title: Accounting for aetiology: can regional surveillance data alongside host biomarker-guided antibiotic therapy improve treatment of febrile illness in remote settings?

text: Background: Across Southeast Asia, declining malaria incidence poses a challenge for healthcare providers, in how best to manage the vast majority of patients with febrile illnesses who have a negative malaria test. In rural regions, where the majority of the population reside, empirical treatment guidelines derived from central urban hospitals are often of limited relevance. In these settings, relatively untrained health workers deliver care, often without any laboratory diagnostic support. In this paper, our aim was to model the impact on mortality from febrile illness of using point-of-care C-reactive protein testing to inform the decision to prescribe antibiotics and regional surveillance data to inform antibiotic selection, rooted in the real-world context of rural Savannakhet province, southern Laos. Methods: Our model simulates 100 scenarios with varying quarterly incidence of six key pathogens known to be prevalent in rural Laos. In the simulations, community health workers either prescribe antibiotics in-line with current practice as documented in health facilities in rural Laos, or with the aid of the two interventions. We provide cost-effectiveness estimates for each strategy alone and then for an integrated approach using both interventions. Results: We find that each strategy alone is predicted to be highly cost-effective, and that the combined approach is predicted to result in the biggest reduction in mortality (averting a predicted 510 deaths per year in rural Savannakhet, a 28% reduction compared to standard practice) and is highly cost-effective, with an incremental cost-effectiveness ratio of just $66 per disability-adjusted life year averted. Conclusions: Substantial seasonal variation in the predicted optimal empirical antibiotic treatment for febrile illness highlights the benefits of up-to-date information on regional causes of fever. In this modelling analysis, an integrated system incorporating point-of-care host biomarker testing and regional surveillance data appears highly cost-effective, and may warrant piloting in a real-life setting.


title: Complications of mechanical thrombectomy for acute ischemic stroke-a retrospective single-center study of 176 consecutive cases.

text: INTRODUCTION There is only very limited data about complications in mechanical thrombectomy for acute ischemic stroke. The purpose of this study was to evaluate the frequency and the clinical relevance of procedure-related complications in mechanical thrombectomy. METHODS We conducted a retrospective analysis of 176 consecutive acute ischemic stroke cases that were treated with mechanical thrombectomy. Primary outcome measures included the following: symptomatic intracranial hemorrhage (sICH), vessel dissection, emboli to new vascular territories, vasospasm, and stent dislocation/occlusion whenever appropriate. Secondary outcome measures included mTICI score, time from symptom onset to revascularization, and time from groin puncture to revascularization as well as the early clinical outcome at discharge. RESULTS Complications occurred in 20/176 patients (11 %) comprising 23 adverse events at the following rates: sICH 8/176 (5 %), emboli to new vascular territories 4/176 (2 %); vessel dissection 3/176 (2 %); vasospasm of the access vessel 5/176 (3 %); stent dislocation in 1/42 (2 %); and stent occlusion in 2/42 (5 %). Two out of 20 (10 %) suffered from two or more procedure-related complications. There was a statistically significant correlation of complications with time from groin puncture to revascularization, unfavorable revascularization results, and unfavorable clinical outcome. CONCLUSION Overall, the frequency of procedure-related complications lies within acceptable limits for an emergency procedure. The endovascular treatment does not seem to add significantly to the stroke patients' risk of sICH but implies an innate risk of stroke in an initially uninvolved territory. Furthermore, a prolonged endovascular procedure beyond an hour is correlated with higher complication rates, which underlines the importance of a swift and complete revascularization.


Train and deploy a community level public health workforce to combat covid-19.


Chest CT and Coronavirus Disease (COVID-19): A More Complete Review.


title: Rapid learning curve for Solitaire FR stent retriever therapy: evidence from roll-in and randomised patients in the SWIFT trial.

text: BACKGROUND In light of recent positive trial data for endovascular therapy in acute ischemic stroke (AIS), stent retriever use by practitioners without prior experience with these devices may become more common. OBJECTIVE To assess the safety and efficacy of thrombectomy for AIS using Solitaire for patients treated in the roll-in period of the Solitaire With the Intention For Thrombectomy (SWIFT) trial, which represented the first clinical use of the device for these interventionalists. METHODS Prospectively collected demographic, clinical, and angiographic data on patients treated in the initial roll-in and subsequent randomized phases of the SWIFT study were collected and analyzed. Key statistical analyses were validated by an independent external statistician. RESULTS Patients in the roll-in period achieved equivalently high rates of reperfusion (55%) compared with those treated with the device in the randomized phase (61%). Rates of adverse events were comparable (13% vs. 9%). Rates of good neurological outcome were equivalent between the roll-in and randomized patients treated with Solitaire (63% vs. 58%). Including the roll-in patients strengthened the conclusions of the study, that reperfusion rates without symptomatic hemorrhage with Solitaire were greater than with Merci (59% vs. 24%, p<0.001). CONCLUSIONS Thrombectomy in AIS using the Solitaire stent retriever device can be performed safely and effectively when used by experienced neurointerventionalists without previous experience with the device. TRIAL REGISTRATION NUMBER The SWIFT study is registered with ClinicalTrials.gov, number NCT 01054560.


title: Factor analysis of the COVID-19 Perceived Risk Scale: A preliminary study.

text: This study adapted an 8-item COVID-19 Perceived Risk Scale (CPRS) to assess COVID-19 related personal risk. The sample comprised 3,109 Turkish adults (49.98% males; Meanage = 38.64 ± 10.40). Exploratory and confirmatory factor analyses confirmed a two-factor structure (cognitive and emotional dimensions), with satisfactory reliability. The subscales were correlated with severity and self-efficacy related to COVID-19 and mental health. Women reported higher levels of emotional risk, overall risk, and severity than men. Findings indicate that the CPRS is a psychometrically-sound scale for assessing COVID-19 related perceived risk. The scale can be used to assess people who are vulnerable to the risk of COVID-19.


docid: tyeptmzb

title: Psychotherapy in the Post-COVID-19 Era.

text: This column anticipates challenges likely to be faced by psychotherapists and their patients after the coronavirus disease 2019 (COVID-19) pandemic subsides. It looks beyond the current impact of loneliness, isolation, thwarted belongingness, and loss toward the longer term impact of moral injury and blocked opportunities for mourning.


docid: jhdamlmf

title: Intraoperative surgical margin re-resection for colorectal liver metastasis: is it worth the effort?

text: OBJECTIVE This study was conducted to evaluate recurrence and survival among patients who underwent intraoperative margin re-resection for colorectal cancer liver metastases (CRLM). BACKGROUND Among patients who receive intraoperative margin re-resection, the relation between final margin status, pattern of recurrence, and survival is largely unknown. METHODS Three hundred thirty-two patients who underwent hepatic resection for CRLM between 2000 and 2013 were identified. Demographics, operative data, pathologic margin status, site of recurrence, and long-term survival data were collected and analyzed. Patients were stratified in three groups based on their margin status: R0, R1, and R1 → R0. RESULTS R0 resections were achieved in 247 (74.4%) patients, 61 (18.4%) patients had an R1 resection, whereas 24 (7.2%) had an R1 → R0. Median survival for patients undergoing R0 resections was 50.2 (95% confidence interval (CI) 49.2-66.2) months versus 63.0 (95% CI 50.3-70.5) months for patients undergoing R1 resections versus 49.2 (95% CI 29.9-NA) months for patients undergoing intraoperative margin re-resection (P > 0.05). Differences in recurrence rate and pattern were not significant between the three groups (P > 0.05). CONCLUSION In the era of modern systemic chemotherapy, it seems that the impact of margin status on outcomes may be minimal compared to that of patient and tumor factors. In this scenario, margin re-resection to achieve R0 status does not improve long-term outcomes.


title: Antihelminth compound niclosamide downregulates Wnt signaling and elicits antitumor responses in tumors with activating APC mutations.

text: Wnt/β-catenin pathway activation caused by adenomatous polyposis coli (APC) mutations occurs in approximately 80% of sporadic colorectal cancers (CRC). The antihelminth compound niclosamide downregulates components of the Wnt pathway, specifically Dishevelled-2 (Dvl2) expression, resulting in diminished downstream β-catenin signaling. In this study, we determined whether niclosamide could inhibit the Wnt/β-catenin pathway in human CRCs and whether its inhibition might elicit antitumor effects in the presence of APC mutations. We found that niclosamide inhibited Wnt/β-catenin pathway activation, downregulated Dvl2, decreased downstream β-catenin signaling, and exerted antiproliferative effects in human colon cancer cell lines and CRC cells isolated by surgical resection of metastatic disease, regardless of mutations in APC. In contrast, inhibition of NF-κB or mTOR did not exert similar antiproliferative effects in these CRC model systems. In mice implanted with human CRC xenografts, orally administered niclosamide was well tolerated, achieved plasma and tumor levels associated with biologic activity, and led to tumor control. Our findings support clinical explorations to reposition niclosamide for the treatment of CRC.


title: Luciferase-tagged wild-type and tropism-deficient mouse cytomegaloviruses reveal early dynamics of host colonization following peripheral challenge.

text: Cytomegaloviruses (CMVs) establish persistent, systemic infections and cause disease by maternal-foetal transfer, suggesting that their dissemination is a key target for antiviral intervention. Late clinical presentation has meant that human CMV (HCMV) dissemination is not well understood. Murine CMV (MCMV) provides a tractable model. Whole mouse imaging of virus-expressed luciferase has proved a useful way to track systemic infections. MCMV, in which the abundant lytic gene M78 was luciferase-tagged via a self-cleaving peptide (M78-LUC), allowed serial, unbiased imaging of systemic and peripheral infection without significant virus attenuation. Ex vivo luciferase imaging showed greater sensitivity than plaque assay, and revealed both well-known infection sites (the lungs, lymph nodes, salivary glands, liver, spleen and pancreas) and less explored sites (the bone marrow and upper respiratory tract). We applied luciferase imaging to tracking MCMV lacking M33, a chemokine receptor conserved in HCMV and a proposed anti-viral drug target. M33-deficient M78-LUC colonized normally in peripheral sites and local draining lymph nodes but spread poorly to the salivary gland, suggesting a defect in vascular transport consistent with properties of a chemokine receptor.


title: Extracellular matrix collagen I promotes the tumor progression of residual hepatocellular carcinoma after heat treatment.

text: BACKGROUND Accelerated malignant behaviors induced by insufficient thermal ablation have been increasingly reported, however, the exact mechanisms are still unclear. Here, we investigated the importance of the extracellular matrix (ECM) in modulating the progression of residual hepatocellular carcinoma (HCC) after heat treatment. METHODS Heat-exposed residual HCC cells were cultured in different ECM gels. We used basement membrane gel (Matrigel) to simulate the normal microenvironment and collagen I to model the pathological stromal ECM. The alterations of morphology and parameters of proliferation, epithelial-mesenchymal transition (EMT) and stemness were analyzed in vitro and in vivo. RESULTS Increased collagen I deposition was observed at the periablational zone after incomplete RFA of HCC in a xenograft model. The markers of cell proliferation, EMT, motility and progenitor-like traits of heat-exposed residual HCC cells were significantly induced by collagen I as compared to Matrigel (p values all < 0.05). Importantly, collagen I induced the activation of ERK phosphorylation in heat-exposed residual HCC cells. ERK1/2 inhibitor reversed the collagen I-promoted ERK phosphorylation, cell proliferative, protrusive and spindle-like appearance of heat-treated residual HCC cells in vitro. Moreover, collagen I promoted the in vivo tumor progression of heat-exposed residual HCC cells, and sorafenib markedly reversed the collagen I-mediated protumor effects. CONCLUSIONS Our findings demonstrate that collagen I could enhance the aggressive progression of residual HCC cells after suboptimal heat treatment and sorafenib may be a treatment approach to thwart this process.


title: Amplitudes of SSEP and outcome in cardiac arrest survivors: A prospective cohort study.

text: OBJECTIVE To investigate the relationship between somatosensory evoked potential (SSEP) amplitudes and neurologic outcome after cardiac arrest. METHODS We prospectively studied SSEPs, recorded 24 hours to 4 days after cardiac arrest, in patients with targeted temperature management. SSEP amplitude was defined pragmatically as the highest short-latency amplitude of 4 cortical recordings (2 per side, CP3/CP4 vs Fz) at least 4.5 ms after the spinal SSEP. Cerebral performance category (CPC) was determined upon intensive care unit discharge. CPC 1-3 was defined as good, CPC 4-5 as poor outcome. RESULTS Of 318 patients, 25 had incomplete recordings, no reproducible spinal SSEP, or high noise level. Of the remaining 293 patients, 137 (47%) had poor and 156 (53%) good outcome. The lowest amplitude in a survivor with good outcome was 0.62 μV. All 78 patients with lower amplitudes had poor outcome. None of 27 patients with CPC 4 (unresponsive wakefulness) had amplitudes above 2.5 μV. In the majority of 24 patients who died despite amplitudes above 2.5 μV, clinical course and other prognostic parameters argued against severe hypoxic encephalopathy. CONCLUSIONS The prognostic value of SSEPs extends beyond an absent/present dichotomy. Absent and very low amplitude SSEPs appear to be highly predictive of poor outcome after cardiac arrest. Prospective external validation of the lower threshold found in our study is necessary. SSEP recordings should not be used for prognostication if noise could mask potentials with critically low amplitudes. High SSEP amplitudes argue against severe hypoxic encephalopathy.


title: Assessment of COVID-19 Knowledge Among University Students: Implications for Future Risk Communication Strategies.

text: The purpose of this study was to describe population knowledge and beliefs about COVID-19 and current social media coverage to address a gap in what is known about risk communication during health crises. A survey with 27 questions was developed. Twenty-three percent (N = 1,136) of respondents started the survey. Less than half of the students reported a high health literacy level (43%, n = 365/855). When asked where students have heard about COVID-19, the majority reported the Internet and social media. Students reported a basic level of COVID-19 knowledge, but few students (18%, n = 173/966) correctly identified all three signs and/or symptoms of COVID-19. Results highlight the need for an increased public health presence on social media and the urgent need to remain diligent in educating community members about COVID-19 myths.


title: Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020.

text: We analyzed transmission of coronavirus disease outside of the Daegu-Gyeongsangbuk provincial region in South Korea. We estimated that nonpharmaceutical measures reduced transmissibility by a maximum of 34% without resorting to a strict lockdown strategy. To optimize epidemic control, continuous efforts to monitor the transmissibility are needed.


title: Molecular Detection of Gamma Coronaviruses in Bird Parks of Iran.

text: Gamma Coronaviruses (GCoVs) are distributed worldwide, affecting a wide range of bird species, the beluga whale, and bottlenose dolphins. Because of the limited proofreading capability in the viral encoded polymerase, they emerge genetically diverse. There has been no molecular surveillance data to describe the epidemiology of GCOVs in avian species. The present study was conducted to detect GCOVs in Tehran birds’ parks, 2015. Cloacal swabs (267 samples) from eight different bird species ((Chickens (Gallus gallus), Pheasant (Phasianus colchicus), Turkey (Meleagris gallopavo), Partridge (Perdix perdix), Quail (Coturnix coturnix), Duck (Anas platyrhynchos), Goose (Anserini),and Guinea fowl (Numididae)) were collected, the viral RNA was extracted, the RT-PCR was performed using QIAGEN one step RT-PCR kit and the primers targeting “3'-UTR” and “Nucleocapsid” genes. The detection rate was approximately 8.99%. GCOVs were detected in the chicken, quail, pheasant, turkey, and the partridge with different prevalence rates. Phylogenetic tree based on partial nucleotide sequences of the N gene clustered the samples into two groups. It is the first report of GCOVs in non-commercial birds in Iran. According to our results, GCOVs are circulating in different avian species, and further studies are needed to isolate these viruses and evaluate their pathogenesis.


title: Sleep quality of mechanically ventilated patients sedated with dexmedetomidine.

text: PURPOSE Dexmedetomidine is thought to activate an endogenous pathway that naturally promotes non-rapid eye movement (NREM) sleep. Dexmedetomidine may induce restorative sleep, that is, NREM stage 3 and 4 (slow wave sleep; SWS) or sleep continuity in mechanically ventilated patients. Few data have been published, however, on the sleep characteristics of mechanically ventilated patients during dexmedetomidine infusion. METHODS We recorded polysomnography (PSG) for 24 h in mechanically ventilated patients sedated with dexmedetomidine. Dexmedetomidine (0.2-0.7 μg/kg/h) was administered intravenously to maintain the Richmond Agitation-Sedation Scale between -1 and -4 only during the nighttime (9:00 p.m. to 6:00 a.m.). During the daytime, we interrupted the sedatives and analgesics unless the patient complained of discomfort. When this occurred midazolam or opioids were administered intermittently. Sleep stages and the frequency of arousal/awakening during the nighttime were analyzed using Rechtschaffen and Kales criteria. RESULTS For the ten mechanically ventilated adult patients recruited into the study, the median total sleep time (TST) during the night was 4.7 h (IQR, 4.2-8.1 h), and 78 % of sleep occurred during the night (median 78 %, IQR: 69-88 %). Sleep architecture was exclusively NREM sleep stage 1 (median 28.9 % of TST) and stage 2 (median 71.2 % of TST). Neither SWS (median 0 % of TST) nor rapid eye movement (REM) sleep (median 0 % of TST) was observed. Median frequency of arousals/awakenings was 9.3/h (IQR, 3-19.5/h). CONCLUSIONS In mechanically ventilated patients, nighttime infusion of dexmedetomidine preserved the day-night cycle of sleep but induced severely disturbed sleep architecture without evidence of SWS or REM sleep.


title: Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery.

text: Background The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems. Methods We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest). Results A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a three-fold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failure-to-rescue, indicating differences between hospitals in the risk of death among patients after they develop complications. Conclusions Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.


title: Long-Term Survival after Radiofrequency Ablation of Lung Oligometastases from Five Types of Primary Lesions: A Retrospective Evaluation.

text: PURPOSE To conduct a retrospective evaluation of long-term survival after radiofrequency (RF) ablation for lung oligometastases from 5 types of primary lesions. MATERIALS AND METHODS The study population consisted of 123 patients with lung oligometastases from colorectal cancer (CRC), non-small-cell lung cancer, hepatocellular carcinoma, esophageal cancer, and renal-cell carcinoma treated with RF ablation. Lung oligometastases were defined as 1-5 metastases confined to the lung while the primary cancer and other metastases were eradicated. Overall survival (OS) and recurrence-free survival (RFS) were estimated for the overall study population and for patients with each type of primary lesion. The OS and RFS rates were compared with those of the patients with any of the other four primary lesion types. Finally, various variables were analyzed to determine what factors influenced OS and RFS. RESULTS The median follow-up was 45.7 months, and the 5-year OS and RFS rates for all 123 patients were 62% and 25%, respectively. The OS time for patients with metastases from CRC was significantly longer (P = .042); it was significantly shorter (P = .022) in patients with metastases from esophageal cancer. Longer disease-free interval was significantly (P = .015) associated with better OS. There was no variable significantly associated with OS and RFS on multivariate analyses. CONCLUSIONS Data from this single-center study appear promising in terms of long-term survival after RF ablation of lung oligometastases from 5 primary lesions.


title: The role of ethylene-vinyl alcohol copolymer in association with other embolic agents for the percutaneous and endovascular treatment of type Ia endoleak.

text: AIM To evaluate safety, technical and clinical success of embolization of type Ia endoleak (T1a EL) using ethylene-vinyl alcohol copolymer as embolic agent alone or in combination with other materials. MATERIALS AND METHODS Five patients presented T1a EL after endovascular repair of aortic aneurysms (EVAR) with radiological evidence of expanding sac size; in particular, three had contained rupture. In one patient, proximal cuff insertion was previously performed, in three patients proximal cuff was urgently inserted but T1a EL persisted; one patient, previously treated with Ovation Abdominal Stent Graft System, was directly proposed for endovascular treatment. In all cases, endovascular embolization was successfully performed and the transfemoral approach was always chosen; in one case it failed and translumbar approach by direct puncture of the sac was required. Used embolization agents were glue, ethylene-vinyl alcohol copolymer (Onyx) and coils in three cases, n-butyl cyanoacrylate and Onyx in one case, Onyx and coils in the last case. RESULTS Technical success rate was 100% as well as clinical success. No major or minor complication, including non-target embolization, was registered. Clinical success was 100% until today and the sac diameter remained stable in four patients and decreased in one. CONCLUSIONS Onyx may be considered a suitable embolic agent in the treatment of patients with type Ia endoleaks after EVAR, after failure of conventional treatments such as prolonged balloon inflation of the aortic neck or deployment of large bare stent.


title: Evaluation of putative anti-cryptosporidial drugs in an in vitro culture system.

text: Cryptosporidium species are major pathogens severely affecting the health of neonate animals, in particular calves, but also cause life-threatening infection of immunocompromised humans. Currently, only halofuginone is approved for prophylactic and metaphylactic treatment of calves but this drug suffers from its limited safety margins. For treatment of immunodeficient human patients, only nitazoxanide and paramomycin are used but data regarding their efficacy are controversial. Aim of the present study was to test a substituted benzimidazole (BAY-AF76184) and a heterocyclic substituted 1,2,4-triazin (BAY-AB24992), both drugs with known anti-protozoal activity, for their potential ability to interfere with Cryptosporidium parvum development in vitro. Development of C. parvum in HCT-8 cells treated with these compounds was compared to negative controls and parasites treated with paromomycin or halofuginone using real-time PCR targeting the 18S rDNAs of parasites and host cells as template. Potential cytotoxic and anti-proliferative effects of drugs were analysed using a lactate dehydrogenase and a WST-1 assay, respectively. BAY-AF76184 and paromomycin dose-dependently inhibited development of C. parvum with EC50 values of 2.37 μM and 69.5 μM, respectively. Although high concentrations of halofuginone and BAY-AB24992 also significantly inhibited parasite development, effects of lower concentrations were very heterogeneous preventing calculation of EC50 values. Halofuginone and BAY-AF76184 dose-dependently interfered with host cell proliferation (EC50 values of 0.35 μM and 9.07 μM, respectively) and the latter also had direct cytotoxic effects (EC50=48.78 μM). However, drug concentrations required for cytopathic were higher than those for effects against C. parvum. Therefore, both BAY-AB24992 and BAY-AF76184 should be considered for further evaluation, e.g. using in vivo models.


title: Prenatal screening diagnosis and management in the era of coronavirus: the Sardinian experience.

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was first identified in December 2019 in Wuhan, China and spread rapidly, affecting many other countries. The disease is now referred to as coronavirus disease 2019 (COVID-19).The Italian government declared a state of emergency on 31st January 2020 and on 11th March World Health Organization (WHO) officially declared the COVID-19 outbreak a global pandemic. Although the COVID-19 incidence remained considerably lower in Sardinia than in the North Italy regions, which were the most affected, the field of prenatal screening and diagnosis was modified because of the emerging pandemic. Data on COVID-19 during pregnancy are so far limited. Since the beginning of the emergency, our Ob/Gyn Department at Microcitemico Hospital, Cagliari offered to pregnant patients all procedures considered essential by the Italian Ministry of Health. To evaluate the influence of the COVID-19 pandemic on the activities of our center, we compared the number of procedures performed from 10th March to 18th May 2020 with those of 2019. Despite the continuous local birth rate decline, during the 10-week pandemic period, we registered a 20% increment of 1st trimester combined screening and a slight rise of the number of invasive prenatal procedures with a further increase in chorionic villi sampling compared to amniocentesis. Noninvasive prenatal testing remained unvariated. The request for multifetal pregnancy reduction as a part of the growing tendency of voluntary termination of pregnancy in Sardinia increased. The COVID-19 pandemic provides many scientific opportunities for clinical research and study of psychological and ethical issues in pregnant women.


title: EMA advice on renin-angiotensin system medicines during covid-19 pandemic.

text: Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.


Hopefulness of 'Hope'.


title: Felid herpesvirus 1 as a causative agent of severe nonsuppurative meningoencephalitis in a domestic cat.

text: Felid herpesvirus 1 is an important respiratory pathogen of domestic cats. This report presents the first case of severe nonsuppurative meningoencephalitis caused by this virus in a cat.


title: Bench evaluation of 7 home-care ventilators.

text: BACKGROUND Portable ventilators continue to decrease in size while increasing in performance. We bench-tested the triggering, battery duration, and tidal volume (V(T)) of 7 portable ventilators: LTV 1000, LTV 1200, Puritan Bennett 540, Trilogy, Vela, iVent 101, and HT50. METHODS We tested triggering with a modified dual-chamber test lung to simulate spontaneous breathing with weak, normal, and strong inspiratory effort. We measured battery duration by fully charging the battery and operating the ventilator with a V(T) of 500 mL, a respiratory rate of 20 breaths/min, and PEEP of 5 cm H(2)O until breath-delivery ceased. We tested V(T) accuracy with pediatric ventilation scenarios (V(T) 50 mL or 100 mL, respiratory rate 50 breaths/min, inspiratory time 0.3 s, and PEEP 5 cm H(2)O) and an adult ventilation scenario (V(T) 400 mL, respiratory rate 30 breaths/min, inspiratory time 0.5 s, and PEEP 5 cm H(2)O). We measured and analyzed airway pressure, volume, and flow signals. RESULTS At the adult settings the measured V(T) range was 362-426 mL. On the pediatric settings the measured V(T) range was 51-182 mL at the set V(T) of 50 mL, and 90-141 mL at the set V(T) of 100 mL. The V(T) delivered by the Vela at both the 50 mL and 100 mL, and by the HT50 at 100 mL, did not meet the American Society for Testing and Materials standard for V(T) accuracy. Triggering response and battery duration ranged widely among the tested ventilators. CONCLUSIONS There was wide variability in battery duration and triggering sensitivity. Five of the ventilators performed adequately in V(T) delivery across several settings. The combination of high respiratory rate and low V(T) presented problems for 2 of the ventilators.


Children diagnosed with coronavirus disease 2019 may have cardiac involvement.


title: Fast SARS-CoV-2 detection by RT-qPCR in preheated nasopharyngeal swab samples.

text: OBJECTIVES The gold-standard COVID-19 diagnosis relies on detecting SARS-CoV-2 using RNA purification and one-step retrotranscription and quantitative PCR (RT-qPCR). Based on the urgent need for high-throughput screening, we tested the performance of three alternative, simple and affordable protocols to rapidly detect SARS-CoV-2, bypassing the long and tedious RNA extraction step and reducing the time to viral detection. METHODS We evaluated three methods based on direct nasopharyngeal swab viral transmission medium (VTM) heating before the RT-qPCR: a) direct without additives; b) in a formamide-EDTA (FAE) buffer, c) in a RNAsnapTM buffer. RESULTS Although with a delay in cycle threshold compared to the gold-standard, we found consistent results in nasopharyngeal swab samples that were subject to a direct 70°C incubation for 10 min. CONCLUSIONS Our findings provide valuable options to overcome any supply chain issue and help to increase the throughput of diagnostic tests, thereby complementing standard diagnosis.


title: Repair of diaphragmatic hernia following spinal surgery by laparoscopic mesh application: a case report and review of the literature.

text: We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.


docid: fnmrnall

title: Supraglottic airway devices in the ambulatory setting.

text: Supraglottic airway devices (SGAs) offer certain advantages over endotracheal intubation, making them particularly well suited for the specific demands of outpatient anesthesia. Patients may tolerate the placement and maintenance of an SGA at a lower dose of anesthetic than that needed for an endotracheal tube; neuromuscular blocking agents are rarely necessary for airway management with an SGA; the incidence of airway morbidity is lower with SGAs than with endotracheal tubes; and SGAs may facilitate faster recovery and earlier discharge of patients. Two limitations of SGAs are incomplete protection against aspiration of gastric contents and inadequate delivery of positive pressure ventilation. Newer variants of the original laryngeal mask airway, the LMA Classic (LMA North America, Inc), as well as an array of other recently developed SGAs, aim to address these limitations. Their utility and safety in specific patient populations (eg, the morbidly obese) and during certain procedures (eg, laparoscopic surgery) remain to be determined.


title: Identification of the myelin oligodendrocyte glycoprotein as a cellular receptor for rubella virus.

text: Rubella virus (RV) is a highly transmissible pathogenic agent that causes the disease rubella. Maternal RV infection during early pregnancy causes the death of the fetus or congenital rubella syndrome in infants. However, the cellular receptor for RV has not yet been identified. In this study, we found that the myelin oligodendrocyte glycoprotein (MOG) specifically bound to the E1 envelope glycoprotein of RV, and an antibody against MOG could block RV infection. Most importantly, we also showed that ectopic expression of MOG on the cell surface of 293T cells rendered this nonpermissive cell line permissive for RV entry and replication. Thus, this study has identified a cellular receptor for RV and suggests that blocking the MOG attachment site of RV may be a strategy for molecular intervention of RV infection.


title: Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial.

text: BACKGROUND In the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications.The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods. METHODS Eligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher's exact test. Time to close and pain with removal of closure material were compared using a Student's t-test. RESULTS The total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52-1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6-7.1) than the suture group (mean=12 min, CI = 7.9-16). Patients in the staple group (mean=3.7, CI =2.8-4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6-3.4). CONCLUSIONS This study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01146236 (registered June 14, 2010).


title: The CD225 domain of IFITM3 is required for both IFITM protein association and inhibition of influenza A virus and dengue virus replication.

text: The interferon-induced transmembrane protein 3 (IFITM3) gene is an interferon-stimulated gene that inhibits the replication of multiple pathogenic viruses in vitro and in vivo. IFITM3 is a member of a large protein superfamily, whose members share a functionally undefined area of high amino acid conservation, the CD225 domain. We performed mutational analyses of IFITM3 and identified multiple residues within the CD225 domain, consisting of the first intramembrane domain (intramembrane domain 1 [IM1]) and a conserved intracellular loop (CIL), that are required for restriction of both influenza A virus (IAV) and dengue virus (DENV) infection in vitro. Two phenylalanines within IM1 (F75 and F78) also mediate a physical association between IFITM proteins, and the loss of this interaction decreases IFITM3-mediated restriction. By extension, similar IM1-mediated associations may contribute to the functions of additional members of the CD225 domain family. IFITM3's distal N-terminal domain is also needed for full antiviral activity, including a tyrosine (Y20), whose alteration results in mislocalization of a portion of IFITM3 to the cell periphery and surface. Comparative analyses demonstrate that similar molecular determinants are needed for IFITM3's restriction of both IAV and DENV. However, a portion of the CIL including Y99 and R87 is preferentially needed for inhibition of the orthomyxovirus. Several IFITM3 proteins engineered with rare single-nucleotide polymorphisms demonstrated reduced expression or mislocalization, and these events were associated with enhanced viral replication in vitro, suggesting that possessing such alleles may impact an individual's risk for viral infection. On the basis of this and other data, we propose a model for IFITM3-mediated restriction.


title: Perioperative Complications of Video-Assisted Thoracoscopic Pulmonary Procedures in Neonates and Infants.

text: Video-assisted thoracoscopic surgery (VATS) has gained broad acceptance among pediatric surgeons. Today, VATS can be regarded as a routine approach for various conditions in neonates and infants. However, there is a lack of information concerning the complications of thoracoscopic pulmonary surgery in neonates and infants. We aimed to review the available data. A systematic review of the literature was performed using PubMed. All publications reporting on VATS for pulmonary procedures in neonates and infants up to the age of 1 year were included. Articles were reviewed in detail for occurrence of perioperative complications and their treatment. Nine case series were eligible for analysis. Entities treated included lung sequestration, congenital pulmonary airway malformation, congenital lobar emphysema, and bronchogenic cyst. Case series reported on a total number of 135 patients. Complications occurred in 14 patients (10.4%). The major complication was an accidental transection of the middle lobar bronchus that concluded in a later resection of a prior unaffected lung lobe. Other relevant complications reported were bleeding in four patients (3.0%) and persistent air leak in four cases (3.0%). Infectious complications were reported in four patients (3.0%). Additionally, iatrogenic phrenic nerve paralysis occurred in one patient. There were no deaths related to the VATS technique. In 11 cases (8.1%), conversion to thoracotomy had been necessary. General recommendations on the treatment of complications could not be derived due to small patient numbers and lack of details of the complications reported. Reports on major complications of pulmonary VATS in neonates and infants below 1 year of age are scarce. As severe complications such as accidental bronchus transection have been described, feasibility of neonatal/infant VATS cannot be unequivocally confirmed. No literature-based recommendation can be given on the treatment of complications.


title: Impact of vedolizumab therapy on extra-intestinal manifestations in patients with inflammatory bowel disease: a multicentre cohort study nested in the OBSERV-IBD cohort.

text: BACKGROUND The effectiveness of vedolizumab as a treatment for extraintestinal manifestations (EIM) is questionable due to its gut-specificity. AIM To assess effectiveness of vedolizumab for EIM in patients with inflammatory bowel disease (IBD) in a large real-life experience cohort. METHODS Between June and December 2014, 173 patients with Crohn's disease and 121 with ulcerative colitis were treated with vedolizumab. Patients were followed until week 54. EIM activity was assessed at weeks 0, 6, 14, 22, 30 and 54 by using a 3-step scale: complete remission, partial response and no response. RESULTS At baseline, 49 (16.7%) patients had EIMs of which 47 had inflammatory arthralgia/arthritis, four had cutaneous lesions and two had both rheumatologic and skin EIM. At week 54, 21 (44.7%) patients had complete remission for inflammatory arthralgia/arthritis and three (75%) for cutaneous EIM. In multivariate analysis, complete remission of inflammatory arthralgia/arthritis was associated with clinical remission of IBD (OR = 1.89, IC95% [1.05-3.41], P = .03) and recent onset of inflammatory arthralgia/arthritis (OR = 1.99, IC95% [1.12-3.52], P = .02). During the follow-up period, 34 (13.8%) patients without any EIM at baseline, developed incident cases of inflammatory arthralgia/arthritis consisting mostly of peripheral arthralgia without evidence of arthritis and 14 (4.8%) incident cases of paradoxical skin manifestation. CONCLUSION Vedolizumab therapy is commonly associated with improvement in EIM. This was associated with quiescent IBD and recent EIM. However, paradoxical skin manifestation and inflammatory arthralgia/arthritis may occur upon vedolizumab therapy.


title: Use of plasma procalcitonin levels as an adjunct to clinical microbiology.

text: Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. Current PCT assays are rapid, specific, and of sufficient sensitivity to detect increases in PCT serum levels within 4 to 6 h of initiation of infection. Clinically, PCT levels may help in decisions regarding the need for empirical antibiotic therapy, "source control" of infection, and duration of antibiotic therapy. The addition of PCT levels to bacterial culture and viral detection results can assist with the separation of colonization and invasion by pathogenic bacteria.


title: Controlled viral glycoprotein expression as a safety feature in a bivalent rabies-ebola vaccine.

text: Using a recombinant rabies (RABV) vaccine platform, we have developed several safe and effective vaccines. Most recently, we have developed a RABV-based ebolavirus (EBOV) vaccine that is efficacious in nonhuman primates. One safety feature of this vaccine is the utilization of a live but replication-deficient RABV construct. In this construct, the RABV glycoprotein (G) has been deleted from the genome, requiring G trans complementation in order for new infectious viruses to be released from the initial infected cell. Here we analyze this safety feature of the bivalent RABV-based EBOV vaccine comprised of the G-deleted RABV backbone expressing EBOV glycoprotein (GP). We found that, while the level of RABV genome in infected cells is equivalent regardless of G supplementation, the production of infectious virus is indeed restricted by the lack of G, and most importantly, that the presence of EBOV GP does not substitute for G. These findings further support the safety profile of this replication-deficient RABV-EBOV bivalent vaccine.


title: Physical Distancing With Social Connectedness.

text: In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.


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title: The Effect of Nebulizer Position on Aerosolized Epoprostenol Delivery in an Adult Lung Model.

text: BACKGROUND Aerosolized epoprostenol is an alternative for inhaled nitric oxide in the management of pulmonary arterial hypertension and possibly acute hypoxemia. Our objective was to determine differences in drug deposition based on different nebulizer positions in the ventilator circuit, using a vibrating mesh nebulizer. METHODS An 8.0-mm inner diameter endotracheal tube (ETT) was connected to a training test lung, compliance of 30 mL/cm H2O, with a collecting filter placed at the ETT-test lung junction. A mechanical ventilator, heated wire circuit, and pass-over humidifier were utilized. A syringe pump continuously instilled a 15,000-ng/mL epoprostenol solution at 30, 50, and 70 ng/kg/min into the vibrating mesh nebulizer at all 4 positions. Tidal volumes (VT) were set at 4, 6, and 8 mL/kg for a 70-kg patient with breathing frequencies of 25, 16, and 12 breaths/min, respectively. Epoprostenol was eluted from the filters (no. = 180) and analyzed with ultraviolet-visible spectrophotometry at 205 nm to estimate drug deposition. RESULTS Epoprostenol deposition increased significantly (P = .02) as the dosage increased from 30 ng/kg/min (median 4,520.0 ng, interquartile range [IQR] 2,285.0-6,712.2 ng) to 50 ng/kg/min (median 6,065.0 ng, IQR 3,220.0-13,002.5 ng) and 70 ng/kg/min (median 9,890.0 ng, IQR 6,270.0-16,140.0 ng). No significant difference was found between variations in ventilator settings. No difference in deposition was found between the humidifier inlet and outlet, but these positions resulted in greater deposition compared with the inspiratory limb and between the ETT and Y-piece. CONCLUSIONS The greatest amount of mean epoprostenol deposition resulted with the nebulizer placed at the humidifier inlet or outlet in a ventilator with bias flow.


title: Choosing Channels, Sources, and Content for Communicating Prostate Cancer Information to Black Men: A Systematic Review of the Literature.

text: The purpose of this study was to identify effective channels, sources, and content approaches for communicating prostate cancer prevention information to Black men. The Web of Science, PubMed and GoogleScholar databases, as well as reviews of reference lists for selected publications, were searched to select articles relevant to cancer communication channels, sources or content for Black men, focused on male-prevalent cancers and published in English. Articles were excluded if they examined only patient-provider communication, dealt exclusively with prostate cancer patients or did not separate findings by race. The selection procedures identified 41 relevant articles, which were systematically and independently reviewed by two team members to extract data on preferred channels, sources, and content for prostate cancer information. This review revealed that Black men prefer interpersonal communication for prostate cancer information; however, video can be effective. Trusted sources included personal physicians, clergy, and other community leaders, family (especially spouses) and prostate cancer survivors. Men want comprehensive information about screening, symptoms, treatment, and outcomes. Messages should be culturally tailored, encouraging empowerment and "ownership" of disease. Black men are open to prostate cancer prevention information through mediated channels when contextualized within spiritual/cultural beliefs and delivered by trusted sources.


title: The use of an acellular porcine dermal collagen implant in the repair of complex abdominal wall defects: a European multicentre retrospective study.

text: BACKGROUND The use of biological materials for the repair of complex abdominal wall defects has increased over the years; however, the role of these materials in routine practice remains unclear. The aim of the study was to evaluate clinical outcomes following the use of Permacol™ porcine collagen surgical implant in complex abdominal wall repair. METHODS This subset analysis of seven European sites from a multicentre retrospective study included patients undergoing open or laparoscopic surgery and treated with Permacol™ surgical implant. Inguinal, parastomal, diaphragmatic, perineal, and hiatal repairs were excluded. Only patients with at least 12 months of follow-up after surgery were included. RESULTS A total of 109 patients (56 males and 53 females) were included. Patients had a median of two comorbidities (range 0-6). Thirty-three per cent of patients were treated for recurrent hernia. All but one case used an open approach. Sixty-six per cent were Center for Disease Control wound class II-IV at the time of surgery. Fascial closure was achieved in 69%. Median follow-up length was 720 days (range 368-2857). Recurrence rates at 1 and 2 years were 9.2 and 18.3 %, respectively, and were higher in cases without fascial closure. One-year recurrence was higher following use of an onlay technique (P = 0.025). In a multivariate analysis, among 16 comorbidities examined only fascial closure significantly impacted 1-year recurrence (P = 0.049). CONCLUSIONS Data from this large retrospective multicentre European study strongly suggest the use of Permacol™ porcine collagen surgical implant to be safe and effective for complex abdominal wall repair. The recurrence rate was impacted by fascial closure.


Diagnosis and recovery from SARS-CoV-2 infection is challenging in kidney patients: tests are an issue.


Meningitis and Reversible Cerebral Vasoconstriction Syndrome During the Postpartum Period.


title: Recommendations on trichological treatments during COVID-19 pandemic.

text: COVID-19 is an infectious disease caused by the novel coronavirus SARS-CoV-2, which rapidly spreads via respiratory droplets and is the cause of the current pandemic. In this alarming situation, it is a delicate matter how to visit patients safely and how to manage their chronic treatments.The aim of this paper is to examine in detail the potential impact on SARS-CoV-2 infection of treatments routinely used in trichology and to provide a useful guide for the therapeutic management of thricological patients in this new COVID-19 era.


title: Robot-assisted anatrophic nephrolithotomy with renal hypothermia for managing staghorn calculi.

text: Treatment of patients with staghorn calculi with percutaneous nephrolithotomy can be challenging, often necessitating multiple tracts or sessions for complete stone clearance. Although open anatrophic nephrolithotomy can result in higher stone-free rates, it is rarely performed because of increased morbidity. To provide a minimally invasive alternative, we developed the technique of robot-assisted anatrophic nephrolithotomy (RANL) incorporating ice slush for renal hypothermia. Three patients with staghorn calculi (mean total stone volume 12887.67 mm(3)) underwent RANL with iced cold ischemia. A GelPOINT™ port was used for ice slush insertion. Intracorporeal temperatures were <9°C within 30 minutes of cold ischemia. Mean console and cold ischemia times were 167 and 56.7 minutes, respectively. Mean blood loss was 100 mL. There were no complications. Two patients had residual fragments measuring 13 mm, and two 9 mm stones, respectively. RANL with iced cold ischemia is a safe and feasible option that may be considered in patients with staghorn stones. Further study is needed to refine the technique and assess long-term functional outcomes.


title: Effect of the COVID-19 pandemic on female sexual behavior.

text: OBJECTIVE To evaluate the effect of the COVID-19 pandemic on female sexual behavior in women in Turkey. METHODS An observational study using data from a previous study conducted prior to the pandemic. We compared frequency of sexual intercourse, desire for pregnancy, Female Sexual Function Index (FSFI) score, contraception type, and menstrual abnormalities among women during the pandemic with 6-12 months prior to the pandemic. Participants were contacted by telephone for questioning. RESULTS Average frequency of sexual intercourse was significantly increased during the pandemic compared with 6-12 months prior (2.4 vs 1.9, P=0.001). Before the pandemic 19 (32.7%) participants desired to become pregnant, whereas during the pandemic it had decreased to 3 (5.1%) (P=0.001). Conversely, use of contraception during the pandemic significantly decreased among participants compared with prior (24 vs 10, P=0.004). Menstrual disorders were more common during the pandemic than before (27.6% vs 12.1%, P=0.008). Participants had significantly better FSFI scores before the pandemic compared with scores during the pandemic (20.52 vs 17.56, P=0.001). CONCLUSION Sexual desire and frequency of intercourse significantly increased during the COVID-19 pandemic, whereas quality of sexual life significantly decreased. The pandemic is associated with decreased desire for pregnancy, decreased female contraception, and increased menstrual disorders.


title: Single-port laparoscopic right hemicolectomy: the learning curve.

text: BACKGROUND AND OBJECTIVES Single-port laparoscopic colectomy is described as a new technique in colorectal surgery. The initial case reports show the safety and feasibility, but the learning curve for this technique is unknown. METHODS Between July 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy underwent a single-port laparoscopic approach without bias in selection. The only exclusion criterion was a prior midline laparotomy. The patients were followed up for 30 days. Chart review was completed for up to 35 months to assess long-term morbidity and mortality rates. RESULTS The median age was 65 years (range, 59-88 years). Ninety percent of patients were men. The median body mass index was 28 kg/m(2) (range, 20-35 kg/m(2)). Seventy-five percent of patients had significant comorbidities with an American Society of Anesthesiologists class of 3 or 4. The estimated blood loss was 25 mL (range, 25-250 mL). The median number of pathologic lymph nodes for patients diagnosed with adenocarcinoma was 16 (range, 8-23). There was one conversion to hand-assisted laparoscopic (case 6) and one to open colectomy (case 9) because of the inability to achieve safe vessel ligation. The median hospital stay was 4.5 days (range, 3-7 days). The length of stay for the first 10 patients was 5.1 days, and it was 3.9 days for the last 10 patients (P = .045). There were no significant postoperative complications within 30 days. The mean operative time for the first 10 cases was 198 minutes (range, 148-272 minutes), and it was 123 minutes (range, 98-150 minutes) for the subsequent 10 cases (P = .0001). All intraoperative complications (minor bleeding) occurred within the first 10 patients, with no significant bleeding recorded for the last 10 cases. CONCLUSION Single-port laparoscopic right hemicolectomy can be safely performed in patients who are candidates for conventional or hand-assisted right hemicolectomy with very low intraoperative and postoperative complication rates. The 30-day morbidity rate remained low with this technique. The higher technical difficulty compared with conventional laparoscopy is reflected in the longer initial operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short, requiring approximately 10 cases to decrease operative times to baseline. The role and feasibility of broad adaptation for single-incision laparoscopy in colorectal surgery need to be further evaluated in larger case series and trials.


The Impact of COVID-19 on Cardiovascular Training Programs: Challenges, Responsibilities and Opportunities.


title: Atrial fibrillation in patients with cryptogenic stroke.

text: BACKGROUND Atrial fibrillation is a leading preventable cause of recurrent stroke for which early detection and treatment are critical. However, paroxysmal atrial fibrillation is often asymptomatic and likely to go undetected and untreated in the routine care of patients with ischemic stroke or transient ischemic attack (TIA). METHODS We randomly assigned 572 patients 55 years of age or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months (cause undetermined after standard tests, including 24-hour electrocardiography [ECG]), to undergo additional noninvasive ambulatory ECG monitoring with either a 30-day event-triggered recorder (intervention group) or a conventional 24-hour monitor (control group). The primary outcome was newly detected atrial fibrillation lasting 30 seconds or longer within 90 days after randomization. Secondary outcomes included episodes of atrial fibrillation lasting 2.5 minutes or longer and anticoagulation status at 90 days. RESULTS Atrial fibrillation lasting 30 seconds or longer was detected in 45 of 280 patients (16.1%) in the intervention group, as compared with 9 of 277 (3.2%) in the control group (absolute difference, 12.9 percentage points; 95% confidence interval [CI], 8.0 to 17.6; P<0.001; number needed to screen, 8). Atrial fibrillation lasting 2.5 minutes or longer was present in 28 of 284 patients (9.9%) in the intervention group, as compared with 7 of 277 (2.5%) in the control group (absolute difference, 7.4 percentage points; 95% CI, 3.4 to 11.3; P<0.001). By 90 days, oral anticoagulant therapy had been prescribed for more patients in the intervention group than in the control group (52 of 280 patients [18.6%] vs. 31 of 279 [11.1%]; absolute difference, 7.5 percentage points; 95% CI, 1.6 to 13.3; P=0.01). CONCLUSIONS Among patients with a recent cryptogenic stroke or TIA who were 55 years of age or older, paroxysmal atrial fibrillation was common. Noninvasive ambulatory ECG monitoring for a target of 30 days significantly improved the detection of atrial fibrillation by a factor of more than five and nearly doubled the rate of anticoagulant treatment, as compared with the standard practice of short-duration ECG monitoring. (Funded by the Canadian Stroke Network and others; EMBRACE ClinicalTrials.gov number, NCT00846924.).


title: Positron emission tomography/computed tomography for optimized colon cancer staging and follow up.

text: OBJECTIVES Optimal management of colon cancer (CC) requires detailed assessment of extent of disease. This study prospectively investigates the diagnostic accuracy of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (PET/CT) for staging and detection of recurrence in primary CC. MATERIAL AND METHODS PET/CT for preoperative staging was performed in 66 prospectively included patients with primary CC. Diagnostic accuracy for PET/CT and CT was analyzed. In addition to routine follow up, 42 stages I-III CC patients had postoperative PET/CT examinations every 6 months for 2 years. Serological levels of tissue inhibitor of metalloproteinase-1 (TIMP-1), carcinoembryonic antigen, and liberated domain I of urokinase plasminogen activator receptor were analyzed. RESULTS Accuracy for tumor, nodal, and metastases staging by PET/CT were 82% (95% confidence interval [CI]: 70; 91), 66% (CI: 51; 78), and 89% (CI: 79; 96); for CT the accuracy was 77% (CI: 64; 87), 60% (CI: 46; 73), and 69% (CI: 57; 80). Cumulative relapse incidences for stages I-III CC at 6, 12, 18, and 24 months were 7.1% (CI: 0; 15); 14.3% (CI: 4; 25); 19% (CI: 7; 31), and 21.4% (CI: 9; 34). PET/CT diagnosed all relapses detected during the first 2 years. High preoperative TIMP-1 levels were associated with significant hazards toward risk of recurrence and shorter overall survival. CONCLUSIONS This study indicates PET/CT as a valuable tool for staging and follow up in CC. TIMP-1 provided prognostic information potentially useful in selection of patients for intensive follow up.


title: Novel Nitinol Stent for Lesions up to 24 cm in the Superficial Femoral and Proximal Popliteal Arteries: 24-Month Results From the TIGRIS Randomized Trial.

text: PURPOSE To evaluate the safety and effectiveness of the TIGRIS stent for lesions up to 24 cm in the superficial femoral and proximal popliteal arteries (SFA/PPA). METHODS This prospective, multicenter, randomized study enrolled 274 subjects at 36 sites in the United States and Europe. Subjects were randomly assigned in a 3:1 ratio to treatment with the TIGRIS stent (n=197; mean age 66.7±9.28 years; 141 men) or LifeStent (n=70; mean age 67.9±8.87 years; 49 men). The primary safety endpoint was 30-day freedom from major adverse events (MAE). The primary efficacy endpoint was primary patency at 12 months. Secondary endpoints included target lesion revascularization (TLR) and stent fracture. Clinical success and quality of life were also assessed. RESULTS Mean lesion length (107.6 vs 117.9 mm, p=0.29), procedure success (99.5% vs 97.1%, p=0.17), and freedom from MAE (99.5% vs 100%, p>0.99) were similar for the TIGRIS and control groups, respectively. Likewise, there was no difference in primary patency at 12 months (60.6% vs 63.2%, p=0.73) or 24 months (56.3% vs 50.2%, p=0.60) or in TLR at the same time points (76.6% vs 80.6%, p=0.49; 70.5% vs 67.2%, p=0.85). There were no differences in the changes in Rutherford category or the ankle/brachial index through 24 months. The rate of stent fracture was lower for TIGRIS compared with LifeStent (0% vs 32.7%, p<0.001). CONCLUSION The TIGRIS stent and LifeStent were similarly effective for the treatment of lesions in the SFA and PPA. The high flexibility and zero fracture rate associated with the TIGRIS stent make this device favorable for use in high-flexion arteries.


title: Crystal structure of mouse coronavirus receptor-binding domain complexed with its murine receptor.

text: Coronaviruses have evolved diverse mechanisms to recognize different receptors for their cross-species transmission and host-range expansion. Mouse hepatitis coronavirus (MHV) uses the N-terminal domain (NTD) of its spike protein as its receptor-binding domain. Here we present the crystal structure of MHV NTD complexed with its receptor murine carcinoembryonic antigen-related cell adhesion molecule 1a (mCEACAM1a). Unexpectedly, MHV NTD contains a core structure that has the same β-sandwich fold as human galectins (S-lectins) and additional structural motifs that bind to the N-terminal Ig-like domain of mCEACAM1a. Despite its galectin fold, MHV NTD does not bind sugars, but instead binds mCEACAM1a through exclusive protein-protein interactions. Critical contacts at the interface have been confirmed by mutagenesis, providing a structural basis for viral and host specificities of coronavirus/CEACAM1 interactions. Sugar-binding assays reveal that galectin-like NTDs of some coronaviruses such as human coronavirus OC43 and bovine coronavirus bind sugars. Structural analysis and mutagenesis localize the sugar-binding site in coronavirus NTDs to be above the β-sandwich core. We propose that coronavirus NTDs originated from a host galectin and retained sugar-binding functions in some contemporary coronaviruses, but evolved new structural features in MHV for mCEACAM1a binding.


title: Biofilm-based implant infections in orthopaedics.

text: The demand for joint replacement surgery is continuously increasing with rising costs for hospitals and healthcare systems. Staphylococci are the most prevalent etiological agents of orthopedic infections. After an initial adhesin-mediated implant colonization, Staphylococcus aureus and Staphylococcus epidermidis produce biofilm. Biofilm formation proceeds as a four-step process: (1) initial attachment of bacterial cells; (2) cell aggregation and accumulation in multiple cell layers; (3) biofilm maturation and (4) detachment of cells from the biofilm into a planktonic state to initiate a new cycle of biofilm formation elsewhere. The encasing of bacteria in biofilms gives rise to insuperable difficulties not only in the treatment of the infection, but also in assessing the state and the nature of the infection using traditional cultural methods. Therefore, DNA-based molecular methods have been developed to provide rapid identification of all microbial pathogens. To combat biofilm-centered implant infections, new strategies are being developed, among which anti-infective or infective-resistant materials are at the forefront. Infection-resistant materials can be based on different approaches: (i) modifying the biomaterial surface to give anti-adhesive properties, (ii) doping the material with antimicrobial substances, (iii) combining anti-adhesive and antimicrobial effects in the same coating, (iv) designing materials able to oppose biofilm formation and support bone repair.


title: Surgical Adhesive Drape (IO-ban) as Postoperative Surgical Site Dressing.

text: STUDY DESIGN Retrospective chart analysis. OBJECTIVE The objective of this study is to describe the senior author's (MNN) experience applying a widely available surgical drape as a postoperative sterile surgical site dressing for both cranial and spinal procedures. SUMMARY OF BACKGROUND DATA Surgical site infection (SSI) is an important complication of spine surgery that can result in significant morbidity. There is wide variation in wound care management in practice, including dressing type. Given the known bactericidal properties of the surgical drape, there may be a benefit of continuing its use immediately postoperatively. METHODS All of the senior author's cases from September 2014 through September 2015 were reviewed. These were contrasted to the previous year prior to the institution of a sterile surgical drape as a postoperative dressing. RESULTS Only one surgical case out of 157 operative interventions (35 cranial, 124 spinal) required operative debridement due to infection. From September 2013 to September 2014, prior to the institution of a sterile surgical drape as dressing, the author had five infections out of 143 operations (46 cranial, 97 spinal) requiring intervention. CONCLUSION The implementation of a sterile surgical drape as a closed postoperative surgical site dressing has led to a decrease in surgical site infections. The technique is simple and widely available, and should be considered for use to diminish surgical site infections.


title: Quality of Randomized Controlled Trials for Surgical Treatment of Carpal Tunnel Syndrome: A Systematic Review.

text: BACKGROUND Randomized controlled trials are considered the gold standard in evidence-based medicine. The authors conducted a systematic review to evaluate the quantity, quality, and trends of randomized controlled trials that assess surgical treatment of carpal tunnel syndrome. METHODS The authors identified randomized controlled trials comparing two or more surgical interventions for carpal tunnel syndrome in PubMed, Cochrane, Scopus, Google Scholar, and Clinicaltrials.gov. Two independent reviewers evaluated articles for inclusion, extracted data, and assessed randomized controlled trial quality using the Jadad score. RESULTS Of 2253 identified studies, 58 met full inclusion criteria. They were published between 1985 and 2015, with a significant increase over time (p = 0.003). They were most frequently published in Journal of Hand Surgery (European Volume) [n = 15 (25.9 percent)]. Most randomized controlled trials were single-center studies [n = 54 (93.1 percent)] conducted in the United Kingdom [n = 13 (22.4 percent)] or the United States [n = 10 (17.2 percent)], with a mean study size of 80.1 ± 55.5 patients. Funding source was unknown in 62.1 percent (n = 36). Three-quarters [n = 44 (75.9 percent)] of randomized controlled trials did not define the primary outcome measure(s). Less than 30 percent (n = 17) of randomized controlled trials conducted a power analysis. Only four studies with patients reported lost to follow-up provided an explanation for each patient. Six randomized controlled trials (10.3 percent) conducted intention-to-treat analysis. The mean Jadad score was 2.14 ± 1.26, with no significant improvement over time (p = 0.245). CONCLUSIONS Despite the significant increase in the number of randomized controlled trials published studying surgical treatment of carpal tunnel syndrome over time, a mean Jadad score of 2.14 with no change over time indicates a need for improvement in quality. Proper study design is key to avoiding introduction of bias and ensuring the validity of conclusions drawn.


title: Ribbon thickness influences fine generation during dry granulation.

text: Uncontrolled fine generation during the milling process is a challenge for dry granulation by roller compaction. Here, we report the observation that ribbon thickness can significantly influence percentage of fines. Thus, among other parameters, ribbon thickness needs to be controlled for the development of a robust roller compaction process and ensure successful scale up.


title: [Burnout among mental health professionals: A Tunisian experience].

text: BACKGROUND Burnout syndrome consists in physical as well as mental exhaustion observed in professionals whose work involves continuous contact with other people. Psychiatrists and psychiatry nursing staff are considered to be vulnerable to experiencing burnout. The purposes of this study aim to investigate the prevalence of burnout syndrome in practitioners, residents and nurses working in the psychiatric hospital of Tunisia. It also aims to investigate the relationship between burnout, depression, and a variety of personal variables, including age, gender, marital, parental and personal difficulties within this population. METHODS A cross-sectional study was conducted among the nursing staff (n=54), residents (n=41) and practitioners (n=11) in Razi hospital in Tunisia. The Maslach Burnout Inventory, the Beck depression inventory and a general questionnaire on demographic data were used. RESULTS High levels of burnout were detected among nurses. This was true for the emotional tiredness sub-scale (mean score: 26.18); the depersonalization subscale (mean score: 10.20) and for the alteration of personal achievements (mean score: 32.94). High scores in emotional tiredness were correlated to depression (P=0.000; R=0.56) and to personal difficulties (P=0.021; R=0.31) in this group. Residents showed high scores in personal achievements (mean score: 32.56), and practitioners did not reach the cutoff scores on the Maslach Burnout Inventory. CONCLUSION Our results are somewhat comparable to those of studies in other countries. Burnout syndrome was highly prevalent among nurses and residents. This study corroborates former results of a relation between depression and burnout. A strong relationship was found between personal difficulties and burnout, but seemed to be more specific to the nursing sample.


title: European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery.

text: BACKGROUND Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. METHODS An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. RESULTS In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. CONCLUSIONS Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.


title: Asymmetry of Brain Excitability: A New Biomarker that Predicts Objective and Subjective Symptoms in Multiple Sclerosis.

text: OBJECTIVES Investigate whether asymmetrical corticospinal excitability exists in Multiple Sclerosis (MS) and its association with MS symptoms. METHODS Bilateral resting and active motor thresholds (RMT, AMT) were gathered using transcranial magnetic stimulation among 82 MS patients. Corticospinal excitability (CSE) asymmetry was expressed as the ratio between weaker and stronger sides' RMT and AMT. Stronger and weaker side was determined by pinch and grip strength. We examined whether CSE asymmetry predicted symptoms. RESULTS AMT asymmetry ratio revealed atypical CSE asymmetry whereby the hemisphere associated with the weaker hand was more excitable in early MS. After controlling for MS disease demographics, shifting of CSE asymmetry towards greater excitability in the stronger side significantly predicted more severe symptoms including Expanded Disease Severity Scale, nine-hole peg test, cognitive processing speed, walking speed, heat sensitivity, fatigue, and subjective impact of MS. CONCLUSION CSE asymmetry significantly predicted the severity of MS-related physical and objective cognitive symptoms. The phenomenon may be related to neuroinflammation-mediated hyperexcitability. Shifting of asymmetry toward less excitability on the weaker side may suggest the onset of a more neurodegenerative phase of the disease. SIGNIFICANCE Shifting of hemispheric excitability, detected using a CSE asymmetry ratio, may be a useful biomarker to track disease progression and understand the benefits of treatments.


title: Endocrinology in the time of COVID-19: Management of adrenal insufficiency.

text: We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, which exposes patients with adrenal insufficiency to an increased risk of acute COVID-19 infection while at the same time restricting access to healthcare due to capacity issues. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20mg hydrocortisone every six hours. We also comment on suggested dosing for patients who usually take modified release hydrocortisone or prednisolone. In patients with clinical insufficiency showing clinical deterioration during an acute COVID-19 infection, we advise immediate (self-)injection of 100mg hydrocortisone intramuscularly, followed by continuous intravenous infusion of 200mg hydrocortisone per 24 hours, or until this can be established, administration of 50mg hydrocortisone every 6 hours.


title: Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure.

text: BACKGROUND Recent data suggest that reoperative fundoplication is associated with poor long-term control of reflux. For long-term reflux control, laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a better option. This study assessed outcomes and quality-of-life data after fundoplication takedown and conversion to LRYGB for patients with failed fundoplications. METHODS After institutional review board approval, the medical records of 25 patients who underwent fundoplication takedown and LRYGB conversion between March 2007 and July 2011 were reviewed. The data recorded included patient demographics, body mass index (BMI), preoperative symptoms, operative duration and findings, hospital length of stay (LOS), estimated blood loss (EBL), length of the follow-up period, and postoperative outcomes. The gastrointestinal quality of life index (GIQLI) and the gastrointestinal symptoms rating scale (GSRS) were used at the most recent follow-up visit to assess symptom severity and quality of life. RESULTS The patients in this study had undergone 40 total prior antireflux surgeries. They had a median age of 55 years (range 36-72 years), a BMI of 34.4 kg/m(2) (range 22-50 kg/m(2)), an operative duration of 345 min (range 180-600 min), an EBL of 181 ml (range 50-500 ml), and an LOS of 7 days (range 2-30 days). Five patients had concomitant incisional hernia repair. There was no mortality. Of the 10 patients (40%) who had had complications, 5 required reoperation. During a 14-month follow-up period (range 1-48 months), 96% of the patients were reflux-free with a GIQLI score of 114 (range 80-135) and a GSRS score of 25 (range 17-45). Excess weight loss was 60%, and comorbidity resolution was 70%. Most of the patients (96%) were satisfied with their outcome and would undergo the surgery again, and 62% reported that their personal relationships and sexual life had improved. CONCLUSIONS Patients who undergo LRYGB after failed fundoplications have excellent symptomatic control of reflux, excellent quality of life, and high rates of satisfaction with their outcome. Nevertheless, because the procedure is challenging and associated with considerable morbidity, it should be performed by surgeons experienced in antireflux and bariatric surgery.


title: Use of tocilizumab in kidney transplant recipients with COVID-19.

text: Acute respiratory distress syndrome associated with coronavirus infection is related to a cytokine storm with large interleukin 6 (IL-6) release. The IL-6-receptor blocker tocilizumab may control the aberrant host immune response in COVID-19 patients. In this pandemic, kidney transplant (KT) recipients are a high-risk population for severe infection and showed poor outcomes. We present a multicenter cohort study of 80 KT patients with severe COVID-19 treated with tocilizumab during hospital admission. High mortality rate was identified (32.5%), related with older age (HR 3.12 for those older than 60 years, p=0.039). IL-6 and other inflammatory markers, including LDH, ferritin, and D-dimer increased early after tocilizumab administration and their values were higher in non-survivors. Instead, C-reactive protein (CRP) levels decreased after tocilizumab, and this decrease positively correlated with survival (mean 12.3 mg/L in survivors vs. 33 mg/L in non-survivors). Each mg/L of CRP soon after tocilizumab increased the risk of death by 1% (HR 1.01 [CI 1.004-1.024], p=0.003). Although patients who died presented with worse respiratory situation at admission, this was not significantly different at tocilizumab administration, and did not impact on outcome in the multivariate analysis. Tocilizumab may be effective in controlling cytokine storm in COVID-19 but randomized trials are needed.


title: Septicaemic pasteurellosis in unvaccinated lambs in Northern Ireland.

text: Northern ireland disease surveillance, july to september 2017Bibersteinia trehalosi causing septicaemic pasteurellosis in lambsAbortion due to Streptococcus pluranimalium in cattleLymphoma in cattleAcute fasciolosis in sheepErysipelas in pigsMarek's disease in chickens.


title: Severe acute respiratory syndrome coronavirus 2 is penetrating to dementia research.

text: 1. Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus infectious disease 2019 (COVID-19), which was first reported in Wuhan, China, in late December, 2019. Despite the tremendous efforts to control the disease, SARS-CoV-2 has infected 1,5 million people and caused the death of more than a hundred thousand people across the globe as of writing. Recently, Mao et al. [1] investigated the penetration potential of SARS-CoV-2 into the central nervous system in 214 patients. They reported that 36.4% of the patients had some neurologic findings which are ranged from nonspecific manifestations, e.g., dizziness, headache, and seizure, to specific manifestations, e.g., loss of sense of smell or taste, and stroke. Whether these common symptoms in their patients are related to SARS-CoV-2 infection is not known. However, it is important to mention here that dramatic neurologic symptoms, i.e., depressed level of consciousness, seizure, and stroke, are common in the patients at the late stage of the disease, accounting for increased mortality rate in severely affected patients. Nevertheless, to objectively delve into the direct relation between the neurologic symptoms and COVID-19, medical comorbidities of patients should also be considered [2]. Further studies are needed because we are in the midst of an ongoing pandemic of COVID-19, and neurologists may be confronted with new-onset neurologic symptoms owing to COVID-19. SARS-CoV-2 penetrates via human angiotensin-converting enzyme-2 receptor (ACE-2) that was also utilized by severe acute respiratory syndrome coronavirus (SARS CoV) [3]. Glial cells and neurons have been reported to express ACE-2 receptors, which make them a potential target of COVID-19. It was indicated that SARS CoV causes neuronal death by invading the brain via olfactory epithelium [4]. The electron microscopy, immunohistochemistry, and real-time reverse transcription- PCR findings have corroborated the presence of SARS-CoV in the brain tissue [4] and cerebrospinal fluid [5]. Together, it can be speculated that SARS-CoV-2 can affect the brain by penetrating the brain via the cribriform plate, which can account for the early findings of the COVID-19 like altered sense of smell or hyposmia. Because SARS-CoV-2 causes severe respiratory symptoms in people aged 60 years and older, it has important implications for patients with Alzheimer's disease (AD) [6]. Therefore, in the countries that have taken action to the virus, clinic studies of AD have been stopped to protect the patients. However, rigorous quarantine of elders has aborted clinic trials and experimental studies conducted with transgenic animals. Transgenic models are quite expensive; the loss of these animals has costly consequences. There is no doubt that this storm will stop, but its catastrophic effects on dementia research will continue for a time. Thus, dementia researchers and pharmaceutical companies should determine an emergency action plan to exit the chaos of this pandemic. Here, we listed some challenges in dementia research during the COVID-19 outbreak and table some suggestions. All countries try to control SARS-CoV-2 by social distancing. Therefore, neurology clinics were closed, and routine examination of Alzheimer's patients was stopped. However, the lockdown of patients with AD caused clinical studies to stop. which has severely affected dementia research. Additionally, the arrest of experimental studies due to the closing of universities in two hundred countries also deprives experimental achievements. The closing of universities may lead to data loss, death of expensive transgenic animals, international researchers to be faced with visa problems, and be lost the laboratory staff whose contract has expired [7]. It is impossible that forecasting when this COVID-19 pandemic will end is impossible and thus, it is essential that a solution be developed to continue dementia studies on Alzheimer's patients. Remote monitoring of the patients with the use of technology is in the lead of possible solutions. Clinicians can continue to follow their patients by telemedicine [8], but extended lockdown of patients may cause depression in both patients and their caregivers [9]. It is also known that movement restriction exacerbates AD symptoms [10]. The monitorization of the patient in this condition with telemedicine would not provide objective data. In addition, when patients living in rural areas are considered, it will not be a surprise that reaching equally all patients is impossible. Therefore, a collective action plan protecting dementia research during the COVID-19 outbreak should be prepared by a consortium of pharmaceutical companies, researchers, clinicians, and patients. Data loss is in the lead of expected problems during the COVID-19 outbreak. For example, the planned ending dates of phase 2/3 trials of gantenerumab (Roche) and solanezumab (Lilly) were missed [11]. It is highly essential that patients be monitored from their homes with telemedicine to protect them. Nonetheless, it is not sufficient for the continuation of clinical trials and experimental studies. We suggest that patients of phase trails should be isolated in fully-equipped nursing homes managed by qualified personnel. In this way, the patients can be more effectively protected from SARS-CoV-2 and the depression caused by the lockdown.Young family members going out for basic needs could infect older family members. Also, patients with AD pay less attention to hand hygiene, which makes them more susceptible to SARS-CoV-2. Moreover, cats have recently been shown to be infected by SARS-CoV-2 [12]. Patients with AD may not follow directions of neurologists on telemedicine and thus, the interaction of Alzheimer's patients with pets can cause a dangerous scenario. Consequently, the lockdown of patients with dementia in their homes might not be an appropriate exit strategy for the future of dementia research. On the other hand, it is important to mention here that the nursing home capacity of the United States may not be sufficient for 5,8 million Alzheimer's patients aged 65 years and older [13]. Thus, we highlight that only the patients involved in the clinic trails should be followed in the nursing homes. The other patients can be monitored with telemedicine from their homes. The data will hardly be lost in patients isolated in nursing homes. In this strategy, secondary risk factors affecting the clinic trails like depression are also removed. The motivations of clinicians and researchers is as important as the patients in the catastrophic atmosphere of the outbreak. Governments, media, and funders can support the motivations of clinicians and researchers. For example, research funders and pharmaceutical companies can extend project deadlines and provide an additional promotion to the researchers who have completed their clinic trails. Consequently, a global action plan should be prepared to block SARS-CoV-2 penetration to dementia research. At first glance, it may be thought that the most appropriate strategy for patients with dementia is social isolation in their homes during the outbreak as in healthy young people and elders. However, we suggest that isolating patients with dementia in fully-equipped nursing homes can be a more appropriate exit strategy for the protection of dementia patients and research.


title: Left atrial appendage occlusion with the AMPLATZER Amulet device: one-year follow-up from the prospective global Amulet observational registry.

text: AIMS Left atrial appendage occlusion (LAAO) is a stroke prevention therapy for patients with non-valvular atrial fibrillation (AF). This study reports one-year outcomes from patients enrolled in the prospective global Amulet registry. METHODS AND RESULTS A total of 1,088 patients were recruited, aged 75±9 years; 65% of patients were male. The CHA2DS2-VASc and HAS-BLED scores were 4.2±1.6 and 3.3±1.1, respectively. Eighty-three percent (83%) of patients had contraindications to anticoagulation (OAC); 72% had a history of major bleeding. An AMPLATZER Amulet LAA occluder was successfully implanted in 99% of cases. Transoesophageal echocardiography one to three months after implant showed no residual flow or flow <3 mm in 98.4%. The observed ischaemic stroke rate was 2.9%/year. Device-related thrombus was noted in 1.7% of patients. There were ten cases between 0 and 90 days and eight cases between 91 and 365 days. Patients discharged without OAC (>80%), in particular those on single aspirin therapy, did not appear to have a higher risk of device-related thrombus. In the first year, major bleeding occurred at an annualised rate of 10.3%. All-cause mortality was 8.4% at one year. CONCLUSIONS In the global prospective Amulet registry of patients at high risk of stroke and bleeding, the annualised ischaemic stroke rate was 2.9%. The LAA was sealed in 98.4% after one to three months and device-related thrombus was observed in 1.7% of cases with only a minority of all patients on anticoagulation treatment.


title: Rational modifications, synthesis and biological evaluation of new potential antivirals for RSV designed to target the M2-1 protein.

text: Respiratory syncytial virus (RSV) is the main cause of lower respiratory tract diseases in infants and young children, with potentially serious and fatal consequences associated with severe infections. Despite extensive research efforts invested in the identification of therapeutic measures, no vaccine is currently available, while treatment options are limited to ribavirin and palivizumab, which both present significant limitations. While clinical and pre-clinical candidates mainly target the viral fusion protein, the nucleocapsid protein or the viral polymerase, our focus has been the identification of new antiviral compounds targeting the viral M2-1 protein, thanks to the presence of a zinc-ejecting group in their chemical structure. Starting from an anti-RSV hit we had previously identified with an in silico structure-based approach, we have designed, synthesised and evaluated a new series of dithiocarbamate analogues, with which we have explored the antiviral activity of this scaffold. The findings presented in this work may provide the basis for the identification of a new antiviral lead to treat RSV infections.


title: Management of Lung Cancer During the COVID-19 Pandemic.

text: Coronavirus disease 2019 (COVID-19) has had a devastating impact around the world. With high rates of transmission and no curative therapies or vaccine yet available, the current cornerstone of management focuses on prevention by social distancing. This includes decreased health care contact for patients. Patients with lung cancer are a particularly vulnerable population, where the risk of mortality from cancer must now be balanced by the potential risk of a life-threatening infection. In these unprecedented times, a collaborative and multidisciplinary approach is required to streamline but not compromise care. We have developed guidelines at our academic cancer center to standardize management of patients with lung cancer across our health care system and provide guidance to the larger oncology community. We recommend that general principles of lung cancer treatment continue to be followed in most cases where delays could result in rapid cancer progression. We recognize that our recommendations may change over time based on clinical resources and the evolving nature of the COVID-19 pandemic. In principle, however, treatment paradigms must continue to be individualized, with careful consideration of risks and benefits of continuing or altering lung cancer-directed therapy.


Quantum computing: how conditions created by the COVID-19 shutdown are delivering 'the best data we have ever seen'.


title: Intramedullary nailing versus locked plate for treating supracondylar periprosthetic femur fractures.

text: The objective of this study was to compare retrograde intramedullary femoral nailing with supracondylar locked screw-plate fixation for the treatment of periprosthetic femur fractures following total knee arthroplasty. Time to union and full weight bearing were the primary study outcomes, with perioperative blood loss, need for transfusion, need for revision surgery, and infection being the secondary outcomes. A retrospective review of 63 patients who sustained Rorabeck Type II periprosthetic femoral fractures was undertaken. Patients were pooled from 3 academic institutions between 2001 and 2009. Patients eligible for the study were identified from the electronic medical record using an IDX query of International Classification of Diseases 9 and Current Procedural Terminology codes for fixation of femur fracture with intramedullary implant or plate and screws. In the series, 35 patients were treated with intramedullary femoral nailing and 28 with a locked screw-plate. The 2 groups were compared for radiographic union at 6, 12, 24, and 36 weeks. At 36 weeks, radiographic union was significantly greater in the locked screw-plate group. Time to full weight bearing was not significantly different. A greater perioperative transfusion rate was observed in the locking plate group, but it also had an overall lower rate of reoperation, for any reason, compared with the intramedullary femoral nailing group. The results support the use of a laterally based locked plate in the treatment of Rorabeck type II distal femur periprosthetic fractures.