title: Psychometric properties of the International Wellbeing Index in community-dwelling older adults.

text: BACKGROUND This is the first study to analyze the psychometric properties of the International Wellbeing Index (IWI), which comprises the Personal Wellbeing Index (PWI) and National Wellbeing Index (NWI), among community-dwelling older adults. METHODS The IWI was applied to 1106 community-dwelling adults aged 60 years and over. The sample was additionally assessed using scales for comorbidity, disability, mood, general orientation to life, social support, health-related quality of life, and two questions assessing satisfaction with life as a whole and with life in Spain. The PWI and NWI were separately analyzed for acceptability, internal consistency, convergent and discriminative validity, and precision. Linear regression analyses of the PWI and the NWI were also conducted. RESULTS Mean scores were 71.0 ± 13.5 for the PWI and 49.5 ± 14.4 for the NWI. No floor or ceiling effects were detected. Cronbach's α was 0.88 for the PWI and 0.92 for the NWI. Factor analysis identified two factors in the IWI, and one factor in the PWI and NWI respectively. The PWI showed a correlation of 0.50 with the "satisfaction with life as a whole" item, and the NWI showed a correlation of 0.73 with the "satisfaction with life in Spain" item. There were significant differences in scores: in the PWI, according to gender, age, social support, education and depression; and in the NWI, according to education and depression. The regression model identified psychosocial, health and functional factors as determinants of the PWI (explained variance: 46.8%). CONCLUSIONS The IWI displays good acceptability and is a consistent, valid and precise measure of global quality of life in older adults.


title: The knowledge level and perceptions towards COVID-19 among Turkish final year medical students.

text: BACKGROUND Coronavirus disease 2019 (COVID-19) has upended medical education as well as the lives of healthcare professionals. Higher education institutions have a crucial role in the solution of public health problems by training young doctor candidates, and it is also essential to increase the knowledge level of physician candidates about the epidemic. So, in this study, we aimed to examine Turkish final year medical students' knowledge level, and perceptions towards the COVID-19 pandemic. METHODS The present descriptive multicentered study was conducted with the medical students in the final year of six medical schools located in six geographic regions of Turkey. After ethical approval, data was gathered using an online questionnaire through Google forms between April 10, 2020, and April 20, 2020. RESULTS In this national survey study, 860 volunteers answered the questions thoroughly. The median age was 24 (22-38) years. 55.3% of the participants were female. The median knowledge level score was 69.0 (0-93.1). The knowledge level was moderate. 34.2% of the participants had a high level of knowledge. 48.7% of participants stated that they felt the most competent about performing CPR. Updates about COVID-19 were followed regularly by 84.5% of the participants. CONCLUSION We determined that final year medical students are knowledgeable and aware of this pandemic. We, medical educators, should inculcate relevant knowledge and educate the medical students to improve practices in the current pandemic, as well as for future epidemics. Different learning techniques should be added to the curriculum, especially at the time which widespread panic and uncertainty are prevalent.


title: Laparoscopy-assisted suprapubic salpingectomy 'Kaya technic' - a low-cost treatment of ectopic pregnancy.

text: We aimed to demonstrate the feasibility and total cost of laparoscopy-assisted suprapubic salpingectomy (LASS), which utilises conventional open surgery equipment without any sealing or coagulation devices and reduces port sites compared to conventional laparoscopy (CL). Fifty-seven consecutive, age-matched patients presenting with a tubal pregnancy were enrolled. In the LASS group, a 10 mm reusable umbilical optical trocar and a 10 mm suprapubic trocar was used. The other 30 patients were managed with multiport CL. All of the patients were asked to use the visual analogue scale and Patient and Observer Scar Assessment Scale to evaluate their cosmetic satisfaction. The duration of surgery was 21.19 ± 2.33 minutes for the LASS group and 36.9 ± 4.9 minutes for the CL group (p < .001). The postoperative 6th-hour VAS score was 2.44 ± 0.5 for the LASS group and 3.03 ± 0.8 for the CL group (p: .005). All of the PSAS and OSAS parameter scores were significantly lower in LASS group than CL group. In conclusion, the LASS procedure is a feasible method for treating ectopic pregnancies with a shorter surgical duration, lower VAS scores, and better cosmetic scores than CL. Impact statement What is already known on this subject? Laparoscopy or laparotomy may be performed for the surgical management of ectopic pregnancy. Conventional laparoscopy has some advantages such as shorter hospital stay and recovery time and the better cosmetic results. However, the equipment used in conventional laparoscopy and single incision laparoscopy are more expensive than conventional open surgery equipment. What the results of this study add? Laparoscopy-assisted suprapubic salpingectomy (LASS) method has shorter operation time, lower VAS scores, better cosmetic scores and cheaper than conventional laparoscopy. What the implications are of these findings for clinical practice and/or further research? The LASS procedure looks like a feasible method for treating ectopic pregnancies and the feasibility of this procedure should be confirmed by a larger series of patients and randomised trials.


Welcome to the ninth international conference on pediatric mechanical circulatory support systems and pediatric cardiopulmonary perfusion.


title: Rapid detection of viral RNA by a pocket-size real-time PCR system.

text: We present an economical, battery-powered real-time polymerase chain reaction (RT-PCR) system suitable for field and point-of-care applications; it has a built-in thermal management, a fluorescence-based detection system, and a single chip controller with a graphic touch-screen display.


title: Transumbilical totally laparoscopic single-port Nissen fundoplication: a new method of liver retraction: the Istanbul technique.

text: INTRODUCTION Mustafa Kemal Atatürk, founder of the Turkish Republic, had guarded many German scientists of a Jewish descent before the Second World War. Dr. Rudolf Nissen was one of the outstanding surgeons who had served in the Turkish university hospitals. He had created an antireflux procedure which is named after his own name while he was working in our clinic, the Cerrahpaşa Hospital. From a laparoscopic approach, the Nissen fundoplication was the gold standard intervention for the surgical treatment of gastroesophageal reflux disease (GERD). Currently, video laparoscopic surgery is evolving quickly with the guidance of new technology. Single-port (SP) laparoscopic transumbilical surgery is one of the newest branches of advanced laparoscopy. DISCUSSION Simple or complex manipulations may be performed with SP laparoscopic transumbilical surgery. The advantages, which are gained from conventional laparoscopy, can be invigorated by an SP laparoscopic approach. The retraction technique of the liver and the optical system were the most important factors, which made the Nissen fundoplication possible via single port. Here, we report that totally laparoscopic transumbilical SP Nissen fundoplication procedure was performed in three patients for sliding hiatal hernia with GERD. CONCLUSION Totally laparoscopic transumbilical SP Nissen fundoplication is a safe and feasible technique for the surgical treatment of GERD.


title: B-cell depleting therapies may affect susceptibility to acute respiratory illness among patients with Multiple Sclerosis during the early COVID-19 epidemic in Iran

text: OBJECTIVE: To determine whether the course of COVID-19 is more severe in patients with MS and if MS disease-modifying treatments (DMTs) affect the risk of contracting the disease. METHODS: In a cross-sectional survey, data were collected by sending a questionnaire to 2000 patients with a demyelinating disease through an online portal system. Collected data included the current MS DMT and patient-reported disability level, history of recent sick contact, recent fever, respiratory symptoms, diagnosis with COVID-19 and the disposition after the diagnosis. We defined a COVID-19-suspect group as patients having fever and cough or fever and shortness of breath, or a presumptive diagnosis based on suggestive chest computed tomography. We calculated the proportion of COVID-19-suspect patients and compared their demographics, clinical characteristics, and DMT categories with the rest of survey-responders, using univariable and multivariable models. RESULTS: Out of 712 patients, 34 (4.8%) fulfilled our criteria for being in the COVID-19-suspect group. Only two patients required hospitalization. No patient required intensive care. In a multivariable model, disease duration (p-value=0.017), DMT category (p-value=0.030) and history of sick contact (p-values<0.001) were associated with the risk of being in the COVID-19-suspect group. Patients on B-cell depleting antibodies had 3.6 times higher risk of being in the COVID-19-suspect group as compared to patients on none-lymphocyte-depleting and non-cell trafficking inhibitor DMTs (95%CI: 1.45, 8.68, p-value=0.005). CONCLUSIONS: The course of infection in MS patients suspected of having COVID-19 was mild to moderate, and all patients had a full recovery. B-cell depleting antibodies may increase the susceptibility to contracting COVID-19.


title: Electrosurgical devices: are we closer to finding the ideal appliance? A critical review of current evidence for the use of electrosurgical devices in general surgery.

text: Over the last decade, the use of electrosurgical devices has become commonplace across all surgical specialities. The current market is large enough to warrant a comparative review of each device. This has even more impetus given the budgetary constraints of NHS organisations. This review aims to compare the benefits and drawbacks of the most popular electrosurgical devices, whilst conducting a critical review of the literature. Structured searches using databases Medline and EMBASE were conducted. The search was restricted to English language papers only. Due to the abundance of literature, this review will focus on common general surgical procedures alone. Despite a plethora of available devices, individual preference still dictates use. Conventional diathermy may always have its place, but may see a decline in use if costs improve. Newer devices have shown comparable precision and added advantages.


title: Nutrients and certain lipid soluble bioactive components in dehusked whole grains (gota) and dehusked splits (dhal) from pigeon pea (Cajanus cajan) and their cooking characteristics.

text: The nutritional quality of dehusked whole grains (gota) and dehusked splits (dhal) in red and white varieties of pigeon pea regarding proximate composition and certain lipid-soluble bioactive components was investigated. A decrease in fat and crude fiber was noticed when gota was converted to dhal. The lipid profile of gota and dhal from red and white husk pigeon pea types indicated that essential fatty acids were greater in gota than in their respective dhals. Gota from white husk variety contained more tocopherols than the red variety. Dhal contained less tocopherols than gota. A decrease in the content of gamma and alpha tocopherols, vitamin E activity and total antioxidant activity also indicates loss of bioactive components on splitting gota into dhal. Cooking time and dispersed solids on cooking indicated good cooking quality of gotta. The results indicated the nutritional superiority of gota over dhal and its similarity with dhal in cooking characteristics.


title: The Inter-α-Trypsin Inhibitor Family: Versatile Molecules in Biology and Pathology.

text: Inter-α-trypsin inhibitor (IαI) family members are ancient and unique molecules that have evolved over several hundred million years of vertebrate evolution. IαI is a complex containing the proteoglycan bikunin to which heavy chain proteins are covalently attached to the chondroitin sulfate chain. Besides its matrix protective activity through protease inhibitory action, IαI family members interact with extracellular matrix molecules and most notably hyaluronan, inhibit complement, and provide cell regulatory functions. Recent evidence for the diverse roles of the IαI family in both biology and pathology is reviewed and gives insight into their pivotal roles in tissue homeostasis. In addition, the clinical uses of these molecules are explored, such as in the treatment of inflammatory conditions including sepsis and Kawasaki disease, which has recently been associated with severe acute respiratory syndrome coronavirus 2 infection in children.


docid: fpywiwoh

title: First impact on services and their preparation. "Instant paper from the field" on rehabilitation answers to the Covid-19 emergency.

text: This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by Covid-19. In a country with almost 5,000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8,900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the Covid-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.


Protecting the health of doctors during the COVID-19 pandemic.


title: Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma.

text: OBJECTIVE Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). METHODS A retrospective cohort study of retinoblastoma patients who received intravitreal injections of Alkeran and Evomela at 30 μg from September 2012 to January 2019 at a single tertiary care center were enrolled. Retinal toxicity was measured using electroretinogram (ERG) and compared using a multivariate analysis of 338 injections in 101 eyes of 96 patients. Ocular survival of 163 eyes in 150 patients was compared across formulations using Cox proportional hazards model. Eyes were censored at the time a patient received a dose other than 30 μg. RESULTS Overall, ERG decline (mean, 95% CI) for each injection was -5.58 μV (-7.17, -3.99). No significant differences in ERG decrement were found between Alkeran (with alcohol) -5.52uV (-6.99, -4.05). and Evomela (without alcohol) -5.65uV (-8.31 to -2.98) formulations (p = 0.93). Ocular survival at 24 months was 93.6% (95% CI 86.2, 97.1) with alcohol and 91.7% (95% CI 53.9, 98.8) without alcohol. The hazard ratio (HR) for without vs with alcohol was 0.50 (95% CI 0.06 to 4.07); no significant difference in ocular survival was found between formulations (p = 0.52). CONCLUSIONS AND RELEVANCE No differences were found in retinal toxicity and ocular survival between 30 μg intravitreal injections of Alkeran or Evomela for intraocular retinoblastoma. Given the increased stability of Evomela, intravitreal treatment could be expanded to centers without the ability to supply Alkeran due to its shorter safety window; however, Alkeran is less expensive. For those with existing infrastructure, Alkeran is a comparable, cost-effective alternative.


COVID-19 in patients with rheumatic diseases: what is the real mortality risk?


title: Safety and effectiveness of bariatric surgery: Roux-en-y gastric bypass is superior to gastric banding in the management of morbidly obese patients: a response.

text: BACKGROUND The recent article by Guller, Klein, Hagen was reviewed and discussed by the authors of this response to critically analyze the validity of the conclusions, at a time when patients and providers depend on peer reviewed data to guide their health care choices. The authors of this response all have high volume bariatric surgery practices encompassing experience with both gastric bypass and gastric banding, and have made significant contributions to the peer reviewed literature. We examined the assumptions of the paper, reviewed the main articles cited, provided more evidence from articles that were included in the materials and methods of the paper, but not cited, and challenge the conclusion that Roux-en-Y gastric bypass is superior to gastric banding. RESULTS AND DISCUSSION The paper by Guller et al was subject to significant bias. The authors did not demonstrate an understanding of gastric banding, selectively included data with unfavorable results towards gastric banding, did not provide equal critique to the literature on gastric bypass, and deliberately excluded much of the favorable data on gastric banding. CONCLUSION The paper's conclusion that gastric bypass is the procedure of choice is biased, unsubstantiated, not supported by the current literature and represents a disservice to the scientific and health care community.


title: Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II).

text: OBJECTIVE Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study. DESIGN In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter. OUTCOMES complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review. RESULTS 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically. CONCLUSIONS In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up. TRIAL REGISTRATION NUMBER NTR 1211, http://www.trialregister.nl.


Pandemic and Persona.


title: Possible Consequences of a Shortage of Hydroxychloroquine for Lupus Patients Amid the COVID-19 Pandemic.

text: As the COVID-19 pandemic took hold in North America, rheumatology clinics across the continent were inundated with phone calls from lupus patients understandably fearful of COVID-19. One of the most common questions from patients was whether they should stop taking their lupus medications.


title: Erectile dysfunction and retinal microvascular network: an optical coherence tomography angiography study.

text: The aims of this study were to examine the microvascular network of the retina using the optical coherence tomography angiography (OCT-A) device in patients with erectile dysfunction (ED) and to determine whether the OCT-A values could assist in the differential diagnosis of ED. The study design was prospective, observational, and cross-sectional. The vessel densities (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and retinal peripapillary capillary plexus (RPCP) were assessed using OCT-A in patients with ED and healthy subjects. All the participants were evaluated and scanned for systemic and hormonal disorders and those with ED also underwent penile Doppler ultrasonography (PDU). After recording the data, the participants were divided into three groups: organic ED, psychogenic ED, and healthy control. The relationships between the OCT-A parameters and other clinical findings were analyzed. The right eyes of 80 patients with ED and 40 healthy volunteers were evaluated in this study. Of the ED patients, 46 were included in the organic ED group according to the results of PDU. The VDs of DCP, SCP, and the temporal sector of RPCP were significantly lower in the organic ED group than the psychogenic ED and healthy control groups. The VDs of SCP and DCP were correlated with the peak systolic velocity of both left and right penile cavernous arteries. The VDs of DCP were also correlated with the left and right resistive indexes. In conclusion, the OCT-A data of SCP and especially DCP could be helpful in evaluating ED, and provide reliable information about the origin of the disease along with the other laboratory testing and penile vascular evaluation.


title: Laparoscopic sleeve gastrectomy: Effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up.

text: BACKGROUND In the short-term, laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of the type 2 diabetes in patients with severe obesity. There are few data with greater follow-up. Our aim was to evaluate the results of laparoscopic sleeve gastrectomy on the control of type 2 diabetes in patients with severe obesity at 5 years at the University Hospital, France. METHODS From a total of 355 patients with severe obesity operated between January 2006 and June 2010, 52 (15%) had a diagnosis of type 2 diabetes before undergoing laparoscopic sleeve gastrectomy. RESULTS There were 31 females (60%) and 21 males (40%), with a mean age of 51 ± 10 years (range 27-67) with a mean body mass index of 48 ± 10 kg/m2 (range 35-82). The mean duration of type 2 diabetes was 10.8 ± 10.8 years before bariatric operation. The preoperative glycated hemoglobin was 8 ± 2% (range 5.9-12.8) in 45 patients; 17 patients (38%) had levels of glycated hemoglobin ≥9%. Three patients (6%) required insulin alone, 4 (8%) were taking oral antidiabetic medicine and insulin, and the remaining 45 patients (87%) were taking only oral antidiabetic medicines. The complete data regarding weight loss at 5-year follow-up were obtained for 46 patients, yielding an overall follow-up rate of 89%. The prolonged remission of type 2 diabetes achieved at 1 year that persisted at 5 years of follow-up was present in 9 patients (17%). No patient with complete remission of their type 2 diabetes required insulin preoperatively. Improvement of type 2 diabetes was observed in 30 patients (58%) at 1 year, which was maintained for 27 patients (52%) at 5-year follow-up. CONCLUSION Laparoscopic sleeve gastrectomy has demonstrated a moderate efficacy in the treatment morbidly obese patients with type 2 diabetes. Markedly increased preoperative glycated hemoglobin levels, older age, and preoperative need for insulin treatment may be the factors predicting failure of complete remission of type 2 diabetes after laparoscopic sleeve gastrectomy.


title: Pseudo-recurrence following laparoscopic ventral and incisional hernia repair.

text: PURPOSE Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall. However, a definition in the literature of "recurrence" is lacking. This study reviews the phenomenon of pseudo-recurrence in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair (LVIHR). METHODS Cases of LVIHR from 1st January 2004 to 31st December 2007 were identified from the Lothian Surgical Audit database. Patients were contacted by telephone after a minimum of 11 months following operation. Pseudo-recurrences were identified by history and clinical examination, together with radiological investigation if the diagnosis remained in doubt. RESULTS One hundred and forty-three repairs were performed in the study period. One hundred and twenty-one patients were contacted (63 incisional and 58 other ventral herniae). Twenty possible recurrences were reported (16.5%). Four were true recurrences and two more were new incisional herniae. There were 14 pseudo-recurrences, arising after 12 incisional and two other ventral hernia repairs. These were due to mesh bulge (10), seroma (3) and retained hernia contents (1). CONCLUSION True recurrences after LVIHR do occur but should be preventable with good surgical technique. Pseudo-recurrences are more common and may mimic true recurrence. We recommend computed tomography (CT) to clarify the diagnosis and determine the indication for revisional surgery.


Facing the COVID-19 Pandemic in France: From Managerialism to Business Logistics.


Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention.


title: Electrosynthesized polymers for biosensing.

text: This tutorial review briefly surveys the chronological evolution of biosensor concepts based on electrogenerated polymers. The most common procedures of biomolecule immobilization are classified as direct electropolymerization, physical entrapment, covalent linkage, and anchoring by affinity interactions via electropolymerized films. These are discussed, and recent bioanalytical applications are described. The discussion emphasizes the use of templates for controlling the formation of nanowires and composite polymers. Recent advances in the design of three-dimensional biological architectures are also highlighted.


docid: yocfiseb

title: Temporomandibular total joint prosthesis infections: a ten-year retrospective analysis.

text: A retrospective review of 178 total temporomandibular joint replacements (TJR) performed on 106 patients at the University of Alabama at Birmingham during the years 2000-2010 was completed. Data regarding sex, past medical history, prosthesis manufacturer, microbiology, antibiotic therapy, and the need for additional procedures were obtained from the medical records of patients who developed a prosthetic joint infection following TJR. Of the 106 patients, 95 (89.6%) were female and 11 (10.4%) were male. The average age of the patients was 47 years (range 19-68 years). Sixty patients underwent bilateral TJR. The average length of follow-up was 41 months. Of the 178 TJR performed, eight joints (4.5%) developed an infection of the prosthesis, all requiring removal despite antibiotic therapy. The average time to onset of infection was 14.3 months (range 6 days to 72 months), while the average time to removal of the prosthesis was 26.9 months (range 10 weeks to 84 months). Microbiology data from the infected joints revealed colonization with coagulase-negative Staphylococcus (4/8 joints) and Propionibacterium (2/8 joints), as well as Serratia and Peptostreptococcus species. Three of the prostheses had negative cultures.


title: Recurrent wheezing illness in preschool-aged children: assessment and management in primary care practice.

text: Recurrent wheezing is common in preschool-aged children, with 1 in 3 children experiencing at least 1 acute wheezing illness before the age of 3 years. These children represent a diverse group, with some going on to present with asthma at school age and others experiencing complete resolution of symptoms. The primary care physician is faced with a dilemma of when to recommend daily therapy. He or she must also answer parents' concerns, often expressed as, "Does my child have asthma?" and "Will my child have to take medication the rest of his or her life?" This article presents recent studies and recommendations that can guide the physician in approaching the child and the parent with rational management. The emphasis is on viewing recurrent wheezing as a continuum requiring a plan of monitoring that starts with the very first episode. Using background information from the parents and a history of the child's allergic disposition, one can discuss with parents the risks of developing asthma and, together with planned monitoring, prescribe appropriate management. The primary care physician can plan management by using the Asthma Predictive Index and employing specific questions for features present during the intervals between acute episodes. Together with close monitoring, the physician will have a compass that effectively directs rational management.


title: Bovine respiratory disease research (1983-2009).

text: Bovine respiratory disease (BRD) research has provided significant understanding of the disease over the past 26 years. Modern research tools that have been used include monoclonal antibodies, genomics, polymerase chain reaction, immunohistochemistry (IHC), DNA vaccines and viral vectors coding for immunogens. Emerging/reemerging viruses and new antigenic strains of viruses and bacteria have been identified. Methods of detection and the role for cattle persistently infected bovine viral diarrhea virus (BVDV) were identified; viral subunits, cellular components and bacterial products have been characterized. Product advances have included vaccines for bovine respiratory syncytial virus, Mannheimia haemolytica and Pasteurella multocida; the addition of BVDV2 to the existing vaccines and new antibiotics. The role of Mycoplasma spp., particularly Mycoplasma bovis in BRD, has been more extensively studied. Bovine immunology research has provided more specific information on immune responses, T cell subsets and cytokines. The molecular and genetic basis for viral-bacterial synergy in BRD has been described. Attempts have been made to document how prevention of BRD by proper vaccination and management prior to exposure to infectious agents can minimize disease and serve as economic incentives for certified health programs.


All roads lead to coronavirus.


Does cuff material and design help prevent ventilator-associated pneumonia?


A49 Molecular evolutionary dynamics of respiratory syncytial virus group A in recurrent epidemics in coastal Kenya.


Unruptured carotid artery aneurysms presenting with symptoms of mass effect: outcome after selective coiling, parent vessel occlusion, and flow diversion.


title: Laparoscopic sacrocolpopexy using barbed sutures for mesh fixation and peritoneal closure: A safe option to reduce operational times.

text: INTRODUCTION Laparoscopic sacrocolpopexy (LSC) has established itself as a safe method for the management of pelvic organ prolapse (POP). Laparoscopic suturing is a time-consuming intraoperative task during LSC. Self-retaining barbed sutures (SBSs) are known to reduce the operative time in laparoscopic cases. The current study aimed to evaluate the efficacy and safety of SBS during the performance of LSC. MATERIALS AND METHODS Twenty female patients with symptomatic POP were treated with LSC by an expert surgeon. The preoperative evaluation included the International Continence Society POP-quantification (POP-Q) and the prolapse-specific quality-of-life questionnaire Mesh fixation was performed with SBS anteriorly on the anterior vaginal wall and posteriorly on the levator ani muscle. A 5-mm titanium tacking device was used for promontofixation. The peritoneum was also closed with an SBS. RESULTS Mean patient's age was 63 years (range: 50-79 years). According to POP-Q, system 3 patients (15%) had Stage I, 12 patients (60%) had Stage II, 3 patients (15%) had Stage III, and 2 patients (10%) had Stage IV prolapse. Concomitant hysterectomy was performed in 14 patients, respectively. Mean operative time was 99.75 (range: 65-140) min, mean blood loss was 57.75 (range: 30-120) ml. One patient had a bladder perforation intraoperatively, and three patients developed transient fever postoperatively. One patient had a recurrent cystocele and three patients recurrent rectocele. CONCLUSIONS The current study renders the use of SBS during LSC to be safe and efficient. Further comparative studies would elucidate the impact of the use of SBS in LSC.


Thoughts on Living in a Nursing Facility during the Pandemic.


title: Epidemiology of childhood tuberculosis: use and evaluation of the pediatric health information system to assess local and national incidence.

text: We used the Pediatric Health Information System (PHIS) administrative database to compare the incidence of childhood tuberculosis at Children's National Medical Center (CNMC) in Washington, DC, with national rates and evaluated PHIS as an epidemiologic tool. The incidence rate of tuberculosis at CNMC was approximately twice that of the national PHIS rate (incidence rate ratio, 1.9; 95% confidence interval 1.4-2.5). Of the 51 cases listed by PHIS as tuberculosis at CNMC between 2003 and 2007, 41 represented active tuberculosis validated by internal chart review, with a positive predictive value of 80%.


title: Multi-Tiered Screening and Diagnosis Strategy for COVID-19: A Model for Sustainable Testing Capacity in Response to Pandemic.

text: Coronavirus disease 2019 (COVID-19), caused by novel enveloped single stranded RNA coronavirus (SARS-CoV-2), is responsible for an ongoing global pandemic. While other countries deployed widespread testing as an early mitigation strategy, the U.S. experienced delays in development and deployment of organism identification assays. As such, there is uncertainty surrounding disease burden and community spread, severely hampering containment efforts. COVID-19 illuminates the need for a tiered diagnostic approach to rapidly identify clinically significant infections and reduce disease spread. Without the ability to efficiently screen patients, hospitals are overwhelmed, potentially delaying treatment for other emergencies.A multi-tiered, diagnostic strategy incorporating a rapid host immune response assay as a screening test; molecular confirmatory testing and rapid IgM/IgG testing to assess benefit from quarantine/further testing and provide information on population exposure/herd immunity would efficiently evaluate potential COVID-19 patients. Triaging patients within minutes with a fingerstick rather than hours/days after an invasive swab is critical to pandemic response as reliance on the existing strategy is limited by assay accuracy, time to results, and testing capacity. Early screening and triage is achievable from the outset of a pandemic with point-of-care host immune response testing which will improve response time to clinical and public health actions. Key MessagesDelayed testing deployment has led to uncertainty surrounding overall disease burden and community spread, severely hampering public health containment and healthcare system preparation efforts.A multi-tiered testing strategy incorporating rapid, host immune point-of-care tests can be used now and for future pandemic planning by effectively identifying patients at risk of disease thereby facilitating quarantine earlier in the progression of the outbreak during the weeks and months it can take for pathogen specific confirmatory tests to be developed, validated and manufactured in sufficient quantities.The ability to triage patients at the point of care and support the guidance of medical and therapeutic decisions, for viral isolation or confirmatory testing or for appropriate treatment of COVID-19 and/or bacterial infections, is a critical component to our national pandemic response and there is an urgent need to implement the proposed strategy to combat the current outbreak.


title: Laparoendoscopic single-site Pfannenstiel versus standard laparoscopic donor nephrectomy.

text: OBJECTIVES To compare laparoendoscopic single-site (LESS) Pfannenstiel donor nephrectomy with a contemporary series of standard laparoscopic (SL) donor nephrectomies. METHODS The initial 6 LESS donor nephrectomies were compared with a case-matched 6 SL donor nephrectomies within the same time period (June 2008 till March 2009). Patient characteristics (sex, age, body mass index, graft volume, and vascular anatomy), perioperative data (operative time, warm ischemia time [WIT], and estimated blood loss), and postoperative information (complications, length of stay, visual analog scale [VAS], and total morphine requirements) were collected prospectively and analyzed retrospectively. RESULTS In the LESS group, there were no conversions to SL or open. There was no significant difference between the two groups in terms of baseline characteristics (age, body mass index, allograft volume). However, SL group included more right-sided patients (three compared with one) and more venous anomalies (retrorenal veins in two patients and multiple veins in another). There was no significant difference between SL and LESS in terms of operative time (117 vs. 142 minutes), WIT (5 minutes in both groups), estimated blood loss (150 vs. 100 mL), median length of stay (2 days in both), and total morphine equivalents (42 vs. 83 mg). None of the patients received transfusions perioperatively. A patient in the SL group developed a wound infection requiring packing and antibiotics. There were no perioperative complications in the LESS group. Although VAS scores were lower in the LESS versus SL group at each of post-operative day (POD) #2 (1.5 vs. 4) and discharge (0 vs. 2), this did not reach statistical significance. CONCLUSIONS In this small retrospective series, SL was associated with more complex renal anatomy. However, there was no difference between the two groups in terms of WIT, narcotic requirements, and VAS scores. Therefore, the advantages of LESS may only be cosmesis. To verify these results, both procedures need to be compared prospectively in a randomized fashion.


title: Mutation Patterns of Human SARS-CoV-2 and Bat RaTG13 Coronavirus Genomes Are Strongly Biased Towards C>U Transitions, Indicating Rapid Evolution in Their Hosts.

text: The pandemic caused by the spread of SARS-CoV-2 has led to considerable interest in its evolutionary origin and genome structure. Here, we analyzed mutation patterns in 34 human SARS-CoV-2 isolates and a closely related RaTG13 isolated from Rhinolophus affinis (a horseshoe bat). We also evaluated the CpG dinucleotide contents in SARS-CoV-2 and other human and animal coronavirus genomes. Out of 1136 single nucleotide variations (~4% divergence) between human SARS-CoV-2 and bat RaTG13, 682 (60%) can be attributed to C>U and U>C substitutions, far exceeding other types of substitutions. An accumulation of C>U mutations was also observed in SARS-CoV2 variants that arose within the human population. Globally, the C>U substitutions increased the frequency of codons for hydrophobic amino acids in SARS-CoV-2 peptides, while U>C substitutions decreased it. In contrast to most other coronaviruses, both SARS-CoV-2 and RaTG13 exhibited CpG depletion in their genomes. The data suggest that C-to-U conversion mediated by C deamination played a significant role in the evolution of the SARS-CoV-2 coronavirus. We hypothesize that the high frequency C>U transitions reflect virus adaptation processes in their hosts, and that SARS-CoV-2 could have been evolving for a relatively long period in humans following the transfer from animals before spreading worldwide.


title: Approach to hemophagocytic syndromes.

text: Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory condition. It may occur as a primary (genetic) condition due to mutations in genes important in the cytolytic secretory pathway that cause perforin and granzymes to induce apoptosis in target cells. Primary HLH is divided into familial HLH (FHLH1-5), in which HLH is the only manifestation of disease, and other genetic causes in which HLH is one of several clinical manifestations. The identical clinical findings may arise secondary to infectious, rheumatologic, malignant, or metabolic conditions. Whether primary or secondary, HLH therapy needs to be instituted promptly to prevent irreversible tissue damage. It is helpful to think of HLH as the severe end of the spectrum of hyperinflammatory disorders when the immune system starts to damage host tissues (immunopathology). Therefore, no single clinical feature alone is diagnostic for HLH, and it is important that the entire clinical presentation be considered in making the diagnosis. This article contains a discussion of the genetic background, clinical presentation, diagnostic dilemmas, and features that are helpful in making the diagnosis of HLH, along with a discussion of common problems in its management.


Addressing the Question of Dermatologic Manifestations of SARS-CoV-2 Infection in the Lower Extremities: A Closer Look at the Available Data and its Implications.


title: Robotic laparoendoscopic single-site radical prostatectomy: technique and early outcomes.

text: BACKGROUND Laparoendoscopic single-site (LESS) surgery is challenging. To help overcome current technical and ergonomic limitations, the da Vinci robotic platform can be applied to LESS. OBJECTIVES Our aim was to describe the surgical technique and to report the early outcomes of robotic LESS (R-LESS) radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS A retrospective review of prospectively captured R-LESS RP data was performed between May 2008 and May 2010. A total of 20 procedures were scheduled (12 with and 8 without pelvic lymph node dissection). SURGICAL PROCEDURE R-LESS prostatectomy was performed using the methods outlined in the paper and in the supplemental video material. INTERVENTIONS All patients underwent R-LESS RP by one high-volume surgeon. Single-port access was achieved via a commercially available multichannel port. The da Vinci S and da Vinci Si surgical platform was used with pediatric and standard instruments. MEASUREMENTS Preoperative, perioperative, pathologic, and functional outcomes data were analyzed. RESULTS AND LIMITATIONS The mean age was 60.4 yr; body mass index was 25.4 kg/m(2). The mean operative time was 189.5 min; estimated blood loss was 142.0 ml. The average length of stay was 2.7 d, and the visual analog pain score at discharge was 1.4 of 10. Four focal positive margins were encountered, with two occurring during the first three cases. Pathology revealed a Gleason score of 3+3 in 3 patients, 3+4 in 11 patients, 4+3 in 4 patients, and 4+4 in 2 patients. There were a total of four complications according to the Clavien system including one grade 1, two grade 2, and one grade 4. The median follow-up has been 4 mo (range: 1-24 mo). Study limitations include the small sample size, the short follow-up, and the lack of comparative cohort. CONCLUSIONS The R-LESS RP is technically feasible and reduces some of the difficulties encountered with conventional LESS RP.


title: Assessment of the effect of pharmacotherapy in common cold/acute bronchitis - the Bronchitis Severity Scale (BSS).

text: BACKGROUND Acute bronchitis (AB) is a highly contagious infection of the airways, presenting mostly in connection with common cold (CC). There is a high variance in duration and course of symptoms which, sooner or later, also may disappear spontaneously and change during the course of the disease. Therefore, assessment of treatment outcome is difficult. METHODS Composite outcome measures are commonly used to examine the effects of pharmacotherapy in complex diseases. We discuss the features of the Bronchitis Severity Scale (BSS) on the basis of the available literature. RESULTS For the BSS the five most important symptoms of AB are rated by the patient and the physician. Since its introduction in 1996, the BSS has been used in many clinical trials evaluating treatment effects of AB. Its score correlates well with clinical findings. As thorough validation analyses revealed, this applies even more to the BSS subscales "cough domain" and "sputum domain". CONCLUSION The validated BSS appears to be a reliable tool to assess therapeutic effects in CC/AB. The BSS and its subscales are recommended as outcome measures for future drug trials in CC/AB, but also help physicians to focus their consultation in patients with CC/AB.


title: Effect of mode of anesthesia on radiation exposure in patients undergoing endovascular recanalization of anterior circulation embolic stroke.

text: PURPOSE To determine the effect of general anesthesia (GA) versus conscious sedation (CS) on radiation exposure (RE), procedure time (PT), and fluoroscopy time (FT) in patients receiving endovascular stroke treatment (EST) for large vessel occlusions (LVOs) in the anterior circulation. METHODS Retrospective analysis of an institutional review board-approved prospective stroke database of a comprehensive stroke center focusing on RE (as dose area product (DAP) in Gy.cm², median (IQR)), PT, and FT (in minutes, median (IQR)) in patients receiving EST for LVOs of the anterior circulation according to the mode of anesthesia during the intervention. RESULTS Overall 544 patients were included in this analysis (GA: n=143, CS: n=401). For all included LVOs in the anterior circulation PTs (GA: 69 (44-100); CS: 59 (37-99); p=0.235), FTs (GA: 33 (20-56); CS: 29 (16-51); p=0.286), and RE (DAP, GA: 116.23 (73.47-173.41); CS: 110.5 (68.35-184.65); p=0.929) were comparable. In a subgroup analysis of occlusions of the middle cerebral artery (M1-segment; GA: n=80/544, 14.7%; CS: n=211/544, 38.8%), PTs (GA: 69 (37-101); CS: 54 (35 - 89); p=0.223), FTs (GA: 33 (19-55); CS: 25 (14-48); p=0.264), and RE (DAP, GA: 110.91 (66.8-169.12); CS: 103.8 (63.17-181); p=0.893) were similar. CONCLUSION In this retrospective analysis, no effect of the mode of anesthesia on the radiation exposure during EST was detected as GA and CS showed comparable PT, FT, and DAPs.


title: Arthroscopic transfer of the pectoralis major for irreparable tear of the subscapularis: a preliminary report.

text: An irreparable tear of the subscapularis is a surgical challenge. Open approaches have been widely described to restore the anatomy and the function of the shoulder. Pectoralis major transfer is the most common technique used in this difficult clinical situation. Although this procedure has only been performed through an open approach, we describe a new arthroscopic technique for pectoralis major transfer. The critical part in this technique, in general, is the musculocutaneous nerve dissection, which is also possible through the arthroscopic approach. Together with an alternative method of harvesting using chips of bone and a minimal skin incision, this promising, less invasive technique presents all the advantages of the arthroscopic approach and provides a strong fixation to the lesser tuberosity.


title: Current Status of the COVID-19 Outbreak and Emerging Management through Pharmaceutical Therapeutic Strategy.

text: The latest SARS COV2 coronavirus contributes to a pandemic of millions of COVID-19. Because there is no defensive immunity in humans and a virus can overcome inborn immune reaction, it can propagate unhindered, mostly in tissues contaminated. No unique therapies for COVID-19 contaminated patients are available at this time. The insights learned from previous respiratory viral infection control have given guidance into COVID-19 therapy. Several complementary treatments have been tentatively introduced in hospital environments such as immune-modulators, antiviral, convalescent plasma transfusions and natural products. In COVID-19 patients, some of these therapies have provided substantial curative benefits. Moreover, numerous studies and clinical trials are being carried out in order to determine the efficacy of current pharmaceutical and natural products and establish possible therapeutic strategies for producing novel COVID-19 medicines. We summarized and defined the modes of mechanism, protection and efficacy on existing therapeutic strategies for diseases linked to COVID-19 infection.


title: Greater palatine block for V2 trigeminal neuralgia: Case report.

text: AIMS This study describes a novel nerve block directed at the maxillary (V2) division of the fifth cranial nerve as treatment for medication-refractory trigeminal neuralgia (TN). METHODS AND RESULTS The authors present three cases of TN treated with V2 nerve block using commonly available local anesthetics injected through the greater palatine foramen. Patients' medications were noted before and after the procedure. Following the injection, patients were followed over time and outcome was assessed. Patients experienced rapid and long-lasting pain relief allowing for significant reduction in antineuralgia medications. This was done with the objective of breaking the pain cycle with subsequent discontinuation or reduction of analgesic medications. CONCLUSION This technique may be an effective treatment for medication-refractory V2 TN. By interrupting the pain cycle, this renders the condition amenable to long-term control using diminished doses of standard antineuralgia pharmaceuticals. The practical implications of the described procedure are that it is simple, safe, and well-tolerated with few or no adverse effects. This novel technique is a diagnostic feature for the dentist to differentiate between sources of facial pain.


title: Stenting for atherosclerotic renal artery stenosis.

text: Atherosclerotic renal artery stenosis (ARAS) is the most common cause of renal artery stenosis in the adult population. ARAS may result in progressive renal impairment, renovascular hypertension, and/or cardiac disturbance syndromes. Because medical therapy does not affect the progressive nature of this disease process, more aggressive treatments are needed to definitively treat ARAS. When performed correctly, renal artery stenting has been shown to stabilize or improve renal function and/or renovascular hypertension in 65-70% of carefully selected patients with ARAS. Therefore, percutaneous renal artery stenting should be considered the primary treatment for patients with symptomatic ARAS.


COVID-19 FAQ's in Pediatric Cardiac Surgery.


title: A rare approach to entero-atmospheric fistula.

text: PATIENT Female, 60 FINAL DIAGNOSIS: Recurrent incisional hernia Symptoms: - MEDICATION - Clinical Procedure: Limited ileo-cecal resection Specialty: Surgery. OBJECTIVE Diagnostic/therapeutic accidents. BACKGROUND Iatrogenic entero-atmospheric fistula is devastating and its management is extremely difficult because it is often associated with fluid and electrolyte disturbances, nutritional problems, and life-threatening sepsis. CASE REPORT A 60-year-old woman underwent laparoscopic repair of a recurrent incisional hernia that was complicated by iatrogenic cecal injury necessitating a limited ileocecal resection and onlay prosthetic mesh repair of the hernia. Postoperatively, sloughing of the overlying skin led to mesh exposure. An attempted rotational flap coverage was complicated by small bowel injury, which was recognized and repaired. However, an entero-atmospheric fistula developed after the removal of contaminated mesh. The fistula was initially treated by vacuum-assisted closure dressing and later was converted to a 'stoma'. Six months later, the small bowel segment bearing the fistula was excised and bowel continuity was restored. CONCLUSIONS In selected cases, the conversion of entero-atmospheric fistula to a 'stoma' allows the patient to be discharged home early and maintain good nutritional status while awaiting the definitive surgical intervention.


title: Surgical treatment of recurrent prolapse after stapled haemorrhoidopexy.

text: BACKGROUND Recurrent prolapse after stapled haemorrhoidopexy is a late complication of the procedure which can present with accompanying symptoms and may require surgery. We describe a technique for treating symptomatic patients, aimed at obtaining remission of symptoms and avoiding recurrences. METHODS After excisional haemorrhoidectomy, a transverse incision is performed on the proximal part of the mucocutaneous bridge, above the plane of the internal sphincter. A flap of anal mucosa is gently raised. Haemorrhoidal tissue is not removed. LigaSure™ may be useful in focussing coagulation and reducing heat diffusion. Denudation of the internal sphincter allows the removal of potential retained staples. Then, stitches are placed between the proximal part of the flap and the proximal divided edge of the rectal mucosa. Excessive devascularisation of the flap must be avoided. RESULTS From January 2007 to January 2011, we treated 11 patients. The procedures lasted a mean of 38.2 ± 11.1 min. One patient (9 %) suffered from bleeding during the night before being discharged, but this did not require surgery, and another (9 %) had urinary retention. No other perioperative complications were observed. The mean visual analogue scale score 1 day and 1 week after surgery was 4.7 ± 1.3 and 2.3 ± 0.5, respectively. At mean follow-up of 4 ± 1.8 years, neither symptomatic nor asymptomatic recurrences have been observed. Two out of three patients presenting with urgency reported regression of symptoms (66.7 %). In all patients suffering from pain after stapled haemorrhoidopexy, the procedure achieved pain relief (2/2, 100 %). No stenoses occurred. CONCLUSIONS This technique is a promising alternative after failed stapled haemorrhoidopexy. Morbidity is low. The procedure may effectively treat associated symptoms.


title: Kathryn Howell (1940-2020) "The Secretory Pathway was Imprinted in her Heart".

text: We were deeply saddened to learn that Kathryn Howell passed away on April 10, another casualty of the ongoing battle against SARS-CoV2. Throughout her career, she was a vibrant and enjoyable spirit, who was passionate about science and unfailingly kind and generous to all who were privileged to know her as a colleague and a friend.


title: [Application of continuous renal replacement therapy in coronavirus disease 2019].

text: Continuous renal replacement therapy (CRRT) has become an effective multiple organ support therapy instead of single renal replacement as initially expected, and it is widely used in intensive care unit (ICU). After the outbreak of coronavirus disease 2019 (COVID-19), a series of expert recommendation or consensus have been developed to diagnose and treat the disease, including CRRT in acute kidney injury (AKI) and hyper inflammatory response. However, CRRT in COVID-19 is extraordinarily different from regular one due to different pathophysiology and infectious clinical scenarios. Accordingly, the paper aims to elaborate the similarities and differences between CRRT in COVID-19 and routine treatment in terms of safety and accessibility, indications and timing, clinical operation, anticoagulation, fluid management, prevention and control of infectious diseases, etc.


title: A novel polyomavirus from the nasal cavity of a giant panda (Ailuropoda melanoleuca).

text: BACKGROUND Polyomaviruses infect a wide variety of mammalian and avian hosts with a broad spectrum of outcomes including asymptomatic infection, acute systemic disease, and tumor induction. METHODS Viral metagenomics and general PCR methods were used to detected viral nucleic acid in the samples from a diseased and healthy giant pandas. RESULTS A novel polyomavirus, the giant panda polyomavirus 1 (GPPyV1) from the nasal cavity of a dead giant panda (Ailuropoda melanoleuca) was characterized. The GPPyV1 genome is 5144 bp in size and reveals five putative open-reading frames coding for the classic small and large T antigens in the early region, and the VP1, VP2 and VP3 capsid proteins in the late region. Phylogenetic analyses of the large T antigen of the GPPyV1 indicated GPPyV1 belonged to a putative new species within genus Deltapolyomavirus, clustering with four human polyomavirus species. The GPPyV1 VP1 and VP2 clustered with genus Alphapolyomavirus. Our epidemiologic study indicated that this novel polyomavirus was also detected in nasal swabs and fecal samples collected from captive healthy giant pandas. CONCLUSION A novel polyomavirus was detected in giant pandas and its complete genome was characterized, which may cause latency infection in giant pandas.


title: Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes.

text: BACKGROUND Recent developments in minimally invasive surgery have introduced scarless surgeries such as natural orifice transluminal endoscopic surgery (NOTES) and single-site laparoscopic surgery. Among surgical procedures, the appendectomy is one of those targeted for early adoption of new minimally invasive surgical techniques. To date, however, only a limited number of case series have been reported. Thus, the current study aimed to evaluate the safety and feasibility of single-site laparoscopic appendectomy (SSLA) compared with conventional laparoscopic appendectomy (CLA). METHODS The study enrolled 43 patients who consecutively received laparoscopic appendectomy and divided them into SSLA and CLA groups. The clinical characteristics and short-term operative outcomes of these patients were reviewed and compared. RESULTS The 23 patients receiving SSLA did not differ from the 20 patients receiving CLA in terms of clinical characteristics including gender, age, body mass index (BMI), location of appendix, and severity of inflammation. Likewise, operation times and postoperative complication rates did not differ between the two groups. Short-term operative outcomes such as visual analog pain score and hospital stay were not different. The incision was shorter for SSLA (22.9 ± 3.9 mm) than for CLA (29.0 ± 3.0 mm) (p < 0.001). CONCLUSIONS The results of the current study suggest that SSLA is a feasible surgical alternative to CLA with an equivalent level of safety. The data also suggest that SSLA results in better cosmetic outcomes than CLA. Data from larger research studies are necessary to confirm these results and validate the use of SSLA over CLA.


title: Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery.

text: Background We assessed whether a near-infrared spectroscopy (NIRS)-based algorithm for the personalized optimization of cerebral oxygenation during cardiopulmonary bypass combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart, and kidneys. Methods In a randomized controlled trial, participants in three UK centres were randomized with concealed allocation to a NIRS (INVOS 5100; Medtronic Inc., Minneapolis, MN, USA)-based 'patient-specific' algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%) or to a 'generic' non-NIRS-based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of > 50% or at > 70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months postsurgery. Results The analysis population comprised eligible randomized patients who underwent valve or combined valve surgery and coronary artery bypass grafts using cardiopulmonary bypass between December 2009 and January 2014 ( n =98 patient-specific algorithm; n =106 generic algorithm). There was no difference between the groups for the three core cognitive domains (attention, verbal memory, and motor coordination) or for the non-core domains psychomotor speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney, and myocardial injury, adverse events, and health-care costs were similar between the groups. Conclusions These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery. Clinical trial registration http://www.controlled-trials.com , ISRCTN 23557269.


title: Hydromorphone-OROS formulation.

text: IMPORTANCE TO THE FIELD Hydromorphone is a semi-synthetic opioid approved in the USA for the treatment and relief of moderate to severe pain and postoperative pain. However, the compound is short-acting, and there is no extended-release formulation clinically available. A previous hydromorphone extended-release formulation that successfully came to market was subsequently withdrawn on account of safety concerns. Clinical need supports the presence of an extended-release formulation of hydromorphone. AREAS COVERED IN THIS REVIEW Medline articles showing from a search of 'hydromorphone and OROS' were included in the review. In addition, searches were done relating to published data regarding regulatory affairs dealing with this specific topic. Physicians prescribing information for hydromorphone was also reviewed. WHAT THE READER WILL GAIN The reader will gain an increased understanding of the use of an extended-release formulation of hydromorphone using the OROS technology and will appreciate that this technology has safety advantages compared with previous extended-release formulations of hydromorphone. TAKE HOME MESSAGE Hydromorphone-OROS is an effective agent for the long-acting control of pain and a welcome addition to other available opioid formulations.


title: Guidelines on the intraoperative transfusion of red blood cells: a protocol for systematic review.

text: INTRODUCTION A significant proportion of red blood cell (RBC) transfusions are administered intraoperatively; yet there is limited evidence to guide transfusion decisions in this setting. The objective of this systematic review is to explore the availability, quality and content of clinical practice guidelines (CPGs) reporting on the indication for allogenic RBC transfusion during surgery. METHODS Major electronic databases (MEDLINE, EMBASE and CINAHL), guideline clearinghouses and Google Scholar, will be systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative allogenic RBC transfusion. Characteristics of eligible guidelines will be reported in a summary table. The AGREE II instrument will be used to appraise the quality of identified guidelines. Recommendations advising on indications for intraoperative RBC transfusion will be manually extracted and presented to allow for comparison of similarities and/or discrepancies in the literature. ETHICS AND DISSEMINATION The results of this systematic review will be disseminated through relevant conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER CRD42018111487.


title: Regional Comparison of Multiphase Computed Tomographic Angiography and Computed Tomographic Perfusion for Prediction of Tissue Fate in Ischemic Stroke.

text: BACKGROUND AND PURPOSE Within different brain regions, we determine the comparative value of multiphase computed tomographic angiography (mCTA) and computed tomographic perfusion (CTP) in predicting follow-up infarction. METHODS Patients with M1-middle cerebral artery occlusions were prospectively included in this multicenter study. Regional analysis was performed for each patient within Alberta Stroke Program Early CT Score regions M2 to M6. Regional pial vessel filling was assessed on mCTA in 3 ways: (1) Washout of contrast within pial vessels; (2) Extent of maximal pial vessel enhancement compared with contralateral hemisphere; (3) Delay in maximal pial vessel enhancement compared with contralateral hemisphere. Cerebral blood flow, cerebral blood volume, and Tmax data were extracted within these Alberta Stroke Program Early CT Score regions. Twenty-four- to 36-hour magnetic resonance imaging/CT was assessed for infarct in each Alberta Stroke Program Early CT Score region (defined as >20% infarction within that region). Mixed effects logistic regression models were used to compare mCTA and CTP parameters when predicting brain infarction. Area under the receiver operating characteristics was used to assess discriminative value of statistical models. RESULTS Seventy-seven patients were included. mCTA parameter washout and CTP parameter Tmax were significantly associated with follow-up infarction in all models (P<0.05). The area under the receiver operating characteristic for mCTA models ranged from 92% to 94% and was not different compared with all CTP models (P>0.05). Mean Tmax and cerebral blood volume values were significantly different between each washout score (P<0.01) and each delay score category (P<0.01). Mean Tmax, cerebral blood flow, and cerebral blood volume values were significantly different between each extent score category (P<0.05). CONCLUSIONS Similar to CTP, multiphase CTA can be used to predict tissue fate regionally in acute ischemic stroke patients.


title: Diagnosing and managing postherpetic neuralgia.

text: Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.


Health in all policies.


title: Single-incision laparoscopic total extraperitoneal repair for a Grynfeltt hernia: a case report.

text: INTRODUCTION A superior lumbar hernia, which is also known as a Grynfeltt hernia, is a rare abdominal wall defect that can be primary or secondary to trauma or orthopedic surgery. The anatomic location of a lumbar hernia makes diagnosis and repair challenging. We successfully repaired a lumbar hernia using a single-incision laparoscopic total extraperitoneal approach. To the best of our knowledge, this is the first report of the use of this surgical technique in the treatment of a primary Grynfeltt hernia. CASE PRESENTATION A 76-year-old Taiwanese man presented to our hospital with a left lower bulging mass noted for over three months. Abdominal computed tomography revealed a left Grynfeltt hernia. We performed a single-incision laparoscopic total extraperitoneal repair. Our patient was discharged uneventfully on the fourth day after the operation. There was no evidence of recurrence after six months of follow-up. CONCLUSION A laparoscopic total extraperitoneal repair for a lumbar hernia provides an excellent operative view and minimal invasiveness. The single-incision technique also provides better cosmetic outcomes. Our experience suggests that the single-incision laparoscopic total extraperitoneal approach may be a feasible and safe alterative to conventional approaches in lumbar hernia repair.


title: Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study.

text: BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) is a feasible technique that provides comparable results to standard laparoscopic cholecystectomy (LC). However, despite the theoretical advantages of minor wound complications and cosmetic results, SILC usually requires a larger incision, which may increase the incidence of incisional hernias. This study evaluated SILC and standard multiport cholecystectomy with respect to perioperative outcomes, hospital stay, cosmetic results, and postoperative complications, including the 5-year incisional hernia rate. METHODS A cohort study was performed with patients who underwent elective laparoscopic surgery for noncomplicated cholelithiasis at our hospital between July 2009 and June 2011. During the study period, there were 45 nonselected patients who underwent SILC, and these patients were compared with a control group of 140 patients who underwent LC using the standard three-trocar technique during the same period. Both patient groups were comparable in age, gender, BMI and ASA classification. RESULTS The mean follow-up was 58.7 ± 10.9 (range 3-80) months. There were no differences between groups in terms of hospital stay, rate and severity of complications, wound infection, and patient cosmetic satisfaction. However, the operating time (57.8 versus 35.2 min) and long-term incisional hernia rate (13.3% versus 4.7%) were significantly higher in the SILC group. CONCLUSION SILC is associated with a statistically significantly higher long-term incisional hernia rate at the umbilical port site than the standard multiport laparoscopic cholecystectomy. Our data show there was no relevant advantage regarding the postoperative course, hospital stay or cosmetic satisfaction. To date, widespread use of SILC cannot be recommended. Registration number: NCT03768661 ( https://www.clinicaltrials.gov ). TRIAL REGISTRATION This study has been registered at www.clinicaltrials.gov . The clinicaltrials.gov ID number is: NCT03768661.


title: Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department.

text: BACKGROUND Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates. METHODS This was a quality improvement initiative using a pre/post design. Phase 1 (PRE1) comprised patients before intensive care unit (ICU) bundle deployment. Phase 2 (PRE2) occurred after ICU but before ED deployment. Phase 3 (POST) included patients received VAP prevention starting at ED intubation. Log-rank test for equality and Cox regression using a Breslow method for ties were performed. Bundle compliance was reported as percentages. Number needed to treat (NNT) was calculated by ventilator day. RESULTS PRE1, PRE2, and POST groups were composed of 195, 192, and 153 patients, respectively, with VAP rates of 22 (11.3%), 11 (5.7%), and 6 (3.9%). Log-rank test showed significant reduction in VAP (χ2 = 9.16, P = .0103). The Cox regression hazard ratio was 1.38 for the Clinical Pulmonary Infection Score (P = .001), and the hazard ratio was 0.26 for the VAP bundle (P = .005). Bundle compliance >50% for head-of-bed elevation, oral care, subglottic suctioning, and titrated sedation improved significantly with introduction of a registered nurse champion. NNT varied from 7 to 11. CONCLUSIONS VAP was common for ED intubated patients. ED-based VAP prevention is feasible. We demonstrate significant reduction in VAP rates, which should be replicated in a multicenter study.


title: Robot-assisted sacrocolpopexy for pelvic organ prolapse: surgical technique and outcomes at a single high-volume institution.

text: BACKGROUND Pelvic organ prolapse (POP) represents a common female pelvic floor disorder that has a serious impact on quality of life. Several types of procedures with different surgical approaches have been described to correct these defects, but the optimal management is still debated. OBJECTIVE To describe our surgical technique of robot-assisted sacrocolpopexy (RASC) for POP and to assess its safety and long-term outcomes. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of the medical records of 95 consecutive patients who underwent RASC for POP at our centre from April 2006 to December 2011 was performed. SURGICAL PROCEDURE RASC with use of polypropylene meshes was performed in all cases using a standardised technique with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) in a four-arm configuration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications, and outcomes of RASC were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS Median operative time was 101 min. No conversion to open surgery was needed. One vaginal and two bladder injuries occurred and were repaired intraoperatively. Only one Clavien grade 3 postoperative complication was observed (bowel obstruction treated laparoscopically). At a median follow-up of 34 mo, persistent POP was observed in four cases (4.2%). One mesh erosion occurred and required robot-assisted removal of the mesh. Ten (10.5%) patients complained de novo urgency after RASC, which resolved in the first few weeks after surgery. No significant de novo bowel or sexual symptoms were reported. CONCLUSIONS Our technique of RASC for correction of POP is safe and effective, with limited risk of complications and good long-term results in the treatment of all types of POP. The robotic surgical system facilitates precise and accurate placement of the meshes with short operative time, thereby favouring wider diffusion of minimally invasive treatment of POP. PATIENT SUMMARY We studied the treatment of patients with vaginal prolapse by using a robot-assisted surgical technique to fix the vaginal wall with a synthetic mesh. This technique was found to be safe and effective, with limited risk of complications and good long-term results.


title: Long Parallel Stent Grafts for the Treatment of Complex Aortic Aneurysms.

text: PURPOSE To describe our experience with the chimney technique in endovascular aneurysm repair (ch-EVAR) using long parallel grafts (PGs) of 100 mm or more for the treatment of complex aortic aneurysms. MATERIALS AND METHODS From 2009 to 2016, data were prospectively collected for patients who underwent ch-EVAR using long PGs. Data included patient demographics and aortic anatomy, technical success, patency and reintervention rate. RESULTS A total of 29 long PGs were placed in 18 patients (males 16, average age 71 years). Nine (50%) suffered from thoracoabdominal aortic aneurysms, 4 (22%) from juxtarenal aortic aneurysms and 3 (17%) from suprarenal aortic aneurysms and 2 (11%) were treated for abdominal aortic aneurysms that required revascularization of a pelvic kidney. Twenty (70%) of the PGs were 100 mm in length, and 9 (30%) were 150 mm. Long PGs were successfully placed in 16 (89%) patients. Two patients (11%) expired in the perioperative period. Mean period of follow-up was 12 months (range 1-43 months). Sac size decreased in size or remained unchanged in 13 patients (72%). Three patients with sac enlargement underwent successful endovascular treatment the type 1A gutter endoleaks. None required reintervention of the PGs. Three patients expired, none from aneurysm-related deaths. CONCLUSION The use of long PGs is a feasible technique and provides a durable repair of complex aortic aneurysms in midterm follow-up. Despite the length of the PGs, gutter endoleaks are encountered only in a minority of the cases and can be treated minimally invasive techniques.


title: Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: A randomized controlled trial.

text: BACKGROUND Low-carbohydrate (LC) and high-fat, low-carbohydrate (HFLC) dietary preparations may enhance (18)F-FDG-PET-based imaging of small, inflamed structures near the heart by suppressing myocardial FDG signal. We compared myocardial (18)F-FDG uptake in patients randomized to LC, HFLC, and unrestricted (UR) preparations prior to (18)F-FDG-PET. METHODS AND RESULTS We randomized 63 outpatients referred for oncologic (18)F-FDG-PET to LC, HFLC, or UR dietary preparations (1:1:1 allocation) starting the evening before PET. After eating dinner according to instructions, UR and LC patients fasted until FDG injection (mean time 745 minutes for UR, 899 minutes for LC), and HFLC patients drank a fatty drink 60-70 minutes prior to FDG injection. Attenuation-corrected PET imaging was performed 60 minutes after FDG administration. Maximal myocardial standard uptake values (MyoSUV(max)) were systematically measured in axial view and compared between the three groups. Using UR patients as reference, mean MyoSUV(max) was lower in LC patients (3.3 +/- 2.7 vs 6.2 +/- 5.2, P = .03) but not in HFLC patients (5.5 +/- 4.2, P = .63). Ratios of MyoSUV(max) to liver SUV(max), calculated to control for background uptake, were not significantly different amongst the groups (1.9 +/- 2.1 LC, 2.6 +/- 2.3 HFLC, 3.6 +/- 3.5 UR). CONCLUSION In this small randomized controlled trial using UR diet as reference, LC dietary preparation followed by extended fasting resulted in significant myocardial uptake suppression.


title: Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience.

text: The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians' needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.


title: Laboratory practices to mitigate biohazard risks during the COVID-19 outbreak: an IFCC global survey.

text: Objectives A global survey was conducted by the IFCC Task Force on COVID-19 to better understand how general biochemistry laboratories manage the pre-analytical, analytical and post-analytical processes to mitigate biohazard risks during the coronavirus disease 2019 (COVID-19) pandemic. Methods An electronic survey was developed to record the general characteristics of the laboratory, as well as the pre-analytical, analytical, post-analytical and operational practices of biochemistry laboratories that are managing clinical samples of patients with COVID-19. Results A total of 1210 submissions were included in the analysis. The majority of responses came from hospital central/core laboratories that serve hospital patient groups and handle moderate daily sample volumes. There has been a decrease in the use of pneumatic tube transport, increase in hand delivery and increase in number of layers of plastic bags for samples of patients with clinically suspected or confirmed COVID-19. Surgical face masks and gloves are the most commonly used personal protective equipment (PPE). Just >50% of the laboratories did not perform an additional decontamination step on the instrument after analysis of samples from patients with clinically suspected or confirmed COVID-19. A fifth of laboratories disallowed add-on testing on these samples. Less than a quarter of laboratories autoclaved their samples prior to disposal. Conclusions The survey responses showed wide variation in pre-analytical, analytical and post-analytical practices in terms of PPE adoption and biosafety processes. It is likely that many of the suboptimal biosafety practices are related to practical local factors, such as limited PPE availability and lack of automated instrumentation.


title: Robot-Assisted Myomectomy for Large Uterine Myomas: A Single Center Experience.

text: Objective. To determine if robot-assisted myomectomy (RAM) is feasible for women with large uterine myomas. Methods. Retrospective review of one gynecologic surgeon's RAM cases between May 2010 and July 2013. Large uterine myomas, defined as the largest myoma ≥9 cm by preoperative magnetic resonance imaging, was age- and time-matched to controls with the largest myoma <9 cm. Primary surgical outcomes compared were operative time and estimated blood loss (EBL). Results. 207 patients were included: 66 (32%) patients were in the ≥9 cm group, while 141 (68%) patients were in the <9 cm group. There was a statistically significant increase in the operative time (130 min versus 92 min) and EBL (100 mL versus 25 mL) for the ≥9 cm group compared to the <9 cm group. Ten (4.8%) patients had the largest myoma measuring ≥15 cm, and 11 (5.3%) patients had a specimen weight >900 gm, of which no major adverse outcomes were observed. All patients in the study cohort were discharged on the same day after surgery. Conclusion. RAM is a feasible surgical approach for patients with myomas ≥9 cm. Patients with large myomas undergoing RAM are also candidates for same-day discharge after surgery.


docid: lyykttke

title: Early postoperative outcomes and medication cost savings after laparoscopic sleeve gastrectomy in morbidly obese patients with type 2 diabetes.

text: Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, P < 0.001). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings.


title: Randomized clinical trial of ropivacaine wound infusion following laparoscopic colorectal surgery.

text: BACKGROUND Wound infusions with local anaesthesia have been used with varying success following laparotomy for colonic resections. This trial sought to determine the efficacy of ropivacaine wound infusion following laparoscopic colonic surgery. METHODS Forty-eight consecutive patients undergoing elective laparoscopic colorectal resection were randomized to receive either a local anaesthetic wound infusion (ropivacaine 0.5%) or normal saline for a period of 72 h. The primary endpoint was postoperative pain as assessed by analgesic consumption, while secondary endpoints assessed were visual analogue pain scores, respiratory function, gastrointestinal function, length of stay and postoperative complications. RESULTS There was no difference in mean postoperative analgesic consumption between the two groups over 72 h (143 mEq morphine control vs 94 mEq intervention; p = 0.108). Likewise, there was no difference in daily postoperative analgesic consumption or visual analogue pain scores between the two groups. Patients in the ropivacaine group experienced less reduction in their postoperative forced expiratory volume at 1 s on day 1 (mean difference FEV1 0.4 l; p = 0.015). There was no difference between the two groups with respect to return of gut function and postoperative complications. CONCLUSIONS In this study, local anaesthetic wound infusion with ropivacaine following elective laparoscopic colorectal surgery improves early respiratory function, but does not appear to provide an improvement in postoperative analgesia or other clinically relevant postoperative outcomes.


title: Single-step multimodal locoregional treatment for unresectable hepatocellular carcinoma: balloon-occluded percutaneous radiofrequency thermal ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE).

text: PURPOSE This study was undertaken to evaluate the feasibility, safety and efficacy of a new combined single-step therapy in patients with unresectable multinodular unilobar hepatocellular carcinoma (HCC), with at least one lesion >3 cm, with balloon-occluded radiofrequency ablation (BO-RFA) plus transcatheter arterial chemoembolization (TACE) of the main lesion and TACE of the other lesions. The second purpose of our study was to compare the initial effects in terms of tumour necrosis of this new combined therapy with those obtained in a matched population treated with TACE alone in a singlestep treatment in our centre in the previous year. METHODS AND MATERIALS This pilot study was approved by the institutional review board, and informed consent was obtained from all patients. Ten consecutive patients with multinodular (two to six nodules) unilobar unresectable HCC and with a main target lesion >3 cm (range, 3.5-6 cm) not suitable for curative therapy were enrolled in our single-centre multidisciplinary pilot study. The schedule consisted of percutaneous RFA (single 3-cm monopolar needle insertion) of the target lesion during occlusion of the hepatic artery supplying the tumour, followed by selective TACE, plus lobar TACE for other lesions (450-mg carboplatin and lipiodol plus temporary embolisation with SPONGOSTAN). Adverse events and intra- and periprocedural complications were clinically assessed. Early local efficacy was evaluated on 1-month follow-up multiphasic computed tomography (CT) on the basis of the Modified Response Evaluation Criteria in Solid Tumors (m-RECIST). A separate evaluation of target lesions in terms of enhancement, necrotic diameter and presence and distribution of lipiodol uptake was also performed. RESULTS No major complications occurred. Overall technical success, defined as complete devascularisation of all nodules during the arterial phase, was achieved in seven of 10 patients, with three cases of partial response (persistence of small hypervascular nodules). When considering only target lesions, technical success was obtained in all patients, with a nonenhancing area corresponding in shape to the previously identified HCC (necrotic diameter, 3.5-5 cm) and with circumferential peripheral lipiodol uptake (safety margin) of at least 0.5 cm (0.5-1.3cm). CONCLUSIONS TACE and BO-RFA, plus TACE in a singlestep approach seems to be a safe and effective combined therapy for treating advanced, unresectable HCC lesions, allowing a high rate of complete local response to be achieved in large lesions also.


docid: iwhdlrbx

title: Canine adenovirus type 1 and Pasteurella pneumotropica co‑infection in a puppy.

text: In 2008, a 2 months-old male German shepherd was presented with fever, depression, and evident organic wasting. The puppy died within 48 hours after the onset of clinical signs. A complete necropsy was performed. Bacteriological examination of samples from the brain, lung, liver, spleen, and bone marrow tested positive for Pasteurella pneumotropica. Histopathology demonstrated inflammatory and vascular lesions in the central nervous system and internal organs. Canine adenovirus type 1 nucleic acid was detected by polymerase chain reaction in the frozen brain but not in the formalin-fixed, paraffin-embedded liver and lung samples. The positive PCR was subsequently confirmed by indirect fluorescent antibody testing of the paraffin-embedded brain and liver sections. Although the liver is the primary site of viral damage, these laboratory findings suggest that Canine adenovirus type 1 infection should be included in the differential diagnosis of neuropathological diseases in dogs and that adenoviral infections could promote septicaemia caused by opportunistic pathogens.


title: Monitoring tissue blood flow and oxygenation: a brief review of emerging techniques.

text: This article describes promising emerging technologies developed for measuring tissue-level oxygenation or perfusion, each with its own inherent limitations. The end user must understand what the instrument measures and how to interpret the readings. Optical monitoring using near-infrared spectrometry, Doppler shift, and videomicroscopy are discussed in terms of their application at the tissue level. Assessment of the metabolic state of the extracellular space with existing technology and proxy indicators of metabolic status are discussed. Also addressed are potential sources of variation for each technique, and the role that the clinician plays in the proper interpretation of the data.


title: Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy: 3 consecutive cases.

text: OBJECTIVE We report the feasibility and the technique of single-port extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer. METHODS The same single port was used for the transperitoneal step (to discriminate intraperitoneal disease) and the extraperitoneal approach used thereafter (in the absence of peritoneal or ovarian spread) for the lymphadenectomy. Para-aortic lymphadenectomy was performed via the left-sided extraperitoneal approach by a 2- to 3-cm incision, which was made 1 cm above the usual incision to the left of McBurney's point. We used conventional instruments in all cases. RESULTS Three consecutive patients with cervical cancer had undergone a pretherapeutic laparoscopic staging procedure (1 stage IB2 and 2 stage IIB). The histologic types were squamous carcinoma (n = 2) and adenocarcinoma (n = 1). No patients had pelvic or para-aortic uptakes on preoperative positron emission tomography computed tomography imaging. The mean operative time was 223 minutes (range, 210-250 minutes). The mean number of lymph nodes removed was 19 (range, 15-23). The definitive pathological analysis had revealed that one patient had metastatic disease. No failures occurred with the single-port procedure, and no conversion to conventional multiport laparoscopy was reported. CONCLUSIONS This preliminary series reports on the feasibility of the para-aortic lymphadenectomy technique via the extraperitoneal approach with a multichannel single port using conventional instruments. Nevertheless, the safety of this procedure (compared to conventional laparoscopic approach) needs to be explored in a further larger study.


docid: nnsiexme

title: Endovascular therapy of extracranial carotid artery pseudoaneurysms: case series and literature review.

text: BACKGROUND Experience with endovascular therapy of extracranial carotid artery pseudoaneurysm (ECAP) has been growing, and various results suggest it as a suitable treatment option. We present a consecutive case series of patients with ECAPs treated with endovascular therapy, and a pertinent literature review. METHODS A prospectively maintained database of neuroendovascular procedures was retrospectively reviewed for cases of ECAP treated between January 2007 and December 2012. The primary outcome of interest was incidence of periprocedural (within 30 days) neurologic and cardiopulmonary complications. PubMed was searched for relevant endovascular studies from 2000 to 2012 for the review. RESULTS In our series, 12 patients with 14 ECAPs received stents, with or without coils. No perioperative neurologic or cardiopulmonary complications occurred. Median duration of clinical follow-up was 6.25 months (range 0-50 months), and median duration of imaging follow-up was 6.25 months (range 0-50 months), with eight patients asymptomatic and three showing improved symptoms (one patient with two lesions was lost to follow-up). Literature review revealed an overall primary outcome of 8.6% and no procedure related deaths. CONCLUSIONS Endovascular treatment of ECAP is safe and effective at improving symptoms. There were no perioperative or permanent neurologic sequelae in the 11 patients with follow-up, and all symptomatology related to ECAP improved or resolved with treatment.


title: Glycyrrhizin inhibits human parainfluenza virus type 2 replication by the inhibition of genome RNA, mRNA and protein syntheses.

text: The effect of glycyrrhizin on the replication of human parainfluenza virus type 2 (hPIV-2) was examined. Cell fusion induced by hPIV-2 was inhibited by glycyrrhizin, and glycyrrhizin reduced the number of viruses released from the cells. Glycyrrhizin did not change cell morphology at 1 day of culture, but caused some damage at 4 days, as determined by the effect on actin microfilaments. However, it affected the cell viability at 1 day: about 20% of the cells were not alive by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay at 1 day of culture. Real-time polymerase chain reaction (PCR) and PCR showed that virus genome synthesis was largely inhibited. mRNA synthesis was also inhibited by glycyrrhizin. Viral protein synthesis was largely inhibited as observed by an indirect immunofluorescence study. Multinucleated giant cell formation was studied using a recombinant green fluorescence protein (GFP)-expressing hPIV-2 without matrix protein (rhPIV-2ΔMGFP). A few single cells with fluorescence were observed, but the formation of giant cells was completely blocked. Taken together, it was shown that viral genome, mRNA and protein syntheses, including F and HN proteins, were inhibited by glycyrrhizin, and consequently multinucleated giant cell formation was not observed and the infectious virus was not detected in the culture medium.


title: Detection of Potential Infectious Enteric Viruses in Fresh Produce by (RT)-qPCR Preceded by Nuclease Treatment.

text: Foodborne illnesses associated with contaminated fresh produce are a common public health problem and there is an upward trend of outbreaks caused by enteric viruses, especially human noroviruses (HNoVs) and hepatitis A virus (HAV). This study aimed to assess the use of DNase and RNase coupled to qPCR and RT-qPCR, respectively, to detect intact particles of human adenoviruses (HAdVs), HNoV GI and GII and HAV in fresh produce. Different concentrations of DNase and RNase were tested to optimize the degradation of free DNA and RNA from inactivated HAdV and murine norovirus (MNV), respectively. Results indicated that 10 µg/ml of RNase was able to degrade more than 4 log10 (99.99%) of free RNA, and 1 U of DNase degraded the range of 0.84-2.5 log10 of free DNA depending on the fresh produce analysed. The treatment with nucleases coupled to (RT)-qPCR was applied to detect potential infectious virus in organic lettuce, green onions and strawberries collected in different seasons. As a result, no intact particles of HNoV GI and GII were detected in the 36 samples analysed, HAdV was found in one sample and HAV was present in 33.3% of the samples, without any reasonable distribution pattern among seasons. In conclusion, RT-qPCR preceded by RNase treatment of eluted samples from fresh produce is a good alternative to detect undamaged RNA viruses and therefore, potential infectious viruses. Moreover, this study provides data about the prevalence of enteric viruses in organic fresh produce from Brazil.