docid: pehqgqmr

title: An Inexpensive Bismuth-Petrolatum Dressing for Treatment of Burns.

text: BACKGROUND Xeroform remains the current standard for treating superficial partial-thickness burns but can be prohibitively expensive in developing countries with prevalent burn injuries. This study (1) describes the production of an alternative low-cost dressing and (2) compares the alternative dressing and Xeroform using the metrics of cost-effectiveness, antimicrobial activity, and biocompatibility in vitro, and wound healing in vivo. METHODS To produce the alternative dressing, 3% bismuth tribromophenate powder was combined with petroleum jelly by hand and applied to Kerlix gauze. To assess cost-effectiveness, the unit costs of Xeroform and components of the alternative dressing were compared. To assess antimicrobial properties, the dressings were placed on agar plated with Escherichia coli and the Kirby-Bauer assay performed. To assess biocompatibility, the dressings were incubated with human dermal fibroblasts and cells stained with methylene blue. To assess in vivo wound healing, dressings were applied to excisional wounds on rats and the rate of re-epithelialization calculated. RESULTS The alternative dressing costs 34% of the least expensive brand of Xeroform. Antimicrobial assays showed that both dressings had similar bacteriostatic effects. Biocompatibility assays showed that there was no statistical difference (P < 0.05) in the cytotoxicity of Xeroform, alternative dressing, and Kerlix gauze. Finally, the in vivo healing model showed no statistical difference (P < 0.05) in mean re-epithelialization time between Xeroform (13.0 ± 1.6 days) and alternative dressing (13.5 ± 1.0 days). CONCLUSIONS Xeroform is biocompatible, reduces infection, and enhances healing of burn wounds by preventing desiccation and mechanical trauma. Handmade petrolatum gauze may be a low-cost replacement for Xeroform. Future studies will focus on clinical trials in burn units.


title: A phase II study of preoperative chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy with D2 plus para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis: JCOG1002.

text: BACKGROUND Gastric cancer with extensive lymph node metastasis is commonly considered unresectable, with a poor prognosis. We previously reported the results of the use of cisplatin and S-1 as preoperative chemotherapy for gastric cancer with extensive lymph node metastasis; docetaxel, cisplatin, and S-1 (DCS) have now been investigated for the same purpose. METHODS Patients received two or three 28-day cycles of DCS therapy (docetaxel at 40 mg/m2 and cisplatin at 60 mg/m2 on day 1, S-1 at 40 mg/m2 twice daily for 2 weeks) followed by gastrectomy with D2 plus para-aortic nodal dissection. After R0 resection, S-1 chemotherapy was given for 1 year. The primary end point was the response rate (RR) to preoperative chemotherapy determined by central peer review according to the Response Evaluation Criteria in Solid Tumors version 1.0. The planned sample size was 50, with one-sided alpha of 10 %, power of 80 %, expected RR of 80 %, and threshold of 65 %. RESULTS Between July 2011 and May 2013, 53 patients were enrolled, of whom 52 were eligible. The clinical RR was 57.7 % [30/52, 80 % confidence interval 47.9-67.1 %, p = 0.89], and R0 resection was achieved in 84.6 % of patients (44/52). Common grade 3 or grade 4 adverse events during DCS therapy were leukocytopenia (18.9 %), neutropenia (39.6 %), and hyponatremia (15.1 %). The common grade 3 or grade 4 surgical morbidity was abdominal infection (10.2 %). The pathological RR was 50.0 % (26/52). CONCLUSIONS Preoperative DCS therapy was feasible but did not show a sufficient RR. Preoperative cisplatin and S-1 therapy is still considered the tentative standard treatment for this population until survival results are known.


Global Effort to Collect Data on Ventilated Patients With COVID-19.


title: Pulmonary Artery Sealing Using the HARMONIC ACE+ Shears for Video-Assisted Thoracoscopic Surgery Lobectomy.

text: BACKGROUND The standard technique for pulmonary arterial (PA) branch sealing in video-assisted thoracoscopic surgery lobectomy consists of vascular endostaplers. We evaluated the immediate efficacy of an ultrasonic energy vessel-sealing device for sealing PA branches and compared it with the gold standard (endostapler) in an ex vivo model. METHODS This was a prospective cohort study. Immediately after anatomical lung resection, PA vessel sealing was achieved using the HARMONIC ACE+ Shears (ACE; Ethicon, Cincinnati, OH) sealing device or a vascular endostapler (VES) in a 3:1 ratio based on vessel diameter. The vessel was slowly pressurized, and the bursting pressure was recorded. RESULTS A total of 137 PA branches were sealed in specimens from 43 patients, of which 90 vessels were sealed with ACE and 47 were sealed with VES. The mean PA branch diameter was 6.0 mm (range, 1.7 mm to 24.0 mm; standard deviation, 3.1 mm Hg). The mean bursting pressure was 333.0 mm Hg (range, 84.0 mm Hg to 1415.1 mm Hg; standard deviation, 231.4 mm Hg) in the ACE group and 114.2 mm Hg (range, 0 mm Hg to 840.0 mm Hg; standard deviation, 124.7) in the VES group (p < 0.001). There were no complete sealing failures in the ACE group. Electron microscopy of ACE-sealed PA vessels demonstrated adventitial sealing with partial preservation of the collagen bundles and media with a sealed matrix of melted collagen. CONCLUSIONS PA branches sealed using the HARMONIC ACE+ in a simulated ex vivo model were able to sustain high intraluminal pressures. ACE-sealed vessels burst at mean bursting pressures equal to or greater than the VES-stapled vessels.


title: Effect of electrocautery on endothelial integrity of the internal thoracic artery: ultrastructural analysis with transmission electron microscopy.

text: The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.


title: Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis.

text: BACKGROUND AND PURPOSE Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. RESULTS Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. CONCLUSIONS RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616.


title: Derivation of a bedside score (MASH-P) to predict 6-month mortality in tuberculous meningitis.

text: BACKGROUND Tuberculous meningitis is commonly associated with a poor outcome. Simple bedside prognostic scores can help immensely in predicting the outcome. MATERIALS AND METHOD A total of 721 patients, from 5 of our previous studies, were included. With primary outcome measure as death, a prognostic model was derived using binary logistic regression. The model was assessed using discrimination and calibration, and internally validated using the bootstrap method. A bedside prognostic score was derived by rounding of the regression coefficients to the nearest integers. RESULTS A total of 126 (17.48%) patients died. The final model found that higher age, stage III disease, baseline MBI ≤ 12, papilledema and hydrocephalus were significant predictors of death. The final model showed good discrimination as evident by an AUC = 83.1% (95% confidence interval 79.5%-86.7%, P < .001) and good calibration (Hosmer and Lemeshow test P = .579). The model remained valid after internal validation by boot strapping. A simple bedside score with the acronym MASH-P to denote variables baseline MBI (M), age (A), stage (S), hydrocephalus (H) and papilledema (P), was thus derived. The score can range from 0 to 10. Higher the score, higher is the probability of death; a score of 0 carries a predicted probability of just 1.7% while a score of 10 corresponds to a predicted probability of 65%. An electronic ready reckoner has also been developed to aid prognostication on the go. CONCLUSION MASH-P is a simple prognostic scoring model that can be used at bedside and aid in decision making as well as counselling.


title: A beam-splitter-type 3-D endoscope for front view and front-diagonal view images.

text: PURPOSE In endoscopic surgery, surgeons must manipulate an endoscope inside the body cavity to observe a large field-of-view while estimating the distance between surgical instruments and the affected area by reference to the size or motion of the surgical instruments in 2-D endoscopic images on a monitor. Therefore, there is a risk of the endoscope or surgical instruments physically damaging body tissues. To overcome this problem, we developed a Ø7- mm 3-D endoscope that can switch between providing front and front-diagonal view 3-D images by simply rotating its sleeves. METHODS This 3-D endoscope consists of a conventional 3-D endoscope and an outer and inner sleeve with a beam splitter and polarization plates. The beam splitter was used for visualizing both the front and front-diagonal view and was set at 25° to the outer sleeve's distal end in order to eliminate a blind spot common to both views. Polarization plates were used to avoid overlap of the two views. We measured signal-to-noise ratio (SNR), sharpness, chromatic aberration (CA), and viewing angle of this 3-D endoscope and evaluated its feasibility in vivo. RESULTS Compared to the conventional 3-D endoscope, SNR and sharpness of this 3-D endoscope decreased by 20 and 7 %, respectively. No significant difference was found in CA. The viewing angle for both the front and front-diagonal views was about 50°. In the in vivo experiment, this 3-D endoscope can provide clear 3-D images of both views by simply rotating its inner sleeve. CONCLUSIONS The developed 3-D endoscope can provide the front and front-diagonal view by simply rotating the inner sleeve, therefore the risk of damage to fragile body tissues can be significantly decreased.


title: [Exploring the Stress, Psychological Distress, and Stress-relief Strategies of Taiwan Nursing Staffs Facing the Global Outbreak of COVID-19].

text: BACKGROUND The global outbreak of coronavirus disease (COVID-19) began in December 2019. The high levels of stress experienced by nurses during this pandemic may have immediate and long-term effects on their mental health. PURPOSE To explore the stress and psychological problems of nurses during this pandemic and to identify strategies used by these nurses to relieve stress. METHODS A cross-sectional online survey was conducted that included a basic information datasheet, stress of nursing staff during COVID-19 outbreak scale, psychological distress scale, and stress relief methods survey form. Convenience sampling was used and a total of 469 practicing nurses participated in this study. RESULTS Most of the participants expressed concerns about living problems (72.7%). On the stress questionnaire, the facets of "burden of taking care of patients" and "worries about social isolation" earned the first and second highest scores, respectively. In terms of items, "worrying about infecting family members and friends" and "worrying about being separated from family after being infected" earned the two highest scores (2.35 ± 0.79 and 2.17 ± 0.92, respectively). Scores for psychological distress averaged 5.49 ± 3.83, with stress anxiety (1.32 ± 0.84) earning the highest mean subscale score followed by distress and irritability (1.17 ± 0.92) and depression (1.12 ± 0.94). Nearly two-thirds (61.8%) of the participants earned psychological and emotional distress scores within the 'normal' range, and 3.4% earned scores indicating severe distress. "Receiving education and training" was the most common method used by the participants to relieve stress (2.27 ± 0.51). CONCLUSIONS The following six strategies are proposed based on the above findings: (1) Caring: provide psychological assessment and care; (2) Supporting: create a friendly team atmosphere and provide support; (3) Inquiring: recruit volunteers with relevant experience; (4) Informing: provide timely, open, and transparent epidemic-prevention information; (5) Equipping: provide complete and appropriate epidemic-prevention education and training; (6) Assisting: establish a strategy for family support and caring to reduce the stress and worries of nurses.


title: Human coronary venous anatomy: implications for interventions.

text: The coronary venous system is a highly variable network of veins that drain the deoxygenated blood from the myocardium. The system is made up of the greater cardiac system, which carries the majority of the deoxygenated blood to the right atrium, and the smaller cardiac system, which drains the blood directly into the heart chambers. The coronary veins are currently being used for several biomedical applications, including but not limited to cardiac resynchronization therapy, ablation therapy, defibrillation, perfusion therapy, and annuloplasty. Knowledge of the details of the coronary venous anatomy is essential for optimal development and delivery of treatments using this vasculature. This article is part of a JCTR special issue on Cardiac Anatomy.


title: Donor variation effect on red blood cell storage lesion: a multivariable, yet consistent, story.

text: BACKGROUND Previous studies have shown that baseline hematologic characteristics concerning or influencing red blood cell (RBC) properties might affect storage lesion development in individual donors. This study was conducted to evaluate whether variation in hemolysis, microparticle accumulation, phosphatidylserine (PS) exposure, and other storage lesion-associated variables might be a function of the prestorage hematologic and biologic profiles of the donor. STUDY DESIGN AND METHODS Ten eligible, regular blood donors were paired and studied before donation (fresh blood) and during storage of RBCs in standard blood banking conditions. Plasma and cellular characteristics and modifications were evaluated by standard laboratory and biochemical or biologic analyses as well as by statistical and network analysis tools. RESULTS Nitrate/nitrite and other bioactive factors exhibited high interdonor variability, which further increased during storage in a donor-specific manner. Storage lesion evaluators, including RBC fragility and PS exposure, fluctuated throughout the storage period in proportion to their values in fresh blood. Donors' levels of phosphatidylserine exposure and hemoglobin F correlated with stored cells' mean cell (RBC) Hb concentration, oxidative stress markers, and cellular fragility. DISCUSSION Storage lesion indicators change in an orderly fashion, namely, by following donor-related prestorage attributes. These correlations are illustrated for the first time in "prestorage versus storage" biologic networks, which might help determine the best candidates for in vivo biomarkers of storage quality and provide deeper insight into the apparently complex donor variation effect on the RBC storage lesion.


title: Role of percutaneous abscess drainage in the management of young patients with Crohn disease.

text: BACKGROUND Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. OBJECTIVE Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. MATERIALS AND METHODS We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. RESULTS All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01). CONCLUSION Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection.


Oncology Practice During the COVID-19 Pandemic.


docid: gfdteyyu

title: Pediatric Peri-Operative Care in the COVID-19 Era.


title: Relation between weight loss and causes of death in patients with cardiovascular disease: finding from the SCOUT trial.

text: AIMS Obesity is associated with an increased incidence of mortality. The Sibutramine Cardiovascular Outcomes (SCOUT) trial can provide the first evidence of the effect of intentional weight loss on mortality in an obese population at high risk. METHODS SCOUT was a randomized, double-blind, placebo-controlled trial testing sibutramine vs. placebo. Eligibility for the trial required both men and women aged at least 55 years, with BMI of at least 27 kg/m and 45 kg/m or less. Study participants with type 2 diabetes mellitus (T2DM) only should have at least one other risk factor defined as hypertension, dyslipidaemia, smoking, or diabetic nephropathy, and/or they had a history of cardiovascular disease. Study participants were stratified in three groups: patients with T2DM, patients with a prior cardiovascular event but without diabetes, and patients with both T2DM and a prior cardiovascular event.The relationship between weight loss and mortality (all-cause, cardiovascular, and noncardiovascular) was investigated with Cox regression models. RESULTS The main study showed that all-cause mortality was not different in patients allocated to sibutramine or placebo. This ancillary analysis demonstrates that there is a general trend showing higher mortality in patients with the greatest weight loss (weight reduction >10 kg) and in those with increasing weight (>1 kg). If integrated weight loss (area under the curve from baseline to 12 months) is used, these observations are confirmed. The impact of substantial weight loss on mortality is marked in those dying of noncardiovascular causes, specifically cancer. CONCLUSION The relationship between weight change and mortality differs for cardiovascular and noncardiovascular mortality.


From START to finish: implications of the START study.


title: Systemic sclerosis and the COVID-19 pandemic: World Scleroderma Foundation preliminary advice for patient management.

text: Due to the frequent presence of interstitial lung disease and widespread use of immunosuppressive treatment, systemic sclerosis (SSc) patients may be considered at risk for a more severe disease course and higher mortality when they develop Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-CoV-2) virus infection. Therefore, with World Scleroderma Foundation endorsement, experts from different specialties including rheumatology, virology and clinical immunology gathered virtually to answer to the main practical clinical questions regarding SARS-CoV-2 infection coming from both patients and physicians. This preliminary advice is aligned with other national and international recommendations, adapted for SSc patients.


title: Safety, efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma.

text: PURPOSE To evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for localised renal cell carcinoma (RCC) and examine potential associations between age, gender, tumour size, location, chronic kidney disease, comorbidities, learning curve and local recurrence. METHODS We retrospectively analysed survival outcomes for patients with biopsy-proven RCC treated by RFA at Westmead Hospital. Complication data were gathered from all patients that underwent renal RFA. 3 and 5 year local recurrence-free (RFS), disease-free (DFS) and overall survival (OS) outcomes were reported. Univariate and multivariate analysis was used to examine each potential predictor. RESULTS A total of 168 patients were eligible for the study. Forty-eight patients with biopsy-proven RCC had minimum 3-year follow-up. Our complication rate was 1.2 % (2/168) and local recurrence rate 10.4 % (5/48). Five-year RFS, DFS and OS were 86.8, 82.3 and 92.6 % on a median 4.1-year follow-up (IQR 3.4-4.9). None of the patient or tumour-specific characteristics were associated with RFS. CONCLUSION Radiofrequency ablation performed at our centre was a safe and effective procedure with low complication rates and durable RFS. Tumour characteristics, comorbidities and learning curve were not associated with local recurrence.


title: Clinical management for complications related to implantable LVAD use.

text: More than 250 continuous flow LVADs have been implanted in Japan during the last 3 years, with 1-year survival rates of 90%. These excellent results cannot be achieved without VAD teams who know the detail of surgical techniques and perioperative management. Preoperative optimization of RV function is essential and intraoperative managements are focused on adequate balance between right and left ventricle to prevent right ventricular (RV) failure. For postoperative RV failure early institution of temporary RV mechanical support improves outcomes. Immediate CT scanning is crucial if LVAD patients complain of new neurological symptoms. When CT reveals cerebral hemorrhage, INR should be reduced as soon as possible. The driveline (DL) exit site remains a significant source of LVAD-related infections, and orientation and immobilization of the DL is important. Although vacuum assisted closure is useful to facilitate drainage and healing in pump pocket as well as DL infections, urgent heart transplantation, bridging to recovery, or pump exchange may become the only options to eradicate LVAD-related infections. Patients with continuous flow LVAD are more prone to developing de novo aortic insufficiency. Although majority of them can be managed medically, some require surgical intervention. The cause of pump thrombosis is multifactorial, including lowered INR and pump speed, and implantation techniques. It is important to exchange pumps in a timely manner either through a median sternotomy or subcostal incision in highly suspected patients indicated by elevated LDH and left-sided heart failure.


Reply to "CT Is Not a Screening Tool for Coronavirus Disease (COVID-19) Pneumonia".


title: Comparison of two laparoscopic splenectomy plus pericardial devascularization techniques for management of portal hypertension and hypersplenism.

text: OBJECTIVE Our research was conducted to analyze the outcomes of two laparoscopic splenectomy plus pericardial devascularization (LSPD) techniques in the management of portal hypertension (PTH) and hypersplenism. METHODS Between May 2012 and May 2013, 41 patients with PTH and hypersplenism undergoing LSPD were retrospectively analyzed. Of them, 29 patients received LSPD by LigaSure Vessel Sealing System (LVSS) and Endo-GIA universal endoscopic vascular linear staplers (Endo-GIA) (EG Group) and 12 patients received LSPD by LVSS and Hem-o-Lock (HL Group). Operating time, intraoperative blood loss, postoperative course, and hospitalization costs were compared between the two LSPD combination techniques. RESULTS There were no significant differences in preoperative patient characteristics of the two groups. Significantly less operating time, intraoperative blood loss, and postoperative complications were observed in EG Group. The incidence of portal vein thrombosis was lower in the EG Group (3.4 vs. 8.3%), as well as the incidence of pancreatic fistula (0 vs. 8.3%). Upper gastrointestinal hemorrhage was not observed in either group. Uncontrolled bleeding warranted conversion to open surgery in one case in EG Group (conversion rate 3.4%) and in two cases in HL Group (conversion rate 16.7%). Two patients (16.7%) in HL Group underwent successful emergency exploratory laparotomy due to uncontrolled intraabdominal bleeding postoperatively. No re-operation was needed in EG Group. Two patients experienced liver failure after surgery in each group. Of those, three patients were managed successfully and one patient refused further therapy. While the overall complication rate was significantly lower in EG Group (17.2 vs. 58.3%, P < 0.05), overall hospitalization costs remained significantly higher for EG Group. CONCLUSION The results suggest that the modified Endo-GIA and LVSS technique is a safe and effective combination approach to LSPD with shorter operative time, less intraoperative blood loss, lower conversion rate to laparotomy, shorter hospital stay, better recovery, and lower postoperative complication rate compared with the Hem-o-Lock and LVSS approach. Higher hospitalization expenses associated with the Endo-GIA and LVSS approach.


title: COVID19 Prevention & Care; A Cancer Specific Guideline.

text: On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.


Translating academic careers into industry healthcare professions.


title: Transversus abdominis plane blocks and enhanced recovery pathways: making the 23-h hospital stay a realistic goal after laparoscopic colorectal surgery.

text: BACKGROUND Although enhanced recovery pathways (ERPs) may permit early recovery and discharge after laparoscopic colorectal surgery (LC), most publications report that the mean hospital stay is 4 and 6 days. This study evaluates the addition of a transversus abdominis plane (TAP) block to the standard ERP. METHODS In this study, 35 consecutive elective patients received a TAP block at the end of LC. The patients were matched by operation, diagnosis, age, gender, and body mass index (BMI) with 35 recent cases and followed in a prospective institutional review board (IRB)-approved database. All the patients were managed with a standardized ERP. The surgeon placed TAP blocks under laparoscopic guidance that infiltrated 15 ml of 0.5 % Marcaine on both sides of the abdomen. RESULTS The cases included 8 low pelvic anastomoses, 4 proctectomies with or without an ileal pouch anal anastomosis, 5 sigmoid/left colectomies, 13 ileocolic/right colectomies, 1 total colectomy, and 5 others. The mean age was 59 years for the TAP group and 64.1 years for the control group (p = 0.21). The mean hospital stay was 2 days for the TAP patients and 3 days for the control patients (p = 0.000013). Of the 35 TAP patients, 13 went home on postoperative day (POD) 1 (37 %), 12 on POD 2 (34 %), 8 on POD 3 (23 %), and the remainder on POD 4. Of the 35 control patients, 1 went home on POD 1 (3 %), 10 on POD 2 (29 %), 10 on POD 3 (29 %), 11 on POD 4 (31 %), and the remainder on POD 5 to 8. The TAP patients required fewer narcotics postoperatively than the control patients (respective mean morphine equivalents, 31.08 vs. 85.41; p = 0.01). DISCUSSION A bilateral TAP block significantly improved the results of an established ERP for patients undergoing LC. Surgeon-administered TAP blocks may be an economical and efficient method for improving the results of LC.


title: Detection of cryptic CCND1 rearrangements in mantle cell lymphoma by next generation sequencing.

text: The accurate detection of recurrent genetic abnormalities for most hematologic neoplasms is critical for diagnosis, prognosis and/or treatment. Rearrangements involving CCND1 are observed in a subset of mature B-cell neoplasms and can be reliably detected by fluorescence in situ hybridization (FISH) in most cases. However, cryptic and complex chromosomal rearrangements may pose a technical challenge for accurate diagnosis. Herein, we describe two patients with suspected mantle cell lymphoma that lacked obvious CCND1 rearrangements by FISH studies. A next generation sequencing (NGS) based assay, mate-pair sequencing (MPseq), was utilized in each case to investigate potential cryptic CCND1 rearrangements and revealed cryptic insertional events resulting in CCND1/IGH and CCND1/IGK rearrangements. These cases demonstrate that NGS-based assays, including MPseq, are a powerful approach to identify cryptic rearrangements of clinical importance that are not detected by current clinical genomics evaluation.


docid: mayezfbc

title: Doubt, Disorientation, and Death in the Plague Time.

text: An account of an experience with contracting an illness that may well have been Covid-19 gives rise to reflections on doubt and on the art of dying well. The upshot: our mortality remains a fundamentally disorienting condition of our existence. If there's any wisdom to be had concerning our deaths, it likely lies in the direction of accepting their deranging character, rather than in searching for the philosophical insight that will reconcile us to our fate.


Combating Emerging Threats--Accelerating the Availability of Medical Therapies.


docid: ktourmxe

title: Transthoracic single port with peroral assistance: an animal experiment to assess a less invasive technique for human esophageal atresia repair.

text: Thoracoscopic repair of esophageal atresia has becoming the gold standard in many centers because it allows a better cosmetic result and avoids the musculoskeletal sequelae of a thoracotomy. Natural orifice translumenal endocopic surgery (NOTES) is a new surgical paradigm, and its human application has already been started in some procedures. In the present study, we explore the feasibility of performing an esophagoesophageal anastomosis using a single transthoracic single port combined with a peroral access in a rabbit model to simulate repair of esophageal atresia by hybrid NOTES in a human newborn. Adult male rabbits (Oryctolagus cuniculus, n=28) were used to perform the surgical protocol. We used a transthoracic telescope with a 3-mm working channel and a flexible endoscope with a 2.2-mm working channel by peroral access. We performed total esophagotomy with peroral scissors followed by an esophagoesophageal anastomosis achieved with a rigid transthoracic scope helped by the peroral operator. Extracorporeal transthoracic knots were performed to complete the anastomosis. The anastomoses were examined in loco and ex loco, after animal sacrifice. We successfully accomplished a complete esophageal anastomosis in all rabbits using a combination of transthoracic and peroral 3-mm instruments. This study provides important insights for a possible translation of hybrid NOTES to human newborns with esophageal atresia. Forward studies to accomplish their feasibility in human newborns will still be necessary.


title: Infant with bilateral pulmonary sequestrations with portal venous drainage excised by video-assisted thoracic surgery.

text: INTRODUCTION Bilateral pulmonary sequestrations are rare congenital anomalies. Despite its benign nature, the potential complications of pulmonary sequestration (PS) are significant, including recurrent pulmonary infections, hemoptysis, congestive heart failure, and malignant potential. Therefore, the main treatment is surgical excision, even for patients with asymptomatic PS. CASE We present an infant in whom an intralobar PS of the right lung and an extralobar PS of the left lung were diagnosed on prenatal screening ultrasonography. Both were found to have venous drainage into the portal vein. Surgical excision was performed via video-assisted thoracic surgery (VATS) at 14 months of age. CONCLUSION PS may present with unique vascular connections, including venous drainage into the portal vein. VATS resection for pulmonary sequestration is feasible and effective as an alternative to bilateral thoracotomies, in the setting of extensive preoperative planning and performance by an experienced thoracoscopic surgeon.


title: Outcomes of laparoscopic and open resection for neuroendocrine liver metastases.

text: BACKGROUND We sought to compare the outcomes in patients with hepatic carcinoid tumor metastases treated with open versus laparoscopic liver resection. METHODS A retrospective analysis of our liver surgery database was performed. All patients who underwent liver resection for hepatic carcinoid tumor metastases were included. Patients were divided into 2 groups depending on the surgical approach. Patients with concomitant primary and metastatic liver lesions underwent open resection. RESULTS Thirty-six patients underwent resection over a 10-year period (21 open and 15 laparoscopic). Both groups were similar in terms of gender, body mass index, tumor size, incidence of carcinoid syndrome, and extent of resection (P > .05). The laparoscopic group had less mean operative time (2.7 vs 5.4 hours), less mean blood loss (158.3 vs 538.9 mL), and a shorter hospital stay (3.2 vs 7.5 days; P < .05 for all). Complications were similar in both groups (20% vs 33%; P = .21). Two laparoscopic cases required conversion. The 3-year disease-free survival for the laparoscopic group was 73.3% compared to 47.6% for the open group (P = .2). CONCLUSION To our knowledge, this is the first reported study comparing laparoscopic versus open liver resection in the treatment of liver metastases from carcinoid tumors. Our series confirms that selective cases can safely be managed laparoscopically.


title: Gene expression profiling of peripheral blood mononuclear cells from children with active hemophagocytic lymphohistiocytosis.

text: Familial hemophagocytic lymphohistiocytosis (FHL) is a rare, genetically heterogeneous autosomal recessive immune disorder that results when the critical regulatory pathways that mediate immune defense mechanisms and the natural termination of immune/inflammatory responses are disrupted or overwhelmed. To advance the understanding of FHL, we performed gene expression profiling of peripheral blood mononuclear cells from 11 children with untreated FHL. Total RNA was isolated and gene expression levels were determined using microarray analysis. Comparisons between patients with FHL and normal pediatric controls (n = 30) identified 915 down-regulated and 550 up-regulated genes with more than or equal to 2.5-fold difference in expression (P ≤ .05). The expression of genes associated with natural killer cell functions, innate and adaptive immune responses, proapoptotic proteins, and B- and T-cell differentiation were down-regulated in patients with FHL. Genes associated with the canonical pathways of interleukin-6 (IL-6), IL-10 IL-1, IL-8, TREM1, LXR/RXR activation, and PPAR signaling and genes encoding of antiapoptotic proteins were overexpressed in patients with FHL. This first study of genome-wide expression profiling in children with FHL demonstrates the complexity of gene expression patterns, which underlie the immunobiology of FHL.


title: The Value of the One Health Approach: Shifting from Emergency Response to Prevention of Zoonotic Disease Threats at Their Source.

text: The majority of emerging infectious diseases have their source in animals, and emergence occurs at the human-animal interface, when infections in animals breach the species barrier to infect humans, the population in which they are often first identified. The response is often a series of emergency activities to contain and manage the infection in human populations, and at the same time to identify the source of the infection in nature. If an infection is found to have a source in animals, and if animals cause a continuous threat of human infection, culling is often recommended, with severe economic impact. Currently the animal and human medicine sectors are working toward interacting more closely at the animal-human interface through joint surveillance and risk assessment, and research is under way in geographic areas where emergence at the animal-human interface has occurred in the past. The goal of this research is to identify infectious organisms in tropical and other wild animals, to genetically sequence these organisms, and to attempt to predict which organisms have the potential to emerge in human populations. It may be more cost-effective, however, to learn from past emergence events and to shift the paradigm from disease surveillance, detection, and response in humans to prevention of emergence at the source by understanding and mitigating the factors, or determinants, that influence animal infection. These determinants are clearly understood from the study of previous emergence events and include human-induced changes in natural environments, urban areas, and agricultural systems; raising and processing of animal-based foods; and the roles of global trade, migration, and climate change. Better understanding of these factors gained from epidemiological investigation of past and present emergence events, and modeling and study of the cost-effectiveness of interventions that could result in their mitigation, could provide evidence necessary to better address the political and economic barriers to prevention of infections in animals. Such economically convincing arguments for change and mitigation are required because of the basic difference in animal health, driven by the need for profit, and human health, driven by the need to save lives.


Lessons to Europe from China for cancer treatment during the COVID-19 pandemic.


title: Gender Analysis of COVID-19 Outbreak in South Korea: A Common Challenge and Call for Action.

text: This study aims to analyze South Korea's experience during the COVID-19 outbreak through a gendered lens. We briefly introduce the COVID-19 outbreak in Korea, scrutinize gendered vulnerability in contracting the virus, and then analyze the gendered aspects of the pandemic response in two phases: quarantine policy and mitigation policy. The authors elicit four lessons from the analysis. First, gender needs to be mainstreamed at all stages of a public health emergency response. Second, in addition to medical care, all formal and informal care work should be considered as an essential component of health care systems. Third, a people-centered approach in health governance should be prioritized to make women's voices heard at every level. Fourth, medical technology and resources to cope with pandemic should be produced and distributed in an equitable manner, acknowledging differential vulnerability and susceptibility.


title: Nested PCR-linked capillary electrophoresis and single-strand conformation polymorphisms for detection of macrolide-resistant Mycoplasma pneumoniae in Beijing, China.

text: Mycoplasma pneumoniae is usually susceptible to macrolides, but macrolide-resistant strains have been found frequently in recent years. Mutations in domain V of the 23S rRNA gene of M. pneumoniae interfere with the binding of macrolides to rRNA and mediate macrolide resistance. In this study, we developed a rapid and inexpensive method that combines nested PCR (nPCR), single-strand conformation polymorphisms (SSCPs), and capillary electrophoresis (CE) to detect macrolide-resistant mutants directly from throat swabs. nPCR was used to specifically amplify M. pneumoniae 23S rRNA gene fragments containing mutations, and amplicons were analyzed by CE-SSCP for macrolide resistance mutations, with results confirmed by sequencing. From January to December 2009, 665 throat swabs were collected in Beijing, China, yielding 110 samples that tested positive for M. pneumoniae by nPCR and serological testing. We randomly selected 64 positive throat swabs for CE-SSCP analysis. The A2063G mutation was found in 57 samples, and a coexisting T2611C mutation was identified in 1 sample. An A2063T mutation was identified in 1 sample. The total mutation rate was 91%. All mutant samples identified by nPCR-CE-SSCP were sequenced. The nPCR-CE-SSCP method could identify macrolide-resistant mutants directly from clinical samples. This is the first report of an nPCR-CE-SSCP assay for the detection of dominant mutations that confer macrolide resistance on M. pneumoniae. This approach would allow clinicians to choose appropriate therapy rapidly and could be used as a screening method for genetic mutations related to antibiotic resistance.


Strategies for Disseminating and Implementing COVID-19 Public Health Prevention Practices in Rural Areas.


title: COVID-19: Avoiding a second tragedy in a tuberculosis burdened country.

text: To the Editor Novel Coronavirus disease (COVID-19) was first notified in December 2019 from Wuhan, China. Now, it has spread rapidly and has been declared a pandemic affecting over 200 countries with widespread morbidity and mortality. It has been postulated that the most vulnerable population are the elderly, people living in crowded areas, children and immune-compromised individuals, such as people living with human immunodeficiency virus (HIV). The correlation of tuberculosis (TB), HIV and malnutrition are well documented and hence, people with tuberculosis should be considered as special population in this pandemic. TB is an ancient disease among humans recorded as far back as seventy thousand years which was declared a global public health emergency in 1993 by the World Health Organisation (WHO). India has the highest TB burden in the world.


title: A Reliable and Reproducible Critical-Sized Segmental Femoral Defect Model in Rats Stabilized with a Custom External Fixator.

text: Orthopedic research relies heavily on animal models to study mechanisms of bone healing in vivo as well as investigate the new treatment techniques. Critical-sized segmental defects are challenging to treat clinically, and research efforts could benefit from a reliable, ambulatory small animal model of a segmental femoral defect. In this study, we present an optimized surgical protocol for the consistent and reproducible creation of a 5 mm critical diaphyseal defect in a rat femur stabilized with an external fixator. The diaphyseal ostectomy was performed using a custom jig to place 4 Kirschner wires bicortically, which were stabilized with an adapted external fixator device. An oscillating bone saw was used to create the defect. Either a collagen sponge alone or a collagen sponge soaked in rhBMP-2 was implanted into the defect, and the bone healing was monitored over 12 weeks using radiographs. After 12 weeks, rats were sacrificed, and histological analysis was performed on the excised control and treated femurs. Bone defects containing only collagen sponge resulted in non-union, while rhBMP-2 treatment yielded the formation of a periosteal callous and new bone remodeling. Animals recovered well after implantation, and external fixation proved successful in stabilizing the femoral defects over 12 weeks. This streamlined surgical model could be readily applied to study bone healing and test new orthopedic biomaterials and regenerative therapies in vivo.


title: Importance of viruses in acute otitis media.

text: PURPOSE OF REVIEW Acute otitis media occurs as a complication of viral upper respiratory tract infection. Bacterial otopathogens and respiratory viruses interact and play important roles in acute otitis media development. A better understanding of viral and bacterial interactions may lead to innovative ways to lessen the burden of this common childhood disease. RECENT FINDINGS There has been increasing evidence that acute otitis media occurs during upper respiratory infection, even in the absence of nasopharyngeal bacterial colonization. Among the types of viruses associated with acute otitis media, respiratory syncytial virus continues to be the most commonly detected. It is still unclear whether viral load plays an important role in acute otitis media development, but symptomatic upper respiratory tract infection (as opposed to asymptomatic viral infection) is crucial. Widespread use of bacterial and viral vaccines in young children, including pneumococcal conjugate and influenza vaccines, has led to the reduction in otitis media-related healthcare use between 2001 and 2011. There has been no new vaccine against respiratory viruses other than influenza. SUMMARY Progress has been made toward the reduction of the burden of acute otitis media in the last decade. Success in reducing acute otitis media incidence will rely mainly on prevention of nasopharyngeal otopathogen colonization, as well as reduction in the incidence of viral upper respiratory tract infection.


title: How we make choices and sacrifices in medical education during the COVID-19 pandemic.

text: In this commentary, we highlight some of the pressing choices and sacrifices we must make in medical education during the COVID-19 pandemic.


title: Early vasopressor use following traumatic injury: a systematic review.

text: OBJECTIVES Current guidelines suggest limiting the use of vasopressors following traumatic injury; however, wide variations in practice exist. Although excessive vasoconstriction may be harmful, these agents may help reduce administration of potentially harmful resuscitation fluids. This systematic review aims to compare early vasopressor use to standard resuscitation in adults with trauma-induced shock. DESIGN Systematic review. DATA SOURCES We searched MEDLINE, EMBASE, ClinicalTrials.gov and the Central Register of Controlled Trials from inception until October 2016, as well as the proceedings of 10 relevant international conferences from 2005 to 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials and controlled observational studies that compared the early vasopressor use with standard resuscitation in adults with acute traumatic injury. RESULTS Of 8001 citations, we retrieved 18 full-text articles and included 6 studies (1 randomised controlled trial and 5 observational studies), including 2 published exclusively in abstract form. Across observational studies, vasopressor use was associated with increased short-term mortality, with unadjusted risk ratios ranging from 2.31 to 7.39. However, the risk of bias was considered high in these observational studies because patients who received vasopressors were systematically sicker than patients treated without vasopressors. One clinical trial (n=78) was too imprecise to yield meaningful results. Two clinical trials are currently ongoing. No study measured long-term quality of life or cognitive function. CONCLUSIONS Existing data on the effects of vasopressors following traumatic injury are of very low quality according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. With emerging evidence of harm associated with aggressive fluid resuscitation and, in selected subgroups of patients, with permissive hypotension, the alternatives to vasopressor therapy are limited. Observational data showing that vasopressors are part of usual care would provide a strong justification for high-quality clinical trials of early vasopressor use during trauma resuscitation. TRIAL REGISTRATION NUMBER CRD42016033437.


title: Development and evaluation of a retroperitoneal dialysis porcine model.

text: OBJECTIVES We attempted to create a surgical model to evaluate the retroperitoneal space for the ability to transfer solutes through the retroperitoneal membrane. Our dual objectives were to develop a technique to assess the feasibility of retroperitoneal dialysis (RPD) in a porcine model. METHODS We incorporated two 35-kg Yorkshire pigs for this pilot study. In the first animal, we clamped renal vessels laparoscopically. In the second animal, we embolized renal arteries. In both animals, we dilated the retroperitoneal space bilaterally and deployed dialysis catheters. We measured serum creatinine (Cr), urea, and electrolytes at baseline 6 hours before the dialysis and every 4 hours after. RESULTS We successfully created retroperitoneal spaces bilaterally and deployed dialysis catheters in both animals. In the first animal, dialysate and plasma Cr ratio (D/P) on the left and right side were 0.43 and 0.3, respectively. Cr clearance by 40 minutes of dialysis treatment was 6.3 mL/min. The ratio of dialysate glucose at 4 hours dwell time to dialysate glucose at 0 dwell time (D/D0) for left/rights sides were 0.02 and 0.02, respectively. kt/Vurea was 0.43. In the second animal, D/P Cr for left/right sides were 0.34 and 0.33, respectively. kt/Vurea was 0.17. We euthanized the pigs due to fluid collection in the peritoneal space and rapid increase of serum Cr, urea, and electrolytes. CONCLUSIONS We demonstrated the feasibility of creation of a functionally anephric porcine model with successful development of retroperitoneal spaces using balloon inflation. Notwithstanding minimal clearance and limited diffusion capacity in this experiment, additional studies are needed to examine potential use of retroperitoneal space for peritoneal dialysis.


COVID-19: A personal thank you to all perioperative practitioners and other key workers.


title: Deep learning for classification and localization of COVID-19 markers in point-of-care lung ultrasound.

text: Deep learning (DL) has proved successful in medical imaging and, in the wake of the recent COVID-19 pandemic, some works have started to investigate DLbased solutions for the assisted diagnosis of lung diseases. While existing works focus on CT scans, this paper studies the application of DL techniques for the analysis of lung ultrasonography (LUS) images. Specifically, we present a novel fully-annotated dataset of LUS images collected from several Italian hospitals, with labels indicating the degree of disease severity at a frame-level, videolevel, and pixel-level (segmentation masks). Leveraging these data, we introduce several deep models that address relevant tasks for the automatic analysis of LUS images. In particular, we present a novel deep network, derived from Spatial Transformer Networks, which simultaneously predicts the disease severity score associated to a input frame and provides localization of pathological artefacts in a weakly-supervised way. Furthermore, we introduce a new method based on uninorms for effective frame score aggregation at a video-level. Finally, we benchmark state of the art deep models for estimating pixel-level segmentations of COVID-19 imaging biomarkers. Experiments on the proposed dataset demonstrate satisfactory results on all the considered tasks, paving the way to future research on DL for the assisted diagnosis of COVID-19 from LUS data.


title: Myriad Genetics: In the eye of the policy storm.

text: From the late 1980s, a storm surrounding the wisdom, ethics, and economics of human gene patents has been brewing. The various winds of concern in this storm touched on the impact of gene patents on basic and clinical research, on health care delivery, and on the ability of public health care systems to provide equal access when faced with costly patented genetic diagnostic tests. Myriad Genetics, Inc., along with its subsidiary, Myriad Genetic Laboratories, Inc., a small Utah-based biotechnology company, found itself unwittingly in the eye of this storm after a series of decisions it made regarding the commercialization of a hereditary breast cancer diagnostic test. This case study examine the background to Myriad's decisions, the context in which these decisions were made and the policy, research and business response to them.


PURPOSE Evaluation of the technical success rate and complications when retrieving dislocated intravascular foreign bodies. MATERIAL AND METHODS Between 1999 and 2015 38 patients (21 female; 17 male; Age: 17 - 92; Average 54.3 years) underwent an extraction of intravascular dislocated foreign bodies, which were not lost during a radiological intervention. The extracted material included 29 port catheters, 3 tips of tunneled dialysis catheters, 2 stents, 2 guide wires, 1 CVC tip and 1 AS occluder device. Various catheters for repositioning and extraction were used. The access was transarterial as well as transvenous. Technical success was defined as complete removal of the foreign body. RESULTS The technical success rate was 92.1 % (35 of 38). In 17 patients an additional catheter was necessary to reposition the foreign body in order to make it accessible for the extraction catheter. In one case a stent was relocated and remodeled within the patient and was not extracted. In another case we experienced a dislocation of a small fragment of the port catheter into the distal parts of the pulmonary artery, which couldn't be extracted. A guide wire could not be extracted as it was already adhered with the vessel wall. Peri-interventional complications were not documented. CONCLUSION The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and poor of complications. Interventional therapy can avoid surgical removal. KEY POINTS • The percutaneous extraction of dislocated intravascular foreign bodies is technically successful and safe.• In most cases surgical removal can be avoided.• The gooseneck-snare catheter was mainly used for the extraction of intravascular foreign bodies. Citation Format: • Ayx I, Goessmann H, Hubauer H et al. Interventional Removal of Intravascular Medical Devices: Methods and Technical Success. Fortschr Röntgenstr 2016; 188: 566 - 573.


title: Contrast extravasation on CT angiography predicts hematoma expansion and mortality in acute traumatic subdural hemorrhage.

text: BACKGROUND AND PURPOSE The presence of active contrast extravasation at CTA predicts hematoma expansion and in-hospital mortality in patients with nontraumatic intracerebral hemorrhage. This study aims to determine the frequency and predictive value of the contrast extravasation in patients with aSDH. MATERIALS AND METHODS We retrospectively reviewed 157 consecutive patients who presented to our emergency department over a 9-year period with aSDH and underwent CTA at admission and a follow-up NCCT within 48 hours. Two experienced readers, blinded to clinical data, reviewed the CTAs to assess for the presence of contrast extravasation. Medical records were reviewed for baseline clinical characteristics and in-hospital mortality. aSDH maximum width in the axial plane was measured on both baseline and follow-up NCCTs, with hematoma expansion defined as >20% increase from baseline. RESULTS Active contrast extravasation was identified in 30 of 199 discrete aSDHs (15.1%), with excellent interobserver agreement (κ = 0.80; 95% CI, 0.7-0.9). The presence of contrast extravasation indicated a significantly increased risk of hematoma expansion (odds ratio, 4.5; 95% CI, 2.0-10.1; P = .0001) and in-hospital mortality (odds ratio, 7.6; 95% CI, 2.6-22.3; P = 0.0004). In a multivariate analysis controlled for standard risk factors, the presence of contrast extravasation was an independent predictor of aSDH expansion (P = .001) and in-hospital mortality (P = .0003). CONCLUSIONS Contrast extravasation stratifies patients with aSDH into those at high risk and those at low risk of hematoma expansion and in-hospital mortality. This distinction could affect patient treatment, clinical trial selection, and possible surgical intervention.


title: Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations.

text: The development of chronic pain is considered a major complication after surgery. Basic science research in animal models helps us understand the transition from acute to chronic pain by identifying the numerous molecular and cellular changes that occur in the peripheral and central nervous systems. It is now well recognized that inflammation and nerve injury lead to long-term synaptic plasticity that amplifies and also maintains pain signaling, a phenomenon referred to as pain sensitization. In the context of surgery in humans, pain sensitization is both responsible for an increase in postoperative pain via the expression of wound hyperalgesia and considered a critical factor for the development of persistent postsurgical pain. Using specific drugs that block the processes of pain sensitization reduces postoperative pain and prevents the development of persistent postoperative pain. This narrative review of the literature describes clinical investigations evaluating different preventative pharmacologic strategies that are routinely used by anesthesiologists in their daily clinical practices for preventing persistent postoperative pain. Nevertheless, further efforts are needed in both basic and clinical science research to identify preclinical models and novel therapeutics targets. There remains a need for more patient numbers in clinical research, for more reliable data, and for the development of the safest and the most effective strategies to limit the incidence of persistent postoperative pain.


title: Frequency and severity of general surgical emergencies during the COVID-19 pandemic: single-centre experience from a large metropolitan teaching hospital.

text: INTRODUCTION The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. MATERIALS AND METHODS This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. RESULTS A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). CONCLUSION Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.


title: [Coagulopathy in COVID-19: pathophysiology].

text: On March 11, 2020, just after 2 months from the first cases of coronavirus disease 2019 (COVID-19) in China, the Director-General of the World Health Organization stated that COVID-19 has to be considered as a pandemic. Italian doctors were the first protagonists, after the Chinese ones, in the management of this disease. Clinical observations showed that, in addition to the respiratory infection, a systemic inflammatory response occurs, which leads to coagulation disorders and consequent venous thromboembolism as well as other thrombotic complications. We here review the available literature on this issue to better understand the pathophysiological mechanisms of coagulopathy useful to draw future clinical and therapeutic conclusions.


title: Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia.

text: BACKGROUND Several studies have shown that laparoscopic hernia repair for large paraesophageal hiatal hernia is associated with a high recurrence rate. Therefore, some authors recommend the use of prosthetic meshes. Considering the dynamic area between the esophagus and the diaphragmatic crura with its constant motion, it is astonishing that only a minor number of surgeons describe mesh-associated complications. METHODS Between January 2000 and August 2008, 26 patients of the Centre Hospitalier Emile Mayrisch (CHEM, Luxembourg) underwent laparoscopic repair for large paraesophageal hiatal hernia (median age, 70 (range, 39-90) years). In nine patients, prosthetic mesh reinforcement was performed (7 composite/2 mono-phase mesh). Crural repair without tension was performed only with sutures. There were no conversions. Follow-up assessment was prospective with the GIQL (Gastro-Intestinal Quality of Life) Index. RESULTS Responses to the GIQLI questionnaires were obtained from 20 patients (6 died of unrelated causes). Nineteen patients were satisfied with their symptom control 1 year after the operation (GIQLI 127). Sixteen patients had radiological follow-up (median, 24 months). Three patients treated without mesh (3/10) showed a radiological recurrence. All of them (3/10) had symptoms. None of the controlled patients with mesh (0/6) showed a recurrence. One patient developed a severe aortal bleeding 1, 2, and 3 weeks after the laparoscopic mono-phase mesh repair. During conventional operation, the bleeding stopped. Three years later, the follow-up showed a satisfied patient (GIQLI 127). CONCLUSIONS In view of the described complication, there is still considerable controversy regarding the routine use of mesh. To increase safety, a composite mesh should be preferred.


docid: wrevlmut

title: Polymeric materials for embolic and chemoembolic applications.

text: Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.


title: Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease.

text: INTRODUCTION Since the introduction of laparoscopic surgery, surgeons have not only been concerned about clinical outcomes, but also surgical scars. Although natural orifice transluminal endoscopic surgery (NOTES) is promising, it is not applicable to clinical practice thus far due to safety concerns. As a transitional procedure between standard laparoscopic surgery and NOTES, single-port transumbilical laparoscopic surgery might be an ideal alternative. The main advantage of single-port transumbilical laparoscopic surgery is that it is performed with existing instruments. Thus, we applied single-port surgery for cholecystectomies and the clinical outcomes were analyzed. METHODS Between July and October 2008, 37 adults with gallbladder pathologies were enrolled in this study. Only one transumbilical incision was made for accessing the abdominal cavity and a multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform the cholecystectomy. RESULTS There were 13 males and 24 females. The mean age of the patients was 47.5 +/- 12.2 years. Twenty-nine patients had gallbladder stones, 7 patients had gallbladder polyps, and 1 patient had biliary dyskinesia. The mean operative time was 83.6 +/- 40.2 minutes. Gallbladder perforations occurred in 11 patients. In 5 patients, the procedure was converted to a standard laparoscopic technique due to technical difficulties. Complications occurred in 2 patients; specifically, a mesenteric injury was caused by the inadvertent grasping of the small-bowel mesentery during the removal of the wound retractor and an inadvertent injury of the right hepatic duct. The mean hospital stay was 2.7 +/- 1.5 days. CONCLUSIONS Our series has demonstrated the feasibility and safety of single-port transumbilical laparoscopic cholecystectomy. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. Additional studies randomizing standard laparoscopic cholecystectomy and single-port transumbilical cholecystectomy are necessary for defining the exact role of this procedure.


Using non invasive dynamic parameters of fluid responsiveness in children: there is still much to learn.


title: Highly improved metabolic stability and pharmacokinetics of indium-111-DOTA-gastrin conjugates for targeting of the gastrin receptor.

text: The development of metabolically stable radiolabeled gastrin analogues with suitable pharmacokinetics is a topic of recent research activity. These imaging vectors are of interest because the gastrin/CCK2 receptor is highly overexpressed in different tumors such as medullary thyroid cancer, neuroendocrine tumors, and SCLC. The drawback of current targeting agents is either their metabolic instability or their high kidney uptake. We present the synthesis and in vitro and in vivo evaluation of 11 (111)In-labeled DOTA-conjugated peptides that differ by their spacer between the peptide and the chelate. We introduced uncharged but hydrophilic spacers such as oligoethyleneglycol, serine, and glutamine. The affinity of all radiopeptides was high with IC(50) values between 0.5 and 4.8 nM. The improvement of human serum stability is 500-fold within this series of compounds. In addition the kidney uptake could be lowered distinctly and the tumor-to-kidney ratio improved almost 60-fold if compared with radiotracers having charged spacers such as glutamic acid.


title: Enhanced hygiene measures and norovirus transmission during an outbreak.

text: Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We analyzed norovirus outbreaks in 7 camps at an international scouting jamboree in the Netherlands during 2004. Implementation of hygiene measures coincided with an 84.8% (95% predictive interval 81.2%-86.6%) reduction in reproduction number. This reduction was unexpectedly large but still below the reduction needed to contain a norovirus outbreak. Even more stringent control measures are required to break the chain of transmission of norovirus.


The British Cardiovascular Society.


title: Targeting SARS-CoV-2: Novel Source of Antiviral Compound(s) against COVID-19?

text: SARS-CoV-2 remains a significant burden on human health. Several lines of evidence suggest that surveillance of sewage and waste can provide an early warning sign for COVID-19 recurrence in a community. In support, SARS-CoV-2 traces were found in sewage in several countries. With this in mind, it is notable that pests, such as cockroaches, are exposed to pathogenic microbes routinely, yet thrive in polluted environments. Such species have likely developed mechanisms to protect themselves against pathogens. In support, recent studies showed that cockroaches possess potent antibacterial molecules to shield themselves from pathogenic bacteria. Among hundreds of molecules, some contained thiazine groups, imidazoles, chromene derivatives, isoquinoline group, sulfonamides, pyrrole-containing analogs, flavanones, and furanones. Here, we propose that cockroaches are a potential source of antiviral molecules to thwart infections. Because this is an unexploited resource for potential antivirals, we believe that cockroaches offer a unique source for novel bioactive molecule(s) to counter COVID-19 with huge clinical impact worldwide.


title: Appropriate protein and specific amino acid delivery can improve patient outcome: fact or fantasy?

text: Protein utilization and requirements in critical illness are much researched and debated topics. The enhanced turnover and catabolism of protein in the setting of critical illness is well described and multifactorial in nature. The need to preserve lean body mass and enhance nitrogen retention in this state to improve immunologic function and reduce morbidity is well described. Debates as to the optimum amount of protein to provide in such states still exist, and a significant amount of research has contributed to our understanding of not only how much protein to supply to these patients, but how best to do so. Small peptide formulations, intact protein formulations, branched chain amino acids, and specialty formulas all exist, and their benefits, drawbacks, and potential uses have been investigated. Specific amino acid therapy has become part of the concept of immunonutrition, or the modification and enhancement of the immune response with specific nutrients. In this article, we describe the changes in outcomes demonstrated through the provision of protein, both as a macronutrient and as specific amino acids.


title: THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial.

text: BACKGROUND AND PURPOSE Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device). METHODS We used data from the TREVO-2 trial to validate the Totaled Health Risks in Vascular Events (THRIVE) score in patients receiving treatment with a third-generation endovascular stroke treatment device and to compare THRIVE to other predictive scores. We used logistic regression to model outcomes and compared score performance with receiver operating characteristic curve analysis. RESULTS In the TREVO-2 trial, the THRIVE score strongly predicts clinical outcome and mortality. The relationship between THRIVE score and outcome is not influenced by either success of recanalization or the type of device used (Trevo versus Merci). The superiority of the Trevo device to the Merci device is evident particularly among patients with a low-to-moderate THRIVE score (0-5; 53.8% good outcome with Trevo versus 27.5% good outcome with Merci). In receiver operating characteristic curve analysis, the THRIVE score was comparable or superior to several other outcome prediction scores (HIAT, HIAT-2, SPAN-100, and iScore). CONCLUSIONS The THRIVE score strongly predicts clinical outcome and mortality in the TREVO-2 trial. Taken together with THRIVE validation data from patients receiving intravenous tissue-type plasminogen activator or no acute treatment, the THRIVE score has broad predictive power in patients with acute ischemic stroke, which is likely because THRIVE reflects a set of strong nonmodifiable predictors of stroke outcome. A free Web calculator for the THRIVE score is available at http://www.thrivescore.org.


docid: npsvnwax

title: An alarm management view of IT and Biomed roles and responsibilities.


title: Passive versus active intra-abdominal drainage following pancreatic resection: does a superior drainage system exist? A protocol for systematic review.

text: BACKGROUND Clinically relevant postoperative pancreatic fistula (CR-POPF) is the most common cause of major morbidity following pancreatic resection. Intra-abdominal drains are frequently positioned adjacent to the pancreatic anastomosis or transection margin at the time of surgery to aid in detection and management of CR-POPF. Drains can either evacuate fluid by passive gravity (PG) or be attached to a closed suction (CS) system using negative pressure. There is controversy as to whether one of these two systems is superior. The objective of this review is to identify and compare the incidence of adverse events (AEs) and resource utilisation associated with PG and CS drainage following pancreatic resections. METHODS AND ANALYSIS MEDLINE, EMBASE, CINAHL and Cochrane Central Registry of Controlled Trials will be searched from inception to April 2019, to identify interventional and observational studies comparing PG and CS drains following pancreatic resection. The primary outcome is POPF as defined by the International Study Group for Pancreatic Fistula in 2017. Secondary outcomes include postoperative AE, resource utilisation (length of stay, return to emergency department, readmission and reintervention), time to drain removal and quality of life. Study selection, data extraction and risk of bias assessment will be performed independently, by two reviewers. A meta-analysis will be conducted if deemed statistically appropriate. Subgroup analysis by study design will be performed. Study heterogeneity will be calculated with the χ2 test and reported as I2 statistics. Statistical analyses will be conducted and displayed using RevMan V.5.3 ETHICS AND DISSEMINATION: Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and peer-reviewed journals for publication. PROSPERO REGISTRATION NUMBER CRD42019123647.


docid: gxvbsqvs

title: Postoperative Cervical Cord Compression Induced by Hydrogel Dural Sealant (DuraSeal®).

text: Cerebrospinal fluid (CSF) leakage is a potential complication of cranial and spinal surgery. Postoperative CSF leakage can induce delayed healing, wound infection and meningitis. DuraSeal® (Covidien, Waltham, MA, USA) is a synthetic product which has been increasingly used to facilitate watertight repair of dural defects after cranial and spinal surgery. Despite some advantages of Duraseal®, the authors report a patient who developed cord compression following the use of DuraSeal® in cervical spine surgery in which the expansion of the DuraSeal® was believed to be the causative factor.


title: Robotic-assisted thoracoscopic enucleation of esophageal leiomyoma.

text: Minimally invasive approaches to esophageal leiomyoma, including thoracoscopic and laparoscopic enucleation, have been shown to have better postoperative recovery compared with thoracotomy approach. We present a case of robotic-assisted thoracoscopic enucleation of esophageal leiomyoma using the da Vinci(®) S system.


docid: mtfplfym

title: Porcine Epidemic Diarrhea Virus and Porcine Deltacoronavirus not Detected in Waterfowl in the North American Mississippi Migratory Bird Flyway in 2013.

text: Cloacal swab samples collected from 538 migratory waterfowl along the Mississippi Migratory Bird Flyway in 2013 were tested for porcine epidemic diarrhea virus and porcine deltacoronavirus. Neither virus was detected in any of the samples, indicating that waterfowl likely did not contribute to the rapid spread of these viruses within central US.


title: Prediction of response to endoscopic therapy of Barrett's dysplasia by using genetic biomarkers.

text: BACKGROUND Endoscopic therapy for the treatment of high-grade dysplasia (HGD) and intramucosal cancer (IMC) in Barrett's esophagus (BE) may not always result in complete remission of dysplasia (CRD). OBJECTIVE To determine whether genetic alterations in the Barrett's mucosa can predict response to endoscopic therapy. DESIGN Retrospective cohort study. SETTING Tertiary-care institution. PATIENTS Selected patients who underwent endoscopic therapy for BE containing HGD/IMC between 2003 and 2010. INTERVENTIONS Endoscopic therapy combining mucosal resection and different ablation modalities was performed based on patient characteristics, endoscopic findings, and technique evolution. Fluorescence in situ hybridization was used to evaluate genetic alterations on baseline endoscopic cytology brushings by using probes directed to loci 8q24 (MYC), 9p21 (CDKN2A; alias P16), 17q12 (ERBB2; alias Her-2/neu), and 20q13.2 (ZNF217). MAIN OUTCOME MEASUREMENTS Genetic biomarkers predicting achievement of CRD after endoscopic therapy. RESULTS A total of 181 patients were included (145 men; 66 ± 10 years of age). There were 130 patients (72%) who responded to endoscopic therapy with CRD. Multiple gains detected by fluorescence in situ hybridization was found to be a negative predictor (hazard ratio 0.57; 95% confidence interval, 0.40-0.82) after adjusting for potential clinical confounders. Similar results were found when analyses were restricted to patients (n = 66) undergoing radiofrequency ablation (hazard ratio 0.58; 95% confidence interval, 0.31-1.09). LIMITATIONS Retrospective study, heterogeneity of treatment modalities. CONCLUSION Patients with multiple gains detected by brush cytology specimens may have a lower response rate to endoscopic therapy. The presence of multiple gains can be an adjunct to standard histology in prognosticating BE patients with HGD/IMC undergoing endoscopic therapy.


Covid-19: Health and care workers will be "highest priority" for vaccination, says JCVI.


title: The Role of Phosphodiesterase 12 (PDE12) as a Negative Regulator of the Innate Immune Response and the Discovery of Antiviral Inhibitors.

text: 2',5'-Oligoadenylate synthetase (OAS) enzymes and RNase-L constitute a major effector arm of interferon (IFN)-mediated antiviral defense. OAS produces a unique oligonucleotide second messenger, 2',5'-oligoadenylate (2-5A), that binds and activates RNase-L. This pathway is down-regulated by virus- and host-encoded enzymes that degrade 2-5A. Phosphodiesterase 12 (PDE12) was the first cellular 2-5A- degrading enzyme to be purified and described at a molecular level. Inhibition of PDE12 may up-regulate the OAS/RNase-L pathway in response to viral infection resulting in increased resistance to a variety of viral pathogens. We generated a PDE12-null cell line, HeLaΔPDE12, using transcription activator-like effector nuclease-mediated gene inactivation. This cell line has increased 2-5A levels in response to IFN and poly(I-C), a double-stranded RNA mimic compared with the parental cell line. Moreover, HeLaΔPDE12 cells were resistant to viral pathogens, including encephalomyocarditis virus, human rhinovirus, and respiratory syncytial virus. Based on these results, we used DNA-encoded chemical library screening to identify starting points for inhibitor lead optimization. Compounds derived from this effort raise 2-5A levels and exhibit antiviral activity comparable with the effects observed with PDE12 gene inactivation. The crystal structure of PDE12 complexed with an inhibitor was solved providing insights into the structure-activity relationships of inhibitor potency and selectivity.


title: A Custom-made Pupillometer System for Characterizing Pupillary Light Response.

text: Objectives This paper presents the design and construction of a viable pupillometer system and demonstrates its merits with extensive validation tests. Materials and Methods A web camera was modified by removing its infrared filter and mounted on a chin rest. Light emitting diodes (LEDs) operating at infrared and visible spectra were integrated to provide background and light stimulus, respectively. The LEDs were controlled by a microprocessor board. Stimulation was presented using a periodic paradigm with variable period and duty cycle. Videos of both pupils were recorded at 30 frames/second and processed offline using software developed in-house. The overall system was validated with data gathered from individuals with healthy vision under different stimulation paradigms. Temporal variations in pupil size were determined and analyzed statistically. Results The analysis revealed that the pupil sizes were accurately measured from the video frames provided that reflections from both infrared and visible lights remain outside the pupil. The system achieved moderate to excellent repeatability scores (87.8 and 86.8% for short 1 second and long 2 second pulses, respectively), which demonstrated its effectiveness and confirmed that it can be used reliably as a pupillometer. Conclusion The proposed pupillometer system produces useful, quantitative data characterizing pupillary light response. However, further development and implementation are needed to potentially turn it into a low-cost alternative for other studies involving the autonomic nervous system, cognitive function, drug metabolism, pain response, psychology, fatigue, and sleep disorders.


title: Cardiac manifestations in COVID-19 patients-A systematic review.

text: OBJECTIVES The coronavirus disease-2019 (COVID-19) pandemic has resulted in the worst global pandemic of our generation, affecting 215 countries with nearly 5.5 million cases. The association between COVID-19 and the cardiovascular system has been well described. We sought to systematically review the current published literature on the different cardiac manifestations and the use of cardiac-specific biomarkers in terms of their prognostic value in determining clinical outcomes and correlation to disease severity. METHODS A systematic literature review across PubMed, Cochrane database, Embase, Google Scholar, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed risk factors for cardiovascular manifestations, cardiac manifestations in COVID-19 patients, and cardiac-specific biomarkers with their clinical implications on COVID-19. RESULTS Sixty-one relevant articles were identified which described risk factors for cardiovascular manifestations, cardiac manifestations (including heart failure, cardiogenic shock, arrhythmia, and myocarditis among others) and cardiac-specific biomarkers (including CK-MB, CK, myoglobin, troponin, and NT-proBNP). Cardiovascular risk factors can play a crucial role in identifying patients vulnerable to developing cardiovascular manifestations of COVID-19 and thus help to save lives. A wide array of cardiac manifestations is associated with the interaction between COVID-19 and the cardiovascular system. Cardiac-specific biomarkers provide a useful prognostic tool in helping identify patients with the severe disease early and allowing for escalation of treatment in a timely fashion. CONCLUSION COVID-19 is an evolving pandemic with predominate respiratory manifestations, however, due to the interaction with the cardiovascular system; cardiac manifestations/complications feature heavily in this disease, with cardiac biomarkers providing important prognostic information.


title: COVID-19, Australia: Epidemiology Report 12 (Reporting week to 23:59 AEST 19 April 2020).

text: Confirmed cases in Australia notified up to 19 April 2020: notifications = 6,606; deaths = 69. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of the disease. Notifications in Australia remain predominantly among people with recent overseas travel, with some locally-acquired cases being detected. Most locally-acquired cases can be linked back to a confirmed case, with a small portion unable to be epidemiologically linked. The distribution of overseas-acquired cases to locally-acquired cases varies by jurisdiction. The crude case fatality rate (CFR) in Australia remains low (1.0%) compared to the World Health Organization's globally-reported rate (6.8%) and to other comparable high-income countries such as the United States of America (4.7%) and the United Kingdom (13.5%). The low CFR is likely reflective of high case ascertainment including detection of mild cases. High case ascertainment enables public health response and reduction of disease transmission. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained. Interpretation of international epidemiology should be conducted with caution as it differs from country to country depending not only on the disease dynamics, but also on differences in case detection, testing and implemented public health measures.


title: Limitations of the db/db mouse in translational wound healing research: Is the NONcNZO10 polygenic mouse model superior?

text: Murine models have provided valuable insights into the pathogenesis of both diabetes and chronic wounds. However, only a few published reports to date have investigated wound healing differences among the differing diabetic mouse models. The goal of the present study was to further define the wound healing deficiency phenotypes of streptozotocin-induced (STZ-induced), Akita, and db/db diabetic mice in comparison with a promising new polygenic strain of Type 2 diabetes (NONcNZO10) by using three specific wound models that targeted different critical processes in the pathogenesis of chronic wounds. Incisional, excisional, and ischemia/reperfusion wound models were established on mice of each strain. Wound healing parameters including tensile strength, epithelial gap, and wound necrosis were evaluated. In contrast to the other diabetic mice, the NONcNZO10 strain was found to have significant wound healing impairments in all wound healing models. Not only do the NONcNZO10 mice appear to better model human Type 2 diabetes, these provocative findings suggest that the mice may show more clinically relevant wound healing deficiencies than previous diabetic mouse models.


docid: vlygbvyi

title: Current status of robot-assisted radical cystectomy for bladder cancer.

text: Radical cystectomy is associated with significant morbidity. However, the introduction of minimally invasive surgical approaches has attempted to improve perioperative outcomes and decrease surgical complications. Emerging data suggest that robot-assisted radical cystectomy (RARC) might have some advantages compared with open radical cystectomy (ORC). However, the oncologic performance of RARC in patients with locally advanced disease is currently unclear, making it crucial to select patients for the procedure very carefully. No long-term prospective studies comparing the robot-assisted and open techniques have been reported. Until long-term oncologic outcomes of RARC and the results of currently ongoing randomized trials comparing the two techniques become available, ORC remains the gold standard.


title: Fatal bilateral pneumothorax and generalized emphysema following contraindicated speaking-valve application.

text: We report a case of a contraindicated attachment of a speaking valve to a tracheal tube with an inflated cuff, which rapidly resulted in the patient's death. The attached one-way valve allowed unrestrained inspiration through the tracheal tube but prevented physiological expiration. The increased pulmonary pressure resulted in alveolar rupture and replaced expiration with a steady release of air into the peribronchial sheaths and the mediastinum, resulting in what is commonly known as the Macklin effect. From the mediastinum, air inflated both pleural cavities, the peritoneum, and the subcutaneous tissue of the entire body. No gas was found in the blood vessels, the brain, the bones, or in the inner organs. The entire air volume was estimated by radiological segmentation to be more than 25 l. This implies continuous inspiration, while expiration turned into an aberrant pulmonary decompression by whole-body gas-enclosure. Death ultimately resulted from asphyxia following bilateral (tension) pneumothorax.


title: Sucrose and warmth for analgesia in healthy newborns: an RCT.

text: BACKGROUND AND OBJECTIVE Increasing data suggest that neonatal pain has long-term consequences. Nonpharmacologic techniques (sucrose taste, pacifier suckling, breastfeeding) are effective and now widely used to combat minor neonatal pain. This study examined the analgesic effect of sucrose combined with radiant warmth compared with the taste of sucrose alone during a painful procedure in healthy full-term newborns. METHODS A randomized, controlled trial included 29 healthy, full-term newborns born at the University of Chicago Hospital. Both groups of infants were given 1.0 mL of 25% sucrose solution 2 minutes before the vaccination, and 1 group additionally was given radiant warmth from an infant warmer before the vaccination. We assessed pain by comparing differences in cry, grimace, heart rate variability (ie, respiratory sinus arrhythmia), and heart rate between the groups. RESULTS The sucrose plus warmer group cried and grimaced for 50% less time after the vaccination than the sucrose alone group (P < .05, respectively). The sucrose plus warmer group had lower heart rate and heart rate variability (ie, respiratory sinus arrhythmia) responses compared with the sucrose alone group (P < .01), reflecting a greater ability to physiologically regulate in response to the painful vaccination. CONCLUSIONS The combination of sucrose and radiant warmth is an effective analgesic in newborns and reduces pain better than sucrose alone. The ready availability of this practical nonpharmacologic technique has the potential to reduce the burden of newborn pain.


title: Safety and feasibility of laparoscopic gastrectomy accompanied by D1+ lymph node dissection for early gastric cancer in elderly patients.

text: INTRODUCTION The age of patients with gastric cancer has increased worldwide. The aim of this study was to investigate the safety and feasibility of laparoscopic gastrectomy (LG) for early gastric cancer in elderly patients. METHODS We retrospectively investigated 221 consecutive patients who underwent LG for early gastric cancer during a 5-year period (January 2010 to December 2014). We divided the patients into two groups: elderly patients (≥75 years old) and younger patients (<75 years old). We compared these two groups with respect to clinical characteristics, histopathological findings, intraoperative factors, and postoperative outcomes. RESULTS The preoperative characteristics were similar in both groups. Except for the number of harvested lymph nodes (42.0 vs 34.9; P = 0.0016), the short-term operative outcomes, including postoperative complications and histopathological findings, were comparable between the two groups. Although significantly fewer lymph nodes were harvested in the elderly group, the overall survival and relapse-free survival rates did not significantly differ between the groups. Postoperative complications, such as acute cholecystitis and internal hernia, occurred during the long-term postoperative period after LG, and these unexpected complications were more frequently observed in elderly patients. All elderly patients required additional emergent surgeries for delayed complications. CONCLUSION The outcomes of LG for early gastric cancer in elderly patients seem to be reasonable. Aggressive lymph node dissection may be omissible in elderly patients with acceptable results. LG can be a safe and feasible procedure in elderly patients. However, the higher rate of delayed but urgent complications during the long-term postoperative period must be considered.


title: Metagenomic study of bacterial microbiota in persistent endodontic infections using Next-generation sequencing.

text: AIM To determine the bacterial microbiota in root canals associated with persistent apical periodontitis and their relationship with the clinical characteristics of patients using next-generation sequencing (NGS). METHODOLOGY Bacterial samples from root canals associated with teeth having persistent apical periodontitis were taken from 24 patients undergoing root canal retreatment. Bacterial DNA was extracted, and V3-V4 variable regions of the 16S rRNA gene were amplified. The amplification was deep sequenced by Illumina technology to establish the metagenetic relationships among the bacterial species identified. The composition and diversity of microbial communities in the root canal and their relationships with clinical features were analysed. Parametric and nonparametric tests were used to analyse differences between patient characteristics and microbial data. RESULTS A total of 86 different operational taxonomic units (OTUs) were identified and Good's nonparametric coverage estimator method indicated that 99.9 ± 0.00001% diversity was recovered per sample. The largest number of bacteria belonged to the phylum Proteobacteria. According to the medical history from the American Society of Anesthesiologists (ASA) Classification System, ASA II-III had higher richness estimates and distinct phylogenetic relationships compared to ASA I individuals (P < 0.05). Periapical index (PAI) score 5 was associated with increased microbiota diversity in comparison to PAI score 4, and this index was reduced in symptomatic patients. CONCLUSIONS Based on the findings of this study, it is possible to suggest a close relationship between several clinical features and greater microbiota diversity with persistent endodontic infections. This work provides a better understanding on how microbial communities interact with their host and vice versa.