic concentration at 12 h postinfection, which was further confirmed by the expression of viral proteins. Mechanism investigations indicated that Ag2S NCs treatment inhibits the synthesis of viral negative-strand RNA and viral budding. Ag2S NCs treatment was also found to positively regulate the generation of IFN-stimulating genes (ISGs) and the expression of proinflammation cytokines, which might prevent PEDV infection. This study suggest the novel underlying of Ag2S NCs as a promising therapeutic drug for coronavirus.


title: Correlations between intra-abdominal pressure and obesity-related co-morbidities.

text: BACKGROUND Obesity is associated with chronic increases in intra-abdominal pressure (IAP). The aim of the present study was to examine the correlation between the IAP and the number of obesity-related co-morbidities. METHODS A total of 63 morbidly obese patients who were undergoing bariatric surgery had their IAP measured intraoperatively while in a supine position and under general anesthesia. The IAP readings were obtained through an indwelling urinary bladder catheter. The correlation of obesity-related co-morbidities, including systemic hypertension, type 2 diabetes mellitus, gastroesophageal reflux disease, urinary stress incontinence, lower extremity edema, obstructive sleep apnea, and abdominal wall hernia, and the level of IAP were examined using a stepwise regression analysis model. RESULTS Of the 62 patients, 57 were women. The mean age was 44 + or - 11 years, and the body mass index was 49 + or - 10 kg/m(2). Of the 62 patients, 48 (77%) had an elevated IAP (> or = 9 cm H(2)O). A significant and positive correlation was found between the IAP level and the number of obesity-related co-morbidities (Pearson's r = .8; P <.05). Stepwise logistic regression analysis revealed that systemic hypertension, American Society of Anesthesiologists score, and body mass index were predictors of elevated IAP. A normal IAP appeared to offer a protective effect against systemic hypertension. CONCLUSION In this cohort of mainly obese women, the baseline IAP of morbidly obese patients was abnormally elevated. A greater IAP correlated with the presence of a greater number of obesity-related co-morbid conditions. Systemic hypertension was significantly associated with an elevated IAP. Chronic increases in IAP might, in part, be responsible for the pathogenesis of systemic hypertension in the morbidly obese.


Combating COVID-19: health equity matters.


docid: yxopmtmr

title: Association of Informal Caregiver Distress with Health Outcomes of Community-Dwelling Dementia Care Recipients: A Systematic Review.

text: BACKGROUND Most dementia care occurs in the community with support from informal caregivers who are often distressed. Dementia caregiver distress is known to be hazardous to the caregiver's health, but the impact on the dementia care recipient is not well known. METHODS We searched the Medline, Embase, PsycINFO, CINAHL, and Cochrane databases from inception until June 2017 for studies investigating the association of informal caregiver distress with health outcomes of community-dwelling dementia care recipients. The search results were screened and then data abstracted, and the risk of bias was appraised independently by pairs of reviewers. RESULTS We included 81 original investigations (n = 43 761 caregivers and dementia care recipients). Sixty-six studies (81.5%) were observational or cross-sectional in design, and 47 studies (58%) had a low risk of bias. There was considerable clinical and methodological heterogeneity precluding quantitative synthesis. Dementia care recipients (n = 21 881) had a mean age of 78.2 years (SD ± 3.8 y), half (50.0%) were women, and two-thirds (66.1%) had Alzheimer's disease. The dementia caregivers (n = 21 880) had a mean age of 62.5 years (SD ± 23.3), three-quarters (74.1%) were women, and one-half (50.5%) were spouses of the dementia care recipient. Twenty-two unique dementia care recipient outcomes were studied including cognition, mood, quality of life, function, healthcare utilization, and costs. Overall, informal caregiver distress is commonly associated with the institutionalization of the dementia care recipient, worsening behavioral and psychological symptoms of dementia, and experiencing elder abuse. CONCLUSION Informal caregiving is a cornerstone of dementia care, and distress related to this role is associated with worsening of several dementia care recipient health outcomes. It is important that clinicians and researchers worldwide consider the broader consequences of caregiver distress. J Am Geriatr Soc 67:609-617, 2019.


docid: ejrahugr

title: A Tribute to Frontline Health Care Professionals During the COVID-19 Pandemic.


docid: hvvymqdv

title: Profiling carbohydrate-receptor interaction with recombinant innate immunity receptor-Fc fusion proteins.

text: The recognition of bacteria, viruses, fungi, and other microbes is controlled by host immune cells, which are equipped with many innate immunity receptors, such as Toll-like receptors, C-type lectin receptors, and immunoglobulin-like receptors. Our studies indicate that the immune modulating properties of many herbal drugs, for instance, the medicinal fungus Reishi (Ganoderma lucidum) and Cordyceps sinensis, could be attributed to their polysaccharide components. These polysaccharides specifically interact with and activate surface receptors involved in innate immunity. However, due to the complexity of polysaccharides and their various sources from medicinal fungi, quantitative analysis of medicinal polysaccharide extracts with regard to their functions represents a major challenge. To profile carbohydrate-immune receptor interactions, the extracellular domains of 17 receptors were cloned as Fc-fusion proteins, such that their interactions with immobilized polysaccharides could be probed in an enzyme-linked immunosorbent assay. The results show that several innate immune receptors, including Dectin-1, DC-SIGN, Langerin, Kupffer cell receptor, macrophage mannose receptor, TLR2, and TLR4, interact with the polysaccharide extracts from G. lucidum (GLPS). This analysis revealed distinct polysaccharide profiles from different sources of medicinal fungi, and the innate immune receptor-based enzyme-linked immunosorbent assay described here can serve as a high-throughput profiling method for the characterization and quality control of medicinal polysaccharides. It also provides a means to dissect the molecular mechanism of medicinal polysaccharide-induced immunomodulation events.


title: COVID-19 Experience in Hemodialysis Patients: A Cue for Therapeutic Heparin-Based Strategies?

text: In our opinion, the use of heparin could play a crucial role in these patients. In fact, recent studies have shown that heparin, the most commonly used anticoagulant during HD procedures, had anti-inflammatory properties and a direct antiviral action, due to its ability to prevent SARS-CoV-2 pseudovirus entry into host cells. These activities, together with its anticoagulant action, could explain the ability of heparin to ameliorate COVID-19 clinical course.


title: Amino acid 159 of the envelope protein affects viral replication and T-cell infiltration by West Nile virus in intracranial infection.

text: West Nile virus (WNV) is an important cause of viral encephalitis in birds and animals, including humans. Amino acid 159 of the envelope (E) protein is reportedly implicated in the different levels of neurovirulence in mice infected with WNV NY99 or Eg101. We investigated the role of amino acid 159 of the E protein in the pathogenesis of WNV infection. We produced recombinant WNV with the structural proteins of the NY99 or Eg101 strain (NY-WT or EgCME-WT) and mutant viruses with substitutions of amino acid 159 of the E protein (NY-E-V159I or EgCME-E-I159V). The NY-WT and NY-E-V159I or EgCME-WT and EgCME-E-I159V titers in culture supernatant were similar. The mortality rate and viral titer in the brains of mice inoculated intraperitoneally with NY-WT or NY-E-V159I were also similar. In contrast, the mortality rate and viral titer in the brains of mice inoculated intracranially with EgCME-E-I159V were significantly higher than those of mice inoculated with EgCME-WT. The numbers of CD3-positive and CD8-positive T cells were greater in brains inoculated with EgCME-E-I159V than in those inoculated with EgCME-WT. Therefore, amino acid 159 of the E protein modulates the pathogenicity of WNV by affecting viral replication and T-cell infiltration in the brain.


title: Development and Evaluation of Novel Real-Time Reverse Transcription-PCR Assays with Locked Nucleic Acid Probes Targeting Leader Sequences of Human-Pathogenic Coronaviruses.

text: Based on findings in small RNA-sequencing (Seq) data analysis, we developed highly sensitive and specific real-time reverse transcription (RT)-PCR assays with locked nucleic acid probes targeting the abundantly expressed leader sequences of Middle East respiratory syndrome coronavirus (MERS-CoV) and other human coronaviruses. Analytical and clinical evaluations showed their noninferiority to a commercial multiplex PCR test for the detection of these coronaviruses.


title: Uniportal right upper video-assisted thoracoscopic surgery lobectomy: safe and feasible.

text: Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is now well established and performed all around the world. We are going to share the surgical technique for uniportal VATS right upper lobectomy based on our experience. A 62-year-old patient underwent Uniportal VATS right upper lobectomy for a primary non-small cell lung cancer (NSCLC). Our patient had no perioperative complications and was then discharged to his home on postoperative day 4. The patient's pain was managed with a paravertebral catheter during the first 48 hours and then with oral analgesics. Pathology report: well-differentiated adenocarcinoma; the size of the tumour was 1 cm × 0.8 cm × 1 cm; all margins were negative for residual tumour. The patient did not require adjuvant radiation or chemotherapy. Uniportal VATS lobectomy is a safe and effective procedure providing a favourable clinical outcome in the patient.


title: Drug-induced sleep endoscopy with target-controlled infusion using propofol and monitored depth of sedation to determine treatment strategies in obstructive sleep apnea.

text: BACKGROUND Drug-induced sleep endoscopy (DISE) has become an important diagnostic examination tool in the treatment decision process for surgical therapies in the treatment of obstructive sleep apnea (OSA). Currently, there is a variety of regimes for the performance of DISE, which renders comparison and assessment across results difficult. It remains unclear how the different regimes influence the findings of the examination and the resulting conclusions and treatment recommendations. This study aimed to investigate the correlation between increasing levels of sedation (i.e., light, medium, and deep) induced by propofol using a target-controlled infusion (TCI) pump, with the obstruction patterns at the levels of the velum, oropharynx, tongue base, and epiglottis (i.e., VOTE classification). A second goal was the establishment of a sufficient sedation level to enable a reliable decision regarding treatment recommendations. MATERIAL AND METHODS Forty-three patients with OSA underwent a DISE procedure using propofol TCI. Three levels of sedation were defined, depending on entropy levels and assessment of sedation: light sedation, medium sedation, and deep sedation. The evaluation of the upper airway at each level, with increasing sedation, was documented using the VOTE classification. The elapsed time at which each assessment was performed was recorded. RESULTS Upper airway changes occurred and were measured throughout the DISE procedure. Clinically useful determinations of airway closure occurred at medium sedation; this level of sedation was most probably achieved with a blood propofol concentration of 3.2 μg/ml. In all 43 patients, definite treatment decisions could be made at medium sedation level. Increasing sedation did not result in changes in the treatment decision. CONCLUSIONS Changes in upper airway collapse during DISE with propofol TCI occur at levels of medium sedation. Decisions regarding surgical treatment could be made at this level of sedation. CLINICAL TRIAL NAME Upper Airway Collapse in Patients with Obstructive Sleep Apnea Syndrome by Drug Induced Sleep Endoscopy (URL: https://clinicaltrials.gov/ct2/results?term=NCT02588300&Search=Search ) REGISTRATION NUMBER: NCT02588300.


The pandemic mixed up what scientists study - and some won't go back.


title: Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects.

text: BACKGROUND The long-term effects of sibutramine treatment on the rates of cardiovascular events and cardiovascular death among subjects at high cardiovascular risk have not been established. METHODS We enrolled in our study 10,744 overweight or obese subjects, 55 years of age or older, with preexisting cardiovascular disease, type 2 diabetes mellitus, or both to assess the cardiovascular consequences of weight management with and without sibutramine in subjects at high risk for cardiovascular events. All the subjects received sibutramine in addition to participating in a weight-management program during a 6-week, single-blind, lead-in period, after which 9804 subjects underwent random assignment in a double-blind fashion to sibutramine (4906 subjects) or placebo (4898 subjects). The primary end point was the time from randomization to the first occurrence of a primary outcome event (nonfatal myocardial infarction, nonfatal stroke, resuscitation after cardiac arrest, or cardiovascular death). RESULTS The mean duration of treatment was 3.4 years. The mean weight loss during the lead-in period was 2.6 kg; after randomization, the subjects in the sibutramine group achieved and maintained further weight reduction (mean, 1.7 kg). The mean blood pressure decreased in both groups, with greater reductions in the placebo group than in the sibutramine group (mean difference, 1.2/1.4 mm Hg). The risk of a primary outcome event was 11.4% in the sibutramine group as compared with 10.0% in the placebo group (hazard ratio, 1.16; 95% confidence interval [CI], 1.03 to 1.31; P=0.02). The rates of nonfatal myocardial infarction and nonfatal stroke were 4.1% and 2.6% in the sibutramine group and 3.2% and 1.9% in the placebo group, respectively (hazard ratio for nonfatal myocardial infarction, 1.28; 95% CI, 1.04 to 1.57; P=0.02; hazard ratio for nonfatal stroke, 1.36; 95% CI, 1.04 to 1.77; P=0.03). The rates of cardiovascular death and death from any cause were not increased. CONCLUSIONS Subjects with preexisting cardiovascular conditions who were receiving long-term sibutramine treatment had an increased risk of nonfatal myocardial infarction and nonfatal stroke but not of cardiovascular death or death from any cause. (Funded by Abbott; ClinicalTrials.gov number, NCT00234832.)


title: ERCP and SARS-COV-2: an urgent procedure that should be immune.

text: BACKGROUND Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed. Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics. RESULTS Under service restrictions (13 March to the end of April 2020), 55 ERCPs were performed compared with 87 ERCPs in 2019. Similar numbers to 2019 were also recorded in the preceding years. One case of coronavirus disease 2019 (COVID-19) was reported in a patient in the days following ERCP, with no cases notified among staff related to endoscopy. CONCLUSIONS A reduction in ERCP referrals raises concern that a cohort of patients with significant biliary disease remain undetected. Whether this results in later, and more severe, presentation remains to be seen but a potential surge in such cases could significantly burden all future endoscopy planning services.


title: In ovo and in vitro susceptibility of American alligators (Alligator mississippiensis) to avian influenza virus infection.

text: Avian influenza has emerged as one of the most ubiquitous viruses within our biosphere. Wild aquatic birds are believed to be the primary reservoir of all influenza viruses; however, the spillover of H5N1 highly pathogenic avian influenza (HPAI) and the recent swine-origin pandemic H1N1 viruses have sparked increased interest in identifying and understanding which and how many species can be infected. Moreover, novel influenza virus sequences were recently isolated from New World bats. Crocodilians have a slow rate of molecular evolution and are the sister group to birds; thus they are a logical reptilian group to explore susceptibility to influenza virus infection and they provide a link between birds and mammals. A primary American alligator (Alligator mississippiensis) cell line, and embryos, were infected with four, low pathogenic avian influenza (LPAI) strains to assess susceptibility to infection. Embryonated alligator eggs supported virus replication, as evidenced by the influenza virus M gene and infectious virus detected in allantoic fluid and by virus antigen staining in embryo tissues. Primary alligator cells were also inoculated with the LPAI viruses and showed susceptibility based upon antigen staining; however, the requirement for trypsin to support replication in cell culture limited replication. To assess influenza virus replication in culture, primary alligator cells were inoculated with H1N1 human influenza or H5N1 HPAI viruses that replicate independent of trypsin. Both viruses replicated efficiently in culture, even at the 30 C temperature preferred by the alligator cells. This research demonstrates the ability of wild-type influenza viruses to infect and replicate within two crocodilian substrates and suggests the need for further research to assess crocodilians as a species potentially susceptible to influenza virus infection.


title: An evaluation of using population pharmacokinetic models to estimate pharmacodynamic parameters for propofol and bispectral index in children.

text: BACKGROUND To study propofol pharmacodynamics in a clinical setting a pharmacokinetic model must be used to predict drug plasma concentrations. Some investigators use a population pharmacokinetic model from existing literature and minimize the pharmacodynamic objective function. The purpose of the study was to determine whether this method selects the best-performing pharmacokinetic model in a set and provides accurate estimates of pharmacodynamic parameters in models for bispectral index in children after propofol administration. METHODS Twenty-eight children classified as American Society of Anesthesiologists physical status 1 who were given general anesthesia for dental treatment were studied. Anesthesia was given using target-controlled infusion of propofol based on the Kataria model. Propofol target plasma concentration was 7 μg/ml for 15 min, followed by 1 μg/ml for 15 min or until signs of awakening, followed by 5 μg/ml for 15 min. Venous blood samples were taken 1, 2, 5, 10, and 15 min after each change in target. A classic pharmacokinetic-pharmacodynamic model was estimated, and the methodology of other studies was duplicated using pharmacokinetic models from the literature and (re-)estimating the pharmacodynamic models. RESULTS There is no clear relationship between pharmacokinetic precision and the pharmacodynamic objective function. Low pharmacodynamic objective function values are not associated with accurate estimation of the pharmacodynamic parameters when the pharmacokinetic model is taken from other sources. CONCLUSION Minimization of the pharmacodynamic objective function does not select the most accurate pharmacokinetic model. Using population pharmacokinetic models from the literature instead of the 'true' pharmacokinetic model can lead to better predictions of bispectral index while incorrectly estimating the pharmacodynamic parameters.


Reorganization of thoracic surgery activity in a national high-volume comprehensive cancer centre in the Italian epicentre of coronavirus disease 2019.


docid: whcpryxn

title: Periorbital fat grafting.

text: Periorbital aging is a multifactorial process involving volume loss (bone and soft tissue), tissue decent, and cutaneous degenerative changes. Traditional approaches to surgery on this area of the face have been subtractive in nature, focusing on excision of skin, muscle, and fat. This has frequently led to a gaunt or hollowed postoperative appearance. Contemporary aesthetic eyelid and periorbital rejuvenation has undergone a paradigm shift from an excisionally based surgical approach to one that prioritizes volume preservation and/or augmentation. The development of fat grafting to the eyelids and periorbita has given the eyelid surgeon a viable surgical alternative to prevent postoperative volume depletion, maintain the smooth transition of the lower eyelid to the cheek, and aid in restoring the youthful appearance desired after surgery. This article will focus of periorbital fat grafting and touch upon fat preservation techniques as primary restorative procedures or as surgical adjuncts.


title: Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess.

text: PURPOSE Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. METHODS The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. RESULTS Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5-14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30-155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0-3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0-5 days) and 3 days (1-7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. CONCLUSION Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.


title: Identification of key amino acid residues required for horseshoe bat angiotensin-I converting enzyme 2 to function as a receptor for severe acute respiratory syndrome coronavirus.

text: Angiotensin-I converting enzyme 2 (ACE2) is the receptor for severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV). A previous study indicated that ACE2 from a horseshoe bat, the host of a highly related SARS-like coronavirus, could not function as a receptor for SARS-CoV. Here, we demonstrate that a 3 aa change from SHE (aa 40-42) to FYQ was sufficient to convert the bat ACE2 into a fully functional receptor for SARS-CoV. We further demonstrate that an ACE2 molecule from a fruit bat, which contains the FYQ motif, was able to support SARS-CoV infection, indicating a potentially much wider host range for SARS-CoV-related viruses among different bat populations.


title: Molecular dynamics simulations and conductance studies of the interaction of VP1 N-terminus from Polio virus and gp41 fusion peptide from HIV-1 with lipid membranes.

text: The icosahedral Polio virus capsid consists of 60 copies of each of the coat proteins VP1, VP2, VP3 and myristolyated VP4 (myrVP4). Catalyzed by the host cell receptor the Polio virus enters the host cell via externalization of myrVP4 and the N terminal part of VP1. There are several assumptions about the individual role of both of the proteins in the mechanism of membrane attachment and genome injection. We use the first 32 N terminal amino acids of VP1 and applied molecular dynamics simulations to assess its mechanism of function when attached and inserted into hydrated lipid membranes (POPC). Helical models are placed in various positions in regard to the lipid membrane to start with. As a comparison, the first 33 amino acids of the fusion peptide of gp41 of HIV-1 are simulated under identical conditions. Computational data support the idea that VP1 is not penetrating into the membrane to form a pore; it rather lays on the membrane surface and only perturbs the membrane. Furthermore, this idea is strengthened by channel recordings of both peptides showing irregular openings.


title: [Study on screening potential traditional Chinese medicines against 2019-nCoV based on Mpro and PLP].

text: With the rapid outbreak of COVID-19, traditional Chinese medicine(TCM) has been playing an active role against the epidemic. However, the screening of TCM is limited by the development cycle and laboratory conditions, which greatly limits the screening speed. This study established optimization docking models and virtual screening to discovery potential active herbs for the prevention and treatment of the novel coronavirus based on molecular docking technology. The crystal structures of 3 CL protease(Mpro) and papain-like protease(PLP) were obtained from PDB database and homologous modeling respectively, and were used to conduct virtual screening of TCMD 2009 database by CDOCKER program. The ingredients scored in the top 100 were selected respectively, and the candidate herbs were ranked by the numbers of hit molecules. Based on Mpro inhibitors screening, 12 322 potential active components were obtained, and the representative active components included aster pentapeptide A, ligustrazine, salvianolic acid B, etc., and Zingiberis Rhizoma Recens, Asteris Radix et Rhizoma, Notoginseng Radix et Rhizoma, Chuanxiong Rhizoma, Salviae Miltiorrhizae Radix et Rhizoma, Zingiberis Rhizoma, Dianthi Herba, Rhei Radix et Rhizoma, Cistanches Herba were obtained. While 11 294 potential active ingredients were obtained by PLP inhibitor screening, representative active ingredients included gingerketophenol, ginkgol alcohol, ferulic acid, etc., and Codonopsis Radix, Notopterygii Rhizoma et Radix, Zingiberis Rhizoma Recens, Ginkgo Semen, Chuanxiong Rhizoma, Trichosanthis Fructus, Paeoniae Radix Alba, Psoraleae Fructus, Sophorae Flavescentis Radix, Notoginseng Radix et Rhizoma, Angelicae Sinensis Radix were chosen. By combining the diagnosis and treatment scheme of Hunan province's and angiotensin converting enzyme 2(ACE2) inhibitors screening from literature, present study also discussed the rational application of candidate herbs to this epidemic situation. Trichosanthis Fructus obtained by PLP inhibitors screening and Fritillaria verticillata obtained by ACE2 inhibitors screening were parts of the Sangbei Zhisou Powder and Xiaoxianxiong Decoction, which might be applicable to the syndromes of cough and dyspnea. Rhei Radix et Rhizoma screened by Mpro and Trichosanthis Fructus screened by PLP were contained in Maxing Shigan Decoction and Xuanbai Chengqi Decoction, and could be applied to the syndromes of epidemic virus blocking lung. Mori Folium, Lonicerae Japonicae Flos and Forsythiae Fructus obtained by ACE2 inhibitors screening were included in the Sangju Decoction and Yinqiaosan, which might be applicable to the syndromes of warm pathogen attacking lung and cough and dyspnea. The results of this study are intended to provide a reference for the further development of traditional Chinese medicine to deal with the new epidemic.


title: Clinical characteristics and outcome of SARS-CoV-2 infection in Italian pediatric oncology patients: a study from the Infectious Diseases Working Group of the AIEOP.

text: BACKGROUND Little is known as yet about the outcome of SARS-CoV-2 infection in children being treated for cancer. METHODS We collected information on the clinical characteristics and outcomes of a cohort of 29 children (16 females and 13 males, median age 7 years, range [0-16]) diagnosed with SARS-CoV-2 infection while on chemotherapy/immunotherapy (N=26), or after stem cell transplantation (N=3) during the peak of the epidemic in Italy. These patients suffered from leukemia (N=16), lymphoma (N=3), solid tumors (N=10), and Langerhans cell histiocytosis (N=1). RESULTS The course of the disease was mild in all cases, with only 12 children developing symptoms (pneumonia in 3 cases), and none needing intensive care. Fifteen patients were hospitalized, including 7 asymptomatic patients. Nine patients (including 5 with no symptoms) were given hydroxychloroquine, and 3 of them were also given lopinavir/ritonavir. CONCLUSIONS SARS-CoV-2 infection seems to take a milder clinical course in children than in adults with cancer. Specific SARS-CoV-2 treatment seems unnecessary for most children. In the light of our findings, and albeit with the necessary caution, we suggest avoiding major changes to planned anticancer treatments in pediatric patients acquiring COVID-19.


title: Development of a novel controllable, multidirectional, reusable metallic port with a wide working space.

text: BACKGROUND Endoscopic surgery is currently a standard procedure in many countries. Furthermore, conventional four-port laparoscopic cholecystectomy is developing into a single-port procedure. However, in many developing countries, disposable medical products are expensive and adequate medical waste disposable facilities are absent. Advanced medical treatments such as laparoscopic or single-port surgeries are not readily available in many areas of developing countries, and there are often no other sterilization methods besides autoclaving. Moreover, existing reusable metallic ports are impractical and are thus not widely used. MATERIAL AND METHODS We developed a novel controllable, multidirectional single-port device that can be autoclaved, and with a wide working space, which was employed in five patients. RESULTS In all patients, laparoscopic cholecystectomy was accomplished without complications. CONCLUSION Our device facilitates single-port surgery in areas of the world with limited sterilization methods and offers a novel alternative to conventional tools for creating a smaller incision, decrease postoperative pain, and improve cosmesis. This novel device can also lower the cost of medical treatment and offers a promising tool for major surgeries requiring a wide working space.


Family-Centered Care and High-Consequence Pathogens: Thinking Outside the Room.


title: Time-varying, serotype-specific force of infection of dengue virus.

text: Infectious disease models play a key role in public health planning. These models rely on accurate estimates of key transmission parameters such as the force of infection (FoI), which is the per-capita risk of a susceptible person being infected. The FoI captures the fundamental dynamics of transmission and is crucial for gauging control efforts, such as identifying vaccination targets. Dengue virus (DENV) is a mosquito-borne, multiserotype pathogen that currently infects ∼390 million people a year. Existing estimates of the DENV FoI are inaccurate because they rely on the unrealistic assumption that risk is constant over time. Dengue models are thus unreliable for designing vaccine deployment strategies. Here, we present to our knowledge the first time-varying (daily), serotype-specific estimates of DENV FoIs using a spline-based fitting procedure designed to examine a 12-y, longitudinal DENV serological dataset from Iquitos, Peru (11,703 individuals, 38,416 samples, and 22,301 serotype-specific DENV infections from 1999 to 2010). The yearly DENV FoI varied markedly across time and serotypes (0-0.33), as did daily basic reproductive numbers (0.49-4.72). During specific time periods, the FoI fluctuations correlated across serotypes, indicating that different DENV serotypes shared common transmission drivers. The marked variation in transmission intensity that we detected indicates that intervention targets based on one-time estimates of the FoI could underestimate the level of effort needed to prevent disease. Our description of dengue virus transmission dynamics is unprecedented in detail, providing a basis for understanding the persistence of this rapidly emerging pathogen and improving disease prevention programs.