Notes

Transhiatal robot-assisted non-invasive esophagectomy: uncertain advantages when compared with standard transhiatal esophagectomy.
A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.
Palisaded neutrophilic granulomatous dermatitis is a rare inflammatory dermatosis with possible underlying systemic conditions including rheumatoid arthritis, autoimmune connective tissue disease, and malignancies.

We report a case of an 84-year-old man presenting with a 3-week eruption of asymptomatic annular plaques on his neck, which progressed to involve his back and legs. Skin biopsies confirmed a diagnosis of palisaded neutrophilic granulomatous dermatitis, and he was treated with prednisone. Full workup related to potential underlying causes of palisaded neutrophilic granulomatous dermatitis was completed.

Palisaded neutrophilic granulomatous dermatitis may precede the onset of underlying systemic conditions or occur concomitantly. Following the diagnosis, clinicians should perform a comprehensive focused history, physical examination, and laboratory investigation related to the associated underlying diseases.
Palisaded neutrophilic granulomatous dermatitis may precede the onset of underlying systemic conditions or occur concomitantly. Following the diagnosis, clinicians should perform a comprehensive focused history, physical examination, and laboratory investigation related to the associated underlying diseases.This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.This paper examines the stability of egocentric networks as reported over time using a novel touchscreen-based participant-aided sociogram. Past work has noted the instability of nominated network alters, with a large proportion leaving and reappearing between interview observations. To explain this instability of networks over time, researchers often look to structural embeddedness, namely the notion that alters are connected to other alters within egocentric networks. Recent research has also asked whether the interview situation itself may play a role in conditioning respondents to what might be the appropriate size and shape of a social network, and thereby which alters ought to be nominated or not. We report on change in these networks across three waves and assess whether this change appears to be the result of natural churn in the network or whether changes might be the result of factors in the interview itself, particularly anchoring and motivated underreporting. Our results indicate little change in average network size across waves, particularly for indirect tie nominations. Slight, significant changes were noted between waves one and two particularly among those with the largest networks. Almost no significant differences were observed between waves two and three, either in terms of network size, composition, or density. Data come from three waves of a Chicago-based panel study of young men who have sex with men.
The emergence of a SARS-CoV-2 variant with a point mutation in the spike (S) protein, D614G, has taken precedence over the original Wuhan isolate by May 2020. With an increased infection and transmission rate, it is imperative to determine whether antibodies induced against the D614 isolate may cross-neutralise against the G614 variant.

Antibody profiling against the SARS-CoV-2 S protein of the D614 variant by flow cytometry and assessment of neutralising antibody titres using pseudotyped lentiviruses expressing the SARS-CoV-2 S protein of either the D614 or G614 variant tagged with a luciferase reporter were performed on plasma samples from COVID-19 patients with known D614G status (
=44 infected with D614,
=6 infected with G614,
=7 containing all other clades O, S, L, V, G, GH or GR).

Profiling of the anti-SARS-CoV-2 humoral immunity reveals similar neutralisation profiles against both S protein variants, albeit waning neutralising antibody capacity at the later phase of infection. Of clinical importance, patients infected with either the D614 or G614 clade elicited a similar degree of neutralisation against both pseudoviruses, suggesting that the D614G mutation does not impact the neutralisation capacity of the elicited antibodies.

Cross-reactivity occurs at the functional level of the humoral response on both the S protein variants, which suggests that existing serological assays will be able to detect both D614 and G614 clades of SARS-CoV-2. More importantly, there should be negligible impact towards the efficacy of antibody-based therapies and vaccines that are currently being developed.
Cross-reactivity occurs at the functional level of the humoral response on both the S protein variants, which suggests that existing serological assays will be able to detect both D614 and G614 clades of SARS-CoV-2. More importantly, there should be negligible impact towards the efficacy of antibody-based therapies and vaccines that are currently being developed.
Nurses are the main administrators of opioids in hospitals and enjoy some autonomy when using them to manage pain. Nevertheless evidence suggests they exercise this freedom restrictively with the reasons for this self-limitation remaining unclear. Nurses are influenced by personal and professional values and by patients' attributes. Intoxicated patients pose a particular challenge. This study therefore investigated whether cautious attitudes towards opioids were aggravated in intoxicated patients and influenced by personal values.

A two-version questionnaire was developed. Each presented a case vignette describing a patient in acute pain who was either intoxicated or not intoxicated. Questionnaires contained identical case statements inquiring about concerns regarding opioids, preferred analgesics and statements about opioids and personal values. They were distributed prospectively in a cross-sectional, multi-centre design. Equal distribution of both questionnaires was achieved through randomization of waent'). Therefore, stigmatizing mental models likely contribute to nurses' reluctance to use opioids. DRB18 clinical trial Interestingly, personal ambition might protect nurses from discriminatory thoughts and practice.
Nurses were concerned giving opioids to intoxicated patients and preferred non-opioids instead. These concerns were predicted by personal values representing 'Conservation' ('conformity') and 'Self-Enhancement' ('achievement'). Therefore, stigmatizing mental models likely contribute to nurses' reluctance to use opioids. Interestingly, personal ambition might protect nurses from discriminatory thoughts and practice.Background Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods We systematically searched Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding 'domains' (baby's behaviour; mother's behaviour; position; latching; effective feeding; breast health; baby's health; mother's view of feed; number, timing and length of feeds). Results We idearch is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.Background There is a mutual effect between central obesity and low total serum testosterone. Moreover, oxidative stress acts as a bridge between obesity and its complications. Taken together, we aimed to evaluate whether atorvastatin (AS), a cholesterol-lowering drug, has protective potential against high fat diet (HFD)-induced low fertility, which was exemplified in serum testosterone determination. Moreover, we aimed to deduce a putative mechanism of action through evaluation of the testicular oxidant/antioxidant system. Methods Adult male albino Wistar rats ( Rattus norvegicus albinus) were divided into three groups 1) normal control group, rats were fed a normal diet for four weeks; 2) HFD group, rats were fed an HFD for four weeks; and 3) AS group, rats were fed an HFD and 5 mg/kg/day atorvastatin for the last two weeks of the experiment. Serum atherogenic index, testosterone, and thyroid stimulating hormone were estimated. Moreover, testicular reduced glutathione and malondialdehyde contents, as well as glutathione-S-transferase, superoxide dismutase, and glutathione reductase activities were also determined. The statistical differences were analyzed using analysis of variance (ANOVA). Results AS ameliorated the increased level of serum atherogenic index induced by an HFD, as well as testicular malonaldehyde and reduced glutathione levels. On the other hand, AS increased the depleted level and activity of serum testosterone and testicular glutathione reductase, respectively, induced by HFD. Conclusion The ameliorative effect of AS on the deteriorated level of total serum testosterone induced by HFD might partially be due to oxidant/antioxidant disturbance. Further studies should be carried out to evaluate mTOR pathway contribution, which could enable researchers to deduce drugs targeting members of the oxidant/antioxidant system and/or mTOR pathway to ameliorate putative HFD-induced low fertility.
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