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Factors linked to unwanted extra virility: secondary evaluation of a nationwide study in Peru.
At least 8.0% patients with COVID-19 suffered the acute cardiac injury. The incidence of acute cardiac injury was about 13 folds higher in ICU/severe patients compared with the non-ICU/severe patients. CONCLUSION Patients with previous cardiovascular metabolic diseases may face a greater risk of developing into the severe condition and the comorbidities can also greatly affect the prognosis of the COVID-19. On the other hand, COVID-19 can, in turn, aggravate the damage to the heart.A novel actinobacterium, YIM 132087T, isolated from Lepraria sp. lichen collected from Yunnan province, south-west PR China. Cells are Gram-stain-positive, catalase-positive and oxidase-negative, aerobic, non-motile and short rod-shaped. Colonies are asporogenous, circular and white brown in colour. Optimal growth occured at 15-35 °C (optimum 28 °C), at pH 5.0-9.0 (optimum pH 6.0), and in the presence of 3% NaCl (w/v). The DNA G+C content of strain YIM 132087T based on the draft genome sequence was 71.3 mol%. Phylogenetic analysis based on 16S rRNA gene sequences suggested that strain YIM 132087T belonged to the genus Nakamurella and exhibited high levels of 16S rRNA gene sequence similarity with Nakamurella endophytica CGMCC 4.7038T (97.9%) and Nakamurella intestinalis NBRC 111844T (97.2%). The DNA-DNA hybridization values between strain YIM 132087T and its closest relatives are lower than 26%. Strain YIM 132087T had meso-diaminopimelic acid as the diagnostic cell-wall diamino acid, and MK-8(H4) as the predominant menaquinone. Predominant cellular fatty acids (> 10%) were iso-C160, iso-C150, C160 and anteiso-C150. The polar lipid profile were found to be diphosphatidylglycerol, phosphatidylmethylethanolamine, phosphatidylethanolamine, phosphatidylinositol, three unknown phospholipids, one unknown aminophospholipid and one unknown lipid. Based on phenotypic, phylogenetic and chemotaxonomic analysis, strain YIM 132087T belongs to the genus Nakamurella and represents a novel species of the genus Nakamurella, for which the name Nakamurella albus sp. nov., with type strain YIM 132087T (=CGMCC 4.7629T =NBRC 114017T), is proposed.BACKGROUND Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus. METHODS A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations. RESULTS A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%). CONCLUSIONS The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations.BACKGROUND The volume-outcome relationship dictates that high-volume centres lead to improved patient outcomes after pancreatoduodenectomy (PD). We conducted a retrospective review to fathom the situation in India for PD and whether referral to high-volume centres would make a positive impact. METHOD A systematic literature search in MEDLINE was performed, and all articles published from Indian centres from 01.03.2008 to 30.11.2019 were scrutinised. Any series with less than 20 patients, case reports, abstracts, unpublished data and personal communications were excluded. RESULTS A total of 36 unique series including 6226 patients from 24 institutes across India were identified. Amongst the 24 institutes, 2 institutes reported less than 10 cases/year, 11 reported 10-25 cases/year and 11 reported ≥26 cases/year. Selleckchem EAPB02303 Overall perioperative morbidity was 42.4%, 43.4% and 41% for centres doing less then 10, 10-25 and ≥26 cases/year, respectively. Operative mortality also improved with increasing number of cases/year (5.1% vs. 6.6% vs. 3.2%, respectively). CONCLUSION With increasing volume of cases per year, trend towards improved PD outcomes is observed. To optimise the use of healthcare facilities, it would be pragmatic to consider building an organised referral system for complex surgeries to deliver unsurpassed patient care with maximum utilisation of the available healthcare infrastructure.BACKGROUND Frequent stooling immediately after pull-through (PT), fecal soiling, and constipation are chronic complications of Hirschsprung's disease (HD). This study aimed to investigate the longitudinal outcomes in terms of bowel function of patients below the age of 1 year undergoing PT. METHODS We retrospectively evaluated 396 patients who underwent PT for HD between September 1979 and March 2014. Stool frequency was analyzed up to 10 years of age, and soiling and constipation were analyzed up to 15 years of age. RESULTS After resection of the aganglionic segment (AS), stool frequency decreased over time. Furthermore, stool frequency among the three groups was similar 4 years after PT. Among the patients with aganglionic bowel resection, those who underwent the Soave procedure (SP) had an increase (0.56/day) in stool frequency than those who underwent the Duhamel procedure (DP). The soiling severity according to the AS was similar after 5 years of age. More severe soiling was better associated with patients who underwent the SP than those who underwent the DP.
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