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Chemical-genetic CRISPR-Cas9 window screens inside human being cells employing a pathway-specific library.
Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P  less then  .004). Histological examination was consistent with collagenous fusion without cavitation defects. CONCLUSION Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. CLINICAL SIGNIFICANCE Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation. © 2020 The American College of Veterinary Surgeons.A Bayesian phase I-II dose-finding design is presented for a clinical trial with four coprimary outcomes that reflect the actual clinical observation process. During a prespecified fixed follow-up period, the times to disease progression, toxicity, and death are monitored continuously, and an ordinal disease status variable, including progressive disease (PD) as one level, is evaluated repeatedly by scheduled imaging. We assume a proportional hazards model with piecewise constant baseline hazard for each continuous variable and a longitudinal multinomial probit model for the ordinal disease status process and include multivariate patient frailties to induce association among the outcomes. A finite partition of the nonfatal outcome combinations during the follow-up period is constructed, and the utility of each set in the partition is elicited. Posterior mean utility is used to optimize each patient's dose, subject to a safety rule excluding doses with an unacceptably high rate of PD, severe toxicity, or death. A simulation study shows that, compared with the proposed design, a simpler design based on commonly used efficacy and toxicity outcomes obtained by combining the four variables described above performs poorly and has substantially smaller probabilities of correctly choosing truly optimal doses and excluding truly unsafe doses. © 2020 John Wiley & Sons, Ltd.OBJECTIVES Corticosteroid injections can provide (temporary) relief in patients with mild to moderate carpal tunnel syndrome (CTS). Hydrodissection as part of an injection has been associated with positive clinical outcomes but data for CTS so far has been scarce. This study is designed to assess patient tolerance and secondarily provide pilot data on the added effect of hydrodissection. METHODS Twenty CTS patients were randomized to an ultrasound-guided betamethasone injection with hydrodissection (5 mL) or without (2 mL). Patient tolerance was assessed directly after intervention and patient-reported outcome after 4 and 24 weeks. Intra-group data were compared using Wilcoxon Signed Rank and inter-group with Wilcoxon rank-sum tests. RESULTS Tolerance and pain scores did not differ between the two groups. Symptom scores decreased in both groups, but to a lesser extent in the hydrodissection group with a mean difference of -0.8 versus -1.5 in the control group at 4 weeks (P = .02). At 6 months, this difference was no longer present (P = .81). No statistically significant differences were found between the hydrodissection and control groups in the function or pain scores at follow-up at either time point. CONCLUSION After injection, both symptomatic and functional scores improved, but the hydrodissected group did not show additional improvement. Data presented can be used to support larger studies to assess the value of hydrodissection in CTS management. © 2020 by the American Institute of Ultrasound in Medicine.BACKGROUND Nutrition therapy plays a major role in the perioperative management of surgical patients. Understanding energy metabolism and correctly establishing the adequate energy needs is a crucial step to provide optimal nutrition care. The aim of this study was to assess the resting energy expenditure (REE) after major abdominal procedures and its associated factors. METHODS This was a prospective observational study conducted at a single center. REEs of patients admitted for gastrointestinal surgical procedures were measured by indirect calorimetry 24 hours prior to the procedure and reassessed at least once within the fifth postoperative day. Substrate oxidation was calculated according to the Frayn equation. Nutrition status was evaluated using subjective global assessment. RESULTS There were no significant changes in the REEs throughout the study period; however, there was a decrease in the respiratory quotient during the postoperative period, as well as a decrease in carbohydrate oxidation and an increase in lipid oxidation. Only 33.3% of the patients presented a postoperative increase in REE > 10%. Those patients presented higher blood-monocyte levels. CONCLUSION Postoperative REE is not increased in most of the patients. In patients who had increased REE, associated factors included higher levels of monocytes. © 2020 American Society for Parenteral and Enteral Nutrition.WHAT IS KNOWN AND OBJECTIVE The comparative efficacy of ancillary drugs on sevoflurane-related emergence agitation (EA) in paediatric anaesthesia for adenotonsillectomy remains unclear. The purpose of this Bayesian network meta-analysis was to investigate the efficacy of ancillary drugs on sevoflurane-related EA in paediatric anaesthesia for adenotonsillectomy. METHODS MEDLINE, Embase, the Cochrane Library and Web of Science databases were electronically searched to identify randomized controlled trials (RCTs) of different ancillary drugs used in adenotonsillectomy from inception to April 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias in included studies. Subsequently, a network meta-analysis was performed using the R software and RevMan 5.3 software. RESULTS AND DISCUSSION We included 25 RCTs, involving 2151 participants. The proportion of patients with sevoflurane-related EA was significantly lower in the dexmedetomidine, ketamine, propofol, fentanyl, midazolam, sufentanil, remifentanil and clonidine groups than in the placebo group (P less then .05). Fentanyl was superior to sufentanil (P less then .05), whereas dexmedetomidine was superior to fentanyl (P less then .05). Among ancillary drugs, dexmedetomidine (90.04%) showed the highest possibility of reducing the risk of EA, followed by fentanyl (87.45%), remifentanil (63.85%), ketamine (52.07%), midazolam (51.27%), clonidine (49.94%), propofol (29.89%), sufentanil (21.38%) and placebo (4.09%). WHAT IS NEW AND CONCLUSION Evidence suggests that the effects of dexmedetomidine in reducing the risk of sevoflurane-related EA in paediatric anaesthesia for adenotonsillectomy were better than the effects of other drugs. However, large, high-quality RCTs are required to further confirm this. © 2020 John Wiley & Sons Ltd.OBJECTIVE To determine the influence of three closure techniques on leakage pressures of canine typhlectomies. STUDY DESIGN Experimental, ex vivo. SAMPLE POPULATION Grossly normal cecal segments from 24 adult canine cadavers. METHODS Typhlectomies were assigned to one of three closure techniques simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location. RESULTS Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P  less then  .0001). Maximum leakage pressure were greater in group 3 than in other groups (P  less then  .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens. CONCLUSION Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. CLINICAL SIGNIFICANCE These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings. © 2020 The American College of Veterinary Surgeons.To map in vivo cortical circuitry at the mesoscale we applied a novel approach to map inter-areal functional connectivity. Electrical intracortical microstimulation (ICMS) in conjunction with optical imaging of intrinsic signals (OIS) was used map functional connections in somatosensory cortical areas in anesthetized squirrel monkeys. ICMS produced activations that were focal and that displayed responses which were stimulation intensity dependent. ICMS in supragranular layers of Brodmann areas 3b, 1, 2, 3a, and M1 evoked inter-areal activation patterns that were topographically appropriate and appeared consistent with known anatomical connectivity. Specifically, ICMS revealed area 3b connections with area 1; area 1 connections with areas 2 and 3a; area 2 connections with areas 1, 3a, and M1; area 3a connections with areas M1, 1, and 2; and M1 connections with areas 3a, 1, and 2. These somatosensory connectivity patterns were reminiscent of feedforward patterns observed anatomically, although feedback contributions are also likely present. Further consistent with anatomical connectivity, intra-areal and intra-areal patterns of activation were patchy with patch sizes of 200-300 μm. In summary, ICMS with OIS is a novel approach for mapping inter-areal and intra-areal connections in vivo. Comparisons with feedforward and feedback anatomical connectivity is discussed. This article is protected by copyright. All rights reserved. © 2020 Wiley Periodicals, Inc.PURPOSE Brief and effective screening measures are required to detect clinical depression in bipolar disorder (BD) patients. The purpose of this study was to demonstrate the clinical utility of a six-item, self-report Hamilton Depression Rating Scale (HAMD-6). DESIGN AND METHOD Sixty BD outpatients completed questionnaires including the HAMD-6 before regular psychiatric appointments. FINDINGS A 7+ HAMD-6 cut-off score correctly identified six of eight depressed patients, indicating 75% sensitivity and 84% specificity. PRACTICE IMPLICATIONS The results of this study suggest the HAMD-6 is an effective depression screening measure with BD patients living in the community. This brief self-report scale can be used in clinical settings to quickly identify those requiring more thorough clinical attention. © 2020 Wiley Periodicals, Inc.Cowpea is an important pulse crop cultivated in arid and semi-arid regions of the world. During field survey, a characteristic wilt was observed in around 45 ha of cowpea fields with incidence 17 - 25%. Infection was seen in pre-flowering stage and infected plants showed quick wilt symptoms with tan lesions near the stem-soil interface. Fungal pathogens associated were isolated on PDA, which produced dark to grey olivaceous colonies in the center, and aerial mycelia were appressed with floccose and white to smoke-grey. Conidia are aseptate, initially hyaline, smooth-walled, broadly ellipsoidal with rounded ends becoming dark brown. Based on these morphological features, the fungal pathogen was identified as Aplosporella sp. The ITS-rDNA region was amplified using ITS1/ITS4 primers and sequenced. The nBLAST and phylogenetic analysis confirmed the pathogen as Aplosporella hesperidica. The Koch's postulates were performed on 45 d old cowpea plants with mycelial disc of A. hesperidica. Development of typical necrotic lesions was observed after 28 d of post-inoculation and the pathogen's identity was confirmed based on re-isolation.
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