Efficacy of detergent-based cleaning and wiping against SARS-CoV-2 on high-touch surfaces.

Efficacy of cleaning methods against SARS-CoV-2 suspended in either 5% soil load (SARS-soil) or simulated saliva (SARS-SS) was evaluated immediately (hydrated virus, T0) or 2 hours post-contamination (dried virus, T2). Hard water dampened wiping (DW) of surfaces, resulted in 1.77-3.91 log reduction (T0) or 0.93-2.41 log reduction (T2). Incorporating surface pre-wetting by spraying with a detergent solution (D + DW) or hard water (W + DW) just prior to dampened wiping did not unilaterally increase efficacy against infectious SARS-CoV-2, however, the effect was nuanced with respect to surface, viral matrix, and time. Cleaning efficacy on porous surfaces (seat fabric, SF) was low. W + DW on stainless steel (SS) was as effective as D + DW for all conditions except SARS-soil at T2 on SS. DW was the only method that consistently resulted in > 3-log reduction of hydrated (T0) SARS-CoV-2 on SS and ABS plastic. These results suggest that wiping with a hard water dampened wipe can reduce infectious virus on hard non-porous surfaces. Pre-wetting surfaces with surfactants did not significantly increase efficacy for the conditions tested. Surface material, presence or absence of pre-wetting, and time post-contamination affect efficacy of cleaning methods.

Peritoneal carcinomatosis of colorectal origin treated by cytoreductive surgery and hyperthermic intraoperative peritoneal chemotherapy at the Bulovka University Hospital.

INTRODUCTION: Peritoneal carcinomatosis (PK) of colorectal origin is a malignant tumour of the peritoneum caused by spreading of colorectal carcinoma (KRK) over the peritoneal surface of the abdominal cavity and its organs. PK occurs as a synchronous tumour in 1520% of patients, and as metachronous disease in 2550% of patients. METHODS: A group of 66 patients operated on for PK was retrospectively evaluated; 18 patients were excluded due to insufficient data. We evaluated 48 patients in total (22 men and 26 women) with mean age of 58 and 53 years, respectively; 12 patients (25%) were aged over 65 years. The patients were operated on between 2000 and 2019 using the Sugarbaker´s method of maximal cytoreduction (CRS) + HIPEC (Hyperthermic Intraoperative Peritoneal Chemotherapy). We evaluated the length, median survival, the incidence of complications and lethality in relation to the Peritoneal Carcinoma Index (PCI) and the Completeness of Cytoreduction (CC) score. The patients were divided into two subgroups according to the PCI score (012 and >12, respectively) and the CC score (CC 01 and CC 23, respectively). RESULTS: The mean survival was 26.3 months in the group with PCI up to 12 and 21.4 months in patients with PCI above 12 (p=0.02). In the group with CC 01 the mean survival was 27.1 months, while in the patients with the CC 23 it reached 12.6 months (p=0.06). The morbidity rate requiring an intervention was 18.7% and the lethality rate was 6.25% in the entire group. The median survival of the entire group was 22 months (1334 months). CONCLUSION: Literary references and our results are comparable, confirming the high efficiency of this method both in our country and worldwide. The use of CRS and HIPEC, associated with acceptable mortality and morbidity in selected patients with PK of colorectal origin, results in a significant extension of overall survival (OS).

[Patient reported outcome measurements in orthopedics and trauma surgery : Chances and risks for statutory quality assurance]. / "Patient reported outcome measurements" in Orthopädie und Unfallchirurgie : Chancen und Risiken für die gesetzliche Qualitätssicherung.

The routine use of patient reported outcome measurements (PROMs) can support the orientation of healthcare systems towards the value and usefulness for patients. The collation of patient reported experience measurements (PREMs) is suitable for bringing transparency to the patient orientation of healthcare processes and the experience gained. Both PREM and PROM will become an integral component of the assessment of medical quality in Germany when the guidelines for data-supported quality assurance across institutions (DeQS-RL) come into force. By means of newly developed patient surveys per medical service area, they will be used as additional sources for the legally binding quality assurance. Although this gives more weight to the evaluation of the quality of treatment by patients, special features must be taken into account in the development and implementation for orthopedics and trauma surgery in order to avoid misinterpretation of the results and subsequent misguidance in the healthcare system.

Pseudomyxoma peritonei (PMP) and its therapy - 20 years experience of a single surgical department.

INTRODUCTION: Pseudomyxoma peritonei (PMP) is a rare malignant disease with various grades of malignancy, producing mucinous and gelatinous masses. The origin of PMP is usually connected with the rupture of appendiceal mucinous tumours, other mucinous tumours of the gastrointestinal tract or of the ovary. The staging of this disease is determined by the PCI score (peritoneal cancer index), and the efficiency of surgical procedure by the CC score. Clinical presentation is very variable and depends on the stage of the disease. Many patients are asymptomatic with a minimal clinical finding, presented only with abdominal discomfort. A typical finding of the “jelly belly“ syndrome expands with progression of the disease. The diagnosis consists in preoperative determination of the tumour characteristics and PCI based on imaging methods, especially CT imaging. METHODS: The Sugarbaker technique of complete tumour removal or the so-called cytoreductive surgery (CRS) was used, including hyperthermic intraperitoneal chemotherapy (HIPEC) or alternatively early postoperative intraperitoneal chemotherapy (EPIC). We performed retrospective evalu-ation of 73 patients with pseudomyxoma peritonei undergoing surgery, 39 males and 34 females, mean age 50.6 and 56.4 years, respectively. Surgical revision was performed in 18 patients, 14 males and 4 females. The mean age of this group was 48.8 for the males and 47 for the females. The surgical procedures were performed between 1999 and 2018. Survival rates, median survival, complications based on Clavien-Dindo classification, lethality rates, and PCI and CC scores were assessed in the patient group. RESULTS: 96 surgeries were performed in 73 patients with pseudomyxoma peritonei at our surgical department between 19992018. The surgery had to be repeated in 18 patients (24.6%). High grade (HG) pseudomyxoma was diagnosed in 29 patients (39.7%), and low grade (LG) pseudomyxoma in 44 patients (60.3%). Overall morbidity was 27.3%, and the mortality rate was 5.4%. The mean overall survival (OS) was 139.5 months in the LG pseudomyxoma group and 71.5 months in the HG pseudomyxoma group. Median survival was 86 months in the entire group and 72 in the HG pseudomyxoma group; the median was not reached in the LG pseudomyxoma group. CONCLUSIONS: Results in the literature and our results are comparable, confirming the high efficiency of this method both in the world and in the Czech republic. The results indicate a highly statistically significant improvement of the OS with acceptable mortality and morbidity. These results confirm this method as a gold standard therapy for selected patients.

[Complications of hemorrhoids]. / Komplikace hemoroidu

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred.

[Acute periproctal abscesses]. / Akutní periproktální abscesy.

Periproctal inflammations related to the anus are characterized by the rapid spread of the infection to the surrounding tissue, which is determined by the anatomical characteristics and infectious agents. Inflammation, which starts as a phlegmon, quickly forms boundaries and an abscess develops in most cases. Up to 80-90% of anorectal abscesses develop according to the crypto-glandular theory on the basis of infection of the anal glands, spilling into the Morgagni crypts in the anal canal. Up to two-thirds of such abscesses are associated with the emergence of anorectal fistulas. Anorectal abscesses can be divided into marginal and subcutaneous perianal abscesses, submucosal, intersphincteric, ischiorectal and supralevator abscesses. Their diagnosis is based on thorough physical examination, sometimes also with the help of imaging methods such as computed tomography, magnetic resonance imaging and endoanal ultrasound. What is decisive for the successful treatment of anorectal abscessess is their early and adequate surgical drainage. Adjuvant antibiotic therapy is necessary only when the overall signs of sepsis are present and for patients with a comorbidity such as diabetes, valvular heart disease, or immunodeficiency.

[Anorectal injury]. / Poranení anorekta.

Anal and rectal traumas are relatively rare (with the exception of iatrogenic damage) due to the anatomical position of the anorectum. The anal canal is injured more frequently due to its relatively superficial position, but injuries involving the extraperitoneal rectum, although more rare, tend to be much more severe and may affect the surrounding organs. Intraperitoneal rectal injury is associated with bleeding or perforation and may lead to peritonitis and diffuse contamination of the abdominal cavity. The decisive factor is the early detection of the injury and early initiation of treatment. The first step in surgical treatment of severe anorectal injury is the control of massive bleeding and volume resuscitation. The aim of the surgery is to preserve life, control infections and to preserve the patients anal continence and evacuation function. Key words: anorectal trauma - aetiology - surgical treatment.

[Differential diagnosis of myeloproliferative neoplasms. Quantitative NF-E2 immunohistochemistry for differentiating between essential thrombocythemia and primary myelofibrosis]. / Differenzialdiagnose myelproliferativer Neoplasien. Quantitative NF-E2-Immunhistochemie zur Unterscheidung zwischen essenzieller Thrombozythämie und primärer Myelofibrose.

BACKGROUND: Besides essential thrombocythemia (ET), polycythemia vera (PV) and primary myelofibrosis (PMF) the myeloproliferative neoplasms (MPN) defined by the World Health Organization (WHO) comprise the entity of unclassifiable MPNs (MPN, U). The exact differential diagnosis of the specific MPN entities can be challenging particularly at early stages of the diseases. So far, pathologists have had to rely only on histomorphological evaluation of bone marrow biopsies in combination with laboratory data because helpful ancillary tests are not yet available. Even molecular tests, such as JAK2 mutation analysis are not helpful particularly in the differential diagnosis of ET and PMF because both entities are associated with the V617F mutation in 50 % of the cases. Recently overexpression of the transcription factor NF-E2 in MPN was described. MATERIALS AND METHODS: A collective of samples consisting of 163 bone marrow biopsies including 139 MPN cases was stained immunohistochemically for NF-E2 and analyzed regarding the subcellular localization of NF-E2 in erythroid progenitor cells. The results were compared between the MPN entities as well as the controls and statistical analyses were conducted. RESULTS AND DISCUSSION: This study showed that NF-E2 immunohistochemistry and analysis of the proportion of nuclear positive erythroblasts of all erythroid precursor cells can help to distinguish between ET and PMF even in early stages of the diseases. An MPN, U case showing a proportion of more than 20 % nuclear positive erythroblasts can be classified as a PMF with 92 % accuracy.

The Cole relaxation frequency as a parameter to identify cancer in breast tissue.

PURPOSE: To correlate the Cole relaxation frequencies obtained from measurements of the electrical properties of breast tissue to the presence or absence of cancer. METHODS: Four-lead impedance measurements were obtained on ex vivo specimens extracted during surgery from 187 volunteer patients. Data were acquired with a commercial Solartron impedance bridge employing 4-lead Ag-AgCl or blackened platinum (BPt) electrodes at frequencies logarithmically spaced from 1 Hz to 3.2 × 10(7) Hz utilizing 6-10 frequencies per decade. The Cole frequencies obtained from these measurements were correlated with the tissue health status (cancer or noncancer) obtained from histological analysis of the specimens. RESULTS: Analysis of the impedance measurements showed that the Cole relaxation frequencies correlated to the presence or absence of cancer in the examined tissue with a sensitivity up to 100% (95% CI, 99%-100%) and a specificity up to 85% (95% CI, 79%-91%) based on the ROC curve of the data with the Cole frequency as the classifier. CONCLUSIONS: The results show that the Cole frequency alone is a viable classifier for malignant breast anomalies. Results of the current work are consistent with recent bioimpedance measurements on single cell and cell suspension breast cell lines.

Transplantability and therapeutic effects of bone marrow-derived mesenchymal cells in children with osteogenesis imperfecta.

In principle, transplantation of mesenchymal progenitor cells would attenuate or possibly correct genetic disorders of bone, cartilage and muscle, but clinical support for this concept is lacking. Here we describe the initial results of allogeneic bone marrow transplantation in three children with osteogenesis imperfecta, a genetic disorder in which osteoblasts produce defective type I collagen, leading to osteopenia, multiple fractures, severe bony deformities and considerably shortened stature. Three months after osteoblast engraftment (1.5-2.0% donor cells), representative specimens of trabecular bone showed histologic changes indicative of new dense bone formation. All patients had increases in total body bone mineral content ranging from 21 to 29 grams (median, 28), compared with predicted values of 0 to 4 grams (median, 0) for healthy children with similar changes in weight. These improvements were associated with increases in growth velocity and reduced frequencies of bone fracture. Thus, allogeneic bone marrow transplantation can lead to engraftment of functional mesenchymal progenitor cells, indicating the feasibility of this strategy in the treatment of osteogenesis imperfecta and perhaps other mesenchymal stem cell disorders as well.

[Antibiotic prophylaxis in acute surgical procedures--the current praxis in Czech Republic]. / Antibiotická profylaxe u akutních chirurgických výkonu--soucasná situace v CR.

INTRODUCTION: Surgical site infections (SSI) are currently one of the most frequent postoperative complications. Emergent surgery is generally subject to a higher risk of SSI. Antibiotic prophylaxis is one of many measures that should be taken to prevent postoperative infection. However, due to possible adverse effects it must be applied only in indicated cases. Many guidelines have been published abroad, but still missing in Czech Republic. Standard use of prophylaxis can be currently followed due to compliance with SCIP (Surgical Care Improvement Project) measurements and reflects the quality of surgical care. OBJECTIVES: The aim of our study was to evaluate the current clinical praxis of prophylactic antibiotic administration in Czech Republic in emergent surgery for diagnosis: acute appendicitis, small bowel obstruction and perforated gastroduodenal ulcer and evaluate the SCIP criteria adherence. METHOD: The survey was sent to 149 surgical departments. The questionnaire included 7 questions and feedback was considered to be anonymous. The compliance with 3 main SCIP measurements (INF-1, INF-2, INF-3) was evaluated by the patients with acute appendicitis as a indication for emergent surgery. RESULTS: Overall, 85 (57%) completed questionnaires were received back. According to a survey results, antibiotic prophylaxis is always administered in 15% of patients operated for acute appendicitis, 27% operated for small bowel obstruction and 47% of patients with gastroduodenal perforation. No prophylaxis is given in 11 (13%) hospitals for either of the mentioned diagnoses. Antibiotics are mostly (46%) administered at induction of general anesthesia and extended to 24 hours. The SCIP measurements adherence was as follows: INF-1--4.7%; INF-2--86%; INF-3--81% of evaluated departments. All of 3 (all-or-none) criteria were fulfilled only at 3 (3.5%) surgical departments. CONCLUSION: The clinical praxis of antibiotic prophylaxis in urgent surgical procedures in Czech Republic is highly variable and mostly ignores the current international guidelines (SCIP). There is a need of local specific guideline concerning antibiotic prophylaxis guaranteed by scientific company.

Defective iron homeostasis in beta 2-microglobulin knockout mice recapitulates hereditary hemochromatosis in man.

Previously, hepatic iron overload resembling that in hereditary hemachromatosis (HH) has been found in beta 2-microglobulin knockout (beta 2m-/-) mice. We have now characterized iron metabolism in beta 2m-/- mice. The mutant mice fail to limit the transfer of iron from mucosal cells into the plasma. Transferrin saturation is abnormally high. Pathologic iron depositions occur predominantly in liver parenchymal cells. Reconstitution with normal hematopoietic cells redistributes the iron from parenchymal to Kupffer cells, but does not correct the mucosal defect. We conclude that (a) iron metabolism is defective in the gut mucosa as well as the liver of beta 2m-/- mice; and (b) a beta 2m-dependent gene product is involved in iron homeostasis. Recently, a novel gene of the major histocompatibility complex class I family, HLA-H, has been found to be mutated in a large proportion of HH patients. Our data provide functional support for the proposed causative role of HLA-H mutations in HH.

Comparison of MRSASelect Agar, CHROMagar Methicillin-Resistant Staphylococcus aureus (MRSA) Medium, and Xpert MRSA PCR for detection of MRSA in Nares: diagnostic accuracy for surveillance samples with various bacterial densities.

Rapid laboratory methods provide optimal support for active surveillance efforts to screen for methicillin-resistant Staphylococcus aureus (MRSA). Most laboratories struggle to determine the optimal use of resources, considering options to balance cost, speed, and diagnostic accuracy. To assess the performance of common methods, the first comparison of MRSASelect agar (MS) and CHROMagar MRSA (CA), with and without broth enrichment followed by a 24-h subculture to MS, was performed. Results were compared to those of the Xpert MRSA assay. For direct culture methods, the agreement between MS and CA was 98.8%. At 18 h, direct MS identified 93% of all positive samples from direct culture and 84% of those identified by the Xpert MRSA. For Trypticase soy broth-enriched MS culture, incubated overnight and then subcultured for an additional 24 h, the agreement with Xpert MRSA was 96%. The agreement between direct MS and Xpert MRSA was 100% when semiquantitative culture revealed a bacterial density of 2+ or greater; however, discrepancies between culture and Xpert MRSA arose for MRSA bacterial densities of 1+ or less, indicating low density as a common cause of false-negative culture results. Since 1+ or less was established as the most common MRSA carrier state, broth enrichment or PCR may be critical for the identification of all MRSA carriers who may be reservoirs for transmission. In this active-surveillance convenience sample, the use of broth enrichment followed by subculture to MS offered a low-cost but sensitive method for MRSA screening, with performance similar to that of Xpert MRSA PCR.

Medicine. DNA arrays reveal cancer in its many forms.

The use of microarrays--slides or chips systematically dotted with DNA from thousands of genes--to determine gene expression patterns is providing a wealth of new information that should aid in cancer diagnosis and ultimately in therapy. In the past several months, researchers in several labs have used microarray technology to identify specific subtypes of a variety of cancers, including leukemias and lymphomas, the dangerous skin cancer melanoma, and breast cancer. In some cases, they can determine which cancers are likely to respond to current therapies and which aren't. In addition, the studies are giving researchers a fix on which genes are important for the development, maintenance, and spread of the various cancers, and are thus possible drug targets.

Tumor angiogenesis. Gene expression patterns identified.

Researchers have obtained the most detailed sketch yet of how cancerous tumors secure the blood supplies that nourish their growth. On page 1197, a team reports the results of a large-scale comparison of the genes expressed in the blood vessels of human colon cancers and of normal colon tissue. They've found that the gene expression patterns of the two types of vasculature are distinctly different. The findings could help researchers develop new anticancer drugs that work by homing in on the protein products of genes that are overexpressed in tumor vessels, thus shutting off the growth of blood vessels the tumor needs to survive.

Molecular biology. Cancer fighter's modus operandi revealed.

Researchers have deciphered how a promising cancer drug acts like a smart bomb, homing in on only a very narrow range of its potential targets in the cell. The compound, known as STI-571, has shown remarkable success in early clinical trials on patients with chronic myelogenous leukemia. Now, in work reported on page 1938, scientists reveal just how the compound works--information that could aid in the design of similar cancer therapies.

ALZHEIMER'S CONGRESS: Drug Shows Promise for Advanced Disease.

Although the b-amyloid vaccine now being explored as a potential Alzheimer's therapy attracted the bulk of the attention at the World Alzheimer Congress 2000 (see previous story), another, more conventional, drug is showing promise in clinical trials. A neuropsychiatrist reported at the "hot topics" session of the congress that the drug memantine, which has been used in Germany for 10 years to treat dementias, significantly slowed the progression of Alzheimer's symptoms in patients with moderately severe disease.

The cell cycle coming under control.

An article in 30 June issue (";Dangerous' liaisons in cell biology," p. 1539), which discussed the commentary in the 2 June issue of the journal Cell by Max L. Birnstiel and Meinrad Busslinger regarding the transgenic mice experiments of Corrado Spadafora and co-workers, stated that Vienna's Institute of Molecular Pathology (IMP), for which Birnstiel and Busslinger work, was seeking patents on extensions of the Spadafora experiments. On further investigation, we have learned that this is not correct. At present no applications have been applied for or granted to IMP or its parent companies Genentech and Boehringer Ingelheim. We wish to correct the record, apologize to Dr. Birnstiel and Dr. Busslinger for this misstatement, and alert our readers to their letter, which is printed in our Letters section on page 243.

Photoreceptor deactivation and retinal degeneration mediated by a photoreceptor-specific protein kinase C.

The protein kinase C (PKC) family of serine-threonine kinases has been implicated in the regulation of a variety of signaling cascades. One member of this family, eye-PKC, is expressed exclusively in the Drosophila visual system. The inaC (inactivation-no-afterpotential C) locus was shown to be the structural gene for eye-PKC. Analysis of the light response from inaC mutants showed that this kinase is required for the deactivation and rapid desensitization of the visual cascade. Light adaptation was also defective in inaC mutant flies. In flies carrying the retinal degeneration mutation rdgB, absence of eye-PKC suppressed photoreceptor cell degeneration. These results indicate that eye-PKC functions in the light-dependent regulation of the phototransduction cascade in Drosophila.

An educational multimedia campaign improves stroke knowledge and risk perception in different stroke risk groups.

BACKGROUND AND PURPOSE: Stroke risk factor knowledge and individual risk perception are low in the general public. Our study aimed at identifying the educational effects of a multimedia campaign on stroke knowledge and risk perception in several subgroups at increased risk of stroke. METHODS: Telephone surveys were administered in a random sample of 500 members of the general public, before and immediately after an intense 3 months educational campaign using various mass and print media. RESULTS: A total of 32.7% of respondents considered themselves as being at risk of stroke before, and 41.9% (P < 0.01) after the intervention. Evaluation of stroke risk increased with number of appreciated individual stroke risk factors. Knowledge of different stroke risks varied considerably and proved to be especially high in obese individuals (98.7%) and smokers (97.9%) and particularly low in patients with coronary heart disease (80.6%). CONCLUSIONS: Our data indicate that educational programs and the introduction of stroke risk factors can increase stroke risk perception in the public. Even though some risk groups (smokers, obese) reveal a ceiling effect, future campaigns should focus on high risk populations remarkably underrating their risk, like those with coronary heart disease or the elderly.