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The coronavirus disease 2019 (COVID-19) pandemic has resulted in reduced performance of elective surgeries and procedures at medical centers across the United States. Awareness of the prevalence of asymptomatic disease is critical for guiding safe approaches to operative/procedural services. As COVID-19 polymerase chain reaction (PCR) testing has been limited largely to symptomatic patients, health care workers, or to those in communal care centers, data regarding asymptomatic viral disease carriage are limited.
In this retrospective observational case series evaluating UCLA Health patients enrolled in pre-operative/pre-procedure protocol COVID-19 reverse transcriptase (RT)-PCR testing between April 7, 2020 and May 21, 2020, we determine the prevalence of COVID-19 infection in asymptomatic patients scheduled for surgeries and procedures.
Primary outcomes include the prevalence of COVID-19 infection in this asymptomatic population. Secondary data analysis includes overall population testing results and p safe procedural practices during COVID-19.
These data demonstrating low levels (0.13% prevalence) of COVID-19 infection in an asymptomatic population of patients undergoing scheduled surgeries/procedures in a large urban area have helped to inform perioperative protocols during the COVID-19 pandemic. Testing protocols like ours may prove valuable for other health systems in their approaches to safe procedural practices during COVID-19.
Advances in minimally invasive surgery and perioperative care have decreased substantially the duration of time that patients spend recovering in hospital, with many laparoscopic procedures now being performed on an ambulatory basis. There are limited studies, however, on same-day discharge after laparoscopic adrenalectomy. The objectives of this study were to investigate the outcomes and trends of ambulatory laparoscopic adrenalectomy in a multicenter cohort of patients.
Adult patients who underwent elective laparoscopic adrenalectomy between 2005 and 2016 were identified in the database of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Baseline demographics and 30-day outcomes were compared between patients who underwent ambulatory laparoscopic adrenalectomy and those who were discharged after an inpatient stay. selleck kinase inhibitor Multivariable logistic regression and Cox proportional hazards modelling were used to investigate the association between same-day discharge and 30-d inpatient hospitalization in selected patients. Further study is needed to determine the cost savings, barriers to uptake, and optimal selection criteria for this approach.
Ambulatory laparoscopic adrenalectomy is a safe and feasible alternative to inpatient hospitalization in selected patients. Further study is needed to determine the cost savings, barriers to uptake, and optimal selection criteria for this approach.
Hyperparathyroidism is an almost universal feature of multiple endocrine neoplasia type 1 syndrome. We present a systematic review and meta-analysis of the postoperative outcomes of patients undergoing initial operative treatment of primary hyperparathyroidism complicating multiple endocrine neoplasia1.
A comprehensive literature search was performed with a priori defined exclusion criteria for studies comparing total parathyroidectomy, subtotal parathyroidectomy, and less than subtotal parathyroidectomy.
Twenty-one studies incorporating 1,131 patients (272 undergoing total parathyroidectomy, 510 subtotal parathyroidectomy, and 349 less than subtotal parathyroidectomy) were identified. Pooled results revealed increased risk for long-term hypoparathyroidism in total parathyroidectomy patients (relative risk 1.61; 95% confidence interval, 1.12-2.31; P= .009) versus those undergoing subtotal parathyroidectomy. In the less than subtotal parathyroidectomy or subtotal parathyroidectomy comparison group, a gre 1 phenotypes should be pursued in an effort to delineate a patient-tailored, operative approach that optimizes long-term outcomes.
Subtotal parathyroidectomy compares favorably to total parathyroidectomy, exhibiting similar recurrence and persistence rates with a decreased propensity for long-term postoperative hypoparathyroidism. The benefit of the decreased risk of hypoparathyroidism in less than subtotal parathyroidectomy is negated by the increase in the risk for recurrence, persistence, and reoperation. Future studies evaluating the performance of less than subtotal parathyroidectomy in specific multiple endocrine neoplasia 1 phenotypes should be pursued in an effort to delineate a patient-tailored, operative approach that optimizes long-term outcomes.
Sometimes the development of new surgical procedures takes place during patient treatment in clinical practice but can result in undesirable outcomes and social concerns. This study aims to reveal how university hospitals in Japan supervise the implementation of new surgical procedures and what difficulties they confront.
Self-administered questionnaire surveys were conducted, targeting all university-affiliated hospitals in Japan.
It was found that most university hospitals in Japan supervised new surgical procedures internally, but they considered it difficult and burdensome to review and monitor them, both technically and practically, owing to several factors.
It is advisable to set up more effective and efficient organizational collaborations and implement standard processes of supervision, in both domestic and international clinical settings.
It is advisable to set up more effective and efficient organizational collaborations and implement standard processes of supervision, in both domestic and international clinical settings.
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Diabetes mellitus and the associated hyperglycemia are important risk factors for acute ischemic stroke and are associated with poor prognosis. Neurovascular protection is an important therapeutic target to achieve in patients with stroke, especially in those receiving thrombolytic reperfusion therapy. Sodium glucose-linked cotransporter 2 (SGLT2) inhibitors are a novel class of antidiabetic agents that target SGLT2. Hyperglycemia exacerbates the neuronal damage through the SGLT2 transporter. The purpose of this narrative review is to discuss the pleiotropic effects of SGLT2 inhibitors and their role in the treatment and prevention of ischemic stroke in experimental and clinical studies.
We searched the PubMed database using different term combinations from the date of inception to May 2019. Deselection methods were followed to exclude unrelated articles. The total number of articles included was 14.
In expend registries may be the first step to help answer this question.
It is unlikely that SGLT inhibitors have a positive or negative effect on stroke risk, but the question that remains unanswered is whether SGLT inhibitors can yield a protective effect after acute ischemic stroke. Future observational studies and registries may be the first step to help answer this question.The excavation of Manot Cave (Israel) reveals intensive occupation during the Early Upper Paleolithic and provides the first continuous set of anthracological data available for the Ahmarian, Levantine Aurignacian and post-Levantine Aurignacian periods. The paper aims to study the vegetal landscape around Manot Cave in the context of climate changes that characterized the last part of the Marine Isotope Stage 3 (MIS 3) and to address the issue of firewood and food procurement among Paleolithic hunter-gatherers. Charcoal samples recovered from the archaeological layers at Manot Cave shed light on the fuel and food procurement strategies while radiocarbon dating and stable carbon isotope analysis (Δ13C) of selected charcoals provide information about the ancient climate. The results show that five woody taxa were exploited at the site; Amygdalus sp. was the most common species, whereas Quercus ithaburensis, Tamarix sp., Pomoideae indet., and Pistacia atlantica were relatively rare. The representations of the recovered wooden species suggest that an open forest of almonds and oaks existed in the area during MIS 3. Radiocarbon dating of Amygdalus sp. charcoals, coupled with stable carbon isotope analysis (Δ13C) of modern and archaeological Amygdalus sp. clearly indicate variations in rainfall that could have decreased the density of tree cover. These analyses provide high-resolution data on the climate changes affecting the surroundings of Manot Cave between ∼46 and 28 ka cal BP and indicate two drier phases corresponding to the Ahmarian and post-Levantine Aurignacian cultures while a more humid period identified during the Levantine Aurignacian.Electrogenic bacteria can mediate electron transfer to conserve energy and promote growth. To examine bacterial electrogenicity, an L. mesenteroides EH-1 strain was cultured in rich media in the presence and absence of 2% glucose. After 12 h incubation, glucose triggered fermentation of L. mesenteroides EH-1 to produce >10 mmol/l acetate and elicit electricity measured by voltage changes. The electricity production was mediated by glucose fermentation since pre-treatment of L. mesenteroides EH-1 with furfural, a fermentation inhibitor, completely diminished the voltage increases. The deficiency of furfural pre-treated L. mesenteroides EH-1 in electricity production can be restored by the external addition of acetate into the bacterial culture, suggesting the function of acetate as an electron donor. Oral administration of HFD-fed mice with L. mesenteroides EH-1 in the presence or absence of glucose significantly attenuated the high level of pro-inflammatory IL-6 cytokine in blood. Bacterial electricity can be elicited by fermentation. Supplementation of fermenting and electrogenic L. mesenteroides EH-1 may provide a novel approach for the reduction of pro-inflammatory IL-6 cytokine that increased in chronic inflammation, autoimmune diseases, cancers, and infections.Previous studies have reported that continuous infusion with substance P (SP) into rat dorsal striatum ameliorated both mechanical allodynia in both formalin-evoked transient inflammatory pain and neuropathic pain models. However, a role of striatal SP in persistent inflammatory pain has not been demonstrated. The current study examined the effect of continuous infusion of SP into the rat dorsal striatum by reverse microdialysis on persistent inflammatory pain induced by complete Freund's adjuvant (CFA). Intraplantar injection of CFA evoked both mechanical allodynia and paw edema 3 and 7 days post-injection. The continuous infusion of SP ameliorated the CFA-evoked mechanical allodynia, but not paw edema, 3 days after the CFA injection. This antinociceptive effect of SP was partially inhibited by co-infusion with the neurokinin-1 (NK1) receptor antagonist CP96345. Conversely, at 7 days both CFA-evoked mechanical allodynia and paw edema were not affected by SP treatment. To clarify why the effect of SP treatment on CFA-induced pain changed, we evaluated NK1 receptor protein levels at both time points. The NK1 receptor protein level was decreased at 7, but not 3, days post CFA injection. These data suggest that persistent inflammatory pain can downregulate the striatal NK1 receptor. The current study demonstrates that striatal SP-NK1 receptor pathway can exert antinociceptive effect only on the third days of inflammatory pain phase defined as an acute but not the 7 days defined as a subacute.
