title: Delayed ipsilateral parenchymal hemorrhage following flow diversion for the treatment of anterior circulation aneurysms.

text: BACKGROUND AND PURPOSE The PED is a flow-diverting stent designed for the treatment of cerebral aneurysms. We report 4 cases of delayed ipsilateral IPH following the technically successful treatment of anterior circulation aneurysms with the PED. MATERIALS AND METHODS Clinical and imaging data from all patients undergoing aneurysm treatment with the PED at 2 institutions were analyzed to assess the incidence of delayed IPH after treatment with the PED. RESULTS A total of 66 patients (47 anterior circulation) with cerebral aneurysms underwent treatment with a PED between January 2008 and November 2010. Four patients experienced delayed periprocedural IPH, all after the treatment of anterior circulation aneurysms (8.5%, 4/47). The aneurysm size ranged from 5 to 21 mm. All IPHs occurred within the cerebral hemisphere, ipsilateral to the treated aneurysm, and were anatomically remote from the treated aneurysms. All procedures were uncomplicated, and patients emerged from general anesthesia at neurologic baseline. The hemorrhages became clinically evident between 1 and 6 days after the procedure. Two patients had unfavorable outcomes (mRS scores, 4 and 6). CONCLUSIONS Delayed IPH may occur after the treatment of anterior circulation aneurysms with flow diverters. This complication does not seem to be restricted to a specific aneurysm subtype and does not seem to be related to an intraprocedural complication or solely attributable to DAT.


title: [Strategy of pharmaceutical care services for clinical Chinese pharmacists in coronavirus disease 2019 (COVID-19)].

text: The outbreak of coronavirus disease 2019(COVID-19) seriously endangers people's health. Traditional Chinese medicine(TCM) has been recommended for the treatment of COVID-19 in Novel Coronavirus Pneumonia Prevention and Control Strategy, which have made outstanding contributions to the prevention and control of the epidemic. The wide application of Chinese medicine asked the pharmacists and doctors, nurses, and medical technicians in Wuhan and around the country to stand on the front line of COVID-19 treatment, and provide pharmaceutical care services, which has effectively guaranteed the safety and rational use of Chinese medicine. This article will introduce the TCM cognition of the COVID-19, analyze the clinical application of Chinese medicine and the entry point of pharmaceutical care, and clarify that clinical Chinese pharmacists can participate in making medication therapy plan, medication reconciliation, and prescription review, promoting rational drug use, pharmaceutical monitoring, and drug risk management. The participation of clinical Chinese pharmacists in the prevention and treatment of COVID-19 is conducive to improving the level of rational use of TCM, by ensuring the effectiveness, and safety.


title: COVID-19 treatment: Combining anti-inflammatory and antiviral therapeutics using a network-based approach.

text: To date, there are no effective antiviral medications for COVID-19. Drug repurposing, a strategy that uses existing drugs, offers potential prevention and treatment options for COVID-19. We discuss one treatment strategy that combines anti-inflammatory (melatonin) and antiviral (toremifene) agents for patients infected with SARS-CoV-2 from network medicine-based findings. We also describe the pathobiology and immunologic characteristics of COVID-19 and highlight the rationale of combination drug treatment to rescue the pulmonary and cardiovascular conditions resulting from COVID-19. A preliminary analysis reveals a high potential for the synergistic effects of melatonin and toremifene to reduce viral infection and replication, and the aberrant host inflammatory responses, offering strong biologic plausibility as an effective therapy for COVID-19.


docid: vjvczmrq

title: Diet quality during preconception or pregnancy and gestational weight gain: protocol for a systematic review and meta-analysis.

text: INTRODUCTION Inappropriate gestational weight gain (GWG), including inadequate and excessive GWG, has become pandemic across nations and continents. This review aims to synthesise the evidence on the correlation between diet quality and GWG. If this association is confirmed, improving diet quality could become an intervention target in the efforts to reduce inappropriate GWG. METHODS AND ANALYSIS We will conduct a systematic review of all prospective cohort studies on diet quality in preconception or pregnancy and GWG. Our secondary outcomes include gestational diabetes, pre-eclampsia and birth weight. A comprehensive search of all published articles in MEDLINE ALL (Ovid), Embase (Ovid), Food Science and Technology Abstracts (Ovid) and CINAHL (EBSCOHost), from database creation to 20 April 2019, will be conducted. Studies will be screened for eligibility by title, abstract and full text in duplicate by two independent reviewers. Study quality and risk of bias will be assessed using the adapted Newcastle-Ottawa Scale. Results will be reported following the meta-analysis of observational studies in epidemiology guidelines. If sufficient data are available, a meta-analysis will be conducted to synthesise the effect size reported as OR with 95% CI using both fixed-effect and random-effect models. I2 statistics and visual inspection of the forest plots will be used to assess heterogeneity and identify the potential sources of heterogeneity. Publication bias will be assessed by visual inspections of funnel plots and Egger's test. ETHICS AND DISSEMINATION Formal ethical approval is not required as no primary data will be collected. We aim to publish the results of this study in a peer-reviewed journal and present them at conferences and scientific meetings to promote knowledge transfer. PROSPERO REGISTRATION NUMBER CRD42019128732.


Endoscopic electronic medical record systems.


title: Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months After Total Knee Arthroplasty: A Systematic Review.

text: Background One-third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. Purpose This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. Data Sources In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. Study Selection Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. Data Extraction Information on study design, patient characteristics, analysis, and results was extracted using pilot-tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. Data Synthesis Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. Limitations The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. Conclusions Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.


title: Consequences of an early catheter-based intervention on pulmonary artery growth and right ventricular myocardial function in a pig model of pulmonary artery stenosis.

text: OBJECTIVE To determine the consequences of an early catheter-based intervention on pulmonary artery (PA) growth and right ventricular (RV) myocardial function in an animal model of branch PA stenosis. BACKGROUND Acute results and safety profiles of deliberate stent fracture within the pulmonary vasculature have been demonstrated. The long-term impact of early stent intervention and deliberate stent fracture on PA growth and myocardial function is not understood. METHODS Implantation of small diameter stents was performed in a pig model of left PA stenosis at 6 weeks (10 kg) followed by dilations at 10 (35 kg) and 18 weeks (65 kg) with intent to fracture and implant large diameter stents. Hemodynamics, RV contractility, and 2D/3D angiography were performed with each intervention. The heart and pulmonary vasculature were histologically assessed. RESULTS Stent fracture occurred in 9/12 and implantation of large diameter stents was successful in 10/12 animals with no PA aneurysms or dissections. The final stented PA segment and distal left PA branch origins equaled the corresponding PA diameters of sham controls. Growth of left PA immediately beyond the stent was limited and there was diffuse fibro-intimal proliferation within the distal left and right PA. RV contractility was diminished in the intervention group and the response to dobutamine occurred uniquely via increases in heart rate. CONCLUSIONS Early stent intervention in this surgically created PA stenosis model was associated with improved growth of the distal PA vasculature but additional investigation of PA vessel physiology and impact on the developing heart are needed.


title: Identification and biochemical characterization of small-molecule inhibitors of west nile virus serine protease by a high-throughput screen.

text: West Nile virus and dengue virus are mosquito-borne flaviviruses that cause a large number of human infections each year. No vaccines or chemotherapeutics are currently available. These viruses encode a serine protease that is essential for polyprotein processing, a required step in the viral replication cycle. In this study, a high-throughput screening assay for the West Nile virus protease was employed to screen approximately 32,000 small-molecule compounds for identification of inhibitors. Lead inhibitor compounds with three distinct core chemical structures (1 to 3) were identified. In a secondary screening of selected compounds, two compounds, belonging to the 8-hydroxyquinoline family (compounds A and B) and containing core structure 1, were identified as potent inhibitors of the West Nile virus protease, with K(i) values of 3.2 +/- 0.3 microM and 3.4 +/- 0.6 microM, respectively. These compounds inhibited the dengue virus type 2 protease with K(i) values of 28.6 +/- 5.1 microM and 30.2 +/- 8.6 microM, respectively, showing some selectivity in the inhibition of these viral proteases. However, the compounds show no inhibition of cellular serine proteases, trypsin, or factor Xa. Kinetic analysis and molecular docking of compound B onto the known crystal structure of the West Nile virus protease indicate that the inhibitor binds in the substrate-binding cleft. Furthermore, compound B was capable of inhibiting West Nile virus RNA replication in cultured Vero cells (50% effective concentration, 1.4 +/- 0.4 microM; selectivity index, 100), presumably by inhibition of polyprotein processing.


docid: odnmhgfx

title: Percutaneous endoscopic gastrostomy (PEG) with T-fasteners obviates the need for emergent replacement after early tube dislodgement.

text: BACKGROUND Despite technical refinements of percutaneous endoscopic gastrostomy (PEG) tube placement, complications such as early tube dislodgement remain relatively static. This study aimed to review the experience of a high-volume endoscopy center after the introduction of T-fastener placement in high-risk patients. METHODS The authors retrospectively reviewed PEG placement from October 2010 to September 2011, when their group began to use T-fasteners selectively in high-risk patients. Patients deemed to have an increased risk for early tube dislodgement underwent T-fastener placement at the time of PEG placement. Patients with PEG alone were compared with patients who had PEG with T-fastener (PEG-T) placement. Statistical analysis was performed using SPSS version 18. RESULTS During the study period, 195 patients underwent PEG placement. For 121 patients, PEG alone was performed, whereas PEG-T was performed for 74 patients. Six patients had tube dislodgement (five early, one late) in the PEG-T cohort versus none in the PEG-alone cohort (P = 0.003). The first patient underwent diagnostic laparoscopy with replacement gastrostomy 2 days after tube dislodgement and was noted to have no contamination, with direct apposition of the stomach to the abdominal wall from the T-fasteners. The subsequent four patients with early tube dislodgement underwent non-emergent PEG replacement in the endoscopy unit within 24 h after tube dislodgement. In the short-term follow-up period, no repeat dislodgements were noted. Early mortality in the entire cohort was experienced by 38 (19.5%) of the 195 patients. CONCLUSION Placement of T-fasteners in high-risk patients may decrease overall morbidity if early tube dislodgement occurs. The findings show the safety of non-emergent endoscopic replacement of PEGs in certain patients. Early tube dislodgement may be a marker of overall mortality.


title: Active change interventions to de-implement low-value healthcare practices: a scoping review protocol.

text: BACKGROUND There is recognition that the overuse of procedures, tests and medications strains the healthcare system financially and can cause unnecessary stress and harm to patients. In recent years, several initiatives have targeted the reduction or elimination of low-value practices in healthcare. Research suggests that passive interventions, such as the publication of guidelines, are often not sufficient to change behaviour and that active change interventions - interventions which actively implement strategies to change practices - are required to effect significant, sustained practice change. The purpose of this scoping review is to identify and characterise studies of active change interventions designed to reduce or eliminate low-value healthcare practices. METHODS We will conduct a review of MEDLINE, EMBASE, CINAHL and Scopus databases from inception. Building on previous research, 40 key terms will be used to search literature. The screening process will be conducted separately by two researchers, with discrepancies resolved by a third. Empirical studies of active change interventions used to reduce or eliminate low-value practices will be included. Descriptive statistics and thematic analysis will be used to categorise the characteristics of the studies. ETHICS AND DISSEMINATION Ethics approval is not required for this study. This scoping review will provide insights into the impact of several characteristics of active change interventions, including the number of interventions (single-faceted or multifaceted) and the level of implementation (individual or organisational). These results can provide guidance and direction for future research in de-implementation. The results will be disseminated through presentations at national and international conferences and the publication of a manuscript.


title: Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy.

text: PURPOSE Despite multimodal pain management and advances in anesthetic techniques, total knee arthroplasty (TKA) remains painful during the early postoperative phase. This trial investigated whether computer-assisted cryotherapy (CAC) is effective in reduction of pain and consumption of opioids in patients operated for TKA following an outpatient surgery pathway. METHODS Sixty patients scheduled for primary TKA were included in this prospective, double-blind, randomized controlled trial receiving CAC at 10-12 °C (Cold-group, n = 30) or at 21 °C (Warm-group, n = 30) during the first 7 days after TKA according to a fixed schedule. All patients received the same pre-, peri- and postoperative care with a multimodal pain protocol. Pain was assessed before and after every session of cryotherapy using the numerical rating scale for pain (NRS-pain). The consumption of opioids was strictly noted during the first 4 postoperative days. Secondary outcomes were knee swelling, visual hematoma and patient reported outcome measures (PROMs). These parameters were measured pre-, 1, 2 and 6 weeks postoperatively. RESULTS In both study groups, a reduction in NRS-pain after every CAC session were seen during the postoperative period of 7 days. A mean reduction of 0.9 and 0.7 on the NRS-pain was seen for respectively the Cold- (P = 0.008) and Warm-group (n.s.). A significant (P = 0.001) lower number of opioids were used by the Cold-group during the acute postoperative phase of 4 days, 47 and 83 tablets for respectively the Cold and Warm-group. No difference could be observed for secondary outcomes and adverse effects between both study groups. CONCLUSIONS Postoperative CAC can be in added value in patients following an outpatient surgery pathway for TKA, resulting in reduced experienced pain and consumption of opioids during the first postoperative days.


title: Antiviral Activity of Graphene Oxide: How Sharp Edged Structure and Charge Matter.

text: Graphene oxide and its derivatives have been widely explored for their antimicrobial properties due to their high surface-to-volume ratios and unique chemical and physical properties. However, little information is available on their effects on viruses. In this study, we report the broad-spectrum antiviral activity of GO against pseudorabies virus (PRV, a DNA virus) and porcine epidemic diarrhea virus (PEDV, an RNA virus). Our results showed that GO significantly suppressed the infection of PRV and PEDV for a 2 log reduction in virus titers at noncytotoxic concentrations. The potent antiviral activity of both GO and rGO can be attributed to the unique single-layer structure and negative charge. First, GO exhibited potent antiviral activity when conjugated with PVP, a nonionic polymer, but not when conjugated with PDDA, a cationic polymer. Additionally, the precursors Gt and GtO showed much weaker antiviral activity than monolayer GO and rGO, suggesting that the nanosheet structure is important for antiviral properties. Furthermore, GO inactivated both viruses by structural destruction prior to viral entry. The overall results suggest the potential of graphene oxide as a novel promising antiviral agent with a broad and potent antiviral activity.


Effectiveness of Preventive Measures against Coronavirus Disease of 2019 in a Plastic Surgery Unit at the Epicenter of the Pandemic in Italy.


title: Efficacy and Safety of Pirfenidone in Patients with Second-Degree Burns: A Proof-of-Concept Randomized Controlled Trial.

text: OBJECTIVE Several studies suggest that pirfenidone may have a potential off-label use for wound healing. However, the effectiveness of this medication in patients with burns remains uncertain. Accordingly, investigators sought to assess wound re-epithelialization in patients with second-degree burns after adding pirfenidone to usual care. DESIGN AND SETTING Single-center pilot, proof-of-concept, single-blind randomized controlled trial. PATIENTS AND INTERVENTION Eight patients with second-degree burns were treated with occlusive hydrocolloid dressings and were randomly allocated to receive either no additional treatment or pirfenidone. OUTCOME MEASURES The primary outcome of the study was to evaluate wound healing between groups based on the thickness of the re-epithelialized epidermis at day 7. Secondary outcomes were to qualitatively assess the development of fibrotic tissue in the dermis, anomalies in the basal membrane, and the development of collagen fibers by histologic analysis. Liver and renal functions were measured daily to assess the overall safety of oral pirfenidone. MAIN RESULTS Patients treated with pirfenidone showed a remarkable improvement in wound re-epithelialization at day 7 (148.98 ± 13.64 vs 119.27 ± 15.55 μm; P = .029; 95% confidence interval, 4.14-55.29). Histologic evaluations showed less wound fibrosis in the pirfenidone group. CONCLUSIONS A decrease in wound healing time by enhancing wound re-epithelialization was observed with pirfenidone. Larger clinical trials are needed to reach more reliable conclusions.


title: Chronic heart failure patients' experiences of German healthcare services: a protocol for a scoping review.

text: INTRODUCTION Chronic heart failure (CHF) is a heterogeneous condition requiring complex treatment from diverse healthcare services. An increasingly holistic understanding of healthcare has resulted in contextual factors such as perceived quality of care, as well as patients' acceptance, preferences and subjective expectations of health services, all gaining in importance. How patients with CHF experience the use of healthcare services has not been studied within the scope of a systematic review in a German healthcare context. The aim of this scoping review is therefore to review systematically the experiences of patients affected by CHF with healthcare services in Germany in the literature and to map the research foci. Further objectives are to identify gaps in evidence, develop further research questions and to inform decision makers concerned with improving healthcare of patients living with CHF. METHODS AND ANALYSIS This scoping review will be based on a broad search strategy involving systematic and comprehensive electronic database searches in MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Cochrane's Database of Systematic Reviews, grey literature searches, as well as hand searches through reference lists and non-indexed key journals. The methodological procedure will be based on an established six-stage framework for conducting scoping reviews that includes two independent reviewers. Data will be systematically extracted, qualitatively and quantitatively analysed and summarised both narratively and visually. To ensure the research questions and extracted information are meaningful, a patient representative will be involved. ETHICS AND DISSEMINATION Ethical approval will not be required to conduct this review. Results will be disseminated through a clearly illustrated report that will be part of a wider research project. Furthermore, it is intended that the review's findings should be made available to relevant stakeholders through conference presentations and publication in peer-reviewed journals (knowledge transfer). Protocol registration in PROSPERO is not applicable for scoping reviews.


docid: linnxjar

title: The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale.

text: BACKGROUND The incidence of clinically apparent stroke in transcatheter aortic valve implantation (TAVI) exceeds that of any other procedure performed by interventional cardiologists and, in the index admission, occurs more than twice as frequently with TAVI than with surgical aortic valve replacement (SAVR). However, this represents only a small component of the vast burden of neurological injury that occurs during TAVI, with recent evidence suggesting that many strokes are clinically silent or only subtly apparent. Additionally, insult may manifest as slight neurocognitive dysfunction rather than overt neurological deficits. Characterisation of the incidence and underlying aetiology of these neurological events may lead to identification of currently unrecognised neuroprotective strategies. METHODS The Silent and Apparent Neurological Injury in TAVI (SANITY) Study is a prospective, multicentre, observational study comparing the incidence of neurological injury after TAVI versus SAVR. It introduces an intensive, standardised, formal neurologic and neurocognitive disease assessment for all aortic valve recipients, regardless of intervention (SAVR, TAVI), valve-type (bioprosthetic, Edwards SAPIEN-XT) or access route (sternotomy, transfemoral, transapical or transaortic). Comprehensive monitoring of neurological insult will also be recorded to more fully define and compare the neurological burden of the procedures and identify targets for harm minimisation strategies. DISCUSSION The SANITY study undertakes the most rigorous assessment of neurological injury reported in the literature to date. It attempts to accurately characterise the insult and sustained injury associated with both TAVI and SAVR in an attempt to advance understanding of this complication and associations thus allowing for improved patient selection and procedural modification.


title: Resilience to loss and potential trauma.

text: Initial research on loss and potentially traumatic events (PTEs) has been dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the limitations of these approaches and review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identified a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes. Finally, we critically evaluate the question of whether resilience-building interventions can actually make people more resilient, and we close with suggestions for future research on resilience.


title: Making progress with the automation of systematic reviews: principles of the International Collaboration for the Automation of Systematic Reviews (ICASR).

text: Systematic reviews (SR) are vital to health care, but have become complicated and time-consuming, due to the rapid expansion of evidence to be synthesised. Fortunately, many tasks of systematic reviews have the potential to be automated or may be assisted by automation. Recent advances in natural language processing, text mining and machine learning have produced new algorithms that can accurately mimic human endeavour in systematic review activity, faster and more cheaply. Automation tools need to be able to work together, to exchange data and results. Therefore, we initiated the International Collaboration for the Automation of Systematic Reviews (ICASR), to successfully put all the parts of automation of systematic review production together. The first meeting was held in Vienna in October 2015. We established a set of principles to enable tools to be developed and integrated into toolkits.This paper sets out the principles devised at that meeting, which cover the need for improvement in efficiency of SR tasks, automation across the spectrum of SR tasks, continuous improvement, adherence to high quality standards, flexibility of use and combining components, the need for a collaboration and varied skills, the desire for open source, shared code and evaluation, and a requirement for replicability through rigorous and open evaluation.Automation has a great potential to improve the speed of systematic reviews. Considerable work is already being done on many of the steps involved in a review. The 'Vienna Principles' set out in this paper aim to guide a more coordinated effort which will allow the integration of work by separate teams and build on the experience, code and evaluations done by the many teams working across the globe.


Selective covalent protein immobilization: strategies and applications.


title: Mannose-binding lectin enhances Toll-like receptors 2 and 6 signaling from the phagosome.

text: Innate immunity is the first-line defense against pathogens and relies on phagocytes, soluble components, and cell-surface and cytosolic pattern recognition receptors. Despite using hard-wired receptors and signaling pathways, the innate immune response demonstrates surprising specificity to different pathogens. We determined how combinatorial use of innate immune defense mechanisms defines the response. We describe a novel cooperation between a soluble component of the innate immune system, the mannose-binding lectin, and Toll-like receptor 2 that both specifies and amplifies the host response to Staphylococcus aureus. Furthermore, we demonstrate that this cooperation occurs within the phagosome, emphasizing the importance of engulfment in providing the appropriate cellular environment to facilitate the synergy between these defense pathways.


title: Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China.

text: Cities across China implemented stringent social distancing measures in early 2020 to curb coronavirus disease outbreaks. We estimated the speed with which these measures contained transmission in cities. A 1-day delay in implementing social distancing resulted in a containment delay of 2.41 (95% CI 0.97-3.86) days.


Soaps and serenity: care the Cantonese way.


title: Treatment time, ease of use and cost associated with use of Equashield™, PhaSeal® , or no closed system transfer device for administration of cancer chemotherapy to a dog model.

text: This prospective experimental simulation study evaluated the efficiency, ease of use (EOU) and cost of administering chemotherapy with two closed system transfer devices (CSTD, Equashield™ and PhaSeal® ) and no CSTD. Forty-six veterinary technicians (VT) working in oncology specialty practices were timed during chemotherapy administration simulated with water and a model canine limb 10 times with each system and with no CSTD. EOU and likelihood of recommending each system were rated by VT using visual analog scales. Costs were obtained from veterinary distributors. Administration was fastest with Equashield™ (P = 0.0003), but the difference was not enough to affect case flow. Equashield™ was easier to use than PhaSeal® or no CSTD (P = 0.002), however VT recommended both CSTD more strongly than no CSTD (P < 0.0001). Equashield™ cost less than PhaSeal® but was sold only in bulk quantities. CSTD did not decrease efficiency in administering chemotherapy and were readily accepted by VT.


title: Graft durability and fatigue after in situ fenestration of endovascular stent grafts using radiofrequency puncture and balloon dilatation.

text: OBJECTIVES In situ fenestration of endovascular stent grafts is a technique that is becoming more common, as it has the advantages of decreased cost, increased availability, and more anatomic configuration than other methods of branch revascularization. However, a significant concern is the short- and long-term durability of the stent graft fabric during and after fenestration. METHODS This study utilizes the textiles analysis techniques of macro- and microscopic imaging, tear strength testing, burst strength testing, and accelerated cyclic fatigue testing on the fabrics of the Cook Zenith, Medtronic Talent, and Medtronic Endurant stent grafts (three polyester grafts), as well as two different expanded polytetrafluoroethylene (ePTFE) membranes. Specimens were punctured using radiofrequency, and serially dilated with angioplasty balloons (3, 5, and 7 mm). For each type of fabric, three groups were analyzed: control, radiofrequency (RF) puncture only, and balloon dilated. RESULTS A total of 110 specimens were analyzed, with 80 of them having been fenestrated. The Zenith fabric had the greatest strength after fenestration, but was limited by the inability to fully dilate the fenestration with the conventional balloons, which only achieved 26-29% of their nominal balloon diameter. While the Talent and Endurant grafts could be dilated with balloons, the orifices were markedly elliptical not circular. After accelerated fatigue testing, there was an increase in the size of fenestrations of the Talent fabric. There was no increase in fenestration size for the Endurant fabric, Zenith fabric, or the ePTFE fabrics, after fatigue testing. CONCLUSIONS While the Zenith fabric was the strongest both before and after fenestration, it requires further study with cutting balloons to achieve full-sized fenestrations. All fenestrations remained stable during fatigue testing except for the Talent fabric. This study serves as the baseline for future studies that will include stent grafts, branch stents, and cutting balloons.


title: Effectiveness of behavioral change techniques employed in eHealth interventions designed to improve glycemic control in persons with poorly controlled type 2 diabetes: a systematic review and meta-analysis protocol.

text: BACKGROUND The incorporation of Behavioral Change Techniques (BCTs) in eHealth interventions for the management of non-communicable diseases (NCDs), such as type 2 diabetes mellitus (T2DM), might be a promising approach to improve clinical and behavioral outcomes of NCDs in the long run. This 3paper reports a protocol for a systematic review that aims to (a) identify the effects of individual BCTs in eHealth interventions for lowering glycated hemoglobin levels (HbA1c) and (b) investigate which additional intervention features (duration of intervention, tailoring, theory-base, and mode of delivery) affect levels of HbA1c in this population. The protocol follows the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 guideline. METHODS/DESIGN To identify eligible studies, an extensive systematic database search (PubMed, Web of Science, and PsycINFO) using keywords will be conducted. This review will include randomized controlled trials examining the effects of eHealth interventions on HbA1c in persons with poorly controlled T2DM over a minimum follow-up period of 3 months. Relevant data will be extracted from the included studies using Microsoft Excel. The content of the interventions will be extracted from the description of interventions and will be classified according to the BCT taxonomy v1 tool. The quality of studies will be independently assessed by two reviewers using the Cochrane risk of bias tool. If the studies have adequate homogeneity, meta-analysis will be considered. The effect sizes of each BCT will be calculated using the random effect model. The quality of the synthesized evidence will be evaluated employing the Grading of the Recommendations Assessment, Development and Evaluation (GRADE) criteria. DISCUSSION This systematic review is one of the firsts to appraise the effectiveness of eHealth interventions employing BCTs which aimed at improving glycemic control in persons with poorly controlled T2DM. The review will aggregate the effect sizes of BCTs on HbA1c levels. The results may inform future eHealth interventions targeting poorly controlled T2DM populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049940.


'Hello' - the humble telephone re-emerges among the COVID-19 pandemic.


Robotic Heller myotomy for achalasia after laparoscopic Roux-en-Y gastric bypass: a case report and literature review.


title: Sexual dysfunction and satisfaction in obsessive compulsive disorder: protocol for a systematic review and meta-analysis.

text: BACKGROUND Obsessive compulsive disorder (OCD) is a chronic mental health condition recognized as one of the most serious causes of disability and impaired quality of life. In the literature, there is no review about sexual dysfunction and satisfaction in OCD. The current paper presents the protocol for a systematic review and meta-analysis aimed to summarize data (1) comparing the presence of sexual dysfunction between groups with OCD and non-clinical groups, (2) investigating prevalence of each one of the sexual dysfunctions in patients with OCD, (3) comparing risk for sexual dysfunction in OCD groups with the prevalence in control groups, (4) comparing sexual satisfaction between OCD groups and non-clinical groups, and (5) investigating moderators of sexual dysfunction in OCD groups as compared with control groups. Gender, age, marital status, OCD symptom severity and subtypes, comorbid depressive disorders, comorbid anxiety disorders, concurrent psychiatric medications, comorbid general medical disease, and study quality will be investigated as moderators. METHODS The protocol is reported according to PRISMA-P guidelines. The search will be conducted by independent reviewers during the second week of December 2019 by using electronic databases (Scopus, PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Library), by contacting the authors of the included studies to identify further data, by examining the references of the included studies, and by handsearching conference proceedings and theses/doctoral dissertations. The study quality will be independently evaluated using the Newcastle-Ottawa Quality Assessment Scale. Random-effect meta-analyses will be computed. If there is insufficient data for a specific outcome, only a systematic review will be performed. DISCUSSION This review may support clinical practice highlighting the importance of the assessment of sexuality in patients with OCD and suggesting the use of therapeutic strategies dedicated to sexuality in this clinical population with the aim of improving patients' quality of life. Potential limitations will regard the heterogeneity of the studies in terms of the instruments used to assess sexual dysfunction/satisfaction and of the definitions used to conceptualize sexual dysfunction. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42019132264.


Coronavirus disease 2019 (covid-19): a guide for UK GPs.


title: Non-Hypervascular Hypointense Hepatic Nodules during the Hepatobiliary Phase of Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced MRI as a Risk Factor of Intrahepatic Distant Recurrence after Radiofrequency Ablation of Hepatocellular Carcinoma.

text: BACKGROUND Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI have been reported to be associated with intrahepatic distant recurrence (IDR) after hepatectomy or radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). IDR is categorized into hypervascular transformation of non-hypervascular hypointense hepatic nodules and new intrahepatic recurrence. The aim of this study was to evaluate the relationship between non-hypervascular hypointense hepatic nodules on Gd-EOB-DTPA-enhanced MRI and IDR after RFA, focusing on new intrahepatic recurrence. METHODS Ninety-one consecutive patients with 115 HCCs undergoing pretreatment Gd-EOB-DTPA-enhanced MRI and RFA for treatment of HCC were enrolled. RESULTS Of the 91 patients who underwent RFA for HCC, 24 had non-hypervascular hypointense hepatic nodules on pretreatment Gd-EOB-DTPA-enhanced MRI. Recurrences were observed in 15 and 19 patients with and without non-hypervascular hypointense hepatic nodules, respectively. Of the 15 recurrences in patients with non-hypervascular hypointense hepatic nodules, 10 patients had new intrahepatic recurrences. The cumulative incidence of new intrahepatic recurrence was significantly higher in patients with non-hypervascular hypointense hepatic nodules than in those without non-hypervascular hypointense hepatic nodules (p < 0.0001). Multivariate analysis revealed that the presence of non-hypervascular hypointense hepatic nodules and Child-Pugh score were independent risk factors for new intrahepatic recurrence. CONCLUSIONS Non-hypervascular hypointense hepatic nodules during the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were a useful predictive factor for IDR, particularly for new intrahepatic recurrence, after RFA.


How can I break bad news remotely?


docid: vhdfhiyc

title: The transfer of 241Am and 137Cs to the tissues of broilers' organs.

text: Data on the transfer of artificial radionuclides from the environment to the food supply is necessary for internal dose assessment. There is a necessity for expanding and improving the available information on these factors in order to make better dose models for specific scenarios. This paper describes the results of a field experiment with broiler chickens on the transfer factor (Ff) and concentration ratio (CR) for the long-term intake of 241Am and 137Cs with grass meal and soil. The broilers were divided into two groups, each group had nine subgroups and each subgroup had three broilers. The radionuclide concentrations in the feed and the thigh muscle, thigh bone, and liver of 54 broilers divided between the grass meal and soil groups were evaluated by gamma spectrometry for 241Am and 137Cs. The duration of feeding with "contaminated" sources ranged between 1-70 days. The equilibrium stage of 241Am in muscle and bone occurs on the 1st and 40th day, respectively; for 137Cs in muscle- 30th days of intake and for liver and bone- 7th days. For 241Am, the liver did not reach equilibrium stage during the 70 days of intake. Ff of 137Cs in the "forage-muscle" and "soil-muscle" systems were determined as 1.9±0.3 and 0.18±0.05; Ff of 241Am in the "soil-muscle" system was-7.5×10-5.


Undergraduate ophthalmology teaching in COVID-19 times: Students' perspective and feedback.


Academic leaders must support inclusive scientific communities during COVID-19.


title: An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery.

text: INTRODUCTION AND HYPOTHESIS a terminology and standardized classification has yet to be developed for those complications arising directly from the insertion of synthetic (prostheses) and biological (grafts) materials in female pelvic floor surgery. METHODS this report on the above terminology and classification combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and a Joint IUGA/ICS Working Group on Complications Terminology, assisted at intervals by many expert external referees. An extensive process of 11 rounds of internal and external review took place with exhaustive examination of each aspect of the terminology and classification. Decision-making was by collective opinion (consensus). RESULTS a terminology and classification of complications related directly to the insertion of prostheses and grafts in female pelvic floor surgery has been developed, with the classification based on category (C), time (T) and site (S) classes and divisions, that should encompass all conceivable scenarios for describing insertion complications and healing abnormalities. The CTS code for each complication, involving three (or four) letters and three numerals, is likely to be very suitable for any surgical audit or registry, particularly one that is procedure-specific. Users of the classification have been assisted by case examples, colour charts and online aids ( www.icsoffice.org/complication ). CONCLUSIONS a consensus-based terminology and classification report for prosthess and grafts complications in female pelvic floor surgery has been produced, aimed at being a significant aid to clinical practice and research.


title: Radiofrequency ablation of non-small-cell carcinoma of the lung under real-time FDG PET CT guidance.

text: Radiofrequency ablation (RFA) is a well-established method in treatment of patients with lung carcinomas who are not candidates for surgical resection. Usually computed tomographic (CT) guidance is used for the procedure, thus enabling needle placement and permitting evaluation of complications such as pneumothorax and bleeding. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is generally used for tumor activity assessment and is therefore useful in follow-up after tumor treatment. A method that provides real-time image-based monitoring of RFA to ensure complete tumor ablation would be a valuable tool. In this report, we describe the behavior of preinjected FDG during PET CT-guided RFA of a non-small-cell lung carcinoma and discuss the value of FDG as a tool to provide intraprocedure monitor ablation. The size and the form of the activity changed during ablation. Ablation led to increase of the size and blurring and irregularity of the contour compared to pretreatment imaging. The maximal standardized uptake value decreased only slightly during the procedure. Therefore, before RFA, FDG PET can guide initial needle placement, but it does not serve as a monitoring tool to evaluate residual viable tissue during the procedure.


title: How we perform a posterior sacrospinous ligament fixation by the vaginal route.

text: Posterior sacrospinous fixation (SSF) was first described by Amreich in 1950 and then modified by Richter in 1968. The main difficulty of this technique is the pararectal approach with dissection under visual guidance. Our aim was to teach young surgeons to use this alternative technique for apical suspension and to facilitate the pararectal approach. We divide the sacrospinous ligament fixation technique into ten surgical steps: exposure, infiltration, vaginal incision, recto-vaginal dissection, pararectal dissection, SSL suture, vaginal fixation (with vaginal strips), vaginal closure, SSF and final closure. We have performed > 500 SSFs following the sacrospinous ligament fixation technique. Inexperienced surgeons are generally not comfortable with the dissection of the SSL. A video of the procedure with pararectal dissection, SSL identification and suturing clearly shown can help to perform this technique. The use of vaginal strips has been designed to help strengthen the vaginal part of the SSF. It is important to share such a video showing how to approach the pararectal fossa with a dissection under visual guidance. The aim is to help young surgeons better understand the surgical technique and dissection.


title: Contributing factors that influence medication errors in the prehospital paramedic environment: a mixed-method systematic review protocol.

text: INTRODUCTION There is limited reliable research available on medication errors in relation to paramedic practice, with most evidence-based medication safety guidelines based on research in nursing, operating theatre and pharmacy settings. While similarities exist, evidence suggests that the prehospital environment is distinctly different in many aspects. The prevention of errors requires attention to factors from the organisational and regulatory level down to specific tasks and patient characteristics. The evidence available suggests errors may occur in up to 12.76% of medication administrations in some prehospital settings. With multiple sources stating that the errors are under-reported, this represents significant potential for patient harm. This review will seek to identify the factors influencing the occurrence of medication errors by paramedics in the prehospital environment. METHODS AND ANALYSIS The review will include qualitative and quantitative studies involving interventions or phenomena regarding medication errors or medication safety relating to paramedics (including emergency medical technicians and other prehospital care providers) within the prehospital environment. A search will be conducted using MEDLINE (Ovid), EBSCOhost Megafile Search, the International Committee of Medical Journal Editors trial registry, Google Scholar and the OpenGrey database to identify studies meeting this inclusion criteria, with initial searches commencing 30 September 2019. Studies selected will undergo assessment of methodological quality, with data to be extracted from all studies irrespective of quality. Each stage of study selection, appraisal and data extraction will be conducted by two reviewers, with a third reviewer deciding any unresolved conflicts. The review will follow a convergent integrated approach, conducting a single qualitative synthesis of qualitative and 'qualitised' quantitative data. ETHICS AND DISSEMINATION No ethical approval was required for this review. Findings from this systematic review will be disseminated via publications, reports and conference presentations.


title: Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial.

text: BACKGROUND In 2006, we reported results of a randomized trial of laparoscopic paraesophageal hernia repair (LPEHR), comparing primary diaphragm repair (PR) with primary repair buttressed with a biologic prosthesis (small intestinal submucosa [SIS]). The primary endpoint, radiologic hiatal hernia (HH) recurrence, was higher with PR (24%) than with SIS buttressed repair (9%) after 6 months. The second phase of this trial was designed to determine the long-term durability of biologic mesh-buttressed repair. METHODS We systematically searched for the 108 patients in phase I of this study to assess current clinical symptoms, quality of life (QOL) and determine ongoing durability of the repair by obtaining a follow-up upper gastrointestinal series (UGI) read by 2 radiologists blinded to treatment received. HH recurrence was defined as the greatest measured vertical height of stomach being at least 2 cm above the diaphragm. RESULTS At median follow-up of 58 months (range 42 to 78 mo), 10 patients had died, 26 patients were not found, 72 completed clinical follow-up (PR, n = 39; SIS, n = 33), and 60 repeated a UGI (PR, n = 34; SIS, n = 26). There were 20 patients (59%) with recurrent HH in the PR group and 14 patients (54%) with recurrent HH in the SIS group (p = 0.7). There was no statistically significant difference in relevant symptoms or QOL between patients undergoing PR and SIS buttressed repair. There were no strictures, erosions, dysphagia, or other complications related to the use of SIS mesh. CONCLUSIONS LPEHR results in long and durable relief of symptoms and improvement in QOL with PR or SIS. There does not appear to be a higher rate of complications or side effects with biologic mesh, but its benefit in reducing HH recurrence diminishes at long-term follow-up (more than 5 years postoperatively) or earlier.


title: Acetabular ventroversion with double pelvic osteotomy versus triple pelvic osteotomy: a cadaveric study in dogs.

text: OBJECTIVE To determine which of 3 different plate angles (20°, 25°, 30°) used in double pelvic osteotomy (DPO) would result in the most similar acetabular angle (AA) achieved with a 20° triple pelvic osteotomy (TPO) technique in dogs. STUDY DESIGN Experimental anatomic study. ANIMALS Cadaveric canine pelves (n = 8). METHODS Transverse plane computed tomographic images of cadaveric pelves with intact sacroiliac joints, mounted in a custom jig, were made (baseline) and again after DPO (20°, 25°, 30°) and TPO (20°) and pelvic angles measured in 6 transverse planes. Pelvic angles of the 3 DPO techniques were compared with TPO using concordance correlation to determine which DPO angle resulted in an acetabular ventroversion angle closest to TPO. RESULTS Mean ± SD AAs were 32.89 ± 2.23 (baseline), 47.39 ± 4.39 (20° DPO), 51.43 ± 5.06 (25° DPO), 54.75 ± 4.38 (30° DPO), and 50.20 ± 5.76 (20° TPO). Concordance correlations for the AA compared with 20° TPO were 0.027 (baseline), 0.721 (20° DPO), 0.902 (25° DPO), and 0.593 (30° DPO). A concordance correlation of ≥ 0.8 indicates good correlation. CONCLUSIONS A 25° DPO is most similar in acetabular ventroversion to 20° TPO (concordance correlation, 0.902).


title: The management of patients with metastatic prostate cancer during the COVID-19 pandemic.

text: During the ongoing global pandemic of coronavirus disease 2019 (COVID-19), the benefit of treating patients with cancer must be weighed against the COVID-19 infection risks to patients, staff and society. Prostate cancer is one of the most common cancers among men and raises particular interest during the pandemic as recent reports show that the TMPRSS2 (and other serine proteases), which facilitate the entry, replication and budding of the virion from a cell, can be inhibited using androgen deprivation therapy. Nevertheless, patients with metastatic prostate cancer commonly receive chemotherapy which may compromise their immune system. This paper aims to address the current status of the COVID-19 in patients with cancer overall and suggests an optimal approach to patients with metastatic prostate cancer.


title: Continuous topical oxygen for the treatment of chronic wounds: a pilot study.

text: Oxygen is essential for all stages of wound healing. Previous research has shown topical administration of oxygen to have positive effects on wound healing. In this study, the application of transdermal continuous topical oxygen therapy (TCOT) was evaluated for its effect on chronic wound healing in 9 patients. After 4 weeks of treatment, mean wound surface area and wound infection checklist scores were significantly reduced. Signs of bacterial damage were also reduced. Findings from this study suggest TCOT may be beneficial in promoting chronic wound healing.


title: Chikungunya Virus Infection-related Rhabdomyolysis: A Case Report.

text: Chikungunya virus infection is an infection transmitted by mosquitoes. It classically presents with fever and arthralgia. The rhabdomyolysis as a complication of this infection is rarely reported in the literature. We report a case of a previously healthy 34-year-old male patient with acute onset of fever, myalgia, arthralgia, and dark colored urine. Laboratory values revealed elevated creatinine, positive urine dipstick for blood, but urine microscopy showed no red blood cells. Serum creatine kinase (CK) was elevated (>2000 U/L). Serology was positive for Chikungunya IgM antibodies. Rhabdomyolysis due to acute Chikungunya viral infection was diagnosed. Patient condition improved with supportive treatment and was discharged home.


title: Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer.

text: PURPOSE Lymph node harvest of >or=12 has been adopted as a marker for adequacy of resection for colorectal cancer. We have noted a paucity of lymph nodes in rectal cancer specimens after neoadjuvant therapy, positing that the number of lymph nodes depends on the response to radiation and may not be an appropriate benchmark. Our purpose was to determine whether the number of lymph nodes harvested after neoadjuvant therapy is a useful quality indicator. METHODS A database of rectal cancer patients was queried to identify patients undergoing total mesorectal excision after neoadjuvant chemoradiation between January 1997 and August 2007. We compared patients with <12 lymph nodes to those with >or=12 lymph nodes relative to multiple patient and treatment factors. RESULTS One hundred seventy-six patients were identified (119 men; mean age, 60.4 y (range, 22-87)). Mean lymph node harvest was 10.1 (range, 1-38). Only 28% had >or=12 lymph nodes and 32% had <6 lymph nodes. There was no statistically significant difference in lymph node harvest relative to radiation dosage, age, tumor response, or type of surgery. There was no correlation between the number of lymph nodes harvested and the number of nodes positive for cancer. CONCLUSIONS With a standardized surgical technique and pathologic evaluation, the number of lymph nodes present after neoadjuvant chemoradiation and total mesorectal excision for rectal cancer varies greatly.


title: Do we really know how much we are feeding our patients?

text: BACKGROUND Nutrition support is important in critical illness, and accurate recording is particularly important to determine whether nutritional goals are met both from a caloric and volume perspective. OBJECTIVE To assess accuracy of enteral feeding records, to increase nursing education and to improve nutritional documentation. METHODS An uncontrolled, prospective, pre- and post-intervention study was completed as part of a quality improvement initiative. This study was performed in a 950-bed university hospital (Philadelphia, Pennsylvania) and focused in a 25-bed, closed intensive care unit (ICU) with a multidisciplinary rounding team of intensivist, nurse, pharmacist, dietitian and respiratory therapist. Nurse researchers reviewed 188 patient electronic medical records (EMR) and compared the data to volume data saved on enteral feeding pump. Data analysis revealed inconsistencies between the pump readings and EMR. The need for a prospective intervention was recognized and implementation of this intervention included pump calibration and teaching modules aimed at improving enteral feeding protocols. During post-intervention, another 234 records were reviewed. RESULTS The intervention of an education program reduced the documented discrepancy between the pump readings and charted volumes from 44 to 33%. A correlation analysis also showed a tighter relationship post-intervention (rpost = 0.84 vs. rpre = 0.76, both had a p < 0.01). CONCLUSION This study highlights the importance of accurate nutritional monitoring in the ICU and demonstrates that educational interventions can improve enteral feeding protocols. Pump calibrations, frequent interrogation and vigilant nutritional documentation can improve enteral nutrition delivery. Future studies are needed to determine if the effects are sustainable and if further education will further improve documentation and delivery.


title: [Thinking on Clinical rational use of TCM injection in the treatment of novel coronavirus pneumonia (COVID-19)].

text: 国家卫生健康委员会针对新型冠状病毒肺炎（COVID-19）疫情先后组织专家制定了6版诊疗方案，其中推荐于重型和危重型患者使用中药注射剂。本文基于中医药理论，从临床合理用药的角度分析了第六版方案推荐的中药注射剂的特点，认为COVID-19重型和危重型病机以血瘀为基础，疫毒炽盛进而导致闭证和脱证同时并现，提出：重型疫毒闭肺证可使用喜炎平注射液；重型气营两燔证可使用痰热清注射液和热毒宁注射液；危重型内闭外脱证使用参附注射液、生脉注射液或参麦注射液固脱，但必须与苏合香丸、安宫牛黄丸或醒脑静注射液开窍合用，且须辨明阴阳，阳脱者使用参附注射液，阴脱者使用生脉注射液，阳闭者使用醒脑静注射液；血瘀证是重型和危重型的共有病机，应选用血必净注射液等改善微循环，保证各组织器官充分灌流，为调动人体抗病潜能，截断扭转病势奠定基础。.


title: Specialized instrumentation facilitates stable peritoneal access, gastric decompression, and visualization during transgastric endoscopic peritoneoscopy.

text: PURPOSE The lack of high-fidelity instrumentation has impeded the development and implementation of natural orifice transluminal endoscopic surgery (NOTES). A steerable flexible trocar (SFT), a rotary access needle (RAN), and an articulating needle knife were developed as components of a flexible instrument set to facilitate transgastric peritoneal access and transluminal abdominal procedures. This cohort study aimed to assess the safety, feasibility, and efficacy of these devices during transgastric peritoneoscopy. METHODS Ten morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass participated in the study. Following laparoscopic access, transgastric peritoneal access was established using the SFT and RAN, and transgastric peritoneoscopy performed. NOTES adhesiolysis was performed in 2 patients with significant intra-abdominal adhesions due to prior surgery. Outcome measures included time to enter the peritoneal cavity, ability to visualize each quadrant of the abdomen, ability to perform adhesiolysis, and complications. RESULTS Ten patients with a median body mass index as stated in table 1 of 47.5 kg/m(2) were enrolled. Successful transgastric access was achieved in 8 of the 10 patients. One procedure was aborted because of difficulty creating the gastrotomy. Another procedure was aborted because of the difficult passage of the device through the oropharynx. An upper esophageal laceration occurred in one patient. Transgastric peritoneal access required 17.4 ± 5.5 minutes, and peritoneoscopy averaged 24.7 ± 7.6 minutes. The 4 abdominal quadrants were visualized and were accessible with the endoscope in all patients. CONCLUSIONS The SFT and RAN facilitate transgastric peritoneal access and visualization of difficult-to-reach areas of the peritoneum. These devices provide advanced instrumentation for transgastric NOTES procedures; however, care must be taken during the transoral insertion to avoid complications.


docid: qapzfhvp

title: Clinicopathologic Aspects of a Papulovesicular Eruption in a Patient With COVID-19.


title: Incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction: the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial.

text: BACKGROUND Reinfarction after primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction has negative consequences. Little is known about reinfarction after drug-eluting stents and bivalirudin anticoagulation. We, therefore, sought to determine the incidence, predictors, and implications of reinfarction after primary percutaneous coronary intervention in the contemporary era. METHODS AND RESULTS Outcomes were assessed in 3202 patients undergoing stent implantation for ST-segment-elevation myocardial infarction in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Independent predictors of reinfarction and mortality were identified by Cox proportional hazards modeling. The cumulative incidence of reinfarction was 1.8% at 30 days, 4.0% at 1 year, and 6.9% at 3 years. Definite stent thrombosis was responsible for 76.3% of reinfarctions occurring within 30 days and 52.0% of all reinfarctions within 3 years. Independent predictors of reinfarction were current smoking, Killip class ≥2, baseline thrombocytosis, multivessel disease, symptom onset-to-balloon time, and total stent length. Randomization to bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor and use of drug-eluting versus bare metal stents were not significant predictors of reinfarction. Reinfarction was a powerful independent predictor of subsequent cardiac mortality (hazard ratio [95% confidence interval]=7.65 [4.47-13.09]; P<0.0001) and all-cause mortality (hazard ratio [95% confidence interval]=2.88 [1.74-4.78]; P<0.0001). CONCLUSIONS Despite advances in pharmacotherapy and stents, reinfarction after primary percutaneous coronary intervention is not infrequent, in the contemporary era is most often attributable to stent thrombosis, and is strongly associated with subsequent cardiac and all-cause mortality. Further enhancements in drugs and devices to prevent reinfarction are needed to improve outcomes in high-risk patients with ST-segment-elevation myocardial infarction. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00433966.


title: Ultrafiltration characteristics of glucose polymers with low polydispersity.

text: BACKGROUND Icodextrin, a glucose polymer with a polydispersity [ratio of weight-average molecular weight (Mw) to number-average molecular weight] of approximately 2.6, has been shown, compared with glucose, to provide superior ultrafiltration (UF) efficiency [ratio of UF to carbohydrate (CHO) absorbed] when used as an osmotic agent during a long-dwell peritoneal dialysis exchange. In an experimental rabbit model, we evaluated the effect of Mw on the UF and UF efficiency of glucose polymers with low polydispersity. METHODS A crossover trial in female New Zealand White rabbits (2.20 - 2.65 kg) with surgically implanted peritoneal catheters evaluated two glucose polymers at nominal concentrations of 7.5 g/dL: a 6K polymer (Mw: 6.4 kDa; polydispersity: 2.3) and a 19K polymer (Mw: 18.8 kDa; polydispersity: 2.0). Rabbits were randomized to receive either the 6K (n = 11) or the 19K (n = 12) solution during the first exchange (40 mL/kg body weight). The alternative solution was evaluated in a second exchange 3 days later. During each 4-hour dwell, the UF and total glucose polymer CHO absorbed were determined. RESULTS The UF was higher for the 6K (p < 0.0001) than for the 19K polymer (mean ± standard deviation: 73.6 ± 30.8 mL vs. 43.0 ± 20.2 mL), as was the amount of CHO absorbed (42.5% ± 9.8% vs. 35.7% ± 11.0%, p = 0.021). In spite of higher CHO absorption, an approximately 50% higher (p = 0.029) UF efficiency was achieved with the 6K polymer (28.3 ± 18.8 mL/g) than with the 19K polymer (19.0 ± 11.3 mL/g). The results were independent of the order of the experimental exchanges. CONCLUSIONS Glucose polymers with low polydispersity are effective osmotic agents in a rabbit model. The low-Mw polymer was more effective at generating UF and had a higher UF efficiency, but those results came at the expense of the polymer being more readily absorbed from the peritoneal cavity.


title: Proteomics and NF-κB: an update.

text: The transcription factor NF-κB was discovered in 1986 and since then has been extensively studied in relation to cancer research and inflammatory or autoimmune diseases due to its important roles in the regulation of apoptosis and inflammation as well as innate and adaptive immunity. Although much is known about NF-κB signaling, novel NF-κB functions in different diseases are still being uncovered, together with its target proteins, interaction partners and regulators of its activation cascade. Proteomic approaches are particularly suited to the discovery of new proteins involved in distinct signal transduction cascades. This review provides an update on and extension of a recent review that summarized a number of proteomic approaches to NF-κB signaling. The studies discussed here utilized innovative techniques and offer several new hypotheses on the role of NF-κB in physiological and pathophysiological processes, which open new avenues for research on NF-κB in the future.


title: Complete genome of transmissible gastroenteritis virus AYU strain isolated in Shanghai, China.

text: Transmissible gastroenteritis virus strain AYU was isolated in Shanghai. The complete genome has a length of 28,582 bp and contains seven open reading frames. Sequence analysis suggested that Shanghai strain AYU and U.S. strain Purdue P115 are derived from a common ancestor, as they have 99.6% similarity at the nucleotide level.


title: How do smoking cessation medicines compare with respect to their neuropsychiatric safety? A protocol for a systematic review, network meta-analysis and cost-effectiveness analysis.

text: INTRODUCTION Cigarette smoking is one of the leading causes of early death in the UK and worldwide. Public health guidance recommends the use of varenicline, bupropion and nicotine replacement therapy (NRT) as smoking cessation aids in the UK. Additionally, the first electronic cigarette has been licensed for use as a smoking cessation medicine. However, there are ongoing concerns about the safety of these medicines. We present a protocol for a systematic review and network meta-analysis (NMA) to determine how these smoking cessation medicines compare to each other with respect to their neuropsychiatric safety in adult smokers. Secondary aims include updating the evidence regarding the effectiveness and cardiovascular safety of these medicines for use in a cost-effectiveness analysis. METHODS AND ANALYSIS We will include randomised controlled trials and observational studies with control groups comparing monotherapy with varenicline, bupropion, NRT or electronic cigarette and combination therapies to each other, placebo or usual care. The primary composite safety outcome will be serious adverse events, defined as events that resulted in death, were life threatening, required hospitalisation or resulted in significant disability or congenital/birth defect. The preferred effectiveness outcome will be sustained smoking cessation defined as abstinence for a minimum of 6 months as determined by biochemical validation. We will include trials identified by previous reviews and search relevant databases for newly published trials as well as contacting study authors to identify unpublished information. We will conduct fixed-effect and random-effect meta-analyses for each pairwise comparison of treatments and outcome; where these estimates differ, we will consider reasons for heterogeneity, quantified using the between-study variance (τ2). For each outcome, we will construct a NMA in a Bayesian framework which will be compared with the pair-wise results, allowing us to rank treatments. The effectiveness estimates from the NMA will be entered into a probabilistic economic model. ETHICS AND DISSEMINATION Ethics approval is not required for this evidence synthesis study as it involves analysis of secondary data from randomised controlled trials and observational studies. The review will make an important contribution to the knowledge base around the effectiveness, safety and cost-effectiveness of smoking cessation medicines. Results will be disseminated to the general public, healthcare practitioners and clinicians, academics, industry and policy makers. PROSPERO REGISTRATION NUMBER CRD42016041302.


title: Treatment of Psoriasis - Unburdened by Fear During SARS-CoV2 Menace.

text: In a matter of mere months, humanity was unexpectedly struck by the appearance of SARS-CoV-2, shifting our perception as medical practitioners regarding our day-to-day activity. One especially disconcerting change was patient addressability to medical facilities, as well as access to proper healthcare in various fields. As these changes occurred rapidly, dermatologists too had to adapt by means of teledermatology, giving us back the ability to reach, treat, and comfort our patients. Among the individuals requiring special dermatological attention are those suffering from psoriasis, especially considering that the biological therapies employed in treating this debilitating disease become questionable in the circumstance of the current pandemic. As more evidence surfaces concerning the pathophysiology of SARS-CoV-2, we become closer to understanding which therapies may interfere with its clearance, and which are actually safe to use. This review aims to answer the question, are biological therapies warranted in the treatment of psoriasis during the COVID-19 outbreak, or should they be discontinued?


title: Diagnosis and Management of Functional Heartburn.

text: Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists. Heartburn that does not respond to traditional acid suppression is a diagnostic and therapeutic dilemma. In the era of high utilization of proton pump inhibitors, a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease. Subjects without objective evidence of reflux as a cause of their symptoms have "functional heartburn". The diagnostic role of endoscopy, reflux and motility testing in functional heartburn (FH) patients is discussed. Lifestyle modifications, pharmacological interventions, and alternative therapies for FH are also presented. Recognition of patients with FH allows earlier assignment of these patients to different treatment algorithms, which may allow greater likelihood of success of treatment, diminished resource utilization and improved quality of life. Further data on this large and understudied group of patients is necessary to allow improvement in treatment algorithms and a more evidence-based approach to care of these patients.


title: A critical interpretive synthesis of the roles of midwives in health systems.

text: BACKGROUND Midwives' roles in sexual and reproductive health and rights continues to evolve. Understanding the profession's role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system. METHODS A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction. RESULTS A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession. CONCLUSIONS Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.


docid: odkxrise

title: The moment to see the poor.


title: Coagulopathy in COVID-19 and Its Implication for Safe and Efficacious Thromboprophylaxis.

text: The novel coronavirus, SARS-CoV-2, is causing a global pandemic of life-threatening multiorgan disease, called COVID-19. Accumulating evidence indicates that patients with COVID-19 are at significant risk of thromboembolic complications, mainly affecting the venous, but also the arterial vascular system. While the risk of venous thromboembolism (VTE) appears to be higher in patients requiring intensive care unit support compared to those admitted to general wards, recent autopsy findings and data on the timing of VTE diagnosis relative to hospitalization clearly suggest that thromboembolic events also contribute to morbidity and mortality in the ambulatory setting. In addition to a severe hypercoagulable state caused by systemic inflammation and viral endotheliitis, some patients with advanced COVID-19 may develop a coagulopathy, which meets established laboratory criteria for disseminated intravascular coagulation, but is not typically associated with relevant bleeding. Similar to other medical societies, the Society of Thrombosis and Haemostasis Research has issued empirical recommendations on initiation, dosing, and duration of pharmacological VTE prophylaxis in COVID-19 patients.


title: Pathogenic diversity of RNA variants and RNA variation-associated factors in cancer development.

text: Recently, with the development of RNA sequencing technologies such as next-generation sequencing (NGS) for RNA, numerous variations of alternatively processed RNAs made by alternative splicing, RNA editing, alternative maturation of microRNA (miRNA), RNA methylation, and alternative polyadenylation have been uncovered. Furthermore, abnormally processed RNAs can cause a variety of diseases, including obesity, diabetes, Alzheimer's disease, and cancer. Especially in cancer development, aberrant RNAs caused by deregulated RNA modifiers or regulators are related to progression. Accumulating evidence has reported that aberrant RNAs promote carcinogenesis in many cancers, including liver cancer, leukemia, melanoma, lung cancer, breast cancer, and other cancers, in which abnormal RNA processing occurs in normal cells. Therefore, it is necessary to understand the precise roles and mechanisms of disease-related RNA processing in various cancers for the development of therapeutic interventions. In this review, the underlying mechanisms of variations in the RNA life cycle and the biological impacts of RNA variations on carcinogenesis will be discussed, and therapeutic strategies for the treatment of tumor malignancies will be provided. We also discuss emerging roles of RNA regulators in hepatocellular carcinogenesis.


Use of home hemodialysis after peritoneal dialysis technique failure.


title: A Novel Loading Method for Doxycycline Liposomes for Intracellular Drug Delivery: Characterization of In Vitro and In Vivo Release Kinetics and Efficacy in a J774A.1 Cell Line Model of Mycobacterium smegmatis Infection.

text: Doxycycline (doxy) is used in treating intracellular and extracellular infections. Liposomal (LE) antibiotics allow low-frequency dosing and extended efficacy compared with standard (STD) formulations. We developed a novel sulfuric acid-loading method for doxycycline liposomes (LE-doxy). We hypothesized that a single s.c. injection of LE-doxy would be detectable in serum for at least 2 weeks at concentrations equal to or better than STD-doxy and would be bactericidal in an in vitro Mycobacterium smegmatis infection of J774A.1 macrophage cells. Liposomes were encapsulated by sulfuric acid gradient loading, and release kinetics were performed in vitro and in vivo. LE-doxy made using 8.25 mg/ml doxycycline loaded for 24 hours achieved 97.77% capture in 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and 43.87% in sphingomyelin (sphing). Rats were injected s.c. with 50 mg/kg LE-doxy or 5 mg/kg STD-doxy, and serial blood samples were collected. Pharmacokinetics were analyzed using high-performance liquid chromatography. Liver and injection site skin samples were collected at euthanasia (4 weeks postinjection). Minimal histologic tissue reactions occurred after injection of STD (nonliposomal), DPPC, or sphing-doxy. DPPC-doxy had slightly faster in vitro leakage than sphing liposomes, although both were detectable at 264 hours. The mean residence time for DPPC was the highest (111.78 hours), followed by sphing (56.00 hours) and STD (6.86 hours). DPPC and sphing-doxy were detectable at 0.2 μg/ml in serum at 336 hours postadministration. LE-doxy was not toxic to J774A.1 cells in vitro and produced inhibition of viable Mycobacterium smegmatis at 24 and 48 hours. LE-doxy will require further testing in in vivo infection models.


title: The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department.

text: BACKGROUND Patient crowding in emergency departments (ED) is a common challenge and associated with worsened outcome for the patients. Previous studies on biomarkers in the ED setting has focused on identification of high risk patients, and and the ability to use biomarkers to identify low-risk patients has only been sparsely examined. The broader aims of the TRIAGE study are to develop methods to identify low-risk patients appropriate for early ED discharge by combining information from a wide range of new inflammatory biomarkers and vital signs, the present baseline article aims to describe the formation of the TRIAGE database and characteristize the included patients. METHODS We included consecutive patients ≥ 17 years admitted to hospital after triage staging in the ED. Blood samples for a biobank were collected and plasma stored in a freezer (-80 °C). Triage was done by a trained nurse using the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database. RESULTS Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46-76), 49.8 % were male and median length of stay was 1 day (IQR 0-4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219 (3.6 %) died within 30 days. A higher triage acuity level was associated with numerous events, including acute surgery, endovascular intervention, i.v. treatment, cardiac arrest, stroke, admission to intensive care, hospital transfer, and mortality within 30 days (p < 0.001). CONCLUSION The TRIAGE database has been completed and includes data and blood samples from 6005 unselected consecutive hospitalized patients. More than 40 % experienced no events and were therefore potentially unnecessary hospital admissions.


title: Laparoscopic Sleeve Gastrectomy After Endoscopic Sleeve Gastroplasty: Technical Aspects and Short-Term Outcomes.

text: BACKGROUND Endoscopic sleeve gastroplasty (ESG) utilizes full-thickness sutures to plicate the greater curvature of the stomach. As with other weight loss interventions, some patients end up requiring revision to another procedure for insufficient weight loss or weight regain, discomfort, and procedure-related adverse events. OBJECTIVES In this paper, we report our technique and short-term outcomes of revisional sleeve gastrectomy (LSG) after ESG. SETTING Specialized medical center with standardized multidisciplinary protocols for medical, surgical, and endoscopic management of obesity. METHODS A combined laparoscopic-endoscopic technique that identifies plication orientation and the location of anchors and sutures was employed. This prepares the stomach for safe stapling, excluding sutures and anchors from the staple line and the retained sleeve. Hereby, we report this technique with its short-term safety and efficacy outcomes. RESULTS Twenty patients (16 female; mean age 40 ± 6 years) underwent revisional LSG from a total of 1665 (1.2%) who underwent primary ESG. Mean body mass index at the time of primary and revision procedures were 35.0 ± 4.0 and 35.2 ± 3.8 kg/m2, respectively. Nadir % total weight loss (%TWL) after primary ESG was 7.7 ± 3.5%. %TWL at 6 and 12 months after LSG was 21.0 ± 2.7 (n = 11) and 25.6 ± 4.1 (n = 8), respectively. There were no missed follow-up visits. Additionally, there was no mortality, prolonged hospital stay, adverse events, reoperations, or readmissions. CONCLUSIONS Based on this combined laparoscopic-endoscopic technique, laparoscopic sleeve gastrectomy is a safe and feasible revision option for patients who fail ESG.


title: Traumatic peroneal split lesion with retinaculum avulsion: Diagnosis and post-operative multymodality imaging.

text: Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability. The typical clinical presentation is retro-malleolar pain, in some cases associated with palpable swelling around the fibular malleolus, pain during activities and difficulty in walking. We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury. An early diagnosis allowed treating the injury and promptly resuming sport activity, after rehabilitation training. Surgical reconstruction key-points and post-surgical follow-up were also discussed. A late diagnosis would have caused a symptomatology worsening and an increased recovery time.


title: Fetal Transient Skin Edema in Two Pregnant Women With Coronavirus Disease 2019 (COVID-19).

text: BACKGROUND The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection. CASES The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful. CONCLUSION Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness.


title: Bispectral Index monitoring in cancer patients undergoing palliative sedation: a preliminary report.

text: INTRODUCTION Continuous palliative sedation (PS) is currently titrated based on clinical observation; however, it is often unclear if patients are still aware of their suffering. The aim of this prospective study is to characterize the level of consciousness in patients undergoing PS using Bispectral Index (BIS) monitoring. PATIENTS AND METHODS We enrolled consecutive patients with refractory symptoms requiring PS. We documented the level of sedation using Ramsay Sedation Scale (RSS) and BIS at 0, 2, 4, 6, 12, and 24 h during the first day of PS and examined their degree of association. Intravenous midazolam or propofol was titrated according to the sedation level. RESULTS Twenty patients on PS were recruited and had BIS continuous monitoring. Delirium was the most frequent reason for PS (n = 15, 75%). The median time of sedation was 24.5 h (interquartile range 6-46). The average time to achieve the desired sedation level was 6 h, and dose titration was required in 80% of the cases. At baseline, 14 (70%) patients were considered to be awake according to RSS (i.e., 1-3) and 19 (95%) were awake according to BIS (i.e., >60%). This proportion decreased to 31 and 56% at 4 h, 27% and 53 at 6 h, and 22 and 33% at 24 h. RS and BIS had moderate correlation (rho = -0.58 to -0.65); however, a small proportion of patients were found to be awake by BIS (i.e., ≥60%) despite clinical observation (i.e., RSS 4-6) indicating otherwise. CONCLUSIONS The BIS is a noninvasive, bedside, real-time continuous monitoring method that may facilitate the objective assessment of level of consciousness and dose titration in patients undergoing PS.


title: Comparison of prasugrel and bivalirudin vs clopidogrel and heparin in patients with ST-segment elevation myocardial infarction: Design and rationale of the Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 trial.

text: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI). Effective and safe adjunct antithrombotic therapy is a major determinant for short- and long-term outcomes after primary PCI. Two separate studies have shown significant benefits vs conventional therapy for 2 recently approved drugs. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial, bivalirudin after pretreatment with clopidogrel resulted in improved net clinical outcome compared with heparin plus glycoprotein IIb/IIIa inhibitors. However, during the first 24 hours after PCI, there was an increase in stent thrombosis rates with bivalirudin. In the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction (TRITON-TIMI) 38 trial, prasugrel was superior to clopidogrel in patients with acute coronary syndrome with and without ST-segment elevation. The synergic actions of prasugrel and bivalirudin may maximize the benefit of antithrombotic therapy for STEMI patients undergoing primary PCI. However, no specifically designed studies have so far compared the combination of prasugrel plus bivalirudin with that of clopidogrel plus unfractionated heparin in these patients. The Bavarian Reperfusion Alternatives Evaluation (BRAVE) 4 study is a randomized, open-label, multicenter trial aimed to test the hypothesis that a strategy based on prasugrel plus bivalirudin is superior to a strategy based on clopidogrel plus unfractionated heparin in terms of net clinical outcome in STEMI patients with planned primary PCI.


title: Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19).

text: BACKGROUND At present, the severity of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a focal point. METHODS To assess the factors associated with severity and prognosis of patients infected with SARS-CoV-2, we retrospectively investigated the clinical, imaging, and laboratory characteristics of confirmed 280 cases of novel coronavirus disease (COVID-19) from January 20 to February 20, 2020. RESULTS The median age of patients in the mild group was 37.55 years old, while that in the severe group was 63.04 years old. The proportion of patients over 65 years old in the severe group was significantly higher than that of the mild group (59.04% vs. 10.15%, P < 0.05). 85.54% of severe patients had diabetes or cardiovascular diseases, which was significantly higher than that of the mild group (51.81% vs 7.11%, P = 0.025; 33.73% vs 3.05%, P = 0.042). Patients in the mild group experienced earlier initiation of antiviral treatment (1.19 ± 0.45 vs 2.65 ± 1.06 days in the severe group, P < 0.001). Our study showed that comorbidity, time from illness onset to antiviral, and age >=65 were three major risk factors for COVID-19 progression, while comorbidity and time from illness onset to antiviral were two major risk factors for COVID-19 recovery. CONCLUSIONS The elderly and patients with underlying diseases are more likely to experience a severe progression of COVID-19. It is recommended that timely antiviral treatment should be initiated to slow the disease progression and improve the prognosis.


title: Performance of different mono- and multiplex nucleic acid amplification tests on a multipathogen external quality assessment panel.

text: An external quality assessment (EQA) panel consisting of a total of 48 samples in bronchoalveolar lavage (BAL) fluid or transport medium was prepared in collaboration with Quality Control for Molecular Diagnostics (QCMD) (www.qcmd.org). The panel was used to assess the proficiency of the three laboratories that would be responsible for examining the 6,000 samples to be collected in the GRACE Network of Excellence (www.grace-lrti.org). The main objective was to decide on the best-performing testing approach for the detection of influenza viruses A and B, parainfluenza virus types 1 to 3, respiratory syncytial virus (RSV), human metapneumovirus, coronavirus, rhinovirus, adenovirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila by nucleic acid amplification techniques (NAATs). Two approaches were chosen: (i) laboratories testing samples using their in-house procedures for extraction and amplification and (ii) laboratories using their in-house amplification procedures on centrally extracted samples. Furthermore, three commercially available multiplex NAAT tests-the ResPlex (Qiagen GmbH, Hilden, Germany), RespiFinder plus (PathoFinder, Maastricht, The Netherlands), and RespiFinder Smart 21 (PathoFinder) tests-were evaluated by examination of the same EQA panel by the manufacturer. No large differences among the 3 laboratories were noticed when the performances of the assays developed in-house in combination with the in-house extraction procedures were compared. Also, the extraction procedure (central versus local) had little effect on performance. However, large differences in amplification efficacy were found between the commercially available tests; acceptable results were obtained by using the PathoFinder assays.


title: Suture versus tack fixation of mesh in laparoscopic umbilical hernia repair.

text: BACKGROUND AND OBJECTIVES Mesh fixation in laparoscopic umbilical hernia repair is poorly studied. We compared postoperative outcomes of laparoscopic umbilical hernia repair in suture versus tack mesh fixation. METHODS Patients who underwent laparoscopic umbilical hernia repair were separated by method of mesh fixation: sutures versus primarily tacks. Medical history and follow-up data were collected through medical records. The primary outcome of this study was the recurrence rates of hernias. Postoperative major and minor complications, such as surgical site infection, small-bowel obstruction, and seroma formation, were regarded as secondary outcomes. Additionally, a telephone interview was conducted to assess postoperative pain, recovery time, and overall patient satisfaction. RESULTS Eighty-six patients were identified: 33 in the suture group and 53 in the tacks group. The number of emergent cases was increased in the tacks group (6 vs 0; P = .022). Mean follow-up time was 2.7 years for both groups. Documented postoperative follow-up was obtained in 29 (90%) suture group and 31 (58%) tacks group patients. Hernia recurrence occurred in 3 and 2 patients in the sutures and tacks groups, respectively (P was not significant). No differences were found in secondary outcomes, including subjective outcomes from telephone interviews, between groups. CONCLUSIONS There are no differences in postoperative complication rates in suture versus tack mesh fixation in laparoscopic umbilical hernia repair.


Potentially repurposing adamantanes for COVID-19.


title: The Role of Human Coronavirus Infection in Pediatric Acute Gastroenteritis.

text: Since human coronavirus (HCoV)-like particles were detected in the stool specimens of acute gastroenteritis and necrotizing enterocolitis children with electron microscopy, the relationship between HCoV and the pediatric gastrointestinal illness had been recognized. In recent years, the overall detection rates have been low and have varied by region. HCoVs have not been considered as the major pathogens in pediatric acute gastroenteritis. HCoVs detected in children with acute gastroenteritis have included 229E, OC43, HKU1, NL63, and severe acute respiratory syndrome coronavirus, Middle East Respiratory Syndrome Coronavirus and severe acute respiratory syndrome coronavirus-2 have also been associated with gastrointestinal symptoms in children. Although digestive tract has been recognized as an infection route, it has not been possible to fully investigate the association between HCoVs infection and the gastrointestinal symptoms because of the limited number of pediatric cases. Furthermore, pathological features have not been clear. Till now, our knowledge of severe acute respiratory syndrome coronavirus-2 is limited. However, diarrhea and vomiting have been seen in pediatric cases, particularly in newborns and infants. It has been necessary to pay more attention on gastrointestinal transmission to identify the infected children early and avoid the children without apparent or mild symptoms becoming the sources of infection.


title: Development of a multiplex PCR to detect and discriminate porcine circoviruses in clinical specimens.

text: BACKGROUND A diagnostic method to simultaneously detect and discriminate porcine circovirus type 1 (PCV1), porcine circovirus type 2 (PCV2) and porcine circovirus type 3 (PCV3) in clinical specimens is imperative for the differential diagnosis and monitoring and control of PCVs in the field. METHODS Three primer pairs were designed and used to develop a multiplex PCR assay. And 286 samples from 8 farms in Hubei province were tested by the developed multiplex PCR assay to demonstrate the accuracy. RESULTS Each of target genes of PCV1, PCV2 and PCV3 was amplified using the designed primers, while no other porcine viruses genes were detected. The limit of detection of the assay was 10 copies/μL of PCV1, PCV2 OR PCV3. The results of the tissue samples detection showed that PCV1, PCV2 and PCV3 are co-circulating in central China. The PCV1, PCV2 and PCV3 singular infection rate was 52.4% (150/286), 61.2% (175/286) and 45.1% (129/286), respectively, while the PCV1 and PCV2 co-infection rate was 11.2% (32/286), the PCV1 and PCV3 co-infection rate was 5.9% (17/286), the PCV2 and PCV3 co-infection rate was 23.4% (67/286), and the PCV1, PCV2 and PCV3 co-infection rate was 1.7% (5/286), respectively, which were 100% consistent with the sequencing method and real-time PCR methods. CONCLUSIONS The multiplex PCR assay could be used as a differential diagnostic tool for monitoring and control of PCVs in the field. The results also indicate that the PCVs infection and their co-infection are severe in Hubei province, Central China.


title: Fluorescence angiography with indocyanine green (ICG) to evaluate anastomosis in colorectal surgery: where does it have more value?

text: BACKGROUND Indocyanine green (ICG) fluorescence angiography (FA) was introduced to provide the real-time intraoperative evaluation of the vascular supply of anastomosis. However, further studies are required to evaluate its advantages in colorectal surgery and to know in which procedure this technology has more value. The aim of the present study is to assess the usefulness of the ICG-FA in the colorectal anastomosis evaluation and to evaluate where it is most useful depending on type of resection performed in terms of change of section line based on the ICG-FA and anastomotic leakage (AL) rates. METHODS This is a prospective study. From September 2014 to November 2018, all patients who underwent any colorectal surgical procedure with ICG-FA in our center were enrolled in the study. Based on the type of surgery, patients were grouped in 4 categories: Group A, right hemicolectomy; Group B, segmental resection of the splenic flexure; Group C, left hemicolectomy; and Group D, anterior resection of the rectum. RESULTS One-hundred-ninety-two unselected consecutive patients were enrolled: 67 in group A, 9 in B, 81 in C, and 35 in D. Change of section line based on ICG-FA occurred in 35 cases (18.2%): 4 in group A (6%), 1 in group B (11.1%), 21 in group C (25.9%), and 9 in group D (25.7%). ALs occurred in 5 patients (2.6%): 2 in group A (3%), 1 in C (1.2%), and 2 in D (5.7%). CONCLUSIONS ICG-FA leads to significantly more changes in the resection line in case of left hemicolectomy followed by anterior resection. FA is a promising optical imaging technique to reduce the AL incidence after colorectal procedures. To confirm this data, further studies with wider sample size and with an objective evaluation of the anastomotic perfusion are required.