title: Posterior reversible encephalopathy syndrome.

text: PURPOSE OF REVIEW Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by acute cerebral endotheliopathy with consecutive disruption of the blood-brain barrier and vasogenic edema. Since its first description in 1996, PRES is increasingly recognized. However, many aspects of this syndrome with its wide spectrum of clinical and radiological features are still incompletely understood. In this review, possible pathophysiological mechanisms, approaches to diagnosis, recent study results on outcome, and future directions of research are described. RECENT FINDINGS Clinical manifestations of PRES include seizures, headache, visual disturbances, altered mental state, and more rarely hemiparesis or aphasia. Vasogenic edema predominantly occurs in the parieto-occipital region, but lesions affecting formerly called 'atypical' regions such as frontal lobe, cerebellum, or basal ganglia are common. If treated early and adequately, that is by removal of the underlying cause, PRES has a favorable prognosis, but neurological residual symptoms and even mortality can occur, particularly in patients with complications such as intracranial hemorrhage. SUMMARY In summary, validated diagnostic criteria and algorithms are warranted to standardize the diagnosis of PRES. This is essential for further research and future prospective studies that should investigate risk factors for unfavorable outcome and identify the roles of imaging features, clinical symptoms, and other biomarkers in predicting outcome.


title: Effects of resistance training on self-reported disability in older adults with functional limitations or disability - a systematic review and meta-analysis.

text: Background Self-reported disability has a strong negative impact on older people's quality of life and is often associated with the need for assistance and health care services. Resistance training (RT) has been repeatedly shown to improve muscle function (e.g. strength) and functional capacity (e.g. gait speed, chair-rise) in older adults with functional limitations. Nevertheless, it is unclear whether such objectively assessed improvements translate into a reduction in self-reported disability. Objectives To assess: i) whether and to what extent RT interventions have an effect on self-reported disability in older adults (≥65 years) with functional limitations or disability; and ii) whether the effects on self-reported disability are associated with changes in objective measures of muscle strength and functional capacity across studies. Methods PubMed, Embase, Web of Science, CINAHL and SPORTDiscus electronic databases were searched in June 2018. Randomized controlled trials reporting effects of RT on self-reported disability/function in ≥65 year-old adults with defined, functional limitations or self-reported disability were eligible. Data on self-reported disability/function were pooled by calculating adjusted standardized mean differences (SMD) using Hedges'g. Likewise, effect sizes for three secondary outcomes: knee extensor muscle strength; gait capacity; and lower body functional capacity were calculated and fit as covariates in separate meta-regressions with self-reported disability as the dependent factor. Results Fourteen RCTs were eligible for the primary meta-analysis on self-reported disability. The total number of participants was 651 (intervention n = 354; control n = 297). A significant moderate positive effect of RT was found (SMD: 0.59, 95% CI: 0.253 to 0.925, p = 0.001). Between-study heterogeneity was present (I2 statistic = 75,1%, p < 0.001). RT effects on objective measures of lower body functional capacity were significantly associated with effects on self-reported disability (Adj. R2 = 99%, p = 0.002, n = 12 studies), whereas no significant associations with gait capacity or knee extensor strength were found. Conclusions This review provides evidence that RT has a moderate positive effect on self-reported disability/function in old people with or at risk for disability. The effects are strongly associated with effects on objective measures of lower body functional capacity.


title: Porcine epidemic diarrhea virus infection induces NF-κB activation through the TLR2, TLR3 and TLR9 pathways in porcine intestinal epithelial cells.

text: Porcine epidemic diarrhea virus (PEDV) is a coronavirus that induces persistent diarrhoea in swine, resulting in severe economic losses in swine-producing countries. Insights into the interplay between PEDV infection and the innate immune system are necessary for understanding the associated mechanism of pathogenesis. The transcription factor NF-κB plays an important role in regulating host immune responses. Here, we elucidated for the first time to our knowledge the potential mechanism of PEDV-mediated NF-κB activation in porcine small intestinal epithelial cells (IECs). During PEDV infection, NF-κB p65 was found to translocate from the cytoplasm to the nucleus, and PEDV-dependent NF-κB activity was associated with viral dose and active replication. Using small interfering RNAs to screen different mRNA components of the Toll-like receptor (TLR) or RIG-I-like receptor signalling pathways, we demonstrated that TLR2, TLR3 and TLR9 contribute to NF-κB activation in response to PEDV infection, but not RIG-I. By screening PEDV structural proteins for their ability to induce NF-κB activities, we found that PEDV nucleocapsid protein (N) could activate NF-κB and that the central region of N was essential for NF-κB activation. Furthermore, TLR2 was involved in PEDV N-induced NF-κB activation in IECs. Collectively, these findings provide new avenues of investigation into the molecular mechanisms of NF-κB activation induced by PEDV infection.


title: Laparoscopic-assisted one-stage resection of rectal cancer with synchronous liver metastasis utilizing a pfannenstiel incision.

text: Laparoscopic approaches have been increasingly used in selected patients with either colorectal or liver cancer. However, simultaneous resection of colorectal carcinoma with synchronous liver metastases is still a subject of debate. The present case describes combined laparoscopic rectal and liver resections for a patient with primary rectal cancer and a synchronous liver metastasis utilizing a Pfannenstiel incision for specimen extraction. The operative time was 370 min and estimated blood loss was 400 mL. Postoperatively, the patient required parenteral analgesia for 48 h, resumed normal diet on day 3 and was discharged on day 7 after the operation. A laparoscopic approach utilizing a Pfannenstiel extraction incision may present an advantageous and attractive option for simultaneous laparoscopic rectal and liver resection in selected patients with the aim of improving short-term outcomes.


title: COVID-19 information propagation dynamics in the Chinese Sina-microblog.

text: The outbreak of a novel coronavirus (COVID-19) generated an outbreak of public opinions in the Chinese Sina-microblog. To help in designing effective communication strategies during a major public health emergency, we propose a multiple-information susceptible-discussing-immune (M-SDI) model in order to understand the patterns of key information propagation on social networks. We develop the M-SDI model, based on the public discussion quantity and take into account of the behavior that users may re-enter another related topic or Weibo after discussing one. Data fitting using the real data of COVID-19 public opinion obtained from Chinese Sina-microblog can parameterize the model to make accurate prediction of the public opinion trend until the next major news item occurs. The reproduction ratio has fallen from 1.7769 and maintained around 0.97, which reflects the peak of public opinion has passed but it will continue for a period of time.


docid: xtbhoihk

title: Double-lumen balloon for Onyx® embolization via extracranial arteries in transverse sigmoid dural arteriovenous fistulas: initial experience.

text: Transverse-sigmoid dural arteriovenous fistulas (TS DAVFs) can be challenging to treat by endovascular means. Indeed, a total cure of the fistula can only be achieved when complete occlusion of the fistulous point(s) is obtained by penetration of the embolic agent. However, in some cases, especially for transosseous branches from extracranial arteries like the occipital artery (OcA) or the superficial temporal artery (STA), such penetration is usually poor, leading to major proximal reflux and incomplete fistula obliteration. We present three cases of embolization in two patients with TS DAVF through the OcA and/or the STA with Onyx® using a double-lumen balloon (Microvention, Tustin, CA, USA). This technique allows the penetration of the embolic agent in the transosseous branches by forming a counter-pressure with the inflated balloon. This technique may be useful to achieve complete occlusion of TS DAVFs by endovascular means.


title: Validation of Metagenomic Next-Generation Sequencing Tests for Universal Pathogen Detection.

text: CONTEXT - Metagenomic sequencing can be used for detection of any pathogens using unbiased, shotgun next-generation sequencing (NGS), without the need for sequence-specific amplification. Proof-of-concept has been demonstrated in infectious disease outbreaks of unknown causes and in patients with suspected infections but negative results for conventional tests. Metagenomic NGS tests hold great promise to improve infectious disease diagnostics, especially in immunocompromised and critically ill patients. OBJECTIVE - To discuss challenges and provide example solutions for validating metagenomic pathogen detection tests in clinical laboratories. A summary of current regulatory requirements, largely based on prior guidance for NGS testing in constitutional genetics and oncology, is provided. DATA SOURCES - Examples from 2 separate validation studies are provided for steps from assay design, and validation of wet bench and bioinformatics protocols, to quality control and assurance. CONCLUSIONS - Although laboratory and data analysis workflows are still complex, metagenomic NGS tests for infectious diseases are increasingly being validated in clinical laboratories. Many parallels exist to NGS tests in other fields. Nevertheless, specimen preparation, rapidly evolving data analysis algorithms, and incomplete reference sequence databases are idiosyncratic to the field of microbiology and often overlooked.


title: COVID-19: The outbreak caused by a new coronavirus.

text: Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.


title: Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy.

text: BACKGROUND The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of less invasive surgery without the need to create a complicated intraabdominal anastomosis. METHODS From 2008 to 2011, 262 patients with gastric cancer underwent total gastrectomy and reconstruction with a Roux-en-Y anastomosis, and 52 patients underwent LATG with DST. A retrospective analysis then was performed comparing the patients who experienced postoperative stenosis after LATG-DST (positive group) and the patients who did not (negative group). A comparative analysis was performed among patients comparing conventional open total gastrectomy and LATG, and multivariate analysis was performed to evaluate risk factors for the development of anastomotic stenosis. RESULTS A minor leak was found in 1 patient (1.9 %), and 11 patients experienced anastomotic stenosis (21 %) after LATG with DST. Among the patients with anastomotic stenosis, three (3/4, 75 %) anastomoses were performed with the 21-mm end-to-end anastomosis (EEA) stapler, and eight anastomoses were performed (8/47, 17 %) with the 25-mm EEA stapler. The median interval to the diagnosis of anastomotic stenosis was 43 days after surgery. The patients with stenosis needed endoscopic balloon dilation an average of four times, and the rate of perforation after dilation was 13 %. The clinical and operative characteristics did not differ between the two groups. Anastomotic stenosis after open total gastrectomy occurred in two cases (0.98 %). Multivariate analysis showed that the size of the EEA stapler and the use of DST were risk factors for anastomotic stenosis. CONCLUSION Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis.


docid: yxejvexc

title: Sleepless in COVID-19: how not to lose sleep in lockdowns.

text: The corona virus disease 2019 (COVID-19) outbreak started in December 2019 in Wuhan, China, and spread all over the world leading to declaration of a pandemic by World Health Organization (WHO) on 11th March 2020. Most countries around the world have been on lockdown in an effort to halt the spread of virus. People around the world have been pushed into uncharted waters of uncertainty, fear, anxiety, stress and depression due to economic crash down, job losses and fear for their own health and that of their loved ones. There is a known association between anxiety/stress and sleep disturbances and vice versa. The most vulnerable population in this isolation like condition, in this lockdown, are the chief earning member of the family, women, young ones, and people with psychiatric illness.


docid: wsqlwxuu

title: Restorative Mechanisms Regulating Protein Balance in Skeletal Muscle During Recovery From Sepsis.

text: Muscle deconditioning is commonly observed in patients surviving sepsis. Little is known regarding the molecular mechanisms regulating muscle protein homeostasis during the recovery or convalescence phase. We adapted a sepsis-recovery mouse model that uses cecal ligation and puncture (CLP), followed 24 h later by cecal resection and antibiotic treatment, to identify putative cellular pathways regulating protein synthesis and breakdown in skeletal muscle. Ten days after CLP, body weight and food consumption did not differ between control and sepsis-recovery mice, but gastrocnemius weight was reduced. During sepsis-recovery, muscle protein synthesis was increased 2-fold and associated with enhanced mTOR kinase activity (4E-BP1 and S6K1 phosphorylation). The sepsis-induced increase in 4E-BP1 was associated with enhanced formation of the eIF4E-eIF4G active cap-dependent complex, while the increased S6K1 was associated with increased phosphorylation of downstream targets S6 and eIF4B. Proximal to mTOR, sepsis-recovery increased Akt and TSC2 phosphorylation, did not alter AMPK phosphorylation, and decreased REDD1 protein content. Despite the decreased mRNA content for the E3 ubiquitin ligases atrogin-1 and muscle RING-finger 1, proteasomal activity was increased 50%. In contrast, sepsis-recovery was associated with an apparent decrease in autophagy (e.g., increased ULK-1 phosphorylation, decreased LCB3-II, and increased p62). The mRNA content for IL-1β, IL-18, TNFα, and IL-6 in muscle was elevated in sepsis-recovery. During recovery after sepsis skeletal muscle responds with an increase in Akt-TSC2-mTOR-dependent protein synthesis and decreased autophagy, but full restoration of muscle protein content may be slowed by the continued stimulation of ubiquitin-proteasome activity.


title: Characteristics and effectiveness of vasodilatory and pressor compensation for reduced relaxation time during rhythmic forearm contractions.

text: NEW FINDINGS What is the central question of this study? Reduced relaxation time between contractions in exercise requires increased vasodilatation and/or pressor response to prevent hypoperfusion and potential compromise to exercise tolerance. However, it remains unknown whether and to what extent local vasodilatation and/or systemic pressor compensation occurs and whether the efficacy of compensation is exercise intensity dependent. What is the main finding and its importance? We demonstrate that in a forearm exercise model vasodilatory but not pressor compensation occurs and is adequate to prevent hypoperfusion below but not above ∼40% peak work rate. Inadequate compensation occurs with exercise still well inside the submaximal domain, despite a vasodilatory reserve, and compromises exercise performance. During muscle contraction in rhythmic exercise, muscle blood flow is significantly impeded by microvascular compression. The purpose of this study was to establish the nature and magnitude of vasodilatory and/or pressor compensatory responses during forearm exercise in the face of an increased duration of mechanical microvascular compression, and whether the effectiveness of such compensation was exercise intensity dependent. Seven healthy males (21.0 ± 1.8 years old) completed progressive forearm exercise (24.5 N every 3 min; 2 s contraction-4 s relaxation duty cycle) in two conditions: control (CON), 2 s 100 mmHg forearm cuff inflation during contraction; and impedance (IMP), extension of cuff inflation 2 s beyond contraction. Forearm blood flow (in millilitres per minute); brachial artery Doppler and echo ultrasound), mean arterial blood pressure (in millimetres of mercury; finger photoplethysmography) and exercising forearm venous effluent (antecubital vein catheter) measurements revealed an exercise intensity-dependent compensatory vasodilatation effectiveness whereby increased vasodilatation fully protected forearm blood flow up to the 30% exercise intensity in IMP. Above this exercise intensity, forearm blood flow was defended only in part, although submaximal oxygen uptake was not compromised for any completed work rate. As a result, peak exercise intensity (175 ± 22 versus 196 ± 28 N, P = 0.04) and oxygen delivery (76 ± 14 versus 112 ± 22 ml O2 min-1 , P = 0.01) were significantly reduced in IMP compared with CON. In conclusion, reducing relaxation time compromised exercise capacity without compromise to oxygen uptake. Vasodilatory compensation was complete at lower but not higher exercise intensities, whereas pressor compensation was absent. The reasons for the exercise intensity dependence of the efficacy of vasodilatory compensation remain to be determined.


title: DISEQUILIBRIUM BETWEEN THE CLASSIC RENIN-ANGIOTENSIN SYSTEM AND ITS OPPOSING ARM IN SARS-COV-2 RELATED LUNG INJURY.

text: A dysregulation of the renin-angiotensin-system (RAS) has been involved in the genesis of lung injury and acute respiratory distress syndrome (ARDS) from different causes, including several viral infections. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection of pneumocytes, the hallmark of the pandemic coronavirus disease 2019 (COVID-19) involving both alveolar interstitium and capillaries, is linked to angiotensin-converting-enzyme 2 (ACE2) binding and its functional downregulation. ACE2 is a key enzyme for the balance between the two main arms of the RAS: the ACE/Angiotensin (Ang) II/Ang II type 1 receptor axis ("classic RAS"), and the ACE2/Ang 1-7/MasR axis ("anti-RAS"). The ACE2 downregulation, as a result of SARS-coronaviruses binding, enhances the "classic RAS", leading to lung damage and inflammation with leaky pulmonary blood vessels and fibrosis, when the attenuation mediated by the "anti-RAS" arm is reduced. ACE inhibitors (ACE-I) and Ang II type 1 receptor blockers (ARB), effective in cardiovascular diseases, were found to prevent and counteract acute lung injury in several experimental models, by restoring the balance between these two opposing arms. The evidence of RAS arms disequilibrium in COVID-19 and the hypothesis of a beneficial role of RAS modulation supported by preclinical and clinical studies are the focus of the present review. Preclinical and clinical studies on drugs balancing RAS arms might be the right way to counter COVID-19.


title: An inverted J-shaped association of serum uric acid with muscle strength among Japanese adult men: a cross-sectional study.

text: BACKGROUND Uric acid (UA) may protect muscle function from oxidative damage due to reactive oxygen species through its powerful antioxidant capacity. However, several studies have demonstrated that hyperuricemia is closely related to systemic inflammation and has oxidant properties effects, both of which may increase the risk of muscle strength loss. The purpose of this study was to examine the association of serum UA concentration with grip strength and leg extension power in adult men. METHODS This study is a cross-sectional survey in which 630 Japanese male employees aged 30 years and older participated. Five hundred and eighty-six subjects participated in the measurement of grip strength, and 355 subjects participated in the measurement of leg extension power. Blood samples were obtained for serum UA analysis. RESULTS After adjustment for potential confounders, grip strength differed significantly between participants with and those without hyperuricemia (geometric mean and 95% confidence interval [CI]: 40.3 [39.2-41.3] kg vs. 41.9 [41.3-42.5] kg; P = 0.01). In addition, serum UA levels (quartiles) showed an inverted J-shaped curve with grip strength (mean and 95% CI: Q1, 41.6 [40.6-42.6] kg; Q2, 42.2 [41.2-43.2] kg; Q3, 41.8 [40.8-42.8] kg; Q4, 40.4 [39.3-41.4] kg; P for quadratic trend = 0.05). The results in the leg extension power group were similar to those observed in the grip strength group. CONCLUSION This population-based cross-sectional study shows for the first time that hyperuricemia is associated with poor muscle strength. Moreover, the results indicate an inverted J-shaped association between serum UA quartiles and muscle strength.


Bi-national survey of intraoperative cuff pressure monitoring of endotracheal tubes and supraglottic airway devices in operating theatres.


title: Update on flow diverters for the endovascular management of cerebral aneurysms.

text: Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.


title: Use of Smartphones to Detect Diabetic Retinopathy: Scoping Review and Meta-Analysis of Diagnostic Test Accuracy Studies.

text: BACKGROUND Diabetic retinopathy (DR), a common complication of diabetes mellitus, is the leading cause of impaired vision in adults worldwide. Smartphone ophthalmoscopy involves using a smartphone camera for digital retinal imaging. Utilizing smartphones to detect DR is potentially more affordable, accessible, and easier to use than conventional methods. OBJECTIVE This study aimed to determine the diagnostic accuracy of various smartphone ophthalmoscopy approaches for detecting DR in diabetic patients. METHODS We performed an electronic search on the Medical Literature Analysis and Retrieval System Online, EMBASE, and Cochrane Library for literature published from January 2000 to November 2018. We included studies involving diabetic patients, which compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting DR to an accurate or commonly employed reference standard, such as indirect ophthalmoscopy, slit-lamp biomicroscopy, and tabletop fundus photography. Two reviewers independently screened studies against the inclusion criteria, extracted data, and assessed the quality of included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, with disagreements resolved via consensus. Sensitivity and specificity were pooled using the random effects model. A summary receiver operating characteristic (SROC) curve was constructed. This review is reported in line with the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines. RESULTS In all, nine studies involving 1430 participants were included. Most studies were of high quality, except one study with limited applicability because of its reference standard. The pooled sensitivity and specificity for detecting any DR was 87% (95% CI 74%-94%) and 94% (81%-98%); mild nonproliferative DR (NPDR) was 39% (10%-79%) and 95% (91%-98%); moderate NPDR was 71% (57%-81%) and 95% (88%-98%); severe NPDR was 80% (49%-94%) and 97% (88%-99%); proliferative DR (PDR) was 92% (79%-97%) and 99% (96%-99%); diabetic macular edema was 79% (63%-89%) and 93% (82%-97%); and referral-warranted DR was 91% (86%-94%) and 89% (56%-98%). The area under SROC curve ranged from 0.879 to 0.979. The diagnostic odds ratio ranged from 11.3 to 1225. CONCLUSIONS We found heterogeneous evidence showing that smartphone ophthalmoscopy performs well in detecting DR. The diagnostic accuracy for PDR was highest. Future studies should standardize reference criteria and classification criteria and evaluate other available forms of smartphone ophthalmoscopy in primary care settings. CLINICALTRIAL


title: Efficacy of Chondroitin Sulfate in Patients with Knee Osteoarthritis: A Comprehensive Meta-Analysis Exploring Inconsistencies in Randomized, Placebo-Controlled Trials.

text: INTRODUCTION There are some controversies about treatment modalities in osteoarthritis (OA), including chondroitin sulfate (CS). The objective of this study was to determine whether CS is effective at alleviating pain and improving function in patients with knee OA and to identify the factors that explain inconsistencies in clinical trial results. METHODS We conducted a systematic review of randomized, placebo-controlled trials, searching the databases Medline, Cochrane central register for controlled trials and Scopus. Random effects meta-analysis was then performed, using tau2 and I2 statistics to assess heterogeneity. The pain and Lequesne index (LI) scores were expressed as standardized mean differences (SMDs), with a 95% confidence interval (CI). Heterogeneity was explored by stratifying the analyses according to pre-specified study-level characteristics and assessing the sources of funnel plot asymmetry. RESULTS The inclusion criteria yielded 18 trials. Overall, CS significantly but inconsistently reduced pain (SMD: - 0.63; 95% CI: - 0.91, - 0.35; I2 = 94%) and improved function (SMD: - 0.82; 95% CI: - 1.31, - 0.33; I2 = 95%). When limiting the analysis to studies with a low risk of bias, the pharmaceutical grade CS of IBSA origin showed a greater reduction in pain (SMD: - 0.25; 95% CI: - 0.34, - 0.16; I2 = 75%) and function (SMD: - 0.33; 95% CI: - 0.47, - 0.20; I2 = 53%, p = 0.07) compared with the other preparations (SMDPain: - 0.08; 95% CI: - 0.19, + 0.02; I2 = 20%; SMDFunction: - 0.18; 95% CI: - 0.36, +0.01; I2 = 0%). Assessing funnel plot asymmetry in the studies with a low risk of bias, we found strong correlations between the treatment effects and study size (pain: rS = 0.93; LI: rS = 0.86; p < 0.05). Ultimately, there was no residual heterogeneity in the CS effects when the smallest studies were removed from the analyses. CONCLUSION This new meta-analysis suggests that CS provides a moderate benefit for pain and has a large effect on function in knee OA, however with large inconsistency. The risks of bias, brand and study size were the factors explaining heterogeneity among the clinical trial results.


title: Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review.

text: Congenital cytomegalovirus (cCMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL), and efforts are geared towards prevention through vaccine development. Transmission rates following primary maternal infection occur at rates of 30-40%, however reported placental rates upon non-primary maternal infection is reported to be less than <4%. There is significant debate about whether this reduction in transmission rate is due to pre-existing maternal immunity, which could identify possible immunologic targets for vaccines. To address this question, we performed a systemic review of the literature using Preferred Reporting Items for Systematic Review and Analysis (PRISMA) guidelines. We identified cohort studies in high CMV seroprevalent (>80%) areas or in developing regions that examined a cohort of at least 50 infants for congenital CMV acquisition. We identified 19 articles that met criteria and were further categorized based on pre-conception serology, maternal seroprevalence, or previously known seroprevalence. Birth prevalence rates ranged from 0.4% to 6% (median 1.1%), with the studies reporting on clinical outcome (16/19 studies) noting the majority of infected infants as asymptomatic. We also utilized a recent study that differentiated primary maternal infections from chronic infections in a highly seropositive population to calculate a placental transmission rate in women with pre-existing immunity compared to that of no pre-existing immunity. This work confirms a low cCMV birth prevalence in highly seropositive populations, indicates via a calculated placental transmission rate that the CMV placental transmission rate is lower in non-primary infection than that of primary infection, and reveals gaps in data for further research aiming to identify targets for vaccine development.


title: Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives.

text: PURPOSE Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. CONCLUSIONS Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.


title: Application of nanomaterials to arrays for infectious disease diagnosis.

text: As our understanding of infectious agents increases it has become possible to identify the biological components of individual strains with greater accuracy. This ability is aiding clinical microbiologists to control both existing and emerging infectious disease problems. Microarray technologies are playing an increasingly important role in supplying relevant test data. Control of the nanoscale structures of the materials used in arrays, including the supports, reagents and analytes, is now essential. New techniques for the manufacture of nanostructured supports is now allowing rapid advances in the fields of multianalyte testing and high-volume DNA sequencing.


title: The effect of sunitinib on primary renal cell carcinoma and facilitation of subsequent surgery.

text: PURPOSE We investigated the effect of sunitinib on locally advanced primary renal carcinoma tumors and the ability to facilitate subsequent surgery. MATERIALS AND METHODS Patients with an unresectable primary renal tumor, with or without distant metastases, received 50 mg sunitinib with continuous daily dosing in a phase II trial. Computerized tomography was performed every 12 weeks to determine surgical resectability. The primary end point of the trial was the percentage of patients with renal cell carcinoma and initially unresectable primary tumors who could undergo nephrectomy after sunitinib therapy. RESULTS Of 30 patients enrolled in the study (19 with distant metastases) 28 (35 total renal tumors) were evaluable for response. The median change in primary renal cell carcinoma tumors was a 22% decrease, corresponding to a median absolute reduction of 1.2 cm. The median reduction in primary renal cell carcinoma tumors of clear cell histology was -28% (absolute reduction 1.7 cm) compared to a 1.4% increase (0.1 cm absolute increase) in nonclear cell tumors. Of these patients 13 (45%) met the primary end point of being able to undergo nephrectomy after preoperative sunitinib. All patients had viable renal cell carcinoma in the surgical specimen and surgical morbidity was consistent with prior experience of nephrectomy in patients without preoperative therapy. CONCLUSIONS Sunitinib as initial therapy in patients with locally advanced features of the primary tumor was feasible and resulted in an antitumor effect that enabled subsequent surgery in a subset of patients. Further prospective study is required to refine the most suitable application of this approach.


title: The effect of prazosin on outcome in feline urethral obstruction.

text: OBJECTIVE To determine whether prazosin administration following urethral obstruction (UO) reduces the risk for recurrent urethral obstruction (rUO) or lower urinary tract signs, and to document adverse effects associated with prazosin use in cats. DESIGN Double-blinded, prospective, interventional study. SETTING University teaching hospital. ANIMALS A population of 47 consecutive male cats with UO not associated with urinary tract calculi >2 mm in diameter. INTERVENTIONS Cats were randomized to receive either prazosin (0.25 mg/cat PO q 12 h, n = 27) or placebo (n = 20) for 1 month following UO. MEASUREMENTS AND MAIN RESULTS Cats were monitored for rUO, severity of lower urinary tract signs, and medication adverse effects during hospitalization and through weekly conversations with the owner during the 1- month study period and once more at 6 months following discharge. There was no difference in the rUO rate among cats that received prazosin or placebo prior to hospital discharge (2/26 (7%) versus 1/19 (5%), P = 1.00), during the 1- month medication period (4/26 (15%) versus 3/18 (17%), P = 0.776), or at 6 months following treatment for UO (7/19 (37%) versus 4/13 (31%), P = 0.811). There was no difference in the severity of lower urinary tract signs reported by the owners at the 1-, 2-, 3-, or 4-week follow-up periods among the cats in either group (P = 0.62, 0.68, 0.33, 1.00, respectively). Reported adverse effects from prazosin administration included lethargy, ptyalism, diarrhea, anorexia, and malodorous stool. CONCLUSIONS Although our study results failed to find a difference in the incidence of rUO and severity of lower urinary tract signs among cats receiving prazosin and those receiving placebo, these study results should be interpreted cautiously as our study was underpowered to identify such differences. Larger placebo-controlled, prospective studies are needed to determine the clinical utility of prazosin in prevention of rUO.


title: Renal cell carcinoma arising from a horseshoe kidney in a chronic hemodialysis patient.

text: A 60-year-old man undergoing hemodialysis for 13 years was referred to our department for evaluation of gross hematuria and a right renal mass. Voided urine cytology was negative. Computed tomography and magnetic resonance imaging demonstrated a right renal mass (32 × 22 × 20 mm in diameter). We clinically diagnosed the tumor as renal cell carcinoma staged T1aN0M0 arising from a horseshoe kidney, and performed right heminephrectomy. Pathological examination of the surgical specimen showed a grade 2, pT1a, clear cell carcinoma and negative surgical margin. To our knowledge, this is a rare case of a renal cell carcinoma arising from a horseshoe kidney in a chronic hemodialysis patient.


title: Transanal total mesorectal excision (taTME) for rectal cancer: a training pathway.

text: BACKGROUND With increasing interest in natural orifice surgery, there has been a dramatic evolution of transanal and endoluminal surgical techniques. These techniques began with transanal endoluminal surgical removal of rectal masses and have progressed to transanal radical proctectomy for rectal cancer. The first transanal total mesorectal excision (taTME) was performed in 2009 by Sylla, Rattner, Delgado, and Lacy. The improved visibility and working space associated with the taTME technique is intriguing. This video manuscript outlines the training pathway followed by pioneers in the taTME technique, the process of implementation into clinical practice, and initial case report. METHODS A double board-certified colorectal surgeon with expertise in rectal cancer, minimally invasive total mesorectal excision, transanal endoscopic surgery (TES), and intersphincteric dissection, underwent taTME training in male cadaver models. Institutional review board (IRB) approval for a phase I clinical trial was achieved. The entire operative team including surgeons, nurses, and operative staff underwent taTME cadaver training the day prior to the first clinical case. The case was proctored by an expert in taTME. RESULTS A 66-year-old male with uT3N1M0 rectal cancer located in the posterior distal rectum, underwent taTME with laparoscopic abdominal assistance, hand sewn coloanal anastomosis, and diverting loop ileostomy. The majority of the TME was performed transanally with laparoscopic assistance for exposure, splenic flexure mobilization, and high ligation of the vascular pedicles. Operative time was 359 min. There were no intraoperative complications. Pathology revealed a ypT2N1 moderately differentiated invasive adenocarcinoma, grade I TME, 1 cm circumferential radial margin, and 2/13 positive lymph nodes. CONCLUSION Implementation of taTME into practice can be achieved by surgeons with expertise in minimally invasive TME, TES, pre-clinical taTME training in cadavers, case observation, proctoring, and ongoing mentorship. IRB peer review process and participation in a clinical registry are additional measures that should be employed.


Crisis Leadership During and Following COVID-19.


Considerations for the Use of Respiratory Filters in Children During the COVID-19 Pandemic.


docid: dangsohy

title: Cost analysis of leak after sleeve gastrectomy.

text: BACKGROUND Leaks after laparoscopic sleeve gastrectomy (LSG) are serious complications of this procedure. The objective of the present study was to evaluate the costs of leaks after LSG. SETTING Private hospital, France. METHODS A retrospective analysis was conducted on a prospective cohort of 2012 cases of LSG between September 2005 and December 2014. Data were collected on all diagnostic and therapeutic measures necessary to manage leaks, ward, and intensive care unit (ICU) length of stay. Additional outpatient care was also analyzed. RESULTS Twenty cases (0.99%) of gastric leak were recorded. Fifteen patients had available data for cost analysis. Of these, 13 patients were women (86.7%) with a mean age of 41.4 years (range 22-61) and mean BMI of 43.2 kg/m2 (range 34.8-57.1). The leaks occurred after 7.4 days (±2.3) postoperatively. Only one gastric leak was recorded for the last 800 cases in which absorbable staple line reinforcement was used. Mean intra-hospital cost was 34398 € (range 7543-91,632 €). Prolonged hospitalization in ICU accounted for the majority of hospital costs (58.9%). Mean additional outpatient costs for leaks were 41,284 € (range 14,148-75,684€). CONCLUSIONS Leaks after LSG are an expensive complication. It is therefore important to take all necessary measures to reduce their incidence. Our data should be considered when analyzing the cost effectiveness of staple line reinforcement usage.


title: Resection as first-line therapy for large hepatic sclerosing hemangioma: a case report.

text: Hepatic sclerosing hemangioma is a rare benign disease that occurs in association with hepatic cavernous hemangioma degeneration and sclerosis. Recent studies have shown that radiofrequency (RF) ablation is an alternative treatment for hepatic cavernous hemangiomas, even for large hemangiomas (≥10 cm). However, RF ablation might not be suitable to treat large sclerosing hemangiomas. We herein report the successful surgical removal of a large hepatic sclerosing hemangioma after RF ablation treatment failure in a 65-year-old man. In conclusion, we suggest that resection should be chosen as a first-line therapy for the disease.


title: Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations.

text: OBJECTIVE To evaluate the feasibility of reaching the interpeduncular cistern (IC) through an endoscopic endonasal approach that leaves the pituitary gland in place. METHODS In a series of 10 injected cadaver heads, the transtuberculum ("above") and transclival ("below") approaches were combined, without pituitary transposition. Using 0-degree, 30-degree, and 45-degree endoscopes, the extent of overlap and if a blind spot occurred were determined. Also, the visualization of the IC was compared with the transposition of the pituitary gland approach. Nonparametric statistics were used to evaluate the results. The approach was implemented in 2 patients. RESULTS For both the "above" and "below" views, there was a statistically significant increase in field of view when comparing the 0-degree endoscope with either the 30-degree endoscope (P < 0.05) or the 45-degree endoscope (P < 0.05). There was no difference between the 30-degree endoscope and the 45-degree endoscope (P > 0.05) in the "below" approach, but there was a difference (P < 0.05) in the "above" approach. There was no blind spot with any combination of endoscopes. There was no practical statistically significant difference between the transposition approach and the "above and below" approach. The "above and below" approach was used successfully in 2 surgeries. CONCLUSIONS It is possible to work both "above" and "below" the pituitary gland to reach the IC through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. There is no blind spot using this approach that would be revealed with a pituitary transposition. The feasibility of this approach has been confirmed in 2 patients.


title: Video-Assisted Thoracoscopic Resection of a Noninvasive Thymoma in a Cat with Myasthenia Gravis Using Low-Pressure Carbon Dioxide Insufflation.

text: OBJECTIVE To report the use of low-pressure carbon dioxide insufflation during video-assisted thoracoscopic surgery for resection of a noninvasive thymoma in a cat with secondary myasthenia gravis. STUDY DESIGN Clinical case report. ANIMAL Client-owned cat. METHODS An 11-year-old castrated male domestic shorthair cat was examined for generalized weakness, voice change, hypersalivation, hyporexia, vomiting, coughing, and gagging. Thoracic ultrasound revealed a cranial mediastinal mass for which cytology was consistent with a thymoma (or lymphoid tissue). Acetylcholine receptor antibody concentration was elevated at 3.16 mmol/L (reference interval < 0.3 mmol/L). Thoracic computed tomography showed two round, contrast-enhancing structures in the cranioventral mediastinum identified as the sternal lymph node and a cranial mediastinal mass (11 × 17 × 24 mm). A presumptive diagnosis of thymoma with paraneoplastic myasthenia gravis was made and surgical resection of both mediastinal masses was recommended. RESULTS Video-assisted thoracoscopic resection of the cranial mediastinal mass and sternal lymph node were performed with low-pressure carbon dioxide insufflation maintained at an intrathoracic pressure of 2-3 mmHg. The cat recovered from surgery without serious complications. Nineteen months after surgery, the cat developed hind limb stiffness. Thoracic radiographs ruled out a cranial mediastinal mass or megaesophagus. Acetylcholine receptor antibody concentration remained elevated at 2.72 mmol/L. CONCLUSION Low-pressure thoracic insufflation facilitated video-assisted thoracoscopic resection of cranial mediastinal masses in this cat.


title: Real-Time In Vivo Characterization of Primary Liver Tumors With Diffuse Optical Spectroscopy During Percutaneous Needle Interventions: Feasibility Study in Woodchucks.

text: OBJECTIVE This study presents the first in vivo real-time optical tissue characterization during image-guided percutaneous intervention using near-infrared diffuse optical spectroscopy sensing at the tip of a needle. The goal of this study was to indicate transition boundaries from healthy tissue to tumors, namely, hepatic carcinoma, based on the real-time feedback derived from the optical measurements. MATERIALS AND METHODS Five woodchucks with hepatic carcinoma were used for this study. The woodchucks were imaged with contrast-enhanced cone beam computed tomography with a flat panel detector C-arm system to visualize the carcinoma in the liver. In each animal, 3 insertions were performed, starting from the skin surface toward the hepatic carcinoma under image guidance. In 2 woodchucks, each end point of the insertion was confirmed with pathologic examination of a biopsy sample. While advancing the needle in the animals under image guidance such as fluoroscopy overlaid with cone beam computed tomography slice and ultrasound, optical spectra were acquired at the distal end of the needles. Optical tissue characterization was determined by translating the acquired optical spectra into clinical parameters such as blood, water, lipid, and bile fractions; tissue oxygenation levels; and scattering amplitude related to tissue density. The Kruskal-Wallis test was used to study the difference in the derived clinical parameters from the measurements performed within the healthy tissue and the hepatic carcinoma. Kurtoses were calculated to assess the dispersion of these parameters within the healthy and carcinoma tissues. RESULTS Blood and lipid volume fractions as well as tissue oxygenation and reduced scattering amplitude showed to be significantly different between the healthy part of the liver and the hepatic carcinoma (P < 0.05) being higher in normal liver tissue. A decrease in blood and lipid volume fractions and tissue oxygenation as well as an increase in scattering amplitude were observed when the tip of the needle crossed the margin from the healthy liver tissue to the carcinoma. The kurtosis for each derived clinical parameter was high in the hepatic tumor as compared with that in the healthy liver indicating intracarcinoma variability. CONCLUSIONS Tissue blood content, oxygenation level, lipid content, and tissue density all showed significant differences when the needle tip was guided from the healthy tissue to the carcinoma and can therefore be used to identify tissue boundaries during percutaneous image-guided interventions.


Judge rules that baby should be removed from ventilator and given palliative care.


title: Laparoscopic versus open pediatric splenectomy for massive splenomegaly.

text: Laparoscopic splenectomy (LS) has rapidly evolved into the technique of choice compared with open splenectomy (OS) because of the advantages of the minimally invasive approach. Splenomegaly increases the technical difficulties of LS. LS for massive splenomegaly has generally been found to fail in adults and children. With improvements in laparoscopic technique and accumulation of laparoscopic experience, however, concerns about completing the procedure in pediatric cases with even massive splenomegaly have been lowered. A retrospective review (April 1997-October 2009) of databases at 2 institutions identified 145 children undergoing splenectomy, 79 laparoscopic and 66 open. We defined splenic margin below the umbilicus or anteriorly extending over the midline as massive splenomegaly. By this definition, 22 cases of pediatric laparoscopic and 17 cases of open splenectomies for massive splenomegaly were performed. Perioperative and follow-up data of laparoscopic pediatric splenectomies were compared with those of open splenectomies, including operative time, bleeding, spleen size, complications, and hospital stay. There were no deaths, wound infections, or instances of pancreatitis. No accessory spleen was missed by laparoscopic; accessory spleens were missed in 2 patients in open splenectomies. The complication rate of laparoscopic versus open was 13.6% versus 41.2%. No subsequent surgery was necessary for dealing with complications both in laparoscopic and open series. Laparoscopic pediatric splenectomy for massive splenomegaly is a feasible, effective, and safe procedure and is associated with low morbidity and a short hospital stay.


A simple technical option for single-port cholecystectomy.


title: Hyphenated Analytical Methods in Determination of Biologically Active Compounds in Hen's Eggs.

text: Hen's egg is a complete material needed for the development of the embryo; it is an important source of nutraceutical compounds, such as protein, fats, vitamins, trace metals, and minerals. Moreover, avian egg contains biologically active compounds that exhibit antibacterial and antimicrobial activities as well as antitumor, antiviral, antioxidant, immunomodulating, and therapeutic properties. Eggs are mostly very good sources of valuable, easily digestible proteins. This review focuses on the biologically active compounds from hen's egg and applications of these compounds in medicine and the pharmaceutical industry. Additionally, it gives an overview of the hyphenated separation techniques, including sample preparation, analysis, and identification, used in the proteomics and lipidomics analysis.


The Response of the Anesthesia & Analgesia Community to Coronavirus Disease 2019


title: Risk factors and visual fatigue of baggage X-ray security screeners: a structural equation modelling analysis.

text: This study identified the risk factors influencing visual fatigue in baggage X-ray security screeners and estimated the strength of correlations between those factors and visual fatigue using structural equation modelling approach. Two hundred and five X-ray security screeners participated in a questionnaire survey. The result showed that satisfaction with the VDT's physical features and the work environment conditions were negatively correlated with the intensity of visual fatigue, whereas job stress and job burnout had direct positive influences. The path coefficient between the image quality of VDT and visual fatigue was not significant. The total effects of job burnout, job stress, the VDT's physical features and the work environment conditions on visual fatigue were 0.471, 0.469, -0.268 and -0.251 respectively. These findings indicated that both extrinsic factors relating to VDT and workplace environment and psychological factors including job burnout and job stress should be considered in the workplace design and work organisation of security screening tasks to reduce screeners' visual fatigue. Practitioner Summary: This study identified the risk factors influencing visual fatigue in baggage X-ray security screeners and estimated the strength of correlations between those factors and visual fatigue. The findings were of great importance to the workplace design and the work organisation of security screening tasks to reduce screeners' visual fatigue.


title: General anesthesia improves contact force and reduces gap formation in pulmonary vein isolation: a comparison with conscious sedation.

text: Compared to conscious sedation (CS), the use of general anesthesia (GA) in pulmonary vein isolation (PVI) is associated with a lower recurrence rate of atrial fibrillation (AF). GA may improve catheter stability and mapping system accuracy compared to CS, but its influence on contact force (CF) parameters during ipsilateral PVI has not previously been investigated. The study population comprised 176 consecutive patients (107 in GA group and 69 in CS group) with AF who underwent their first PVI procedure. We retrospectively assessed CF parameters, force-time integral (FTI), FTI/wall thickness during anatomical ipsilateral PVI and long-term outcome after ablation. Complete PVI with single continuous circular lesions around the ipsilateral PVs was achieved in 54 patients (50.5%) in the GA group but only 24 patients (34.8%) in the CS group (P = 0.04). The distribution of gaps did not differ between the groups. All CF parameters were significantly higher in the GA group than in the CS group (average CF: 19.4 ± 8.7 vs. 16.7 ± 7.7 g, P < 0.0001; FTI: 399.0 ± 262.5 vs. 293.9 ± 193.4 gs, P < 0.0001; FTI/wall thickness: 155.5 ± 106.1 vs. 115.7 ± 85.5 gs, P < 0.0001). GA was associated with lower AF recurrence rate in patients with paroxysmal AF but not with persistent AF. Compared with CS, GA improves CF parameters, FTI and FTI/wall thickness, and reduced gap formation after ipsilateral PVI.


title: Diagnostic Performance of Chest X-Ray for COVID-19 Pneumonia During the SARS-CoV-2 Pandemic in Lombardy, Italy.

text: Chest x-ray (CXR) can play a role in diagnosing patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but only few small-scale studies are available. We assessed the diagnostic performance of CXR in consecutive patients presenting at the emergency room at the Policlinico San Donato, Milan, Italy from February 24 to April 8, 2020 for suspected SARS-CoV-2 infection. The results of CXR were classified as positive or negative according to the original prospective radiologic reports. To overcome the limitations of reverse transcriptase-polymerase chain reaction (RT-PCR) swab, especially oscillating sensitivity, we added the information obtained from phone calls to discharged patients with negative initial RT-PCR. Thus, we included 535 patients with concomitant CXR and RT-PCR on admission (aged 65±17 y; 340 males, 195 females), resulting in 408 RT-PCR positive and 127 negative patients at the composite reference standard. Original CXR reports showed an 89.0% sensitivity (95% confidence intervals [CI], 85.5%-91.8%), 60.6% specificity (95% CI, 51.6%-69.2%), 87.9% positive predictive value (95% CI, 84.4%-90.9%), and 63.1% negative predictive value (95% CI, 53.9%-71.7%). The adoption of CXR alongside RT-PCR to triage patients with suspected SARS-CoV-2 infection could foster a safe and efficient workflow, counteracting possible false negative RT-PCR results.


title: Can Composite Nutritional Supplement Based on the Current Guidelines Prevent Vitamin and Mineral Deficiency After Weight Loss Surgery?

text: BACKGROUND Nutritional deficiencies occur after weight loss surgery. Despite knowledge of nutritional risk, there is little uniformity of postoperative vitamin and mineral supplementation. The objective of this study was to evaluate a composite supplement based on the clinical practice guidelines proposed in 2008 regarding vitamin and mineral supplementation after Roux-en-Y gastric bypass. The composite included iron (Fe) and calcium as well. METHODS A retrospective chart review of 309 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) was evaluated for the development of deficiencies in iron and vitamins A, B1, B12, and D. Patients were instructed to take a custom vitamin and mineral supplement that was based on society-approved guidelines. The clinical practice guidelines were modified to include 1600 international units (IU) of vitamin D3 instead of the recommended 800 IU. RESULTS The compliant patients' deficiency rates were significantly lower than those of the noncompliant patients for iron (p = 0.001), vitamin A (p = 0.01), vitamin B12 (p ≈ 0.02), and vitamin D (p < 0.0001). Women's menstrual status did not significantly influence the development of iron deficiency. CONCLUSIONS Use of a composite based on guidelines proposed by the AACE, TOS, and the ASMBS appears to be effective for preventing iron and vitamins A, B1, B12, and D deficiencies in the LRYGB patients during the first postoperative year. Separation of calcium and Fe does not need to be mandatory. Even with simplification, compliance is far from universal.


title: Radiofrequency ablation of T1 lung carcinoma: comparison of outcomes for first primary, metachronous, and synchronous lung tumors.

text: PURPOSE To report and compare outcomes after radiofrequency ablation for treatment-naïve first primary, metachronous, and synchronous T1 lung tumors. MATERIALS AND METHODS This institutional review board-approved retrospective study reviewed 29 patients (12 men and 17 women; median age, 73 y; age range, 55-86 y) with treatment-naïve T1 lung tumors treated with radiofrequency ablation. Tumors in the 29 patients included 21 T1a and 8 T1b first primary (n = 11), metachronous (n = 14), or synchronous (n = 4) tumors (adenocarcinoma, n = 25; squamous cell carcinoma, n = 3; unspecified, n = 1). Median tumor diameter was 14 mm (range, 10-26 mm). Surveillance computed tomography or positron emission tomography-computed tomography was performed over a median period of 28 months (range, 12-83 mo). Technical success and effectiveness rates and overall and progression-free 1-year, 3-year, and 5-year survivals were calculated according to stage, first primary, metachronous, and synchronous tumor status. RESULTS Technical success and effectiveness was 97%. Local control occurred in 17 of 21 T1a tumors (81%) and 5 of 8 T1b tumors (62.5%). The local progression rate of first primary tumors (5 of 11; 45%) was higher than that of metachronous (2 of 14; 14%; P = .07) and synchronous (0 of 4; P = .01) tumors. Estimated 1-year, 3-year, and 5-year local tumor progression-free survival was 79%, 75%, and 75%. Estimated 1-year, 3-year, and 5-year overall survival was 100%, 60%, and 14%. Survival outcomes were similar for patients with first primary, metachronous, or synchronous tumors. CONCLUSIONS Radiofrequency ablation results in good local control and progression-free survival in patients with treatment-naïve T1 lung tumors, including patients with metachronous and synchronous tumors.


title: Aligning the many definitions of treatment resistance in anxiety disorders: A systematic review.

text: Anxiety Disorders often show a chronic course, even when treated with one of the various effective treatments available. Lack of treatment effect could be due to Treatment Resistance (TR). Consensus on a definition for TR Anxiety Disorders (TR-AD) is highly needed as currently many different operationalizations are in use. Therefore, generalizability in current TR-AD research is suboptimal, hampering improvement of clinical care. The objective of this review is to evaluate the currently used definitions of TR-AD by performing a systematic review of available literature. Out of a total of n = 13 042, 62 studies that operationalized TR-AD were included. The current review confirms a lack of consensus on TR-AD criteria. In 62.9% of the definitions, TR was deemed present after the first treatment failure. Most studies (93.0%) required pharmacological treatment failures, whereas few (29.0%) required psychological treatment failures. However, criteria for what constitutes "treatment failure" were not provided in the majority of studies (58.1%). Definitions for minimal treatment duration ranged from at least 4 weeks to at least 6 months. Almost half of the TR-AD definitions (46.8%) required elevated anxiety severity levels in TR-AD. After synthesis of the results, the consensus definition considers TR-AD present after both at least one first-line pharmacological and one psychological treatment failure, provided for an adequate duration (at least 8 weeks) with anxiety severity remaining above a specified threshold. This definition could contribute to improving course prediction and identifying more targeted treatment options for the highly burdened subgroup of TR-AD patients.


title: Electrolyte and plasma changes after ingestion of pickle juice, water, and a common carbohydrate-electrolyte solution.

text: CONTEXT Health care professionals advocate that athletes who are susceptible to exercise-associated muscle cramps (EAMCs) should moderately increase their fluid and electrolyte intake by drinking sport drinks. Some clinicians have also claimed drinking small volumes of pickle juice effectively relieves acute EAMCs, often alleviating them within 35 seconds. Others fear ingesting pickle juice will enhance dehydration-induced hypertonicity, thereby prolonging dehydration. OBJECTIVE To determine if ingesting small quantities of pickle juice, a carbohydrate-electrolyte (CHO-e) drink, or water increases plasma electrolytes or other selected plasma variables. DESIGN Crossover study. SETTING Exercise physiology laboratory. PATIENTS OR OTHER PARTICIPANTS Nine euhydrated, healthy men (age = 25 +/- 2 years, height = 179.4 +/- 7.2 cm, mass = 86.3 +/- 15.9 kg) completed the study. INTERVENTION(S) Resting blood samples were collected preingestion (-0.5 minutes); immediately postingestion (0 minutes); and at 1, 5, 10, 15, 20, 25, 30, 45, and 60 minutes postingestion of 1 mL/kg body mass of pickle juice, CHO-e drink, or tap water. MAIN OUTCOME MEASURE(S) Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma potassium concentration, plasma osmolality, and changes in plasma volume were analyzed. Urine specific gravity, osmolality, and volume were also measured to characterize hydration status. RESULTS Mean fluid intake was 86.3 +/- 16.7 mL. Plasma sodium concentration, plasma magnesium concentration, plasma calcium concentration, plasma osmolality, and plasma volume did not change during the 60 minutes after ingestion of each fluid (P >or= .05). Water ingestion slightly decreased plasma potassium concentration at 60 minutes (0.21 +/- 0.14 mg/dL [0.21 +/- 0.14 mmol/L]; P <or= .05). CONCLUSIONS At these volumes, ingestion of pickle juice and CHO-e drink did not cause substantial changes in plasma electrolyte concentrations, plasma osmolality, or plasma volume in rested, euhydrated men. Concern that ingesting these volumes of pickle juice might exacerbate an athlete's risk of dehydration-induced hypertonicity may be unwarranted. If EAMCs are caused by large electrolyte loss due to sweating, these volumes of pickle juice or CHO-e drink are unlikely to restore any deficit incurred by exercise.


title: Robotic Pyeloplasty in Children: A "Barbed" Shortcut.

text: INTRODUCTION Dismembered pyeloplasty remains the gold standard for the treatment of pelviureteric junction obstruction (PUJO). Robotic approach to this procedure has proven its efficacy and is gaining popularity. The introduction of barbed sutures such as "V-Loc™" (Covidien) has provided an addition to the sutures available for pyeloplasty. This work provides our experience with the V-Loc suture for closure of pelvis in children for robotic pyeloplasty (RP). MATERIALS AND METHODS A review of 10 pediatric RP (da Vinci Robotic System) during which the V-Loc suture was used was performed. Comparison was made with 15 cases in which 5-0 Vicryl® suture was used as an alternative. Overall median age was 4 (range 9 months to 16 years), M:F = 14:9. All had confirmed PUJO on renal ultrasound and mercaptoacetyltriglycine (mertiatide) (MAG-3). RP was done in the standard Anderson-Hynes manner with the placement of a multilength JJ ureteral stent intraoperatively. Patients had removal of the JJ stent 6 weeks postoperatively followed by renal ultrasound 3-4 months later. RESULTS Twenty-five RPs have been performed between May 2013 and November 2015, of which 10 have had closure of the pelvis performed using the V-Loc suture and 15 with Vicryl. One patient (6.67%) in the Vicryl group underwent redo-pyeloplasty secondary to a stent-related complication. The entire V-Loc group made an eventful initial recovery; however, four (40%) developed worsening hydronephrosis and drainage on ultrasound and MAG-3 after stent removal, despite remaining completely asymptomatic. These four required either restenting and observation (n = 1) or redo-pyeloplasty (n = 3). Histology demonstrated a "plaque-like" inflammatory reaction at the pelvic suture line. CONCLUSION Closure of the pelvis using V-Loc suture material during RP can lead to a significant hydronephrosis requiring further procedures, including redo-pyeloplasty. These children can be asymptomatic and so extra vigilance on postoperative follow-up is essential.


title: Coronavirus infection in a litter of pups.

text: Summary An outbreak of a coronavirus infection in a litter of 10-week-old poodle pups from a commercial kennel is described. Coronavirus-like particles were demonstrated by electron microscopy in the intestinal contents and in the colonic mucosa. Treponemas and campylobacters were excreted in great numbers in the faeces. The gastrointestinal disturbances were complicated by hepatic and renal degeneration and severe bronchopneumonia.


title: Human Pegivirus in Patients with Encephalitis of Unclear Etiology, Poland.

text: Human pegivirus (HPgV), previously called hepatitis G virus or GB virus C, is a lymphotropic virus with undefined pathology. Because many viruses from the family Flaviviridae, to which HPgV belongs, are neurotropic, we studied whether HPgV could infect the central nervous system. We tested serum and cerebrospinal fluid samples from 96 patients with a diagnosis of encephalitis for a variety of pathogens by molecular methods and serology; we also tested for autoantibodies against neuronal antigens. We found HPgV in serum and cerebrospinal fluid from 3 patients who had encephalitis of unclear origin; that is, all the markers that had been tested were negative. Single-strand confirmation polymorphism and next-generation sequencing analysis revealed differences between the serum and cerebrospinal fluid-derived viral sequences, which is compatible with the presence of a separate HPgV compartment in the central nervous system. It is unclear whether HPgV was directly responsible for encephalitis in these patients.


docid: imodkvdm

title: Benefits of a straight laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis: a retrospective case-matched study.

text: PURPOSES The aim of this study was to evaluate the benefit of straight laparoscopic restorative proctocolectomy (sLRP) with ileal pouch anal anastomosis for ulcerative colitis (UC). METHODS Twenty patients underwent sLRP or open restorative proctocolectomy. The 2 groups were retrospectively well matched with respect to sex, body mass index, and American Society of Anesthesiologists' score. RESULTS The median operative time was longer in the sLRP group (P=0.0003). The median operative blood loss was significantly less in the sLRP group (P=0.0054). The median analgesic drug usage during the first 7 days after surgery was lower in the sLRP group (P=0.038). There were no differences in morbidity rates and long-term functional outcome measures between the groups. CONCLUSIONS An sLRP for UC has the advantage over an open restorative proctocolectomy of better short-term outcomes, and both groups have similar long-term outcomes. This procedure is acceptable for minimally invasive surgery in patients with UC.


Surgical Smoke in the Era of the COVID-19 Pandemic: Is It Time to Reconsider Policies on Smoke Evacuation?


title: Lung ultrasound for the identification of COVID-19 pneumonia.

text: The SARS-CoV-2 infection has as a clinical manifestation the disease known as COVID-19. Although knowledge of the nature of the disease is dynamic, with dozens of scientific articles being published every day about new features of COVID-19, the typical presentation is that of interstitial pneumonia. Despite the large amount of information that has been developed in recent weeks, it has been estimated that this disease can have up to 72% underdiagnosis, which requires clinical tools that are simple, easily accessible, and increase the detection of cases in a feasible way and that yield information with prognostic value. Given this need, some proposals have emerged to be able to diagnose, monitor and respond to the treatment of patients with COVID-19, such as pulmonary ultrasound (USP). It is worth mentioning that the USP has proven to be an efficient and easily reproducible technique for diagnosing heart failure and pleuro-pulmonary pathologies, especially in critically ill patients. Evidence of the usefulness of USP in COVID-19 is still scarce, although preliminary, it seems to be a sensitive technique whose findings have a high gold standard. In this brief review we will emphasize its technical aspects, the advantages and disadvantages, and finally a proposal for the approach in this type of patient.


title: Non-metallic implant for patellar fracture fixation: A systematic review.

text: INTRODUCTION Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants. METHODS A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria. RESULTS A total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal. CONCLUSION There is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation.


title: Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis.

text: Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.


WHO to probe claims that Dutch scientists restricted access to novel coronavirus.


title: Psychological status of postpartum women under the COVID-19 pandemic in Japan.

text: Under the COVID-19 (Coronavirus Disease 2019) pandemic, limitations are known to cause some psychosocial problems. We compared the results of mental screening of the postpartum women conducted during the COVID-19 epidemic with those at the same period last year. Based on the results, the worse mother-infant bonding was suspected at 1 month after birth under the COVID-19 pandemic.


title: Inhibition of endoplasmic reticulum-resident glucosidases impairs severe acute respiratory syndrome coronavirus and human coronavirus NL63 spike protein-mediated entry by altering the glycan processing of angiotensin I-converting enzyme 2.

text: Endoplasmic reticulum (ER)-resident glucosidases I and II sequentially trim the three terminal glucose moieties on the N-linked glycans attached to nascent glycoproteins. These reactions are the first steps of N-linked glycan processing and are essential for proper folding and function of many glycoproteins. Because most of the viral envelope glycoproteins contain N-linked glycans, inhibition of ER glucosidases with derivatives of 1-deoxynojirimycin, i.e., iminosugars, efficiently disrupts the morphogenesis of a broad spectrum of enveloped viruses. However, like viral envelope proteins, the cellular receptors of many viruses are also glycoproteins. It is therefore possible that inhibition of ER glucosidases not only compromises virion production but also disrupts expression and function of viral receptors and thus inhibits virus entry into host cells. Indeed, we demonstrate here that iminosugar treatment altered the N-linked glycan structure of angiotensin I-converting enzyme 2 (ACE2), which did not affect its expression on the cell surface or its binding of the severe acute respiratory syndrome coronavirus (SARS-CoV) spike glycoprotein. However, alteration of N-linked glycans of ACE2 impaired its ability to support the transduction of SARS-CoV and human coronavirus NL63 (HCoV-NL63) spike glycoprotein-pseudotyped lentiviral particles by disruption of the viral envelope protein-triggered membrane fusion. Hence, in addition to reducing the production of infectious virions, inhibition of ER glucosidases also impairs the entry of selected viruses via a post-receptor-binding mechanism.


title: Liver impairment in COVID-19 patients: a retrospective analysis of 115 cases from a single center in Wuhan city, China.

text: BACKGROUND The SARS-CoV-2 pandemic is an ongoing global health emergency. The aim of our study was to investigate the changes of liver function and its clinical significance in COVID-19 patients. METHOD This retrospective, single-center study was conducted on 115 confirmed cases of COVID-19 in Zhongnan hospital of Wuhan University from Jan 18 to Feb 22, 2020. Liver function and related indexes were analyzed to evaluate its relationship with disease progression in COVID-19 patients. RESULTS Part of the COVID-19 patients presented with varying degrees of abnormality in liver function indexes. However, the levels of ALT, AST, TBIL, GGT and LDH in COVID-19 patients were not significantly different in compared with hospitalized community-acquired pneumonia patients, and the levels of albumin is even significantly higher. Levels of ALT, AST, TBIL, LDH and INR showed statistically significant elevation in severe COVID-19 cases compared with that in mild cases. However, the clinical significance of the elevation is unremarkable. Majority of severe COVID-19 patients showed significantly decreasing in albumin level and continuously decreasing in the progress of illness. Most of the liver function indexes in COVID-19 patients were correlated with CRP and NLR, the markers of inflammation. Logistic regression analysis further identified NLR as the independent risk factor for severe COVID-19, as well as age. CONCLUSIONS Although abnormalities of liver function indexes are common in COVID-19 patients, the impairment of liver function is not a prominent feature of COVID-19, and also may not have serious clinical consequences.


title: Transseptal ascending aortic access facilitates transcatheter embolization of proximal type I endoleak associated with bird-beak configuration of an endograft in the proximal aortic arch.

text: PURPOSE To report the initial use of antegrade transseptal ascending aortic access to perform transcatheter embolization of a proximal type I endoleak associated with bird-beak configuration of an endograft in the proximal aortic arch. CASE REPORT A 61-year-old man underwent endovascular repair of a large, symptomatic aortic arch aneurysm located distal to the left common carotid artery using a fenestrated endograft. Completion angiography showed bird-beak configuration of the proximal endograft and a large type Ia endoleak. In a separate procedure, the endoleak was embolized with cyanoacrylate glue via an antegrade ascending aortic access obtained through a transseptal sheath stabilized by an indwelling arteriovenous wire loop. This approach provided straight-line access into the endoleak with requisite catheter support, and complete thrombosis of the aneurysm sac was achieved. The patient's symptoms abated, and at 1-year follow-up, there was no endoleak, and the aneurysm sac had shrunken markedly. CONCLUSION Antegrade transseptal ascending aortic access facilitates transcatheter embolization of type Ia endoleak in the proximal aortic arch.


title: The effect of the Covid-19 Pandemic on pediatric urology.

text: Medical and surgical priorities have changed dramatically at the time of this pandemic. Scientific societies around the World have provided rapid guidance, underpinned by the best knowledge available, on the adaptation of their guidelines recommendations to the current situation. There are very limited scientific evidence especially in our subspecialty of pediatric urology. We carry out a review of the little scientific evidence based mainly on the few publications available to date and on the recommendations of the main scientific societies regarding which patients should undergo surgery, when surgery should be performed and how patient visits should be organize.


title: Review of Mental Health Response to COVID-19, China.

text: Public mental health response to coronavirus disease is essential. After reviewing systemic and local efforts in China, we found efficient coordination and human resources. We recommend better symptom assessment, monitoring of organizations, and basic needs protection. This recommendation can inform how other countries can overcome mental health challenges during this pandemic.


title: Physico-chemical and Biological Evaluation of Flavonols: Fisetin, Quercetin and Kaempferol Alone and Incorporated in beta Cyclodextrins.

text: BACKGROUND Fisetin,quercetin and kaempferol are among the important representatives of flavonols, biological active phytocomounds, with low water solubility. OBJECTIVE To evaluate the antimicrobial effect, respectively the antiproliferative and pro apoptotic activity on the B164A5 murine melanoma cell line of pure flavonols and their beta cyclodextrins complexes. METHOD Incorporation of fisetin, quercetin and kaempferol in beta cyclodextrins was proved by scanning electron microscopy (SEM), differencial scanning calorimetry (DSC) and X-ray powder diffraction (XRPD). Pure compounds and their complexes were tested for antiproliferative (MTT) and pro-apoptotic activity (Annexin V-PI) on the B164A5 murine melanoma cell line and for the antimicrobial properties (Disk Diffusion Method) on the selected strains. RESULTS The phytocompounds presented in a different manner in vitro chemopreventive activity against B164A5 murine melanoma cell line and weak antimicrobial effect. CONCLUSION The three flavonols: fisetin, quercetin and kaempferol were successfully incorporated in beta-cyclodextrin (BCD) and hydroxylpropyl-beta-cyclodextrin (HPBCD). Incorporation in beta cyclodextrins had a mix effect on the biological activity conducing to decrease, increase or consistent effect compared to pure phytocompound, depending on the screened process and on the chosen combination.


docid: pdkikcou

title: Risk and protective factors of dementia among adults with post-traumatic stress disorder: a systematic review protocol.

text: INTRODUCTION Post-traumatic stress disorder (PTSD) is associated with an increased risk of dementia. Individual epidemiological studies have controlled for several confounders of the relationship between PTSD and increased dementia risk, yet particular risk factors underlying this relationship have not been determined. This systematic review protocol aims to identify risk and protective factors of dementia among adults with PTSD. METHODS AND ANALYSIS We will conduct an electronic search of the databases: PubMed, CINAHL, PsychINFO, The Cochrane Library, Scopus and ProQuest Dissertation and Theses Global. After screening the studies, quantitative synthesis will be performed, if possible. Otherwise, a narrative synthesis will be performed. We will include randomised controlled trials and other types of research evidence including longitudinal cohort studies. Strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations method. Examples of variables that will be extracted are: year of PTSD diagnosis, comorbid conditions, health behaviours, pharmacological treatments and year of mild cognitive impairment or dementia diagnosis. We developed this systematic review protocol according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement. ETHICS AND DISSEMINATION The proposed study will not collect individual-level data and, therefore, does not require ethical approval. Results of this study will provide current evidence on risk and protective factors of dementia in adults with PTSD. Findings will be disseminated in peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42019128553.


title: Hang Height of Enteral Nutrition Influences the Delivery of Enteral Nutrition.

text: PURPOSE Adequate enteral nutrition (EN) delivery to critically ill patients is difficult to achieve. Given the large number of unpreventable influences affecting adequate caloric intake, further research on preventable influences of adequate EN administration is warranted. The purpose of this study was to evaluate whether hang height of EN formula, formula viscosity, or flow rate influences pump accuracy and formula delivery. METHODS Formulas of varying viscosities (1.0, 1.5, and 2.0 kcal/mL) were infused at different hang heights (0, 6, 12, and 18 inches) and rates (20, 40, and 80 mL/h). The mean percent difference and the bias between the programmed volume, volume reported, and volume delivered were calculated for the different hang heights, formula compositions, and infusion rates studied. RESULTS For all prespecified hang heights and infusion rates, the volume delivered was less than the programmed volume and volume reported; the mean percent difference increased as the hang height decreased. The volume was overestimated for both the programmed volume (14.4% ± 5.5%) and volume reported (12.9% ± 6.7%) compared with volume delivered. The overestimation bias was significantly influenced by differences in hang height as well as type of formula (P < .0001, each) but not by rate of delivery (P = .4633 for programmed volume and .8411 for volume reported). CONCLUSIONS Measures should be taken in clinical practice to ensure adequate hang height of EN. Appropriate hang height of EN may result in more accurate delivery of nutrition provisions to the critically ill patient and subsequently reduce complications related to underfeeding.


title: Assessment of the Health Status of the Oldest Olds Living on the Greek Island of Ikaria: A Population Based-Study in a Blue Zone.

text: Objective To describe the demographic characteristics, socio-economic status, functional status (autonomy, strength), and health status (cognitive and thymic functions, cardiovascular risk factors, and nutritional status) of the oldest olds living on the Greek island of Ikaria. We also try to explain the longevity observed in this population. Methods A cross-sectional observational study of people aged 90 and over living in both municipalities of north-western Ikaria (Evdilos and Raches) was conducted over one year, from October 21, 2012 to October 21, 2013. The participants were interviewed (medical history), had a brief clinical examination, and underwent standardized geriatric assessments including the Geriatric Depression Scale (GDS-15), the Mini-Mental-State Examination (MMSE), the Activities of Daily Living (ADL), the Instrumental ADL (IADL), and an assessment of grip strength. Results Seventy-one persons (37 females, 34 males), aged 94.1 years on average, were interviewed at their homes. Seven percent were current smokers (females 5.4%, males 8.8%). Hypertension was diagnosed in 70.4% of participants, diabetes in 19.7%, hypercholesterolemia in 12.7%, and obesity in 17.2%; 66.0% of the population had one chronic disease or more. The mean score for the GDS-15 scale was 3.7/15.0, 23.7/30.0 for the MMSE, 4.0/6.0 for the ADL, and 4.2/8.0 in females and 3.6/5.0 in males for the IADL. Grip strength was 17.0 kg in females and 26.5 kg in males. Conclusions This study provides an overview of the socio-demographic and medical characteristics of the oldest olds living in a longevity Blue Zone.


title: Facile labelling of an anti-epidermal growth factor receptor Nanobody with 68Ga via a novel bifunctional desferal chelate for immuno-PET.

text: PURPOSE The ∼15 kDa variable domains of camelid heavy-chain-only antibodies (called Nanobodies®) have the flexibility to be formatted as monovalent, monospecific, multivalent or multispecific single chain proteins with either fast or slow pharmacokinetics. We report the evaluation of the fast kinetic anti-epidermal growth factor receptor (EGFR) Nanobody 7D12, labelled with (68)Ga via the novel bifunctional chelate (BFC) p-isothiocyanatobenzyl-desferrioxamine (Df-Bz-NCS). Df-Bz-NCS has recently been introduced as the chelate of choice for (89)Zr immuno-positron emission tomography (PET). METHODS Nanobody 7D12 was premodified with Df-Bz-NCS at pH 9. Radiolabelling with purified (68)Ga was performed at pH 5.0-6.5 for 5 min at room temperature. For in vitro stability measurements in storage buffer (0.25 M NaOAc with 5 mg ml(-1) gentisic acid, pH 5.5) at 4°C or in human serum at 37°C, a mixture of (67)Ga and (68)Ga was used. Biodistribution and immuno-PET studies of (68)Ga-Df-Bz-NCS-7D12 were performed in nude mice bearing A431 xenografts using (89)Zr-Df-Bz-NCS-7D12 as the reference conjugate. RESULTS The Df-Bz-NCS chelate was conjugated to Nanobody 7D12 with a chelate to Nanobody molar substitution ratio of 0.2:1. The overall (68)Ga radiochemical yield was 55-70% (not corrected for decay); specific activity was 100-500 MBq/mg. Radiochemical purity of the conjugate was >96%, while the integrity and immunoreactivity were preserved. (68/67)Ga-Df-Bz-NCS-7D12 was stable in storage buffer as well as in human serum during a 5-h incubation period (<2% radioactivity loss). In biodistribution studies the (68)Ga-labelled Nanobody 7D12 showed high uptake in A431 tumours (ranging from 6.1 ± 1.3 to 7.2 ± 1.5%ID/g at 1-3 h after injection) and high tumour to blood ratios, which increased from 8.2 to 14.4 and 25.7 at 1, 2 and 3 h after injection, respectively. High uptake was also observed in the kidneys. Biodistribution was similar to that of the reference conjugate (89)Zr-Df-Bz-NCS-7D12. Tumours were clearly visualized in a PET imaging study. CONCLUSION Via a rapid procedure under mild conditions a (68)Ga-Nanobody was obtained that exhibited high tumour uptake and tumour to normal tissue ratios in nude mice bearing A431 xenografts. Fast kinetic (68)Ga-Nanobody conjugates can be promising tools for tumour detection and imaging of target expression.


title: Genomic Analysis of the Emergence, Evolution, and Spread of Human Respiratory RNA Viruses.

text: The emergence and reemergence of rapidly evolving RNA viruses-particularly those responsible for respiratory diseases, such as influenza viruses and coronaviruses-pose a significant threat to global health, including the potential of major pandemics. Importantly, recent advances in high-throughput genome sequencing enable researchers to reveal the genomic diversity of these viral pathogens at much lower cost and with much greater precision than they could before. In particular, the genome sequence data generated allow inferences to be made on the molecular basis of viral emergence, evolution, and spread in human populations in real time. In this review, we introduce recent computational methods that analyze viral genomic data, particularly in combination with metadata such as sampling time, geographic location, and virulence. We then outline the insights these analyses have provided into the fundamental patterns and processes of evolution and emergence in human respiratory RNA viruses, as well as the major challenges in such genomic analyses.


title: Immune monitoring of a child with autoimmune hepatitis and type 1 diabetes during COVID-19 infection.

text: Immunocompromised patients may be at increased risk to develop COVID-19 during the 2019 β-coronavirus infection. We present the unique opportunity we had to monitor the liver, IL-6 and immune cell course before, during and after COVID-19 in a boy with autoimmune hepatitis (AIH) and type 1 diabetes (T1D). CD4 and CD8 T cells frequencies decreased because of prednisolone, followed by a plateauing increase whereas CD19CD20 B cell increased strongly and was unaffected by COVID-19 infection. Moreover, the percentage of activated CD8 T cells expressing HLA-DR (CD8HLA-DR) increased during COVID-19 and subsided after its clearance. Total regulatory T cells (Tregs: CD4CD25CD127FOXP3) remained stable. Although activated Tregs (CD4CD45RAFOXP3) strongly increased upon prednisolone, it decreased afterwards. Furthermore, regulatory B cells (Bregs: CD19CD20CD24CD38) declined sharply owing to prednisolone. Serum IL-6 remained undetectable at all times. We demonstrated for the first time immune monitoring in a child with AIH and T1D before, during and after COVID-19. We hypothesize that continuing with low level of prednisolone without azathioprine may have abrogated activated Tregs, Bregs and IL-6 production and therefore permitting the activation of CD8 T cells, clearing the virus.


Oscillatory Turbulent Flow in Chronic Venous Disease Induces Pro-inflammatory and Reparative Biological Signaling.


title: "Quantifying the precision of ecological risk: Misunderstandings and errors in the methods for assessment factors versus species sensitivity distributions".

text: The science of species sensitivity distributions (SSDs) is a blend of statistical theory, ecotoxicological testing, study reliability, and biodiversity. The utility of SSDs has been well reviewed and they are viewed as a high tier assessment tool in environmental risk assessment and other disciplines. SSDs seek to improve upon probabilistic extrapolation of laboratory (and sometimes field) collected ecotoxicity data for environmental protection by modeling the diversity of multiple experimental results in the form of a single statistical distribution which reduces or eliminates the need for extrapolation with deterministic assessment factors. SSDs thus depend heavily on both statistical and biological knowledge. In this commentary we review recently published literature identifying areas of improvement based on fundamental statistical theory or application in environmental assessment contexts. We reveal that sound application of SSDs relies heavily upon a grasp of probability distributions, how asymmetric confidence intervals are derived for distributions common to SSDs, the influence of sample size on parameter estimation, and how these are collectively applied across the myriad of regulatory systems globally. Statisticians and ecotoxicologists are inextricably bound together in the goal of actually improving hazard assessment using both probabilistic and deterministic methodologies.


title: [Management strategies for patients with gynecological malignancies during the outbreak of COVID19].

text: Objective: To explore the management strategies for patients with gynecological malignant tumors during the outbreak and transmission of COVID19. Methods: We retrospectively analyzed the clinical characteristics, treatment, and disease outcomes of three patients with gynecological malignancies associated with COVID19 in Renmin Hospital of Wuhan University in January 2020, and proposed management strategies for patients with gynecological tumors under risk of COVID19. Results: Three patients were treated COVID19 based on the national diagnosis and treatment protocol as well as research progress. Meanwhile, these patients were appropriately adjusted the treatment plan in accordance with the clinical guidelines for gynecological tumors. Pneumonia was cured in 2 patients, and one patient died of COVID-19. Conclusions: Patients with gynecological malignant tumors are high-risk groups prone to COVID-19 infection, and gynecological oncologists need to carry out education, prevention, control and treatment according to specific conditions. While actively preventing and controlling COVID-19, the diagnosis and treatment of gynecological malignant tumors should be carried out in an orderly and safe manner.


title: Endotracheal tubes: old and new.

text: The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.