During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available.

BACKGROUND: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. METHODS: Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5% ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. RESULTS: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). CONCLUSIONS: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic.
Amides ; Brachial Plexus ; Female ; Humans ; Median Nerve ; Nerve Block ; Outcome Assessment (Health Care) ; Prospective Studies ; Upper Extremity

Pleomorphic adenoma is a tumor rarely seen in the breast. To date, only about 70 cases have been reported in the literature. Many reports have used fine-needle aspiration biopsy in the preoperative diagnosis of these lesions. However, pleomorphic adenoma is sometimes mistaken for a malignant tumor because of its cytologic features. In this study, we present a 56-year-old woman with a palpable breast mass. Ultrasound indicated a 15 mm oval-shaped hypoechoic mass with complex echogenicity in the palpable region. Ultrasound-guided core needle biopsy (US-CNB) revealed a pleomorphic adenoma of the breast, which was confirmed through surgical excision. Although pleomorphic adenoma is rarely seen in the breast, results demonstrate the usefulness and accuracy of US-CNB in diagnosing pleomorphic adenoma of the breast.
Adenoma, Pleomorphic ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast ; Female ; Humans

Absorption ; Alveolar Process ; Animals ; Bone Regeneration ; Collagen ; Collagen Type I ; Giant Cells ; Lymphocytes ; Membranes ; Osteogenesis ; Rats ; Rats, Sprague-Dawley ; Transplants

PURPOSE: The significant drastic complications of performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients are gastric staple line leakage and bleeding. The aim of our study is to evaluate the efficacy of the clinical data for detecting postoperative complications after LSG. METHODS: The study enrolled 150 consecutive patients who underwent LSG from January 2003 to July 2006. When abnormal data (heart rate > or = 10/min, or temperature > or = 7.5degrees C) was detected on postoperative day 1, then laboratory tests (blood, urine, chest X-ray and abdominal sonogram) and water soluble gastrografin UGIS were performed to detect the postoperative complications after LSG (group A). The patients who had normal postoperative clinical data (group B) were compared with group A. RESULTS: Of the 150 patients who underwent LSG, 9 patients (6%) had postoperative complications. Two patients had major complications: 1 case of leakage (0.6%) and 1 case of delayed bleeding (0.6%), and 4 patients had minor complications in group A. But no major complications were detected in group B (P<0.01). The heart rate and body temperature in group A were significantly faster and higher than those in group B (P<0.01). Especially, 2 patients who had major complications had severe tachycardia over 120 beats per minute (bpm). However, when the body temperature of a patient was elevated, there was no high grade fever in all the cases ( > 39degrees C). CONCLUSION: Evidence of tachycardia or a high body temperature may be useful to detect major complications after LSG. We also recommend performing laboratory test and UGIS when clinically indicated.
Body Temperature ; Diatrizoate Meglumine ; Fever ; Gastrectomy ; Heart Rate ; Hemorrhage ; Humans ; Obesity, Morbid ; Postoperative Complications ; Tachycardia ; Thorax

Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of an unknown etiology, and its major clinical manifestations include high spiking fever, polyarthralgia, salmon-colored evanescent rash and neutrophilic leukocytosis. We describe here a 41 year old woman with AOSD who presented with non-remitting high fever, polyarthralgia, sore throat, skin rash, splenomegaly, thrombocytopenia, neutrophilic leukocytosis, hyperferritinemia and coagulopathy with disseminated intravascular coagulation (DIC). The patient had a history of laparoscopic cholecystectomy due to acalculous cholecystitis prior to admission. We suspected sepsis due to bile peritonitis after the previous laparoscopic cholecystectomy. Yet we could not detect infectious organisms on the cultures or serologic studies. Finally, we suspected AOSD-associated hemophagocytic syndrome (HS). So, intravenous immunoglobulin and pulse methylprednisolone treatment brought about transient improvement of the fever and the neutrophilic leukocytosis, but the disease progressed and the patient expired due to acute renal failure. HS is a fatal cause of AOSD. If a patient has DIC and sepsis and these fail to respond to conservative treatment, then AOSD should be added to the differential diagnosis of sepsis and DIC.
Acalculous Cholecystitis ; Acute Kidney Injury ; Adult* ; Arthralgia ; Bile* ; Cholecystectomy, Laparoscopic ; Dacarbazine ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Exanthema ; Female ; Fever ; Humans ; Immunoglobulins ; Leukocytosis ; Lymphohistiocytosis, Hemophagocytic ; Methylprednisolone ; Neutrophils ; Peritonitis* ; Pharyngitis ; Sepsis* ; Splenomegaly ; Still's Disease, Adult-Onset* ; Thrombocytopenia

The constrained alpha-helical structure of a C-peptide is useful for enhancing anti-HIV-1 activity. The i and i+3 positions in an alpha-helical structure are located close together, therefore D-Cys (dC) and L-Cys (C) were introduced at the positions, respectively, to make a dC-C disulfide bond in 28mer C-peptides. Accordingly, this study tested whether a dC-C disulfide bond would increase the alpha-helicity and anti-HIV-1 activity of peptides. A C-peptide can be divided into three domains, the N-terminal hydrophobic domain (HPD), middle interface domain (IFD), and C-terminal hydrogen domain (HGD), based on the binding property with an N-peptide. In general, the dC-C modifications in HPD enhanced the anti-HIV-1 activity, while those in IFD and HGD resulted in no or much less activity. The modified peptides with no activity clearly showed much less alpha-helicity than the native peptides, while those with higher activity showed an almost similar or slightly increased alpha-helicity. Therefore, the present results suggest that the introduction of a dC-C bridge in the N-terminal hydrophobic domain of a C-peptide may be useful for enhancing the anti-HIV-1 activity.
Amino Acid Sequence ; Anti-HIV Agents/chemical synthesis/*chemistry/isolation & purification/*pharmacology ; Cell Line ; Circular Dichroism ; Cysteine/chemistry ; Disulfides/chemistry ; HIV Envelope Protein gp41/*chemistry ; HIV-1/*drug effects/growth & development ; Humans ; Inhibitory Concentration 50 ; Models, Molecular ; Molecular Sequence Data ; Peptides/chemical synthesis/*chemistry/isolation & purification/*pharmacology ; Protein Structure, Secondary ; Protein Structure, Tertiary ; Research Support, Non-U.S. Gov't ; Structure-Activity Relationship

<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. Terudermis(R) group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with Terudermis(R) group of same interval(p<0.05) but no differences were found with AM group(p<0.05). CONCLUSION: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with Terudermis(R). AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.
Amnion* ; Animals ; Bandages* ; Biological Dressings ; Collagen* ; Epidermal Growth Factor ; Leukocytes ; Microvessels ; Neutrophil Infiltration ; Rats* ; Skin ; Wound Healing* ; Wounds and Injuries*

Dentures ; Epithelium ; Fascia ; Keratinocytes ; Laminin ; Mastication ; Mouth Mucosa ; Mucous Membrane ; Oral Hygiene ; Proliferating Cell Nuclear Antigen ; Rabbits ; Rehabilitation ; Skin ; Transplants

PURPOSE: Urachal anomalies are rare, but often give rise to a number of problems, such as infection, rupture, sepsis and malignant change. The abdominal manifestation of urachal remnants often prompts referral to general or urologic surgeons. Herein, our clinical experiences were analyzed and guide lines for the preoperative diagnosis and proper management of complicated urachal anomalies suggested. METHODS: Twelve cases of urachal cyst, who visited the surgery department of Pochon CHA university hospital between April 1, 1995 and December 10, 2002, were studied. Clinical data, including clinical manifestations, diagnostic modalities and treatment methods were reviewed. RESULTS: Of the twelve cases reviewed, nine were males and three were females with a mean age of 33.6 years. The most common clinical manifestation was abdominal pain (58%), followed by a palpable mass (25%). The accuracies of the diagnostic modalities were 60 and 37% for abdominopelvic computed tomography and abdominal ultrasonography, respectively. The preoperative diagnosis rate was 50%, with one case not even diagnosed during surgery. CONCLUSION: Persistent urachal remnants can present at any age, with a variety of clinical manifestations. Abdominal computed tomography is a reliable diagnostic tool, and additional diagnostic studies are not generally warranted. The early surgical treatment seems to be the best solution prior to the onset of complications that would expose patients to difficult surgical operations and protract hospitalization.
Abdomen, Acute* ; Abdominal Pain ; Diagnosis ; Diagnosis, Differential* ; Female ; Hospitalization ; Humans ; Male ; Referral and Consultation ; Rupture ; Sepsis ; Ultrasonography ; Urachal Cyst