title: Beyond the fear: Nurses' experiences caring for patients with Middle East respiratory syndrome: a phenomenological study.

text: AIM AND OBJECTIVES We explored the experiences of Korean nurses who had directly cared for patients with Middle East respiratory syndrome (MERS) to derive the structure and meaning of these experiences. BACKGROUND In 2015, the MERS epidemic struck Korea, and ill-prepared nurses had to care for patients with MERS. Nurses experienced conflict between their fear of the disease and their work and professional ethic. DESIGN We employed a phenomenological qualitative approach. METHODS Inductive, qualitative, in-depth interviews were performed with 17 nurses. The study process followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS The qualitative inductive content analysis generated seven theme cluster and 18 themes. The theme clusters were "Fear of Uncertainty", "Beyond Hesitation", "A Scene Like a Battlefield", "Chaotic Nursing Identity", "Buttresses for Sustainability", "Lingering Trauma" and "Expanded Horizon of Nursing". The final analysis revealed that the core theme was "Beyond the fear of uncertainty". CONCLUSIONS This study contrives a more in-depth, holistic understanding by describing the experiences of nurses who directly cared for patients with MERS-the first large-scale infectious disease in Korea. Although nurses saw themselves as vital caregivers, they were frightened of the disease, had to work in a harsh environment, experienced various internal conflicts, and had to deal with varying forms of uncertainty. RELEVANCE TO CLINICAL PRACTICE This study sheds light on the nursing situation during crises involving serious infectious diseases; to combat these, more medical facilities are needed, and staff should be proactively guided on how to care for patients. It can serve as part of a good foundation for further study of medical staff during recurring epidemics.


title: Robotic partial nephrectomy with intracorporeal renal hypothermia using ice slush.

text: OBJECTIVE To outline our technique for intracorporeal cooling with ice slush during robotic partial nephrectomy (RPN), with real-time parenchymal temperature monitoring. MATERIALS AND METHODS Eleven consecutive patients with enhancing solid renal masses suitable for treatment with RPN between September 2013 and January 2014 were included in the analysis. Institutional review board approval and informed consent were obtained. Preoperative patient characteristics, intraoperative surgical parameters including patient body temperature and ipsilateral kidney temperature with real-time monitoring, and short-term functional outcomes were analyzed. RESULTS Median age was 55 years (range, 39-75 years) and American Society of Anesthesiologists score was 3 (range, 2-4). Median tumor size was 4 cm (range, 2.3-7.1) and RENAL nephrometry score was 9 (range, 5-11). One patient had a solitary kidney. During cooling, the lowest median renal parenchymal temperature was 17.05°C (range, 11°C-26°C) and cold ischemia time was 27.17 minutes (range, 18-49 minutes). Median time to latest postoperative estimated glomerular filtration rate was 12 days (range, 2-30 days). Median glomerular filtration rate preservation was 81% (range, 47.9%-126%). There was one positive margin. There were no postoperative complications, and no patients experienced a prolonged ileus. The limitations of this study include a small number of patients and short-term follow-up. CONCLUSION RPN with renal hypothermia using intracorporeal ice slush is technically feasible. Our simplified method of introducing the ice slush was free of complications and highly reproducible. The use of a needle temperature probe allowed us to monitor in real time cooling of the renal parenchyma.


docid: mygsuief

title: Use of the microangiographic fluoroscope for coiling of intracranial aneurysms.

text: BACKGROUND Neurointervention is an ever-evolving specialty with tools including microcatheters, microwires, and coils that allow treatment of pathological conditions in increasingly smaller intracranial arteries, requiring increasing accuracy. As endovascular tools evolve, so too should the imaging. OBJECTIVE To detail the use of microangiography performed with a novel fluoroscope during coiling of intracranial aneurysms in 2 separate patients and discuss the benefits and potential limitations of the technology. METHODS The microangiographic fluoroscope (MAF) is an ultra high-resolution x-ray detector with superior resolution over a small field of view. The MAF can be incorporated into a standard angiographic C-arm system for use during endovascular procedures. RESULTS The MAF was useful for improved visualization during endovascular coiling of 2 unruptured intracranial aneurysms, without adding significant time to the procedure. No significant residual aneurysm filling was identified post-coiling, and no complications occurred. CONCLUSION The MAF is a high-resolution detector developed for use in neurointerventional cases in which superior image quality over a small field of view is required. It has been used with success for coiling of 2 unruptured aneurysms at our institution. It shows promise as an important tool in improving the accuracy with which neurointerventionists can perform certain intracranial procedures.


Confronting COVID-19: Issues in Hemophilia and Congenital Bleeding Disorders.


title: Nontransfemoral Approaches to Transcatheter Aortic Valve Replacement.

text: Transcatheter aortic valve replacement (TAVR) is noninferior to surgical aortic valve replacement in patients with high operative risk and superior to medical treatment in patients deemed unsuitable for surgical intervention. However, up to 30% to 50% of patients screened for this intervention are not candidates for TAVR via the preferred transfemoral route because of severe peripheral arterial disease. Alternative access routes must be considered and include the transapical, transaortic, transsubclavian, and transcarotid approaches. The use of alternative access is predicated on appropriate patient selection as determined by a dedicated multispecialty heart valve team and can lead to excellent outcomes.


Why covid-19 antibody tests are not the game changer the UK government claims.


title: Laparoscopic approach to colo-renal fistula with renal preservation and omentoplasty: A case report.

text: Colorenal fistula as a result of percutaneous cryoablation has not been extensively reported. We report a gentleman who presented with urosepsis after percutaneous biopsy of a renal mass complicated by colorenal fistula. After failed attempts at conservative management, he underwent laparoscopic resection of his fistula with renal salvage and omentoplasty highlighting that nephrectomy is not always indicated.


docid: syeqobao

title: Combination therapy with lopinavir/ritonavir, ribavirin and interferon-α for Middle East respiratory syndrome.

text: Since the first report of Middle East respiratory syndrome (MERS) in 2012 in Saudi Arabia, no standard treatment guideline has been set despite the virulence of MERS-coronavirus (CoV) and the high case-fatality rate. The outbreak in South Korea in 2015 demonstrates that MERS outbreaks can occur outside of the Middle East. The combination of ribavirin and interferon-α has been the most widely used therapy for this infection. However, due to the varying results of treatment with these drugs, a new antiviral combination regimen is urgently needed. This is a case report of use of lopinavir/ritonavir-based combination antiviral therapy for a patient with MERS-CoV infection.


title: Clinical characteristics and outcomes of cancer patients with COVID-19.

text: OBJECTIVE This retrospective study aimed to analysis clinical characteristics and outcomes of cancer patients with novel coronavirus disease-19 (COVID-19). METHOD Medical records, laboratory results and radiologic findings of 52 cancer patients with COVID-19 were collected, clinical characteristics and outcomes were summarized. RESULTS A total of 52 cancer patients with COVID-19 were included. Median age of 52 cancer patients with COVID-19 was 63 years (34-98). 33(63.5%) patients were mild and 19(36.5%) were severe/critical. Lung cancer was the most frequent cancer type (10, 19.2%). The common symptoms were as follows: fever (25%), dry cough (17.3%), chest distress (11.5%) and fatigue (9.6%).There were 33(63.5%) patients had comorbidities, the most common symptom was hypertension (17, 51.5%). 26(78.8%) patients developed pneumonia on admission. Lymphocytes (0.6×109 /L) decreased in both mild and severe/critical patients. Median levels of D-dimer, C-reactive protein(CRP), procalcitonin (PCT) and lactate dehydrogenase(LDH) were 2.8 mg/L, 70.5 mg/L, 0.3 ng/mL, and 318 U/L respectively, which increased significantly in severe/critical patients compared to the mild patients. Interleukin 6(IL-6) (12.6 pg/ml) increased in both mild and severe/critical patients, there was a significant difference between them. Complications were observed in 29(55.8%) patients, such as liver injury (19, 36.5%), acute respiratory distress syndrome (ARDS) (9, 17.3%), sepsis (8, 15.4%), myocardial injury (8, 15.4%), renal insufficiency (4, 7.7%), and multiple organ dysfunction syndrome (MODS) (3, 5.8%).11(21.2%) cancer patients died. CONCLUSION The infection rate of severe acute respiratory syndrome coronavirus 2(SARS-COV-2) in cancer patients was higher than the general population, cancer patients with COVID-19 showed deteriorating conditions and poor outcomes. This article is protected by copyright. All rights reserved.


title: Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery.

text: PURPOSE To compare the results of conventional Lichtenstein hernioplasty with polypropylene mesh (PLP) with a lightweight self-adhesive mesh (Parietene Progrip®; Covidien, Dublin, Ireland) (PPG) used in patients with bilateral inguinal hernia. METHODS Randomised clinical trial with 89 patients with a minimum follow-up of 1 year. Every patient had bilateral inguinal hernia and had both prostheses implanted randomly, one on each side. Early postoperative and chronic pain was evaluated using the visual analogue scale. Also recurrence rate and subjective evaluation of patients were analysed. RESULTS Pain in the early postoperative period was inferior on the side where the self-adhesive mesh had been implanted (6.12 vs. 6.62, p=0.005 during the 1st postoperative day; 2.12 vs. 2.62, p=0.001 during the 7th postoperative day). Differences disappeared with the long-term evaluation (0.71 vs. 0.98, p=0.148 1 year after the surgery). The operative time was significantly shorter on the PPG mesh side (24.37 ± 5.1 in case of the PPG mesh and 29.66 ± 5.6 in case of the PLP mesh, p<0,001). Recurrence occurred in seven patients (7.8%), six of them (6.7%, CI 3.0-14.4) on the PPG mesh side and one (1.1%, CI 0.2-7.8) on the PLP side. These differences were not statistically significant (p=0.125) CONCLUSIONS: Although hernioplasty with self-adhesive mesh reduced early postoperative pain, this reduction was clinically irrelevant and it had no influence on chronic pain. There was a trend towards a higher recurrence rate when self-adhesive meshes were used, and although in this study differences were not statistically significant they should be confirmed in later studies using larger samples. Surgical procedures that do not need fixing sutures are promising, but further studies are needed before they become the gold standard of inguinal hernia repair.


title: [Relationship between D-dimer concentration and inflammatory factors or organ function in patients with coronavirus disease 2019].

text: OBJECTIVE To explore the relationship between D-dimer concentration and inflammatory factors or organ function in patients with coronavirus disease 2019 (COVID-19). METHODS A retrospective study was conducted. The clinical data of 72 patients with COVID-19 admitted to intensive unit of Tongji Guanggu Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei Province from February 10th to 29th in 2020 were collected, including their general information, routine blood test, coagulation function, inflammatory parameters, cytokines, and organ function related laboratory parameters at admission. The patients were divided into two groups, namely D-dimer normal group (< 0.5 mg/L) and D-dimer elevated group (≥ 0.5 mg/L). The differences of general data, inflammatory parameters and cytokines between the two groups were compared. Besides, the correlation between D-dimer and organ function was analyzed by linear regression. The change in sequential organ failure assessment (SOFA) between the first visit after the onset of the disease and admission to intensive unit ≥ 2 was defined as being combined with organ damage. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of D-dimer on organ damage in patients with COVID-19. RESULTS 65.3% of the 72 patients had abnormal coagulation. The D-dimer level of COVID-19 patients gradually increased with the aggravation of the disease, and the levels of ordinary type (n = 14), severe type (n = 49), and critical type (n = 9) were 0.43 (0.22, 0.89), 0.66 (0.26, 1.36), and 2.65 (0.68, 15.45) mg/L, respectively, with statistically significant difference (P < 0.05). Thirty-two patients (44.4%) had normal D-dimer, and 40 (55.6%) had elevated D-dimer. Compared with the normal D-dimer group, the patients in the D-dimer elevated group were older (years old: 67.7±11.6 vs. 54.0±13.1), and the levels of white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), interleukins (IL-6, IL-8, IL-10), IL-2 receptor (IL-2R) and tumor necrosis factor-α (TNF-α) at admission were significantly higher [WBC (×109/L): 7.16 (5.55, 9.75) vs. 5.25 (4.59, 6.98), NEU (×109/L): 7.11±5.46 vs. 3.33±1.58, PCT (μg/L): 0.08 (0.06, 0.21) vs. 0.05 (0.04, 0.06), hs-CRP (mg/L): 27.9 (3.4, 58.8) vs. 1.3 (0.8, 6.6), IL-6 (ng/L): 11.80 (2.97, 30.61) vs. 1.98 (1.50, 4.73), IL-8 (ng/L): 19.90 (13.33, 42.28) vs. 9.40 (12.35, 15.30), IL-10 (ng/L): 5.00 (5.00, 8.38) vs. 5.00 (5.00, 5.00), IL-2R (kU/L): 907.90±458.42 vs. 572.13±274.55, TNF-α (ng/L): 10.94±5.95 vs. 7.77±3.67], while lymphocyte (LYM) and monocyte (MON) counts were lower [LYM (×109/L): 1.14±0.49 vs. 1.46±0.42, MON (×109/L): 0.63±0.25 vs. 0.87±0.21], with significant differences (all P < 0.05). Linear regression analysis showed that D-dimer level was negatively related with pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2) and platelet count (PLT) with β values of -0.493, -11.615, and -0.018, respectively (all P < 0.05). However, D-dimer level was positively related with respiratory rate (RR), aspartate aminotransferase (AST), total bilirubin (TBil) and direct bilirubin (DBil) with β values of 0.485, 0.107, 0.291, and 0.404 (all P < 0.05). ROC curve analysis showed that the area under ROC curve (AUC) of D-dimer for predicting organ injury in COVID-19 patients was 0.889, and the 95% confidence interval (95%CI) was 0.753-1.000. When the optimal cut-off value was 2.36 mg/L, the sensitivity was 85.7%, and the specificity was 78.1%. CONCLUSIONS D-dimer levels in COVID-19 patients are correlated with inflammatory factors and organ function, and it can be used to predict organ injury.


News Feature: How air pollution threatens brain health.


title: Direct upper kidney pole access and early ligation of renal pedicle significantly facilitates transperitoneal laparoscopic nephrectomy procedures: Tunc technique.

text: We modified our technique in transperitoneal laparoscopic nephrectomies and compared its results with the classical technique. Classical technique was performed in 85 cases (group 1). Modified technique (n=98) included direct kidney upper pole access and early ligation of renal pedicle (group 2). No significant differences were detected regarding mean patient age, intraoperative blood loss, and duration of hospital stay between the 2 groups (P>0.05). Mean operation time was 64.9 ± 19.3 and 28.2 ± 7.7 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including right nephrectomies was 68.7 ± 23.4 and 24.2 ± 6.3 minutes, respectively in groups 1 and 2 (P=0.001). Mean operation time including left nephrectomies was 63.8 ± 17.1 and 33.6 ± 5.1 minutes, respectively in groups 1 and 2 (P=0.001). Similarly, mean operation time was significantly shorter in group 2 when analysis was performed among right and left radical and simple nephrectomies between the 2 groups (P=0.001). Direct upper kidney pole access and early ligation of renal pedicle seems to be significantly facilitating transperitoneal laparoscopic nephrectomy procedures.


Endovascular stapler failure necessitating cardiopulmonary resuscitation of the donor after laparoscopic donor nephrectomy.


title: Laparoscopic intussuscepting pancreaticojejunostomy.

text: Perhaps the greatest barrier to adoption of laparoscopic pancreaticoduodenectomy by experienced pancreatic surgeons is the technical challenge of constructing the pancreaticojejunostomy (PJ). The authors present a less demanding PJ technique they have developed that creates an end-to-end intussuscepting anastomosis using a running monofilament suture. This method reduces technical complexity and operative time while producing acceptably comparable outcomes.


title: Crystal structure of bovine coronavirus spike protein lectin domain.

text: The spike protein N-terminal domains (NTDs) of bovine coronavirus (BCoV) and mouse hepatitis coronavirus (MHV) recognize sugar and protein receptors, respectively, despite their significant sequence homology. We recently determined the crystal structure of MHV NTD complexed with its protein receptor murine carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), which surprisingly revealed a human galectin (galactose-binding lectin) fold in MHV NTD. Here, we have determined at 1.55 Å resolution the crystal structure of BCoV NTD, which also has the human galectin fold. Using mutagenesis, we have located the sugar-binding site in BCoV NTD, which overlaps with the galactose-binding site in human galectins. Using a glycan array screen, we have identified 5-N-acetyl-9-O-acetylneuraminic acid as the preferred sugar substrate for BCoV NTD. Subtle structural differences between BCoV and MHV NTDs, primarily involving different conformations of receptor-binding loops, explain why BCoV NTD does not bind CEACAM1 and why MHV NTD does not bind sugar. These results suggest a successful viral evolution strategy in which coronaviruses stole a galectin from hosts, incorporated it into their spike protein, and evolved it into viral receptor-binding domains with altered sugar specificity in contemporary BCoV or novel protein specificity in contemporary MHV.


title: Preparing maternity for COVID-19: A translational simulation approach.

text: COVID-19 has posed major challenges for health care. Hospitals around the world have needed to rapidly prepare for the emerging pandemic. Translational simulation - simulation that is integrated and focused on emerging clinical priorities - offers numerous opportunities to aid in pandemic preparation. We describe our approach to preparing our institution's maternity services for the COVID-19 pandemic using translational simulation. We suggest lessons for providers of maternity services, and for those who support them through simulation activities.


title: Bilateral spermatic cord en bloc ligation by laparoendoscopic single-site surgery: preliminary experience compared to conventional laparoscopy.

text: BACKGROUND Laparo Endoscopic Single-site Surgery (LESS) represents an evolution of minimally invasive surgery and aims to improve cosmetic outcome and reduce surgical trauma and complications associated with traditional laparoscopy. This study was performed to present our preliminary experience in bilateral spermatic cord ligation with the LESS technique and compare the results with the outcomes of conventional laparoscopic surgery. METHODS Between June 2007 and May 2013, 24 patients were referred to our institute for bilateral varicocelectomy. The indications for this type of procedure were bilateral varicocele with impairment of semen parameters or chronic bilateral testicular pain. All procedures were performed via the same surgeon. The patients were divided into two groups according to the type of laparoscopic surgery. Group A included 10 patients underwent LESS technique while group B included the remaining 14 patients that underwent conventional laparoscopy. RESULTS The comparison between the two techniques showed some important advantages for LESS: shorter operating time (45.4 min vs. 88.3 (P < .001), shorter hospital stay (16.6 hours vs. 51.4 hours) (P < .001), early return to the normal activity (2.3 days vs. 4.7 days) and better cosmetic outcomes. No conversions from LESS to conventional laparoscopy were necessary and blood loss was insignificant in all patients.All patients in the LESS group reported full satisfaction with the cosmetic outcome, whereas 85.7% of patients after conventional laparoscopy were fully satisfied with cosmesis. CONCLUSIONS Bilateral spermatic cord ligation with LESS is an alternative to conventional laparoscopy. The procedure was successfully performed in all patients. The trans-umbilical approach offers the advantage of a better cosmetic result, shorter hospital stay and less postoperative pain.


docid: hetqphsd

title: Otolaryngologists and the Doctor-Patient Relationship during a Pandemic.

text: The COVID-19 pandemic has forced otolaryngologists and their patients to confront issues that they have rarely if ever previously faced. Prominent among these is the need to put the collective good ahead of the interests of individual patients with otolaryngologic disorders. We argue that the individual doctor-patient relationship remains paramount even at a time when public health principles mandate systems-level thinking.


title: Comparison of OrVil™ and RPD in laparoscopic total gastrectomy for gastric cancer.

text: BACKGROUND Laparoscopic total gastrectomy (LTG) is frequently performed for treating patients with gastric cancer; however, the absence of anastomotic techniques with greater superiority has impaired its popularization. We have compared two types of anastomotic techniques with regard to technical perspectives and clinical outcomes. METHODS We reviewed 43 patients with gastric cancer who underwent LTG. Two types of anastomotic techniques have been applied after LTG-the trans-orally inserted anvil (OrVil™) and the reverse puncture device (RPD). Data on the type of anastomosis, blood loss, operation time, anastomosis time, location of tumors, distance between the top border of tumors and top resection margin, diameter of tumor, length of postoperative hospital stay, early and late postoperative complications, and total cost of surgical consumables were obtained by reviewing patient medical records and analyzed thereafter. RESULTS We included 32 men and 11 women (mean age 61 years). The loss to follow-up rate was 13.2%. The median survival time for the OrVil™ and RPD groups was 23 and 22 months, respectively. The total rate of complications was 9.3%. The difference in the anastomosis times between the groups was statistically significant. OrVil™ required more time than RPD and cost more than RPD. CONCLUSIONS Both the OrVil™ and RPD techniques showed good safety and applicability in LTG. RPD showed an advantage with regard to lesser operative complexity and lower cost.


title: Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma?

text: BACKGROUND LESS (laparoendoscopic single-site) surgery has been developed as a treatment option for adrenal tumors that has less postoperative pain and greater cosmetic benefits. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as an advanced indication. The aim of this study is to compare LESS adrenalectomy (ADX) with conventional adrenalectomy (CL-ADX) in patients with PHE, with attention paid not only to immediate postoperative outcomes but also to the intraoperative hemodynamic changes that occur with each technique. METHODS The records of 265 consecutive patients who underwent laparoscopic ADX at Keio University Hospital in Tokyo from January 2001 to June 2011 were entered into a database. Surgical procedures were performed or supervised by two experienced laparoscopic surgeons, who performed more than 100 cases of urologic laparoscopic surgery in 2011. Twenty consecutive patients who underwent LESS-ADX from December 2009 to October 2011 were compared with patients who underwent CL-ADX (controls, n = 30) to look at differences in hemodynamic parameters and surgical outcomes in a case-control analysis. RESULTS Each group was equivalent with respect to age, sex, and BMI. The mean size of 50 PHE was 45.1 ± 4.0 mm, the mean operative time was 151.8 ± 10.6 min, and there was no significant difference between the two groups. In one case of LESS-ADX, two additional ports were added. There was no significant difference between the CL-ADX and LESS-ADX groups in terms of operation time, total fluid during the operation, estimated blood loss, first oral feeding, postoperative stay in the intensive care unit, or postoperative hospital stay. CONCLUSIONS We consider the safety of LESS-ADX of PHE as similar to that of CL-ADX. With appropriate pre- and intraoperative hemodynamic control and experienced hands, LESS-ADX could become one of the treatments of choice for resection of PHE.


title: Proper mesh overlap is a key determinant in hernia recurrence following laparoscopic ventral and incisional hernia repair.

text: BACKGROUND Ventral hernia can be repaired through either an open or laparoscopic approach. A major problem following hernia repair is recurrence, and the technique used for hernia repair influences the rate of hernia recurrence. Data from individual studies show that the area of mesh overlap used during hernia repair correlates with hernia recurrence, but no meta-analyses have previously been published. The aim of this review was to perform a meta-analysis to determine if the area of mesh overlap correlates with the rate of hernia recurrence after ventral and incisional hernia repair. METHODS Studies from 1990 to 2013 that used a mesh in open or laparoscopic procedures, and that reported both the area of mesh overlap beyond the fascial defect and the recurrence rate, were assessed for inclusion in the final analysis. A pooled estimation of combined overall risk was calculated according to a random effect model. RESULTS A total of 95 articles, with 111 study populations, met all criteria and were included in the final analysis. For open procedures, results showed no correlation between the pooled estimation of risk for recurrence of ventral hernia and area of mesh overlap used for hernia repair (<3 cm, incidence rate 0.065; 3-5 cm, incidence rate 0.070; >5 cm, incidence rate 0.060). In laparoscopic procedures, the pooled estimation of risk for recurrence of hernia decreased with increasing area of mesh overlap (<3 cm, incidence rate 0.086; 3-5 cm, incidence rate 0.046; >5 cm, incidence rate 0.014). CONCLUSION Risk of hernia recurrence decreases with increasing area of mesh overlap in laparoscopic, but not open, procedures for ventral hernia repair.


How coronavirus dashed Ethiopia's dream of hosting Africa's first major AI conference.


title: Elevated pro-brain natriuretic peptide, troponin T and malnutrition inflammatory score in chronic hemodialysis patients with overt cardiovascular disease.

text: BACKGROUND We assessed the relationship between pro-brain natriuretic peptide (pro-BNP), troponin T (TropT) and nutritional status. METHODS A total of 48 chronic hemodialysis patients were grouped according to the presence [group A (GA); n = 24] or not [group B (GB)] of cardiovascular disease. RESULTS Compared to GB subjects, GA subjects were older, had been on hemodialysis for a longer period and had higher prevalences of vascular grafts, hypertension and elevated C-reactive protein (CRP) [GA vs. GB: 1.1 (range 0.1-32.9) vs. 0.4 (0-28.1) mg/dl; p = 0.028], malnutrition inflammatory score (MIS) (GA vs. GB: 7.50 vs. 4.00; p = 0.001), pro-BNP [GA vs. GB: 6,760 (601-103,200) vs. 686 (75-83,700) pg/ml; p < 0.001] and TropT [GA vs. GB: 0.3650 (0.011-0.199) vs. 0.010 (0.0-0.290) ng/ml; p = 0.002]. Pro-BNP correlated with TropT (rho 0.539; p < 0.001), MIS (rho 0.502; p < 0.0001), homocysteine (rho 0.321; p = 0.13) and CRP (rho 0.511; p < 0.0001). Pro-BNP levels were lower in GB patients as the body mass index increased; the opposite occurred in GA. CONCLUSIONS Patients with cardiovascular disease had elevated pro-BNP and TropT levels. In patients without cardiovascular disease, malnutrition and inflammation were associated with vascular prostheses, while pro-BNP was lower in obese patients.


title: Cerebral Angiography for Evaluation of Patients with CT Angiogram-Negative Subarachnoid Hemorrhage: An 11-Year Experience.

text: BACKGROUND AND PURPOSE CT angiography is increasingly used to evaluate patients with nontraumatic subarachnoid hemorrhage given its high sensitivity for aneurysms. We investigated the yield of digital subtraction angiography among patients with SAH or intraventricular hemorrhage and a negative CTA. MATERIALS AND METHODS An 11-year, single-center retrospective review of all consecutive patients with CTA-negative SAH was performed. Noncontrast head CT, CTA, DSA, and MR imaging studies were reviewed by 2 experienced interventional neuroradiologists and 1 neuroradiologist. RESULTS Two hundred thirty patients (mean age, 54 years; 51% male) with CTA-negative SAH were identified. The pattern of SAH was diffuse (40%), perimesencephalic (31%), sulcal (31%), isolated IVH (6%), or identified by xanthochromia (7%). Initial DSA yield was 13%, including vasculitis/vasculopathy (7%), aneurysm (5%), arteriovenous malformation (0.5%), and dural arteriovenous fistula (0.5%). An additional 6 aneurysms/pseudoaneurysms (4%) were identified by follow-up DSA, and a single cavernous malformation (0.4%) was identified by MRI. No cause of hemorrhage was identified in any patient presenting with isolated intraventricular hemorrhage or xanthochromia. Diffuse SAH was due to aneurysm rupture (17%); perimesencephalic SAH was due to aneurysm rupture (3%) or vasculitis/vasculopathy (1.5%); and sulcal SAH was due to vasculitis/vasculopathy (32%), arteriovenous malformation (3%), or dural arteriovenous fistula (3%). CONCLUSIONS DSA identifies vascular pathology in 13% of patients with CTA-negative SAH. Aneurysms or pseudoaneurysms are identified in an additional 4% of patients by repeat DSA following an initially negative DSA. All patients with CT-negative SAH should be considered for DSA. The pattern of SAH may suggest the cause of hemorrhage, and aneurysms should specifically be sought with diffuse or perimesencephalic SAH.


title: Robotic radical parametrectomy in cervical cancer.

text: Radical parametrectomy is indicated in cases of undiagnosed early-stage invasive cervical carcinoma discovered after simple hysterectomy performed for a presumed benign disease process. This radical surgical procedure is rarely performed for benign disease; however, there are some benign conditions such as endometriosis or ovarian remnant syndrome which may require wide excision, including parametria. Traditionally, radical parametrectomy has been performed via laparotomy; however, a minimally invasive approach via laparoscopy has been reported to be feasible and safe. Here we describe the robotic surgical approach to radical parametrectomy.


title: Treatment Outcomes of Meniscal Root Tears: A Systematic Review.

text: Purpose To report changes in outcomes for these 3 treatment options for meniscal root tears. Methods We systematically searched databases including PubMed, SCOPUS, and ScienceDirect for relevant articles. Criteria from the National Heart, Lung, and Blood Institute was used for a quality assessment of the included studies. A meta-analysis was performed to analyze changes in outcomes for meniscal repair. Results Nineteen studies, 12 level III and 7 level IV, were included in this systematic review, with a total of 1086 patients. Conversion to total knee arthroplasty (TKA) following partial meniscectomy ranged from 11% to 54%, 31% to 35% for nonoperative, conservative treatment, and 0% to 1% for meniscal repair. Studies comparing repair with either meniscectomy or conservative treatment found greater improvement and slower progression of Kellgren-Lawrence grade with meniscal repair. A meta-analysis of the studies included in the systematic review using forest plots showed repair to have the greatest mean difference for functional outcomes (International Knee Documentation Committee and Lysholm Activity Scale) and the lowest change in follow-up joint space. Conclusions In patients who experience meniscal root tears, meniscal repair may provide the greatest improvement in function and lowest risk of conversion to TKA when compared with partial meniscectomy or conservative methods. Partial meniscectomy appears to provide no benefit over conservative treatment, placing patients at a high risk of requiring TKA in the near future. However, future high-quality studies-both comparative studies and randomized trials-are needed to draw further conclusions and better impact treatment decision-making. Level of Evidence Level IV, systematic review of level III and level IV evidence.


title: Whole-proteome phylogeny of large dsDNA virus families by an alignment-free method.

text: The vast sequence divergence among different virus groups has presented a great challenge to alignment-based sequence comparison among different virus families. Using an alignment-free comparison method, we construct the whole-proteome phylogeny for a population of viruses from 11 viral families comprising 142 large dsDNA eukaryote viruses. The method is based on the feature frequency profiles (FFP), where the length of the feature (l-mer) is selected to be optimal for phylogenomic inference. We observe that (i) the FFP phylogeny segregates the population into clades, the membership of each has remarkable agreement with current classification by the International Committee on the Taxonomy of Viruses, with one exception that the mimivirus joins the phycodnavirus family; (ii) the FFP tree detects potential evolutionary relationships among some viral families; (iii) the relative position of the 3 herpesvirus subfamilies in the FFP tree differs from gene alignment-based analysis; (iv) the FFP tree suggests the taxonomic positions of certain "unclassified" viruses; and (v) the FFP method identifies candidates for horizontal gene transfer between virus families.


title: Detection of a respiratory coronavirus from tissues archived during a pneumonia epizootic in free-ranging Pacific harbor seals Phoca vitulina richardsii.

text: In June 2000, 21 adult harbor seals Phoca vitulina richardsii were found dead along a localized section of the central California coast. Necropsy of 5 fresh carcasses revealed pulmonary congestion, consolidation, and hemorrhage. Histopathological changes in lungs from 2 of these seals included a necrotizing lymphocytic and histocytic lobar pneumonia with intra-lesional bacteria. A coronavirus (CoV) was detected in archived tissues from 1 of the 5 seals via a degenerate PCR for nidoviral RNA-dependent RNA polymerase (RdRp), and was subsequently confirmed via specific PCR. Based on the partial RdRp sequence, the CoV was identified as a novel, divergent member of the CoV group 1a. The virus is tentatively named harbor seal coronavirus (HSCoV). The clinical significance of HSCoV and its involvement in the etiology of the epizootic pneumonia and deaths of the harbor seals is uncertain.


title: Personal protective equipment management and policies: European Network for Highly Infectious Diseases data from 48 isolation facilities in 16 European countries.

text: OBJECTIVE To collect data about personal protective equipment (PPE) management and to provide indications for improving PPE policies in Europe. DESIGN Descriptive, cross-sectional survey. SETTING AND PARTICIPANTS Data were collected in 48 isolation facilities in 16 European countries nominated by National Health Authorities for the management of highly infectious diseases (HIDs). METHODS Data were collected through standardized checklists at on-site visits during February-November 2009. Indications for adequate PPE policies were developed on the basis of a literature review, partners' expert opinions, and the collected data. RESULTS All facilities have procedures for the selection of PPE in case of HID, and 44 have procedures for the removal of PPE. In 40 facilities, different levels of PPE are used according to a risk assessment process, and in 8 facilities, high-level PPE (e.g., positive-pressure complete suits or Trexler units) is always used. A fit test is performed at 25 of the 40 facilities at which it is applicable, a seal check is recommended at 25, and both procedures are used at 17. Strategies for promoting and monitoring the correct use of PPE are available at 42 facilities. In case of a sudden increase in demand, 44 facilities have procedures for rapid supply of PPE, whereas 14 facilities have procedures for decontamination and reuse of some PPE. CONCLUSIONS Most isolation facilities devote an acceptable level of attention to PPE selection and removal, strategies for the promotion of the correct use of PPE, and ensuring adequate supplies of PPE. Fit test and seal check procedures are still not widely practiced. Moreover, policies vary widely between and within European countries, and the development of common practice procedures is advisable.


Social isolation in Covid-19: The impact of loneliness.


title: The RNA- and TRIM25-Binding Domains of Influenza Virus NS1 Protein Are Essential for Suppression of NLRP3 Inflammasome-Mediated Interleukin-1β Secretion.

text: UNLABELLED Inflammasomes are cytosolic multimolecular protein complexes that stimulate the activation of caspase-1 and the release of mature forms of interleukin-1β (IL-1β) and IL-18. We previously demonstrated that the influenza A virus M2 protein stimulates IL-1β secretion following activation of the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome. The nonstructural protein 1 (NS1) of influenza virus inhibits caspase-1 activation and IL-1β secretion. However, the precise mechanism by which NS1 inhibits IL-1β secretion remains unknown. Here, we showed that J774A.1 macrophages stably expressing the NS1 protein inhibited IL-1β secretion after infection with recombinant influenza virus lacking the NS1 gene. Coimmunoprecipitation assay revealed that the NS1 protein interacts with NLRP3. Importantly, the NS1 protein inhibited the NLRP3/ASC-induced single-speck formation required for full activation of inflammasomes. The NS1 protein of other influenza virus strains, including a recent pandemic strain, also inhibited inflammasome-mediated IL-1β secretion. The NS1 RNA-binding domain (basic residues 38 and 41) and TRIM25-binding domain (acidic residues 96 and 97) were required for suppression of NLRP3 inflammasome-mediated IL-1β secretion. These results shed light on a mechanism by which the NS1 protein of influenza virus suppresses NLRP3 inflammasome-mediated IL-1β secretion. IMPORTANCE Innate immune sensing of influenza virus via pattern recognition receptors not only plays a key role in generating type I interferons but also triggers inflammatory responses. We previously demonstrated that the influenza A virus M2 protein activates the NLRP3 inflammasome, leading to the secretion of interleukin-1β (IL-1β) and IL-18 following the activation of caspase-1. Although the nonstructural protein 1 (NS1) of influenza virus inhibits IL-1β secretion, the precise mechanism by which it achieves this remains to be defined. Here, we demonstrate that the NS1 protein interacts with NLRP3 to suppress NLRP3 inflammasome activation. J774A.1 macrophages stably expressing the NS1 protein suppressed NLRP3-mediated IL-1β secretion. The NS1 RNA-binding domain (basic residues 38 and 41) and TRIM25-binding domain (acidic residues 96 and 97) are important for suppression of NLRP3 inflammasome-mediated IL-1β secretion. These results will facilitate the development of new anti-inflammatory drugs.


title: Telehealth in palliative care is being described but not evaluated: a systematic review.

text: BACKGROUND Telehealth is growing and its application in palliative care is seen as a solution to pressures on palliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of evidence-based research to support its use. The primary aim of this review was to describe the current use of telehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The secondary aim was to explore whether telehealth results in a reduction in emergency care access. METHODS Systematic review of the literature with thematic synthesis. Records were screened and data extracted by two reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were searched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking was also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038. RESULTS The search identified 3807 titles and 30 studies were included in the review. Telehealth was used to support patients and carers, electronic record keeping and professional education. Notably, the number of home telemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were small scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently detailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some extent. Seven studies made reference to emergency care access. CONCLUSIONS Although there is growth of telehealth services, there remains a lack of evaluation and robust study design meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn. There is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is needed to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service standards.


title: A 10-year experience of totally extraperitoneal endoscopic repair for adult inguinal hernia.

text: PURPOSE Laparoscopic surgery is fast becoming the treatment of choice for inguinal hernia. By reviewing our 10-year experience of performing totally extraperitoneal repair (TEP), we sought to establish its clinical significance in the treatment of adult inguinal hernia. METHODS We reviewed retrospectively the clinical records of patients who underwent TEP for adult inguinal hernia between January 2003 and December 2012. RESULTS None of the 303 patients with adult primary or recurrent inguinal hernia in our study needed TEP converted to other procedures or suffered serious complications during the procedure. A significant difference was noted in the operation time between direct (n = 32) vs indirect (n = 128) hernias in the primary unilateral inguinal hernia group (91 ± 27 vs 80 ± 32 min, p = 0.033) and between direct/direct (n = 31) vs indirect/indirect (n = 24) hernias (136 ± 58 vs 89 ± 24 min, p = 0.01) in the primary bilateral inguinal hernia group. The only postoperative complications recorded were four cases of hernia recurrence (1.3 %) and one case of chronic pain (0.3 %). CONCLUSIONS The results obtained for TEP over 10 years support this as a promising procedure for the treatment of adult inguinal hernia.


title: Vitamin A and micronutrient deficiencies post-bariatric surgery: aetiology, complications and management in a complex multiparous pregnancy.

text: Adequate vitamin A is essential for healthy pregnancy, but high levels may be teratogenic. We present a patient who underwent bariatric surgery, prior to child bearing, and suffered maternal and foetal complications during eleven pregnancies, possibly associated with vitamin A deficiency, amongst multiple micronutrient deficiencies and risk factors including smoking and obesity. Maternal complications included visual disturbance, night blindness and recurrent infections. Recurrent foetal pulmonary hypoplasia and microphthalmia led to foetal and neonatal loss, not previously described in the medical literature. Current guidance on vitamin A deficiency in pregnancy is focused on developing countries where aetiology of vitamin A deficiency is different to that of women in developed countries. We describe nutritional management of the micronutritient deficiencies, focusing on vitamin A, during her last pregnancy. The need for specific antenatal nutritional guidance for pregnant women post-bariatric surgery is becoming more urgent as more mothers and offspring will be affected.


title: Percutaneous ablation of the small renal mass-techniques and outcomes.

text: An increasing number of T1a renal cell carcinomas are being diagnosed in recent years, in part due to incidental detection from the increased use of cross-sectional imaging. Although partial nephrectomy is still considered the primary treatment for these small renal masses, percutaneous ablation is now being performed as a standard therapeutic, nephron-sparing approach in patients who are poor surgical candidates. Clinical studies to date have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical settings. This article will review various clinical aspects regarding the percutaneous ablation of small renal masses, including patient selection, preprocedural preparations, and the procedural considerations of commonly employed ablative technologies. Specific techniques such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, and high-intensity focused ultrasound will be addressed in detail. In addition, the technical and oncologic outcomes of percutaneous ablation will be discussed and referenced to that of partial nephrectomy.


Modelling the pandemic.


title: Ureteric embolization for lower urinary tract fistulae: use of two amplatzer vascular plugs and N-butyl cyanoacrylate employing the "sandwich" technique.

text: PURPOSE This study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N-butyl cyanoacrylate. MATERIALS This is a retrospective study (January 2007-December 2010) of patients with urinary-vaginal fistulae undergoing distal ureter embolization utilizing an Amplatzer-N-butyl cyanoacrylate-Amplatzer sandwich technique. An 8-12-mm type-I or type-II Amplatzer vascular plug was delivered using the sheath and deployed in the ureter distal to the pelvic brim. Instillation of 0.8-1.5 cc of N-butyl cyanoacrylate into ureter proximal to the Amplatzer plug was performed. This was followed by another set of 8-12-mm type-I or type-II Amplatzer vascular plugs in a technique referred to as the "sandwich technique." RESULTS Five ureters in three patients were occluded utilizing the above-described technique during the 4-year study period. Mean maximum size Amplatzer used per ureter was 10.8 mm (range, 8-12). One ureter required three Amplatzer plugs and the rest required two. Two patients (3 ureters) were clinically successful with complete resolution of symptoms in 36-48 h. The third patient (2 ureters) was partly successful and required a second Amplatzer-N-butyl cyanoacrylate sandwich technique embolization. The mean clinical follow-up was 11.3 months (range, 1.7-29.2). CONCLUSIONS The Amplatzer-N-butyl cyanoacrylate-Amplatzer sandwich technique for occluding the distal ureter is safe and effective with a quick (probably due to the N-butyl cyanoacrylate) and durable (probably due to the Amplatzer plugs) clinical response.


The Author's Response: A Lesson from Temporary Closing of a Single University-affiliated Hospital owing to In-Hospital Transmission of Coronavirus Disease 2019.


The Promise of Electronic Case Reporting.


Profound sustained hypotension following renal denervation: a dramatic success?


title: Nonvascular Interventional Procedures in an Urban General Hospital: Analysis of 2001-2010 with Comparison to the Previous Decade.

text: RATIONALE AND OBJECTIVES To determine trends in nonvascular image-guided procedures at an urban general hospital over a 10-year period and to compare utilization of nonvascular interventional radiology (IR) over the decade 2001-2010 to a previously reported analysis for 1991-2000. METHODS With institutional review board approval, a 20-year quality assurance database verified against the radiology information system was queried for procedure location (eg, pleura, liver, bowel, and abdomen) and type (eg, biopsy, catheter insertion, and transient drainage), demographics, and change over time. Yearly admissions and new hospital numbers assigned each year served to normalize for overall hospital activity. RESULTS A total of 50,195 IR procedures were performed in 24,309 distinct patients (male:female, 12,625:11,684; average age, 60 years), 940 procedures performed in age <20 years, and 571 procedures performed in patients aged ≥90 years. A total of 15345, 4377, and 1754 patients had one, two, or three procedures, respectively; 470 had ≥10 procedures. Twenty-seven supervising radiologists and 277 individuals participated as operators, double the previous decade. Biopsy (4.8% average yearly increase), abdominal drainage (7.3%), paracentesis (12.9%), tube manipulation (13.0%), suprapubic bladder tube insertion (21.0%), and gastrostomy (44.6%) all increased strongly (P < .001) over 120 months but not biliary drainage, nephrostomy, or chest tubes. Procedures increased faster than either admissions or new hospital numbers (P < .001). For each 1000 new hospital numbers, IR service performed 48 procedures versus 31 the previous decade (P < .0005). CONCLUSIONS Referrals for nonvascular IR procedures have doubled over 2 decades, outpacing growth in new hospital patients and requiring increased resource allocation.


title: Radiological findings and clinical characteristics of pregnant women with COVID-19 pneumonia.

text: OBJECTIVE To study chest CT images and clinical characteristics of COVID-19 pneumonia in pregnant patients to examine any correlation. METHODS Between December 31, 2019 and March 7, 2020, 23 hospitalized pregnant patients with confirmed COVID-19 were enrolled in the study. Clinical presentations were collected retrospectively from records, including laboratory testing, chest CT imaging, and symptoms. Descriptive analysis and correlation of patients' clinical and CT characteristics were performed. Laboratory results from time of first admission and CT absorption (defined as reduction in lesion area, decrease in density, and absorption of some solid components) were compared between symptomatic and asymptomatic patients. RESULTS Fifteen (65.2%) patients were asymptomatic with patchy ground-glass opacity in a single lung lobe. Eight (34.8%) patients were symptomatic with multiple patchy ground-glass shadows, consolidation, and fibrous stripes. Differences in lymphocyte percentage and neutrophil granulocyte rate between first admission and CT absorption were significant (P<0.001). Median absorption time was shorter in the asymptomatic group compared with the symptomatic group (5 vs 10 days; P<0.001). Median hospitalization time between asymptomatic and symptomatic patients was 14 vs 25.5 days; P>0.001. Median absorption time and length of hospitalization for all patients was 6 days (IQR 5-8) and 17 days (IQR 13-25), respectively. CONCLUSION Radiological findings and clinical characteristics in pregnant women with COVID-19 were similar to those of non-pregnant women with COVID-19. Median absorption time and length of hospitalization in asymptomatic patients were significantly shorter than in symptomatic patients. Lymphocyte percentage and neutrophil granulocyte rate may be used as laboratory indicators of CT absorption.


title: Development of an Intracranial Dural Arteriovenous Fistula after Venous Sinus Stenting for Idiopathic Intracranial Hypertension.

text: We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.


title: Effect of acute nitrate supplementation on neurovascular coupling and cognitive performance in hypoxia.

text: The matching of oxygen supply to neural demand (i.e., neurovascular coupling (NVC)) is an important determinant of cognitive performance. The impact of hypoxia on NVC remains poorly characterized. NVC is partially modulated by nitric oxide (NO), which may initially decrease in hypoxia. This study investigated the effect of acute NO-donor (nitrate) supplementation on NVC and cognitive function in hypoxia. Twenty healthy men participated in this randomized, double-blind, crossover design study. Following normoxic cognitive/NVC testing, participants consumed either nitrate (NIT) or a NIT-depleted placebo (PLA). Participants then underwent 120 min of hypoxia (11.6% ± 0.1% O2) and all cognitive/NVC testing was repeated. NVC was assessed as change in middle cerebral artery (MCA) blood flow during a cognitive task (incongruent Stroop) using transcranial Doppler. Additional computerized cognitive testing was conducted separately to assess memory, executive function, attention, sensorimotor, and social cognition domains. Salivary nitrite significantly increased following supplementation in hypoxia for NIT (+2.6 ± 1.0 arbitrary units (AU)) compared with PLA (+0.2 ± 0.3 AU; p < 0.05). Memory performance (-6 ± 13 correct) significantly decreased (p < 0.05) in hypoxia while all other cognitive domains were unchanged in hypoxia for both PLA and NIT conditions (p > 0.05). MCA flow increased during Stroop similarly in normoxia (PLA +5 ± 6 cm·s(-1), NIT +7 ± 7 cm·s(-1)) and hypoxia (PLA +5 ± 9 cm·s(-1), NIT +6 ± 7 cm·s(-1)) (p < 0.05) and this increase was not altered by PLA or NIT (p > 0.05). In conclusion, acute hypoxia resulted in significant reductions in memory concomitant with preservation of executive function, attention, and sensorimotor function. Hypoxia had no effect on NVC. Acute NIT supplementation had no effect on NVC or cognitive performance in hypoxia.


title: Single-incision laparoscopic cholecystectomy--can we afford that? Cost comparison of different surgical techniques.

text: UNLABELLED One of the most commonly performed surgeries in general surgery wards with laparoscopic technique as a method of choice is gall-bladder excision. In addition to -the commonly used conventional laparoscopic cholecystectomy single incision laparoscopic cholecystectomy is getting more and more attention. Despite many works and studies comparing these methods, there is still a shortage of results assessing efficiency of this new surgical technique. The aim of the study was to evaluate cost-effectiveness of this method in Polish financial reality. We have analyzed costs of three different surgical techniques: conventional (multi- incision) laparoscopic cholecystectomy, SILC and 'no-port' SILC. MATERIAL AND METHODS We conducted a retrospective study that compared three groups of patients who underwent treatment with conventional laparoscopic cholecystectomy (n=20), SILC (n=20) and no-port SILC (n=20). These groups were matched by age, sex and BMI. Following parameters were analyzed: complication rate, operative time, operative costs, length of hospital stay, hospitalization costs. The SILC cases were performed with one of the three-trocar SILC ports available on the market. The 'no- port' SILC cases were performed by single skin incision in the umbilicus, insertion of one 10 mm trocar for the operating instrument, another instrument and scope were inserted directly thorough small incisions in the aponeurosis without a dedicated port RESULTS The average operative cost was significantly higher in the SILC group comparing to the conventional laparoscopy group and the no-port SILC group. There was no significant difference in complication rate, operative time, length of hospital stay, or hospitalization costs between the three groups CONCLUSIONS Currently the cost of the dedicated SILC port does not allow a regular use of this procedure in Polish financial reality. According to our experience improved cosmesis is the only advantage of the single incision laparoscopy, therefore we believe that it is reasonable to consider this technique in a a very selected group of patients.


title: Stroke prevention in atrial fibrillation changes after dabigatran availability in China: The GLORIA-AF registry.

text: Background Until the approval of dabigatran etexilate, treatment choices for stroke prevention in patients with atrial fibrillation (AF) were vitamin K antagonists (VKAs) or antiplatelet drugs. This analysis explored whether availability of non-vitamin K antagonist oral anticoagulants post-dabigatran approval was associated with changing treatment patterns in China. Methods Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) collected data on antithrombotic therapy choices for patients with newly diagnosed nonvalvular AF at risk for stroke. In China, enrollment in phase 1 (before dabigatran approval) and phase 2 (after dabigatran approval) occurred from 2011 to 2013 and 2013 to 2014, respectively. Analyses were restricted to sites within China that contributed patients to both phases. The weighted average of the site-specific results was estimated for standardization. Sensitivity analyses used multiple regression. Results Thirteen sites participated in both phase 1 (419 patients) and phase 2 (276 patients), 76.1% and 16.0% were known to be at high risk for stroke (CHA2DS2-VASc ≥2) and bleeding (HAS-BLED ≥3); 55.5% were male. In phase 1, 16.7%, 61.6%, and 21.7% of patients were prescribed oral anticoagulants (OACs), antiplatelet agents, and no treatment, respectively. Respective proportions were 26.4%, 40.6%, and 33.0% in phase 2. The absolute increase in the site-standardized proportion of patients prescribed OACs after dabigatran availability was 9.9% (95% confidence interval [CI]: 3.7%-16.0%). There was a standardized 17.3% (95% CI: -24.3% to -10.4%) absolute decrease in antiplatelet agent use. Conclusions There was an increase in OAC and decrease in antiplatelet agent prescription since dabigatran availability in China. However, a large proportion of AF patients at risk for stroke remained untreated.


title: Intraluminal erosion of laparoscopic gastric band tubing into duodenum with recurrent port-site infections.

text: BACKGROUND Intraluminal erosion of a laparoscopic gastric band into the stomach has been reported as a complication of laparoscopic adjustable gastric banding. To our knowledge, however, intraluminal erosion of the band tubing into the duodenum has not been described. PATIENT AND METHODS We report a 46-year-old man in whom a laparoscopic adjustable gastric band tubing eroded into the duodenal lumen, causing recurrent port-site infections. This complication was diagnosed on upper endoscopy and also, in retrospect, on an upper gastrointestinal barium study and computed tomography. RESULTS The patient underwent surgical removal of the band and tubing, with a primary duodenal repair, and made a complete recovery without complications. CONCLUSION Erosion of laparoscopic band tubing into the duodenum should be included in the differential diagnosis for recurrent port-site infections after laparoscopic adjustable gastric banding. Radiographic or endoscopic visualization of the intraluminal portion of the tubing may be required for confirmation. Definitive treatment of this complication entails surgical removal of the tubing from the duodenum.


title: A Systematic Review of Physical Rehabilitation of Facial Palsy.

text: Background: Facial palsy is a frequent and debilitating sequela of stroke and brain injury, causing functional and aesthetic deficits as well as significant adverse effects on quality of life and well-being. Current literature reports many cases of acquired facial palsy that do not recover spontaneously, and more information is needed regarding the efficacy of physical therapies used in this population. Methods: A systematic search of eight electronic databases was performed from database inception to December 2018. Gray literature searches were then performed to identify additional articles. Studies were included if they addressed physical rehabilitation interventions for adults with acquired facial palsy. Reasons for exclusion were documented. Independent data extraction, quality assessment, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Following abstract screening, a total of 13 full-text articles were identified for independent screening by two reviewers. This included four randomized control trials, two non-randomized control trials, one cohort study, and six prospective case series studies. Twelve out of the 13 included studies reported on facial palsy as a sequela of stroke. A total of 539 participants received intervention for facial palsy across the 13 included studies. Therapy design, length and frequency of intervention varied across the studies, and a wide range of outcome measures were used. Improvement on various outcome measures was reported across all 13 studies. The quality of the evidence was low overall, and most studies were found to have high risk of bias. Conclusions: All the studies in this review report improvement of facial movement or function following application of various methods of physical rehabilitation for facial palsy. Methodological limitations and heterogeneity of design affect the strength of the evidence and prevent reliable comparison between intervention methods. Strong evidence supporting physical rehabilitation was not found; well-designed rigorous research is required.


title: How are patient-reported outcomes and symptoms being measured in adults with relapsed/refractory multiple myeloma? A systematic review.

text: PURPOSE Patients with relapsed and/or refractory multiple myeloma (RRMM) are living longer due in part to changing treatment patterns. It is important to understand how changing treatment patterns affect patients' lives beyond extending survival. Research suggests that direct patient report is the best way to capture information on how patients feel and function in response to their disease and its treatment. Therefore, the purpose of this review is to summarize evidence of patients' experience collected through patient-reported outcomes (PRO) in RRMM patients, and to explore PRO reporting quality. METHODS We conducted a systematic search to identify manuscripts reporting PROs in RRMM and summarized available evidence. We assessed PRO reporting quality using the Consolidated Standards of Reporting Trials (CONSORT) PRO Extension checklist. RESULTS Our search resulted in 30 manuscripts. Thirteen unique PRO measures were used to assess 18 distinct PRO domains. Pain, fatigue, and emotional function were commonly assessed domains though reporting formats limited our ability to understand prevalence and severity of PRO challenges in RRMM. Evaluation of PRO reporting quality revealed significant reporting deficiencies. Several reporting criteria were included in less than 25% of manuscripts. CONCLUSIONS Existing evidence provides a limited window for understanding the patient experience of RRMM and is further limited by suboptimal reporting quality. Observational studies are needed to describe prevalence, severity and patterns of PROs in RRMM overtime. Future studies that incorporate PROs would benefit from following existing guidelines to ensure that study evidence and conclusions can be fully assessed by readers, clinicians and policy makers.


China's new WHO flu monitoring center seeks to reverse criticism.


docid: ryuelzbj

title: Is Covid-19 sowing the seeds for future litigation?

text: We consider various types of litigation that may follow the Covid-19 pandemic, including: claims against National Health Service (NHS) Trusts by patients who have contracted the coronavirus (or by their bereaved families), claims by NHS staff against their employer for a failure to provide any or adequate personal protective equipment or testing, commercial claims arising from the procurement of medical supplies, the potential liabilities to those who suffer adverse reactions to any vaccine and the guidance issued by the regulators in relation to subsequent disciplinary action.


title: Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department.

text: Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity.


title: Clinical strategies for the primary health care professional to minimize prescription opioid abuse.

text: Prescription opioid analgesic therapy can be effective in managing chronic noncancer pain in appropriately selected patients. However, the risks and benefits of prescription opioids should be carefully considered when treating this patient population. A dramatic increase in opioid-related morbidity and mortality has been observed in the United States in the past decade. Therefore, health care providers must balance the treatment of chronic pain with the need to minimize the risks of opioid misuse, abuse, addiction, and diversion. Current literature suggests that most patients with chronic pain are managed at the primary care level. However, many of these practitioners are not skilled in risk assessment, stratification, and monitoring. This article reviews strategies and tools that providers may implement to help identify appropriate patients for chronic opioid therapy and recognize signs of drug-related aberrant behaviors and abuse. In addition, the potential role of abuse-deterrent, extended-release opioid formulations to reduce risk in patients and nonmedical users of opioids is introduced. Collectively, these preventative measures may effectively reduce opioid misuse, abuse, and diversion without denying adequate analgesia in appropriate patients.


title: Usefulness of an optical tracking system in laparoscopic surgery for motor skills assessment.

text: INTRODUCTION The objective of this study is to assess the usefulness of an evaluation system of surgical skills based on motion analysis of laparoscopic instruments. METHOD This system consists of a physical laparoscopic simulator and a tracking and assessment system of technical skills in laparoscopy. Six surgeons with intermediate experience (between 1 and 50 laparoscopic surgeries) and 5 experienced surgeons (more than 50 laparoscopic surgeries) took part in this study. All participants were right-handed. The subjects performed 3 repetitions of a cutting task on synthetic tissue with the right hand, dissection of a gastric serous layer, and a suturing task in the dissection previously done. Objective metrics such as time, path length, speed of movements, acceleration and motion smoothness were analyzed for the instruments of each hand. RESULTS In the cutting task, experienced surgeons show less acceleration (P=.014) and a smoother motion (P=.023) using the scissors. Regarding the dissection activity, experienced surgeons need less time (P=.006) and less length with both instruments (P=.006 for dissector and P=.01 for scissors). In the suturing task, experienced surgeons require less time (P=.037) and distance travelled (P=.041) by the dissector. CONCLUSIONS This study shows the usefulness of the evaluation system for the cutting, dissecting, and suturing tasks. It represents a significant step in the development of advanced systems for training and assessment of surgical skills in laparoscopic surgery.


title: Intraabdominal partitioning of the laparoscopic sleeve gastrectomy remnant optimizes the specimen extraction ergonomics and postoperative pain and is an attractive technique in teenage patients.

text: INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) has become an increasingly popular bariatric procedure in the pediatric population worldwide. The fear of complications, postoperative pain, and recovery remain the reservations for wider application of surgery in morbidly obese children. We present a novel technique for LSG remnant retrieval. MATERIALS AND METHODS The patient was a 16-year old girl with a body mass index of 55 kg/m(2) and significant comorbidities who underwent LSG and liver biopsy. In the extraction technique, a specimen containing the gastric body and fundus, approximately 80% of the stomach volume, was partitioned longitudinally and intracorporeally with endoshears; subsequently, it was retrieved in one fragment via the lumen of a 15-mm port. RESULTS The procedure time was 65 minutes (specimen extraction time was 7 minutes). Her recovery was uneventful, and she was discharged home on the second postoperative day. At the 1-, 3-, and 6-month follow-up, she has shown all the benefits of weight loss and associated improvement in metabolic parameters and quality of life, without any complications. CONCLUSIONS This technique for gastric remnant retrieval results in minimizing postoperative pain, reducing operative costs, and minimizing the likelihood of wound infection.


title: Association of smoking habits with TXNIP DNA methylation levels in leukocytes among general Japanese population.

text: Thioredoxin-interacting protein (TXNIP) inhibits the activity of thioredoxin (TXN), leading to increased oxidative stress. Expression of the TXNIP gene is regulated by DNA methylation. However, no study has reported the influence of lifestyle factors on TXNIP DNA methylation. Our goal was to determine the association between smoking habits and TXNIP DNA methylation levels in a Japanese population. We conducted a cross-sectional study of 417 subjects (180 males and 237 females) participating in a health examination. We used a pyrosequencing assay to determine TXNIP DNA methylation levels in leukocytes. The mean TXNIP DNA methylation level in current smokers (75.3%) was significantly lower than that in never and ex-smokers (never: 78.1%, p < 0.001; ex: 76.9%, p = 0.013). Multivariable logistic regression analyses showed that the OR for TXNIP DNA hypomethylation was significantly higher in current smokers than that in never smokers, and significantly higher in current smokers with years of smoking ≥ 35 and Brinkman Index ≥ 600 compared to that in non-smokers. In conclusion, we found that current smokers had TXNIP DNA hypomethylation compared to never and ex-smokers. Moreover, long-term smoking and high smoking exposure also were associated with TXNIP DNA hypomethylation.


title: Detection of VR-2332 strain of porcine reproductive and respiratory syndrome virus type II using an aptamer-based sandwich-type assay.

text: Porcine reproductive and respiratory syndrome virus (PRRSV) causes porcine reproductive and respiratory syndrome disease (PRRS), a disease that has a significant and economic impact on the swine industry. In this study, single-stranded DNA (ssDNA) aptamers with high specificity and affinity against VR-2332 strain of PRRSV type II were successfully obtained. Of 19 candidates, the LB32 aptamer was found to be the most specific and sensitive to VR-2332 strain according to an aptamer-based surface plasmon resonance (SPR) analysis. The detection of VR-2332 of PRRSV type II was successfully accomplished using the enzyme-linked antibody-aptamer sandwich (ELAAS) method. The detection limit of ELAAS was 4.8 × 10(0) TCID(50)/mL that is comparable to some of the previous reports of the PCR-based detection but does not require any complicated equipment or extra costs. Moreover, this ELAAS-based PRRSV detection showed similar sensitivity for both the VR-2332 samples spiked in diluted swine serum and in buffer. Therefore, this VR-2332 strain-specific aptamer and its assay method with high specificity can be used as an alternative method for the fast and precise detection of PRRSV.


title: A case of acute cerebral infarction associated with an accessory middle cerebral artery in a patient who underwent thrombectomy.

text: Background The accessory middle cerebral artery (AMCA) is a middle cerebral artery (MCA) anomaly originating from the anterior cerebral artery. We report our experience of a case in which thrombectomy was undertaken for a patient with hemodynamics that were specific to the AMCA. Case Presentation An 84-year-old man with a history of atrial fibrillation developed paralysis of the left upper and lower extremities. Imaging examinations suggested tandem occlusion of the right internal carotid artery and the origin (M2 segment) of the right MCA. An extremely narrow MCA was visualized. Because there was concern regarding development of frontal lobe infarction, thrombectomy was carried out to restore anterograde blood flow, but an AMCA was found. Recanalization of the main MCA in the infarction zone resulted in hemorrhagic infarction, and the patient died of cerebral herniation. Conclusion When a vascular variation like AMCA is suspected, a careful evaluation of hemodynamics is necessary before undertaking endovascular intervention.


title: Preconditioning Vaccine Sites for mRNA-Transfected Dendritic Cell Therapy and Antitumor Efficacy.

text: Messenger RNA (mRNA)-transfected dendritic cell (DC) vaccines have been shown to be a powerful modality for eliciting antitumor immune responses in mice and humans; however, their application has not been fully optimized since many of the factors that contribute to their efficacy remain poorly understood. Work stemming from our laboratory has recently demonstrated that preconditioning the vaccine site with a recall antigen prior to the administration of a dendritic cell vaccine creates systemic recall responses and resultantly enhances dendritic cell migration to the lymph nodes with improved antitumor efficacy. This chapter describes the generation of murine mRNA-transfected DC vaccines, as well as a method for vaccine site preconditioning with protein antigen formulations that create potent recall responses.


title: What is the evidence for the use of parenteral nutrition (PN) in critically ill surgical patients: a systematic review and meta-analysis.

text: BACKGROUND Malnutrition is associated with poor outcomes in surgical patients and corrective enteral feeding may not be possible. This is a particular problem in the acute setting where malnutrition is prevalent. The aim of this systematic review was to evaluate the use of parenteral nutrition (PN) in critically ill surgical patients. METHODS This review was registered with PROSPERO (CRD42017079567). Searches of the CENTRAL, EMBASE, and MEDLINE databases were performed using a predefined strategy. Randomised trials published in English since 1995, reporting a comparison of PN vs any comparator in a critically ill surgical population were included. The primary outcome was mortality. Risk of bias was assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analysis was performed using a random effects model to assess variation in mortality and length of stay. RESULTS Fourteen RCTs were identified; standard PN was compared vs other forms of PN in ten studies, to PN with variable dose amino acids in one, and to enteral nutrition (EN) in three. In trials comparing glutamine-supplemented PN (PN-GLN) to PN, a non-significant reduction in mortality was noted (risk difference - 0.08. 95% CI - 0.17, 0.01, p = 0.08). A trend for a reduction in length of stay was seen in PN-GLN to PN comparator (mean reduction - 2.4, 95% CI - 7.19 to 2.32 days, I2 = 92%). Impact on other outcome measures varied in direction of effect. CONCLUSIONS PN may offer benefit in critically ill surgical patients. The size and quality of studies lead to uncertainty around the estimates of clinical effect, meaning a robust trial is required.


title: Effects of Galvanic Vestibular Stimulation on Upper and Lower Extremities Motor Symptoms in Parkinson's Disease.

text: As a neurodegenerative movement disorder, Parkinson's disease (PD) is commonly characterized by motor symptoms such as resting tremor, rigidity, bradykinesia, and balance and postural impairments. While the main cause of PD is still not clear, it is shown that the basal ganglia loop, which has a role in adjusting a planned movement execution through fine motor control, is altered during this disease and contributes toward the manifested motor symptoms. Galvanic vestibular stimulation (GVS) is a non-invasive technique to influence the vestibular system and stimulate the motor system. This study explores how the motor symptoms of upper and lower extremities in PD are instantly affected by vestibular stimulation. In this regard, direct current GVS was applied to 11 individuals with PD on medication while they were performing two sets of experiments: (1) Instrumented Timed Up and Go (iTUG) test and (2) finger tapping task. The performance of participants was recorded with accelerometers and cameras for offline processing of data. Several outcome measures including coefficient of variation of the step duration, gait phase, phase coordination index, tapping score, and the number and duration of manual motor blocks (MMBs) were considered for objective quantifying of performance. Results showed that almost all of considered outcome measures were improved with the application of GVS and that the improvement in the coefficient of variation of the step duration, the tapping score, and the number of MMBs was statistically significant (p-value < 0.05). The results of this study suggest that GVS can be used to alleviate some of the common motor symptoms of PD. Further research is required to fully characterize the effects of GVS and determine its efficacy in the long term.


A modified lengthened nasopharyngeal airway.


title: What is the impact of sensory practices on the quality of life of long-term care residents? A mixed-methods systematic review protocol.

text: BACKGROUND With age, the acuity of the five senses (i.e., hearing, sight, taste, smell, touch) is reduced. These types of sensory changes can affect day-to-day activities, making it more difficult for individuals to communicate and to interact with the world around them. The five senses allow us to receive information from the environment in the form of sound, light, smell, taste, and touch. As an older person's senses decline, they need more stimulation to be aware of these sensations. In long-term care settings, appropriate sensory practices are needed to address the diminishing senses of older adults. The objective of this mixed-methods systematic review is to examine the relationship between the sensory practices and the quality of life of residents living in long-term care settings and to develop an aggregated synthesis of mixed-methods studies to derive recommendations for policy, practice, and research. METHODS We will conduct a mixed-methods systematic review in accordance with the Cochrane Handbook. A search strategy has been developed with an expert health sciences librarian and peer reviewed using Peer Review for Electronic Search Strategies (PRESS). Seven databases: MEDLINE (Ovid), PubMed (non-MEDLINE-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), and Cochrane Central Register of Controlled Trials (CENTRAL) will be searched for studies that meet the inclusion criteria. Two reviewers will independently screen the results of the literature search using a two-step process. Eligible studies will undergo a quality assessment and data extraction. Disagreements will be resolved through consultation with a third reviewer. We will assess the quality of individual studies using the Mixed Methods Appraisal Tool (MMAT). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be used to summarize the strength of the quantitative evidence, and the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool to assess confidence in the qualitative syntheses. DISCUSSION This systematic review will summarize evidence-based knowledge for sensory practices, identify gaps in the literature, and inform an audit program for assessing the presence of sensory practices in the long-term care setting. The results will be relevant to policy makers, decision-makers, clinicians, and residents/families in long-term care settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration # CRD42017032330 .


title: Salinomycin Inhibits Influenza Virus Infection by Disrupting Endosomal Acidification and Viral Matrix Protein 2 Function.

text: Screening of chemical libraries with 2,000 synthetic compounds identified salinomycin as a hit against influenza A and B viruses, with 50% effective concentrations ranging from 0.4 to 4.3 μM in cells. This compound is a carboxylic polyether ionophore that exchanges monovalent ions for protons across lipid bilayer membranes. Monitoring the time course of viral infection showed that salinomycin blocked nuclear migration of viral nuclear protein (NP), the most abundant component of the viral ribonucleoprotein (vRNP) complex. It caused cytoplasmic accumulation of NP, particularly within perinuclear endosomes, during virus entry. This was primarily associated with failure to acidify the endosomal-lysosomal compartments. Similar to the case with amantadine (AMT), proton channel activity of viral matrix protein 2 (M2) was blocked by salinomycin. Using purified retroviral Gag-based virus-like particles (VLPs) with M2, it was proved that salinomycin directly affects the kinetics of a proton influx into the particles but in a manner different from that of AMT. Notably, oral administration of salinomycin together with the neuraminidase inhibitor oseltamivir phosphate (OSV-P) led to enhanced antiviral effect over that with either compound used alone in influenza A virus-infected mouse models. These results provide a new paradigm for developing antivirals and their combination therapy that control both host and viral factors.IMPORTANCE Influenza virus is a main cause of viral respiratory infection in humans as well as animals, occasionally with high mortality. Circulation of influenza viruses resistant to the matrix protein 2 (M2) inhibitor, amantadine, is highly prevalent. Moreover, the frequency of detection of viruses resistant to the neuraminidase inhibitors, including oseltamivir phosphate (OSV-P) or zanamivir, is also increasing. These issues highlight the need for discovery of new antiviral agents with different mechanisms. Salinomycin as the monovalent cation-proton antiporter exhibited consistent inhibitory effects against influenza A and B viruses. It plays multifunctional roles by blocking endosomal acidification and by inactivating the proton transport function of M2, the key steps for influenza virus uncoating. Notably, salinomycin resulted in marked therapeutic effects in influenza virus-infected mice when combined with OSV-P, suggesting that its chemical derivatives could be developed as an adjuvant antiviral therapy to treat influenza infections resistant or less sensitive to existing drugs.


title: Transdiaphragmatic omental harvest: a simple, efficient method for sternal wound coverage.

text: BACKGROUND The greater omentum is easily harvested for coverage of sternal wounds without muscle sacrifice. Its major disadvantage is a laparotomy incision with potential bowel injury, adhesions, or hernia. Over the past 20 years, the authors' technique has evolved to use a transdiaphragmatic opening for omental harvest when possible. METHODS The authors performed a retrospective cohort analysis of 140 consecutive patients undergoing omental flap harvest for treatment of sternal wounds following median sternotomy. Patients were divided into two groups by access incision: laparotomy incision (n = 80) versus a transdiaphragmatic opening (n = 60). RESULTS The authors found that both techniques provided reliable closure of sternal wounds, but the transdiaphragmatic approach was faster, with less blood loss. There was no significant difference in rates of ventral hernias. We had only one bowel injury (laparotomy group) and no postoperative abdominal bleeding or small bowel obstruction. CONCLUSION Transdiaphragmatic omental harvest provides safe and efficient coverage of deep sternal wounds without a laparotomy incision.


title: Delayed small bowel obstruction after robotic-assisted sacrocolpopexy.

text: We report 2 unusual cases of partial bowel obstruction resulting from adherence to a barbed suture presenting 3 to 4 weeks after robotic-assisted sacrocolpopexy for uterovaginal prolapse. Both patients underwent an uncomplicated robotic-assisted supracervical hysterectomy and sacrocolpopexy. Immediate postoperative recovery was uncomplicated. Three to four weeks after surgery, both patients presented with symptoms of nausea, vomiting, and abdominal pain and were found to have small bowel obstructions requiring a return to the operating room. Upon surgical exploration, a loop of small bowel was found to be adhered to a segment of the barbed suture at the sacral promontory, which had been used to close the peritoneum over the mesh. Subsequent to release, both patients had an uneventful recovery.


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title: Management of Ruptured and Rapidly Progressive Mycotic Cerebral Aneurysms in the Setting of Unilateral Carotid Occlusion and Endocarditis with Valve Failure.

text: Mycotic cerebral aneurysms can present unique neurosurgical challenges. We report a patient with left carotid occlusions, a ruptured left middle cerebral artery mycotic aneurysm, and a rapidly appearing unruptured left anterior cerebral artery/anterior communicating artery (ACA/ACom) mycotic aneurysm in the setting of mitral valve endocarditis with a perivalvular leak and evolving congestive heart failure. Following medical stabilization and antibiotic administration, a combined endovascular (with contralateral access via the ACom) and open surgical approach was used to selectively secure both aneurysms with preservation of distal flow, allowing lifesaving cardiac valve replacement. This case illustrates the therapeutic complexity of mycotic cerebral aneurysms, which we discuss in the context of an increasing reliance on endovascular approaches.


title: Effect of surgeon's experience on complications from laparoscopic hysterectomy.

text: OBJECTIVE To analyze the effect of learning in two surgeons on complications and conversion to laparotomy during total and subtotal laparoscopic hysterectomy. MATERIAL AND METHODS We analyzed retrospectively 236 total and subtotal laparoscopic hysterectomies done by two surgeons from the time they first performed the procedure. The interventions were classified in three groups based on the surgeon's experience: the first 75 hysterectomies ("novice period"), the subsequent 75 hysterectomies ("intermediate"), and the subsequent 86 hysterectomies ("routine period"). RESULTS Patient's characteristics changed as surgeons gained experience, with more complex operations (greater obesity, previous surgery and malignant disease) becoming more frequent. During the second group of operations when surgeons had an intermediate level of experience, the risk of major complications decreased (adjusted odds ratio: 0.28, 95% confidence interval: 0.10-0.85), as did the risk of type III complications of Clavien-Dindo classification (adjusted odds ratio 0.15, 95% confidence interval: 0.03-0.93). However, the percent rate of conversion to laparotomy remained stable in the second (intermediate experience) group. In the third group, after the surgeons had performed 150 procedures and when the risk of any type of complication was lowest, the risk of conversion to laparotomy decreased compared to the routine group. CONCLUSIONS The surgeon's experience in performing laparoscopic hysterectomy plays an essential role in the decrease in the risk of complications, and this finding supports the importance of providing appropriate training for residents and gynecologists to enable them to perform this procedure with an optimal degree of competence and safety.


title: Effect of chronic treatment with conventional and organic purple grape juices (Vitis labrusca) on rats fed with high-fat diet.

text: Serra Gaucha is described as the most important wine region of Brazil. Regarding cultivars widespread in the Serra Gaucha, about 90 % of the area is occupied by vines of Vitis labrusca that is the most important specie used in grape juice production. The objective of this study was to investigate the antioxidant and neuroprotective effect of chronic intake of purple grape juice (organic and conventional) from Bordo variety (V. labrusca) on oxidative stress in different brain regions of rats supplemented with high-fat diet (HFD) for 3 months. A total of 40 male rats were randomly divided into 4 groups. Group 1 received a standard diet and water, group 2 HFD and water, group 3 HFD and conventional grape juice (CGJ), and group 4 HFD and organic grape juice (OGJ). All groups had free access to food and drink and after 3 months of treatment the rats were euthanized by decapitation and the cerebral cortex, hippocampus and cerebellum isolated and homogenized on ice for oxidative stress analysis. We observed that the consumption of calories in HFD and control groups, were higher than the groups supplemented with HFD and grape juices and that HFD diet group gain more weight than the other animals. Our results also demonstrated that HDF enhanced lipid peroxidation (TBARS) and protein damage (carbonyl) in cerebral cortex and hippocampus, reduced the non-enzymatic antioxidants defenses (sulfhydryl) in cerebral cortex and cerebellum, reduced catalase and superoxide dismutase activities in all brain tissues and enhanced nitric oxide production in all cerebral tissues. CGJ and OGJ were able to ameliorate these oxidative alterations, being OGJ more effective in this protection. Therefore, grape juices could be useful in the treatment of some neurodegenerative diseases associated with oxidative damage.


title: Comprehensive systematic review of healthcare workers' perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases.

text: AIM To determine healthcare workers' perceptions of risk from exposure to emerging acute respiratory infectious diseases and the perceived effectiveness of strategies used to facilitate healthy coping in acute hospital and community healthcare settings. METHODS Electronic databases (Cumulative Index to Nursing and Allied Health Literature, Ovid, PubMed, ScienceDirect, Scopus and Wiley InterScience) were searched using a three-step search strategy to identify the relevant quantitative and qualitative studies published in English from 1997 to 2009. The grey literature was not included in the review. The identified studies were evaluated using the Meta-Analysis of Statistics, Assessment and Review Instrument and the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Fourteen quantitative studies were included and the findings included in a narrative summary. The findings from the two qualitative studies were categorised into a meta-synthesis that generated two synthesised findings. RESULTS Findings indicated that healthcare workers perceived personal and familial health risks and stigmatisation from their exposure to emerging acute respiratory infectious diseases, but the majority were accepting of these risks. Organisational implementation of infection control measures, avoidance of patients and complying with personal protective equipment were identified as risk-mitigating strategies. Demographic, individual and organisational factors were found to influence their risk perceptions and their adoption of strategies to mitigate the risk. CONCLUSIONS It appears that healthcare workers' risk perceptions can influence their behaviour towards patients with emerging acute respiratory infectious diseases as well as their use of risk-mitigating strategies. Institutions need to ensure that appropriate infection control safeguards are in place to protect workers and their families. Institutions can also offer incentives to encourage healthcare workers to comply with the policies and procedures introduced to mitigate risk. IMPLICATIONS FOR PRACTICE Institutions and government need to ensure that policies and procedures are communicated and adequate institutional measures (i.e. personal protective equipment; education and training; and personal support) are implemented to safeguard healthcare workers during and after pandemic outbreaks. IMPLICATIONS FOR RESEARCH Future research needs to examine how perception of risk related to acute emerging respiratory infectious diseases, epidemic or pandemic, and the factors that would influence healthcare workers': decisions to stay within the workforce and provide care or resign from the workforce and compliance with institutional and government policies and procedures, as well as compliance to use of personal protective equipment.


Safety of Propranolol Therapy for Severe Infantile Hemangioma.


[My treatment strategies for severe and critical coronavirus disease 2019].


title: Preferred practice guidelines for glaucoma management during COVID-19 pandemic.

text: The COVID-19 pandemic has threatened the humanity at a global level to a large extent by the burden of the disease with significant mortality and to a certain extent as a byproduct of the necessary efforts to contain the same. There is a significant impact on the health care system, as we not only have to contain pandemic, but continue to treat our non-COVID-19 patients in a safe and responsible manner. Ophthalmology practice in general and glaucoma in particular needs certain modifications and additional precautions while examining as well as managing these patients keeping their and our safety in mind. As the lockdown relaxations are in vogue we need to learn how to deal with our regular patients as well in addition to emergency care. This paper presents the consensus-based guidelines by an expert panel on how to restart glaucoma practice during this COVID-19 time. These guidelines will be applicable across the country and should help ophthalmologists and glaucoma specialist to restart their practices while safeguarding the patients and their own selves from getting infected.


title: Bladder Cancer at the time of COVID-19 Outbreak.

text: The COVID-19 outbreak has led to the deferral of a great number of surgeries in an attempt to reduce transmission of infection, free up hospital beds, intensive care and anaesthetists, and limit aerosol-generating procedures. Guidelines and suggestions have been provided to categorize Urological diseases into risk groups and recommendations are available on procedures that can be or cannot be deferred. We aim to summarise updates on diagnosis, treatment and follow up of bladder cancer during the COVID-19 outbreaks.


Effective Chemicals against Novel Coronavirus (COVID-19) in China.