title: Global biogeography of human infectious diseases.

text: The distributions of most infectious agents causing disease in humans are poorly resolved or unknown. However, poorly known and unknown agents contribute to the global burden of disease and will underlie many future disease risks. Existing patterns of infectious disease co-occurrence could thus play a critical role in resolving or anticipating current and future disease threats. We analyzed the global occurrence patterns of 187 human infectious diseases across 225 countries and seven epidemiological classes (human-specific, zoonotic, vector-borne, non-vector-borne, bacterial, viral, and parasitic) to show that human infectious diseases exhibit distinct spatial grouping patterns at a global scale. We demonstrate, using outbreaks of Ebola virus as a test case, that this spatial structuring provides an untapped source of prior information that could be used to tighten the focus of a range of health-related research and management activities at early stages or in data-poor settings, including disease surveillance, outbreak responses, or optimizing pathogen discovery. In examining the correlates of these spatial patterns, among a range of geographic, epidemiological, environmental, and social factors, mammalian biodiversity was the strongest predictor of infectious disease co-occurrence overall and for six of the seven disease classes examined, giving rise to a striking congruence between global pathogeographic and "Wallacean" zoogeographic patterns. This clear biogeographic signal suggests that infectious disease assemblages remain fundamentally constrained in their distributions by ecological barriers to dispersal or establishment, despite the homogenizing forces of globalization. Pathogeography thus provides an overarching context in which other factors promoting infectious disease emergence and spread are set.


docid: urtjpgee

title: A qualitative study of the vocational and psychological perceptions and issues of transdisciplinary nurses during the COVID-19 outbreak.

text: BACKGROUND Due to its high infectivity and concealment, the coronavirus disease 2019 (COVID-19) outbreak that occurred in Wuhan attracted global attention. A special nursing group of transdisciplinary nurses (TNs) who had not worked in respiratory medicine, infection departments, or emergency and intensive medicine but who accounted for a large proportion of all nurses also drew our attention. Few studies have examined this special group of TNs. Therefore, this study collected the experiences and views of TNs at the forefront of the COVID-19 outbreak to investigate their potential problems. RESULTS Twenty-five TNs and 19 nurses with experience in infectious diseases (non-TNs) were enrolled in the study. Compared with non-TNs, TNs showed higher levels of perceived stress and relatively less perceived social support. For TNs, the ambiguous roles, transition of operating mode, unfamiliar work content, and reversal of their daily schedule were the most common vocational problems. Additionally, most TNs had psychological problems such as anxiety, pain and insomnia. The incomprehension of parents, concern for family members and long-term isolation were the most common causes of psychological stress. CONCLUSION This survey is the first to focus on the group of TNs at the forefront of the COVID-19 outbreak and to investigate their experiences, vocational issues and psychological stresses qualitatively and quantificationally. We found that TNs had more perceived stress and less perceived social support than non-TNs. The vocational and psychological issues of TNs should be highlighted. These findings identify important issues and offer insights into the underlying issues to help TNs ultimately win the battle against novel coronavirus epidemics. METHODS Semi-structured and face-to-face individual interviews and quantitative assessments were conducted. The Braun Clarke Thematic Analysis method and the strategy outlined by Miles and Huberman were used in the data analysis process of the qualitative study. The perceived stress scale and perceived social support scale were utilized to quantificationally evaluate the perceived stress level and the amount of perceived social support. Both qualitative and quantitative methods were adopted to assess the vocational and psychological perceptions and issues.


title: Neurointerventional Stenting and Antiplatelet Function Testing: To Do or Not to Do?

text: BACKGROUND AND PURPOSE Platelet function testing in neurointerventional (NI) procedures is still controversial. We compared the clinical outcomes between antiplatelet responders and nonresponders based on the results of the VerifyNow (VN) testing method. METHODS This is a retrospective single-center analysis of all consecutive patients who underwent NI stenting procedures from January 2007 through July 2013 and had documented preprocedural aspirin (ASA) and clopidogrel VN assays. Patients were divided into two groups based on their responsiveness to antiplatelet. Baseline characteristics, good functional outcome measured by the modified Rankin Scale (mRS) at 90 days, combined procedural complication rate defined as postprocedural stroke, in-stent thrombosis, and intraoperative rupture were compared between the two groups. RESULTS Our cohort included 37 patients: 26 were in the responder group (RG) and 11 were in the nonresponder group (NRG). Baseline characteristics were similar between the two groups. Even though the combined complication rate was similar between the two groups [NRG: 2/11 (18%) vs. RG: 2/26 (7%); p = 0.33], there was a trend for a higher rate of good functional outcome (90-day mRS: 0-2) in the RG (22/22, 100%) as compared to the NRG (8/10, 80%) (p = 0.0907). CONCLUSION Overall, utilizing the VN antiplatelet function testing did not significantly change the clinical outcome after the NI procedures. Larger randomized trials are warranted to provide a better understanding of the utility of the antiplatelet testing in NI stenting procedures.


Management of respiratory failure due to covid-19.


title: A new method of choice for organoleptic scoring: The negative-pressure technique.

text: AIM To examine an organoleptic scoring method (OLS) whereby the sample is collected by negative pressure in a syringe and is subsequently smelled and rated away from the patient. MATERIALS AND METHODS Data of 476 patients visiting a specialized halitosis clinic in Leuven (Belgium) were reviewed retrospectively. Organoleptic (with the classic and with the negative-pressure method) and instrumental (with the Halimeter® and OralChroma™ ) ratings of breath odour were retrieved from patient files together with the final diagnosis. The correlations between the different methods were examined (Spearman correlation coefficient) as well as the positive (PPV) and negative predictive value (NPV), sensitivity and specificity of all methods. RESULTS Both methods of OLS correlated similarly with the instrumental measurements (Halimeter® and OralChroma™ ). Analysis of PPV, NPV, sensitivity and specificity of both methods of examination showed that the negative-pressure method performed best. CONCLUSION The negative-pressure method is a valid method for organoleptic scoring of the breath odour and performs as good as the classic organoleptic method.


docid: xmizaepo

title: Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case-control study.

text: INTRODUCTION Acute kidney injury (AKI) is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Renal near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in a non-invasive continuous real-time fashion, and reflects tissue perfusion. The aim of this study was to evaluate the relationship between renal oximetry and development of AKI in the operative and post-operative setting in infants undergoing cardiopulmonary bypass surgery. METHODS In this prospective study, we enrolled 59 infants undergoing cardiopulmonary bypass surgery for congenital heart disease for univentricular (n = 26) or biventricular (n = 33) repair. Renal NIRS was continuously measured intraoperatively and for at least 24 hours postoperatively and analysed for the intraoperative and first 12 hours, first 24 hours and first 48 hours postoperatively. The renal oximetry values were correlated with the paediatric risk, injury, failure, loss, end (pRIFLE) classification for AKI, renal biomarkers and the postoperative course. RESULTS Twenty-eight (48%) infants developed AKI based on pRIFLE classification. Already during intraoperative renal oximetry and further in the first 12 hours, 24 hours and 48 hours postoperatively, significantly lower renal oximetry values in AKI patients compared with patients with normal renal function were recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths occurred. Infants with decreased renal oximetry values developed significantly higher lactate levels 24 hours after surgery. Cystatin C was a late parameter of AKI, and neutrophil gelatinase-associated lipocalin values were not correlated with AKI occurrence. CONCLUSION Our results suggest that prolonged low renal oximetry values during cardiac surgery correlate with the development of AKI and may be superior to conventional biochemical markers. Renal NIRS might be a promising non-invasive tool of multimodal monitoring of kidney function and developing AKI in infants undergoing cardiac surgery with cardiopulmonary bypass.


title: Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks.

text: During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift-to some degree-from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by "crisis standards of care," but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities.


title: Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management.

text: BACKGROUND A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. METHODS A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease. RESULTS Five patients met the study entry criteria. Their mean age was 78.4 years (range 65-93). All presented with substantial deficits (median NIHSS score 11, range 5-22), but improved while in supine position during initial imaging to normal or near-normal (NIHSS score 0-2). MRA showed persistent M1 MCA occlusions in 4, critical ICA stenosis or occlusion in 1, and substantial perfusion-diffusion mismatch in all. To evaluate the potential for eventual collateral failure, patients were placed in a head of bed upright posture. Mean arterial pressure and heart rate were unchanged. Two showed no neurologic worsening and were treated with supportive care with excellent final outcome. Three showed worsening, including recurrent hemiparesis and aphasia at the 6th, recurrent aphasia at the 23rd, and recurrent hemineglect at the 15th upright minute. These 3 underwent endovascular recanalization therapies with successful reperfusion and excellent final outcome. CONCLUSION The 'Heads Up' test may be a useful, simple maneuver to assess the risk of collateral failure and guide the decision to pursue recanalization therapy in acute cerebral ischemia patients with minimal deficits despite persisting large cerebral artery occlusion.


title: Catheter-directed interventions for acute iliocaval deep vein thrombosis.

text: Acute deep vein thrombosis (DVT) is associated with significant morbidity in the form of acute limb-threatening compromise from phlegmasia cerulea dolens, development of the postthrombotic syndrome (PTS), and even death secondary to pulmonary embolism. Initial therapy for DVT is anticoagulation, which inhibits thrombus propagation but lacks the thrombolytic properties to facilitate active thrombus removal. The existing thrombus burden can cause increased venous hypertension from occlusion as well as damage to venous valves by initiating an inflammatory response, which can ultimately result in PTS in up to half of patients on anticoagulation. The manifestations of PTS include leg pain, swelling, lifestyle-limiting venous claudication, skin hyperpigmentation, venous varicosities, and, in rare cases, venous stasis ulcers. Furthermore, patients with iliocaval DVT and large, free-floating thrombus are at an increased risk for pulmonary embolism despite adequate anticoagulation. Early attempts at thrombus removal with surgical thrombectomy or systemic thrombolysis or both demonstrated reductions in the incidence of PTS but were of limited utility owing to their invasiveness and increased risk of bleeding complications. New minimally invasive endovascular therapies, such as pharmacomechanical catheter-directed thrombolysis, have been proposed, which focus on rapid thrombus removal while decreasing the rate of bleeding complications associated with systemic therapy. This article provides an overview of the current pharmacomechanical catheter-directed thrombolysis protocol utilized at the Mount Sinai Hospital for acute iliocaval DVT.


title: Effect of different dental articulating papers on SEMG activity during maximum clenching.

text: This study evaluated the influence of two different occlusal indicators (articulating papers of 40μm and 200μm) on muscular activity of the temporalis anterior (TA) and superficial masseter (MS) during maximum voluntary clenches (MVC), using surface electromyography (SEMG). It was hypothesized that an articulating paper positioned between dental arches during MVC elicits a different muscular activity compared with the occlusion on natural dentition (without the occlusal indicator). 30 healthy adult subjects with a complete, natural dentition were recruited; SEMG activity was recorded in the following experimental conditions: MVC with cotton rolls for standardization purposes; MVC on natural dentition; MVC onto the 40μm or 200μm paper indicator positioned on right or left side of the dental arch. Percentage Overlapping Coefficient (POC; separate values obtained for TA and MS), antero-posterior coefficient (APC) and total muscle activities (IMP) were the analyzed SEMG parameters. The use of an occlusal indicator statistically changed POC_TA, POC_MS and IMP median values (p<0.05). Both 40μm and 200μm occlusal papers did not significantly affect APC values (P=0.86). A pronounced asymmetric muscular activity has been recorded with the introduction of an interocclusal media. All indices of muscular activity did not differ between sexes (Kruskal Wallis test, P>0.05). In conclusion, the examined articulating papers affected two specific SEMG parameters (POC and IMP); the recorded muscular activity with the occlusal indicator varied regardless left or right side positioning, and independently from tested paper thicknesses.


title: Psychological support and psychotherapy via digital devices in Covid-19 emergency time: Some critical issues.

text: The Covid-19 pandemic and the resulting fear, quarantine and lockdown measures implemented in Italy and other countries to contain the risk of contagion have seriously impacted the mental health of a large number of people. The need to offer psychological and psychotherapeutic support to these people, while respecting the government's pressing calls to "stay home", have led many psychologists and psychotherapists, both in the public and private sectors, to provide their professional services via teleconference, telephone, smartphone, etc. The aim of this work is to highlight some critical issues related to the sudden switch from the traditional method of providing psychological services to the digital one in Italy.


title: Infections in pediatrics: old and new diseases.

text: Paediatric infectious diseases have been reported since Hippocrates, and were always closely linked with the evolution of medicine. Current insights and recommendations by the Pediatric Infectious Diseases Group of Switzerland for the management of common paediatric diseases, such as acute otitis media, pharyngitis, and acute viral gastroenteritis are reviewed. The emergence of "old" vaccine-preventable diseases - pertussis and measles - is also discussed. Furthermore, the impact of the appearance of new hosts in paediatric - very low birthweight infants, immunosuppressed patients - is evaluated. Finally, new emerging paediatric infectious diseases caused by newly discovered viruses, such as human metapneumovirus, human bocavirus, or human coronavirus NL63 are explored. This overview gives a general idea on some topics that are currently significant and specific to paediatric infectious diseases.


The impact of covid-19 on rehabilitation services and activities. Letter to the editor in response to official document of SIMFER.


docid: xmoqvdst

title: Are Wireless Electronic Stethoscopes Useful for Respiratory Rate Monitoring During Intravenous Sedation?

text: PURPOSE Wireless stethoscopes can measure respiratory rate noninvasively and continuously, but there are no reports of their use during dental treatment. This study evaluated the usefulness of wireless stethoscopes during dental procedures requiring intravenous sedation (IVS). MATERIALS AND METHODS This study was a prospective cohort study. The study sample consisted of dental patients who received IVS by propofol or midazolam administration at the Nippon Dental University Hospital (Tokyo, Japan). The predictor was respiratory rate measured using the wireless stethoscope (BrRR), and the outcome variable was respiratory rate measured during capnography (RR). Pearson correlation coefficients and paired-samples t tests were used for data analysis. A P value less than .05 was considered statistically significant. RESULTS The study sample consisted of 12 patients. BrRR and RR were significantly and positively correlated (r = 0.93, P < .01). The mean ± standard deviation of BrRR was 14.16 ± 2.67 and that of RR was 14.32 ± 2.77. There was no significant difference between the 2 groups (P = .27). CONCLUSIONS The results of this study suggest that wireless stethoscopes are suitable for monitoring respiratory rate during dental procedures requiring IVS because their use is as accurate as capnography.


title: Efficacy of regional saturation of oxygen monitor using near-infrared spectroscopy for lower limb ischemia during minimally invasive cardiac surgery.

text: Lower limb ischemia with an occlusive cannula is a potential complication of minimally invasive cardiac surgery (MICS). We evaluated intraoperative local oxygen supply-demand balance by monitoring regional saturation of oxygen (rSO2) using near-infrared spectroscopy (NIRS), and analyzed the correlation between cannula size and fluctuation range of rSO2. Fifty-four patients undergoing MICS surgery using femoral artery cannulation from April 2015 to August 2016 were enrolled. The rSO2 of both the cannulated and uncannulated lower limbs were measured using NIRS. The association between the decline of rSO2 from baseline (delta-rSO2) and the ratio of the cannula diameter to the femoral artery diameter (Cd/FAd) was analyzed. Of the 54 patients, 16 (30%) (Group 1) showed values over 0.65 for Cd/FAd, and the remaining 38 (70%) (Group 2) showed values under 0.65. No patient developed postoperative lower limb ischemia. No patient was treated with an ipsilateral distal perfusion cannula. There were significant differences between Group 1 and Group 2 in the decrease of rSO2 at the point of cannulation on the cannulated limb. In the lower limb on the cannulated side, delta-rSO2 showed a significant decrease in Group 1 compared to Group 2 (Group 1 vs Group 2: 19.9 vs 11.0%; p < 0.001). Delta-rSO2 was significantly correlated with body surface aera (BSA), but not with gender or age. Decreasing rSO2 correlates with the Cd/FAd index. Low BSA, Cd/Fad > 0.65 is considered as the risk factor for decline of rSO2 in cannulated limb in MICS.


title: Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose).

text: BACKGROUND Whereas thermal ablation of incompetent saphenous veins is highly effective, all heat-based ablation techniques require the use of perivenous subfascial tumescent anesthesia, involving multiple needle punctures along the course of the target vein. Preliminary evidence suggests that cyanoacrylate embolization (CAE) may be effective in the treatment of incompetent great saphenous veins (GSVs). We report herein early results of a randomized trial of CAE vs radiofrequency ablation (RFA) for the treatment of symptomatic incompetent GSVs. METHODS Two hundred twenty-two subjects with symptomatic GSV incompetence were randomly assigned to receive either CAE (n = 108) with the VenaSeal Sapheon Closure System (Sapheon, Inc, Morrisville, NC) or RFA (n = 114) with the ClosureFast system (Covidien, Mansfield, Mass). After discharge, subjects returned to the clinic on day 3 and again at months 1 and 3. The study's primary end point was closure of the target vein at month 3 as assessed by duplex ultrasound and adjudicated by an independent vascular ultrasound core laboratory. Statistical testing focused on showing noninferiority with a 10% delta conditionally followed by superiority testing. No adjunctive procedures were allowed until after the month 3 visit, and missing month 3 data were imputed by various methods. Secondary end points included patient-reported pain during vein treatment and extent of ecchymosis at day 3. Additional assessments included general and disease-specific quality of life surveys and adverse event rates. RESULTS All subjects received the assigned intervention. By use of the predictive method for imputing missing data, 3-month closure rates were 99% for CAE and 96% for RFA. All primary end point analyses, which used various methods to account for the missing data rate (14%), showed evidence to support the study's noninferiority hypothesis (all P < .01); some of these analyses supported a trend toward superiority (P = .07 in the predictive model). Pain experienced during the procedure was mild and similar between treatment groups (2.2 and 2.4 for CAE and RFA, respectively, on a 10-point scale; P = .11). At day 3, less ecchymosis in the treated region was present after CAE compared with RFA (P < .01). Other adverse events occurred at a similar rate between groups and were generally mild and well tolerated. CONCLUSIONS CAE was proven to be noninferior to RFA for the treatment of incompetent GSVs at month 3 after the procedure. Both treatment methods showed good safety profiles. CAE does not require tumescent anesthesia and is associated with less postprocedure ecchymosis.


title: Empirically Tested Health Literacy Frameworks.

text: BACKGROUND Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior. METHODS We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis. KEY RESULTS The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent. DISCUSSION Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21-e44.] PLAIN LANGUAGE SUMMARY: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens.


title: Computational discovery of small drug-like compounds as potential inhibitors of SARS-CoV-2 main protease.

text: A computational approach to in silico drug discovery was carried out to identify small drug-like compounds able to show structural and functional mimicry of the high affinity ligand X77, potent non-covalent inhibitor of SARS-COV-2 main protease (MPro). In doing so, the X77-mimetic candidates were predicted based on the crystal X77-MPro structure by a public web-oriented virtual screening platform Pharmit. Models of these candidates bound to SARS-COV-2 MPro were generated by molecular docking, quantum chemical calculations and molecular dynamics simulations. At the final point, analysis of the interaction modes of the identified compounds with MPro and prediction of their binding affinity were carried out. Calculation revealed 5 top-ranking compounds that exhibited a high affinity to the active site of SARS-CoV-2 MPro. Insights into the ligand - MPro models indicate that all identified compounds may effectively block the binding pocket of SARS-CoV-2 MPro, in line with the low values of binding free energy and dissociation constant. Mechanism of binding of these compounds to MPro is mainly provided by van der Waals interactions with the functionally important residues of the enzyme, such as His-41, Met-49, Cys-145, Met-165, and Gln-189 that play a role of the binding hot spots assisting the predicted molecules to effectively interact with the MPro active site. The data obtained show that the identified X77-mimetic candidates may serve as good scaffolds for the design of novel antiviral agents able to target the active site of SARS-CoV-2 MPro. Communicated by Ramaswamy H. Sarma.


docid: azxecnaz

title: A review on the use of artificial intelligence for medical imaging of the lungs of patients with coronavirus disease 2019.

text: The results of research on the use of artificial intelligence (AI) for medical imaging of the lungs of patients with coronavirus disease 2019 (COVID-19) has been published in various forms. In this study, we reviewed the AI for diagnostic imaging of COVID-19 pneumonia. PubMed, arXiv, medRxiv, and Google scholar were used to search for AI studies. There were 15 studies of COVID-19 that used AI for medical imaging. Of these, 11 studies used AI for computed tomography (CT) and 4 used AI for chest radiography. Eight studies presented independent test data, 5 used disclosed data, and 4 disclosed the AI source codes. The number of datasets ranged from 106 to 5941, with sensitivities ranging from 0.67-1.00 and specificities ranging from 0.81-1.00 for prediction of COVID-19 pneumonia. Four studies with independent test datasets showed a breakdown of the data ratio and reported prediction of COVID-19 pneumonia with sensitivity, specificity, and area under the curve (AUC). These 4 studies showed very high sensitivity, specificity, and AUC, in the range of 0.9-0.98, 0.91-0.96, and 0.96-0.99, respectively.


title: Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia.

text: INTRODUCTION The use of a system for continuous control of endotracheal tube cuff pressure reduced the incidence of ventilator-associated pneumonia (VAP) in one randomized controlled trial (RCT) with 112 patients but not in another RCT with 142 patients. In several guidelines on the prevention of VAP, the use of a system for continuous or intermittent control of endotracheal cuff pressure is not reviewed. The objective of this study was to compare the incidence of VAP in a large sample of patients (n = 284) treated with either continuous or intermittent control of endotracheal tube cuff pressure. METHODS We performed a prospective observational study of patients undergoing mechanical ventilation during more than 48 hours in an intensive care unit (ICU) using either continuous or intermittent endotracheal tube cuff pressure control. Multivariate logistic regression analysis (MLRA) and Cox proportional hazard regression analysis were used to predict VAP. The magnitude of the effect was expressed as odds ratio (OR) or hazard ratio (HR), respectively, and 95% confidence interval (CI). RESULTS We found a lower incidence of VAP with the continuous (n = 150) than with the intermittent (n = 134) pressure control system (22.0% versus 11.2%; p = 0.02). MLRA showed that the continuous pressure control system (OR = 0.45; 95% CI = 0.22-0.89; p = 0.02) and the use of an endotracheal tube incorporating a lumen for subglottic secretion drainage (SSD) (OR = 0.39; 95% CI = 0.19-0.84; p = 0.02) were protective factors against VAP. Cox regression analysis showed that the continuous pressure control system (HR = 0.45; 95% CI = 0.24-0.84; p = 0.01) and the use of an endotracheal tube incorporating a lumen for SSD (HR = 0.29; 95% CI = 0.15-0.56; p < 0.001) were protective factors against VAP. However, the interaction between type of endotracheal cuff pressure control system (continuous or intermittent) and endotracheal tube (with or without SSD) was not statistically significant in MLRA (OR = 0.41; 95% CI = 0.07-2.37; p = 0.32) or in Cox analysis (HR = 0.35; 95% CI = 0.06-1.84; p = 0.21). CONCLUSIONS The use of a continuous endotracheal cuff pressure control system and/or an endotracheal tube with a lumen for SSD could help to prevent VAP in patients requiring more than 48 hours of mechanical ventilation.


title: Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy: A prospective cohort study.

text: Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients.The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China.A total of 74 patients received NPPV and 90 patients received CMV. Inclusion criteria included the following: physician-diagnosed AECOPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly-Matthay scale score of 3 to 5. Exclusion criteria included the following: preexisting psychiatric/neurological disorders unrelated to HE, upper gastrointestinal bleeding, upper airway obstruction, acute coronary syndromes, preadmission tracheostomy or endotracheal intubation, and urgent endotracheal intubation for cardiovascular, psychomotor agitation, or severe hemodynamic conditions.Intensive care unit participants were managed by NPPV. Participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, intravenous doxofylline, corticosteroids (e.g., salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted only in participants who developed gastric distension. No pharmacological sedation was administered.The primary and secondary outcome measures included comparative complication rates, durations of ventilation and hospitalization, number of invasive devices/patient, and in-hospital and 1-year mortality rates.Arterial blood gases and sensorium levels improved significantly within 2 hours in the NPPV group with lower hospital mortality, fewer complications and invasive devices/patient, and superior weaning off mechanical ventilation. Mechanical ventilation duration, hospital stay, or 1-year mortality was similar between groups.NPPV combined with a noninvasive strategy to clear secretions during the first 2 hours may offer advantages over CMV in treating AECOPD patients complicated by HE.


Giant sinus of Valsalva aneurysm mimicking severe pulmonary hypertension.


title: Use of an ECG-based confirmatory technique for bedside placement of reverse-tunneled cuffed dialysis catheters in three morbidly obese patients.

text: We are currently in the midst of a worldwide obesity epidemic, including in patients with end-stage kidney disease. Placing hemodialysis catheters is a particular challenge in patients with extreme obesity. Here we describe the merging of two technologies to place catheters in patients who are too heavy (over 225 kg) to be placed safely on a procedure table for fluoroscopic guidance. The first technology is ECG-guided placement of catheters, well established for guidance of peripherally inserted central catheters (PICCs) and tunneled and nontunneled central venous catheters. The second is reverse-tunneling dialysis catheters, which allow precise placement of the tip of the catheter before creating the tunnel. We successfully placed catheters in three morbidly obese patients with acute kidney injury and followed them until their kidneys recovered and the catheters were removed. The catheters were placed in the patient's bed in a procedure room with subsequent confirmatory chest radiographs. Catheter performance based on blood flow rates was excellent and there were no complications. We suggest placement of ECG-guided tunneled hemodialysis catheters using a reversed-tunneling technique in those patients with extreme obesity who are too heavy to place on a fluoroscopy procedure table.


title: Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature.

text: PURPOSE Thoracoscopic sympathetic surgery is nowadays a broadly accepted technique in the treatment of primary hyperhidrosis as well as facial blushing. The objective of this study was to compare the two currently most commonly used methods for thoracic sympathicotomy: transection (ETS) and clipping (ETC.). METHODS This is a retrospective study on a total of 63 patients, who underwent rib-oriented sympathicotomy, either by transection (n = 36, 57 %) or by clipping (n = 27, 43 %). Moreover, the up-to-date international literature is reviewed concerning which level(s) of the sympathetic trunk should be addressed, depending on the patients underlying condition. Furthermore, the highly controversial topic of reversibility of sympathetic clipping is debated. RESULTS Our results confirm that clipping is at least as effective as transection of the sympathetic chain in the treatment of hyperhidrosis and facial blushing. Furthermore, the analysis of all larger studies on unclipping in humans shows a surprisingly high reported reversal rate between 48 and 77 %. CONCLUSIONS Depending on the symptoms of the patient, different levels of the sympathetic chain should be addressed. When a higher rib level such as R2 is approached, which more likely will result in moderate to severe compensatory sweating, clipping should be preferred as it seems that this technique has indeed a potential for reversibility. As demonstrated, this method is at least as effective as an irreversible transection of the sympathetic chain.


docid: qejbcvjq

title: Covid-19 wake-up call for exotic pet trade.


title: Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS) : Randomized Comparison Using Simulated Stroke Interventions.

text: PURPOSE Stroke patients are excluded from expeditious thrombectomy in regions lacking neurointerventional specialists. An audiovisual online streaming system was tested, allowing a neurointerventional specialist located at a neurovascular center to supervise and instruct a thrombectomy performed at a distant hospital without being physically present (remote streaming support [RESS]). METHODS In total, 36 thrombectomy procedures were performed on a Mentice endovascular simulator by six radiologists not specialized in neurointerventions. Each radiologist was challenged with six different endovascular simulation scenarios under alternating conventional local support (specialist inside the room [LOS]) and RESS, which was performed using an advanced live streaming platform. RESULTS Both support modes led to a median of 2 attempts (interquartile range [IQR] 2.0-2.0 each) until successful recanalization. There was no statistically significant difference in time from first catheter insertion to recanalization between LOS (median 24.9 min, IQR 21.0-31.5 min) and RESS (23.9 min, IQR 21.7-28.7 min, p = 0.89). The percentage of thrombi covered by the stent-retriever and average speed when retrieving the stent-retriever (3.7 mm/s, IQR 3.25-5.35 mm/s vs. 3.6 mm/sec, IQR 2.5-4.7) were similar in both groups. Fluoroscopy time did not differ (19.0 min, IQR 16.9-23.5 min vs. 19.9 min, IQR 15.9-23.5 min) with a trend towards increased median amounts of contrast medium used under RESS (62.9 ml vs. 43.1 ml; p = 0.055). CONCLUSION This study confirmed the feasibility of RESS for thrombectomy procedures in a simulated environment. This serves as basis for future studies planned to analyze the effectiveness of RESS in a real-world environment and to test if it improves the learning curve of interventionalists with limited thrombectomy experience in remote areas.


title: Assessment of abattoir based monitoring of PRRSV using oral fluids.

text: Various porcine reproductive and respiratory syndrome virus (PRRSV) regional elimination projects have been implemented in the U.S., but none have yet succeeded. In part, this reflects the need for efficient methods to monitor over time the progress of PRRSV status of participating herds. This study assessed the feasibility of monitoring PRRSV using oral fluids collected at the abattoir. A total of 36 pig lots were included in the study. On-farm oral fluid (n = 10) and serum (n = 10) collected within two days of shipment to the abattoir were used to establish the reference PRRSV status of the population. Oral fluids (n = 3 per lot) were successfully collected from 32 lots (89%) at the lairage. Three veterinary diagnostic laboratories (VDLs) tested the sera (VDL1 and VDL3: n = 316, VDL2: n = 315) and oral fluids (VDL1 and VDL3: n = 319, VDL2: n = 320) for PRRSV antibodies (ELISA) and RNA (rRT-PCR). Environmental samples (n = 64, 32 before and 32 after pigs were placed in lairage) were tested for PRRSV RNA at one VDL. All oral fluids (farm and abattoir) tested positive for PRRSV antibody at all VDLs. PRRSV positivity frequency on serum ranged from 92.4% to 94.6% among VDLs, with an overall agreement of 97.6%. RNA was detected on 1.3% to 1.9%, 8.1% to 17.7%, and 8.3% to 17.7% of sera, on-farm and abattoir oral fluids, respectively. Between-VDLs rRT-PCR agreement on sera and oral fluids (farm and abattoir) ranged from 97.8% to 99.0%, and 79.0% to 81.2%, respectively. Between-locations agreement of oral fluids varied from 31.3% to 50% depending on the VDL. This study reported the application of swine oral fluids collected at the abattoir for monitoring PRRSV, and describes the between-VDL agreement for PRRS testing of serum and oral fluid field samples.


Hydroxychloroquine reduces the risk of covid-19 in patients with rheumatic diseases: myth or reality?


title: Fighting COVID-19 Misinformation on Social Media: Experimental Evidence for a Scalable Accuracy-Nudge Intervention.

text: Across two studies with more than 1,700 U.S. adults recruited online, we present evidence that people share false claims about COVID-19 partly because they simply fail to think sufficiently about whether or not the content is accurate when deciding what to share. In Study 1, participants were far worse at discerning between true and false content when deciding what they would share on social media relative to when they were asked directly about accuracy. Furthermore, greater cognitive reflection and science knowledge were associated with stronger discernment. In Study 2, we found that a simple accuracy reminder at the beginning of the study (i.e., judging the accuracy of a non-COVID-19-related headline) nearly tripled the level of truth discernment in participants' subsequent sharing intentions. Our results, which mirror those found previously for political fake news, suggest that nudging people to think about accuracy is a simple way to improve choices about what to share on social media.


title: Improving health services for African migrants in China: A health diplomacy perspective.

text: Global health has become an increasingly prominent component of foreign policy in the last decade. The term health diplomacy has been used to describe this growing interface between foreign policy and global health, and it encompasses both the concept of using health to further foreign policy objectives as well as the idea that diplomatic tools can be helpful for attaining public health goals. The Chinese presence in Africa has grown in the last 15 years, generating increased interest in Sino-African relations. While much has been written in recent years about the Chinese presence in Africa, the growing numbers of Africans in China have attracted considerably less attention. Many are small-scale traders and might be expected to face many of the health challenges common among foreign migrants, but their health needs have been largely unrecognised. In this paper, we consider how a health diplomacy approach could be applied to African migrants in China, and the potential advantages and limitations of this strategy. We identify areas of overlap between public health, trade and foreign policy goals that can be emphasised to generate support for improved services for African migrants in China and to engage partners from a diversity of sectors.


title: Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey.

text: PURPOSE To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. MATERIAL AND METHODS A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. RESULTS Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. CONCLUSIONS At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.


title: Travel-Related Parasitic Infections in Travellers to Southeast Asia and Western Pacific Countries.

text: In the last decades, there has been a significant increase in international human mobility with increase in the prosperity, travel possibilities, and number of refugees. In the first half of 2016, the Asian continent showed the fastest growth in the number of tourists. Such increase is seen due to the interest in Asian history, culture, and cuisine. In the globalizing world, human mobility causes changes in the epidemiology of diseases and the spread of various infections across continents. Parasitic infections that may pose a risk for travellers to the Asia-Pacific are malaria, leishmaniasis, filariasis, foodborne trematode infections, schistosomiasis, soil-transmitted infections, and tourist diarrhea. Consulting a travel medical expert and using health services such as pre-travel vaccination and chemoprophylaxis will reduce the risk of infectious diseases among travelers.


title: Insect transmission of plant viruses: Multilayered interactions optimize viral propagation.

text: By serving as vectors of transmission, insects play a key role in the infection cycle of many plant viruses. Viruses use sophisticated transmission strategies to overcome the spatial barrier separating plants and the impediment imposed by the plant cell wall. Interactions among insect vectors, viruses, and host plants mediate transmission by integrating all organizational levels, from molecules to populations. Best-examined on the molecular scale are two basic transmission modes wherein virus-vector interactions have been well characterized. Whereas association of virus particles with specific sites in the vector's mouthparts or in alimentary tract regions immediately posterior to them is required for noncirculative transmission, the cycle of particles through the vector body is necessary for circulative transmission. Virus transmission is also determined by interactions that are associated with changes in vector feeding behaviors and with alterations in plant host's morphology and/or metabolism that favor the attraction or deterrence of vectors. A recent concept in virus-host-vector interactions proposes that when vectors land on infected plants, vector elicitors and effectors "inform" the plants of the confluence of interacting entities and trigger signaling pathways and plant defenses. Simultaneously, the plant responses may also influence virus acquisition and inoculation by vectors. Overall, a picture is emerging where transmission depends on multilayered virus-vector-host interactions that define the route of a virus through the vector, and on the manipulation of the host and the vector. These interactions guarantee virus propagation until one or more of the interactants undergo changes through evolution or are halted by environmental interventions.


title: Differentiating pneumonia with and without COVID-19 using chest CT images: from qualitative to quantitative.

text: BACKGROUND Pneumonia caused by COVID-19 shares overlapping imaging manifestations with other types of pneumonia. How to objectively and quantitatively differentiate pneumonia patients with and without COVID-19 virus remains clinical challenge. OBJECTIVE To formulate standardized scoring criteria and an objective quantization standard to guide decision making in detection and diagnosis of COVID-19 virus induced pneumonia in clinical practice. METHODS A retrospective dataset includes computed tomography (CT) images acquired from 43 pneumonia patients with COVID-19 virus detected by reverse transcription-polymerase chain reaction (RT-PCR) tests and 49 pneumonia patients without COVID-19 virus. All patients were treated during the same time period in two hospitals. Key indicators of differential diagnosis were identified in relevant literature and the scores were quantified namely, patients with more than 8 points were identified as high risk, those with 6-8 points as moderate risk, and those with fewer than 6 points as low risk for COVID-19 virus. In the study, 3 radiologists determined the scores for all patients. Diagnostic sensitivity and specificity were subsequently calculated. RESULTS A total of 61 patients were determined as high risk, among which 42 were COVID-19 positive by RT-PCR tests. Next, 9 were identified as moderate risk, one of whom was COVID-19 positive. Last, 22 were classified into the low-risk group, all of them are COVID-19 negative. Based on these results, the sensitivity of detection COVID-19 positive cases between the high-risk group and the non-high-risk group was 0.98 with 95% confidence interval [0.88, 1.00], and the specificity was 0.61 [0.46, 0.75]. The detection sensitivity between the moderate-/high-risk group and the low-risk group was 1.00 [0.92, 1.00], and the specificity was 0.45 [0.31, 0.60]. CONCLUSION The proposed quantitative scoring criteria showed high sensitivity and moderate specificity in detecting COVID-19 using CT images, which indicates that these criteria may be beneficial for screening in real-world practice and helpful for long-term disease control.


title: Identification of common deletions in the spike protein of SARS-CoV-2.

text: SARS-CoV-2 is a novel coronavirus first identified in December 2019. Notable features make SARS-CoV-2 distinct from most other previously-identified Betacoronaviruses, including the receptor binding domain of SARS-CoV-2 and a unique insertion of twelve nucleotide or four amino acids (PRRA) at the S1/S2 boundary. In this study, we identified two deletion variants of SARS-CoV-2 that either directly affect the polybasic cleavage site itself (NSPRRAR) or a flanking sequence (QTQTN). These deletions were verified by multiple sequencing methods. In vitro results showed that the deletion of NSPRRAR likely does not affect virus replication in Vero and Vero-E6 cells, however the deletion of QTQTN may restrict late phase viral replication. The deletion of QTQTN was detected in 3 of 68 clinical samples and half of 24 in vitro isolated viruses, whilst the deletion of NSPRRAR was identified in 3 in vitro isolated viruses. Our data indicate that (i) there may be distinct selection pressures on SARS-CoV-2 replication or infection in vitro and in vivo, (ii) an efficient mechanism for deleting this region from the viral genome may exist, given that the deletion variant is commonly detected after two rounds of cell passage, and (iii) the PRRA insertion, which is unique to SARS-CoV-2, is not fixed during virus replication in vitro These findings provide information to aid further investigation of SARS-CoV-2 infection mechanisms and a better understanding of the NSPRRAR deletion variant observed here.Important notes The spike protein determines the infectivity and host range of coronaviruses. SARS-CoV-2 has two unique features in its spike protein, the receptor binding domain and an insertion of twelve nucleotides at the S1/S2 boundary resulting a furin-like cleavage site. Here, we identified two deletion variants of SARS-CoV-2 that either directly affect the furin-like cleavage site itself (NSPRRAR) or a flanking sequence (QTQTN) and investigated these deletions in cell isolates and clinical samples. The absence of the polybasic cleavage site in SARS-CoV-2 did not affect virus replication in Vero or Vero-E6 cells. Our data indicate the PRRAR and its flanking sites are not fixed in vitro, thus there appears to be distinct selection pressures on SARS-CoV-2 sequences in vitro and in vivo Further investigation of the mechanism of generating these deletion variants and their infectivity in different animal models would improve our understanding of the origin and evolution of this virus.


title: Individual-based simulation model for COVID-19 transmission in Daegu,Korea.

text: Objectives The aims of this study were to obtain insights into the current coronavirus disease 2019 (COVID-19) epidemic in the city of Daegu, which accounted for 6,482 of the 9,241 confirmed cases in South Korea as of March 26, 2020, to predict the future spread, and to analyze the impact of school opening. Methods Using an individual-based model, we simulated the spread of COVID-19 in Daegu. An individual can be infected through close contact with infected people in a household, at work/school, and at religious and social gatherings. We created a synthetic population from census sample data. Then, 9,000 people were randomly selected from the entire population of Daegu and set as members of the hotspot of the Shincheonji church. We did not take into account population movements to and from other regions in South Korea. Results Using the individual-based model, the cumulative confirmed cases in Daegu through March 26, 2020, were reproduced, and it was confirmed that the hotspot had a different probability of infection than non-hotspot areas. For 3 scenarios (I: school closing, II: school opening after April 6, III: school opening after April 6 and the mean period from symptom onset to hospitalization increasing to 4.3 days), we predicted future changes in the pattern of COVID-19 spread in Daegu. Conclusion Compared to scenario I, it was found that in scenario III, the cumulative number of patients would increase by 107 and the date of occurrence of the last patient would be delayed by 92 days.


title: Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model.

text: PURPOSE Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model. METHODS CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared. RESULTS There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001). CONCLUSION The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated.


title: The mutREAD method detects mutational signatures from low quantities of cancer DNA.

text: Mutational processes acting on cancer genomes can be traced by investigating mutational signatures. Because high sequencing costs limit current studies to small numbers of good-quality samples, we propose a robust, cost- and time-effective method, called mutREAD, to detect mutational signatures from small quantities of DNA, including degraded samples. We show that mutREAD recapitulates mutational signatures identified by whole genome sequencing, and will ultimately allow the study of mutational signatures in larger cohorts and, by compatibility with formalin-fixed paraffin-embedded samples, in clinical settings.


title: Videothoracoscopic lobectomy training in non-small cell lung cancer.

text: Background This study aims to evaluate the outcomes of video-assisted thoracoscopic surgery lobectomies performed by a training consultant or an experienced consultant. Methods The study included 103 patients (81 males, 22 females; mean age 59.6±9.5 years; range, 32 to 84 years) who underwent video-assisted thoracoscopic surgery lobectomy due to non-small cell lung cancer. The training consultant assisted on the same side with the experienced consultant during the operations of the experienced consultant. The experienced consultant observed in the operating room and provided advice from a distance during the first five operations of the training consultant. Comorbidities, postoperative complications, and mortality were evaluated. Results Patients" demographic characteristics, comorbidities, and postoperative complications were similar between the two surgeons (p>0.05). Operative time, incidence of prolonged air leak, and length of hospital stay were higher in procedures performed by the training consultant (p<0.05). There were no significant differences in rates of life-threatening complications or mortality. Conclusion Video-assisted thoracoscopic surgery lobectomy can be performed safely by surgeons in training. Effective training programs may produce outcomes comparable to those of experienced surgeons.


title: PROF-ETEV study: prophylaxis of venous thromboembolic disease in critical care units in Spain.

text: PURPOSE Venous thromboembolic disease (VTE) in critically ill patients has a high incidence despite prophylactic measures. This fact could be related to an inappropriate use of these measures due to the absence of specific VTE risk scores. To assess the current situation in Spain, we have performed a cross-sectional study, analyzing if the prophylactic measures were appropriate to the patients' VTE risk. METHODS Through an electronic questionnaire, we carried out a single day point prevalence study on the VTE prophylactic measures used in several critical care units in Spain. We performed a risk stratification for VTE in three groups: low, moderate-high, and very high risk. The American College of Chest Physicians guidelines were used to determine if the patients were receiving the recommended prophylaxis. RESULTS A total of 777 patients were included; 62% medical, 30% surgical, and 7% major trauma patients. The median number of the risk factors for VTE was four. According to the proposed VTE risk score, only 2% of the patients were at low risk, whereas 83% were at very high risk. Sixty-three percent of patients received pharmacological prophylaxis, 12% mechanical prophylaxis, 6% combined prophylaxis, and 19% did not receive any prophylactic measure. According to criteria suggested by the guidelines, 23% of medical, 71% of surgical, and 70% of major trauma patients received an inappropriate prophylaxis. CONCLUSIONS Most critically ill patients are at high or very high risk of VTE, but there is a low rate of appropriate prophylaxis. The efforts to improve the identification of patients at risk, and the implementation of appropriate prevention protocols should be enhanced.


title: Radiofrequency Ablation of the Main Lesion of Hepatocellular Carcinoma and Bile Duct Tumor Thrombus as a Radical Therapeutic Alternative: Two Case Reports.

text: Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) formation is a rare entity found microscopically in 1% to 9.2% of resected specimens. The ideal treatment for HCC is surgical resection. However, because of poor hepatic functional reserve in patients with HCC, most tumors are unresectable. Here, we report 2 cases of HCC with BDTT type III accompanied by hepatic dysfunction that were successfully treated with radiofrequency (RF) ablation. We used RF ablation as both a radical therapeutic method and an efficient way to control bleeding from the origin of BDTT after BDTT removal. At the time of writing, the 2 patients have been disease-free for 16 and 12 months, respectively.Our results show that RF ablation may be used as a radical therapeutic alternative for HCC with BDTT in patients with liver cirrhosis and obstructive jaundice.


docid: kbgkrrui

title: Chemoradionuclide therapy with 186Re-labeled liposomal doxorubicin in combination with radiofrequency ablation for effective treatment of head and neck cancer in a nude rat tumor xenograft model.

text: PURPOSE To determine the therapeutic efficacy of rhenium 186 ((186)Re)-labeled PEGylated liposomal doxorubicin ((186)Re-liposomal doxorubicin) in combination with radiofrequency (RF) ablation of human head and neck squamous cell carcinoma (HNSCC) xenograft in nude rats. MATERIALS AND METHODS This investigation was approved by the animal care committee. Sixty nude rats with subcutaneously implanted HNSCC xenografts (six per group) were treated with (a) RF ablation (70 °C for 5 minutes), (b) PEGylated liposomes, (c) liposomal doxorubicin, (d) (186)Re-PEGylated liposomes (1295 MBq/kg), (e) (186)Re-liposomal doxorubicin (555 MBq/kg), (f) PEGylated liposomes plus RF ablation, (g) liposomal doxorubicin plus RF ablation, (h) (186)Re-PEGylated liposomes plus RF ablation, or (i) (186)Re-liposomal doxorubicin plus RF ablation. Six rats did not receive any treatment (control group). Tumor uptake in (186)Re therapy groups was monitored with small-animal single photon emission computed tomography for 5 days. Therapeutic efficacy was monitored for 6 weeks with measurement of tumor volume, calculation of the percentage injected dose of fluorine 18 fluorodeoxyglucose (FDG) in tumor from small-animal positron emission tomography (PET) images, and determination of viable tumor volume at histopathologic examination. Significant differences between groups were determined with analysis of variance. RESULTS The average tumor volume (± standard deviation) on the day of therapy was 1.32 cm(3) ± 0.17. At 6 weeks after therapy, control of tumor growth was better with (186)Re-liposomal doxorubicin than with liposomal doxorubicin alone (tumor volume, 2.26 cm(3) ± 0.89 vs 5.43 cm(3) ± 0.93, respectively; P < .01). The use of RF ablation with liposomal doxorubicin and (186)Re-liposomal doxorubicin further improved tumor control (tumor volume, 2.05 cm(3) ± 1.36 and 1.49 cm(3) ± 1.47, respectively). The tumor growth trend correlated with change in percentage of injected dose of FDG in tumor for all groups (R(2) = 0.85, P < .001). Viable tumor volume was significantly decreased in the group treated with (186)Re-liposomal doxorubicin plus RF ablation (0.54 cm(3) ± 0.38; P < .001 vs all groups except (186)Re-liposomal doxorubicin alone). CONCLUSION Triple and dual therapies had an observable trend ((186)Re-liposomal doxorubicin plus RF ablation > (186)Re-liposomal doxorubicin > liposomal doxorubicin plus RF ablation > liposomal doxorubicin) of improved tumor growth control and decreased viable tumor compared with other therapies. FDG PET could be used as a noninvasive surrogate marker for tumor growth and viability in this tumor model.


title: Design and Psychometric Analysis of the COVID-19 Prevention, Recognition and Home-Management Self-Efficacy Scale.

text: In order to control the spread of COVID-19, people must adopt preventive behaviours that can affect their day-to-day life. People's self-efficacy to adopt preventive behaviours to avoid COVID-19 contagion and spread should be studied. The aim of this study was to develop and psychometrically test the COVID-19 prevention, detection, and home-management self-efficacy scale (COVID-19-SES). We conducted an observational cross-sectional study. Six-hundred and seventy-eight people participated in the study. Data were collected between March and May 2020. The COVID-19-SES' validity (content, criterion, and construct), reliability (internal consistency and test-retest reliability), and legibility were studied. The COVID-19-SES' reliability was high (Cronbach's alpha = 0.906; intraclass correlation coefficient = 0.754). The COVID-19-SES showed good content validity (scale's content validity index = 0.92) and good criterion validity when the participants' results on the COVID-19-SES were compared to their general self-efficacy (r = 0.38; p < 0.001). Construct validity analysis revealed that the COVID-19-SES' three-factor structure explained 52.12% of the variance found and it was congruent with the World Health Organisation's recommendations to prevent COVID-19 contagion and spread. Legibility analysis showed that the COVID-19-SES is easy to read and understand by laypeople. The COVID-19-SES is a psychometrically robust instrument that allows for a valid and reliable assessment of people's self-efficacy in preventing, detecting symptoms, and home-managing COVID-19.


title: Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study.

text: BACKGROUND To characterize and identify prognostic factors for 28-day mortality among patients with hospital-acquired fungemia (HAF) in the Intensive Care Unit (ICU). METHODS A sub-analysis of a prospective, multicenter non-representative cohort study conducted in 162 ICUs in 24 countries. RESULTS Of the 1156 patients with hospital-acquired bloodstream infections (HA-BSI) included in the EUROBACT study, 96 patients had a HAF. Median time to its diagnosis was 20 days (IQR 10.5-30.5) and 9 days (IQR 3-15.5) after hospital and ICU admission, respectively. Median time to positivity of blood culture was longer in fungemia than in bacteremia (48.7 h vs. 38.1 h; p = 0.0004). Candida albicans was the most frequent fungus isolated (57.1%), followed by Candida glabrata (15.3%) and Candida parapsilosis (10.2%). No clear source of HAF was detected in 33.3% of the episodes and it was catheter-related in 21.9% of them. Compared to patients with bacteremia, HAF patients had a higher rate of septic shock (39.6% vs. 21.6%; p = 0.0003) and renal dysfunction (25% vs. 12.4%; p = 0.0023) on admission and a higher rate of renal failure (26% vs. 16.2%; p = 0.0273) at diagnosis. Adequate treatment started within 24 h after blood culture collection was less frequent in HAF patients (22.9% vs. 55.3%; p < 0.001). The 28-day all cause fatality was 40.6%. According to multivariate analysis, only liver failure (OR 14.35; 95% CI 1.17-175.6; p = 0.037), need for mechanical ventilation (OR 8.86; 95% CI 1.2-65.24; p = 0.032) and ICU admission for medical reason (OR 3.87; 95% CI 1.25-11.99; p = 0.020) were independent predictors of 28-day mortality in HAF patients. CONCLUSIONS Fungi are an important cause of hospital-acquired BSI in the ICU. Patients with HAF present more frequently with septic shock and renal dysfunction on ICU admission and have a higher rate of renal failure at diagnosis. HAF are associated with a significant 28-day mortality rate (40%), but delayed adequate antifungal therapy was not an independent risk factor for death. Liver failure, need for mechanical ventilation and ICU admission for medical reason were the only independent predictors of 28-day mortality.


Coronavirus 2020.


title: Nutraceuticals and nutritional supplements for the treatment of bipolar disorder: protocol for a systematic review.

text: INTRODUCTION First line pharmacological treatments for bipolar disorder (BD) can leave shortfalls in recovery leading to patients seeking alternative and adjunctive treatments such as nutraceuticals. This protocol for a systematic review and proposed meta-analysis aims to answer the research question: in patients with BD, how does use of nutraceutical treatments compare with placebo in reducing depressive and mania symptoms? METHODS AND ANALYSIS Clinical trials will be identified through database searches using PubMed via PubMed, EMBASE via embase.com, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) via cochranelibrary.com and CINAHL Complete via EBSCO. Search terms for BD and specific nutraceuticals (75 total search terms) will be used. Double-blind, randomised, controlled, clinical trials of adults with BD will be included in the review. Risk of bias will be assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. ETHICS AND DISSEMINATION This review will only look at published data (already reviewed for ethical compliance); therefore, ethical approval is not required. We aim to publish the systematic review in a peer-reviewed journal and present at conferences. PROSPERO REGISTRATION NUMBER CRD42019100745.


title: Hyperoxic resuscitation after hypoxia-ischemia induces cerebral inflammation that is attenuated by tempol in a reporter mouse model with very young mice.

text: BACKGROUND Oxygen supplementation is still part of international resuscitation protocols for premature children. Mechanisms for tissue damage by hypoxia/ischemia in the extreme premature involve inflammation. AIM AND METHOD To study cerebral inflammation after hypoxia/ischemia and oxygen treatment in the premature, we measured NF-κB activity in 5-day-old transgenic reporter mice in response to experimental hypoxia/ischemia. results were correlated to cerebral histological evaluation and plasma cytokine levels. A treatment strategy with the antioxidant tempol was tested. RESULTS One day after hypoxia/ischemia NF-κB activation was increased compared to controls [mean difference: 10.6±4.6% (P=0.03)]. Exposure to 100% oxygen after hypoxia/ischemia further increased NF-κB activation compared to hypoxia/ischemia alone [mean difference: 15.0±5.5% (P=0.01)]. Histological changes in the brain were positively correlated with NF-κB activity (P<0.001), but we found no significant difference in tissue damage between resuscitation with air and resuscitation with pure oxygen. Administration of tempol reduced NF-κB activation [mean difference: 14.6±5.0% (P=0.01)] and the plasma level of cytokines; however, the histological damage score was not affected. CONCLUSION Cerebral inflammatory response after hypoxia/ischemia in a mouse model with immature brain development corresponding to human prematurity prior to 32 weeks' gestation was influenced by administration of oxygen. Tempol treatment attenuated inflammation but did not reduce the extent of histological cerebral damage.


title: Role of perforin secretion from CD8+ T-cells in neuronal cytotoxicity in multiple sclerosis.

text: OBJECTIVES Multiple sclerosis (MS) is the most prevalent autoimmune disease of the central nervous system, and is characterized by inflammation and myelin damage. The immune system initiates the autoimmune response, although the mechanisms of neuronal damage have not been elucidated. The purpose of the present study was to investigate autoreactive CD4+ and CD8+ T lymphocytes, in conjunction with other inflammatory cells and cytokines in active MS lesions. METHODS EAE animal models was established by plantar injections of MBP (200 μg per rat). Purified CD4+ or CD8+ T-cells were isolated from heparinized peripheral blood (EAE animals and control animals) via negative selection. To examine effects of presence of autoreactive CD4+ and CD8+ T lymphocytes, we carried out ELISA, Western blot analysis and TUNEL. In addition, we examined the direct effects of various factors on neuronal cell death using MTT assay. RESULTS The data revealed that CD8+ T-cells were more toxic to neurons compared to CD4+ T-cells, in both the MBP and EAE conditions. Bax was greater increased when neurons were co-cultured with CD8+ T-cells in the MBP group. There is a significant increase in IL-17 secretion by CD4+ T-cells in both the MBP group and EAE group. Neuronal viability were affected by Perforin (1.5 μg/mL). CONCLUSION The present study extends previous research by demonstrating the role of CD8+ T-cells in MS and supports perforin secretion by CD8+ T-cells as a potential therapeutic factor. Furthermore, we determined that CD4+ T-cells can enhance CD8+ T-cell neuronal cytotoxicity via induction of intense inflammation.


title: Selective approach for upper rectal cancer treatment: total mesorectal excision and preoperative chemoradiation are seldom necessary.

text: BACKGROUND The implementation of preoperative chemoradiation combined with total mesorectal excision has reduced local recurrence rates in rectal cancer. However, the use of both types of treatment in upper rectal cancer is controversial. OBJECTIVE The purpose of this work was to assess oncological results after radical resection of upper rectal cancers compared with sigmoid, middle, and lower rectal cancers and to determine risk factors for local recurrence in upper rectal cancer. DESIGN This was a retrospective analysis of prospectively collected data. SETTINGS This study was conducted in a tertiary care referral hospital in Valencia, Spain. PATIENTS Analysis included 1145 patients who underwent colorectal resection with primary curative intent for primary sigmoid (n = 450), rectosigmoid (n = 70), upper rectal (n = 178), middle rectal (n = 186), or lower rectal (n = 261) cancer. MAIN OUTCOME MEASURES Oncological results, including local recurrence, disease-free survival, and cancer-specific survival, were compared between the different tumor locations. Univariate and multivariate analyses were performed to identify risk factors for local recurrence in upper rectal cancer. RESULTS A total of 147 patients (82.6%) with upper rectal tumors underwent partial mesorectal excision, and only 10 patients (5.6%) of that group received preoperative chemoradiation. The 5-year actuarial local recurrence, disease-free survival, and cancer-specific survival rates for upper rectal tumors were 4.9%, 82.0%, and 91.6%. Local recurrence rates showed no differences when compared among all of the locations (p = 0.20), whereas disease-free survival and cancer-specific survival were shorter for lower rectal tumors (p = 0.006; p = 0.003). The only independent risk factor for local recurrence in upper rectal cancer was an involved circumferential resection margin at pathologic analysis (HR, 14.23 (95% CI, 2.75-73.71); p = 0.002). LIMITATIONS This was a single-institution, retrospective study. CONCLUSIONS Most upper rectal tumors can be treated with partial mesorectal excision without the systematic use of preoperative chemoradiation. Involvement of the mesorectal fascia was the only independent risk factor for local recurrence in these tumors.


title: Cardiopulmonary changes induced by retroperitoneal insufflation in healthy dogs in sternal recumbency with the abdomen unsupported.

text: This study assessed the effects of retroperitoneal carbon dioxide (CO2) insufflation on cardiopulmonary variables and intra-abdominal pressure (IAP) in mechanically ventilated dogs in sternal recumbency with the abdomen unsupported, following placement of a positioning kit and towels under the pectoral and pelvic regions. General anesthesia was induced in eight healthy adult male Beagles. A Swan-Ganz catheter was placed in the pulmonary artery via the jugular vein for cardiac output measurements. A Foley urethral catheter was placed to monitor transvesical IAP. A 10 mm balloon blunt-tip trocar was inserted into the retroperitoneal space. With a fixed respiratory rate and tidal volume by mechanical ventilation, insufflation pressure was sequentially increased from 0 to 10 mmHg in 5 mmHg increments, followed by desufflation. All variables were measured before insufflation, 5 min after the establishment of each insufflation pressure, and after desufflation. At 10 mmHg, the IAP was nearly equal to insufflation pressure. Cardiopulmonary function was not compromised at any point, although the cardiac index (CI), heart rate, mean arterial pressure (MAP), and mean pulmonary arterial pressure increased within normal ranges. End-tidal CO2 concentration, arterial CO2 partial pressure, and oxygen delivery index (DO2I) increased, whereas pH decreased, at 10 mmHg. CI, MAP, and DO2I did not recover to baseline after decompression. Thus, retroperitoneal CO2 insufflation up to 10 mmHg is well tolerated by mechanically ventilated dogs positioned in sternal recumbency with the abdomen unsupported, although sympathetic changes may occur with an insufflation pressure increase.


title: Thoracoscopic purse string technique for minimally invasive Ivor Lewis esophagectomy.

text: OBJECTIVE Thoracolaparoscopic esophagectomy with chest anastomosis (TLE-chest) is increasingly performed for middle and lower esophageal cancer; however, gastroesophageal anastomosis for this surgery remains both challenging and inefficient. To address this issue, we previously reported our MIE technique with Ivor-Lewis anastomosis. Here we present the video to introduce our TLE-chest operation procedures. METHODS TLE-chest with a combined thoracoscopic and laparoscopic technique was performed by one group of surgeons. From October 2011 to September 2013, 80 esophageal cancer patients were treated with TLE-chest using this improved anastomotic technique. RESULTS The surgery was successful for all patients, although the anastomosis in one patient required intraoperative manual repair. No patients required open conversion. In this video, dissociation of stomach, and dissection of lymph nodes, creation of gastric tube and staple line embedding, jejunostomy were carried out by laparoscopic surgery. Dissection of esophageal cancer and mediastinal lymph nodes were done through rib 3 or 4 by a 3-4 cm video-assisted right anterior minithoracotomy, then esophago-gastric anastomosis was performed in right thoracic cavity This video shows the R0 resection of T3N0M0 esophageal cancer. Totally, 36 lymph nodes were dissected, including 21 mediastinal lymph nodes and 15 abdominal lymph nodes. The patient recovered well and was discharged on day 8 after the surgery, with good short term outcomes. CONCLUSIONS A safe, cost effective purse string stapled anastomotic technique has been presented for TLE-chest in our video. It is consistent with the oncology principles.


title: The Effect of Perioperative Ischemia and Reperfusion on Multiorgan Dysfunction following Abdominal Aortic Aneurysm Repair.

text: Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening medical problems. The aim of this review is to provide an overview of the effect of I/R injury on multiorgan failure following AAA repair. The PubMed, CINAHL, EMBASE, Medline, Cochrane Review, and Scopus databases were comprehensively searched for articles concerning the pathophysiology of I/R and its systemic effects. Cross-referencing was performed using the bibliographies from the articles obtained. Articles retrieved were restricted to those published in English. One of the most prominent characteristics of AAA open repair is the double physiological phenomenon of ischemia-reperfusion (I/R) that happens either at the time of clamping or following the aortic clamp removal. Ischemia-reperfusion injury causes significant pathophysiological disturbances to distant organs, increasing the possibility for postoperative multiorgan failure. Although tissue injury is mediated by diverse mechanisms, microvascular dysfunction seems to be the final outcome of I/R.


Covid-19 pandemic has derailed progress on sustainable development goals, says WHO.


title: Effectiveness and Safety of Intrathecal Ziconotide: Interim Analysis of the Patient Registry of Intrathecal Ziconotide Management (PRIZM).

text: BACKGROUND The Patient Registry of Intrathecal Ziconotide Management (PRIZM) evaluated long-term effectiveness, safety, and tolerability of intrathecal ziconotide treatment in clinical practice. METHODS Patient Registry of Intrathecal Ziconotide Management was an open-label, long-term, multicenter, observational study of adult patients with severe chronic pain. This interim analysis (data through July 10, 2015) of ziconotide as the first vs. not first intrathecal agent in pump included change from baseline in the Numeric Pain Rating Scale (NPRS; primary efficacy measure) and Patient Global Impression of Change (PGIC) scores. RESULTS Enrollment closed at 93 patients; data collection was ongoing at the time of this interim analysis. Fifty-one patients (54.8%) received ziconotide as the first agent in pump (FIP+), whereas 42 (45.2%) did not (FIP-). Mean (SD) baseline NPRS scores were 7.4 (1.9) and 7.9 (1.6) in FIP+ and FIP- patients, respectively. Mean (SEM) percentage changes in NPRS scores were -29.4% (5.5%) in FIP+ patients (n = 26) and +6.4% (7.7%) in FIP- patients (n = 17) at month 6 and -34.4% (9.1%) in FIP+ patients (n = 14) and -3.4% (10.2%) in FIP- patients (n = 9) at month 12. Improvement from baseline, measured by PGIC score, was reported in 69.2% of FIP+ (n = 26) and 35.7% of FIP- (n = 14) patients at month 6 and 85.7% of FIP+ (n = 7) and 71.4% of FIP- (n = 7) patients at month 12. The most common adverse events (≥ 10% of patients overall as of the data cut) were nausea (19.6% vs. 7.1% of FIP+ vs. FIP- patients, respectively), confusional state (9.8% vs. 11.9%), and dizziness (13.7% vs. 7.1%). CONCLUSIONS Greater improvements in efficacy outcomes were observed when ziconotide was initiated as first-line intrathecal therapy vs. not first intrathecal agent in pump. The adverse event profile was consistent with the ziconotide prescribing information.


title: Comparison of diclofenac with apigenin-glycosides rich Clinacanthus nutans extract for amending inflammation and catabolic protease regulations in osteoporotic-osteoarthritis rat model.

text: BACKGROUND Osteoporotic-osteoarthritis is an incapacitating musculoskeletal illness of the aged. OBJECTIVES The anti-inflammatory and anti-catabolic actions of Diclofenac were compared with apigenin-C-glycosides rich Clinacanthus nutans (CN) leaf extract in osteoporotic-osteoarthritis rats. METHODS Female Sprague Dawley rats were randomized into five groups (n = 6). Four groups were bilateral ovariectomised for osteoporosis development, and osteoarthritis were induced by intra-articular injection of monosodium iodoacetate (MIA) into the right knee joints. The Sham group was sham-operated, received saline injection and deionized drinking water. The treatment groups were orally given 200 or 400 mg extract/kg body weight or 5 mg diclofenac /kg body weight daily for 28 days. Articular cartilage and bone changes were monitored by gross and histological structures, micro-CT analysis, serum protein biomarkers, and mRNA expressions for inflammation and catabolic protease genes. RESULTS HPLC analysis confirmed that apigenin-C-glycosides (shaftoside, vitexin, and isovitexin) were the major compounds in the extract. The extract significantly and dose-dependently reduced cartilage erosion, bone loss, cartilage catabolic changes, serum osteoporotic-osteoarthritis biomarkers (procollagen-type-II-N-terminal-propeptide PIINP; procollagen-type-I-N-terminal-propeptide PINP; osteocalcin), inflammation (IL-1β) and mRNA expressions for nuclear-factor-kappa-beta NF-κβ, interleukin-1-beta IL-1β, cyclooxygenase-2; and matrix-metalloproteinase-13 MMP13 activities, in osteoporotic-osteoarthritis rats comparable to Diclofenac. CONCLUSION This study demonstrates that apigenin-C-glycosides at 400 mg CN extract/kg (about 0.2 mg apigenin-equivalent/kg) is comparable to diclofenac in suppressing inflammation and catabolic proteases for osteoporotic-osteoarthritis prevention. Graphical abstract.


Unlocking towns and cities: COVID-19 exit strategy.


title: A novel surgical technique: single-incision transumbilical laparoscopic Roux-en-Y gastric bypass.

text: Conventional laparoscopic Roux-en-Y gastric bypass (LRYGB) is a gold standard for bariatric surgery, but the procedure requires five to seven incisions for placement of multiple trocars and thus may produce less-than-ideal cosmetic results. We have developed a new approach, single-incision transumbilical LRYGB (SITU-LRYGB) to treat morbid obesity. We compared the surgical results and patient satisfaction in a study of five-port LRYGB and SITU-LRYGB. Fifty morbidly obese patients (14 males, 36 females) underwent either Roux-en-Y gastric bypass with five-port LRYGB or the SITU-LRYGB approach. During the operation, we used a novel intraoperative liver traction method with a "liver suspension tape" that we specifically designed for SITU-LRYGB. Compared to five-port surgery with SITU-LRYGB, there were no intraoperative complications, wound healing was excellent, and there was no abdominal scarring. SITU surgical time was longer than that with five-port LRYGB (99.8 vs. 67.6 min, P < 0.001). Patients treated with the five-port method were more obese than those in the SITU group (127.9 vs. 112.4 kg, P = 0.016). After the bariatric surgery, no difference in comorbidity was found in both groups. Patient satisfaction was greater with SITU than with the five-port method (4.48 vs. 3.96, P = 0.006). Roux-en-Y gastric bypass can be successfully achieved via a single umbilical incision, a method that provides a short operative time and good recovery and eliminates abdominal scarring.


COVID-19: Perspective of a Dean of Dentistry.


Non-steroidal anti-inflammatory drugs and covid-19.


Viropathic multinuclear syncytial giant cells in bronchial fluid from a patient with COVID-19.


title: Endovascular approach and technique for treatment of transverse-sigmoid dural arteriovenous fistula with cortical reflux: the importance of venous sinus sacrifice.

text: BACKGROUND Treatment of dural arteriovenous fistula involving the transverse-sigmoid region with cortical reflux is complex and treatment options may require sacrifice of the fistulous segment of the sinus. OBJECTIVE To review our results in this subset of patients and describe current endovascular decision-making and approaches. METHODS We reviewed cases of endovascular sinus sacrifice for dural fistulas at our institution from 2007 to 2012. Demographic, decision-making, technical and outcome data were collected. RESULTS Seven patients were identified who underwent endovascular sinus sacrifice for treatment of dural fistula during this 4-year period. Determination of the fistulous sinus segment was based on the pattern of cortical drainage. Endovascular access to the sinus was achieved by transarterial, transvenous or via open surgery in one case. Complete cure of the target fistula was obtained in all cases. One patient had transient post-procedure headache. There were no hemorrhages, new neurological deficits or signs of increased intracranial pressure. Six of the seven patients had angiographic follow-up at least 6 months after treatment with no recurrence. CONCLUSIONS Fistulas of the transverse-sigmoid sinuses with cortical reflux may require sacrifice of the parent sinus for cure. Defining the fistulous segment and occluding this segment deliberately, completely and precisely is essential for cure. Several modalities and approaches can be used to achieve this. For properly selected patients, cure of the lesions can be achieved with this method with low risk of morbidity.


title: Increased serum autotaxin levels in hepatocellular carcinoma patients were caused by background liver fibrosis but not by carcinoma.

text: BACKGROUND Controversy exists as to whether autotaxin (ATX) may be importantly associated with pathophysiology of hepatocellular carcinoma (HCC). METHODS We evaluated serum ATX levels and its mRNA expression in consecutive 148 HCC patients treated with radiofrequency ablation (RFA) and 30 patients with hepatic resection. RESULTS Although increased serum ATX levels were observed in almost all the patients treated with RFA, they were not reduced after RFA. Furthermore, serum ATX levels were associated not with tumor burden but with the parameters predicting for liver fibrosis, such as liver stiffness values. Then, in surgically-treated patients, there was no significant correlation between serum ATX levels and ATX mRNA expression levels in HCC tissues. Notably, ATX mRNA expression levels in HCC tissues were not higher than those in peri-tumorous tissues. Finally, serum ATX levels in surgically-treated HCC patients were rather correlated with ATX mRNA expression levels in peri-tumorous tissues as well as with liver fibrosis stage. CONCLUSION The increase in serum ATX levels in HCC patients may not be caused by abundant ATX production in HCC tissues but by fibrosis in the background livers.


title: Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol.

text: BACKGROUND AND PURPOSE There is need to improve image acquisition speed for MR imaging in evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of a 3T MR stroke protocol that combines low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion, without additional contrast. METHODS Thirty patients with acute stroke who underwent 3T MR imaging followed by DSA were retrospectively enrolled. TOF-MRA of the neck and brain and 3D contrast-enhanced MRA of the craniocervical arteries were obtained. A total of 0.1 mmol/kg of gadolinium was used for both contrast-enhanced MRA (0.05 mmol/kg) and dynamic susceptibility contrast perfusion (0.05 mmol/kg) (referred to as half-dose). An age-matched control stroke population underwent TOF-MRA and full-dose (0.1 mmol/kg) dynamic susceptibility contrast perfusion. The cervicocranial arteries were divided into 25 segments. Degree of arterial stenosis on contrast-enhanced MRA and TOF-MRA was compared with DSA. Time-to-maximum maps (>6 seconds) were evaluated for image quality and hypoperfusion. Quantitative analysis of arterial input function curves, SNR, and maximum T2* effects were compared between half- and full-dose groups. RESULTS The intermodality agreements (k) for arterial stenosis were 0.89 for DSA/contrast-enhanced MRA and 0.63 for DSA/TOF-MRA. Detection specificity of >50% arterial stenosis was lower for TOF-MRA (89%) versus contrast-enhanced MRA (97%) as the result of overestimation of 10% (39/410) of segments by TOF-MRA. The DWI-perfusion mismatch was identified in both groups with high interobserver agreement (r = 1). There was no significant difference between full width at half maximum of the arterial input function curves (P = .14) or the SNR values (0.6) between the half-dose and full-dose groups. CONCLUSIONS In patients with acute stroke, combined low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion at 3T is feasible and results in significant scan time and contrast dose reductions.


title: In Vivo Impedance Characterization of Cortical Recording Electrodes Shows Dependence on Electrode Location and Size.

text: OBJECTIVE Neural prostheses are improving the quality of life for those suffering from neurological impairments. Electrocorticography electrodes located in subdural, epidural, and intravascular positions show promise as long-term neural prostheses. However, chronic implantation affects the electrochemical environments of these arrays. METHODS In the present work, the effect of electrode location on the electrochemical properties of the interface was compared. The impedances of the electrode arrays were measured using electrochemical impedance spectroscopy in vitro in saline and in vivo four-week postimplantation. RESULTS There was not a significant effect of electrode location (subdural, intravascular, or epidural) on the impedance magnitude, and the effect of the electrode size on the impedance magnitude was frequency dependent. There was a frequency-dependent statistically significant effect of electrode location and electrode size on the phase angles of the three arrays. The subdural and epidural arrays showed phase shifts closer to -90° indicating the capacitive nature of the interface in these locations. The impact of placing electrodes within a blood vessel and adjacent to the blood vessel wall was most obvious when looking at the phase responses at frequencies below 10 kHz. CONCLUSION Our results show that intravascular electrodes, like those in subdural and epidural positions, show electrical properties that are suitable for recording. These results provide support for the use of intravascular arrays in clinically relevant neural prostheses and diagnostic devices. SIGNIFICANCE Comparison of electrochemical impedance of the epidural, intravascular, and subdural electrode array showed that all three locations are possible placement options, since impedances are in comparable ranges.


title: Safety and efficacy of a novel linear staple device with bioabsorbable polyglicolic acid felt in laparoscopic colorectal surgery.

text: INTRODUCTION Laparoscopic surgery is widely used for the treatment of colorectal cancer, but it is often associated with postoperative anastomotic complications. Generally, gastrointestinal anastomosis for colorectal surgery is performed using mechanical anastomosis with a double stapling technique. Using the automatic suture device with bioabsorbable polyglycolic acid (PGA) felt is expected to adequately reinforce staple lines on fragile tissue, helping to prevent anastomotic complications, including leakage. METHODS This study included 17 patients who underwent laparoscopic surgery after a diagnosis of colorectal cancer. The rectosigmoidal colon was resected toward the dentate line with a novel automatic PGA-felt suture device. RESULTS None of the patients had any postoperative bleeding, and none developed grade III or higher postoperative complications based on the Clavien-Dindo classification. When the sigmoid colon, rectosigmoid, or rectum was anastomosed, holding the excess portion of the PGA felt, stapled with the automatic PGA-felt suture device, allowed us to adequately maneuver the part of the colon or rectum to be anastomosed. With this technique, we could easily and safely insert and remove the automatic anastomotic device. When the lower rectum was resected in a planned, two-step operation, the orientation of the PGA felt helped to determine the direction in which the automatic suture device was to be inserted in the second step. Thus, the resected rectum could easily be stapled in a straight line. CONCLUSION The automatic PGA-felt suture device is safe and effective for colorectal resections and anastomoses.


title: Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging.

text: PURPOSE The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.