关键词： Cardioplasty   Laparoscopy   Achalasia   Lower oesophageal sphincter   Intraoperative endoscopy  

摘要： Background Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative 'oesophagus-preserving' procedure in patients with end-stage achalasia. Methods We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations;and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires. Results Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10;p = 0.03) but developed post-operative gastroesophageal reflux. Conclusion To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a 'rescue' procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively.

关键词： central venous catheter   central line-associated bloodstream infection   intestinal failure   parenteral nutrition   pediatrics   sepsis  

摘要： Background Patients with intestinal failure (IF) are dependent on parenteral nutrition (PN), however, they are at risk of central line-associated bloodstream infections (CLABSIs) and line complications. Four-percent tetrasodium ethylenediaminetetraacetic acid (EDTA) solution is an effective nonantibiotic, antimicrobial, antibiofilm, and anticoagulant agent. Our objective was to determine 4% tetrasodium EDTA efficacy in preventing CLABSIs and reducing line occlusions in pediatric IF patients. Methods We conducted a retrospective cohort study of patients managed at 2 tertiary Canadian pediatric centers between April 2016 and December 2018 who received 4% tetrasodium EDTA solution under the brand name Kitelock. Data were collected for 12 months pre and post-Kitelock. CLABSIs and alteplase administration were compared using a Wilcoxon matched-pairs signed-rank test. Data were reported as medians and frequencies. Results Twenty patients were included (10 boys;median age, 83 months [range, 8-232 months]). The rate of CLABSIs before 4% tetrasodium EDTA was 2.7+4 per 1000 catheter days. Patients received 4% tetrasodium EDTA for a median of 365 (278-365) days, with no infections in the 12 months post-therapy (P= .002). Median rates of occlusive episodes for the entire cohort before 4% tetrasodium EDTA were 0 (0-5.0) and 0 (0-2.0) after starting therapy (P= .018). In patients with previous occlusions (n = 9), the median episodes of alteplase use previously was 5.5 (2.7-19.2) compared with 2.7 (0-2.7) (P= .018). Conclusions Our preliminary findings suggest 4% tetrasodium EDTA solution is effective in reducing CLABSIs and catheter occlusions in pediatric patients with long-term central-access.

关键词： alternative milk products   cow's milk   goat's milk   milk nutrition   plant-based milk  

摘要： Objective: Alternative milk products are becoming more visible and popular, but nutrient data to compare these products to traditional cow's milk are not easily accessible. By summarizing this nutritional information, this project aims to help primary care providers take better care of their patients by providing easy to access nutritional comparison between cow's milk and milk alternatives such as plant-based milks and goat's milk. Methods: This project uses data from the United States Department of Agriculture's Food Data Central database and publicly available nutrition label data to compare the nutritional content of selected milk. Results: Almond and oat milks provide less than half of the protein provided by soy, goat's, and cow's milk. Goat's milk contains the most fat of the products surveyed, while skim milk contains the lowest fat per serving. Soy milk, almond milk, and oat milk contain at least half the fat of cow's milk. Almond milk contained the most calcium of the milks surveyed. Quantities of folate and vitamin B12 were most notably decreased in goat's milk and almond milk while soy milk had almost double the amount of folate and vitamin B12 present in cow's milk. Conclusion: Cow's milk still remains the best source of fats, protein, and micronutrients. For parents who prefer an alternative to cow's milk, the child's health should be considered. Parents may consider nutrition information when making decisions for their families, and primary care pediatricians should be able to provide current nutritional data on frequently advertised products. © 2020 Academic Pediatric Association

关键词： Routine recommendations   Alternative birth practices   Refusal   Therapeutic hesitancy  

摘要： has been a shift from paternalistic practices to a shared decision-making model. Patients regularly report doing their research and come to a visit with ideas about their diagnosis and treatment. It is not uncommon for expectant parents to spend hours deciding how and where to deliver their newborn. Expectant parents reach out to a wide circle for information including friends, family, books, the Internet, and social media. Although in-hospital births are still the norm in the United States, freestanding birthing centers and midwives offering home births are more prevalent than in the near past. In addition to choosing the ideal location to give birth, many Web sites,

关键词： SARS-CoV2   COVID-19   MIS-C   Kawasaki   Macrophage activation syndrome (MAS)  

摘要： Purpose of Review In this article, I have reviewed current reports that explore differences and similarities between multisystem inflammatory syndrome in children (MIS-C) and other known multisystem inflammatory diseases seen in children, particularly Kawasaki disease. Recent Findings Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a human coronavirus causing the COVID-19 disease which emerged in China in December 2019 and spread rapidly to the entire country and quickly to other countries. Currently, there is a pandemic of SARS-CoV-2 infection that results in 20% of patients admitted to hospital with illness, with 3% developing intractable acute respiratory distress syndrome (ARDS) with high mortality. However, pediatric COVID-19 is still reported to be a mild disease, affecting only 8% of children. Pathogenesis in children is comparable to adults. There are suggested impaired activation of IFN-alpha and IFN regulator 3, decreased cell response causing impaired viral defense, yet the clinical course is mild, and almost all children recover from the infection without major complications. Interestingly, there is a subset of patients that develop a late but marked immunogenic response to COVID-19 and develop MIS-C. Clinical features of MIS-C resemble certain pediatric rheumatologic diseases, such as Kawasaki disease (mucocutaneous lymph node syndrome) which affects small-medium vessels. Other features of MIS-C resemble those of macrophage activation syndrome (MAS). However, recent research suggests distinct clinical and laboratory differences between MIS-C, Kawasaki disease, and MAS. Since the start of the SARS-CoV-2 pandemic, MIS-C has become the candidate for the most common cause of acquired heart disease in children.

摘要： The author of this medical humanities article is a clinician-educator who finds himself relying more and more on poetry to make sense of the complexity, frustration, and wonder that attend the work of doctoring. Here, he posits that poems, in all their forms, are attempts at establishing order and meaning through meter, language, and sound, and that they may be particularly valuable for medical students and residents as they develop professional identities, habits of mind, and coping strategies. The author recalls that for Edward Hirsch, poetry is "a way of connecting-through the medium of language-more deeply with yourself even as you connect more deeply with others." It is this purpose-to connect learners with themselves, their patients, and one another-that compels the author to read poems to teams of residents and medical students in lieu of traditional afternoon teaching rounds. In this article, the author artfully illustrates one such "Post-Call Poetry" session, quoting some of the poems he shares with learners. At the end of each 2-week rotation on the wards, few of the learners remark on the attending's lessons on pathophysiology;however, nearly all of them, regardless of their background or career path, express appreciation for the poetry.

关键词： GWP   R-448A   R-449A   R-455A   R-454C   R-404A   Evaporation heat transfer   Microfin tube  

摘要： The literature survey reveals that the studies on evaporation of an alternative refrigerant for R-404A are lacking. In this study, four R-404A alternative refrigerants - two short term refrigerants (R-488A, R-449A) and two long term refrigerants (R-455A, R-454C) - including R-404A were tested in a 7.0 mm O.D. mi-crofin tube. The tests were conducted changing the mass flux from 90 to 300 kg m(-2) s(-1), heat flux from 5 to 15 kW m(-2) and vapor quality from 0.2 to 0.8. During the test, the saturation temperature was maintained at 10 degrees C. The heat transfer coefficients of R-404A were higher than those of the alternative refrigerants. However, the difference tended to decrease as the mass flux increased. The higher heat transfer coefficient of R-404A may be due to the smaller temperature glide of R-404A as compared with those of other refrigerants. The microfin / smooth tube heat transfer enhancement ratios of the alternative refrigerants ranged from 1.14 to 1.93. With the mixture correction, pure refrigerant correlations successfully predicted the mixture refrigerant data. (C) 2021 Elsevier Ltd and IIR. All rights reserved.

关键词： Idiopathic granulomatous mastitis   Methotrexate   Treatment  

摘要： Background: Idiopathic granulomatous mastitis (IGM) is a rare, recurrent and progressive breast disease with an unknown etiology. Patients with IGM will probably face stressful, time-consuming treatment procedures with side effects due to medications. There are different treatment modalities in clinical use including medical and surgical interventions. Objective: The aim of this study was to present the results of using the combination therapy of low-dose methotrexate (MTX) and steroid in IGM. Methods: Seventeen patients diagnosed with IGM and treated with MTX were included into the study. Low-dose MTX at 5 mg/week and 8 mg/day prednisone were given for 2-3 months. Results: After 2-3 months of treatment, 10 patients exhibited (58.5%) complete, 3 patients (17.6%) partial recovery, and no response to the treatment process was observed in 4 patients (23.5%). No side effects of MTX and recurrent events were noted in any of the patients. Conclusion: Low-dose MTX and prednisone treatment for IGM patients, who did not respond to steroids alone, should be considered as an alternative treatment method instead of surgical intervention.

关键词： Coronavirus   Policy alternatives   Snow crab   Lobster   Landed prices   Revenue  

摘要： The coronavirus will have serious consequences for the fishing industry. The purpose here is to simulate price and revenue outcomes for Canadian lobster and snow crab markets under alternative policy shocks due to the coronavirus. Predictions are based on three policy scenarios representing upper and lower bounds on the range of possible landings and economic outcomes for the period 2019-2021. Based on past research, demand equations for both the lobster and snow crab markets are used to empirically simulate price projections. The results for snow crab are startling with predicted serious declines in price and generated revenue, particularly for Que ' bec and Newfoundland and Labrador (NL). Compared to 2018, projections suggest a decline in average revenue for 2021 of - 18% Gulf, - 32% Maritimes, - 53% Que ' bec, and - 57% NL. The outcome for lobster is not as bleak, projections showing a 21% decline in revenue for 2020 but with recovery in 2021.

关键词： Artemisia argyi fermentation Liquid   Salmonella typhimurium   Lactobacillus plantarum   Virulence gene   Bacteria load   Intestinal barrier  

摘要： Immediate attention has been drawn to the discovery of anti-infection strategies to avoid rapid development of antibiotic resistance in pathogens. Our prior study has demonstrated that probiotic Lactobacillus plantarum WLPL01-fermented Artemisia argyi liquid broth could inhibit the growth of Listeria monocytogenes CMCC54007 and Candida albicans ATCC14053. In this study antagonistic effect of Artemisia argyi fermentation liquid (AAFL) on Salmonella Typhimurium ATCC13311 was systematically evaluated by culture inhibition assay in vitro, adhesion and invasion assays using HT-29 cell line, and measurements of epithelial barrier integrity and cytokines in mice. Results showed that AAFL (50, 25 and 15 mg/mL) significantly inhibited the growth of S. Typhimurium ATCC13311 in vitro (P < 0.05);5 mg/mL of AAFL achieved maximal reduction of adhesion and invasion rate by 41.92% and 24.03%, respectively, and down-regulated sipA by 5.26 folds in HT-29 cell line. Anti-infection experiment in mice showed that 25 mg/mL of AAFL significantly (P < 0.05) decreased the load of S. Typhimurium ATCC13311 in gastrointestinal tract (ileum, colon and cecum) and internal organs (liver, spleen and MLN), improved epithelial barrier integrity, and decreased physiological score as well as the levels of proinflammation cytokines in the serum. In conclusion, AAFL might be a potential probiotic fermentation liquid against S. Typhimurium infection.