title: Health assessment of wild lowland tapir (Tapirus terrestris) populations in the Atlantic Forest and Pantanal biomes, Brazil (1996-2012).

text: Abstract The lowland tapir (Tapirus terrestris) is found in South America and is listed as Vulnerable to Extinction by the International Union for Conservation of Nature, Red List of Threatened Species. Health issues, particularly infectious diseases, are potential threats for the species. Health information from 65 wild tapirs from two Brazilian biomes, Atlantic Forest (AF) and Pantanal (PA), were collected during a long-term study (1996-2012). The study included physic, hematologic and biochemical evaluations, microbiologic cultures, urinalysis, and serologic analyses for antibodies against 13 infectious agents (viral and bacterial). The AF and PA tapirs were significantly different for several hematologic and biochemical parameters. Ten bacteria taxa were identified in the AF and 26 in the PA. Antibodies against five viruses were detected: Bluetongue virus, eastern equine encephalitis virus, western equine encephalitis virus, infectious bovine rhinotracheitis virus, and porcine parvovirus. A high prevalence of exposure to Leptospira interrogans (10 serovars: Autumnalis, Bratislava, Canicola, Copenhageni, Grippotyphosa, Hardjo, Hebdomadis, Icterohaemorrhagiae, Pomona, and Pyrogenes) was detected in both the AF and PA sites. A greater diversity of serovars and higher antibody titers were found in the PA. Statistically significant differences between sites were found for L. interrogans, equine encephalitis virus, and porcine parvovirus. Based on physical evaluations, both AF and PA populations were healthy. The differences in the overall health profile of the AF and PA tapir populations appear to be associated with environmental factors and infectious diseases ecology. The extensive datasets on hematology, biochemistry, urinalysis, and microbiology results from this paper can be used as reference values for wild tapirs.


title: Impact of the COVID-19 Pandemic on Orthopaedic and Trauma Surgery in University Hospitals in Germany: Results of a Nationwide Survey.

text: BACKGROUND The purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges. METHODS In this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated. RESULTS Communication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments. CONCLUSIONS Our study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments. CLINICAL RELEVANCE To our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.


docid: tokkxubx

title: Hypothermic Neuronal Rescue from Infection-Sensitised Hypoxic-Ischaemic Brain Injury Is Pathogen Dependent.

text: Perinatal infection increases the vulnerability of the neonatal brain to hypoxic-ischaemic (HI) injury. Hypothermia treatment (HT) does not provide neuroprotection after pre-insult inflammatory sensitisation by lipopolysaccharide (LPS), a gram-negative bacterial wall constituent. However, early-onset sepsis in term babies is caused by gram-positive species in more than 90% of cases, and neuro-inflammatory responses triggered through the gram-negative route (Toll-like receptor 4, TLR-4) are different from those induced through the gram-positive route via TLR-2. Whether gram-positive septicaemia sensitises the neonatal brain to hypoxia and inhibits the neuroprotective effect of HT is unknown. Seven-day-old Wistar rats (n = 178) were subjected to intraperitoneal injections of PAM3CSK4 (1 mg/kg, a synthetic TLR-2 agonist) or vehicle (0.9% NaCl). After an 8-h delay, the left carotid artery was ligated followed by 50 min of hypoxia (8% O2) at a rectal temperature of 36°C. Pups received a 5-h treatment of normothermia (NT, 37°C) or HT (32°C) immediately after the insult. Brains were harvested after 7 days' survival for hemispheric and hippocampal area loss analyses and immunolabelling of microglia (Iba1) and hippocampal neurons (NeuN). Normothermic PAM3CSK4-injected animals showed significantly more brain injury than vehicle animals (p = 0.014). Compared to NT, HT significantly reduced injury in the PAM3CSK4-injected animals, with reduced area loss (p < 0.001), reduced microglial activation (p = 0.006), and increased neuronal rescue in the CA1 region (p < 0.001). Experimental induction of a sepsis-like condition through the gram-positive pathway sensitises the brain to HI injury. HT was highly neuroprotective after the PAM3CSK4-triggered injury, suggesting HT may be neuroprotective in the presence of a gram-positive infection. These results are in strong contrast to LPS studies where HT is not neuroprotective.


docid: bqufyfsg

title: COVID-19 and Iranian Medical Students; A Survey on Their Related-Knowledge, Preventive Behaviors and Risk Perception.

text: BACKGROUND Since December 2019, a novel coronavirus disease (COVID-19) began its journey around the world. Medical students, as frontline healthcare workers, are more susceptible to be infected by the virus. The aim of this study was to assess COVID-19 related knowledge, self-reported preventive behaviors and risk perception among Iranian medical students within the first week after the onset of the outbreak in Iran. METHODS This cross-sectional study was conducted from 26th to 28th of February, 2020. Participants were Iranian medical students (5th-7th year) whose knowledge, preventive behaviors and risk perceptions of COVID-19 were assessed using an online questionnaire. The questionnaire consisted of 26 questions including 15 items about COVID-19 related knowledge, 9 items regarding preventive measures and 2 items about COVID-19 risk perception. The validity and reliability of the questionnaire were shown to be satisfactory. RESULTS A total of 240 medical students completed the questionnaire. The mean age of participants was 23.67 years. The average of correct answers of knowledge was 86.96%; and 79.60% had high level of related knowledge. The average rate of practicing preventive behaviors was 94.47%; and 94.2% had high level of performance in preventive behaviors. The cumulative score of risk perception was 4.08 out of 8 which was in moderate range. Risk perception was significantly different between stagers and interns and between those being trained in emergency room (ER) and non-ER wards. There was a significant negative correlation between preventive behaviors and risk perception. CONCLUSION We found a high level of COVID-19 related knowledge and self-reported preventive behaviors and moderate risk perception among Iranian medical students.


title: Buyang Huanwu decoction facilitates neurorehabilitation through an improvement of synaptic plasticity in cerebral ischemic rats.

text: BACKGROUND Loss of neural function is a critical but unsolved issue after cerebral ischemia insult. Neuronal plasticity and remodeling are crucial for recovery of neural functions after brain injury. Buyang Huanwu decoction, which is a classic formula in traditional Chinese medicine, can positively alter synaptic plasticity. This study assessed the effects of Buyang Huanwu decoction in combination with physical exercise on neuronal plasticity in cerebral ischemic rats. METHODS Cerebral ischemic rats were administered Buyang Huanwu decoction and participated in physical exercise after the induction of a permanent middle cerebral artery occlusion. The neurobehavioral functions and infarct volumes were evaluated. The presynaptic (SYN), postsynaptic (GAP-43) and cytoskeletal (MAP-2) proteins in the coronal brain samples were evaluated by immunohistochemistry and western blot analyses. The ultrastructure of the neuronal synaptic junctions in the same region were analyzed using transmission electron microscopy. RESULTS Combination treatment of Buyang Huanwu decoction and physical exercise ameliorated the neurobehavioral deficits (p < 0.05), significantly enhanced the expression levels of SYN, GAP-43 and MAP-2 (p < 0.05), and maintained the synaptic ultrastructure. CONCLUSIONS Buyang Huanwu decoction facilitated neurorehabilitation following a cerebral ischemia insult through an improvement in synaptic plasticity. Graphical abstract The Buyang Huanwu decoction (BYHWD) combined with physical exercise (PE) attenuates synaptic disruption and promotes synaptic plasticity following cerebral ischemia (stroke).


docid: oixlgyxe

title: Is asthma an exclusionary condition for SARS-CoV-2 infection in China?

text: During the COVID-19 outbreak, asthma was very rare in China, and there were significant differences from previous clinical perceptions and the data from American, and we analyzed the possible causes.


title: [Application and thinking of health standards related to public health in prevention and control of coronavirus disease 2019].

text: Objective: To systematically analyze the basic characteristics and contents of the current health standards for infectious disease, environmental health, school health and disinfection in the context of COVID-19 prevention and control, and provide support for the further optimization of epidemic prevention and control guidelines and reference for the revision and improvement of related health standards. Methods: Public health standards used in COVID-19 prevention and control were selected for a systematic comparison with "The Plan of COVID19 Prevention and Control" (the 6th Edition) and other epidemic prevention and control guidelines from the perspectives of application scope and technical elements. Results: The current standards of public health are with scientificity, timeliness and feasibility. The application scope and technical elements of the current public health standards basically meet the needs of the prevention and control of COVID-19 epidemic, but the public health standardization system still needs improvement, and some public health standards need to be revised. Conclusions: The implementation of current public health standards can provide strong technical support for the prevention and control of COVID-19 epidemic. The experience obtained from COVID-19 epidemic prevention and control might promote the further improvement of the health standardization system.


title: Coronavirus disease 2019 among pregnant Chinese women: Case series data on the safety of vaginal birth and breastfeeding.

text: OBJECTIVE To assess whether vaginal secretions and breast milk of COVID-19 patients contain SARS-CoV-2 virus. DESIGN Single center cohort study. SETTING Renmin Hospital of Wuhan University, Wuhan, Hubei province, China. POPULATION OR SAMPLE We studied 13 COVID-19 infected pregnant women diagnosed between January 31 and March 9, 2020. METHODS We collected clinical data, vaginal secretions and stool specimens, breast milk from COVID-19 infected women during different stages of pregnancy and neonatal throat, anal swabs. MAIN OUTCOME(S) AND MEASURE(S) We assessed viral presence in different biosamples. RESULTS Of the 13 women with COVID-19, 5 were in their first trimester, 3 in their second trimester, and 5 in their third trimester. Of the 5 women during their third trimester who gave birth, all delivered live newborns. Among these 5 deliveries, the primary adverse perinatal outcomes included premature delivery (n = 2) and neonatal pneumonia (n = 2). One of 9 stool samples was positive; and all 13 vaginal secretion samples, and 5 throat swabs and 4 anal swabs collected from newborns were negative for the novel coronavirus. However, 1 of 3 samples of breast milk was positive by viral nucleic acid testing. CONCLUSIONS In this case series of 13 pregnant women with COVID-19, we observed negative viral test results in vaginal secretion specimens, suggesting that a vaginal delivery may be a safe delivery option. However, additional research is urgently needed to examine breast milk and the potential risk for viral contamination.


title: Development of Reliable, Valid and Responsive Scoring Systems for Endoscopy and Histology in Animal Models for Inflammatory Bowel Disease.

text: Background and Aims Although several endoscopic and histopathologic indices are available for evaluating the severity of inflammation in mouse models of colitis, the reliability of these scoring instruments is unknown. Our aim was to evaluate the reliability of the individual items in the existing indices and develop new scoring systems by selection of the most reliable index items. Methods Two observers scored the histological slides [n = 224] and endoscopy videos [n = 201] from treated and untreated Interleukin[IL]-10 knock-out and T-cell transferred SCID mice. Intra-rater and inter-rater reliability for endoscopy and histology scores, and each individual item, were measured using intraclass correlation coefficients [ICCs]. The Mouse Colitis Histology Index [MCHI] and Mouse Colitis Endoscopy Index [MCEI] were developed using the most reliable items. Both were correlated to the colon density and to each other and were evaluated for their ability to detect changes in pathobiology. Results The intraclass correlation coefficients (ICCs) for inter-rater agreement (95% CIs) for the total histology and endoscopy scores were 0.90 [0.87-0.92] and 0.80 [0.76-0.84], respectively. The MCHI and MCEI were highly correlated with colon density, with a Spearman Rho = 0.81[0.75-0.85] and 0.73 [0.66-0.79], respectively, and with each other, Spearman Rho = 0.71 [0.63-0.77]. The MCHI and MCEI were able to distinguish between the experimental groups within the models, with pairwise differences between the treated and untreated groups being statistically significant [p < 0.001]. Conclusions These histological and endoscopic indices are valid and reliable measures of intestinal inflammation in mice, and they are responsive to treatment effects in pre-clinical studies.


Covid-19: medical students and FY1 doctors to be given early registration to help combat covid-19.


title: Spindle-like abdominal wall-lifting device in gasless laparoscopic surgery in animal experiments.

text: INTRODUCTION CO2 pneumoperitoneum has been used to establish an operation space in laparoscopic surgery. It may have some bad consequences, such as respiratory and circulatory system changes, hypotension and hypoxia in infants and the release of free tumor cells into the abdominal cavity. Gasless laparoscopic technique can avoid these adverse effects. But present gasless laparoscopic techniques have their own disadvantages. The main shortcoming of gasless laparoscopic techniques is inadequate operative space. MATERIAL AND METHODS We herein describe a new technique. We used a self-designed spindle-like abdominal wall-lifting device to perform gasless laparoscopic cholecystectomy in seven pigs, recording the operation time, bleeding volume and unexpected occurrences during the operation. RESULTS Seven pigs underwent laparoscopic cholecystectomy using this technique with no conversion to open operation. The operation time was between 21 minutes and 65 minutes, with a mean operative time of 42.5 minutes. The range of bleeding volumes was 2 ml to 8 ml, with a mean operative bleeding volume of 4.3 ml. There were no massive hemorrhages, internal organ injuries or other complications during the operation. CONCLUSIONS These preliminary outcomes indicate that the spindle-like abdominal wall-lifting device is feasible and safe in gasless laparoscopic cholecystectomy, which can provide sufficient exposure of the operative filed.


title: Virus-induced double-membrane vesicles.

text: Many viruses that replicate in the cytoplasm compartmentalize their genome replication and transcription in specific subcellular microenvironments or organelle-like structures, to increase replication efficiency and protect against host cell defences. Recent studies have investigated the complex membrane rearrangements induced by diverse positive-strand RNA viruses, which are of two morphotypes : membrane invagination towards the lumen of the endoplasmic reticulum (ER) or other specifically targeted organelles and double-membrane vesicles (DMVs) formed by extrusion of the ER membrane. DMVs resemble small autophagosomes and the viruses inducing these intriguing organelles are known to promote autophagy, suggesting a potential link between DMVs and the autophagic pathway. In this review, we summarize recent findings concerning the biogenesis, architecture and role of DMVs in the life cycle of viruses from different families and discuss their possible connection to autophagy or other related pathways.


title: Return of spontaneous circulation with a compression:ventilation ratio of 15:2 versus 3:1 in newborn pigs with cardiac arrest due to asphyxia.

text: OBJECTIVE International guidelines recommend a compression to ventilation (C:V) ratio of 3:1 in neonates, and 15:2 for other paediatric age groups. The authors aimed to compare these two C:V ratios in a neonatal swine model of cardiac arrest following asphyxia. DESIGN Experimental animal study. SETTING Facility for animal research. SUBJECTS 22 newborn pigs (age 12-36 h, weight 2.0-2.7 kg). INTERVENTIONS Progressive asphyxia until asystole. Animals were randomised to receive C:V 3:1 (n=11) or 15:2 (n=11). MAIN OUTCOME MEASURES Return of spontaneous circulation (ROSC) was defined as a heart rate ≥ 100 bpm. Also of interest were haemodynamic parameters, cerebral and systemic oxygen saturation and the proinflammatory cytokine interleukin-1β (IL-1β). RESULTS Two animals in each group did not achieve ROSC. Mean (SD) increase in diastolic blood pressure (DBP; mm Hg) during compression cycles was significantly higher at a C:V ratio of 15:2 than 3:1 (7.1 (2.8) vs 4.8 (2.6)). Median time (IQR) to ROSC for the 3:1 group was 150 (140-180) s, and 195 (145-358) s for the 15:2 group. There were no significant differences in the temporal changes in haemodynamic parameters or oxygen saturation indices between the groups. IL-1β levels in cerebrospinal and bronchoalveolar lavage fluid was comparable between the groups. CONCLUSION In neonatal pigs with asphyxia-induced cardiac arrest, the response to a C:V ratio of 15:2 is not better than the response to a C:V ratio of 3:1 despite better generation of DBP during resuscitation.


title: Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up.

text: BACKGROUND Short-term follow-up studies of severe acute respiratory syndrome (SARS) survivors suggested that their physical conditions continuously improved in the first year but that their mental health did not. We investigated long-term psychiatric morbidities and chronic fatigue among SARS survivors. METHODS All SARS survivors from the hospitals of a local region in Hong Kong were assessed by a constellation of psychometric questionnaires and a semistructured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to determine the presence of psychiatric disorders and chronic fatigue problems. RESULTS Of 369 SARS survivors, 233 (63.1%) participated in the study (mean period of time after SARS, 41.3 months). Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, and 27.1% met the modified 1994 Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. Logistic regression analysis suggested that being a health care worker at the time of SARS infection (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.12- 9.39; P = .03), being unemployed at follow-up (OR, 4.71; 95% CI, 1.50-14.78; P = .008), having a perception of social stigmatization (OR, 3.03; 95% CI, 1.20-7.60; P = .02), and having applied to the SARS survivors' fund (OR, 2.92; 95% CI, 1.18-7.22; P = .02) were associated with an increased risk of psychiatric morbidities at follow-up, whereas application to the SARS survivors' fund (OR, 2.64; 95% CI, 1.07-6.51; P = .04) was associated with increased risk of chronic fatigue problems. CONCLUSIONS Psychiatric morbidities and chronic fatigue persisted and continued to be clinically significant among the survivors at the 4-year follow-up. Optimization of the treatment of mental health morbidities by a multidisciplinary approach with a view for long-term rehabilitation, especially targeting psychiatric and fatigue problems and functional and occupational rehabilitation, would be needed.


title: Adipose-derived stem cell collection and characterization in bottlenose dolphins (Tursiops truncatus).

text: To assess the regenerative properties and potential therapeutic value of adipose-derived stem cells (ASCs) in the bottlenose dolphin, there is a need to determine whether an adequate adipose depot exists, in addition to the development of a standardized technique for minimally invasive adipose collection. In this study, an ultrasound-guided liposuction technique for adipose collection was assessed for its safety and efficacy. The ultrasound was utilized to identify and measure the postnuchal adipose depot and aid in the guidance of the liposuction cannula during aspiration. Liposuction procedures from 6 dolphins yielded 0.9-12.7 g of adipose. All samples yielded sufficient nucleated cells to initiate primary cell cultures, and at passage 2, were successfully differentiated into adipogenic, chondrogenic, neurogenic, and osteogenic cell lineages. The cultured dolphin cells expressed known stem-cell-associated CD markers, CD44 and CD90. Ultrasound-guided liposuction proved to be a safe and minimally invasive procedure that resulted in the successful isolation of ASCs in bottlenose dolphins. This is the first article that conclusively establishes the presence of stem cells in the dolphin.


title: Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection.

text: INTRODUCTION Anastomotic leak (AL) is a major complication following anterior resection for colorectal cancer. Early contrast enema may diagnose subclinical anastomotic leakage. Knowledge of factors concerning AL is vital to its detection. The aim of this study was to define the incidence, risks and outcome of radiological leak following routine early contrast enema after anterior resection. METHODS A cohort of 129 patients who underwent anterior resection for colorectal cancer and had an early Gastrografin enema between July 2008 and December 2012 in a tertiary referral centre was identified from a prospective database. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system. RESULTS Of the 129 patients, 65.1 % were male, and the mean age at surgery was 64.6 ± 1.1 years. Gastrografin enema was performed on average on post-operative day 4.8 ± 0.2. Eighteen patients (14.0 %) had a radiological leak on Gastrografin enema, and nine patients (7.0 %) had a clinical AL. On multivariate analysis, only being of male sex and having a loop ileostomy increased the risk of radiological AL. Gastrografin enema had a sensitivity of 100 % (95 % CI 66-100 %) and specificity of 93 % (95 % CI 86-97 %) for predicting clinical AL. Of the 18 patients with radiological leaks, 11 were ISREC grade A, 3 were grade B and 4 were grade C. CONCLUSIONS In the current series, early Gastrografin enema following anterior resection identifies a 14 % radiological leak rate and has a high sensitivity and specificity for predicting clinical AL. The majority of radiological leaks may be managed conservatively.


title: Broad-spectrum inhibition of common respiratory RNA viruses by a pyrimidine synthesis inhibitor with involvement of the host antiviral response.

text: Our previous screening of 50 240 structurally diverse compounds led to the identification of 39 influenza A virus infection inhibitors (Kao R.Y., Yang D., Lau L.S., Tsui W.H., Hu L. et al. Nat Biotechnol 2010;28:600-605). Further screening of these compounds against common respiratory viruses led to the discovery of compound FA-613. This inhibitor exhibited low micromolar antiviral activity against various influenza A and B virus strains, including the highly pathogenic influenza A strains H5N1 and H7N9, enterovirus A71, respiratory syncytial virus, human rhinovirus A, SARS- and MERS-coronavirus. No significant cellular toxicity was observed at the effective concentrations. Animal studies showed an improved survival rate in BALB/c mice that received intranasal FA-613 treatments against a lethal dose infection of A/HK/415742Md/2009 (H1N1). Further cell-based assays indicated that FA-613 interfer with the de novo pyrimidine biosynthesis pathway by targeting the dihydroorotate dehydrogenase. Surprisingly, FA-613 lost its antiviral potency in the interferon-deficient Vero cell line, while maintaining its inhibitory activity in an interferon-competent cell line which showed elevated expression of host antiviral genes when infected in the presence of FA-613. Further investigation of the specific connection between pyrimidine synthesis inhibition and the induction of host innate immunity might aid clinical development of this type of drug in antiviral therapies. Therefore, in acute cases of respiratory tract infections, when rapid diagnostics of the causative agent are not readily available, an antiviral drug with properties like FA-613 could prove to be very valuable.


title: Robotic partial nephrectomy with cold ischemia and on-clamp tumor extraction: recapitulating the open approach.

text: We describe a reproducible technique for achieving cold ischemia with intraoperative tumor assessment during robotic partial nephrectomy (RPN) that recapitulates the open approach: intracorporeal cooling and extraction (ICE). A total of seven patients underwent the ICE modification of RPN by transperitoneal (n=5) and retroperitoneal (n=2) approaches. A Gelpoint access port was used for the camera and assistant ports. Following hilar clamping, ice slush was introduced through the Gelpoint via syringes and applied over the kidney surface. The excised tumor was immediately extracted through the Gelpoint, allowing gross margin assessment by pathology during the renorrhaphy. RPN was achieved in all cases with successful introduction of ice slush and tumor extraction while on clamp. Median RENAL nephrometry score was 8 (range: 6-10), and there was one solitary kidney. Mean cold ischemia time was 19.6 min (range: 8-37) and mean estimated blood loss was 296.4 ml (range: 50-1000). Renal parenchymal temperatures <16°C were achieved within 7 min of cold ischemia and there was no drop in core body temperature >0.5°C during any procedures. Intraoperative assessment of the excised tumor showed adequate gross margins in all cases and final pathology confirmed negative surgical margins.


title: Advances in the management of patients with vascular disease.

text: Now in its 9th year, the Vascular Interventional Advances (VIVA) Symposium has demonstrated comprehensive, objective, cutting-edge continuing education in the field of vascular medicine and intervention. With a faculty representing expertise across all specialties, and using a proprietary system of interactive educations (Laptop Learning), attendees listen to presentations and debates, and watch cases demonstrating state-of-the-art interventions from sites around the world. This year, VIVA attracted some of the most important studies presented by international investigators. In this article details regarding new stent technologies in the aorta, peripheral artery and carotid arteries will be highlighted.


Lack of efficacy of hydroxychloroquine in covid-19.


title: Development of an index to define overall disease severity in IBD.

text: BACKGROUND AND AIM Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC. METHODS Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute. RESULTS For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities. CONCLUSIONS Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.


title: [Application of Electromagnetic Navigation Bronchoscopic Biopsy Combined with Massage Staining in Diagnosis and Treatment of Peripheral Pulmonary Lesion].

text: BACKGROUND Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL). METHODS The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old. RESULTS The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure. CONCLUSIONS The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.


title: Sex differences in immune responses.

text: Males and females differ in their immunological responses to foreign and self-antigens and show distinctions in innate and adaptive immune responses. Certain immunological sex differences are present throughout life, whereas others are only apparent after puberty and before reproductive senescence, suggesting that both genes and hormones are involved. Furthermore, early environmental exposures influence the microbiome and have sex-dependent effects on immune function. Importantly, these sex-based immunological differences contribute to variations in the incidence of autoimmune diseases and malignancies, susceptibility to infectious diseases and responses to vaccines in males and females. Here, we discuss these differences and emphasize that sex is a biological variable that should be considered in immunological studies.


title: Elaboration of a semi-automated algorithm for brain arteriovenous malformation segmentation: initial results.

text: OBJECTIVES The purpose of our study was to distinguish the different components of a brain arteriovenous malformation (bAVM) on 3D rotational angiography (3D-RA) using a semi-automated segmentation algorithm. MATERIALS AND METHODS Data from 3D-RA of 15 patients (8 males, 7 females; 14 supratentorial bAVMs, 1 infratentorial) were used to test the algorithm. Segmentation was performed in two steps: (1) nidus segmentation from propagation (vertical then horizontal) of tagging on the reference slice (i.e., the slice on which the nidus had the biggest surface); (2) contiguity propagation (based on density and variance) from tagging of arteries and veins distant from the nidus. Segmentation quality was evaluated by comparison with six frame/s DSA by two independent reviewers. Analysis of supraselective microcatheterisation was performed to dispel discrepancy. RESULTS Mean duration for bAVM segmentation was 64 ± 26 min. Quality of segmentation was evaluated as good or fair in 93% of cases. Segmentation had better results than six frame/s DSA for the depiction of a focal ectasia on the main draining vein and for the evaluation of the venous drainage pattern. CONCLUSION This segmentation algorithm is a promising tool that may help improve the understanding of bAVM angio-architecture, especially the venous drainage. KEY POINTS • The segmentation algorithm allows for the distinction of the AVM's components • This algorithm helps to see the venous drainage of bAVMs more precisely • This algorithm may help to reduce the treatment-related complication rate.


title: Progress on the induction of neutralizing antibodies against HIV type 1 (HIV-1).

text: Infection with HIV type 1 (HIV-1), the causative agent of AIDS, is one of the most catastrophic pandemics to affect human healthcare in the latter 20th century. The best hope of controlling this pandemic is the development of a successful prophylactic vaccine. However, to date, this goal has proven to be exceptionally elusive. The recent failure of an experimental vaccine in a phase IIb study, named the STEP trial, intended solely to elicit cell-mediated immune responses against HIV-1, has highlighted the need for a balanced immune response consisting of not only cellular immunity but also a broad and potent humoral antibody response that can prevent infection with HIV-1. This article reviews the efforts made up to this point to elicit such antibody responses, especially with regard to the use of a DNA prime-protein boost regimen, which has been proven to be a highly effective platform for the induction of neutralizing antibodies in both animal and early-phase human studies.


Telemedicine-Enabled Accelerated Discharge of Hospitalized COVID-19 Patients to Isolation in Repurposed Hotel Rooms.


docid: drjmsggx

title: [Effect of Xuebijing injection on inflammatory markers and disease outcome of coronavirus disease 2019].

text: OBJECTIVE To observe the influence of Xuebijing injection on the inflammatory markers and prognosis of coronavirus disease 2019 (COVID-19) patients. METHODS Sixty severe COVID-19 patients admitted to Changsha Public Health Treatment Center (North Hospital of the First Hospital of Changsha City) from January to March in 2020 were randomly divided into routine treatment group, Xuebijing 50 mL group and Xuebijing 100 mL group, with 20 cases in each group. The routine treatment group was treated according to the National Health Commission's guide for COVID-19. On the basis of conventional treatment, Xuebijing injection was injected by 50 mL twice a day for 7 days in Xuebijing 50 mL group, while by 100 mL twice a day for 7 days in Xuebijing 100 mL group. The blood routine test, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acute physiology and chronic health evaluation II (APACHE II) score, 2019 novel coronavirus (2019-nCoV) nucleic acid test and disease classification of three groups before and 8 days after treatment were observed. RESULTS (1) After treatment, the white blood cell count (WBC) and lymphocyte count (LYM) of three groups increased, meanwhile CRP and ESR decreased. Compared with routine treatment group, the WBC count of Xuebijing 100 mL group after treatment significantly increased (×109/L: 7.12±0.55 vs. 5.67±0.51, P < 0.05), and the levels of CRP and ESR in Xuebijing 50 mL and 100 mL groups significantly decreased [CRP (mg/L): 32.3±4.6, 28.0±6.2 vs. 37.3±5.9; ESR (mm/1 h): 45.9±5.7, 40.5±7.4 vs. 55.3±6.6, all P < 0.05]. Compared with Xuebijing 50 mL group, the increase of WBC, and the decrease of CRP and ESR were more significant in Xuebijing 100 mL group [WBC (×109/L): 7.12±0.55 vs. 5.82±0.49, CRP (mg/L): 28.0±6.2 vs. 32.3±4.6, ESR (mm/1 h): 40.5±7.4 vs. 45.9±5.7, all P < 0.05]. (2) After treatment, the APACHE II score of three groups decreased. In Xuebijing 100 mL group, the APACHE II score after treatment was significantly lower than those in routine treatment and Xuebijing 50 mL groups (12.3±1.5 vs. 16.5±1.6, 15.9±1.4, both P < 0.05). After treatment, the 2019-nCoV nucleic acid test in three groups partly turned negative, with 9 cases in routine treatment group, 8 cases in Xuebijing 50 mL group and 9 cases in Xuebijing 100 mL group, without significant difference (P > 0.05). The conditions of patients in the three groups were improved after treatment, among them, 8 cases in the routine treatment group were transformed into common type, 1 case into critical type; 9 cases and 12 cases of Xuebijing 50 mL group and 100 mL group were transformed into common type respectively. Xuebijing 100 mL group was improved more obviously than Xuebijing 50 mL group and routine treatment group (both P < 0.05). CONCLUSIONS The Xuebijing injection can effectively improve the inflammatory markers and prognosis of severe COVID-19 patients.


title: Ongoing outbreak of human adenovirus-associated acute respiratory illness in the Republic of Korea military, 2013 to 2018.

text: Background/Aims Human adenovirus type 55 (HAdV-55), an emerging epidemic strain, has caused several large outbreaks in the Korean military since 2014, and HAdV-associated acute respiratory illness (HAdV-ARI) has been continuously reported thereafter. Methods To evaluate the epidemiologic characteristics of HAdV-ARI in the Korean military, we analyzed respiratory virus polymerase chain reaction (RV-PCR) results, pneumonia surveillance results, and severe HAdV cases from all 14 Korean military hospitals from January 2013 to May 2018 and compared these data with nationwide RV surveillance data for the civilian population. Results A total of 14,630 RV-PCRs was performed at military hospitals. HAdV (45.4%) was the most frequently detected RV, followed by human rhinovirus (12.3%) and influenza virus (6.3%). The percentage of the military positive for HAdV was significantly greater than the percentage of civilians positive for HAdV throughout the study period, with a large outbreak occurring during the winter to spring of 2014 to 2015. The outbreak continued until the end of the study, and non-seasonal detections increased over time. The reported number of pneumonia patients also increased during the outbreak. Case fatality rate was 0.075% overall but 15.6% in patients with respiratory failure. The proportion of severe patients did not change significantly during the study period. Conclusions A large HAdV outbreak is currently ongoing in the Korean military, with a trend away from seasonality, and HAdV-55 is likely the predominant strain. Persistent efforts to control the outbreak, HAdV type-specific surveillance, and vaccine development are required.


Monitoring of patients with systemic lupus erythematosus during the COVID-19 outbreak.


title: Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy.

text: Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy. Design, Setting, and Participants Retrospective case series of 1591 consecutive patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinator center (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network and treated at one of the ICUs of the 72 hospitals in this network between February 20 and March 18, 2020. Date of final follow-up was March 25, 2020. Exposures SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcomes and Measures Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Data were recorded by the coordinator center on an electronic worksheet during telephone calls by the staff of the COVID-19 Lombardy ICU Network. Results Of the 1591 patients included in the study, the median (IQR) age was 63 (56-70) years and 1304 (82%) were male. Of the 1043 patients with available data, 709 (68%) had at least 1 comorbidity and 509 (49%) had hypertension. Among 1300 patients with available respiratory support data, 1287 (99% [95% CI, 98%-99%]) needed respiratory support, including 1150 (88% [95% CI, 87%-90%]) who received mechanical ventilation and 137 (11% [95% CI, 9%-12%]) who received noninvasive ventilation. The median positive end-expiratory pressure (PEEP) was 14 (IQR, 12-16) cm H2O, and Fio2 was greater than 50% in 89% of patients. The median Pao2/Fio2 was 160 (IQR, 114-220). The median PEEP level was not different between younger patients (n = 503 aged ≤63 years) and older patients (n = 514 aged ≥64 years) (14 [IQR, 12-15] vs 14 [IQR, 12-16] cm H2O, respectively; median difference, 0 [95% CI, 0-0]; P = .94). Median Fio2 was lower in younger patients: 60% (IQR, 50%-80%) vs 70% (IQR, 50%-80%) (median difference, -10% [95% CI, -14% to 6%]; P = .006), and median Pao2/Fio2 was higher in younger patients: 163.5 (IQR, 120-230) vs 156 (IQR, 110-205) (median difference, 7 [95% CI, -8 to 22]; P = .02). Patients with hypertension (n = 509) were older than those without hypertension (n = 526) (median [IQR] age, 66 years [60-72] vs 62 years [54-68]; P < .001) and had lower Pao2/Fio2 (median [IQR], 146 [105-214] vs 173 [120-222]; median difference, -27 [95% CI, -42 to -12]; P = .005). Among the 1581 patients with ICU disposition data available as of March 25, 2020, 920 patients (58% [95% CI, 56%-61%]) were still in the ICU, 256 (16% [95% CI, 14%-18%]) were discharged from the ICU, and 405 (26% [95% CI, 23%-28%]) had died in the ICU. Older patients (n = 786; age ≥64 years) had higher mortality than younger patients (n = 795; age ≤63 years) (36% vs 15%; difference, 21% [95% CI, 17%-26%]; P < .001). Conclusions and Relevance In this case series of critically ill patients with laboratory-confirmed COVID-19 admitted to ICUs in Lombardy, Italy, the majority were older men, a large proportion required mechanical ventilation and high levels of PEEP, and ICU mortality was 26%.


title: Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report.

text: Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.


title: Response to the COVID-19 Pandemic: Practical Guide to Rapidly Deploying Home Workstations to Guarantee Radiology Services During Quarantine, Social Distancing, and Stay Home Orders.

text: OBJECTIVE. The purpose of this article is to share an experience in the rapid deployment of home workstations that illustrates a creative solution that transcended typical administrative barriers. CONCLUSION. In response to the global coronavirus disease (COVID-19) pandemic, radiology departments need to rapidly deploy home PACS workstations to facilitate physical distancing and to guarantee radiologic expertise despite possible home quarantining or stay home, work safe orders.


title: Redesigning Primary Care to Address the COVID-19 Pandemic in the Midst of the Pandemic.

text: During a pandemic, primary care is the first line of defense. It is able to reinforce public health messages, help patients manage at home, and identify those in need of hospital care. In response to the COVID-19 pandemic, primary care scrambled to rapidly transform itself and protect clinicians, staff, and patients while remaining connected to patients. Using the established public health framework for addressing a pandemic, we describe the actions primary care needs to take in a pandemic. Recommended actions are based on observed experiences of the authors' primary care practices and networks. Early in the COVID-19 pandemic, tasks focused on promoting physical distancing and encouraging patients with suspected illness or exposure to self-quarantine. Testing was not available and contract tracing was not possible. As the pandemic spread, in-person care was converted to virtual care using telehealth. Practices remained connected to patients using registries to reach out to those at risk for infection, with uncontrolled chronic conditions, or were socially vulnerable. Practices managed most patients with suspected COVID-19 at home. As the pandemic decelerates, practices are now preparing to address the direct and indirect consequences-complications from COVID-19 infections, missed treatment for acute problems, inadequate prevention, uncontrolled chronic disease, mental illness, and greater social needs. Throughout, practices bore tremendous financial burden, laying off staff or even closing at a time when most needed. Primary care must learn from this experience and be ready for the next pandemic. Policymakers and payers cannot fail primary care during their next time of need.


title: Correlation of lung collapse and gas exchange - a computer tomographic study in sheep and pigs with atelectasis in otherwise normal lungs.

text: BACKGROUND Atelectasis can provoke pulmonary and non-pulmonary complications after general anaesthesia. Unfortunately, there is no instrument to estimate atelectasis and prompt changes of mechanical ventilation during general anaesthesia. Although arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt have both been suggested to correlate with atelectasis, studies yielded inconsistent results. Therefore, we investigated these correlations. METHODS Shunt, PaO2 and atelectasis were measured in 11 sheep and 23 pigs with otherwise normal lungs. In pigs, contrasting measurements were available 12 hours after induction of acute respiratory distress syndrome (ARDS). Atelectasis was calculated by computed tomography relative to total lung mass (Mtotal). We logarithmically transformed PaO2 (lnPaO2) to linearize its relationships with shunt and atelectasis. Data are given as median (interquartile range). RESULTS Mtotal was 768 (715-884) g in sheep and 543 (503-583) g in pigs. Atelectasis was 26 (16-47) % in sheep and 18 (13-23) % in pigs. PaO2 (FiO2 = 1.0) was 242 (106-414) mmHg in sheep and 480 (437-514) mmHg in pigs. Shunt was 39 (29-51) % in sheep and 15 (11-20) % in pigs. Atelectasis correlated closely with lnPaO2 (R2 = 0.78) and shunt (R2 = 0.79) in sheep (P-values<0.0001). The correlation of atelectasis with lnPaO2 (R2 = 0.63) and shunt (R2 = 0.34) was weaker in pigs, but R2 increased to 0.71 for lnPaO2 and 0.72 for shunt 12 hours after induction of ARDS. In both, sheep and pigs, changes in atelectasis correlated strongly with corresponding changes in lnPaO2 and shunt. DISCUSSION AND CONCLUSION In lung-healthy sheep, atelectasis correlates closely with lnPaO2 and shunt, when blood gases are measured during ventilation with pure oxygen. In lung-healthy pigs, these correlations were significantly weaker, likely because pigs have stronger hypoxic pulmonary vasoconstriction (HPV) than sheep and humans. Nevertheless, correlations improved also in pigs after blunting of HPV during ARDS. In humans, the observed relationships may aid in assessing anaesthesia-related atelectasis.


title: The prevention of colorectal anastomotic leakage with tissue adhesives in a contaminated environment is associated with the presence of anti-inflammatory macrophages.

text: BACKGROUND Colorectal anastomoses created in a contaminated environment result in a high leakage rate. This study investigated whether using anastomotic sealants (TissuCol(®), Histoacryl(®) Flex, and Duraseal(®)) prevents leakage in a rat peritonitis model. STUDY DESIGN Sixty-seven Wistar rats were divided into control and experimental groups (TissuCol, Histoacryl, and Duraseal groups). Peritonitis was induced 1 day before surgery with the cecal ligation puncture model. On day 0, colonic anastomosis was constructed with sutures and then sealed with no adhesive (control group) or one select adhesive (experimental groups). Bursting pressure, abscess formation, and adhesion severity were evaluated on day 3 or day 14. Hematoxylin and eosin staining and immunohistochemical staining for CD4, CD8, CD206, and iNOS were performed. RESULTS On day 3, bursting pressures of the TissuCol group (120.1 ± 25.3 mmHg), Histoacryl group (117.3 ± 20.2 mmHg), and Duraseal group (123.6 ± 35.4 mmHg) were significantly higher than the that of the control group (24.4 ± 31.7 mmHg, p < 0.001). Abscesses around the anastomosis were found in the control group (6/7) and Duraseal group (2/9) but not in the TissuCol group or Histoacryl group. A higher number of CD206+ cells (M2 macrophages), a lower number of iNOS+ cells (M1 macrophages), a higher M2/M1 index, and a higher CD4+/CD8+ index were seen at the anastomotic site in all experimental groups compared with the control group on day 3. On day 14, abscesses were only found in the control group. Adhesion severity in the Duraseal group was significantly lower than that in the control group (p = 0.001). CONCLUSIONS Anastomotic sealing using TissuCol(®), Histoacryl(®) Flex, or Duraseal(®) seems to be an effective and safe option to prevent leakage in contaminated colorectal surgery. The presence of large numbers of anti-inflammatory macrophages seems to be involved in preventing the leakage.


How covid-19 is accelerating the threat of antimicrobial resistance.


title: The chemical convulsant diisopropylfluorophosphate (DFP) causes persistent neuropathology in adult male rats independent of seizure activity.

text: Organophosphate (OP) threat agents can trigger seizures that progress to status epilepticus, resulting in persistent neuropathology and cognitive deficits in humans and preclinical models. However, it remains unclear whether patients who do not show overt seizure behavior develop neurological consequences. Therefore, this study compared two subpopulations of rats with a low versus high seizure response to diisopropylfluorophosphate (DFP) to evaluate whether acute OP intoxication causes persistent neuropathology in non-seizing individuals. Adult male Sprague Dawley rats administered DFP (4 mg/kg, sc), atropine sulfate (2 mg/kg, im), and pralidoxime (25 mg/kg, im) were monitored for seizure activity for 4 h post-exposure. Animals were separated into groups with low versus high seizure response based on behavioral criteria and electroencephalogram (EEG) recordings. Cholinesterase activity was evaluated by Ellman assay, and neuropathology was evaluated at 1, 2, 4, and 60 days post-exposure by Fluoro-Jade C (FJC) staining and micro-CT imaging. DFP significantly inhibited cholinesterase activity in the cortex, hippocampus, and amygdala to the same extent in low and high responders. FJC staining revealed significant neurodegeneration in DFP low responders albeit this response was delayed, less persistent, and decreased in magnitude compared to DFP high responders. Micro-CT scans at 60 days revealed extensive mineralization that was not significantly different between low versus high DFP responders. These findings highlight the importance of considering non-seizing patients for medical care in the event of acute OP intoxication. They also suggest that OP intoxication may induce neurological damage via seizure-independent mechanisms, which if identified, might provide insight into novel therapeutic targets.


title: Results from the Tack Optimized Balloon Angioplasty (TOBA) study demonstrate the benefits of minimal metal implants for dissection repair after angioplasty.

text: OBJECTIVE The mechanism of angioplasty is disruption of atherosclerotic plaque, which often results in dissections. Dissection after percutaneous transluminal angioplasty (PTA) remains a significant clinical problem and untreated may cause acute occlusion or later restenosis. Stents are used to manage dissections, which is often followed by in-stent restenosis and occasionally stent fracture. Tack (Intact Vascular, Wayne, Pa) implants have minimal metal and low radial force and are specifically designed for dissection repair. This study evaluated Tack implants for treatment of dissections resulting from standard balloon PTA for femoral-popliteal arterial disease. Twelve-month outcomes after Tack treatment of post-PTA dissections are described. METHODS This prospective, single-arm study evaluated patients with ischemia (Rutherford clinical category 2-4) caused by lesions of the superficial femoral and popliteal arteries. Patients were treated with standard balloon angioplasty, and post-PTA dissections were treated with Tacks. The primary end points were core laboratory-adjudicated device technical success, defined as the ability of the Tack implants to resolve post-PTA dissection, and device safety, defined as the absence of new-onset major adverse events. Patients were followed up to 12 months after implantation. RESULTS Tacks were used in 130 patients with post-PTA dissections (74.0% ≥ grade C). Technical success was achieved in 128 (98.5%) patients with no major adverse events at 30 days. The 12-month patency was 76.4%, and freedom from target lesion revascularization was 89.5%. Significant improvement from baseline was observed in Rutherford clinical category (82.8% with grade ≤1) and ankle-brachial index (0.68 ± 0.18 to 0.94 ± 0.15; P < .0001). CONCLUSIONS Tack implant treatment of post-PTA dissection was safe, produced reasonable patency, and resulted in low rates of target lesion revascularization. Tack treatment represents a new, minimal metal paradigm for dissection repair that can safely improve the clinical results associated with PTA.


title: Effectiveness of preventive measures against COVID-19: A systematic review of In Silico modeling studies in indian context.

text: Background In the absence of any approved treatment or vaccine against novel Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) infection, Non-Pharmaceutical Interventions (NPIs) are the cornerstone to prevent the disease, especially in a populous country like India. Objectives To understand the effectiveness of NPIs reported in the contemporary literatures describing prediction models for prevention of the ongoing pandemic of SARS-CoV-2 specifically in Indian population. Methods Original research articles in English obtained through keyword search in PubMed, WHO Global Database for COVID19, and pre-print servers were included in the review. Thematic synthesis of extracted data from articles were done. Results Twenty-four articles were found eligible for the review - four published articles and twenty pre-print articles. Compartmental model was found to be the most commonly used mathematical model; along with exponential, time varying, neural network and cluster kinetic models. Social distancing, specifically lockdown, was the most commonly modelled intervention strategy. Additionally, contact tracing using smartphone application, international travel restriction, increasing hospital/ICU beds, changes in testing strategy were also dealt with. Social distancing along with increasing testing seemed to be effective in delaying the peak of the epidemic and reducing the peak prevalence. Conclusion Although there is mathematical rationality behind implementation of social distancing measures including lockdown, this study also emphasised the importance of other associated measures like increasing tests and increasing the number of hospital and ICU beds. The later components are particularly important during the social mixing period to be observed after lifting of lockdown.


title: The Contour-Early Human Experience of a Novel Aneurysm Occlusion Device.

text: BACKGROUND AND PURPOSE Endosaccular flow disruption is a recognized treatment options for treating both unruptured and ruptured aneurysms. The Contour device is designed to target the neck of an aneurysm and cause flow disruption within the aneurysm hence promoting thrombosis and neo-endothelialization at the neck. This article presents initial experiences with the Contour. METHODS The prospectively maintained database was retrospectively reviewed to identify patients treated with the Contour device. Demographic data, aneurysm characteristics, clinical result, and clinical and radiological follow-up information were recorded. RESULTS The review identified 3 patients (2 female), with 3 unruptured aneurysms, of average age 67 ± 8.7 years (range 62-77 years). The aneurysms were all located in the anterior circulation including one pericallosal, one at the A1-2 junction and one on the ICA bifurcation. The mean average dome height was 7.6 ± 0.62 mm (range 7.1-8.3 mm), dome width 5.7 ± 2 mm (range 3.5-7.5 mm), and neck width 3.6 ± 0.95 mm (range 2.5-4.2 mm). At follow-up angiography two of the aneurysms were completely occluded and one device had displaced into the aneurysm sac due to inappropriate positioning of the device. Of the patients one had minor stroke during the postoperative period but returned to baseline neurology. All patients were mRS 0 at last follow-up. CONCLUSION The Contour is a promising new aneurysm occlusion device. Further studies with longer term follow-up are required to determine the efficacy of this novel device.


title: Use of Myometrium as an Internal Reference for Endometrial and Cervical Cancer on Multiphase Contrast-Enhanced MRI.

text: BACKGROUND Myometrial smooth muscle is normally within the field of view for the gynecological imaging. This study aimed to investigate the use of normal myometrium as an internal reference for endometrial and cervical cancer during multiphase contrast-enhanced magnetic resonance imaging (MCE-MRI) and to explore whether this information regarding tumor enhancement relative to the myometrium could be used to discriminate between endometrial and cervical cancer. METHODS MRI images, before and after contrast enhancement, were analyzed in newly diagnosed cervical (n = 18) and endometrial cancer (n = 19) patients. Signal intensities (SIs) from tumor tissue and non-neoplastic myometrium were measured using imaging software. RESULTS The relative signal for cervical cancer was approximately 30% higher than that of endometrial cancer after contrast administration. The area under receiver operating characteristic curve for SI, relative signal enhancement, and tumor to myometrium contrast ratio (as used to discriminate between cervical cancer and endometrial cancer) was 0.7807, 0.7456 and 0.7895, respectively. There was no difference in SI of the normal myometrium between endometrial and cervical cancer patients prior to and after contrast administration. Using non-tumorous myometrium as an internal reference, the tumor to myometrium contrast ratio was significantly higher in tumor tissue from cervical cancer compared with that from endometrial cancer at 25 s post contrast enhancement (p = 0.0016), with an optimal sensitivity of 72.22% and specificity of 84.21%. CONCLUSION With SI normalized to baseline or normal myometrium, tumor tissue from cervical cancer patients showed significant hyperintensity compared with that of tumor tissue from endometrial cancer patients after contrast enhancement, yielding acceptable performance. The use of the myometrium as an internal reference may provide an alternative method to analyze MCE-MRI data.


title: Risk of COVID-19 in young kidney transplant recipients. Results from a single-center observational study.

text: Coronavirus Disease 2019 (COVID-19) represents a global public health emergency, recently taken on pandemic proportions, with over 2.7 million confirmed cases worldwide(1). Children/young adults seem to have a less severe clinical manifestation of COVID-19 (2), but data on disease susceptibility in pediatric transplant recipients on chronic immunosuppressive therapy are limited (3, 4). This poses major uncertainties regarding pediatric transplant activity and management of anti-rejection therapy.


title: [Early containment strategies and core measures for prevention and control of novel coronavirus pneumonia in China].

text: In December 2019, novel coronavirus pneumonia epidemic occurred in Wuhan, Hubei Province, and spread rapidly across the country. In the early stages of the epidemic, China adopted the containment strategy and implemented a series of core measures around this strategic point, including social mobilization, strengthening case isolation and close contacts tracking management, blocking epidemic areas and traffic control to reduce personnel movements and increase social distance, environmental measures and personal protection, with a view to controlling the epidemic as soon as possible in limited areas such as Wuhan. This article summarizes the background, key points and core measures in the country and provinces. It sent prospects for future prevention and control strategies.


title: Clinical and quantitative computed tomography predictors of response to endobronchial lung volume reduction therapy using coils.

text: Objectives Bronchoscopic lung volume reduction using coils (LVRC) is a well-known treatment option for severe emphysema. The purpose of this study was to identify quantitative computed tomography (QCT) and clinical parameters associated with positive treatment outcome. Patients and methods The CT scans, pulmonary function tests (PFT), and 6-minute walk test (6-MWT) data were collected from 72 patients with advanced emphysema prior to and at 3 months after LVRC treatment. The procedure involved placing 10 coils unilaterally. Various QCT parameters were derived using Apollo imaging software (VIDA). Independent predictors of clinically relevant outcome (Δ6-MWT ≥ 26 m, ΔFEV1 ≥ 12%, ΔRV ≥ 10%) were identified through stepwise linear regression analysis. Results The response outcome for Δ6-MWT, for ΔFEV1 and for ΔRV was met by 55%, 32% and 42%, respectively. For Δ6-MWT ≥ 26 m a lower baseline 6-MWT (p = 0.0003) and a larger standard deviation (SD) of low attenuation cluster (LAC) sizes in peripheral regions of treated lung (p = 0.0037) were significantly associated with positive outcome. For ΔFEV1 ≥ 12%, lower baseline FEV1 (p = 0.02) and larger median LAC sizes in the central regions of treated lobe (p = 0.0018) were significant predictors of good response. For ΔRV ≥ 10% a greater baseline TLC (p = 0.0014) and a larger SD of LAC sizes in peripheral regions of treated lung (p = 0.007) tended to respond better. Conclusion Patients with lower FEV1 and 6-MWT, with higher TLC and specific QCT characteristics responded more positively to LVRC treatment, suggesting a more targeted CT-based approach to patient selection could lead to greater efficacy in treatment response.


title: COVID-19 Pandemic: What Every Otolaryngologist-Head and Neck Surgeon Needs to Know for Safe Airway Management.

text: The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.


title: COVID-19 More Frequent, Severe in Cancer Patients.

text: Using data from China, two studies suggest that people with cancer are more likely than the general population to contract COVID-19 and to develop more severe disease or die from it.


Covid-19: Papers justifying government's plans to reopen schools are "inconclusive," say union bosses.


Learning from history: Coronavirus outbreaks in the past.


title: Double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft: technique and 2- to 5-year follow-up.

text: BACKGROUND Nonanatomic transtibial single-bundle anterior cruciate ligament reconstruction (SB-ACLR) with a bone-patellar tendon-bone (BPTB) allograft has been used for a long time and has shown the same satisfactory clinical results as an autograft; however, it has not been reported if a double-bundle ACLR (DB-ACLR) could be performed with a BPTB allograft and achieve even better results. HYPOTHESIS The DB-ACLR with a BPTB allograft is technically feasible and will be superior to the SB technique in restoring better anterior and rotating stability. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study was performed with 56 patients, and 52 (25 in the DB group and 27 in the SB group) of them were followed up at 2 to 5 years. With an irradiated deep-frozen BPTB allograft, a standard single-incision arthroscopic technique was used, and the graft was fixed with bioabsorbable interference screws on both the femoral and tibial sides. Outcome assessment at final follow-up included International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores; side-to-side difference by conventional KT-2000 arthrometer; total anteroposterior (AP) laxity by the back-pushing KT-2000 arthrometer; pivot shift (0, +, ++); range of motion (ROM); and isokinetic muscle strength evaluation. RESULTS Mean follow-up was 47.3 ± 11.5 and 58.2 ± 6.6 months for the DB group and SB group, respectively. A statistically significant difference in favor of the DB group was found with the total AP laxity at 30° (P < .05). The overall incidence of pivot shift in the DB group (4% ++) was significantly lower than that in the SB group (26%: 19% + and 7% ++; P = .029). No significant differences were found between the 2 groups in terms of IKDC score, Lysholm score, Tegner score, conventional KT-2000 arthrometer anterior laxity, ROM, and muscle strength. CONCLUSION A DB-ACLR with a BPTB allograft is feasible and achieved more satisfactory results than the transtibial SB technique in terms of total AP stability and rotational stability in spite of no significant differences among other clinical parameters.


Reflux and Barrett's disease.


title: The effects of aging on hydromorphone-induced thermal antinociception in healthy female cats.

text: Introduction This study aimed to evaluate the effects of aging on hydromorphone-induced thermal antinociception in cats. Methods In a prospective, randomized, blinded, controlled design, 10 healthy female cats received each of the following treatments intramuscularly: hydromorphone (0.1 mg/kg) and 0.9% saline (0.05 mL/kg) with a 1-week washout between treatments at 6, 9, and 12 months of age. Skin temperature and thermal thresholds (TTs) were recorded before and up to 12 hours after injection. Data were analyzed using a repeated-measures linear mixed model (α = 0.05). Results After saline treatment, TT was not significantly different from baseline at any time point for any age group. After hydromorphone treatment, TT was significantly higher than baseline at 6 months for up to 1 hour, and at 9 and 12 months for up to 4 hours. Peak TT at 6, 9, and 12 months were 50.4 ± 2.7, 50.9 ± 2.0, and 53.6 ± 2.0°C at 0.5, 1, and 1 hours, respectively. Mean TT was significantly higher after hydromorphone treatment when compared with saline treatment at 9 and 12 months for up to 4 hours but not at 6 months. Magnitude of antinociception was consistently larger at 12 months when compared with 6 months of age. Hydromorphone provided a shorter duration and smaller magnitude of antinociception at 6 months when compared with 9 and 12 months. Conclusion Pediatric cats may require more frequent dosing of hydromorphone than adults.


title: Identification of etiologic agents and clinical characteristics for patients suspected of having pertussis in a large Children's Hospital in China.

text: Background In China, pertussis is a major health problem with an increasing incidence despite immunization efforts. Timely and accurate diagnosis is essential for the optimal management of pertussis, especially in severe cases. Methods Nasopharyngeal swabs or sputum specimens were obtained from patients suspected of having pertussis on the day of hospitalization at Shanghai Children's Medical Center from December 01, 2016, to November 30, 2017. The specimens were tested with the FilmArray Respiratory Panel, a multiplex polymerase chain reaction (PCR) assay that detects 16 viruses, Bordetella pertussis (B. pertussis), Mycoplasma pneumoniae (M. pneumoniae), and Chlamydophila pneumoniae (C. pneumoniae). Results Among the 140 children studied, 50.0% (70/140) were detected with a single pathogen, 45.0% (63/140) were detected with multiple pathogens, and 5.0% (7/140) had no detected pathogens. Forty-nine (35%, 49/140) patients tested positive for B. pertussis. Respiratory syncytial virus (RSV), parainfluenza virus (Para) and rhinovirus/enterovirus (Rhino/Entero) were the most prevalent pathogens in patients with pertussis-like syndrome. No significant differences between the groups with pertussis and pertussis-like syndrome were observed regarding the clinical symptoms. Severe cases were more frequently observed in unvaccinated, premature and pertussis/RSV co-infection patients. Conclusions Our study highlights the importance of the timely and accurate diagnosis of pertussis based on both clinical symptoms and laboratory methods.


title: Coronavirus: a clinical update of Covid-19.

text: A covid-19 pandemic decreed by WHO has raised greater awareness of it. The infection reached the mark of 350,000 patients in 33 countries and affected as comorbidities the presence of comorbidities and advanced age. The transmissibility calculated so far is similar to the H1N1 epidemic, but with lower mortality rates. The SARS-CoV-2 virus, of the Coronaviridae family, has the capacity for cellular invasion through the angiotensin-converting enzyme 2 does not have a lower respiratory epithelium and in the cells of the small intestine mucosa. A presentation can be divided into mild (fever, fatigue, cough, myalgia, and sputum) and severe (cyanosis, dyspnoea, tachypnea, chest pain, hypoxemia and need for clinical measurement) and has an estimated estimate of 2%.allows the detection of viral load in CRP-TR of patients with high clinical suspicion. Based on supportive measures and infection control. In severe cases, the use of medications such as hydroxychloroquine and azithromycin or medication can be promising. Take care to avoid the use of corticosteroids. There are no restrictions on the use of resources and ACEIs / ARBs.


title: Superior hemodynamic performance of a thigh-length versus knee-length intermittent pneumatic compression device.

text: OBJECTIVE There is a lack of consensus regarding which length of intermittent pneumatic compression (IPC) device provides optimal thromboprophylaxis. This trial was conducted to compare hemodynamic performance of a thigh-length and knee-length IPC device. The hypothesis is that thigh-length IPC will be more efficient in preventing stasis. METHODS This single-center trial tested the thigh-length sleeve (TLS) and knee-length sleeve (KLS) in 47 healthy volunteers. Peak systolic velocity and total volume flow were measured at rest and during the 11-second compression cycle. Measurements were obtained at the popliteal vein for the KLS and at the common femoral vein for the TLS. RESULTS The study was completed by 47 volunteers (32 women, 15 men), who were a mean age of 39.7 years (range, 18-68 years). There was a statistically significant difference in augmented total volume flow and peak systolic velocity between the KLS and TLS favoring the TLS: median total volume flow was 357.54 mL/min for the KLS vs 668.21 mL/min for the TLS (P < .0001), and median peak systolic velocity was 47.70 cm/s for the KLS vs 58.47 cm/s for the TLS (P = .0019). CONCLUSIONS This trial suggests that the improved hemodynamic effects of a thigh-length IPC system may provide superior thromboprophylaxis to a knee-length IPC.


title: The effect of transversus abdominis plane blocks on postoperative pain in laparoscopic colorectal surgery: a prospective, randomized, double-blind trial.

text: BACKGROUND Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking. OBJECTIVE The aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway. DESIGN This study is based on a prospective, randomized, double-blind controlled trial. SETTINGS The trial was conducted at a tertiary referral center. PATIENTS Patients undergoing elective laparoscopic colorectal resection were selected. INTERVENTIONS(S) Patients were randomly assigned to receive either a transversus abdominis plane block or a placebo placed intraoperatively under laparoscopic guidance. All followed a standardized enhanced recovery pathway. Patient demographics, perioperative procedures, and postoperative outcomes were collected. MAIN OUTCOME MEASURES Postoperative pain and nausea/vomiting scores in the postanesthesia care unit and department, opioid use, length of stay, and 30-day readmission rates were measured. RESULTS The trial randomly assigned 41 patients to the transversus abdominis plane block group and 38 patients to the control group. Demographic, clinical, and procedural data were not significantly different. In the postanesthesia care unit, the transversus abdominis plane block group had significantly lower pain scores (p < 0.01) and used fewer opioids (p < 0.01) than the control group; postoperative nausea/vomiting scores were comparable (p = 0.99). The transversus abdominis plane group had significantly lower pain scores on postoperative day 1 (p = 0.04) and throughout the study period (p < 0.01). There was no significant difference between groups in postoperative opioid use (p = 0.65) or nausea/vomiting (p = 0.79). The length of stay (median, 2 days experimental, 3 days control; p = 0.50) and readmission rate (7% experimental, 5% control, p = 0.99) was similar across cohorts. LIMITATIONS This study was conducted a single center. CONCLUSIONS Transversus abdominis plane blocks improved immediate short-term opioid use and pain outcomes. Pain improvement was durable throughout the hospital stay. However, the blocks did not translate into less overall narcotic use, shorter length of stay, or lower readmission rates.


title: Morphology of susceptibility vessel sign predicts middle cerebral artery recanalization after intravenous thrombolysis.

text: BACKGROUND AND PURPOSE We aimed to evaluate the predictive value of susceptibility vessel sign (SVS) burden and morphology in middle cerebral artery recanalization. METHODS We retrospectively examined clinical and imaging data from 72 consecutive patients with acute ischemic stroke with middle cerebral artery occlusion and examined the association of recanalization with SVS length and shape. RESULTS None of the patients with a middle cerebral artery SVS >20 mm in length achieved recanalization. For patients with a relatively short SVS (length <20 mm), irregular shape was a strong independent predictor for no recanalization (odds ratio, 6.891; 95% confidence interval, 1.441-32.950; P=0.016). CONCLUSIONS Irregular shape and long length (>20 mm) of SVS decrease the potential to recanalize the occluded middle cerebral artery with intravenous thrombolysis.


title: Complications of Supine Surgical Achilles Tendon Repair.

text: BACKGROUND Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. METHODS Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20-66 years). Median length of follow-up was 116 days (range, 25-1,589 days). Average body mass index was 29 kg/m2 (range, 23-36 kg/m2). RESULTS There were no infections, sural nerve injuries, or reruptures. CONCLUSIONS The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. LEVEL OF EVIDENCE Level IV, case series.


docid: rmholalb

title: Genetic and epigenetic analyses of panic disorder in the post-GWAS era.

text: Panic disorder (PD) is a common and debilitating neuropsychiatric disorder characterized by panic attacks coupled with excessive anxiety. Both genetic factors and environmental factors play an important role in PD pathogenesis and response to treatment. However, PD is clinically heterogeneous and genetically complex, and the exact genetic or environmental causes of this disorder remain unclear. Various approaches for detecting disease-causing genes have recently been made available. In particular, genome-wide association studies (GWAS) have attracted attention for the identification of disease-associated loci of multifactorial disorders. This review introduces GWAS of PD, followed by a discussion about the limitations of GWAS and the major challenges facing geneticists in the post-GWAS era. Alternative strategies to address these challenges are then proposed, such as epigenome-wide association studies (EWAS) and rare variant association studies (RVAS) using next-generation sequencing. To date, however, few reports have described these analyses, and the evidence remains insufficient to confidently identify or exclude rare variants or epigenetic changes in PD. Further analyses are therefore required, using sample sizes in the tens of thousands, extensive functional annotations, and highly targeted hypothesis testing.


title: Standardization of the Jendrassik maneuver in Achilles tendon tap reflex.

text: Objective For many decades, the Jendrassik maneuver (JM) has been used as a reinforcement for stretch reflexes, although the underlying mechanism of this reinforcement is still not fully understood. Moreover, the term JM has been used for many different muscle contraction strategies as there is no fixed movement for the maneuver in the literature. In this study, we aimed to investigate the effects of clenched hand pull, teeth clenching, and their combined effects to reach standardization. Methods Achilles tendon tap reflex responses in the soleus were recorded during rest (R), hand pull (HP), teeth clench (TC), and HP + TC combined, hereafter referred to as the JM. Results Reflex response amplitudes significantly increased during JM, HP, and TC in the soleus. HP and JM significantly changed the background activity in the soleus, but TC alone did not. Conclusion These results suggest that dominantly presynaptic disinhibitory mechanisms may be responsible for the increase in the tendon tap reflex during HP, TC, and JM. Significance Because the findings indicate that HP increases the background activity of the soleus, we suggest that researchers should use only TC during the Jendrassik maneuver to avoid any confounding background activity change.


title: Effects of Stomach Inflation on Cardiopulmonary Function and Survival During Hemorrhagic Shock: A Randomized, Controlled, Porcine Study.

text: BACKGROUND Ventilation of an unprotected airway may result in stomach inflation. The purpose of this study was to evaluate the effect of clinically realistic stomach inflation on cardiopulmonary function during hemorrhagic shock in a porcine model. METHODS Pigs were randomized to a sham control group (n = 9), hemorrhagic shock (35 mL kg over 15 min [n = 9]), and hemorrhagic shock combined with stomach inflation (35 mL kg over 15 min and 5 L stomach inflation [n = 10]). RESULTS When compared with the control group, hemorrhagic shock (n = 9) increased heart rate (103 ± 11 vs. 146 ± 37 beats min; P = 0.002) and lactate (1.4 ± 0.5 vs. 4.0 ± 1.9 mmol L; P < 0.001), and decreased mean arterial blood pressure (81.3 ± 12.8 vs. 35.4 ± 8.1 mmHg; P < 0.001) and stroke-volume index (38.1 ± 6.4 vs. 13.6 ± 4.8 mL min m; P < 0.001). Hemorrhagic shock combined with stomach inflation (n = 10) versus hemorrhagic shock only (n = 9) increased intra-abdominal pressure (27.0 ± 9.3 vs. 1.1 ± 1.0 mmHg; P < 0.001), and decreased stroke-volume index (9.9 ± 6.0 vs. 20.8 ± 8.5 mL min m; P = 0.007), and dynamic respiratory system compliance (10.8 ± 4.5 vs. 38.1 ± 6.1 mL cmH2O; P < 0.001). Before versus after stomach evacuation during hemorrhagic shock, intra-abdominal pressure decreased (27.0 ± 9.3 vs. 9.8 ± 5.4 mmHg; P = 0.042). Survival in the sham control and hemorrhagic shock group was 9 of 9, respectively, and 3 of 10 after hemorrhagic shock and stomach inflation (P < 0.001). CONCLUSIONS During hemorrhagic shock stomach inflation caused an abdominal compartment syndrome and thereby impaired cardiopulmonary function and aerobic metabolism, and increased mortality. Subsequent stomach evacuation partly reversed adverse stomach-inflation triggered effects.


title: Value of Percutaneous Radiologic Gastrostomy for Patients with Advanced Esophageal Cancer.

text: BACKGROUND Nutritional management is important throughout the treatment period for esophageal cancer patients. This study aimed to evaluate the feasibility of percutaneous radiologic gastrostomy (PRG) and to investigate whether PRG can be applied for patients with advanced esophageal cancer. METHODS In this study, 89 patients (74 men and 15 women) with advanced esophageal cancer underwent PRG using computed tomography and fluoroscopic guidance. These patients were unsuitable candidates for endoscopic intervention because of esophageal stricture. Primary placement of a mushroom-retained gastrostomy catheter was intended. The end points were technical success and complications after PRG as well as clinical outcomes and survival of the patients. These end points also were compared between the pre-chemoradiotherapy (pre-CRT) and post-CRT groups using the Chi square test, Fisher's exact test, and the Wilcoxon rank sum test. The survival rate was calculated using the Kaplan-Meier method and compared using the log-rank test. RESULTS All the patients had a successful PRG. The mushroom-tip gastrostomy catheter was primarily inserted in 77 patients (86.5 %) and finally achieved for all the patients. Complications occurred for 14 patients (15.7 %) including Dindo-Clavien classification grade 3 (1 catheter dislodgement), grade 2 (2 gastric hemorrhages), and grade 1 (7 skin infections and 4 oozing hemorrhages) complications. During the follow-up period (median, 6 months), 60 patients (67.4 %) died, giving a 12-month survival rate of 37.7 %. Gastrostomy removal was more common in the pre-CRT group (P = 0.011). The pre-CRT group had higher survival rates than the post-CRT group (P = 0.021). CONCLUSIONS Because PRG provided high technical success with limited complications, it can be used for patients with advanced esophageal cancer whose treatment plan involves multimodal therapy.


Radiofrequency ablation of an unusual vertebral body osteoid osteoma contiguous with the intervertebral disc.


How to manage rheumatic patients during the coronavirus pandemic.


title: da Vinci® single-site platform: anthropometrical, docking and suturing considerations for hysterectomy in the cadaver model.

text: BACKGROUND The paper describes specific technical requirements, limitations, anthropometrical, docking and suturing considerations on the performance of robotic hysterectomy using the da Vinci® Single-Site Platform in the cadaver model METHODS A data set was collected for each procedure including port placement, docking sequence, robotic arms placement and angles, robotic instrumentation, optimal ergonomics, operative time, and cadaver anthropometrical measurements. Pearson correlation coefficients were calculated to determine whether age, BMI or docking approach were correlated with docking difficulty and likelihood of successful procedure completion. Analysis of the data was performed using SPSS v19.0.0. RESULTS The planned surgical procedure was successfully completed with single-port robotics in 87.5% of cases. High BMI was correlated with difficulty docking the robot, correlation coefficient 0.98. CONCLUSIONS Further work is needed in the development and advancement of single-site robotic platforms, articulated instrumentation, and optics.


Myopericarditis, Rhabdomyolysis, and Acute Hepatic Injury: Sole Expression of a SARS-CoV-2 Infection.


title: Naso- or Orbitocutaneous Fistulas after Free Flap Reconstruction of Orbital Exenteration Defects: Retrospective Study, Systematic Review, and Meta-Analysis.

text: Objective Naso- or orbitocutaneous fistula (NOF) is a challenging complication of orbital exenteration, and it often requires surgical repair. We sought to identify the incidence and risk factors for NOF after orbital exenteration. Study Design Retrospective chart review, systematic review, meta-analysis. Setting Tertiary care center. Participants Patients undergoing free flap reconstruction following orbital exenteration. Records were reviewed for clinicopathologic data, operative details, and outcomes. Main Outcome Measures Univariate analysis was used to assess risk factors for incidence of postoperative NOF. PubMed and Cochrane databases were searched for published reports on NOF after orbital exenteration. Rates of fistula and odds ratios for predictive factors were compared in a meta-analysis. Results Total 7 of 77 patients (9.1%) developed NOF; fistula formation was associated with ethmoid sinus involvement ( p < 0.05) and minor wound break down ( p < 0.05). On meta-analysis, pooled rates of fistula formation were 5.8% for free flap patients and 12.5% for patients receiving no reconstruction. Conclusion Immediate postoperative wound complications and medial orbital wall resection increased the risk for NOF. On review and meta-analysis, reconstruction of orbital exenteration defects decreased the risk for fistula formation, but published series did not demonstrate a significant decrease in risk with free flaps compared with other methods of reconstruction.


title: Attitudes about mental illness and its treatment: validation of a generic scale for public health surveillance of mental illness associated stigma.

text: The purpose of this study was to test a brief instrument to monitor the U.S. public's attitudes about mental illness. A SAMHSA and CDC-led panel reached consensus through an iterative process to identify generic, multidimensional measures to test using a representative sample of 5,251 adults. Exploratory factor analysis revealed two subscales (Negative Stereotypes [alpha = 0.66]; Recovery and Outcomes [alpha = 0.69]). Confirmatory factor analysis supported the convergent validity of the two subscales. Subscale scores differed by sex, race/ethnicity, and experience with mental illness. Inclusion of these brief subscales on existing population-based surveys can help states and others track attitudes about mental illness.


title: Who let the cats out? A global meta-analysis on risk of parasitic infection in indoor versus outdoor domestic cats ( Felis catus).

text: Parasitic infection risks in domestic animals may increase as a result of outdoor activities, often leading to transmission events to and from owners, other domestic animals and wildlife. Furthermore, outdoor access has not been quantified in domestic animals as a risk factor with respect to latitude or parasite transmission pathway. Cats are an ideal model to test parasitic infection risk in outdoor animals because there have been many studies analysing this risk factor in this species; and there is a useful dichotomy in cat ownership between indoor-only cats and those with outdoor access. Thus, we used meta-analysis to determine whether outdoor access is a significant risk factor for parasitic infection in domestic pet cats across 19 different pathogens including many relevant to human, domestic animal and wildlife health, such as Toxoplasma gondii and Toxocara cati. Cats with outdoor access were 2.77 times more likely to be infected with parasites than indoor-only cats. Furthermore, absolute latitude trended towards significance such that each degree increase in absolute latitude increased infection likelihood by 4%. Thus, restricting outdoor access can reduce the risk of parasitic infection in cats and reduce the risk of zoonotic parasite transmission, spillover to sympatric wildlife and negative impacts on feline health.


title: American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.

text: Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.


title: Differences in the angiographic evaluation of coiled cerebral aneurysms between a core laboratory reader and operators: results of the Cerecyte Coil Trial.

text: BACKGROUND AND PURPOSE Independent evaluation of angiographic images is becoming widely applied in the assessment of treatment outcomes of cerebral aneurysms. In the current study, we assessed the agreement between an independent core laboratory and the operators regarding angiographic appearance in a recent randomized, controlled trial. MATERIALS AND METHODS Data were derived from the Cerecyte Coil Trial. Angiographic images of each coiled aneurysm, taken immediately after embolization and at 5- to 7-month follow-up, were evaluated by the operator at the treating center and by an independent neuroradiologist at the core laboratory. For the purpose of this study, images were interpreted on a 3-point scale to provide uniformity for analysis; grade 1: complete occlusion, grade 2: neck remnant; and grade 3: sac filling. "Unfavorable angiographic appearance" was defined as grade 3 at follow-up or interval worsening of grade between the 2 time points. RESULTS The study included 434 aneurysms. Immediately after embolization, grade 3 was reported by operators in 39 (9%) compared with 52 (12%) by the core laboratory (P = .159). On follow-up, grade 3 was reported by operators in 44 (10%) compared with 81 (19%) by the core laboratory (P < .0001). Overall, operators noted unfavorable angiographic appearance in 78 (18%) compared with 134 (31%) by the core laboratory (P < .0001). At every time point, agreement between the core laboratory and the operators was slight. CONCLUSIONS Unfavorable angiographic appearance was noted almost twice as frequently by an independent core laboratory as compared with the operators. Planning of trials and interpretation of published studies should be done with careful attention to the mode of angiographic appearance interpretation.


title: Effects of Depth of Propofol and Sevoflurane Anesthesia on Upper Airway Collapsibility, Respiratory Genioglossus Activation, and Breathing in Healthy Volunteers.

text: BACKGROUND Volatile anesthetics and propofol impair upper airway stability and possibly respiratory upper airway dilator muscle activity. The magnitudes of these effects have not been compared at equivalent anesthetic doses. We hypothesized that upper airway closing pressure is less negative and genioglossus activity is lower during deep compared with shallow anesthesia. METHODS In a randomized controlled crossover study of 12 volunteers, anesthesia with propofol or sevoflurane was titrated using a pain stimulus to identify the threshold for suppression of motor response to electrical stimulation. Measurements included bispectral index, genioglossus electromyography, ventilation, hypopharyngeal pressure, upper airway closing pressure, and change in end-expiratory lung volume during mask pressure drops. RESULTS A total of 393 attempted breaths during occlusion maneuvers were analyzed. Upper airway closing pressure was significantly less negative at deep versus shallow anesthesia (-10.8 ± 4.5 vs. -11.3 ± 4.4 cm H2O, respectively [mean ± SD]) and correlated with the bispectral index (P < 0.001), indicating a more collapsible airway at deep anesthesia. Respiratory genioglossus activity during airway occlusion was significantly lower at deep compared with light anesthesia (26 ± 21 vs. 35 ± 24% of maximal genioglossus activation, respectively; P < 0.001) and correlated with bispectral index (P < 0.001). Upper airway closing pressure and genioglossus activity during airway occlusion did not differ between sevoflurane and propofol anesthesia. CONCLUSIONS Propofol and sevoflurane anesthesia increased upper airway collapsibility in a dose-dependent fashion with no difference at equivalent anesthetic concentrations. These effects can in part be explained by a dose-dependent inhibiting effect of anesthetics on respiratory genioglossus activity.


Is there a period of liability with initiation of warfarin in patients with atrial fibrillation?


Covid-19: Cancer mortality could rise at least 20% because of pandemic, study finds.